title: Risk of emergency medical treatment following consumption of cannabis or synthetic cannabinoids in a large global sample.
abstract: BACKGROUND
  Synthetic cannabinoids (SCs) have become increasingly popular in recent years. Diverse in chemical structure, many have been subjected to legislative regulation, but their availability and use persists. Often marketed to reflect their similar effects to cannabis, their use has been associated with a range of negative health effects. We sought to determine the relative risk of seeking emergency medical treatment (EMT) following use of SCs and natural cannabis.
  
  
  METHODS
  We utilized an anonymous online survey of drug use, obtaining data from 22,289 respondents. We calculated the relative risk of seeking EMT between the two substances using an estimate for days used in the past year.
  
  
  RESULTS
  Thirty-seven cannabis users (0.2%) and 21 SC users (1.0%) had sought EMT during the past year following use. The relative risk associated with the use of SCs was 30 (95% CI 17.5-51.2) times higher than that associated with cannabis. Significantly more symptoms (p=0.03) were reported by respondents seeking treatment for SCs than for cannabis.
  
  
  CONCLUSIONS
  Whilst these findings must be treated with caution, SCs potentially pose a greater risk to users' health than natural forms of cannabis. Regulation is unlikely to remove SCs from the market, so well-informed user-focused health promotion messages need to be crafted to discourage their use.
authors.affiliation: Institute of Psychiatry, King's College London, London, UK adam.winstock@kcl.ac.uk.
authors.forename: Adam
authors.initials: A
authors.lastname: Winstock
authors.affiliation: Institute of Psychiatry, King's College London, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Lynskey
authors.affiliation: Institute of Psychiatry, King's College London, London, UK.
authors.forename: Rohan
authors.initials: R
authors.lastname: Borschmann
authors.affiliation: Global Drug Survey, Fergusson House, London, UK.
authors.forename: Jon
authors.initials: J
authors.lastname: Waldron
mesh_terms: D002186:Cannabinoids / Q000009:adverse effects* / Q000627:therapeutic use*; D002188:Cannabis / Q000009:adverse effects*; D006801:Humans; D002189:Marijuana Abuse / Q000209:etiology; D008385:Marijuana Smoking / Q000009:adverse effects*; D012306:Risk; D019966:Substance-Related Disorders / Q000209:etiology
chemical_list: D002186:Cannabinoids
keywords: Cannabis; emergency medical treatment; synthetic cannabis