User Experiences of Development of Dependence on the Synthetic Cannabinoids, 5f-AKB48 and 5F-PB-22, and Subsequent Withdrawal Syndromes

Abstract

RationaleEmergence of synthetic cannabinoids (SCBs) in herbal smoking mixtures is a public health concern. New SCB's such as 5f-AKB48 and 5F-PB-22 have been detected in French seizures and in sudden death post mortems in the US. ObjectivesThe aim was to describe development of dependence on herbal smoking mixtures containing the SCB's, 5f-AKB48 and 5F-PB-22 and subsequent withdrawal syndromes. MethodsDependent users of herbal smoking mixtures known to contain the SCB's 5f-AKB48 and 5F-PB-22with an average Severity of Dependence Score (SDS) of 13 were interviewed using a structured guide (three males/three females). Narratives were analysed using the Empirical Phenomenological Psychological (EPP) five step method. Six themes with 68 categories emerged from the analysis. ResultsThemes are illustrated as 1) Networks and Product Availability; 2) Drivers and Motives for Use; 3) Effect and Pathways toward Dependence; 4) Poly Substance Use and Comparisons to Natural Cannabis; 5) Dependence and Withdrawal and 6) Self-detoxification Attempts. Two higher levels of abstraction above these theme-levels emerged from the data, with sole use of herbal smoking mixtures containing 5f-AKB48 and 5F-PB-22 centering on the interplay between intense cravings, compulsive all-consuming seeking, use and re-dose behaviours, and fear of the psychiatric and selfharms caused when in withdrawal. ConclusionsThis is the first study describing dependence and withdrawal experiences in users dependent on 5f-AKB48 and 5F-PB-22. Given the potential for adverse psychiatric and physical consequences of dependent use, further development of specific clinical responses and clinical research around toxicity and withdrawal severity are warranted.

Synthetic Cannabinoids (SCs) in Metaphors: a Metaphorical Analysis of User Experiences of Synthetic Cannabinoids in Two Countries

“…New-generation SCs include the hexyl homolog JWH-019 (Dresen et al 2011), the aminoalkylindoles JWH-073 (Lindigkeit et al 2009), JWH-250 (Westphal et al 2010) and JWH-398 (Hudson et al 2010) and JWH-015, JWH-122, HU-210 and AM-694 (EMCDDA 2009;Ernst et al 2011). More recently, 5f-AKB48 and 5F-PB-22 have been detected in both seizures and fatalities (Roussel et al 2015;Van Hout and Hearne 2017). These synthetic psychoactive compounds are sprayed or added to the herbal mixtures (Uchiyama et al 2010) generally sold in metal foil sachets containing 1-3 g of dried leaves, resin or flowers (Dresen et al 2011;Zuba et al 2011;Kikura-Hanajiri et al 2011;Zawilska and Wojcieszak 2014).…”

“…2014;Van Hout 2017). SC users report on euphoric pleasurable effects both similar to natural cannabis and distinct to SCs (drowsiness, time distortion, inability to think clearly, hallucinations) and general use for intoxication and relaxation purposes (Schneir et al 2011;Fattore and Fratta 2011;Vandrey et al 2012;Barratt et al 2013;Soussan and Kjellgren 2014;Bonar et al 2014;Van Hout and Hearne 2017;Kassai et al 2017a). Decisions to use herbal mixtures are also grounded in a perception of safety (Fattore and Fratta 2011;Vandrey et al 2012;Van Hout and Hearne 2017).…”

“…In comparison to natural cannabis, available literature indicates that more unpredictable and adverse symptomatology is reported by users (Bonar et al 2014;Castaneto et al 2014;Fantegrossi et al 2014;Van Hout and Hearne 2017;Kassai et al 2017a). Users describe intense and rapid trajectories of SC use from positive toward the negative and with dependent resulting in severe psychopathological and withdrawal symptoms (Zimmermann et al 2009;Van Der Veer and Friday 2011;Nacca et al 2013;Macfarlane and Christie 2015;Bilgrei 2016) and solitary daily use (Van Hout and Hearne 2017; Kassai et al 2017a).…”

“…Users describe intense and rapid trajectories of SC use from positive toward the negative and with dependent resulting in severe psychopathological and withdrawal symptoms (Zimmermann et al 2009;Van Der Veer and Friday 2011;Nacca et al 2013;Macfarlane and Christie 2015;Bilgrei 2016) and solitary daily use (Van Hout and Hearne 2017; Kassai et al 2017a). Continued and compulsive use characterized by craving and multiple re-dosing, despite fear around psychotic and other unpleasant effects (panic, paranoia, aggression, chest pain, palpitations, anxiety, insomnia) is common (Vandrey et al 2012;Winstock and Barratt 2013;Barratt et al 2013;Fattore 2016;Van Hout and Hearne 2017;Kassai et al 2017a).…”

“…New psychoactive substances (NPS) remain a global public health and clinical challenge (Gunderson et al 2012;Spaderna et al 2013;Corazza et al 2013;EMCDDA 2015;Van Hout and Hearne 2017;Kassai et al 2017a;Dolengevich-Segal et al 2017;Barnard et al 2017). The United Nations Office on Drugs and Crime (UNODC) defines NPS as 'substances of abuse, either in a pure form or a preparation, that are not controlled by the 1961 Single Convention on Narcotic Drugs or the 1971 Convention on Psychotropic Substances, but which may pose a public health threat' (UNODC 2013).…”