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In its most recent weekly update on the outbreak of vaping-related illnesses, the Centers for Disease Control (CDC) announced that there have been 39 deaths and 2,051 confirmed and probable lung injury cases associated with use of electronic cigarettes, or vaping, products in 49 U.S. states, the District of Columbia, and the U.S. Virgin Islands. Although it has provided guidelines for recognizing what constitutes a case of vaping-related lung disease, the CDC has yet to identify a single common factor in all the cases beyond the use of vaporizers or e-cigarettes.

An extensive review of the scientific literature by Project CBD has found that the CDC’s diagnostic criteria for confirmed cases in the ongoing vaping-related outbreak parallels the symptoms of pulmonary injury associated with the use of “synthetic cannabinoids,” a group of difficult-to-detect research compounds that powerfully influence the endocannabinoid system (ECS).

Synthetic Cannabinoid Toxicity

There are numerous case reports of repiratory depression triggered by the consumption of synthetic cannabinoids, which can cause a variety of potentially lethal health problems, including diffuse alveolar hemorrhage and acute respiratory failure, according to Adrian Devitt-Lee, author of “Under the Radar: Synthetic Cannabinoids and Vaping-Related Lung Injuries,” a special report published by Project CBD.

Devitt-Lee, Project CBD’s chief science writer, provides several examples of case reports involving synthetic cannabinoid toxicity, which show a consistent set of symptoms (ground glass opacities, ruptured blood vessels, oxygen deprivation as lungs fill with fluid, etc.) that aligns with many of the confirmed cases of vaping-related illness.

Yet despite this striking correlation of symptoms, the CDC doesn’t mention synthetic cannabinoids in its weekly reports on the current vaping-related outbreak. Project CBD believes this is a serious omission. Synthetic cannabinoids warrant careful scrutiny as health professionals and public policy experts seek a better understanding of the multiple factors contributing to vaping-related lung injuries and how best to respond to this scourge.

What Are Synthetic Cannabinoids?

Synthetic cannabinoids are a class of research compounds designed to interact with the endocannabinoid system, which mediates many of the effects of tetrahydrocannabinol (THC) and other cannabis constituents. But synthetic cannabinoids are significantly different in their molecular structure than THC and they are much more dangerous than naturally occurring botanical cannabinoids.

“Synthetic cannabinoids are, in many ways, a product of cannabis prohibition,” Project CBD asserts in its report. “The proliferation of these compounds has been fostered by marijuana’s Schedule 1 status, which continues to undermine research efforts to understand the endocannabinoid system.”

Scientists, with few exceptions, are not allowed to work directly with the cannabis flower or oil extracts. So molecular chemists have designed potent new compounds – synthetic cannabinoids – to study the intricacies of the endocannabinoid system, which plays a major role in health and disease.

Safety was not a top priority for these new preclinical research compounds given that they were not designed for human consumption and they were not meant to be used outside of the lab. But their formulas were published in scientific journals, and blackmarket operators have been able to reproduce and peddle some these compounds as synthetic substitutes for cannabis – with tragic results.

Synthetic Cannabinoids Versus Cannabis

As discussed in the Project CBD report, synthetic cannabinoids differ from THC and other natural cannabinoids in several important ways. Synthetic cannabinoids are typically much more potent than THC and they bind with greater efficacy to the CB1 cannabinoid receptor, which mediates the impairing effects of THC. This means that it is much easier to accidentally overdose on synthetic cannabinoids and consuming too much can have severe and sometimes deadly consequences, whereas an overdose of THC, while unpleasant, has never killed anyone.

Sprayed on cannabis and other herbs or added to e-cigarette juice and vape oil, synthetic cannabinoids (with names like Spice and K2) are lucrative for illicit manufacturers because they are cheap to produce and very difficult to detect. Black market producers can increase their profits by diluting a poor-quality base oil and boosting the “high” by adding a synthetic cannabinoid adulterant.

Numerous synthetic cannabinoids have been identified in various products around the world. Since legal markets do not require testing for synthetic cannabinoids, they have turned up in both legal and illegal products, including THC and CBD vapes and nicotine e-cigarettes.

Regulators face a number of challenges that make synthetic cannabinoids particularly hard to detect. “It’s nearly impossible to detect hundreds of potential synthetic cannabinoids in a single test, and dozens of new synthetic cannabinoids are designed every year,” according to Project CBD, which notes that many of these designer drugs “are orders of magnitude more potent than THC. A chemical 100 times more powerful than THC has to be detected at very low concentrations, and most labs do not specialize in synthetic cannabinoid detection.”

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