Cooper Ziva D
Division on Substance Abuse, New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, Unit 120, New York, NY, 10032, USA.
Curr Psychiatry Rep. 2016 May;18(5):52. doi: 10.1007/s11920-016-0694-1.
Although several chemical structural classes of synthetic cannabinoids (SCs) were recently classified as Schedule I substances, rates of use and cases of serious toxic effects remain high. While case reports and media bring attention to severe SC toxicity, daily SC use resulting in dependence and withdrawal is a significant concern that is often overlooked when discussing the risks of these drugs. There is a rich literature on evidence-based approaches to treating substance use disorders associated with most abused drugs, yet little has been published regarding how to best treat symptoms related to SC dependence given its recency as an emerging clinically significant issue. This review provides a background of the pharmacology of SCs, recent findings of adverse effects associated with both acute intoxication and withdrawal as a consequence of daily use, and treatment approaches that have been implemented to address these issues, with an emphasis on pharmacotherapies for managing detoxification. In order to determine prevalence of use in cannabis smokers, a population at high risk for SC use, we obtained data on demographics of SC users, frequency of use, and adverse effects over a 3.5-year period (2012-2015) in the New York City metropolitan area, a region with a recent history of high SC use. While controlled studies on the physiological and behavioral effects of SCs are lacking, it is clear that risks associated with using these drugs pertain not only to the unpredictable and severe nature of acute intoxication but also to the effects of long-term, chronic use. Recent reports in the literature parallel findings from our survey, indicating that there is a subset of people who use SCs daily. Although withdrawal has not been systematically characterized and effective treatments have yet to be elucidated, some symptom relief has been reported with benzodiazepines and the atypical antipsychotic, quetiapine. Given the continued use and abuse of SCs, empirical studies characterizing (1) SCs acute effects, (2) withdrawal upon cessation of use, and (3) effective treatment strategies for SC use disorder are urgently needed.
尽管最近几类化学结构的合成大麻素（SCs）被列为一类管制物质，但使用率和严重毒副作用案例仍然居高不下。虽然病例报告和媒体报道引起了人们对严重合成大麻素毒性的关注，但在讨论这些药物风险时，日常使用合成大麻素导致成瘾和戒断的情况却是一个常被忽视的重大问题。关于治疗与大多数滥用药物相关的物质使用障碍的循证方法，已有丰富的文献记载，但鉴于合成大麻素作为一个新出现的具有临床重要意义的问题，关于如何最佳治疗与合成大麻素成瘾相关症状的文献却很少。本综述提供了合成大麻素的药理学背景、因日常使用导致的急性中毒和戒断相关不良反应的最新研究结果，以及为解决这些问题而实施的治疗方法，重点是用于管理脱毒的药物治疗。为了确定大麻吸食者（合成大麻素使用的高危人群）中的使用流行率，我们收集了纽约市大都市区在3.5年期间（2012 - 2015年）合成大麻素使用者的人口统计学数据、使用频率和不良反应数据，该地区近期合成大麻素使用量一直很高。虽然缺乏关于合成大麻素生理和行为影响的对照研究，但很明显，使用这些药物的风险不仅与急性中毒的不可预测性和严重性有关，还与长期、慢性使用的影响有关。文献中的最新报告与我们调查的结果相似，表明有一部分人每天使用合成大麻素。虽然戒断症状尚未得到系统描述，有效的治疗方法也尚未阐明，但据报道，苯二氮䓬类药物和非典型抗精神病药物喹硫平可缓解一些症状。鉴于合成大麻素的持续使用和滥用情况，迫切需要开展实证研究来明确：（1）合成大麻素的急性效应；（2）停止使用后的戒断反应；（3）针对合成大麻素使用障碍的有效治疗策略。
