Pharmacology and Toxicology of the Synthetic Cannabinoid Receptor Agonists

The synthetic cannabinoid receptor agonists (SCRAs) are a large group of new psychoactive substances (NPS) that have emerged over the last 5-10 years. There have been 134 SCRAs reported in Europe which makes them the largest group amongst the NPS. SCRAs are active at the cannabinoid receptors and most are very potent CB1 receptor agonists. They are generally sold in smoking mixtures but are also available in incenses and in powder form. This article discusses the numerous reports of acute toxicity related to the use of SCRA products. In summary, these reports suggest that in addition to cannabis like neuropsychiatric effects the SCRAs are also associated with stimulant features (e.g., agitation, tachycardia, hypertension, seizures) and there are reports of SCRA-related ischaemic stroke, acute coronary syndrome, and acute kidney injury.