Well-Being Prevention & Cures

Fewer synthetic cannabinoid poisonings seen in states with legalized cannabis

“We know that there are many cannabinoids being developed and on the market – and the regulators are struggling to catch up.”
Marijuana farm.
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Story at a glance


  • Synthetic cannabinoids are dangerous illegal substances and sometimes used in place of traditional cannabis.

  • Although tracking these substances is challenging, new research suggests poisonings from synthetic cannabinoids decreased in states with legalized marijuana.

  • Researchers emphasize more data is needed and the reported totals are likely an underestimate. 

A review of National Poison Data System (NPDS) data collected between 2016 and 2019 found states with legalized recreational cannabis had 37 percent fewer poisoning reports for synthetic cannabinoids compared with states with restrictive laws. 

Findings were published in the journal Clinical Toxicology. States with restrictive laws were any that considered cannabis illegal or had limited legislation in place for medical use. 

The chemicals in synthetic cannabinoids are similar to those found in marijuana, but the products are illegal and do not contain any mediating constituents of whole plant cannabis. Their high toxicity can result in severe impairment and sometimes death.

Although some synthetic cannabinoids are used for medical purposes, illicit versions are illegal. The products also typically do not show up in standard urine drug tests.

Of the 7,600 exposures reported in the NPDS throughout the study period, around 65 percent required medical attention and 61 deaths occurred. However, reported exposures decreased over time, while state-level medical cannabis laws were associated with 13 percent fewer annual exposures. 


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“This study shows some potential public health benefits to the legalization and regulation of adult use of cannabis,” said study co-author Tracy Klein of Washington State University in a statement. 

“Based on both past research and this current study, it’s evident that users who have a choice to use a less toxic product would potentially do so,” said Klein, who is also assistant director of the University’s Center for Cannabis Policy, Research and Outreach.

States with permissive laws also saw 22 percent fewer quarterly exposures to synthetic cannabinoids. Those with retail markets had 36 percent less reported exposures compared with states where only medical use was permitted, researchers wrote. 

Authors estimate around 0.2 to 4 percent of the U.S. population uses synthetic cannabinoids, while use is more common among those in their late teens and early twenties.

However, “defining synthetic cannabinoids and their constituents are challenging due to variable and illicit production, and synthetic cannabinoid poisonings can often overlap with other drug poisonings.” 

Cases reported to the NPDS — either by clinicians or the general public — rely on self-reported consumption and analytical data, but authors caution that more research is needed to better understand the prevalence of synthetic cannabinoid use, and that the current study likely underestimates use. 

“We know that there are many cannabinoids being developed and on the market – and the regulators are struggling to catch up,” Klein added.

“You can’t easily test for illicit cannabinoids. A lot of times, we only find out if a patient has been using them because they’re hospitalized or because they’re dead.”