This page shows what was measured, who it was measured in, and what that does not settle.
What JWH-018 does in the body
Unapproved laboratory chemicals sold as synthetic cannabis products.
JWH-018 and its relatives bind the same receptor as THC but switch it on completely rather than partially. THC has a built-in ceiling: past a point, more of it does not produce more receptor activation. These compounds have no such ceiling, so the dose-response curve keeps climbing into seizures, agitated delirium and unresponsiveness. They are sprayed from solution onto inert plant matter, which distributes them unevenly, so two pinches from the same packet are not the same dose. And because they are structurally unlike THC, cannabis urine screens do not detect them.
What happened in people
They stimulate the cannabis system more fully than the plant’s main intoxicating chemical and have caused mass poisonings.
✓ Reviewed first-read answer
Where this came from
A person wrote this and a reviewer approved it against this exact record. It carries no effect size.
A reviewer approved this against this record. The reviewed-claim record carrying the exact population and effect size does not exist yet.
No source is stored against this line.
The limit that matters most
Cannabis safety evidence does not transfer to stronger, rapidly changing synthetic chemicals.
Where it acts
CB1 receptors on presynaptic terminals in the hippocampus and elsewhere in the central nervous system; the receptor is internalised within minutes of exposure
Kind of result
A number that stands in for health
Supervision
RNAWiki has not recorded a supervision or regulatory status for this substance.
What the registries record it as
The substance registry classes this as chemical.
FDA substance registry · G391998J57 · read 2026-08-29
Its recorded molecular formula is C10H16, weighing 136.23.
PubChem record · 18818 · read 2026-08-29
Where each sentence above came from
No recorded sentence describes the change this makes in a way that stands on its own. The page opens with what it is taken for instead, and the recorded explanation follows below.
Shown as the opening line on this page.
The limit a reviewer approved as the one that matters most here.
The four opening statements run to 120 words.
Words this page uses
Four words worth knowing first
Chosen from what this page shows, with each one explained before the word it depends on.
Biomarker
A biomarker is a number from a test that stands in for something about health.
A picture of it, and where the picture fails
A biomarker is like a fuel gauge.
Where that stops being true. A gauge is wired to the tank. Many biomarkers are only loosely tied to health.
What people get wrong. A better number is read as a better life. Several medicines improved a number and helped nobody.
A measurable indicator used as a substitute for a clinical outcome of interest.
Placebo
A placebo is a dummy treatment given so the real one can be compared with it.
A picture of it, and where the picture fails
A placebo is like a blank control in an experiment.
Where that stops being true. A blank does nothing. People given a placebo often do get better.
What people get wrong. A placebo effect is read as imaginary. The improvement is measured and real.
An inactive intervention matched in appearance to the test intervention, used to control for non-specific effects.
Comparator
A comparator is whatever the treatment was measured against.
A picture of it, and where the picture fails
It is like the other runner in a race.
Where that stops being true. A race has one winner. A study can show both arms improved.
What people get wrong. Results are read without asking what the other group got. Beating nothing is not beating a treatment.
The control condition against which the experimental intervention is assessed.
What happened in people◇Read from sources, not yet reviewed
What happened in people
Each card is one study: the exact question it asked, who was in it, and whether it showed what it set out to show.
CB1-mediated inhibition of excitatory transmission, ERK1/2 activation and receptor internalisation
✓ The study showed what it set out to show
Who was studied
Atwood et al. 2010 CB1 receptor pharmacology of JWH-018
How many people
0
Study design
In vitro neuronal and cell-based pharmacology
Compared against
Not recorded for this study
Kind of result
A number that stands in for health
What was found
IC50 14.9 nM for excitatory postsynaptic current inhibition; EC50 4.4 nM for ERK1/2 phosphorylation; EC50 2.8 nM and t½ 17.3 min for CB1 internalisation
Repeated elsewhere
Replicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. In vitro only. The clinical significance of full versus partial agonism at CB1 is inferred from these data plus the clinical series, not measured in a controlled human study — no such study exists or could be run.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Solution sprayed onto inert plant material, smoked; also sold as liquids for vaping
Interval reported. Not recorded in this summary
Written into the record, not signed off as a reviewed claim.
Acute kidney injury associated with synthetic cannabinoid use — multiple states, 2012. MMWR Morb Mortal Wkly Rep 2013;62:93-98 (23407124) · a recorded source, not a stored snapshot
Identification of the causative compound in the product and in patient samples
✓ The study showed what it set out to show
Who was studied
Adams et al. 2017 New York mass intoxication investigation
How many people
33
Study design
Outbreak investigation with analytical confirmation
Compared against
Not recorded for this study
Kind of result
A number that stands in for health
What was found
AMB-FUBINACA at 16.0 ± 3.9 mg/g in the product; de-esterified acid metabolite at 77-636 ng/mL in all 8 patients tested
Repeated elsewhere
Unreplicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. Only 8 of the 33 affected persons were sampled, and only 18 were transported to hospital, so the concentration range describes a subset. No dose-response could be established.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Solution sprayed onto inert plant material, smoked; also sold as liquids for vaping
Interval reported. Not recorded in this summary
Written into the record, not signed off as a reviewed claim.
Acute kidney injury associated with synthetic cannabinoid use — multiple states, 2012. MMWR Morb Mortal Wkly Rep 2013;62:93-98 (23407124) · a recorded source, not a stored snapshot
Confirmation and clinical course of synthetic cannabinoid-associated coagulopathy
✓ The study showed what it set out to show
Who was studied
Kelkar et al. 2018 Illinois coagulopathy case series
How many people
34
Study design
Hospital case series within a statewide outbreak
Compared against
Not recorded for this study
Kind of result
A number that stands in for health
What was found
Superwarfarin confirmed in 15 of 15 tested: brodifacoum 100%, difenacoum 33%, bromadiolone 13%, warfarin 7%. One death from intracranial haemorrhage
Repeated elsewhere
Replicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. Confirmatory testing was at physician discretion and performed in only 15 of 34 patients. The specific synthetic cannabinoid compounds involved were never identified.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Solution sprayed onto inert plant material, smoked; also sold as liquids for vaping
Interval reported. Not recorded in this summary
Written into the record, not signed off as a reviewed claim.
Acute kidney injury associated with synthetic cannabinoid use — multiple states, 2012. MMWR Morb Mortal Wkly Rep 2013;62:93-98 (23407124) · a recorded source, not a stored snapshot
What we know
RNAWiki holds 3 written-up human studies for this substance, each with the question it asked.
How we know it
Each card names the study, the number of people and what the study set out to measure.
What this does not prove
These summaries were written by a person and have not been signed off as reviewed claims.
Why it matters
A study that failed is as informative as one that worked, and both are here.
What we still do not know
No reviewed claim exists, so no exact population, effect size or interval is published yet.
What it changes in the body◇Read from sources, not yet reviewed
The path through the body
From what a person takes to what changes. A solid line is a step measured in people. A dashed line is a step nobody has measured that way.
Start
JWH-018
What a person takes: Solution sprayed onto inert plant material, smoked; also sold as liquids for vaping.
The measurement behind this step
The plant matter is a carrier with no pharmacology of its own. Application by spraying gives an uneven distribution across the packet, so dose per portion varies substantially even when the mean content is known — the New York product measured 16.0 ± 3.9 mg per gram. Products carry brand names rather than chemical names, and the compound inside a given brand changes over time.
Getting in
Sprayed onto plant matter and smoked
The compound is dissolved, sprayed over inert dried leaves and dried. The leaves do nothing; they are a carrier.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Solution application to inert plant material, then drying. Distribution is uneven — in the New York product AMB-FUBINACA measured 16.0 ± 3.9 mg per gram, a standard deviation of nearly a quarter of the mean across the same product. Two portions from one packet are not the same dose.
Inhalation puts the compound into arterial blood immediately, with no chance to stop once the effect proves stronger than expected.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Pulmonary absorption with rapid central distribution. Because the compounds are potent at low nanomolar concentrations, the milligram quantities present on plant material are far above what is needed for maximal receptor occupancy.
Unlike THC, which only partly activates the receptor, these compounds switch it on completely — and keep going as the dose rises.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
JWH-018 inhibits excitatory postsynaptic currents with IC50 14.9 nM, phosphorylates ERK1/2 with EC50 4.4 nM and internalises CB1 with EC50 2.8 nM and t½ 17.3 minutes. Full agonism at a receptor where delta-9-THC is partial is the mechanistic basis for the whole class's toxicity.
The receptor is pulled off the cell surface within minutes
Sustained full activation makes the cell withdraw its receptors, which is the likely basis of the rapid tolerance users describe.
──Measured in people. Written by a person from the study named beside the step. Not signed off as a reviewed claim.
The measurement behind this step
Rapid and robust CB1 internalisation with a half-time of 17.3 minutes at nanomolar concentrations. Receptor removal on this timescale is a plausible substrate for the fast tolerance and escalating use reported in this class, though no human study has demonstrated the link.
Seizures, agitated delirium, unresponsiveness — or bleeding
The clinical picture ranges from a cannabis-like effect to complete unresponsiveness. And when the product has been adulterated, the presentation may not be intoxication at all.
──Measured in people. Written by a person from the study named beside the step. Not signed off as a reviewed claim.
The measurement behind this step
Mass intoxication of 33 people in one neighbourhood, with the acid metabolite at 77 to 636 ng/mL in the eight patients tested. Separately, 34 patients with brodifacoum coagulopathy in one Illinois hospital: gross haematuria in 56%, intravenous vitamin K1 in 68%, fresh frozen plasma in 56%, one death from intracranial haemorrhage.
No suggested links are held for this record, so nothing is hidden from this path.
What we know
The record describes 5 steps from taking it to an effect in a person.
How we know it
Each step names the study behind it in the technical detail beside it.
What this does not prove
A change inside the body is a reason to look. It is not a result in a person.
Why it matters
A reader can see exactly where the chain stops being measured in people.
What we still do not know
No reviewed claim binds any of these steps to a named population.
What is missing or unclear◇Read from sources, not yet reviewed
Were people like you studied?
RNAWiki cannot tell whether a study fits you. It can show who was in it, and where the result stops carrying.
Who was studied
People similar to this profile were included.
People choosing a compound that a urine drug screen does not detect, and people buying the cheapest available intoxicant. The 2016 New York mass intoxication involved 33 people in one neighbourhood on one day.
Who is missing from the studies
Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
Where the result stopped carrying
Compound-by-compound scheduling was followed by structurally unrelated replacements, from naphthoylindoles to indazole carboxamides
In the Illinois outbreak, the causative synthetic cannabinoids were never identified — only the rodenticide adulterant was
This is a scope explorer, not a diagnosis engine.
It shows who was studied so you can see whether people similar to you were included.
RNAWiki cannot tell whether a study fits you. It can show who was in it.
What it would be like to take◇Read from sources, not yet reviewed
Why it might seem to do nothing
A real effect and a noticed effect are different things. These are the recorded reasons the two come apart.
It was studied in different people
The people in the studies were not much like the reader.
On this record: Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
The evidence may simply be wrong
Small early studies often do not hold up.
On this record: RNAWiki has not yet published a reviewed conclusion for this use.
Other reasons RNAWiki checked and found nothing for (11)
It was studied for a different goal
The studies measured something else entirely. Nothing in this record points to this reason.
A different form was studied
The studied form is not the form on the shelf. Nothing in this record points to this reason.
There was nothing to correct
Where a level is already normal, topping it up may change nothing. Nothing in this record points to this reason.
Something else had to happen too
In the studies it was paired with training, a diet or another treatment. Nothing in this record points to this reason.
The change is too small to feel
A real change can still sit below what a person notices. Nothing in this record points to this reason.
Day-to-day swing hides it
Sleep, food, stress and time of day move most numbers more than this would. Nothing in this record points to this reason.
Not enough time yet
The studies ran longer than the person has waited. Nothing in this record points to this reason.
It was not taken as studied
Missed days change the result, and studies count them. Nothing in this record points to this reason.
Something else changed at the same time
Two changes at once cannot be told apart afterwards. Nothing in this record points to this reason.
The product may not be what it says
Contents of a sold product are not always what the label states. Nothing in this record points to this reason.
No recorded reason
RNAWiki has nothing stored that would explain it. Nothing in this record points to this reason.
None of these is a reason to take more. Taking more is not a step this page ever suggests.
What it would be like to take◇Read from sources, not yet reviewed
What taking it involves
The recorded facts about getting hold of it and using it. Nothing here is a suggestion about what you should do.
How it is supplied
Not available
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
Read from the recorded approval status.
No source is stored against this line.
Form and route
Solution sprayed onto inert plant material, smoked; also sold as liquids for vaping
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form and route recorded on this substance.
No source is stored against this line.
Who oversees it
RNAWiki has not recorded a supervision or regulatory status for this substance.
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
No register row and no identity class settled the question.
No source is stored against this line.
What is in the pack
The plant matter is a carrier with no pharmacology of its own. 9 mg per gram. Products carry brand names rather than chemical names, and the compound inside a given brand changes over time.
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
Recorded notes on how this is sold and what that means for what is in the pack.
No source is stored against this line.
Where it is registered
Not recorded.
∅ Nothing recorded
Where this came from
RNAWiki holds nothing here and says so rather than guessing.
No register entry is recorded.
No source is stored against this line.
Why people stop
Not recorded.
∅ Nothing recorded
Where this came from
RNAWiki holds nothing here and says so rather than guessing.
No record of why people stopped taking it is stored for this substance.
No source is stored against this line.
What it would be like to take◇Read from sources, not yet reviewed
What can go wrong
Sorted by where each line came from. A regulator's label and a report somebody sent in are not the same kind of fact.
·Worth asking a clinician aboutWritten into the record from the studies named on this page
Documented presentations include agitated delirium, seizures, profound central nervous system depression and unresponsiveness, tachycardia and hypertension, acute kidney injury in previously healthy young people, and death. The class-defining hazard is full CB1 agonism without the ceiling that limits delta-9-THC, combined with a product that cannot be dosed. Adulteration is a separate and independent hazard: the 2018 Illinois outbreak involved long-acting anticoagulant rodenticides, presenting as bleeding rather than intoxication and requiring prolonged vitamin K1 replacement. No routine cannabinoid screen detects these compounds, so a clinical suspicion has to come from the history.
Nobody counted how many people took this and were fine, so this cannot be turned into a rate.
Over a long time. No completed tested study window is recorded, so long-term effects are not established by the registry record.
Groups the studies covered thinly. Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
What is missing or unclear◇Read from sources, not yet reviewed
Does the exact form matter?
Evidence belongs to the exact thing that was tested. A different salt, a different mixture or a different preparation is a different question.
The form that was studied
Solution sprayed onto inert plant material, smoked; also sold as liquids for vaping
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form used in the studies cited on this page.
No source is stored against this line.
What is sold
9 mg per gram. Products carry brand names rather than chemical names, and the compound inside a given brand changes over time.
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
Recorded notes on which forms are sold and how they compare.
No source is stored against this line.
What is recorded as being sold
112520 marketed supplement labels list this ingredient, classed as other combinations and vitamin.
Those labels carry all other, nutrient and structure/function claims. A claim of that kind is written by the manufacturer and is not assessed by any regulator, so its presence says nothing about whether it is true.
Evidence carries across two names for one substance. It does not carry across a salt, a mirror form or a mixture.
What it would be like to take◇Read from sources, not yet reviewed
What you could measure
This one is decided with a clinician, so this section holds questions to ask rather than a plan to run.
RNAWiki could not confidently classify this substance, so no self-experiment plan is offered.
Questions worth asking
Which of the trials of JWH-018 studied people like me?
What was measured, and for how long?
Was the result a laboratory value or a health outcome?
What would we watch for, and when would we stop?
Tracking can show whether something changed for you. It cannot show what caused it.
RNAWiki records evidence. It does not say whether this substance is right for you.
What is missing or unclear◇Read from sources, not yet reviewed
Claims that go past the evidence
Things said about this substance that sound reasonable, and the exact step that is missing between the evidence and the claim.
✗Goes past the evidence
That these compounds resemble cannabis in effect or safety because they share the CB1 receptor
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That a scheduling action removes a compound class from the market; the observed response has been structural replacement
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That published case counts describe the burden of this class, when most series cannot identify the compound involved and routine screens do not detect it
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That rapid CB1 internalisation explains the tolerance users describe — that link is plausible and undemonstrated in humans
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
What is missing or unclear◇Read from sources, not yet reviewed
What nobody knows yet
Open questions, each with why it is open and what would close it.
Missing populations
Which groups were under-represented in the studies has not been recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing long-term data
No completed tested study window is recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
No reviewed conclusion
RNAWiki has not yet published a reviewed conclusion for this use.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing interaction studies
No interaction was found in the registers checked. Not finding one is not the same as showing there is none.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Formulation uncertainty
Several salts, forms or products of JWH-018 are recorded. Results from one form may not transfer to another.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Mechanism not reviewed
No reviewed mechanism story exists for this substance.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
What happened in people◇Read from sources, not yet reviewed
Check any of this yourself
Every line above traced back to the study it came from. This is the technical layer, and the vocabulary changes here.
Every line above can be traced to the study named beside it. Follow the link and read it.
Full agonists where THC is partial — the whole difference in one property
In plain words
THC only partly switches on the cannabinoid receptor, and past a point more of it does nothing extra. JWH-018 switches the receptor on completely, at nanomolar concentrations, with no such ceiling.
What was measured
IC50 for inhibition of excitatory postsynaptic currents, EC50 for ERK1/2 phosphorylation and for CB1 internalisation, in neurons
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
Atwood et al. measured JWH-018 in cultured autaptic hippocampal neurons and in HEK293 cells stably expressing CB1. It inhibited excitatory postsynaptic currents with IC50 14.9 nM in a concentration- and CB1-dependent manner, increased ERK1/2 MAPK phosphorylation with EC50 4.4 nM, and induced rapid and robust CB1 receptor internalisation with EC50 2.8 nM and a half-time of 17.3 minutes. The authors conclude that the subjective effects of "Spice" are due to CB1 activation by JWH-018. The point that matters clinically is the one implicit in "efficacious": delta-9-THC is a partial agonist with a ceiling on receptor activation, and these compounds are full agonists without one. That is why a class of drugs marketed as cannabis substitutes produces seizures, agitated delirium and death, which cannabis does not.
Written into the record, not signed off as a reviewed claim
Thirty-three people intoxicated in one neighbourhood on one day
In plain words
On 12 July 2016, 33 people in one New York City neighbourhood were incapacitated by a herbal incense product. Testing found an ultrapotent synthetic cannabinoid in the product and its metabolite in every patient sampled.
What was measured
AMB-FUBINACA concentration in the product and its acid metabolite in patient blood across 8 of 33 affected persons
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
Adams et al. investigated the mass intoxication of 33 people in one New York City neighbourhood on 12 July 2016, of whom 18 were transported to hospital. Serum, whole blood and urine from 8 of those patients, and a sample of the implicated product "AK-47 24 Karat Gold", were analysed by liquid chromatography-quadrupole time-of-flight mass spectrometry. AMB-FUBINACA was identified in the product at a mean of 16.0 ± 3.9 mg per gram. Its de-esterified acid metabolite was present in the serum or whole blood of all eight patients at 77 to 636 ng/mL. The authors describe AMB-FUBINACA as an example of the emerging class of "ultrapotent" synthetic cannabinoids and attribute the depressant, "zombielike" presentation to its potency. The identification depended on collaboration between a clinical toxicology laboratory, clinicians and law enforcement, because no routine test would have found it.
Written into the record, not signed off as a reviewed claim
Thirty-four patients bleeding from rat poison in the packet
In plain words
In spring 2018, more than 150 people in Illinois presented with unexplained bleeding. The synthetic cannabinoid products had been adulterated with brodifacoum, a long-acting rat poison. One patient died of a brain haemorrhage.
What was measured
Confirmed superwarfarin poisoning, presenting features, treatment and outcome across 34 patients in 45 hospitalisations
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
Kelkar et al. reported 34 patients with synthetic cannabinoid-associated coagulopathy across 45 hospitalisations at one Peoria medical centre between 28 March and 21 April 2018, part of a statewide outbreak of more than 150 patients. Confirmatory anticoagulant testing was performed in 15 of the 34 and superwarfarin poisoning was confirmed in all 15: brodifacoum in 15 (100%), difenacoum in 5 (33%), bromadiolone in 2 (13%) and warfarin in 1 (7%). Presenting features included gross haematuria in 19 (56%) and abdominal pain in 16 (47%), with renal abnormalities on CT in 12. All 34 received oral vitamin K1 and 23 (68%) also received it intravenously; 19 (56%) received fresh frozen plasma and 5 (15%) red-cell transfusion. One patient died from complications of spontaneous intracranial haemorrhage. The authors note that the specific synthetic cannabinoid compounds involved are not known — the adulterant was identified and the drug was not.
Written into the record, not signed off as a reviewed claim
Acute kidney injury in previously healthy young people
In plain words
In 2012, health departments across several states reported clusters of sudden kidney failure in teenagers and young adults after smoking synthetic cannabinoid products.
What was measured
Clusters of acute kidney injury temporally associated with synthetic cannabinoid use across multiple states
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
CDC reported acute kidney injury associated with synthetic cannabinoid use across multiple states in 2012, in patients who were predominantly young and previously healthy and who presented with nausea, vomiting, flank or abdominal pain and a rise in creatinine after smoking a synthetic cannabinoid product. The mechanism was not established and no single compound was identified across the clusters. The episode belongs in this record for what it demonstrates about the class rather than about any molecule: a toxicity that had no precedent in the cannabinoid literature, appearing simultaneously in several states, in products whose composition nobody could state.
Source
Acute kidney injury associated with synthetic cannabinoid use — multiple states, 2012. MMWR Morb Mortal Wkly Rep 2013;62:93-98
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
verified
Review state
Written into the record, not signed off as a reviewed claim
Scheduling a compound produces the next compound
In plain words
DEA placed the first five synthetic cannabinoids in Schedule I in 2011. Manufacturers responded by changing the molecule, and the class now runs to dozens of entries in the regulation.
What was measured
Sequence of scheduling actions against the chemical families of the compounds subsequently encountered
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
DEA published a notice of intent to temporarily place five synthetic cannabinoids — including JWH-018 — into Schedule I on 24 November 2010 (75 FR 71635), and the temporary scheduling final order took effect on 1 March 2011 (76 FR 11075). The class has since expanded to occupy dozens of entries in 21 CFR 1308.11(d), and the compounds encountered have moved through structurally unrelated families: naphthoylindoles such as JWH-018, then indazole carboxamides such as AMB-FUBINACA, which shares no scaffold with the first generation. The regulatory lesson recorded here is structural: listing a named compound creates a selection pressure for a compound not on the list, and the replacement is typically more potent because potency reduces the mass that must be shipped. The 2016 New York outbreak compound is the demonstration.
Source
DEA notice of intent 75 FR 71635 (24 November 2010); DEA final order 76 FR 11075 (1 March 2011); 21 CFR 1308.11(d), current eCFR text
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
contested
Review state
Written into the record, not signed off as a reviewed claim
"Synthetic cannabis" is a marketing name, not a pharmacological one
In plain words
These products are sold as legal cannabis substitutes. They act on the same receptor, but with a different efficacy profile, and none of what is known about cannabis safety transfers.
What was measured
That compounds sharing the CB1 receptor with delta-9-THC share its effect profile or its safety record
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
The class shares a receptor with delta-9-THC and nothing else — not chemical scaffold, not efficacy at that receptor, not dose range, not metabolism, and not the composition of the product. The inference that the safety record of cannabis says anything about these compounds fails on the efficacy difference alone: a full agonist at a receptor where the reference drug is partial has a different maximum, and the clinical series show what that maximum looks like. The inference also fails at the product level, since a given packet contains an unknown compound at an uneven concentration, sometimes with a non-cannabinoid adulterant. This record files it as inferred because the phrase "synthetic cannabis" carries the inference invisibly.
Written into the record, not signed off as a reviewed claim
Routine cannabis screens do not detect them
In plain words
A urine test for cannabis looks for THC metabolites. These compounds are chemically unrelated, so they do not show up — which is a substantial part of why they are used.
What was measured
Requirement for compound-specific high-resolution mass spectrometry rather than cannabinoid immunoassay
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
Immunoassay screens for cannabis target delta-9-THC-carboxylic acid. Synthetic cannabinoids are structurally unrelated to THC and are not detected by those assays, and their metabolites require compound-specific methods. In the New York investigation the identification required liquid chromatography-quadrupole time-of-flight mass spectrometry run against both the product and the patient samples, and in the Illinois outbreak the specific cannabinoids were never identified at all. The consequence for the record is that no clinical or forensic series in this class can state which compound it is describing without a dedicated analytical effort, and most do not — which is why prevalence and mortality for this class are systematically undercounted.
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What is not here
8 questions this page could not answer
These sections were prepared and left out because there was nothing to put in them. They are listed rather than hidden, so the gaps in this record are visible.
What was measured, goal by goal — found nothing in the sources checked.
How close this is to real life — found nothing in the sources checked.
Felt, measured, or meaningful — found nothing in the sources checked.
How long anything takes — found nothing in the sources checked.
What it may clash with — found nothing in the sources checked.
Other ways to the same goal — found nothing in the sources checked.
How this medicine reached us — found nothing in the sources checked.
What changed on this page — found nothing in the sources checked.
The record as stored
The full record, for auditing
Everything above is built from what is below. This layer keeps the technical vocabulary, record identifiers and every stored row, so a reader who wants to check the page can.
The older medicine-wide conclusion held in this record
Written for a clinical reader, and about the medicine as a whole rather than about one indication, population and set of trials. RNAWiki does not treat it as a programme conclusion and no reviewer has signed it off in that form. It is here word for word because it is what the record holds.
A class built from academic receptor probes: full CB1 agonists where THC is only partial, potent at low nanomolar concentrations, responsible for a 33-person mass intoxication in New York in 2016 and — when the plant matter was adulterated with rat poison — 34 patients with superwarfarin coagulopathy in one Illinois hospital in 2018, one of whom died of intracranial haemorrhage.
Recorded evidence blocks (0)
Where it is registeredIdentifiers, relations and other names
✗ required summary fields resolved: 4 required field(s) not terminal: Why people use it, Best-supported result, Biggest unanswered question, Human evidence
✓ public claims reviewed: 0 reviewed claim(s); drafts are never rendered
✓ source coverage passed: 1 source rows
✓ no critical contamination: no quarantine open
✓ canonical metadata passed: slug and display name present
✓ no raw internal fields: enforced by the copy-contract test over the rendered page
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