Abstract
To the Editor
In June 2011, products containing synthetic cannabinoids were banned in Western Australia (Sydney Morning Herald, 2011; Daily Telegraph, 2011). Elsewhere, they are sold in tobacco shops and are widely available (Sydney Morning Herald, 2011; Daily Telegraph, 2011). These products are most commonly known as ‘kronic’ or ‘kronic black’ in Western Sydney, but are also known as ‘spice’, ‘K2’, ‘purple haze’, ‘kaos’, ‘dream’, and ‘voodoo’. Often these products are sold as mixtures of herbs and they are of particular relevance to Australian mining communities where they are not detected by urine drug testing (Sydney Morning Herald, 2011). There have been several case reports published internationally associating these products with psychosis (Muller et al., 2010; Johnson et al., 2011; Schneir et al., 2011; Simmons et al., 2011).
Although these products are reported to have been available in Australia for the last 2 years (Daily Telegraph, 2011), only in recent months has the problem of synthetic cannabis products and psychosis been recognized in patients presenting to Nepean hospital, Sydney. In these cases, psychosis has been associated with more agitation than would be expected from cannabis alone. This has been reported in case reports (Muller et al., 2010; Schneir et al., 2011; Simmons et al., 2011) and has been hypothesized to be related to differences in its chemical structure and in particular the absence of cannabidiol (CBD) which in itself is presumed to have antipsychotic potency (Every-Palmer, 2011).
Synthetic cannabinoid products are associated with psychosis, more prominent agitation, and are not detected by routine drug testing. Clinicians should consider screening for synthetic cannabinoid use when interviewing patients presenting with psychosis or agitation.