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Fourth generation of synthetic cannabinoid receptor agonists: A review on the latest insights

Author(s):

Sara Malaca, Francesco Paolo Busardò*, Giulio Nittari, Ascanio Sirignano and Giovanna Ricci  

Abstract:


Background: Over the past few years, an emerging number of new psychoactive substances (NPSs) entered the illicit market. NPSs are designed to resemble the effects of classical drugs of abuse, reinforcing their effects and duration. Among the most abused NPS, synthetic cannabinoids are cannabinoid receptor agonists (SCRAs) and mimic the effect of the main psychotropic phytocannabinoid Δ9-tetrahydrocannabinol (THC).

Methods: We herein reviewed the international literature to provide available information on the newest SCRAs generation.

Results: Compared to the previous SCRAs generations, the structures of the last generation result in increased affinity for and efficacy at cannabinoid CB1 receptors, which are thought to be mainly responsible for the psychoactive effects of THC and its analogues. Accordingly, these more potent cannabimimetic effects may increase the number of adverse reactions such as neurological disorders (e.g., psychosis, agitation, irritability, paranoia, confusion, and anxiety), psychiatric episodes (e.g., hallucinations, delusions, self-harm), other physical conditions (e.g., tachycardia, hypertension, arrhythmia, chest pain, nausea, vomiting, and fever) and deaths. In the last decade, more than a hundred SCRAs from different chemical classes emerged on the illicit web market. SCRAs have been thoroughly studied: they were physico-chemically characterized and pharmaco-toxicological characteristics were investigated. The last SCRAs generations include increasingly potent and toxic compounds, posing a potential health threat to consumers.

Conclusion: From November 2017 to February 2021, at least 20 new “fourth-generation” SCRAs were formally reported to international drug agencies. Our understanding about the neurotoxicity of these compounds is still limited due to the lack of global data, but their potency and their toxicity are likely higher than those of the previous generations.

Keywords:

synthetic cannabinoids, new psychoactive substances, receptor agonists, toxicology

Affiliation:

Department of Excellence of Biomedical Sciences and Public Health. University “Politecnica delle Marche” of Ancona,Ancona, Department of Excellence of Biomedical Sciences and Public Health. University “Politecnica delle Marche” of Ancona,Ancona, School of law, Camerino University, Camerino, School of law, Camerino University, Camerino, School of law, Camerino University, Camerino



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