Prevalence and Correlates of Synthetic Cannabinoid Use in a Substance Use Treatment Population: An Electronic Health Record Study in Brazil.

This Brazilian study provides critical epidemiological insights into synthetic cannabinoid (SC) use patterns among individuals seeking substance use treatment. Researchers analyzed electronic health records from 6,660 treatment seekers in São Paulo, finding that nearly 30% reported synthetic cannabinoid use in the past 12 months. The research reveals a concerning profile: SC users were significantly younger, with 28.9% initiating use before age 21, and many had already progressed through other substances—51.7% reported prior polysubstance use involving cocaine, crack-cocaine, and cannabis before transitioning to SCs. Perhaps most alarming, 63.4% of SC users reported daily consumption, indicating high addiction potential.

The study identifies key risk factors and correlates distinguishing SC users from non-users. SC users demonstrated significantly higher rates of polydrug use, more severe cocaine and crack-cocaine addiction, and greater prevalence of psychotic symptoms. They were more likely to frequent open drug scenes and had attended other treatment services in the past year. This pattern suggests SCs represent an escalation in drug-using careers rather than a standalone phenomenon, with users often simultaneously engaged with other potent stimulants. The co-occurrence of psychiatric symptoms, particularly psychotic symptoms, raises important questions about whether SCs trigger psychosis in vulnerable individuals or whether those predisposed to psychosis preferentially use these drugs.

These findings have substantial implications for public health policy and treatment approaches in Brazil and similar contexts. The research underscores that adaptive public health policies, enhanced drug surveillance, and tailored treatment interventions are urgently needed to address the evolving complexity of synthetic cannabinoid use within Brazil's drug landscape. The data suggest that SC users represent a diverse population requiring different intervention strategies—from younger, first-time drug users to individuals already embedded in open drug scenes with severe polyaddiction profiles. Clinicians and policymakers should recognize synthetic cannabinoids not as a simple cannabis substitute, but as part of a broader, more severe pattern of polysubstance use requiring comprehensive, multi-modal treatment approaches.