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Caring for Patients Who Use Synthetic Cannabinoids

Synthetic cannabinoids are classified as new psychoactive substances, which are recently introduced mind-altering chemicals designed to imitate common illegal drugs.

Caring for Patients Who Use Synthetic Cannabinoids

Synthetic cannabinoids are classified as new psychoactive substances, which are recently introduced mind-altering chemicals designed to imitate common illegal drugs. These synthetic versions mimic the pharmacological effects of the original substance, while avoiding classification as illegal. A variety of consumption methods are available for synthetic cannabinoids, such as smoked in joints and/or pipes, ingested, used in tea, and vaporized and inhaled in e-cigarettes or through the mouth and nose. Manufacturers sell these herbal incense products in colorful foil packages and liquid incense products, marketing them under myriad names to appeal to young people.

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Public Health Threat

Many federal, state, and local government officials have determined that synthetic drug use is a public health threat. Users don’t know what they are consuming, leaving them unaware of health or addiction risks. Synthetic cannabinoids produce similar effects to cannabis, such as elevated mood, relaxation, altered perception, and symptoms of psychosis, while also bearing the risk of serious adverse health effects.

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Patient Assessment

During the assessment phase, oral health professionals should ask questions, such as whether the patient uses any form of tobacco or marijuana, frequency and amount of use, and interest in quitting. Other screening tools include the Cage Questionnaire and the Five A’s Model (Ask, Advise, Assess, Assist, and Arrange). These are most effective when used while taking a routine medical history.

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Signs and Symptoms

Indicators of recent synthetic cannabinoid use may include conjunctival injection (red sclera); breath with a smoky, chemical smell; tachycardia; hypertension; light­headedness; and headache. Similar to tobacco and marijuana use, patients who consume synthetic cannabinoids are at increased risk of xerostomia, which is associated with increased caries risk, staining, and oral malodor. Chronic smoking can create inflammation of the oral epithelium, leukoplakia, periodontal diseases, and delay wound healing. Marijuana users tend to have poor oral hygiene compared with nonusers and this may also be true for synthetic cannabinoid users. Vital signs are often increased with marijuana use and careful intra- and extraoral examination may include signs, such as lack of oral hygiene; dilated pupils; red, inflamed, or bloodshot eyes; mucosal dryness; heavy biofilm; moderate to severe gingival inflammation; and caries.

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Referral Information

Oral health professionals should compile a list of local drug prevention and treatment agencies and programs to provide to patients. A 1-page fact sheet on synthetic cannabinoid use, similar to educational resources regarding tobacco/smoking, may be disseminated in dental practices.

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