Early Warning System Drug Alert

Background to Alert

There was a recent seizure of products from a small, independently owned store in Barbados. The products were found to contain the semi-synthetic cannabinoid Hexahydrocannabinol (HHC) and delta-9 tetrahydrocannabinol (THC) (the main psychoactive compound in cannabis). 

What Are Semisynthetic Cannabinoids (SSCs)?

Semi-synthetic cannabinoids (SSCs) are a rapidly evolving group of New Psychoactive Substances (NPS). SSCs are cannabis compounds which have been created by chemically modifying naturally occurring cannabinoids, such as THC and cannabidiol (CBD), found in the cannabis plant. The chemical modifications are designed to retain the psychoactive properties of THC but circumvent narcotic legislation through the creation of cannabis compounds (SSCs) which often fall outside of existing drug control laws. It is important to note that SSCs are distinct from fully synthetic cannabinoids that are not structurally related to phytocannabinoids (naturally occurring from plants).

SSCs are a more recent phenomenon than fully synthetic cannabinoids and are currently fewer in number, but their prevalence is increasing. Cannabinoids that have been detected in recent years and classified as SSCs include hexahydrocannabinol (HHC,), tetrahydrocannabiphorol (THCP), hexahydrocannabiphorol (HHCP), tetrahydrocannabioctyl (THC-C8), and hexahydrocannabioctyl (HHC-C8). 

Why are semisynthetic cannabinoids a concern? 

Given that SSCs are new to consumer markets, little is known about their potency, risk for dependency and adverse effects. This is compounded by the fact that many existing toxicology tests cannot detect these cannabinoids, complicating monitoring and emergency response.

Semi-synthetic cannabinoid products:

SSCs are sold openly as purportedly legal replacements for THC and cannabis in a range of highly attractive branded and unbranded products, some of which are sold as ‘legal highs’. These include foods (commonly known as edibles, such as gummies and marshmallows), vapes and concentrated oils, as well as hemp sprayed or mixed with SSCs (which looks and smells like cannabis).

What is Hexahydrocannabinol (HHC)?

Hexahydrocannabinol or HHC, is a compound found in small amounts in the pollen and seeds of the cannabis plant. Its chemical structure is similar to delta-9 and delta-8 tetrahydrocannabinol (THC). It is often called “light cannabis,” suggesting that HHC is not as potent as delta-9 and delta-8 THC. People use it recreationally for its euphoric and relaxing properties.

Health effects and risks of HHC

HHC is not well-studied, so its overall health effects are unknown. But its side effects may be similar to those of THC, including: • Anxiety, fear and panic

• Dry mouth 
• Dizziness and confusion 
• Fast heart rate
• Fatigue
• Hallucinations
• Impaired coordination and reaction time
• Increased appetite
• Memory loss
•  Other potential health concerns related to THC (and likely HHC) include:
• Addiction
• Cannabinoid hyperemesis syndrome
• Impaired brain development in people who start using HHC before age 26
• Weight loss and other complications if used during pregnancy
• Lung disease from vaping
• Personal injuries and motor vehicle accidents
• Psychosis
• Withdrawal 
• As with other addictions, SSC addiction can lead to withdrawal symptoms after the last dose. This occurs as the brain attempts to readjust from suddenly quitting these substances, resulting in painful and often damaging effects. These symptoms may be mild or severe, depending on the person and can cause: 
• Headache
• Nausea
• Sweating
• Restlessness
• Breathing issues
• Rapid heart rate
• Chest pain
• Seizures
• Recovery  
• Given that HHC is relatively new, research on long-term effects and dependence potential is limited, and predicting HHC withdrawal symptoms is difficult. Due to its structural similarity to THC, treatment for dependence or withdrawal would generally follow principles used for Cannabis Use Disorder. After medical detox or while gradually tapering substances, clients may be offered different forms of therapy to help them through the recovery process. 
• Inpatient programs are highly beneficial for those who require intensive addiction treatment. Outpatient care might follow inpatient care as a form of ongoing treatment or as a substitute for residential care. Outpatient programs allow clients to receive addiction treatment while simultaneously taking care of work, home or school obligations.
• Other treatments components may include:
• Motivational Interviewing: Through motivational interviews, clients can better understand how sobriety will benefit their life and enter treatment with an optimistic outlook to beat addiction. 
• Cognitive Behavioral Therapy (CBT): In CBT, specialists can help clients face addiction triggers and provide the tools to overcome them. They learn healthier coping skills and treat any co-occurring mental health disorders that may worsen their substance use disorder.  Support groups: When individuals attend support groups and group counseling, they have a safe space to discuss their substance use. They work with others struggling with addiction and, together, they help each other to heal and maintain sobriety. Peers and counselors might also provide tips to help them navigate the changes associated with a healthier lifestyle. 12-step groups and other support groups can also help those struggling to avoid relapse.
• Additional considerations regarding seized products:
• Packaging
• The packaging of the seized products highlighted the presence of HHC, Tetrahydrocannabiphorol (THCP) and delta-9 tetrahydrocannabinol (THC). See pictures below.
• In accordance with Section 20 of the Drug Abuse Prevention and Control Act (Cap 131): It is illegal to sell, offer, or prepare to sell any product that claims to contain a controlled drug (in this case THC), even if it does not actually contain one.
• Therefore:
• • If the label or packaging says the products contains THC (a banned substance/drug), that alone breaks this law.
• • Breaking this law is considered a criminal offence.
• THCP
• While the products were not found to contain THCP as listed on their labels, it is important to note that THCP is the most potent phytocannabinoid in the cannabis plant and is therefore much more potent than THC. THCP can cause almost psychedelic effects but does not cause hallucinations. 
• According to one study, THCP binds more tightly than THC to the endocannabinoid receptor CB1, thereby producing stronger effects than THC at lower doses. While THCP is a naturally occurring cannabinoid, most of the THCP on the market is semi-synthetic. THCP was discovered in 2019 in Italy when a team of scientists managed to isolate the compound from cannabis plants using advanced liquid chromatography. (PR/GIS)