Vapes with cannabinoids causing psychosis in users as young as 13

Problems linked to hexahydrocannabinol in vapes began to emerge in youth addiction and mental health services some 14 months ago, but presentations are now escalating. Picture: iStock

Dangerous synthetic cannabinoids being sold in vape shops are causing psychosis in children as young as 13 that may damage them for life, a leading psychiatrist has warned.

Professor Bobby Smyth, a consultant child and adolescent psychiatrist and clinical professor at Trinity College Dublin, said 20-25% of presentations to adolescent addiction services he works in now involve hexahydrocannabinol (HHC) — a semi-synthetic cannabinoid with broadly similar effects to cannabis.

The drug is now the main component in 5%-10% of presentations to youth addiction services he works with,  “and that's from a base of zero 18 months ago,” Prof. Smyth said.

Problems linked to the drug began to emerge in youth addiction and mental health services some 14 months ago, but presentations are now escalating month on month and are found across the country, he added.

My colleagues in the mental health service are seeing more and more cases of acute mental disturbance linked to HHC use. And this is sold in shops

Young people are presenting psychotic in some cases, he said. His colleagues have seen children as young as 13 suffering from HHC use.

“Because it's sold at shops, people seem to think it's been tested or regulated or in some way safe when it's none of those things.

“Why has this stuff been sold in shops across the country to children with absolute impunity?” 

Hexahydrocannabinol vapes seem to fall within a legal loophole as they are not a health product, meaning they're not regulated by the Health Products Regulatory Authority (HPRA). They are also not a food product, so are not regulated by the Food Safety Authority (FSA). Responsibility may also be seen to fall between the departments of Health and Justice, he said.

“That's the problem with these things. Really everyone's responsible, but no one's responsible,” he said.

'Headshop' closures

However, legislation was passed banning the sale of psychoactive substances following the rise in synthetic drug sales in "headshops" in the 2000s.

The Criminal Justice Psychoactive Substances Act 2010 banned the sale, supply, import, export or advertising of psychoactive substances. This resulted in the closure of multiple "headshops" that had opened across Ireland — often highly lucrative small businesses which sold largely synthetic drugs, which were then called "legal highs".

That legislation was left purposely broad and undefined to catch all psychoactive substances so that producers could not merely tweak a chemical formula to evade bans on certain substances.

“The Psychoactive Substances Act was very novel legislation at the time. We were a world leader. It was effective in shutting down the headshops and other countries around the world started learning from it," Prof. Smyth said.

We had the best protection systems in the world, but the protection system is no use if you don't use it

“It's hard not to be frustrated by the collective system response in this case. It really has let young people down badly.

“The people who engage in drug selling, as these people are, need a sharp shock to realise that our society doesn't want this."

Psychiatric illnesses suffered by young people who use this drug may be long-term and irreversible, he said.

“Some of them will be left with psychotic illnesses probably for the rest of their lives,” Prof. Smyth said.

“We shouldn't be paying that sort of price as a society for something entirely avoidable. It should have been stopped on day one.

“It needs to be removed from the shelves by whatever mechanism immediately. There needs to be a pretty immediate review of the systems we have in place in Ireland to ensure this doesn't happen again.”

Psychotic episodes

The former lord mayor of Cork City and youth services manager, Mick Finn, is also concerned about teenagers and young adults now struggling due to hexahydrocannabinol vape use.

Mr Finn, who is running in the general election, said that young people are being admitted to Cork University Hospital and the Mercy Hospital suffering psychotic episodes after using these vapes.

“Young people are seeing things that are not there. They’re suffering psychotic episodes, having heightened anxiety,” Mr Finn said. He is concerned that multiple suicides may now be linked to use of these vapes.

“Users are appearing in Cork hospitals with severe psychosis fallout following use of these vapes that contain hexahydrocannabinol or HHC for short,” Mr Finn said.

“I have come across the situation in my role as youth services manager with Cork ETB, with those working on the frontline in drug counselling and addiction services saying it requires urgent attention.” 

Mr Finn said that use of these vapes does not obviously impact all users. However, he said that the dosage and ingredients within the vapes can be altered to keep them within legal parameters and that this unknown mix can adversely affect many people who use it in vapes.

“Episodes relate to users becoming paranoid, having severe mood swings, and increased aggression, and I know that a large number of young people have been referred to psychiatric services over the last months because of use.

Some children as young as 13 are using it, and there are concerns that it might lead to developmental and social issues and even more serious consequences

“I recall a number of years ago there were several deaths linked to the use of headshop incense and bath salts, and moves were made to control the sale and usage of those. 

"My call now is for similar controls to be made on HHC products, especially for vapers who are minors and for whom the impact of using HHC vapes could be extremely serious."

One third of young people attending certain youth services are now misusing hexahydrocannabinol vapes and experiencing psychotic episodes, violent outbursts, paranoia, severe anxiety and suicidal ideation, he said.

Synthetic cannabinoids have caused many serious poisonings, mass poisonings, and deaths internationally in recent years, Professor Eamon Keenan of the HSE’s addiction services said.

“There is a high level of risk associated with edibles, herbal, and vape products currently available on the Irish market nationally,” Prof. Keenan said.

“There is a risk they contain new and more dangerous substances than what is stated on the packaging, even if the packet looks legitimate.

Risks are increased if these substances are taken in combination with other drugs

Synthetic cannabinoids are man-made chemicals produced to mimic the effects of tetrahydrocannabinol (THC), the main psychoactive compound in cannabis.

“Often, products do not contain THC but instead they can contain a synthetic cannabinoid which will produce similar, more potent effects. They will greatly increase the risks of a drug emergency occurring, because they produce more intense adverse effects,” Prof. Keenan said.

Hexahydrocannabinol was reported to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) as a drug of concern in May 2022, and is currently the subject of intensive monitoring, Prof. Keenan said.

The HSE is concerned about the use of this drug in Ireland as it is being sold openly in vape shops.