Conditions and factors leading to synthetic cannabinoid use: A qualitative study

In this study aims to find out the factors and conditions affecting the initiation and continuation of synthetic cannabinoid use by the young population. We aimed to collect data on how the individuals started to use synthetic cannabinoids, demographic and socioeconomic features of the users, characteristics of their surroundings, experiences about their first use, cigarette, alcohol or other drug use history before this substance and perception patterns about the substance. This is a qualitative observational study. The sample consists of 31 patients who were under treatment and were hospitalized in the Alcohol and Drug Addicts Treatment and Research Center Unit (AMATEM) of Erenköy Psychiatry and Neurology Training and Research Hospital, İstanbul, and provided informed consent for the interviews. Sociodemographic data were collected using a structured questionnaire. Other data were obtained through face-to-face interview using a semi-structured form. The interview data were captured either by voice recording during the interview or in cases when the participant refused to give permission for voice recording the data has been written down during and immediately after the interview. Thematic analysis methot was used to obtain the results. Of the 31 participants aged between 18 and 40, who were current or former synthetic cannabinoid users, 27 were male, and 26 younger than or equal to age 31. All participants, except one, also reported the use of some other substances including cannabis, ecstasy, cocaine, heroin, and methamphetamine. Of the 27 male participants, 15 described their neighbourhood as a place where the use and sale of illicit substances is culturally normal. Among those 15 participants, six started using an illicit substance at age 13 or younger. Several participants stated that they first experienced the use of synthetic cannabinoids in the years between 2007 and 2009, well before 2010, in which formal discovery of the problem occurred in Turkey. Of the participants, 26 started illicit substance use with cannabis, 4 with synthetic cannabinoids, and 1 with heroin. The bucket use of synthetic cannabinoids among the participants was also widespread and seem inherited from their cannabis culture. Based on the participants' accounts, both the bucket use and the use within a cigarette can be fatal. All of the participants obtained the synthetic cannabinoid products from the street dealers who had been selling also the other illicit substances. Several participants stated that they started using synthetic cannabinoids because of a cannabis availability problem. The participants' accounts also revealed that in addition to the strong rewarding and craving effects of the drug, and its cheap and easy availability, social environment particularly some neighbourhoods where substance use and trade are perceived normal, male gender, friends who use substances, poor family protection may be the most important factors contributing to synthetic cannabinoid use. The epidemic of synthetic cannabinoid use in Turkey may have started in neighbourhoods where illicit substance use and trade are widespread, making the male adolescents with weak family protection living in these places the most vulnerable group. Keywords: synthetic cannabinoid, drug addiction, bonsai, narcotic