Prevalence and correlates of synthetic cannabinoid use in a substance use treatment population: an electronic health record study in Brazil

Background: Synthetic cannabinoids (SCs) are the fastest-growing class of novel psychoactive substances in Brazil, yet epidemiological data on their prevalence and correlates remain limited. This study examined differences in sociodemographic, treatment, and clinical characteristics between individuals in substance use treatment who reported SCs use and those who did not, and identified factors associated with SCs use frequency.<br/><br/>Methods: The study extracted data from electronic health records (EHR) of all individuals who sought treatment for their alcohol and/or drug use in “HUB de Cuidados em Crack e Outras Drogas” (HUB), Sao Paulo, Brazil, between June 2024 and July 2025 (N=6660).<br/><br/>Results: 1,943 service users (29.17%) self-reported using SCs in the past 12 months. Of these, 28.9% initiated use before age 21, 51.7% reported polysubstance use (cocaine, crack cocaine, and cannabis) before initiating SCS use, and 63.4% reported daily use. Compared with non-users, SCs users were more likely to be younger, to have attended another treatment service in the past 12 months, and to have frequented open drug scenes (ODS). They also reported greater use of cocaine, crack cocaine, cannabis, solvents, and methamphetamines, higher rates of polydrug use, more severe cocaine/crack addiction scores, and more frequent high or severe psychotic symptoms. Similar factors were associated with the frequency of SCs use.<br/><br/>Conclusion: The findings reveal a mixed profile of SCs users, comprising individuals from ODS and younger users from other areas. It highlights the need for adaptive public health policies, enhanced surveillance, and tailored treatment approaches to address the evolving complexity of Brazil’s drug landscape.