CB1 Receptor Negative Allosteric Modulators as a Potential Tool to Reverse Cannabinoid Toxicity

While the opiate crisis has justifiably occupied news headlines, emergency rooms are seeing many thousands of visits for another cause: cannabinoid toxicity. This is partly due to the spread of cheap and extremely potent synthetic cannabinoids (“Spice”) that can cause serious neurological and cardiovascular complications – and deaths -- every year. While an opiate overdose can be reversed by naloxone, there is no analogous treatment for cannabis toxicity. Without an antidote, doctors rely on sedatives, with their own risks, or to ‘wait it out’ to treat these patients. We have shown that the canonical Spice cannabinoids are highly potent CB1 receptor agonists and as a result, competitive antagonists may struggle to rapidly reverse an overdose due to Spice cannabinoids. Negative allosteric modulators (NAMs) have the potential to attenuate the effects of synthetic cannabinoids without having to directly compete for binding. We tested a panel of CB1 negative allosteric modulators for their ability reverse the effects of the canonical spice compound JWH018 in vitro in a neuronal model of endogenous cannabinoid signaling and also in vivo. We tested ABD1085, RTI189, and PSNCBAM1 in autaptic hippocampal neurons that endogenously express a retrograde CB1 dependent circuit that inhibits neurotransmission. We found that all of these compounds blocked/reversed JWH018 though some proved more potent than others. We then tested whether these compounds could block the effects of JWH018 in vivo, using a test of nociception in mice. We found that only two of these compounds – RTI189 and PSNCBAM1 – blocked JWH018 when applied in advance. The in vitro potency of a compound did not predict its in vivo potency. PSNCBAM1 proved to be the more potent of the compounds and also reversed the effects of JWH018 when applied afterward, a condition that more closely mimics an overdose situation. Lastly, we found that PSNCBAM1 did not elicit withdrawal after chronic JWH018 treatment. In summary, CB1 NAMs can, in principle, reverse the effects of the canonical Spice compound JWH018 both in vitro and in vivo, without inducing withdrawal. These findings suggest a novel pharmacological approach to at last provide a tool to counter cannabinoid toxicity.