Synthetic Marijuana: Adding Some Spice to Your Life could be Fatal

Synthetic marijuana, AKA “Spice” is made of dried plants (oregano, basil, etc) which are then sprayed with a variety of chemicals that when smoked or “vaped” bind to the same brain receptors as does traditional cannabis. When inhaled they produce immediate and intense mental effects on the user. The intended effects are the same as those with natural marijuana including; euphoria, relaxation, and sociability.

These drugs are sold in bodegas and “head shops”. They are labeled as incense, potpourri, and herbal mixtures; however they do sport a disclaimer stating “not for human consumption” to cover their backsides. Packages of synthetic marijuana (SM) prices are well below those of actual marijuana; packages of the drug cost as little as $5 a packet or $1 for a pre-rolled joint; this makes the drug much more affordable to the homeless population. Consumers are told by marketers that these drugs are “natural” and that they will not be detected on drug screens. The Drug Enforcement Administration (DEA) has designated the five active chemicals most frequently found in synthetic marijuana as Schedule I controlled substances, making it illegal to sell, buy, or possess them. However, manufacturers attempt to evade these legal restrictions by substituting different chemicals in their mixtures, while the DEA continues to monitor the situation and evaluate the need for updating the list of banned cannabinoids.

The more than 100 synthetic cannabinoids are differentiated only by new names. Spice is one of the popular nicknames for synthetic marijuana; others include: K2, Green Giant, Smacked, Wicked X, AK-47, Geeked Up, Ninja, Caution, Red Giant, Keisha Kole, Genie, Senc, Orisha, and “Scooby Snax”

Guess what? Spice is not so nice. Experts warn that the popular term “synthetic marijuana” is truly a misnomer; these substances merely resemble marijuana, and can be 100 times as potent. Poison center experts – as well as many federal, state, and local government officials have called synthetic drug use a risk to the public’s health and a hazard to public safety.

Some Recent Headline Cases Involving Synthetic Marijuana

On July 25, 2015 Kenneth Wakefield stabbed and decapitated his wife Trina Heisch. He went on and killed two dogs. Next he cut off his left hand at the forearm and gouged his right eye out in Phoenix. He told investigators he was “trying to get the evil out of Trina” after he had smoked marijuana and synthetic marijuana about an hour before the onslaught. Wakefield has a history of violent crime and mental illness.
July, 29, 2015 – Five fatal synthetic marijuana cases were reported in one day in Williamson, WV.
Early Saturday morning, 8/3/15, a man who had overdosed in Allerton, PA on synthetic marijuana fought with emergency responders, knocking out a paramedic with a kick to the head, and punching and biting police officers.

Just the Facts Ma’am

Compared to cannabis, these synthetics are far more potent because they can bind as much as 1,000 times more powerfully to brain’s receptors. Additionally, their metabolites linger for much longer than cannabis. Furthermore, naturally-grown cannabis has an ingredient called cannabidiol, which actually mitigates the psychotic-like symptoms marijuana may sometimes produce; synthetic marijuana lacks this inherent protective agent.
Poison centers received 2668 calls about exposures to these drugs in 2013; there were 3680 exposures in 2014.

1 in 20 high school students used the drugs in 2014; about one in 30 adults age 19 to 28 used them in 2013 (the most recent data available for that age group).
Between June 7 and Aug. 1 of this year New York State experienced a 10X increase over the same times last year in emergency department visits and poison control center calls from adverse health effects from synthetic marijuana. Nationally, there have been 15 related deaths reported to poison control centers during January through May 2015.
A survey of 35 major city police departments across the U.S. found that 30% have attributed some violent crimes to synthetic marijuana use.
Most of the synthetic marijuana comes from factories in China and is imported to the U.S., the Drug Enforcement Administration said.
Synthetic marijuana is not detectable in standard urine drug screens.

How Does Spice Affect the Brain?

Spice users report experiences similar to those produced by marijuana; elevated mood, relaxation, and altered perception, but many describe that intended feelings are even stronger than those of marijuana.

Natural cannabinoids (such as THC) and synthetic cannabinoids (such as Spice) act by binding to Cannabinoid receptors in the brain. There are currently two known subtypes of cannabinoid receptors, termed CB1 and CB2. The CB1 receptor is expressed mainly in the brain (central nervous system or "CNS"), but also in the lungs, liver and kidneys. The CB2 receptor is expressed mainly in the immune system and in hematopoietic cells. Synthetic marijuana/cannabinoids tend to bind better and longer to the CB receptors than natural THC; generally producing stronger and more unpredictable effects. These unintended effects can vary widely depending on product strength, active ingredients, fillers, dosing, route of administration, and individual physiology.

Undesired cardiac side effects of synthetic marijuana include tachycardia, increased body temperature, hypertension, difficulty breathing, chest pain or myocardial infarction. The neurological side effects include parasthesias, anxiety, psychosis, paranoia, confusion, tremors, seizures, hallucinations, and excited delirium. The psychological effects of synthetic marijuana include suicidal ideation, self-mutilation, and highly aggressive behavior.

The duration of the effects of synthetic marijuana can vary greatly. The onset of symptoms usually takes 15 to 30 minutes; the "peak" is at approximately 90 minute; the "come down" phase can take anywhere between 1-6 hours. These synthetic drugs can be life-threatening and are highly addictive.

Tips for First Responder in Synthetic Cannabinoid Cases

There has been a "significant" increase in cases of "excited delirium syndrome" in people smoking synthetic marijuana
Users are frequently impervious to
They demonstrate incredible physical strength

Preparing for an Emergency

Police, firefighters, emergency medical service (EMS), and in-hospital healthcare providers must work in close coordination to provide care for these patients, and this coordination must begin well before that first call to 911.

Step One: Manage the Scene

As always, first ensure safety for yourself, your fellow providers, and bystanders
Remember, patients on synthetic marijuana are particularly prone to sudden and violent behavioral changes.
The 911 calls for these patients may not include any information about drug use. Have the dispatcher get additional information from the reporting party: drug paraphernalia or litter on scene, sudden onset tremors, seizures, difficulty breathing, chest pain, anxiety, paranoid, and aggressive or suicidal behavior.
Keep in mind that the drugs might not be the patient's only issue; consider severe mental illness

Step Two: Manage the Patient

Attempt to establish a patient rapport, but always be prepared for sudden changes in patient behavior.
Avoid subjecting suspects to flashing lights and sirens; they become more agitated
Coordinate physical restraint with other emergency responders; be prepared for a prolonged struggle.
Do not attempt chemical restraint without physical restraint.
Use stun guns if necessary
You can use a variety of methods, but be sure to control all four extremities as well as the patient's head.
Do not place the patient in a prone or hog-tied position.
There is no "antidote" for synthetic marijuana intoxication; there is, however, supportive care
BLS and ALS emergency responders can apply a number of very good general guidelines to manage the patient’s changing clinical presentation
If possible, pharmaceutical restraints should quickly follow or occur simultaneously with physical restraint. Administer benzodiazepines such as midazolam (Versed®) or lorazepam (Ativan®) per protocol preferably IN or IM.

Step Three: Manage the Care

As soon as possible, perform a full physical exam, triaging and treating signs and symptoms efficiently.
The patient will often be hyperthermic, consider external cooling. Remember, hyperthermia is a key indicator of excited delirium.
Closely monitor the patient's mental state, level of sedation, ECG, pulse oximetry, and other vital signs.
Continuously reassess your patient; sudden and drastic behavioral and physiological changes are the hallmarks of upcoming emergencies.

Synthetic marijuana isn’t going away any time soon, and the optimal way to prepare yourself is to know and understand what these substances are, how they work, and how best to manage patients who abuse them. SM is addictive, there are significant withdrawal symptoms, treatment can be difficult, and relapses are frequent. As an officer you will encounter synthetic marijuana under a variety of circumstances. It may be difficult to ascertain what was taken, how much, and when. So be safe out there. If you need more information call your local poison center at 1-800-222-1222. Poison centers are open 24 hours a day, seven days a week, every day of the year for poisoning emergencies and for informational calls, too.