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Sugar and Spice Is Not Always Nice

By Melissa L. Halliday

It was right around 2 am, and I was working an overnight shift in our busy downtown emergency department. Suddenly, the paramedics burst through the door with a young male patient in his twenties who was spitting, screaming, fighting and attempting to hit EMS providers. He was incredibly agitated, screaming non-sensical statements and almost flipping his stretcher on its side. He seemed to have super-human strength, requiring eight providers to hold him in place so he could not harm himself or others. The medics stated that they had been told the patient had smoked something called “Spice” and then become agitated and combative.  

Synthetic drugs such as synthetic marijuana derivatives (synthetic cannabinoids) have been used as drugs of abuse since the early 2000s. First developed as a research chemical to help study diseases such as AIDS and multiple sclerosis, they were first found as a recreational street drug in 2002. Since this first discovery, their use has become widespread throughout the United States and the world. Hundreds of chemicals have been synthesized since that time for use as illicit drugs. These chemicals have hundreds of different brand names including Spice, K2, Black Mamba, and Crazy Clown, to name a few. The drug is typically initially a liquid or waxy substance that is sprayed onto herbs or plants, dried, and then smoked by the user. Many different forms of this drug can be found in a single packet, and despite similar packaging, one batch is almost never the same as the prior batch. Synthetic marijuana is often easily obtained and can be sold for as little as $10 an ounce. 

Despite their description as synthetic marijuana, the chemicals that are found in these drugs are actually quite different from naturally occurring marijuana and can have markedly different effects after use. While natural marijuana users are typically calm, sleepy and euphoric, the effects of synthetic marijuana can be quite different. Individuals intoxicated with synthetic marijuana often present to hospitals with severe psychotic symptoms including hallucinations, agitation, combative behavior and confusion. Additionally, certain strains of these drugs have caused heart attacks, seizures, kidney failure and other serious effects in users. Severe psychiatric and physical effects typically require treatment with very high doses of sedative medications and sometimes hospitalization until the effects go away. It can take a few hours up to a few days in severe cases for a patient to return to normal.  

New forms of synthetic marijuana are appearing all the time, making it difficult to detect these drugs in usual drug testing, and also making it difficult to predict the effects that will be seen when a person uses these drugs. While some users may experience an enjoyable high, many others will suffer from severe psychological effects and possibly even life-threatening effects. As there is no way to predict who will suffer severe effects, the only way to avoid life threatening effects is to avoid use of this drug entirely. Users of synthetic marijuana are placing their lives and the safety of others at risk each time they use this substance. 

For those suffering from drug addiction or for those with family or friends suffering from drug addiction, further information regarding drug addiction and resources for recovery can be found at https://www.drugabuse.gov/related-topics/treatment or by calling 1-800-662-HELP (4357). For information on synthetic drugs, go to http://newsroom.acep.org/fact_sheets?item=29936  

About the Author: Melissa L. Halliday, DO, is an attending emergency physician at the University of Washington, Harborview Medical Center.  She is also a medical toxicologist at Washington Poison Center in Washington State.