Synthetic cannabinoids are presenting an increasing health hazard
Drug abusers who have been enjoying synthetic cannabinoids have been placing their lives at risk. The addiction to illicit drugs due to the euphoria associated with these substances has lead to a search for alternatives when legal problems or supply problems stand in the way of the desire of users to get these drugs. Synthetic cannabinoids often show up in such instances. These synthetic substances are posing extreme health hazards for users.
Initially a benign course was described for exposure to synthetic cannabinoids, without much need for emergency care. However, last summer patients began to present to Denver emergency departments with severe symptoms after being exposed to a novel synthetic cannabinoid which is known locally as “black mamba,” reported The New England Journal of Medicine on Jan. 23, 2014. In Sept. the Colorado Department of Public Health and Environment (CDPHE) was notified about this matter.
A case definition with prospective monitoring was developed by toxicologists with assistance from the Centers for Disease Control and Prevention. Records were reviewed from various sources, including:
1: Poison control centers
2: Care providers in nonhospital settings
3: Law enforcement
There were a total of 263 cases of possible exposure to the synthetic cannabinoid which met the CDPHE definition. Only 15 of these cases had been identified by the state poison control call-in centers. There were 76 patients, out of the 263 cases identified, who presented to the emergency departments at two teaching hospitals in Denver and Aurora. There was confirmation of exposure by various means, including:
1: Patient history
2: Bedside consultation
3: Laboratory analyses of products recovered from patients
Single-agent ingestions were responsible for the majority of cases. The symptoms were generally serious and included,
1: Altered mental status
2: Tachycardia followed by bradycardia
Most of the patients were managed in the emergency department. However, 7 of the patients required admission to intensive care units. Then suddenly the outbreak ended.
There were multiple product brands recovered from patients via a joint effort by hospital staff and law enforcement officials. There was a consistent molecule identified by the Denver Police Crime Laboratory with the use of mass spectrophotometry. This molecule known as ADB-PINACA was a novel synthetic cannabinoid. There is not any awareness of any laboratory that can detect ADB PINACA in blood or urine. There have since been efforts to limit the distribution of this novel and potentially dangerous synthetic cannabinoid.
Spice is a term which refers to a large variety of herbal mixtures which produce experiences which are similar to marijuana and that are marketed as safe and legal alternatives to that drug, reports the National Institute on Drug Abuse. Spice is sold under many names, including:
2: Fake weed
3: Yucatan Fire
5: Moon Rocks
These products are labeled "not for human consumption" and contain dried, shredded plant material and chemical additives which are responsible for their psychoactive effects. Misleading advertising is often associated with these products. The advertisements claim these substances contain "natural" psycho-active material which is taken from a variety of plants. Although spice products do contain dried plant material, chemical analyses shows that their active ingredients are synthetic cannabinoid compounds.
Spice mixtures have been easy to buy in head shops and gas stations and via the Internet over the years. Due to the fact that chemicals used in Spice have a high potential for abuse and no medical benefit at all, the Drug Enforcement Administration (DEA) has designated the five active chemicals which are most frequently found in Spice as Schedule I controlled substances, therefore making it illegal to sell, buy, or possess them. Manufacturers of Spice products have been attempting to evade these legal restrictions by substituting different chemicals in their mixtures. The DEA has been continuing to monitor this situation and evaluates the need for updating the list of cannabinoids which are banned.
These Spice products are very popular among young people. They are second only to marijuana among illicit drugs most used by high-school seniors. The easy access to these drugs along with the heavily marketed misperception that Spice products are “natural” and therefore safe have contributed to their popularity. Also, Spice is also popular because the chemicals used in these products are not easily detected in standard drug tests.
Spice products are often sold as incense, but they more closely resemble potpourri. Spice is abused primarily by smoking. Spice is sometimes mixed with marijuana or it is prepared as an herbal infusion for drinking. Users of spice report experiences which are similar to those which are produced by marijuana, including elevated mood, relaxation, and altered perception. Extreme anxiety, paranoia, and hallucinations have been reported by some users.
Poison Control Centers have reported symptoms from Spice which include:
1: Rapid heart rate
6: Raised blood pressure
7: Myocardial ischemia
8: Heart attacks
9: Withdrawal and addiction symptoms
The drug abuse problem in the United States has been catastrophically out of control for a long time. It appears as if every sector of the society is permeated with corrupt and unethical elements which are always on the move to determine the most effective ways to hook more Americans on these substances. Young adults in high school, and sometimes even prior to that, are prime targets for the nation's lucrative drug trade.
We see families mourning the loss of their young sons and daughters from drug abuse daily. The problem of synthetic cannabinoids highlights just how ruthless the drug peddlers are as they work diligently to stay one step ahead of law enforcement with the frequent development of new varieties of Spice. It will take much more aggressive ethical public health education initiatives and law enforcement initiatives to tackle this problem effectively.