K2 Epidemic - Synthetic Cannabinoids

What are synthetic cannabinoids?

Synthetic cannabinoids refer to a growing number of man-made mind-altering chemicals that are either sprayed on dried, shredded plant material so they can be smoked (herbal incense) or sold as liquids to be vaporized and inhaled in e-cigarettes and other devices (liquid incense). 

These chemicals are called cannabinoids because they are related to chemicals found in the marijuana plant. Because of this similarity, synthetic cannabinoids are sometimes misleadingly called "" (or "fake weed"), and they are often marketed as "safe," legal alternatives to that drug. In fact, they may affect the brain much more powerfully than marijuana; their actual effects can be unpredictable and, in some cases, severe or even life-threatening.

False Advertising

Synthetic cannabinoid products are often labeled "not for human consumption." Labels also often claim that they contain "natural" material taken from a variety of plants. However, the only parts of these products that are natural are the dried plant materials. Chemical tests show that the active, mind-altering ingredients are cannabinoid compounds made in laboratories.

Synthetic cannabinoids are included in a group of drugs called Synthetic cannabinoids are included in a group of drugs called "new psychoactive substances" (NPS). NPS are unregulated psychoactive (mind-altering) substances that have become newly available on the market and are intended to copy the effects of illegal drugs. Some of these substances may have been around for years but have reentered the market in altered chemical forms or due to renewed popularity.

Manufacturers sell these herbal incense products in colorful foil packages and sell similar liquid incense products, like other e-cigarette fluids, in plastic bottles. They market these products under a wide variety of specific brand names; in past years, K2 and Spice were common. Hundreds of other brand names now exist, such as Joker, Black Mamba, Kush, and Kronic.

For several years, synthetic cannabinoid mixtures have been easy to buy in drug paraphernalia shops, novelty stores, gas stations, and through the Internet. Because the chemicals used in them have a high potential for abuse and no medical benefit, authorities have made it illegal to sell, buy, or possess some of these chemicals. However, manufacturers try to sidestep these laws by changing the chemical formulas in their mixtures.

Easy access and the belief that synthetic cannabinoid products are "natural" and therefore harmless have likely contributed to their use among young people. Another reason for their use is that standard drug tests cannot easily detect many of the chemicals used in these products. 

How do people use synthetic cannabinoids?

Users usually smoke the dried plant material sprayed with synthetic cannabinoids. Sometimes they mix the sprayed plant material with marijuana, or they brew it as tea. Other users buy synthetic cannabinoid products as liquids to vaporize them in e-cigarettes.

How do synthetic cannabinoids affect the brain?

Synthetic cannabinoids act on the same brain cell receptors asdelta-9-tetrahydrocannabinol (THC), the mind-altering ingredient in marijuana.

So far, there have been few scientific studies of the effects of synthetic cannabinoids on the human brain, but researchers do know that some of them bind more strongly than marijuana to the cell receptors affected by THC, and may produce much stronger effects. The resulting health effects can be unpredictable.

Because the chemical composition of many synthetic cannabinoid products is unknown and may change from batch to batch, these products are likely to contain substances that cause dramatically different effects than the user might expect.

Synthetic cannabinoid users report some effects similar to those produced by marijuana:

• elevated mood
• relaxation
• altered perception—awareness of surrounding objects and conditions
• symptoms of psychosis—delusional or disordered thinking detached from reality

Foto, ©iStock.com/trendobjects

Psychotic effects include:

• extreme anxiety
• confusion
• paranoia—extreme and unreasonable distrust of others
• hallucinations—sensations and images that seem real though they are not

• What are some other health effects of synthetic cannabinoids?
  People who have used synthetic cannabinoids and have been taken to emergency rooms have shown severe effects including:
  • rapid heart rate
  • vomiting
  • violent behavior
  • suicidal thoughts
  Synthetic cannabinoids can also raise blood pressure and cause reduced blood supply to the heart, as well as kidney damage and seizures. Use of these drugs is associated with a rising number of deaths. 

  Are synthetic cannabinoids addictive?

  Foto, Humannet/©Shutterstock
  Yes, synthetic cannabinoids can be addictive. Regular users trying to quit may have the following withdrawal symptoms:
  • headaches
  • anxiety
  • depression
  • irritability
  Behavioral therapies and medications have not specifically been tested for treatment of addiction to these products. 

  Points to Remember

• Synthetic cannabinoids refer to a growing number of man-made mind-altering chemicals sprayed on dried, shredded plant material or vaporized to get high.
• Synthetic cannabinoids are sometimes misleadingly called "synthetic marijuana" (or "fake weed") because they act on the same brain cell receptors as delta-9-tetrahydrocannabinol, the mind-altering ingredient in marijuana.
• The effects of synthetic cannabinoids can be unpredictable and severe or even life-threatening.
• The only parts of synthetic cannabinoid products that are "natural" are the dried plant materials. Chemical tests show that their active ingredients are man-made cannabinoid compounds.  
• Synthetic cannabinoid users report some effects similar to those produced by marijuana:
  • elevated mood
  • relaxation
  • altered perception
  • symptoms of psychosis
• Synthetic cannabinoids can also cause serious mental and physical health problems including:
  • rapid heart rate
  • vomiting
  • violent behavior
  • suicidal thoughts
• Synthetic cannabinoids can be addictive.
• Behavioral therapies and medications have not specifically been tested for treatment of addiction to these products.

• Treatment Overview:

  INHALATION EXPOSURE A) MANAGEMENT OF MILD TO MODERATE TOXICITY 1) For mild and moderate toxicity, treatment consists primarily of supportive care. Most patients do not require any specific treatment and, especially with an inhalational exposure, symptoms should resolve in a few hours. B) MANAGEMENT OF SEVERE TOXICITY 1) Treatment is symptomatic and supportive. Administer benzodiazepines for agitation or delirium. Consider diphenhydramine for dystonia or rigidity. SEIZURES: Initially treat with benzodiazepines, add propofol or barbiturates if seizures persist. Airway support as needed. TACHYCARDIA: In agitated patients, tachycardia usually responds to benzodiazepine sedation. Obtain a baseline ECG and institute continuous cardiac monitoring. CHEST PAIN: Myocardial infarction has been reported in adolescents abusing THC homologs. Perform serial ECGs, institute continuous cardiac monitoring and obtain serial troponin concentrations. Treat with aspirin, nitroglycerin and benzodiazepines. ABSTINENCE SYNDROME: Abrupt discontinuation of chronic use can cause profuse sweating, tremors, palpitations, insomnia, headache, depression, diarrhea, nausea, and vomiting. Treat with benzodiazepines. C) ABSTINENCE SYNDROME 1) Abrupt discontinuation of chronic use can cause profuse sweating, tremors, palpitations, insomnia, headache, depression, diarrhea, nausea, and vomiting. Treat with benzodiazepines D) DECONTAMINATION 1) Primary route of exposure is via inhalation; gastrointestinal decontamination is not necessary even if these substances are ingested. E) AIRWAY MANAGEMENT 1) Rarely necessary, but perform early if life-threatening cardiac dysrhythmias, significant agitation/delirium or seizures develop. F) ANTIDOTE 1) None. G) DELIRIUM 1) Treat agitation/delirium in patients with suspected exposure to THC homologs with oral or IV benzodiazepines.