Chances are, you’ve probably heard about the new trend in synthetic cannabis products either from your local news media or from your ongoing EMS education. Over the past few years, these products have been increasing in prevalence around the US and in Europe. But what are these products anyway? Are they cannabis or not? Are they legal to posses? Are the effects similar to traditional marijuana?
Here’s a quick rundown of what EMS folks should know about this new and growing trend in street pharmacology.
Synthetic cannabis products have a variety of street names including Spice, K2, Herbal Incense, Potpourri, Barely Legal and Kronic. It is frequently sold under the classification of an “herbal smoking blend” and some head shops and online retailers have attempted to skirt the ongoing tide of new regulations by selling the products as legitimate potpourri or plant food with the warning, “Not for human consumption.”
What is it really?
These products are all various dried organic (plant) compounds that are laced with a synthetic cannabinoid chemical that is designed to mimic the effects of cannabis in the body. Many of the products claim that they are a natural blend of legal herbs and spices that combine to give the user a legal and cannabis free high. Investigations into the contents of the products reveal that most of the herbs listed on the product packaging are not truly present in the product and that the often unidentified organic material in the product is laced with one of five common synthetic cannabinoids. (While there are over a hundred known synthetic chemical cannabinoids, these products tend to contain cannabicyclohexanol, JWH-018, JWH-073, CP-47,497 or HU-210.) These products do have a potential for dependance and if you’ve come to this page as a user, it’s worth noting that inpatient spice and K2 rehab centers are available to help you.
The synthetic cannabinoid chemical is sprayed on to the product and then dried. When the user smokes the product these chemicals bind with cannabinoid receptors in the body, producing a similar euphoria and psychoactive experience to THC ingestion. (THC is the active cannabinoid in marijuana.) By this method, users are getting a comparable marijuana high while doing an end run around traditional marijuana laws.
This creates a few new issues for the user and for EMS workers as well. First, while the long term effects of marijuana on the human body are well known, nobody is really sure what the long term effects of synthetic marijuana will bring. There may be a host of chronic ailments waiting to emerge in our traditional pot-smoking patient group. Second, legal or illegal, there is now a new, independent source of cannabis-like drugs to supply this drug-user group without the traditional problems associated with marijuana growth, cultivation and acquisition. Nobody really knows how big this new drug will get, but it has the potential to be huge.
So far, traditional marijuana drug tests have been unreliable at detecting the use of synthetic cannabinoid metabolites. With multiple synthetic compounds in existence and more on the way, it may be hard for reliable blood and urinalysis tests to keep up with the chemical tide. Since most drug users don’t want their drug use known or detectable, the medical community may struggle to find tests that can help them determine when synthetic cannabis has played a role in a given patients presentation.
Is this stuff really legal?
Yes, it was. For a while anyway. First marketed as Spice in the UK in 2004, these drugs were available on the internet for almost four years before they really spiked the radar of regulatory agencies like the FDA. That is, until their popularity surged in 2008 and the media started to take notice. Then local counties and individual states began banning the products sale and possession. Several European countries banned the products. In the US, Kansas was the first state to enact legislation outlawing the products.
In November of 2010, using rare “emergency powers”, the United States D.E.A. announced that the five most popular found in synthetic cannabis would be classified as schedule I drugs. This move makes them illegal to possess or distribute anywhere in the United States.
What are the actions of synthetic cannabis on the body?
While little is known about the real effects of these chemical compounds, some early research suggests that they could be more damaging in both the short term and long term than traditional marijuana.
Canabinoid receptors in the body perform several vital functions including regulating body temperature and heart rate, memory use, advanced cognition, immune system funtion and hunger control. Marijuana only partially binds to cannabinoid receptors so most of these functions remain intact (though sometimes altered). Synthetic cannabinoids bind completely to the receptor sites. What that means is that the underlying bodily function is more completely blocked, causing some physical reactions that are not typical in marijuana users.
These reactions can include dramatically increased heart rate and blood pressure, sleeplessness, paranoia, dehydration, nightmares and immune system dysfunction. That’s not all. The effects of these synthetic drugs can be substantially longer than that of traditional pot. Users report ill effects days and even weeks after use.
And, lastly, the synthetic cannabinoids may have bridged the withdrawal gap as well. What I mean by that is that users actually have physical withdrawl symptoms. Most marijuana users are well aware that the long term addictive affects of marijuana are primarily or completely psycological. Even after long term use, the body never really experiences any physical withdrawls after the user quits using. Not so with synthetics. Researches are seeing true physical withdrawl symptoms even after reletively short term use. This suggests that the long term addictive properties of synthetic cannabis may make it a more widespread and troublesome problem for the drug control community than it’s parent drug, marijuana ever was.
How should we respond to the potential synthetic cannabis user?
Like most drug related responses, the treatment of the synthetic cannabis user is primarily supportive. Support the airway with oxygenation and suctioning as needed. Be prepared for vomiting at higher cannabinoid doses. Restain potentially violent patients and interact with the patient in a calming and supportive manner.
When available, consider the use of benzodiazapines for extreme agitation and anti-emetics for nausea and vomiting control. Fluid may be indicated if signs of dehydration are present.
Trend the patient’s vital signs and watch closely for changes in mood, behavior or level of consciousness and airway control.
Drug users can be highly unpredictable. Be safe on scene and in the back of the rig. Remember your safety is paramount. When you are done dropping your patient off at the hospital, be sure to come back to The EMT Spot and tell the readers about your experience with this new drug in our comments section below. We’d love to learn a little something from you too.