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.)
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Most of us have been there before. A puking, nearly unconscious teenager on our pram. All the 
predictable problems; airway issues, responsiveness issues, behavioral issues. When kids learn the hard lessons about alcohol and drugs we’re often the ones who get called in to clean up the mess. And, as tiring as the routine gets, we do what we can.
We protect the airway, administer our oxygen, start the IV, monitor the capnography, pay attention to the heart rhythms, the whole kit-n-kaboodle. (You may use another term … that’s just me.) The subtleties of treatment change with level of certification and protocols, but the call runs remarkably the same.
Some medics is Tulsa, OK decided that we run this call far to often and they got the bright idea to see if they could change that dynamic. Today in high school classrooms around Tulsa EMT’s and Paramedics are taking their kits and prams into the classrooms to talk to teenagers about just what it’s really like to be laying on that pram after an alcohol or drug use mishap.
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Let’s face it, there are a whole bunch of street drugs out there that we as EMS caregivers should understand. While we can’t always be expected to identify the exact drug a patient has ingested. We do need to be able to predict a given drugs effect on the body. We should also be able to take a fair guess at
the identity of an ingested drug based on our evaluation of the patient’s physical presentation. GHB is one of those drugs that can be hard to nail down based on the physical signs. But it does leave some clues – if you know what your look for.
What Is It? : A Multi-Receptor Stimulant
GHB is short for gamma-Hydroxybutyric Acid, a naturally occurring substance produced by the central nervous system and found in small quantities in beef, wine and citrus fruits. It was first synthesized in a laboratory in 1874 but it wasn’t used in humans until 1960 when it was used in GABA receptor research and found to have a wide range of effects. In that year, scientists began testing GHB as an anesthetic and in the treatment of insomnia and depression.
The drug acts on both GABA and GHB receptors in the brain. Stimulation of GABA receptors has a sedative and analgesic effect. Stimulation of GHB receptors is primarily stimulatory. GHB also produces a biphasic release of Dopamine which produces euphoria. Understanding this multi-function aspect of GHB is key to recognizing the wide range of physical symptoms that are produced from a single GHB ingestion.
The Hallmark of GHB Overdose: Wave-like Altered Mentation
A patient experiencing a GHB high will have many symptoms similar to other drugs. But they’ll also have a unique progression of symptoms unlike any other single street drug. This becomes confusing for the emergency caregiver. GHB overdoses don’t follow a linear progression of symptoms They ride waves of symptoms. … Let me explain.
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A quick inside tip on field instructors; we all have our favorite questions to ask new riders. Those questions that help us get a more firm understanding of where our students knowledge base rests. What kind of practical 
knowledge are they carrying out into the field? Some of them are fair questions. Some of them aren’t. That’s life.
One of my favorite questions to ask that new rider early in the ride along is, “So what is epinephrine anyway?” (For the record, this is an extremely fair question.) I’ve found this to be a telling conversation because the scope of the question gives the student a lot of rope. This is a question where the student can choose to be shockingly simple or impressively complex. The choice is theirs.
I ask this question regardless of the students experience or training. I’ve had brand new EMT students knock the question out of the park and I’ve had experienced paramedics strike out miserably. All baseball metaphors aside, it’s a telling question. It speaks to a care givers understanding of the drugs we are able to administer. (Yes, all of us.) It’s revealing about ones understanding of the autonomic nervous system and it exposes an individuals understanding of basic pathophysiology.
When I ask the question, the answer I’m looking for is something like this:
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