A new wave of drug-related issues with “synthetic drugs” or “designer drugs” is emerging in both emergency departments (EDs) and the community at large. Two of the main groups of these drugs are synthetic cannabinoid products (SCPs) and synthetic cathinones (SCs). SCPs are commonly referred to as Spice, “fake pot,” or “fake marijuana.” SCs are commonly known and sold as “bath salts.” New brands of these drugs are continuously coming on the market and are sold under a variety of street and commercial names (Table 1).
Synthetic cannabinoid products
Synthetic cannabinoids are sprayed on a variety of herbal or dried plant matter for the purposes of being smoked to achieve a “high.” These products are sold over the Internet and in gas stations, liquor stores, convenience stores, smoke shops, and “head shops.” The packages are typically labeled “not for human consumption” but the “omission” of the SCPs on the product labeling suggests that there may be an intentional marketing strategy to misrepresent these as natural products.
When smoked, these substances can produce psychoactive effects similar to those of cannabis. These effects are due to the addition of SCPs—not to the ingredients listed on the product labels. SCPs have become increasingly popular among youths because of their reported “marijuana-like” effects; their ready availability; and the lack of routine, reliable urine toxicology testing. Users smoke the product by wrapping it in joints, smoking it in pipes, or inhaling fumes via vaporizers.
Synthetic cannabinoids are not analogues of tetrahydrocannabinol (THC) and are not produced by cannabis plants, but they act on the same receptors as does THC. They are a large and chemically varied group of molecules with some similarities to THC. As of 2013, few formal human studies have been published. The risks associated with the use of SCPs appear greater than those seen with cannabis. Most of the newer SCPs are more potent than cannabis. As a result, smaller doses of SCPs may produce the same effect as larger amounts of cannabis. Since a variety of SCPs exist, with manufacturers constantly substituting different compounds in their products, toxicity and accidental overdosing are more likely to occur.
The prevalence of SCP use is largely unknown. Easy access and the misperception that SCPs are “natural” and therefore harmless have likely contributed to their popularity among young people. SCP users typically have used marijuana and other drugs. After marijuana, SCPs are the most frequently used illicit drugs by high school seniors. One of 9 high school students reported having used an SCP in 2012.1 Eight percent to 14% of college students have reported use of SCPs, with use more common in males and an average initiation age of 18.2,3 Poison control centers have registered 1413 calls inquiring about “synthetic marijuana” between January 1 and June 30, 2013.4 In 2010, an estimated 11,406 ED visits in the US involved an SCP; three-fourths of these visits involved patients aged 12 to 29.5
Similar to cannabis, SCPs are popular among youths who use it to become intoxicated (“get high”). Adolescents and young adults with a history of marijuana and other drug use and who are being monitored with urine toxicology tests are at risk for using SCPs because they can obtain a cannabis-like high without the risk of being detected. There has recently been increased use of SCPs by military personnel on leave, and consequently, all branches of the US military have banned these products.
SCPs appear to produce a variety of psychoactive effects, many of which are similar to those experienced by marijuana users. However, SCP users can experience a variety of negative psychoactive effects not typical with marijuana use. Agitation and anxiety are the most common negative effects (Table 2).
Dr Castellanos is Professor and Founding Chair in the department of psychiatry and behavioral health at the Herbert Wertheim College of Medicine at Florida International University, Miami. Dr Junquera is Assistant Professor in the department of psychiatry and behavioral health at the Herbert Wertheim College of Medicine, and Founding Residency Program Director at Citrus Health Network, Inc. The authors report no conflicts of interest concerning the subject matter of this article.
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