The Internet age has ushered in a dizzying array of new psychoactive substances. Many of these drugs have been marketed as "legal highs," staying ahead of regulatory authority through drug structure modification.
One of these drug classes is synthetic cannabinoids. This class is often referred to using the generic terms "Spice" or "K2." These substances emerged from scientific investigations in the 1980s into novel therapeutics for AIDS, multiple sclerosis, and cancer. They mimic but do not exactly replicate the structure of THC (tetrahydrocannabinol), the principal psychoactive constituent of cannabis. They are high-affinity full agonists at the cannabinoid receptor, which may be responsible for the adverse clinical effects associated with their use.
What are the effects of this class of drugs?
A recent Morbidity and Mortality Weekly Report provides information about a series of 22 patients who had been examined after using synthetic cannabinoids between Aug. 22 and Sept. 9, 2013 (MMWR 2013;62:939). These patients were aged 16-57 years and 82% were male. Patients experienced hyperglycemia, hypokalemia, acidosis, tachycardia, nausea and vomiting, confusion and disorientation, aggression, unresponsiveness, and seizures. Five patients required assisted ventilation but none of them died. The product was sold in a smoke shop in Brunswick, Ga. Previous reports have highlighted the possibility of kidney injury, as well.
The Synthetic Drug Abuse Prevention Act of 2012 was signed into law in July by President Obama. The act banned synthetic compounds commonly found in synthetic cannabinoids, placing them under schedule I status. But, as we see from the report above, these substances are still available.
Many use synthetic cannabinoids to avoid detection because these substances do not show up on routine drug tests – special testing and a high degree of suspicion are needed. Use of these drugs can lead to dependence and withdrawal symptoms when they are discontinued. Referral to drug treatment specialists is the best approach when we suspect patients are struggling with addiction and using synthetic cannabinoids.
Dr. Ebbert is professor of medicine, a general internist at the Mayo Clinic in Rochester, Minn., and a diplomate of the American Board of Addiction Medicine. The opinions expressed are those of the author. He reported no relevant financial conflicts of interest.