‘Synthetic does not mean safe’

It’s 1 a.m. on a Saturday. Two men enter the hospital through the emergency room doors, a young woman slumped between them. She’s barely moving—in fact, it seems like she’s barely breathing.

The ER doctors have seen patients like her before. The men barely stutter the words “incense” and “spice” when medical personnel realize they are dealing with their latest case of synthetic-cannabinoid use. She requires immediate treatment.

Synthetic cannabinoids may be illegal, but the law—California’s aptly named SB 420, passed last fall—hasn’t eradicated the product. Health-care providers remain concerned and vigilant. They know the manufacturers can find alternate formulas and distribution methods to stay a step ahead of legal restrictions.

Thus, patients like the hypothetical one above are in jeopardy that’s all too real. Some come into the ER comatose; others enter stark-raving mad and require restraints and sedation.

There is no single effect, because synthetic cannabinoids are no single substance. They are herbs or other plants sprayed with compounds that mimic the effect of THC, the active ingredient of marijuana.

“It’s nasty stuff,” said Dr. Craig Corp, a pediatrician in Chico. “It has chemicals not cleared for use in humans. Batch to batch, brand to brand, you don’t know exactly what’s in it. There are a lot of reactions kids aren’t bargaining for when they get it.

“It’s definitely a scary thing. I know it’s a big issue in Chico.”

Synthetic cannabinoids are particularly prevalent among college-age adults but also among younger teens. The substances pose such a serious health risk that the national medical journal Pediatrics devoted part of its April issue to a study of the drugs, which are known by a number of brand names, including “K-2,” “Blaze,” “Ono Budz,” “Panama Red Ball” and “Demon Passion Smoke.” Often marketed as herbal “incense,” they are ingested primarily by smoking, though like marijuana may also be eaten.

Synthetic cannabinoids come in a variety of scents and flavors: vanilla, marshmallow, lotus, honey, clover. In small slick packages, these products have appeared on shelves of convenience stores around the country, though now that 40 states have banned them, sales have gone underground, or into cyberspace. (The federal Food and Drug Administration also has branded synthetic cannabinoids as controlled substances.)

The California law restricts five specific chemical formulas. Corp says this simply prompted some manufacturers to alter their formulations—putting legislators and violators in a race of reaction times.

The risks associated with synthetic cannabinoids are multi-faceted. First, there’s the risk of driving while impaired and causing an accident with injuries or fatalities. Use of synthetic cannabinoids has been shown to impact motor skills and cognitive abilities. This also puts them at risk for victimization—theft, assault or sexual assault—and even possibly for committing a violent act if “out of control.”

Less obvious are possible long-term risks. Is synthetic marijuana habit-forming? Physically addictive? Harmful to the lungs? Harmful to the brain? Answers to these questions are unknown at this point.

“There are really no human studies for some of these drugs,” Corp said. “We have no idea what may happen down the road.

“Marijuana causes habituation—it doesn’t cause physical addiction, but mental addiction. These drugs may well be physically addicting. They’re being made in illegal labs.

“Who knows what herbs these are? Who knows what they are putting in there and what the long-term effects might be?”

Short-term effects are well-documented. “There are two different syndromes we’re seeing in the ER,” Corp explained—manic and near-catatonic.

The former may appear the most frightening. They come into the hospital violent, agitated and boisterous. They can be screaming or moaning, and usually they’re so loud that the sound echoes through the entire emergency department. Often they will attempt to kick, punch, bite or spit at the doctors and nurses trying to give them care. Hospital personnel need to physically restrain and chemically sedate them before proceeding with treatment.

The quiet patients aren’t in any less of a serious state. They run the risk of aspirating (that is, choking on their own vomit) or slumping in a way that blocks the airway. They, too, require special care.

Corp says synthetic cannabinoids take anywhere from four to 12 hours to wear off. Milder cases may resemble marijuana intoxication: unusually elevated mood, confusion, problems with physical coordination. If a friend or relative exhibits the more serious symptoms, call 911 or take him/her to the emergency room.

“Synthetic does not mean safe,” Corp said. “This is not a safe alternative to marijuana.”