Synthetic cannabinoids, also known commonly by the name of “Spice” or “K2”, first became available in the U.S. in the mid-2000’s. These synthetic products are designer drugs in which incense or other leafy materials are sprayed with lab-synthesized liquid chemicals to mimic (copy) the effect of tetrahydrocannabinol (THC), the psychoactive ingredient in the naturally grown cannabis sativa plant.
Synthetic cannabinoids are sometimes incorrectly called “synthetic marijuana” (or “fake weed”), and they are often promoted as safe or legal substitutes to natural marijuana. There is no actual marijuana plant in synthetic cannabinoids; however, the action of the chemicals still take affect on the cannabinoid (THC) receptors in the brain. Synthetic cannabinoids can produce very different actions from smoking natural marijuana. The effects can be much more intense, unpleasant and sometimes dangerous compared to naturally-grown marijuana.
Is synthetic cannabinoids (“synthetic marijuana”) still available in stores?
In July 2012 a national ban was enacted against the sale of synthetic cannabinoids in the U.S.1 Local and state laws also regulate synthetic cannabinoids. While synthetic cannabinoids are illegal in the U.S., the product may still be sold illegally on the streets.
Spice or K2 has been marketed as an incense in colorful three ounce pouches or vials and labeled “not for human consumption”. Spice or K2 became increasingly popular with high school students and young adults in the mid-2000’s because it was legal and easily obtainable from convenience stores, smoke shops, and online.
Popular belief is that “Spice” or “K2” is safe, non-toxic, and results in a psychoactive (mind-altering) effect similar to regular marijuana. However, case reports and surveys have identified serious toxicities that occur with use of synthetic cannabinoids, and some users have required emergency room treatment. The chemicals synthesized for the production of synthetic cannabinoids can be more potent than natural THC found in natural marijuana, and may have more dangerous side effects. Little is known of the pharmacological profile of the chemicals or their by-products.
How are synthetic cannabinoids used?
Synthetic cannabinoids are ingested in a similar manner to marijuana, either smoked alone in a joint or other device, such as a pipe or a bong, or rolled into a joint with tobacco or natural marijuana. This product may also be baked into foods, such as brownies, or made into tea.
Synthetic cannabinoid users report experiences similar to those produced by natural marijuana — elevated mood, relaxation, and altered perception. Often, the effects can be stronger than those of natural marijuana due to the synthesized chemicals. Some users report psychotic effects like extreme anxiety, paranoia, and hallucinations.1 Emergency department visits due to the effects of synthetic cannabinoid ingestion have been reported.
What chemicals are in Spice or K2?
The cannabinoid compounds found in these synthetic agents act on the same cell receptors as those affected by the THC in natural marijuana. Identified compounds include2:
- CP 47,497 and homologues
Some of the synthesized compounds in synthetic cannabinoids bind much more strongly to THC receptors than regular marijuana, which can lead to more powerful, unpredictable or dangerous effects. Some synthesized compounds have been noted to be 100 times more potent than the average THC found in marijuana. The stronger binding of the synthetic chemicals to the THC receptor sites in the brain may lead to the extreme anxiety and paranoia that have been reported in some users.
In addition, as with many illicit designer drugs, the chemical composition may be unknown and some products may be combined with other toxic chemicals. In 2018, reports surfaced of synthetic cannabinoids being laced with fentanyl in Connecticut, as reported by NPR.
The chemicals used in these products have a high potential for abuse and no medical benefit. The Drug Enforcement Administration (DEA) has designated many active chemicals found most frequently in synthetic cannabinoids as Schedule I controlled substances, the most restrictive schedule, making it illegal to sell, buy, or possess them. Manufacturers attempt to evade these legal restrictions by substituting different chemicals in their mixtures, while the DEA continues to monitor and update the list of banned cannabinoid derivatives.1
Are synthetic cannabinoids (synthetic marijuana) dangerous?
Yes, synthetic cannabinoids can be dangerous, as described in several case reports and alerts from U.S. health care authorities. Complications due to synthetic pot use may include:
- high blood pressure
- nausea and vomiting
- anxiety or agitation
- rapid heart rate (tachycardia)
- excessive sweating
Spice and K2, as they are commonly called, can also raise blood pressure and cause reduced blood supply to the heart (myocardial ischemia), and in a few cases it has been associated with heart attacks.1
Published case reports in Pediatrics describe three teenagers who were hospitalized after using synthetic cannabinoids. These patients demonstrated varying degrees of catatonia (an inability to respond to verbal or physical stimulation, including pain) an elevated heart rate, agitation, anxiety, dizziness, headaches, excessive sweating, slowed speech, and confusion. Two of the patients recovered to normal function in three to four hours, while. the third patient was kept in hospital overnight before being released.3,4
Synthetic cannabinoids and bleeding risk
The Illinois Department of Heath reported several cases of severe bleeding in people who had used synthetic cannabinoids, such as Spice or K2, contaminated with blood thinners. Subsequently, the Centers for Disease Control and Prevention (CDC) posted an Outbreak Alert warning of life-threatening vitamin K-dependent antagonist bleeding disorders linked with synthetic cannabinoid use in Illinois and other states. Four deaths due to severe bleeding were reported in Illinois.5