Bath Salts, K2, Spice are all street names for a new group of drugs that are classified as designer drugs that can be deadly.
Packaged and labeled as plant food bath salts and herbal incense “not for human consumption,” these drugs were sold “legally” in tobacco shops, convenience stores and gas stations until recently.
Now banned in many states, it is only a matter of time before “legal” variations of the drugs hit the market to replace them, and many are still available via the Internet. With the rise of social media networks and instant messaging, designer drugs have the potential to go from unknown to epidemic proportions in just a matter of months: reports of baths salts to the American Association of Poison Control Centers increased 93 percent from 2010 to August 2011.
Synthetic Marijuana – know as K2, Spice, Demon or Serenity Now – is also readily available. The chemical makeup of synthetic marijuana makes it stronger than the actual leaves from the cannabis plant.
While traditional bath salts contain little more than sea salt and benign perfuming agents, the impostor contains methylenedioxypyrovalerone (MDPV). The drug has effects similar to methamphetamine and cocaine when snorted, injected or smoked – giving users feelings of euphoria and wakefulness that can last for hours – it is deadly and highly addictive.
Common street names for bath salts include Aura, Bliss, Blizzard, Blue Silk, Charge Plus, Cloud 9, Hurricane Charlie, Ivory Wave, Ivory Snow, Lunar Wave, Ocean Snow, Purple Wave, Red Dove, Scarface, Vanilla Sky, White Lightning, White Rush and Zoom 2.
But these drugs are not without danger. Designer drugs can cause severe agitation: it is reported that one woman under the influence, although petite, required four officers to subdue her, even after she had sedatives.
Many of these new designer drugs have psychedelic properties similar to Ecstasy, cocaine and PCP. In addition to severe agitation, these drugs also produce anxiety, paranoia, hallucinations, vomiting, fever and sweating. The hallucinations and paranoia can last hours or days – and depending upon the person and the amount ingested, can induce life-long paranoia and flashback episodes. Many people hospitalized from using these drugs leave the emergency unit and are admitted to the psychiatric unit.
What makes these drugs so insidious is that the person taking them does not know the dose or strength of the drug. Unlike the LSD of the 60s and 70s which caused psychedelic symptoms because it targeted the serotonin receptors of the brain; these new drugs also affect other systems of the body causing elevated heart rates, increased blood pressure and raising body temperatures to dangerous highs.
Signs and symptoms that may be seen in people under the influence of designer drugs: hallucinations, impaired perception of reality like smelling colors, permanent mental illness such as schizophrenia and schizoaffective disorder, rapid heartbeat, high blood pressure, tremors, flashbacks, feelings of euphoria, delusions, panic, loss of appetite, depression, violent behavior and suicidal tendencies.
New designer drugs also present a challenge to emergency health care providers. If a person who has overdosed on a designer drug comes in the emergency room, valuable time may be lost as the care givers identify the substance and dose that was taken.
Recognizing drug abuse in others
It’s not enough to know that the drugs are on the streets, you need to know how to recognize the effects of drug use in your home and in your community.
A person may be using drugs if you notice:
- A negative change in performance. Does your loved one look for excuses to stay home from school or work? Are the absent often? Are grades or performance assessments dropping?
- Health. Is your loved one agitated, aggressive, paranoid, or listless?
- Appearance. Is there less concern about how they dress or look? Is there a lack of personal hygiene?
- Behavior. Has his or her behavior changed? Does he or she disappear without explanation? Has family relationships changed? Is he or she more moody?
- Money. Drug habits need funding. A person who is using drugs may not be able to account for large sums of cash. Are you missing money or possessions?
If you expect a person may be abusing drugs, get help from your local health care provider or call the Alcohol and Drug Recovery program department of Ministry Saint Joseph’s Hospital at 800.468.9700.
The lab in the kitchen
In addition to the designer drugs that are readily available on the internet, there is another potential hazard that is just insidious – drug recipes.
Searching for drug recipes on the Internet returns over a hundred million results on one search engine. The ready availability of these recipe means that almost anyone can create illegal drugs for sale. People who take “homemade” designer drugs have no idea what is in the formulation or how potent the ingredients are. As a result, users have no idea about the potential dangers.
Synthetic Marijuana: Fake Weed, Real Problem
By Amy Schmidt, Pediatric Trauma Program Coordinator, Ministry Saint Joseph’s Children’s Hospital, Marshfield.
Imagine having access to a drug that looks like marijuana, is cheap, available online or in stores, provides a “high,” many adults have never heard of, and common drug screening will not detect. Welcome to the world of synthetic cannabinoids.
Marketed as incense, these products contain various herbs/botanicals. The dried, crushed, or chopped botanical base is sprayed with a liquid form of a synthetic cannabinoid. Users ingest these chemicals through smoking a wrapped joint or pipe or else inhaling fumes via vaporizers.
These chemicals have not been approved by the U.S. Food and Drug Administration (FDA) for human consumption, have not been tested on humans, and are not regulated. Although the packaging clearly reads “not for human consumption,” that is what users are doing – consuming it through smoking.
Prior to November 24, 2010, when the Drug Enforcement Agency (DEA) enacted an emergency ban on specific synthetic marijuana chemicals (more details to follow), synthetic cannabinoids could be purchased at retail stores under the names of K2, Spice, Demon, or Serenity Now. These and a host of other names all refer to “legal weed.” Sold in head shops, some gas stations, and also available online – including directions on how to make your own “incense blend” – synthetic cannabinoids have become increasingly popular.
Tetrahydrocannabinol (THC), the main psychoactive substance found in the cannabis plant, and synthetic cannabinoids, both bind to the same cannabinoid receptors present in the human body. The brain is rich in the CB1 receptors. Many synthetic cannabinoids (like JKH-018) are full agonists, as opposed to THC, which is a partial agonist. When smoked, users may experience far greater effects than regular cannabis.
According to the National Drug Resource Center, the physiological effects of synthetic cannabinoids include:
- Increased heart rate and blood pressure
- Altered state of consciousness
- Mild euphoria and relaxation
- Perceptual alterations (time distortion)
- Intensification of sensory experiences
- Pronounced cognitive effects
- Impaired short-term memory
- Increased reaction times
Other reactions being reported to the American Association of Poison Control Centers include agitation and anxiety. Other news articles and websites also report paranoia, hallucinations, nausea/vomiting, fever and sweating. With reports of varied concentration of the chemicals in different products, this may explain the variation related to effects found among users.
According to the American Association of Poison Control Centers National Poison Data System as of December 21, 2010, poison centers reported 2,752 calls about the products.
Conventional drug screening test panels will not detect these chemicals, though testing has recently been developed to determine if the metabolites are present in urine.
Communities/States Response and the DEA Ban
The DEA used its emergency powers to enact an emergency ban on specific synthetic marijuana chemicals on November 24, 2010. The DEA has now designated five chemicals (JWH-018, JWH-073, JWH-200, CP-47,497 and cannabicyclohexanol) as Schedule I substances, the most restrictive category. This is in response to a rise in reports from hospitals, poison-control centers, and law enforcement agencies since 2009. The ban will last for one year as the DEA and the United States Department of Health and Human Services further study these chemicals.
At the time of the ban, 15 states had already implemented control measures related to these drugs. Although legislation is pending in the state of Wisconsin, individual communities and counties have enacted bans on synthetic marijuana products. In late 2010, the Wood County Board, the Marshfield Common Council, and the Wausau Common Council passed ordinances to ban the products.
Despite the federal emergency ban, internet sites are marketing alternatives to JKH-018 and other now-banned substances. Links direct you to sites selling AM-2210 or AM-694, substances not affected by the DEA ban.
Implications for EMS
Part of the danger of these chemicals is the unknown. There is limited existing medical literature describing the adverse effects and patient presentations. With lack of FDA regulation, without proper ingredient labeling, and known discrepancies occurring in product potency, users increase the risk of an adverse reaction.
With the varying range of physiologic effects, such as the level of consciousness presenting from obtunded to extreme anxiety and paranoia, responders will rely on their training to evaluate patients.
From scene size-up to initial assessment through additional assessment, including focused history, responders may either identify the root cause of the problem or rule out potential causes. Depending on presentation, protocols and procedures for an “unknown down” may need to be followed. Monitoring A,B,C’s and providing supportive care will be essential for transport to the hospital.
Synthetic cannabinoids are in our communities. Over the past several months, multiple news organizations are reporting cases of use throughout the country. Synthetic cannabinoids may be seen as “fake weed,” but the problems they present are real.
-Schneir, A. B., Cullin, J., & Ly, B. T. (2010, December 15). “Spice” Girls: Synthetic Cannabinoid Intoxication. Journal of Emergency Medicine. Advance online publication.
-Dresen S, Ferreiros N, Westphal F, et al. Monitoring of herbal mixtures potentially containing synthetic cannabinoids as psychoactive compounds. J Mass Spectrom. 2010; 45(10): 1186-1194.
-Spice, K2, and the Problem of Synthetic Cannabinoids. The National Drug Court Resource Center website. Accessed December 28, 2010.
-American Association of Poison Control Centers. (2010). Fake Marijuana Spurs More than 2,500 Calls to U.S. Poison Centers This Year Alone. Alexandria, VA: Jessica Wehrman.
-Drug Enforcement Agency. (2010). DEA Moves to Emergency Control Synthetic Marijuana. Washington, DC: DEA Public Affairs.