Lately I’ve been presented with several legal cases involving “Spice”. A person may have used Spice and was involved in a criminal-related case or presented to medical care for the treatment of symptoms related to Spice. This is not a new street drug, as recreational use of Spice in the United States started in 2009. But due to Spice’s evolving presentation and misconceptions about its properties, this drug’s toxicology warrants an introduction and review for attorneys.
Spice is just one of the many names for synthetic cannabinoids (SCs). Other names include K2, Fubinaca, Fake Weed, Mr. Nice Guy, Black Magic, Scooby Snax…and the list goes on. SCs are sprayed onto dry plant material and sold in bags that look like “potpourri” or “herbal incense”. They may even be labeled as such – but the buyer knows that the contents are not for freshening their kitchen after cooking, however.
The actual chemical compounds found in samples of Spice will vary. SCs were originally developed for medicinal purposes to increase the pain-relieving effects that marijuana would deliver. However, Spice has no accepted medicinal use and according to a 2017 Drug Enforcement Administration report, 26 SCs are Schedule I substances under the Controlled Substances Act. There are more than 26 SCs out there as the SC formulations keep evolving.
SCs are not structurally related to marijuana. The two substances are similar in that they hit the same receptors in the body. However, SCs have more potent receptor-activity than marijuana and SCs do not contain the substances found in marijuana that “blunt” many adverse effects.
A urine drug screen, unless specifically designed to pick up synthetic cannabinoids, will not automatically pick up SCs. The drug is not similar to marijuana (cannabis) in structure, nor does it produce the same metabolites (breakdown products), so a positive result will not be produced by SCs if the drug screen only picks up marijuana. There are laboratories that can test specifically for SCs. These tests, even if geared to pick up SCs, will not pick up all SCs as different iterations of these compounds are continuing to be produced.
SCs are smoked or ingested and acute effects include increased breathing rate, increased heart rate, wide pupils, acute renal failure, nausea, vomiting, agitation, anxiety, and hallucinations (auditory and visual). Other possible acute effects include stroke, seizures, and serotonin syndrome. Serious reactions can manifest as schizophrenic in nature (hence the term “Spiceophrenia”), especially in those with a pre-existing psychiatric disorder or a predisposition for such, and include hallucinations, paranoia, agitation, and violent behavior. Marijuana can do this too but SCs can have greater psychoactive effects compared to natural cannabis. The duration of SC-related psychiatric effects varies from weeks to months and researchers continue to collect data on the long-term effects of these chemical compounds. The withdrawal symptoms following abrupt discontinuation of long-term SC use may present as severe anxiety, restlessness, nightmares, muscle twitches, increased heart rate, and increased blood pressure. Studies are also ongoing regarding the long-term effects of SCs and withdrawal patterns. The take-home message here is that there is not a black-and-white template for determining if a specific behavior is related to SC usage. As with all clinically-related cases, careful assessment of all background information and history is needed.
It is difficult to predict drug interactions with SCs as the amount and type of chemical in one batch of SCs to another vary. As a result, the metabolites formed and the pathways they are enhancing or inhibiting will vary.
The treatment of acute toxicity withdrawal-related symptoms from SC involves emergency department and/or hospital admission for supportive care, benzodiazepines, and intravenous fluids. Antipsychotic drugs are also sometimes used and continued on an outpatient basis once the patient is stabilized. There is no reversal agent (antidote) for the effects of SCs so treatment is guided by the patient’s signs and symptoms. Of important note, there have been numerous reports of SCs being contaminated with a rodenticide, brodifacoum, that thins the blood. Patients using SCs would then present not only with some of the symptoms associated with SC previously described but also unexplained bleeding.
Dr. Muller is available to present seminars to attorneys on drugs of abuse and other toxicology-related topics. She has presented numerous continuing legal education programs to attorneys with an interest in learning the science behind their drug, chemical, and alcohol cases. She can be reached at Allison@AcriMullerConsulting.com.