Synthetic Cannabinoids – A Scary Brew

I attended a conference today on synthetic cannabinoid drugs, such as “Spice,” K-2, and “bath salts.” These are drugs made by altering the chemical properties of an existing drugs, primarily THC (cannabis, or marijuana). Although their popularity seems to have followed from the popularity of “club drugs” such as ecstasy, they are not chemically based on stimulants as ecstasy was. They were originally touted as a “legal high,” but more of them are being made illegal, and with good reason.

The presentation, hosted by the International Brotherhood of Electrical Workers Member Assistance Program, featured Jeffrey Johnson, D.O., who is an addictionologist and the medical director of the substance abuse treatment programs at Cadence Health System (formerly Central DuPage Hospital and Delnor Hospital). The audience was composed of treatment professionals, employee assistance professionals, and others.

What is striking about these drugs is the almost endless variation in their chemical properties, names, and effects on the mind and body. But some of those effects are very scary: psychosis and delusional thinking, hallucinations, physical paralysis, and nearly comatose states. The people who use these drugs – often young males, but including men and women of all ages – often begin using them in order to avoid being caught on drug testing, or to avoid legal risks, or simply to try something new. What seems to happen, though, is that the new high is sought after in its own right, while the drugs are very difficult to manage without overdosage and unpredictable effects. Emergency room personnel must assess the “toxidrome” – or toxic syndrome – that results in each patient, in order to know how to treat the state of intoxication. Some of these syndromes can mimic the effects of strokes, psychosis, or other psychiatric conditions; and actual seizures (and even death in up to two percent of cases) can result.

The attendees agreed that it can be difficult to work with people who are abusing these drugs. One reason is that users expect (and may even enjoy) the experience of an unpredictable and risky trip, so they are not easily deterred by events that cause fear and concern in their family members and friends. The drugs produce intense experiences, even though they wear off rather quickly, and this leads people to anticipate their next use even as they are able to go back and carry on their usual activities at school or work.

Another insidious feature of these drugs is that they are much less likely to cause a negative experience than some older drugs, such as hallucinogens or phencyclidine. The user receives strong positive reinforcement, while family and friends look on, helpless and horrified, as the individual appears to be in grave danger to any outside observer.

There is a subculture of feeling special (by virtue of knowing insider information) involved, as well, because the drugs are sold in unexpected but “safe” places: smoke shops, novelty stores, and gas stations; and the names used are constantly changing and “clever.” the Internet has seemingly fueled this, as users – much like gamers – trade information and secrets about the substances.

The consensus among professionals is that as time goes on, medical providers and testing labs will become better able to diagnose and treat the effects of these drugs, that they will become illegal in more jurisdictions, and that parents, educators, and employers will be more aware of them. People (especially young, thrill-seeking males) will always take chances if they think they will get pleasure, status, or adventure from using substances. But professionals can become better informed and better able to provide compassionate help when users place their well-being, and that of other people, at risk.

 
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