Major metropolitan city emergency departments (ED) are constantly inundated with drug and alcohol intoxications. These days, health care providers are noticing a new surge in consumption of “designer drugs”. As a professional working for some time in a Washington D.C. ED, I have personally seen the dramatic increase in synthetic cannabinoids abuse.
What Are Synthetic Cannabinoids?
Synthetic cannabinoids are a new class of synthetic molecules developed to mimic the naturally occurring, psychoactive component of marijuana: tetrahydrocannabinol (THC). THC naturally binds to endogenous cannabinoid receptors, CB1 and CB2, as partial agonists. The resulting interaction between THC and the CB1 receptor causes changes in perception, relaxation, body temperature, and hunger. In addition, THC has been implicated in providing relief to patients with chronic health issues such as wasting disease and chemotherapy-related emesis and nausea. Since the 1960s, cannabinoid research has focused on creating synthetic analogs of THC, with similar analgesic and anti-inflammatory properties, but without the psychoactive effects. However, some of the chemical structures synthesized act as full-agonists at the same CB1 receptor—increasing the inhibition of GABA neurotransmission and therefore, the severity of the psychoactive and physiological symptoms.
“Spice”, “K2” and “Smoke” are common names for products marketed as “incense”. They contain a mixture of natural herbal ingredients that are sprayed with these chemical analogs. The resulting product is marked as “not for human consumption”, which makes it difficult for regulators to control. In 2011, the Federal Drug Administration marked common synthetic cannabinoids (JWH-018, JWH-073, JWH-200, CP 47-497, and CP-47-497C8) as schedule I substances. However, new synthetic derivatives and homologs with very similar effects are constantly being created, rebranded, and redistributed across the United States. These products are inexpensive and found in local gas stations, bodegas, and on the Internet, which makes them an easy drug to get and use.
What Does A “K2” Patient Look Like In The ED?
ED patients with acute synthetic cannabinoid intoxication may present with a variety of symptoms based on the type, dose and route of consumption. The most notable clinical presentations are either: A) sluggish and drowsy or B) severely agitated and aggressive. Drowsy patients can often present with bradycardia, hypotension, emesis, confusion, and frank unresponsiveness to verbal and physical stimuli. In cases of severe agitation and aggressiveness, patients may present with tachycardia, hypertension, hallucinations, or paranoid behavior, which can be disruptive to a busy ED. These patients sometimes require physical restraints, or chemical restraint, in the form of sedatives. For many patients that I’ve seen, consumption of synthetic cannabinoids is not always an isolated ingestions, but often times combined with alcohol or street drugs.
What are Synthetic Cannabinoids Doing to The Public’s Health and What Can Be Done?
The long-term consequences of prolonged synthetic cannabinoid use remains unclear. Though most of the medical interventions to treat synthetic cannabinoid intoxication is supportive, increased use and abuse of these products is already burdening EDs not inly in major cities, like DC, but around the country. in emergency medicine. Legislation combating the sale of products containing certain ingredients has already been put in place, manufactures simply create new products and distribute them as usual.
However, local communities are doing their part to warn citizens about the harmful effects of the drug. For example, in regions of Washington D.C., educational campaigns have placed advertisements of buses to warn the public of about the dangers of K2 and Spice. Unfortunately, until a broader solution is identified and implemented, healthcare providers in ED across the country will continue to see more and more visits in relation to this dangerous drug.
Sonya Chistov is an ED Technican at The George Washington University.
