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K2 or Spice: Drug experimentation gone wrong

This year, there has been a significant spike in emergency room visits and calls to Poison Control Centers related to a synthetic drug known as K2 or Spice. Here's what you need to know about this dangerous drug.

Today's guest blogger is Jane Miloradovich, PharmD, CSPI, a certified poison information specialist from the Poison Control Center at the Children's Hospital of Philadelphia with over 25 years of experience.

Three state health departments have recently issued warnings about a rise in emergency rooms visits after people fell seriously ill after using a synthetic drug known as K2 or Spice. The substances are sold as 'synthetic marijuana' or 'synthetic cannabinoids.' They're touted as being a legal form of marijuana since a typical urine drug screen cannot detect them. Chemically, they are called THC Homologs.

Poison centers across the country have been receiving an increased levels of calls related to these substances. From January 1 through April 29 this year, poison centers have received 2,365 exposure calls from people seeking help for adverse reactions to these drugs. This is almost four times the rate of calls received in 2014.  There have been five reported deaths of patients suspected of using this category of drugs.

The American Association of Poison Control Centers and the experts at America's 55 poison centers are at the forefront in providing warnings to the public regarding these newer and dangerous synthethic cannabinoids.

In our own region, we have seen a resurgence and spike of synthetic drug abuse. Users typically present with agitation, delirium, increased heart rate and elevated blood pressure. Some have been lethargic, requiring respiratory support. Intense hallucinations and psychotic episodes are common and seizures have been reported. Complications have included myocardial infarction, and renal injury.

Here's a call the PCC received from a physician at a local hospital on Friday evening, around 11:30 pm related to K2.

A 17-year-old male had been brought into the emergency room by friends. He had been drinking and smoking marijuana with them, but left to go outside for a while. After his return about an hour later, they noted he was very disoriented, agitated, confused, and seemed to be twitching and hallucinating. He had scratch marks on his arms and face, and there was evidence that he had vomited.

The same symptoms his friends noted continued in the ER. In addition, his pupils were very large. His body was cold, clammy and sweating profusely. His blood pressure, heart rate, and temperature were also very elevated. He had intermittent jerking or twitching. He required extensive sedation and physical restraints, and was intubated for airway protection.

Within eight hours of admission, the patient began to return to normal. He recalled going into nearby woods to smoke 'fake weed' or K2, which he recently purchased at a concert. He became disoriented and frightened upon hearing noises and got lost on his way out of the woods, falling a few times. He did not recall anything after this. In this case, the patient fully recovered and was discharged from the hospital.

So what is K2, Spice, or THC Homologs?

They are a mixture of herbs and spices that are typically sprayed with a synthetic compound chemically similar to THC (Tetrahydrocannabinol), more commonly known as marijuana. It is marketed as 'fake' or 'legal' weed and can still be purchased online, though Drug Enforcement Administration regulations are making it more difficult.

Mild to moderate intoxication can result in alterations in mood and perception, reddened eyes, and an increase in pulse rate, similar to marijuana. Other effects reported not common to marijuana exposure have included hypertension, agitation, tremors, paranoia, dilated pupils and hallucinations. The type and amount of THC homologs, contained within herbal products, can vary considerably. There is a possibility of severe overdose due to batch-to-batch variability within the same product. In addition, there is very little known regarding the herbal mixtures used as the delivery vehicle. The herbs themselves may also have additive psychoactive properties.

These products were first reported in the U.S. in 2009. In 2010, federal policy made it illegal to manufacture, distribute, possess, import or export. Our PCC has always had steady amount of calls and exposures regarding synthetic drugs, but this year has seen a sharp rise in cases involving significant toxicity. It is believed that the chemical structure has been altered, or other chemicals may be involved. The chemical formula of these drugs frequently changes to avoid regulations banning specific compound formulations.

What else do I need to know?

Adolescents and young adults have always been, and always will be known for some level of experimentation with drugs and alcohol. PCC specialists recommend that we "be wary of the lure of any 'legal', or 'natural' high." Discuss the potential toxicities of products labeled as "all natural" or "herbal" as they can be just as, or even more dangerous, than illicit products, and may not contain what they are purported to contain. For parents, if you notice drastic changes in physical appearance of your teen (pupil size, glassy eyes, changes in behavior, agitation, disorientation, or chemical odor), contact your primary care physician, call the PCC, or go to the emergency department.

Although federal regulation and 41 states ban synthetic cannabinoids, there is still underground access to these agents from illicit sources. Frequently, they are not what they are purported to be and may be cut with other drugs or substances which make them very dangerous.

The PCC often receives more calls around concerts or music festivals, so we urge parents of young adults and anyone who would consider trying something at a concert, to read up on this subject using these resources:

Designer Drug Trends Report

DanceSafe

Erowid (an online library of information about psychoactive plants, chemicals, and related topics)

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