In March 2018 the Illinois Department of Public Health (IDPH) began receiving reports that users of synthetic cannabinoids were experiencing life-threatening symptoms which included severe bleeding from almost every orifice; including their eyes, ears, gums, and nose.

This outbreak included 164 known cases and 4 deaths across 15 counties in Illinois. Tests established that batches of synthetic cannabis were contaminated with a blood thinner called brodifacoum; an ingredient in rat poison.

While recreational cannabis is now legal in over 10 states, there are still many states such as Illinois, where a real cannabis plant is still illegal, which has many people choosing to ingest this accessible and incredibly dangerous alternative.

What it Synthetic Cannabis?

Better known as Spice and K2, this is a man-made chemical concoction which is designed to mimic tetrahydrocannabinol (THC), the active ingredient in cannabis. Unlike real cannabis, which comes in sticky floral buds, synthetic cannabis typically comes finely cut, greenish-brown in color, and has a stale, pungent and sometimes fishy scent that tends to cling to clothing (1). This substance is made with dried plant materials such as tea leaves, dried herbs and grass clippings which are sprayed with chemicals to be sold in catchy packets for just a few dollars (1)(2).

This synthetic drug falls under the category of new psychoactive substances (NPS). Synthetic cathinones, more commonly known as bath salts are also in the category (3). These drugs are designed to mimic the effects of controlled substances, such as cannabis or cocaine, without breaking any drug laws.

Synthetic cannabis has been on the scene since the early 2000’s, gaining popularity from American teenagers and the homeless, due to how inexpensive and accessible they are. Although Spice is similar to marijuana, as it was initially designed to mimic the psychoactive cannabinoids, it does not show up on current drug test panels. Since this designer drug is also not regulated, up until recently it was widely available in convenience stores and head shops for anyone that asked for it.

While synthetic cannabis is often labeled as an incense blend that’s ‘not fit for human consumption’, it’s also often marketed as a safe and legal alternative to controlled substances.

What makes spice so dangerous is that it’s nearly impossible to know what chemicals and potency can be found in any given packet. These drugs are developed in labs in China and other countries before they are smuggled into the United States. When drug enforcement agencies begin to catch on to specific NPS, the producers tweak their recipe and roll out a slightly altered formula. Consistency in these drugs is unachievable, the same brand of spice/K2 can have a completely different chemical makeup and potency in each batch.

With this brodifacoum (a type of rat poison) laced batches of synthetic cannabis, the US Centers for Disease Control and Prevention warned about life-threatening bleeding linked to cases in Illinois. They also noted that there were also some bleeding cases in Indiana, Maryland, Missouri, and Wisconsin.

Brodifacoum prevents blood from clotting, leading to severe and uncontrollable bleeding, according to the IDPH. Treatment for these cases involves high doses of vitamin K, which would help to restore the blood’s natural ability to clot. Patients would be required to take up to 30 tablets a day, for up to six months after an overdose of spice laced with brodifacoum.

With 164 cases in Illinois alone, an extraordinary amount of vitamin K was needed to support this treatment. This treatment would cost patients upwards of $8,000 every 2-weeks (4). In their efforts to place no financial burden on the patients tied to the synthetic cannabinoids outbreak, the IDPH found support in The Bausch Foundation, who charitably donated nearly 800,000 tablets of vitamin K to the department.

There’s a common misconception that Spice is not addictive and is safe to use, however, the uncertain compounds of Spice are what makes it a risk. There is no consistency, the ingredients are a mystery and both addiction and withdrawal are prevalent with its use (5).

When the brain becomes dependent on the stimulation of reward sensors from drugs, the brain ceases to produce its own endorphins. After cutting out the substance, withdrawal symptoms such as depression, headache, loss of appetite, anxiety, suicidal thoughts, tremors, palpitations, and nightmares may occur. This addiction to this is so powerful that the onset of withdrawal symptoms can take place just as your coming out of the euphoric state or “high” (6).

In the case of a spice overdose, immediate medical treatment is required. CDC urges people that are experiencing severe or unexplained bleeding or bruising to be taken to the hospital immediately.

While there are many risks for NPA drugs, they’re still sitting in a legal grey area. The U.S. Food and Drug Administration is aware of the reports and severe illnesses and deaths resulting from the use of tainted K2 products. Despite their efforts, these producers bypass both state and federal drug laws by labeling their products as “not for human consumption”, and frequently duck under legal requirements.

Brodifacoum is thought to extend the duration of euphoria, but, as you’ve seen, the presence of chemical poses a significant public health hazard.

Is Synthetic Cannabis Still an Issue?

In April of 2019, Federal authorities warned the public on the dangers of synthetic cannabis again after a recent spike in overdoses in north Alabama.

The state of New York is also launching a new public awareness campaign in efforts to fight synthetic cannabinoids. This multi-agency initiative includes greater resources for law enforcement, efforts include additional canines who will search for the illicit substance in state correctional facilities, currently, K2 is one of the most common forms of contraband in correctional facilities due to its ability to be easily concealed from detection.

Fox News also reports that the state will also launch an educational campaign for the vulnerable populations, such as high school and post-secondary students, and will include clinical guidance for mental health professionals and emergency room staff who treat users of the drug.

It should be noted that no outbreaks have been reported in the states which have legalized the real-deal cannabis. It is possible that many of these K2 overdoses and deaths could be avoidable if it weren’t for the prohibition against real cannabis.

We should be reminded that these casualties used to happen regularly during alcohol prohibition as well, many drinkers had also suffered from alcohol poisoning due to unregulated and unsafe moonshine.

As we move forward in cannabis legalization, another side effect will potentially be saving lives as we can reduce the use of dangerous and potentially deadly synthetic cannabinoids.

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