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Over the last six months, the drug K2 – or “spice” – has gained national attention both from the media and the medical community. This synthetic cannabinoid, which is completely legal in most states, is sending users to the ED with symptoms from hallucinations to seizures.
K2 is a tetrahydrocannabinol (THC) analogue, which is the psychoactive component of marijuana. Synthetic cannabinoids have been around since the 1980s, when scientists discovered receptors that bind cannabinoids and cause their effects. In fact, in search of a new analgesic, Pfizer developed their own line of synthetic cannabinoids known as the CP series.  In 1994, Clemson professor John W. Huffman developed a series of synthetic cannabinoids.  One of them, JWH-018, is thought to be the active ingredient in K2.

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While many of us in the United States may be unfamiliar with K2, mention of the synthetic marijuana can be found on the internet dating back to 2006.  The drug has gained notoriety in both Asia and Europe leading to Germany banning it in early 2009.  However four weeks after it was outlawed in Germany, second-generation products were reported.  In most places in the United States, K2 can be purchased over the internet or at any local head shop for about $30.  A head shop is any local retail outlet that sells items such as pipes, rolling papers, or other products that can be used as drug paraphernalia.  K2 is sold under many names including Spice, Spice Gold, and Spice Diamond.  It is marketed as an incense or herbal preparation.  In most cases the packaging states that the product is not for human use.  Spice is a combination of different herbs that have been sprayed with a synthetic marijuana such as JWH-018.  The user can then make it into a cigarette or place it into a bong to smoke just as they would with regular marijuana.

The average marijuana user can be envisioned as the college stoner sitting on his couch while eating junk food and laughing at children’s cartoons.  Anyone that has ever treated a patient presenting after using Spice knows that they do not act like this.  While undoubtedly some users have a similar experience when they use Spice as they have after smoking marijuana, an increasing amount of patients are not.  While I can’t remember the last time a patient, assuming they weren’t being detained by the police or involved in a car accident, was brought to the ED because of marijuana intoxication, local poison center data do show a consistent climb in the number of calls originating from EDs regarding patients using K2.  They can present drowsy and with hallucinations.  However a number of them present with agitation, bad GI upset, tachycardia, hypertension, and even seizures.  Marijuana used in large amounts or very high concentrations can cause some of these symptoms; but once again, when was the last time you saw multiple agitated patients after only using marijuana.  Whether these symptoms are due to an inherent characteristic of K2 or just due to the concentration that is sprayed on the herbal product is unknown.  Care generally involves symptomatic treatment with hydration and benzodiazepines for agitation.  The standard urine drug test, while it can detect marijuana, will not detect K2.  While there are some research laboratories that have equipment sensitive enough to detect K2, this technology is not available in a clinically useful manner.  Little research has been conducted on possible long-term sequelae after using these drugs.  

The drug has also gained the attention of law enforcement.  In addition to not showing up on drug tests, part of the popularity of K2 is likely related to it being easily accessible.  Its availability is a consequence of it being completely legal in most states.  Kansas was the first state to outlaw K2.  Missouri and Arkansas have since followed with similar legislation reported in Illinois, Louisiana, Michigan, New Jersey, New York and Texas. 

 

Comments   

# EDDIE CONWAY 2010-10-15 10:59
JUST WHAT WE NEED. ANOTHER DRUG FOR OUR KIDS. AND OH SO EASY TO OBTAIN. AMERICA IS A SNOWBALL HEADED FOR HELL...WAKE UP PEOPLE.
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# k2 spicek2 smoke 2010-10-22 06:37
Of course there should be dui laws and such in place, as with alcohol, but whether or not someone uses this stuff should be a personal decision. Our government has far too much say as it is. Don't you think?? Our citizens are being made into criminals over petty issues and our hard earned money is being wasted on housing them. We need to start demanding some of our freedoms back...
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# k2 incensek2 incense 2010-11-19 11:17
I most definitely feel there should be age restrictions, as there are, with tobacco and alcohol products, but really, what do they hope to accomplish by banning these substances? Prohibition has really never "worked" has it?
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# The LineEDQ 2010-12-01 16:40
Your freedom ends when it infringes on my freedom. If you use a substance that causes you to hallucinate or to make poor choices that harm another, then expect consequences. This country has grown too soft on substance abuse, especially when it puts the lives of others in danger or harms way.
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# csc 2010-12-29 11:50
This is for K2 Smoke........ho w much do you think it costs a family when they lose a parent or child to an accident caused by any mind altering drug. When your freedom interferes with mine it's not longer a freedom. People need to grow up and quit being so selfish and self centered. So many lives are affected in a negative way for your so called freedom.
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# k2 incense 2011-01-20 06:37
Of course there should be age restrictions on k2 incense, as with tobacco and alcohol, but these bans are just another knee-jerk reaction by our Government to control what we can and cannot do. They were passing emergency bans and proclaiming danger before they even knew anything at all about it. These guys, http://www.buyk2incense.com claim to have k2 incense products that aren't restricted in any state by any current ban. So as you see, not only are these petty bans exhausting resources we don't have, they are pretty much useless! It's just going to continue to morph and the authorities are going to continue wasting time and money. People will still buy k2 incense. And so on and so on. Same old cycle.
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# K2 is not like marijuanaMatt P 2011-02-14 10:15
Do you wanna know why K2 smokers end up in emergency rooms? I'll tell you. Everyone says K2 is synthetic cannabis, so it makes sense that it should behave the same way, right? Wrong. K2 is several times more potent than the most potent marijuana. My guess is, most new users try to use K2 the same way they'd use cannabis. If you're used to, say, five hits of weed from a bong, your tendency is to try five hits of K2 the same way. The trouble is, the weakest K2 available is roughly three to five times more potent than typical cannabis. I know this from experience. This means that five hits of K2 would equal anywhere from 15 to 25 hits of weed. Ouch. It doesn't take a genius to see that this would result in a painful, even psychotic, experience. A little goes a long way. Especially with beer. With beer it goes a reeeeaaaaly long way!

People will do drugs, regardless of legislation. If our society wasn't so puritanical in its expectations for personal behavior, there could be education available that would inform people of the differences between various kinds of drugs. We could even have classes on that kind thing, thus preventing the vast majority of bad experiences. It's not the drug that's the problem. It's lack of knowledge. People just don't know. If they knew the effects and potencies of particular drugs, they'd know how to use them properly.

Humans have used drugs recreationally for thousands of years. That isn't going to change just because you want it to.
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# Murphy 2011-02-17 06:30
^Regarding the last comment, I'd like to correct a certain detail: It's not so much mere potency that makes the majority of the synthetic cannabinoids so dangerous compared to 'classical' marijuana, but rather their property of being full agonists. delta9-THC, the active principle of Cannabis, is only a partial agonist. Hence, anxiety and panic attacks, actually the most commonly reported effects of overdoses with synthetic cannabinoids, are MUCH less common with Cannabis-relate d products. Potency is of course not irrelevant.

Add to this fact the highly doubtful toxicological profile of many amino alkyl indols (AAI), carrying a naphthoyl-moiet y while concomitantly very often lacking further obvious sites for metabolic degradation. Hydroxylation at both the indole- and the naphthoyl-ring systems was already described for example for JWH-015 and -018, and also for the closely related "CRA-3", see:

* Analytical and Bioanalytical Chemistry 2006, 386(5), p.1345
* Annales de Toxicologie Analytique 2009, Support 1, p.21
* Analytical and Bioanalytical Chemistry 2010, 398(5), p.2141
* Drug Testing and Analysis 2010, DOI: 10.1002/dta.158
* Drug metabolism and disposition 2009, 37(4), p.827

Ring-hydroxylation usually occurs via epoxide-intermediates, see eg. the well-studied metabolism of benzene.

Finally, add the careless way of preparation of many of these compounds: While practically all of the commercialized synthetic cannabinoids are supposed to be colourless when pure, there were many batches with a deep orange to brown colour sold by the same people who sold their chemicals for the preparation of smoke mixtures a lá "K2".

Did I already mention the problem of entirely unknown pyrolysis products?

And the story goes on and on...
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# K2 and its side effectsNon-Bias but very concerned soon to be parent 2011-05-01 07:05
There are very few people in the U.S. that haven't at least tried marijuana including myself... but I would much rather ride in a car with someone I just smoked some as "Murphy" so elegantly put classic marijuana versus someone I just smoked a blunt of K2 with. I have smoked marijuana for years on end... and with that being said, when I heard of a legal "synthetic" marijuana I went to my nearest head shop and rolled a blunt... The effects were those of marijuana at first, and then slowly turned into the euphoria and unrelenting giggles of a bag of "gold cap shrooms". So my un-biased opinion may not mean much to Doc Murphy who felt the need to break down the chemical "synthetic" marijuana (which being Biology and Science Major) at Appalachian University... I do agree that it should be disclosed at the retailer if not on the package itself that "if" your going to abuse the substance (which why else would someone burn an incense that smells like K2) then do it slowly and in a controlled environment because when any natural substance such as marijuana or opium is made "synthetically" it is no longer God's creation but man's... and doe's always come with side effects undoubtedly, but as doe's aspirin or any other man made substance. And I also agree that d.u.i. laws should be put in place (which I have had one myself for drinking, and am not in the least bit mad at the system for my one extra beer) and that it should be an in home "incense" or recreational party gift, just like i'm sure we all have used alcohol for, But treating it like l.s.d. is ridiculous! It is not some psychotic drug people just use too much at one time and hallucinate (which is generally the users aim) in which case if they are in public or hurt someone while habitually using it or pushing that far much like a drunk driver hitting someone then they should be punished no doubt about it. But to take it off the shelves and outlaw it will just push the creators and users of K2 or any of the other drugs that have been outlawed by our unjustified government to rearrange a chemical or stamp a new name on it (that was for the creators and makers of the synthetic marijuana) or push the users to go to there nearest drug dealer and buy "classic" marijuana, which is indefinitely outlawed in all fifty states (unless you obtain a medical marijuana card) which the Government of this poorly constructed but almost "free" country of ours that we call home can not tax, and will not as long as they keep busting grow ops, giving out misdemeanors, felony charges, and getting free labor out of those that end up being caught with no more then some seeds... They will never legalize Marijuana to the public to use to stay calm and happy and healthy like most people tend to use it for, solely because "THEY" make more money from the court systems fees and the lawyers we all have to hires taxes for the charges for possession and intent to sell felonies and misdemeanors then they would if they actually legalized and harvested themselves, much like tobacco.) And there has never been a case of anyone overdosing on marijuana or K2 to this day, just poorly informed users and bad choices. Such as drinking and driving. Alcohol is the leading cause in automobile accidents and fatalities not just in the U.S. but the world... Now why would they legalize something that has destroyed so many lives including my fathers and other family members i've personally buried from drunk drivers hitting them to Liver failure, but refuse to legalize something that no one has ever o.d.'d on since the beginning of time or killed anyone in a violent rage over
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# Unknown 2011-09-03 06:06
Rarely ever smoke, dexided to try it just for curiosity. Did it last night and i will never do it again. It waa the worst thing ever. The high was wearing away so fast i wanted more and over did it. I felt like i was falling and falline. Felt like i was dying and i wasnt going to make it. Literally saw my life cross my eyes. I didnt think i was going to mak it, being in that situation for so long i just wanted it to stop. I threw up soo much, my heart was hurting, i couldnt talk but i could hear. I was so scared. The few times i had tried regular marijuana it takes 4 hits max for me to get high, and last night i tok about 6-8 hits. I didnt know it was stronger i didnt know other wise i would have taken just 2. Worst decision of my life. Really do value my life now.
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# uknown 2011-11-05 22:10
Idiots I smoke mad K2 and I have to say Weed works so much better HAd 5 blunts of the shit today and I still don feel high. fukin waste if you ask me. P.s. This is comin from sumone who burns tree on the regular so dont try and say I dont know wat im talkin about
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# lianna russ 2011-11-17 10:36
i like the k2 stuff... a little pin noint suites me fine but I used to only smoke a half. Sometimes i over do it and I do get paranoid, really paranoid. But for the most part its cool. I would rather smoke weed but its illegal and I need to be able to pass a pee test at any given time. One thing thats sux about the k2 is the cough ive not been able to shake....weed doesnt do that to me even on a continued basis. Its hard when I smoke because I just keep thinking about the chemicals and then i smoke the k2 and i might about 1/4 of the time get really nervous,and paranoid just wondering what the long term side effects are. I know short term is cough. Its scary...... so legalize weed here in Md... the plant not the pill
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