Users of synthetic drug filling emergency rooms

Three state health departments recently issued warnings about a rise in emergency room visits when people fell seriously ill after using a synthetic drug known as K2 or Spice. The substances are sold as "synthetic marijuana." A typical urine drug screening cannot detect them. Chemically, they're called THC homologs.

Poison centers across the country have been receiving more calls related to these substances. From Jan. 1 through April 29, poison centers received 2,365 calls from people seeking help for adverse reactions to these drugs. That was 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.

In this region, there's been a surge in synthetic-drug abuse. Users 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 heart attack and renal injury.

A case study

Here's a call related to K2 that the Poison Control Center received from a local hospital around 11:30 p.m. on a Friday.

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

In the ER, he required extensive sedation and physical restraint, and was intubated for airway protection.

Within eight hours of admission, the patient began to return to normal. He recalled going into the woods to smoke "fake weed," or K2, which he'd recently bought 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 that. The patient fully recovered.

What is K2?

It's a mixture of herbs and spices typically sprayed with a synthetic compound chemically similar to THC (tetrahydrocannabinol), the ingredient in marijuana that gives users their high. 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 alter mood and perception, make the eyes red, and raise the pulse rate, similar to the effects of marijuana. Additional effects - not seen with pot - have included hypertension, agitation, tremors, paranoia, dilated pupils, and hallucinations.

The type and amount of THC homologs in herbal products can vary considerably, raising the risk of overdose. In addition, little is known regarding the herbal mixtures, which may also have addictive psychoactive properties.  

What can parents do?

Discuss the potential toxicities of products labeled "all natural" or "herbal," because they can be just as dangerous or even more dangerous than illicit products. If you see drastic changes in your teen - pupil size, glassy eyes, altered behavior, agitation, disorientation, or chemical odor - contact your primary-care physician, call the Poison Control Center, or go to the emergency department. And be aware the poison control center often receives more calls around the time of concerts and music festivals.