According to the National Institute on Drug Abuse (NIDA), substances marketed as Spice, K2, or skunk are synthetic cannabinoids that are typically sold as liquids or powders. They can be used in e- cigarettes or rolled up in papers and smoked like cannabis products.
Synthetic cannabinoids are chemically similar to the cannabinoids found in cannabis products, but they are manmade substances. They have an affinity for the same receptors that marijuana and other cannabis products attach to in the brain.
Spice and similar drugs are often incorrectly marketed as being legal alternatives to marijuana and other cannabis products for individuals under the age of 18 or for people who live in areas where marijuana has not yet been legalized for medicinal recreational use. The majority of people who use drugs like Spice are adolescents, young adults, or adults who cannot easily get marijuana products.
Many of these products are produced in countries like Pakistan, India, or China. Their use increased dramatically between 2013 and 2013, but it has dropped off significantly as many different states begin to legalize marijuana for medicinal uses or even for recreational purposes. The United States Drug Enforcement Administration (DEA) provides a list of different types of synthetic cannabinoids and their associated dangers.
Effects of Spice
According to the DEA and NIDA, the initial effects of using Spice and similar drugs include:
- Relaxation, sedation, and lethargy
- Alterations in visual perception
- Varying levels of euphoric feelings
- Psychotic-like experiences (hallucinations and/or delusions)
- Alterations in blood pressure, which most often result in a rise in blood pressure
- Rapid heartbeat or irregular heartbeat
- Irritability, nausea, and vomiting
- Potential suicidality in some people
- Severe delirium in some people
- The potential to develop physical dependence on these drugs
- The potential to develop a substance use disorder
Whenever a substance is manufactured illicitly overseas in countries like China and Pakistan, there is very little supervision regarding the ingredients that are put into the drug. This means that drugs marketed as Spice or other synthetic cannabinoids often do not have the actual ingredients listed on their labels. There is a potential for other dangerous ingredients to be included in these drugs, and there is no accountability for the manufacturers of the drugs regarding any potential dangers or effects that the consumption of the substance can produce. Thus, fatal overdose and serious effects of using the drug are not considerations of the source that manufactures the drug.
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The Development of Physical Dependence and a Substance Use Disorder
Research has indicated that there is a syndrome of physical dependence that occurs in people who chronically abuse synthetic cannabinoids like Spice; however, it does appear that only a small percentage of habitual users develop physical dependence (about 9-10 percent of abusers). Tolerance most likely develops rapidly. Withdrawal symptoms include:
- Headaches, nausea, diarrhea, and vomiting
- Aches and pains, muscle cramps, stiffness, and significant perspiration
- Fever and chills
- Irregular heart rate
- Cravings to use the drug
- Mood swings that can include anxiety, depression, and even potential psychosis
The withdrawal period appears to be quite variable but may begin soon after discontinuation, often within 24 hours after the person has stopped using the drug. In case studies, the symptoms most often peaked within 2-3 days and lasted for approximately a week, although issues with mood swings and cravings often lasted longer (two weeks to a month).
Although the withdrawal syndrome does not appear to be potentially physically dangerous, individuals, particularly adolescents, who are under severe emotional distress or who are psychotic are in danger of self-harm. Issues with acute toxicity in long-term users can also result in significant potential for cardiovascular and neurological issues.
The development of a substance use disorder as a result of Spice abuse entails the use of the drug in such a manner that it results in the person having issues with everyday functioning. These issues produce significant distress in life. Most often, individuals with substance use disorders have problems controlling their use of the drug of choice, continue to use the drug even though it is causing them numerous problems in many different areas of life, and develop symptoms of physical dependence on the drug.
For the vast majority of people who develop substance use disorders, quitting on their own without professional intervention is not effective. Instead, the overwhelming majority of these individuals need some form of intervention to help them stop using their drug of choice. This is also true for individuals who abuse Spice or other synthetic cannabinoids.
Other Potential Long-Term Effects
Based on information from the DEA and NIDA, there are some other potential long-term effects associated with use of Spice. These include:
- The development of seizures, which can be potentially fatal
- Cardiovascular issues, including hypertension and regular or increased heartbeat
- Increased potential to develop heart attacks or stroke
- Respiratory issues
- The development of a psychiatric/psychological disorder other than a substance use disorder, including major depressive disorder, an anxiety disorder, chronic issues with psychosis, or numerous other types of mental health disorders
- Significant potential for damage to the fetus when used by pregnant women
- The potential for significant long-term neurological damage
Because the ingredients in Spice attach to the same receptors in the brain as cannabis products, many of the same long-term issues with cognition that occur with use of cannabis may also occur as a result of using synthetic cannabinoids, although the potential risk is increased because these drugs are unpredictable and often more potent. For adolescents, the risk is even more salient because their brains are still developing. Issues with attention, the ability for new memories, judgment, and motivation often occur.
Research has indicated that the use of cannabis products can interfere with the development of white matter in the brains of adolescents; white matter is the signaling part of the neuron in the brain and spinal cord. Because drugs like Spice attach to the same receptors in the brain and have even more intense effects, it is almost certain that the use of synthetic cannabinoids in young people produces similar effects to natural cannabinoids. Decreases or damage to the white matter in the brain can result in cognitive problems for young people as they mature, including issues with learning, motivation, attention, and movement. It can even foster the development of emotional issues.
Predictability of the short-term and long-term effects of Spice use is very poor because, as mentioned, there can be quite a bit of variability in the actual ingredients in packages of substances labeled as Spice, K2, etc. Some users may experience extremely toxic effects from one batch, whereas others may not even experience significant feelings of euphoria and relaxation from a different batch. Nonetheless, the potential long-term effects associated with the use of synthetic cannabinoids far outweigh the benefits associated with their use. In addition, because the majority of users of these drugs are younger individuals, it is important that educational programs regarding the use of these drugs be standard protocol in schools in order to prevent their use.
Any person who has regularly used Spice or other synthetic cannabinoids should stop their use as soon as possible due to severe potential health risks. Because of the development of physical dependence on these drugs, and difficulty with discontinuing any drug when an individual has developed a substance use disorder, these individuals should become enrolled in a formal substance use disorder treatment program that utilizes physicians, therapists, and other treatment providers to help them remain abstinent from these drugs and develop a solid program of recovery.