Synthetic cannabinoids are chemicals that are added to dried plant material so they can be smoked or inhaled (vaped) by users seeking their specific psychoactive effects. Some of the most common names for these drugs are Spice, K2, skunk, scooby snax, and moon rocks. Many of these substances are manufactured in China where there are very few stipulations regarding the ingredients used in them.

The United States Drug Enforcement Administration noted that synthetic cannabinoid use increased significantly between the first half of 2011 and 2013; however, their use is on the decline, as many states are legalizing marijuana use and stipulations regarding the sale of these substances are tightened. Nonetheless, these drugs still enjoy some level of popularity for individuals who cannot obtain marijuana, and they are more commonly utilized by younger individuals.

The Effects of Using Synthetic Cannabinoids

 

Spice users look for the sedating and relaxing effects of the drug as well as the feelings of euphoria it produces. The National Institute on Drug Abuse reports the effects of using synthetic cannabinoids like Spice as being:

  • Relaxation
  • Elevated mood (euphoria)
  • Alterations of perception (Perception refers to one’s subjective experience of sensory stimulation; thus, one’s awareness of environmental conditions is drastically altered under the influence of these drugs.)
  • Psychosis (hallucinations, delusions, and dissociative experiences, such as feeling detached from one’s body or that things are not real)
  • Tachycardia (unusually rapid heartbeat)
  • High blood pressure
  • Delirium (severe mental confusion)
  • Agitation (in many cases, an agitated delirium)
  • Paranoia
  • Physical dependence

The potential for the development of physical dependence on synthetic cannabinoids significantly complicates the issues that can occur when one develops a substance use disorder to Spice or other synthetic cannabinoid products.

Signs of a Substance Use Disorder to Spice

 

There are a number of specific signs and symptoms of a substance use disorder to synthetic cannabinoids, such as Spice.

  • The person often uses Spice in greater amounts or for longer periods of time than originally anticipated.
  • The person spends a significant amount of time trying to get Spice, using it, or recovering from its use.
  • The person experiences recurrent cravings for Spice.
  • The use of Spice results in problems for the person at work, in their personal relationships, at school, or other important areas of life.
  • The person gives up important activities that use to give them enjoyment or were considered essential as a result of their Spice use.
  • The person continues to use Spice despite experiencing significant issues with their relationships, work, health, or emotional wellbeing.
  • The person repeatedly uses Spice when it is dangerous to do so.
  • The person has taken increasingly larger amounts of the drug over time and no longer experiences the same effects they experienced from the original amounts they used (tolerance).
  • The individual develops marked withdrawal symptoms not using Spice.
  • Friends and family members begin to complain about the person’s use of Spice.

A substance use disorder may be present in the individual if they experienced two or more of the above symptoms, their use of Spice results in significant problems with their functioning or in significant distress, and any of the above symptoms could not be attributed to some other cause.

The development of physical dependence has been documented to occur as a result of the use of synthetic cannabinoids and consists of having both the symptoms of tolerance and withdrawal. Because of the potential for the development of physical dependence, it is important to discuss the withdrawal process associated with synthetic cannabinoids and how this impacts treatment for individuals who have a substance use disorder as a result of their Spice use.

Treatment for Spice Addiction

 

One of the first important considerations when treating any individual for a substance use disorder is the treatment of any issues with physical or psychological dependence that can occur with the specific drug in question. There is little research-based information regarding the exact withdrawal syndrome that can occur in individuals who have abused Spice, and there is no identified formal withdrawal syndrome or timeline at this time associated with a substance use disorder occurring as a result of Spice abuse.

The most complete description of the withdrawal syndrome that occurs in some individuals comes from a report in the International Journal of Neuropsychopharmacology that indicated that at that time (2014), only a few case studies had reliably documented the withdrawal process that occurs in some individuals who abuse Spice.

The symptoms over these case studies were relatively stable and consisted of:

  • Cravings for spice
  • Headache
  • Irregular heartbeat
  • Nausea
  • Vomiting
  • Diarrhea
  • Anxiety
  • Depression
  • Mood swings

The review concluded that when individuals experience withdrawal symptoms from Spice abuse, the symptoms are very similar to the withdrawal syndrome that occurs with a cannabis use disorder, except they may be more intense. The symptoms are not considered to be life-threatening, although some individuals may become very emotionally unstable and could be at risk for accidents, issues with poor judgment, or other potentially threatening behaviors as a result of the withdrawal process.

There is no identified withdrawal timeline associated with synthetic cannabinoid use disorders; however, the symptoms appear to occur rather quickly following discontinuation and peak anywhere between four days and one week. For some people, issues with mood and motivation may continue for up to 30 days.

Treatment for individuals who abuse synthetic cannabinoids should consider this potential for the development of both physical and psychological withdrawal symptoms. The first issue of treatment should be placing the individual in a situation where they can be observed closely, such as an inpatient setting or an intensive outpatient treatment setting. The treatment for abuse to synthetic cannabinoids should include:

  • The implementation of a formal withdrawal management protocol: There is no formal withdrawal management program associated with Spice abuse; however, the above cited literature suggests that in some cases benzodiazepines and antipsychotic medications, such as Seroquel, can be useful in assisting individuals who develop withdrawal symptoms related to Spice abuse. The use of benzodiazepines is useful in controlling issues with nausea, vomiting, delirium, confusion, etc., whereas the use of antipsychotic medications can aid in the treatment of agitation and psychotic-type behaviors, such as hallucinations, delusions, dissociative experiences, and paranoia. These medications are typically given in therapeutic doses that are adjusted for the individual initially and then are slowly tapered down as the individual adjusts and recovers.
  • Intensive therapy for substance use disorders is essential for individuals who are recovering from addiction related to synthetic cannabinoids. This intensive therapy should continue once the individual has completed the withdrawal management process and is released from an inpatient program. Individuals should continue treatment on an outpatient base and participate in individual and group therapy sessions in order to address the issues associated with the development of the substance use disorder, learn positive skills for stress management and coping, and develop a long-term plan of relapse prevention. In addition, the participation in therapy (especially group therapy) can result in the development of a positive social support network for the individual.
  • Individuals should participate in family therapy, if indicated; community treatment, such as community education support groups; and 12-Step groups. Peer support, or 12-Step, groups are particularly useful as ongoing and long-term support options, as these programs are essentially free to attend, ongoing, and offered in many different locations at different times of the day so they are quite accessible. These groups also allow the individual to develop a positive social support network that is conducive to recovery.
  • Treatment should address any co-occurring psychological conditions, such as depression, anxiety, personality disorders, etc. Individuals who are diagnosed with co-occurring disorders (a substance use disorder and another mental health disorder) need to have both disorders treated at the same time.
  • Any other important supportive services should be applied to the specific case, such as vocational rehabilitation, occupational therapy, physical therapy, tutoring, case management, etc.

It is extremely important to understand that the true recovery process only begins after one has completed a withdrawal management program. People who simply go through detox and do not engage in any long-term treatment are at an extremely high risk to relapse within a very short period of time. The relapse rates for individuals simply going through detox programs are above 90 percent, whereas they are significantly lower for individuals who participate in comprehensive treatment. Thus, it is extremely important for an individual suffering from Spice addiction to engage in a full program of recovery.