Spice and K2 are two popular trade names for synthetic cannabinoids. Synthetic cannabinoids are man-made, unregulated chemicals that are meant to mimic THC, the active ingredient of marijuana.1,2 They are added to dried plant material to be smoked or vaporized and inhaled (vaped) by users seeking their psychoactive effects.1,2
Synthetic cannabinoids are often sold as “herbal incense,” “liquid incense,” or “potpourri” and are often manufactured in China. There are many other trade names besides Spice and K2, and other names include: Blaze, RedX Dawn, Paradise, Demon, Black Magic, Spike, Mr. Nice Guy, Ninja, Zohai, Dream, Genie, Sence, Smoke, Skunk, Serenity, Yucatan, Fire, and Crazy Clown.2
Although synthetic cannabinoids are sometimes marketed as safe, legal, synthetic alternatives to marijuana, their varied chemical structures—a result of no oversight or regulation—results in wide variation across doses and individuals and may result in users manifesting life-threatening symptoms.3
Many of the chemicals used in these products are illegal, however, manufacturers constantly tweak the chemical formulas and manage to skirt federal drug laws as well as state and local laws that attempt to curb the sale and use of synthetic cannabinoids.2,4
Synthetic cannabinoids are primarily used by teenagers and young adults. According to the 2019 Monitoring the Future Study, 2.6% of 8th graders and 3.3% of 12th graders used synthetic marijuana in the past year.5
Synthetic cannabinoids pose many dangers to users, who mistakenly assume they are a safe alternative given that they are readily available to purchase on the internet and even in gas stations, liquor stores, or other establishments.1-4
In 2015, the American Association of Poison Control Centers saw the highest number of calls related to synthetic cannabinoids with 7,792 calls registered.6 That number has declined in recent years with only 1,157 calls in 2019.6
Effects and Health Risks of Synthetic Cannabinoids
Although there are a few scientific studies that have examined at the effects of synthetic cannabinoid use, what we do know is that many of these chemicals bind more strongly than marijuana does to the same cell receptors that THC binds to.2 The result is that synthetic cannabinoids produce much stronger effects than marijuana.2 Desirable effects may include:2
- Elevated mood.
- Altered perception and awareness.
- Delusional or disordered thinking that’s detached from reality.
These marijuana-like effects often coincide with less desirable adverse side effects, which may vary widely depending on the chemical formulation.1,3 These effects often differ from those experienced when using marijuana, and are typically more severe and longer acting, and may prompt users to seek medical attention.3 These effects may include:1-3
- Rapid heart rate.
- Elevated blood pressure.
- Extreme anxiety and agitation.
- Confusion and paranoia.
- Violent behavior.
- Suicidal thoughts.
Severe and life-threatening adverse effects have been documented, including kidney failure, heart attack, stroke, cardiac arrest, and coma.1-3
In one survey of 80,000 drug users, those who used synthetic cannabinoids were 30 times more likely to end up in an emergency unit than users of traditional cannabis.7 A study of nearly 3,000 calls to poison control centers in the beginning of 2015 that were related to overdosing of synthetic cannabinoids revealed the most frequently experienced reactions were agitation and cardiovascular effects including rapid heartbeat, as well as vomiting, drowsiness and confusion.8 A total of 15 deaths were also reported in the study.8
Spice Addiction and Treatment
Daily use of synthetic cannabinoids has been associated with the development of a pronounced withdrawal syndrome. Those who use synthetic cannabinoids frequently have reported withdrawal symptoms to occur as soon as 15 minutes after smoking.9
Abrupt cessation of daily synthetic cannabinoid use has been associated with severe symptoms including reoccurring seizures, shortness of breath, and chest pain and palpatations.9
Mild to moderate withdrawal symptoms associated with discontinuation of daily or heavy use of synthetic cannabinoids includes:1,3,9
- Insomnia and sleep disruption.
- Irritability and severe anxiety.
- Nausea and vomiting.
- Loss of appetite.
Given the profound withdrawal syndrome, synthetic cannabinoids are considered to have abuse and addiction potential.1,2 Those who regularly use synthetic cannabinoids may have difficulty quitting or curtailing their use, and may meet the criteria for having a substance use disorder.
Treatment for individuals who abuse synthetic cannabinoids may start with inpatient detoxication, depending on the intensity of intoxication or the severity and type of withdrawal symptoms. In a New Zealand study where 47 people presented with problems withdrawing from synthetic cannabinoids, 20 (43%) were admitted for inpatient medically managed detoxification.10
Severe synthetic cannabinoid withdrawal may require medication such as benzodiazepines and antipsychotic medications.9,10 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.2,9,10
When compared to natural cannabis users, the use of synthetic cannabinoids is associated with increased mental health problems.11 This suggests a need for more intensive substance use disorder treatment that includes behavioral therapy which continues once the individual has completed the withdrawal management process.
Individual and group therapy sessions can help to address issues associated with the development of the substance use disorder. Those in treatment will also learn positive skills for stress management and coping, as well as develop a long-term plan of relapse prevention.
Treatment should also address any co-occurring mental health conditions, such as depression, anxiety, etc. Individuals who are diagnosed with co-occurring disorders (a substance use disorder and another mental health disorder) benefit most when both disorders treated at the same time.
Group therapy and mutual-help groups like Narcotics Anonymous can also help individuals in recovery to develop a positive social support network and help prevent relapse following the completion of treatment.
- U.S. Drug Enforcement Agency. (2020). Drugs of Abuse: A DEA Resource Guide: 2020 Edition.
- National Institute on Drug Abuse. (2018). DrugFacts: Synthetic Cannabinoids (K2/Spice).
- Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
- Centers for Disease Control and Prevention. (2017). About Synthetic Cannabinoids.
- National Institute on Drug Abuse. (2019). Drugs of Abuse: Synthetic Cannabinoids (K2/Spice).
- American Association of Poison Control Centers. (2020). Synthetic Cannabinoids.
- Murray, R. M., Quigley, H., Quattrone, D., Englund, A., & Di Forti, M. (2016). Traditional marijuana, high-potency cannabis and synthetic cannabinoids: increasing risk for psychosis. World Psychiatry, 15(3), 195–204.
- Law, R., Schier, J., Martin, C., Chang, A., Wolkin, A., & Centers for Disease Control (CDC) (2015). Notes from the Field: Increase in Reported Adverse Health Effects Related to Synthetic Cannabinoid Use – United States, January-May 2015. MMWR, 64(22), 618–619.
- Cooper Z. D. (2016). Adverse Effects of Synthetic Cannabinoids: Management of Acute Toxicity and Withdrawal. Current Psychiatry Reports, 18(5), 52.
- Macfarlane, V., & Christie, G. (2015). Synthetic cannabinoid withdrawal: A new demand on detoxification services. Drug and Alcohol Review, 34(2), 147–153.
- Mensen, V. T., Vreeker, A., Nordgren, J., Atkinson, A., de la Torre, R., Farré, M., Ramaekers, J. G., & Brunt, T. M. (2019). Psychopathological symptoms associated with synthetic cannabinoid use: A comparison with natural cannabis. Psychopharmacology, 236(9), 2677–2685.