26 Mar Ever-Changing Synthetic Marijuana Complicates ER Visits
Synthetic marijuana is the common name for a group of lab-created chemicals designed to roughly approximate the drug effects of THC, the main psychoactive ingredient in marijuana and other cannabis products. Doctors and public health officials know that use of one of these chemicals can potentially lead to a range of seriously negative or even life-threatening side effects. In a report published in January 2014 in the New England Journal of Medicine, researchers from the University of Colorado and the Rocky Mountain Poison Control Center detailed some of the problems that doctors and public health officials can face when attempting to identify the specific type of synthetic marijuana causing problems in any given individual.
The active ingredients in various forms of synthetic marijuana are known collectively as synthetic cannabinoids. As a rule, these ingredients have plain, non-descriptive official names such as HU-210 and JWH-018. Street names for the products that contain synthetic cannabinoids are commonly far more elaborate; they include Black Mamba, Spice, K2, Moon Rocks and Yucatan Fire. The main ingredients in synthetic marijuana products come in liquid form. In order to mimic actual marijuana as much as possible, the manufacturers of these products spray the active ingredients onto materials such as herbs, potpourri or other plant-based substances. HU-210 and the other synthetic cannabinoids produce their drug effects through the same brain pathways as THC. However, in many cases, they have an impact far beyond that associated with THC; in fact, some of these chemicals can exceed the potency of THC by an astounding 9,900 percent. A federal law passed in 2012 bans the sale and use of all synthetic cannabinoids known to exist at that time.
Synthetic marijuana use is associated with a number of side effects that range in seriousness from mild to severe and potentially fatal. Examples of these effects include heart rate increases, heightened mental and physical agitation, lightheadedness, high sweat output, an inability to think clearly, sharply boosted blood pressure levels, loss of the ability to respond to external stimulation (i.e., catatonia), heart attacks and strokes.
Difficulty of Identifying the Responsible Substances
Since synthetic marijuana products don’t come from legal or verifiable sources, it can be quite difficult to determine which product contains a given synthetic cannabinoid. In addition, products called by the same name may or may not contain the same active ingredients from batch to batch. This means that scientific researchers can have a very hard time linking the use of a specific form of synthetic marijuana to a specific group of negative health outcomes. To complicate things even further, manufacturers of synthetic marijuana commonly try to skirt the letter of the law by introducing new compounds not mentioned in the 2012 federal legislation. This means that any given individual who experiences an adverse reaction to synthetic marijuana use may have problems stemming from a relatively or completely unstudied substance.
In the report published in the New England Journal of Medicine, the University of Colorado and Rocky Mountain Poison Control Center researchers examined the issues surrounding an outbreak of synthetic marijuana-related toxic reactions that occurred in the Denver area in August and September of 2013. All told, 263 individual cases of these reactions were logged by the Colorado Department of Public Health and Environment. Seventy-six of the affected individuals required rapid care at an emergency room. In addition, seven of those requiring emergency treatment eventually ended up in an intensive care unit. Fifty-five of the people who received emergency care had used no other drug besides synthetic marijuana.
Specific health problems found in the people involved in this spike of toxic reactions included seizures, a form of abnormally rapid heartbeat called tachycardia and a form of abnormally slow heartbeat called bradycardia. Typically, tachycardia and bradycardia occurred in succession in the same affected individual. The researchers concluded that these adverse reactions to synthetic marijuana use came from the poisonous effects that the synthetic cannabinoid in question has on normal heart function and normal nervous system function.
The situation in Denver highlights some of the key difficulties associated with tracking the underlying source of the harms caused by synthetic marijuana use. The products identified as the source of the toxic reactions were sold under the street name Black Mamba, a term already known to scientists and public health officials. However, chemical analysis showed that the products in question actually contained a synthetic cannabinoid called ADB-PINACA, a substance on which doctors, researchers and public health officials have very little information. Fortunately, coordinated efforts among these groups of professionals (and the police) made it possible to rapidly identify the substance responsible for this outbreak.
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