Selected Topics: Toxicology“Spice” Girls: Synthetic Cannabinoid Intoxication
Introduction
“Spice” refers to various products containing synthetic cannabinoids that seem to have become available to the public in the early to mid-2000s and represent the emergence of “designer cannabinoids” 1, 2. Beyond the novelty of use, appeal of these products seems to include a “legal high” and the inability of typical urine drugs-of-abuse screens to detect use (3). Currently, very little medical literature exists on the adverse effects and emergency department (ED) presentations associated with “spice” use 4, 5, 6, 7, 8. We report two young women who presented to the ED with adverse effects after recreationally using the same “spice” product that we subsequently confirmed to contain two synthetic cannabinoids.
Section snippets
Case Reports
Two previously healthy women, aged 20 and 22 years, called 911 after smoking “spice.” Both reported daily smoking of various “spice” products they were acquiring at local smoke shops. They both denied recent use of any other drugs, including marijuana, and were not taking any medications. They described enjoying the use of “spice” and for the first time had smoked a product, “Banana Cream Nuke,” a nearly empty packet of which they brought in with them (Figure 1). They reported sharing the
Discussion
Currently, there is very little literature detailing the clinical presentations of individuals who have used “spice” 4, 5, 6, 7, 8. It seems that anxiety was a prominent feature in both of the patients we describe, and tachycardia in one. In two series recently published as abstracts, one a poison-center-based study, anxiety and tachycardia were common. Additionally, paranoia and hallucinations were described in some patients 7, 8. One additional abstract that confirmed the presence of JWH-018
Conclusion
We describe 2 patients who presented to the ED with, predominantly, anxiety after recreationally using a “spice” product that we subsequently confirmed to contain two synthetic cannabinoids. We suspect that the appeal and popularity of “spice” products and synthetic cannabinoids will continue, particularly due to their current legality in the United States, the inability of current drugs-of-abuse screens to detect them, and the lack of significant harm in the current literature described with
Addendum
Subsequent to submission of the case report, on November 24, 2010 the United States Drug Enforcement Administration temporarily made five synthetic cannabinoids (JWH-018, JWH-073, JWH-200, CP-47,497, and cannabicyclohexanol) schedule I substances (unsafe, highly abused, no medical usage). Further review will determine if these substances will retain this scheduling permananently (http://www.justice.gov/dea/pubs/pressrel/pr112410p.html).
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