Brace for Surge in Synthetic Marijuana ED Visits, Docs Warn

Caroline Cassels

January 23, 2014

The United States should expect and prepare for more outbreaks of illness and possible deaths related to synthetic marijuana use, researchers warn.

Data from the Colorado Department of Public Health and Environment indicate that in the fall of 2013, there was an unusually large increase in emergency department (ED) visits related to synthetic marijuana use in the Denver metropolitan area.

"Outbreaks like this are likely to keep happening. We need better testing to identify these substances, open communication with public health officials when outbreaks occur, and we need to make sure physicians ask patients the right questions about their drug use," lead author Andrew Monte, MD, University of Colorado School of Medicine, in Aurora, said in a statement.

The article was published as a letter to the editor in the January 22 issue of the New England Journal of Medicine.

The investigators note that early reports of exposure to synthetic cannabinoids "described a benign course, with little need for emergency care."

However, in late August 2013, patients began to present to Denver EDs with severe symptoms after exposure to a novel synthetic cannabinoid locally known as "Black Mamba."

According to data from the Colorado Department of Public Health and Environment, between August 21 and September 19, 2013, there were 263 ED visits related to synthetic marijuana use in metropolitan Denver.

Symptoms included altered mental status and neuro- and cardiotoxicity. Approximately 10% of these patients were admitted to intensive care and placed on a ventilator.

The investigators note that although the effects of first-generation synthetic cannabinoids are "largely benign, newer products have been associated with seizures, ischemic stroke, and cardiac toxicity, possibly due to increased potency."

"These substances are not benign. You can buy designer drugs of abuse at convenience stores and on the Internet. People may not realize how dangerous these drugs can be ― up to 1000 times stronger binding to cannabis receptors when compared to traditional marijuana," said Dr. Monte.

The investigators note that synthetic marijuana products, often labeled as incense, potpourri, or herbal smoking blend, are readily available and sold under a variety of brand names, including Black Mamba, K2, and Spice.

Synthetic marijuana is a mixture of dried herbs and spices sprayed with chemicals that, when smoked, create a high that is designed to mimic tetrahydrocannabinol (THC), the active ingredient in marijuana. They further point out that package labels often warn that the products are not for human consumption.

The authors report no relevant financial relationships.

N Engl J Med. 2013;370:299-390. Full article

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