In an earlier post, we discussed the dramatic increase in the use of medical marijuana in Colorado.  Although marijuana may have some medical uses, the rapid surge in the number of people obtaining this drug via prescriptions suggested that recreational users might be taking advantage of the medical system. 

Recreational marijuana use is common, and a recent survey sponsored by the National Institute on Drug Abuse (NIDA) revealed that use among school-aged individuals is increasing. Results from this survey indicate that over 12% of 8th graders, about 28% of 10th graders, and over a third of 12th graders used marijuana during the previous year.  About 7%, 17%, and 22% of these groups, respectively, used marijuana in the previous month.  Many, including over 6% of 12th graders, used marijuana daily. 

This survey also asked 12th graders about their use of agents such as Spice and K2, which contain synthetic substances that have been designed to stimulate the brain's cannabinoid receptors.  These are the receptors in the brain that interact with the psychoactive ingredients in marijuana. It is striking that more than 11% of 12th graders indicated that they had used Spice or K2 during the previous year. 

Why is this trend regarding synthetic cannabinoid-like substances disturbing?  First, the NIDA survey indicates that marijuana use and abuse is common among middle school and high school students.  Second, little is known about synthetic marijuana-like substances, creating a great deal of uncertainty about the risks associated with their use.  While these drugs were developed with the hope that they may have clinical benefits in persons suffering from specific medical conditions, most have not undergone rigorous testing in humans.  Since the brain's cannabinoid system helps regulate important bodily functions including energy, appetite, mood, and pain, these drugs might have clinical potential for a variety of conditions.  Of course, each drug of interest would need to be carefully tested, first in animals and then in humans.  Safety and efficacy would need to be demonstrated. 

Although the synthetic cannabinoid-like substances in Spice and K2 have yet to undergo extensive clinical tests, they are being added to various herbal incense products that are sold over the Internet and in certain retail shops.  There is no quality control for these herbal products since they are not officially marketed for human consumption.  The type, amount, and quality of the synthetic marijuana-like drugs that are mixed with the herbs are unknown. Some of these synthetic drugs are much more powerful than the various types of "regular" marijuana that have been around for many decades. 

Regulatory agencies are having trouble keeping up with these herbal products.  Currently, some of the more common synthetic marijuana-like drugs that have been added to herbal incense products are illegal.  The problem is that there are hundreds of these drugs available, and it will be very difficult for drug enforcement agencies to regulate all of them.

What is the appeal of these products?  Why is their use spreading? Simply put, they are capable of producing strong marijuana-like effects, and many can be easily purchased over the Internet and at retail shops. In addition, since they are structurally very different from natural marijuana products, they are difficult to detect in routine urine testing for marijuana. 

The short-term and long-term health effects of these drugs are unknown. They have the potential to be very dangerous. There are recent case reports of persons requiring emergency room treatment or psychiatric hospitalization for side effects related to these herbal products.  It is likely that most psychiatric units and/or emergency rooms in major hospitals have treated people with severe reactions to these products. It will take years before a clear picture of the potential medical and psychiatric consequences of these products becomes clear.

Will the use of these synthetic drugs affect the use and legal status of marijuana?  If marijuana is legalized, will the appeal of these untested and powerful synthetic marijuana-like substances decrease?  Or will legalization of marijuana lead to increased use of the synthetic drugs?

Only time will tell.  One thing is certain - many young people are interested in exploring the mind-altering effects of various drugs. Although parental influence and social policies have helped reduce the use of certain drugs, many individuals still use recreational drugs, and human nature is such that it is likely that there will always be significant abuse of these substances and hence a significant market.  

This post was co-written by Eugene Rubin MD, PhD and Charles Zorumski MD

About the Authors

Charles F. Zorumski, MD

Charles F. Zorumski, MD, is Samuel B. Guze Professor and Head of Psychiatry at Washington University in St. Louis - School of Medicine.

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