Neither doctors nor patients really know what is in so-called synthetic cannabis, or K2, and often it involves multiple, far more potent drugs than they think, new research suggests.
In 2017, 72,000 people died of drug overdoses in the US, and the sharpest increase in these deaths was among those using fentanyl or similar drugs.
Meanwhile, the last year has seen a surge in ‘synthetic cannabinoids,’ which often aren’t cannabis-like at all.
In fact, new University of Maryland research reveals that the drug is often a dastardly blend of multiple substances, including potent fentanyl.
So when overdose patients arrive at the emergency room, they and the doctors may be equally uncertain drugs are causing their reactions.
Hospitals across the country have seen a sharp rise in emergency room visits for drug overdoses and a new study shows that two-thirds of these involve multiple substances
Fentanyl has drawn the greatest attention from public health officials because it has proven particularly deadly.
But much of the country has seen a wave of bizarre behavior and overdoses on a synthetic cannabinoids, too.
This group of drugs, including substances known as K2 and spice, encompasses a broad set of totally unregulated substances that affect the same cannabinoid receptors in the brain that marijuana does.
However their effects are often more powerful and dangerous than those of real, plant-based marijuana.
Rarely does synthetic cannabis cause death, but it commonly causes bizarre behavior, vomiting, seizures, hallucinations and extremely elevated heart rate and levels of anxiety.
Last week, a bad batch of K2 led to 72 overdoses in one day in Connecticut, and over the course of the last year, scores of cases of eye bleeding ractionsto the drug have been reported.
In an effort to understand these reactions, and perhaps how better to diagnose and treat them, toxicologists at the University of Maryland and the Office of National Drug Control Policy decided to test urine samples from local overdose patients.
They chose a broad swath of drug metabolites to test for, including 26 known synthetic cannabinoids, 59 designer drugs and 84 other street and prescription drugs.
Based on their observations of these patients in the ER, the Maryland doctors had thought most were overdosing on synthetic cannabinoids.
That wasn’t even close to the case.
‘We were thoroughly amazed that in a study where we thought everyone was having a synthetic cannabinoid-related problem, only one specimen tested positive for synthetic cannabinoids,’ said the study’s lead author, Dr Eric Wish of the University of Maryland.
They found few matches to the original 26 metabolites they tested for, and even after expanding their screens to account for signs of 46 different synthetic cannabinoids a year later, only a quarter of overdose patients tested positive for them.
Dr Wish told Daily Mail Online that the government is struggling to keep up with the compounds it needs to ban.
Each time testing efforts identify a new compound to prohibit, chemists in other countries just tweak their formulas so that it won’t match the outlawed substance.
But that doesn’t mean they bother testing what it will do to users.
‘Nowadays, people don’t know what they took. The only person in the world that would know is the chemist that created the molecule,’ Dr Wish said.
We have to tell people that ‘synthetic marijuana’ is a misnomer. The drugs contain unknown substances, and even the scientists can’t keep up with them
Dr Eric Wish, study author and director of University of Maryland’s Center for Substance Abuse Research
‘It’s like Russian Roulette when you buy these drugs on the street.’
In most cases, the patients believed that what they had taken was synthetic marijuana. Their doctors believed them and saw symptoms consistent with overdosing on these drugs.
But according to the drug new research, they were all often wrong.
Bizarrely, the most common drug metabolites the drug screens revealed were those for real marijuana. Among the three hospitals involved in the study, between a fifth and a third of the patients tested positive for weed.
Weed was common everywhere but the prevalence of other drugs in overdoses varied from hospital to hospital.
Fentanyl was most common in Baltimore, where 700 people died of opioid overdoses last year.
Nearly 30 percent of the samples tested at the university’s midtown Baltimore campus were positive for fentanyl.
Dr Wish says that this is an indicator that, in areas where fentanyl is common, like Baltimore, ER doctors should take the time to administer a quick dip stick test for the drug, to make sure a patient that might need Naloxone gets it.
More than half of overdose patients at the Baltimore location were positive for opioids other than fentanyl, including heroin, morphine and codeine, signalling that while the city’s opioid problem may be evolving, it certainly isn’t going away.
At its Washington, DC area campus, on the other hand, nearly half of overdoses involved PCP, a hallucinogenic also known as ‘angel dust.’
Not unlike synthetic cannabis, PCP is known to cause aggression and strange behavior.
PCP was at the height of its popularity in the 1980s and 1990s, but it remains an issue in the DC area and, between 2005 and 2011, emergency room visits for PCP overdoses shot up by 4000 percent, according to drugabuse.com.
Perhaps most worryingly, two-thirds of all of the overdose patients had two or more drugs – some of which the doctors couldn’t even identify – in their systems.
‘We have to tell people that “synthetic marijuana” is a misnomer,’ says Dr Wish.
‘The drugs contain unknown substances, and even the scientists can’t keep up with them’
The good news of the study, however, was that regardless of what the overdose victims had actually taken, doctors were able to effectively treat them based on their symptoms.