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February 5, 2013

Are potential harms of "synthetic marijuana" another good argument for legalizing real pot?

The question in the title of this post was my first reaction to this new CNN story headlined "Teen narrowly escapes death after smoking synthetic marijuana." Here are the excerpts from the very lengthy piece which lead me, quite sincerely, to wonder how the significant potential harms of spice and other forms of fake pot ought to inform the on-going national debates about marijuana law reforms:

Hospital staff removed Emily Bauer's breathing tube and stopped all medication and nourishment at 1:15 p.m. December 16. Only morphine flowed into her body, as the family waited by her side in her final moments.

But the next morning, she was still alive.... Emily was back.

Her family said the drug that landed the Cypress, Texas, teenager, then 16, in the ICU two weeks earlier wasn't bought from a dealer or offered to her at a party. It was a form of synthetic weed packaged as "potpourri" that she and friends bought at a gas station.

At first, her stepfather, Tommy Bryant, said he was "fixing to whip somebody's ass," as he thought someone older than 18 bought it for her. Bryant already knew she used real marijuana occasionally. "It's not that I condoned it," he said, adding that he couldn't follow her around all day. Bryant enforces a strict no-smoking rule in the house, and said that if he ever caught Emily smoking, she'd be grounded.

"Had I thought that there was any chance that she could have been hurt by this stuff, I would have been a lot more vigilant. I had no idea it was so bad," Bryant said. "I'd never have thought we'd be in this situation. If she had bought it off the street or from a corner, that's one thing, but she bought it from convenience store."

Best known by the street names "Spice" or "K2," fake weed is an herbal mixture sprayed with chemicals that's meant to create a high similar to smoking marijuana, according to the National Institute on Drug Abuse. Advertised as a "legal" alternative to weed, it's often sold as incense or potpourri and in most states, it's anything but legal.

Synthetic marijuana was linked to 11,406 drug-related emergency department visits in 2010, according to a first-of-its-kind report by the Substance Abuse and Mental Health Services Administration. This is when it first started showing up on health providers' radar, as the Drug Abuse Warning Nework detected a measurable number of emergency visits.

Who wound up in the emergency room the most? Children ages 12 to 17. The first state laws banning synthetic drugs popped up in 2010. Now at least 41 states -- including Texas, where Emily lives -- and Puerto Rico have banned them, according to the National Conference of State Legislatures.

Older legislation targeted specific versions of the drug, but the makers of Spice were a step ahead. "These drug manufacturers slightly change the chemical compound, and it becomes a different substance that's not covered by the law," said NCSL policy specialist Alison Lawrence. "That's why in 2011 and 2012, we saw the states enacting these broader language bans."...

Emily, a straight-A and B sophomore, developed persistent migraines about two weeks before she wound up in the ICU early on December 8, said Bryant. One bad migraine even sent her to the ER.... While her family doesn't know how long she'd been using the drug, her stepfather suspected she started around two weeks before the night that sent her to the hospital.

Common side effects to smoking synthetic marijuana include bloodshot eyes, disturbed perceptions and a change in mood, said Dr. Melinda Campopiano, a medical officer with the Substance Abuse and Mental Health Services Administration. "People can become very agitated or can be come unresponsive -- conscious but not reacting normal to situations," she said. They may also appear paranoid or describe hallucinations. Some of the more potentially serious effects include an elevated heart rate and elevated blood pressure.

Campopiano said she had never heard of a patient having a stroke in these circumstances, but she described how high blood pressure could lead to one. "Generally, strokes are caused by restricted circulation, or a blood clot that blocks circulation. What we would be looking at with Spice, or K2, is the restrictive circulation model," she said....

Emily complained of a migraine and took a nap at her house after allegedly smoking Spice with friends on December 7, said Bryant. She woke up a different person. Stumbling and slurring her words, she morphed into a psychotic state of hallucinations and violent outbursts, her family said.

They called 911 after they realized she had "done something," some drug, said her stepfather. The Harris County Sheriff's Office confirmed they visited the house but declined to provide details. When paramedics arrived, they restrained her and rushed her to a Houston-area hospital, where she was admitted to the ICU....

She bit guardrails and attempted to bite those trying to help her. Hospital staff strapped Emily down in the bed, said her sister. "We thought once she comes down off the drug, we'd take her home and show her the dangers of this drug," said the 22-year-old. "We didn't think it was as big of a deal until 24 hours later she was still violent and hurting herself. We realized you're not supposed to stay high this long."

To keep Emily safe, doctors put her in an induced coma. After days in the sedated state, an MRI revealed she had suffered several severe strokes, said Bryant. "In four days' time, we went from thinking everything is going to be OK and we'll put her in drug rehabilitation to now you don't know if she's going to make it," he said....

Knowing how different people will react to fake weed is impossible. There are a few reasons that explain why. "You're hearing some pretty bad things with the synthetic cannabinoids -- part of that has to do with the potency. It can be 100 times more potent than marijuana," said U.S. Drug Enforcement Administration spokeswoman Barbara Carreno....

Carreno explained there's no consistency or quality control from one time to the next. The people making these products can be anyone from a college kid wanting to make extra cash to an operation blending large quantities in a cement mixer, she said. Two batches made by the same person could have different doses....

One in every nine high school seniors admits to having used fake weed in 2011, according to a national survey by the University of Michigan. Synthetic marijuana is the second-most popular illicit drug they use, behind marijuana.

In July 2012, President Barack Obama signed legislation banning five common chemicals used to make synthetic marijuana and bath salts. And that same month, the DEA seized almost 5 million packets of fake weed in its first national sweep of the drug....

Bryant and his family are starting a nonprofit organization called Synthetic Awareness For Emily. Their goal with SAFE is to educate families, as well as teachers and doctors, about the dangers and warning signs of synthetic marijuana use. Bryant said he has filed the paper work and is waiting to hear from the federal government on reviewing their nonprofit application.

"That's why we want to let kids and parents know about the warnings signs: migraines and withdrawal," he said. "We all know the warning signs of alcohol and cocaine, but with this synthetic weed stuff, it's so new that nobody knows about this stuff. We want to let other parents know about this so they don't have to go what we've been going through."

February 5, 2013 at 11:01 PM | Permalink

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"Are potential harms of 'synthetic marijuana' another good argument for legalizing real pot?"

Hmmmmmmmmm, well let's see. Are the potential harms of "synthetic marijuana" another good argument for criminalizing synthetic pot?

Or, to put it another way, does the shoe fit as well on the other foot?

Posted by: Bill Otis | Feb 6, 2013 12:23:35 AM

If one of the harms of synthetic pot is simply that it is uncontrolled and unregulated, why not legalize it as well? That way, it can be taxed and regulated to ensure quality and safety.

Posted by: Guy | Feb 6, 2013 9:31:01 AM

This sounds like a job for the tort lawyers. Maybe the manufacturers are hard to find/fly-by-night/semi-judgment proof. But the convenience stores aren't. Seems like they need to take some responsibility for what they are selling. One big judgment might be all it takes to get this off of a lot of shelves.

Posted by: anon | Feb 6, 2013 10:10:42 AM

"Are potential harms of 'synthetic marijuana' another good argument for legalizing real pot?"

Give me what I want or I'm going to hold my breath (hurt myself with other substances) until I pass out and you give me what I want.

Posted by: chris | Feb 6, 2013 11:19:32 AM

I'm still waiting to hear a good argument for keeping marijuana illegal.

Posted by: C.A.J. | Feb 6, 2013 11:37:43 AM

The comments by Guy and anon highlight the idea I hope to raise by this post. Notably, we do not see "synthetic" tobacco cigarettes or moonshine being sold in 7-11 because kids who want access to the "real thing" can (and always will) be able to sneak access to these products. But when they do, the product has the quality controls and the limits on marketing that comes as part of a legal, but highly regulated, vice product.

In contrast, kids cannot sneak access to legal marijuana at a convenience store, and thus there is the significant grey market (likely being aided by lots of legitimate businesses) in this (probably more harmful) "synthetic" stuff. And, not surprisingly, efforts to expand prohibition to now cover this (probably more harmful) "synthetic" stuff cannot keep up with the efforts by manufacturers eager to make a buck by satisfying the teenage market for "some extra party fun."

I do not know which way the data comes out now or would likely come out in the future, but I do think making pot legal and highly regulated like alcohol and tobacco would be the most efficient and effective way to destroy the apparently very harmful and smarmy "synthetic pot" industry.

Posted by: Doug B. | Feb 6, 2013 11:40:41 AM

I understand and can sympathize with the pragmatic harm-reduction point Professor Berman is making, but I've got to say that "increasing de facto access to pot for minors" is probably NOT one of the talking points the legalize-and-regulate lobby is trying to play up. This particular set of synthetic products is apparently a fairly recent phenomenon (there were other not-technically-illegal-at-the-time substances you could get at head shops when I was in high school 30 years ago - no doubt these things go in cycles) and I would expect that it's a fad that will burn itself out in another few years - either legislative tinkering will make the laws loophole-proof-enough to drive this stuff out of convenience stores (eliminating a key facet of its current market advantage) and/or horror stories like this one, if actually typical rather than atypical (which is, you know, an empirical question I'm not inclined to trust media stories like this one on), will eventually have an impact on the demand side.

According to the longitudinal data at monitoringthefuture.org (which I understand is pretty good data as these things go), the percentage of 12th graders who've ingested "any illicit drug other than marijuana" in the previous year is currently at 17% and has bounced around over the last 20 years in a range between approx 15% and 21% (obviously with some variation of the relative popularity of different substances within that subset). I don't think it's particularly obvious how legalizing pot (for, nominally, adults only, bracketing the question of whether that would nominally mean 18 or 21) while leaving the other drug laws unchanged would affect that number or its substance-specific components. Legalization may be a worthwhile policy change without regard to that, of course, but I can't imagine the various reasons kids currently consume other-than-pot substances are all or even primarily driven, directly or indirectly, by the current legal status of pot.

Posted by: JWB | Feb 6, 2013 4:15:02 PM

You raise good points, JWB, but the latest report from MTF (which I agree is a great/respected resource on these fronts) has this to say on the topic:

"MTF first addressed the use of synthetic marijuana in its 2011 survey, by asking 12th graders about their use in the prior 12 months (which would have covered a
considerable period of time prior to the drugs being scheduled). Annual prevalence was found to be 11.4%, making synthetic marijuana the second most widely used class of illicit drug after marijuana among 12th graders. Despite the DEA’s intervention, use
among 12th graders remained unchanged in 2012 at 11.3%, which suggests that either compliance with the new scheduling has been limited or that those who produce these products have succeeded in continuing to change their chemical formulas to avoid using the ingredients that have been scheduled. In 2012 for the first time 8th and 10th graders were asked about their use of synthetic marijuana; annual prevalence rates
were 4.4% and 8.8%, respectively. Among 8th graders, this is the third highest category of illicit drug being used after marijuana and inhalants."

In other words, fake pot apparently is a big deal for teens, even though there is very little awareness among those of us decades away from that personal era.

I think it notable and telling that, as much as I am aware, there is no obvious legal or illicit industry/marketing of "synthetic cocaine" or "synthetic heroin" or really any other synthetic legal or illegal drug. Marijuana is, in my view, a sui generis drug for lots of reasons (use patterns, social history, traditional consumption settings), and I do think there is likely to be an on-going connection between forms/uses of fake pot and real pot.

Posted by: Doug B. | Feb 6, 2013 4:50:29 PM

"Synthetic heroin" = fentanyl. It's used non-medically often enough that it has its own weight-based guidelines ranges and everything. You can't get it at convenience stores, but you can divert it from the legal-but-regulated market.

Posted by: JWB | Feb 6, 2013 5:43:30 PM

People, we need to get the word out this can happen to anyone even your kids or family. Spread the word educate yourself and do what you can to help fight this drug. All our prayers are you you Emily.

Posted by: Synthetic High | Feb 8, 2013 1:43:05 PM

This is a super sad story. Unfortunately, it's happening more and more often. People are having heart attacks, seizures and even worse.

I'm happy that you are getting this info out to people. Education is the best way to keep our kids away from spice.

Posted by: Spice Addiction Support | Jun 30, 2013 11:53:13 PM

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