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K2, Spice and How Drugs Won the Drug War

A few nights ago I was working the Emergency Department when the ambulance brought in two teenagers. Both had smoked "Spice" - a chemical purchased at a local store. One was clearly high, dissociated, and hallucinating, but he was medically stable. The older boy was in much worse shape. His heart rate was greater than 140 at rest, his blood pressure was elevated and he was unable to sit still. His hallucinations were apparently unpleasant and he required one-to-one staffing just to keep him from pulling his IVs out. 

Many of my coworkers hadn't heard about Spice or bath salts, but we've actually had quite a few teenagers in the ED with this over the past year or so. Spice and similar products use analogs of JWH-018 -- the chemical components of marijuana and other illegal drugs. 

It is just one example of the new and profitable front of legal highs being exploited by chemists who are staying one -- or several -- steps ahead of the law. Marketed in stores as bath salts, potpourri or incense, these drugs are often labeled "not for human consumption" as a way to avoid any regulation.  

As WIRED magazine reported: 
During the last several years, the market for legal highs has exploded in North America and Europe ...
Active ingredients in the drugs are compounds originally synthesized by institutional researchers whose esoteric scientific publications were mined by as-yet-unidentified chemists and neuroscientists working in Asia, where most of the new drugs appear to come from.
One class of popular cannabinoid mimics, for example, was developed by respected Clemson University organic chemist John Huffman, who sought to isolate marijuana’s chemical properties for use in cancer research. Other “legal high” ingredients have similar pedigrees, with designers including researchers at Israel’s Hebrew University and the pharmaceutical giant Pfizer.
Researchers say these are much more potent that pot. (I can't remember the last time I had an ED patient in for simple marijuana consumption. ) 

What I have seen with these patients is mirrored in the literature -- often extreme tachycardia, hypertension, hallucinations, sweating. I've also treated a girl who came in with what is called couchlock” or the inability to move.  Numbness, blackouts, headaches, anxiety are also often reported. This kid the other night was actually very similar to those presenting with Meth Induced Psychosis
“The results are toxic and very dangerous, especially for vulnerable people — people with previous psychotic episodes — and the young,” said Liana Fattore, a chemist at Italy’s Institute of Neuroscience told WIRED. 
Fattore studies the latest wave of THC and cannabis analogs. It is a wave of products that are successfully staying ahead of legal controls. In 2010, laws were passed banning the synthetic stimulants, but when researchers looked at the products on the market today, 95 percent did not fall under the ban. Overseas chemists had altered the substance at the molecular level to be different enough to skirt the law, but still perform the same psychopharmaceutical role. 

“If you want any evidence that drugs have won the drug war, you just need to read the scientific studies on legal highs,” wrote Vaughan Bell at neuroscience blog MindHacks.
If you’re not keeping track of the ‘legal high’ scene it’s important to remember that the first examples, synthetic cannabinoids sold as ‘Spice’ and ‘K2′ incense, were only detected in 2009. Shortly after amphetamine-a-like stimulant drugs, largely based on variations on pipradrol and the cathinones appeared, and now ketamine-like drugs such as methoxetamine have become widespread. Since 1997, 150 new psychoactive substances were reported. Almost a third of those appeared in 2010.
From a "get this junk off the streets" standpoint, the problem is almost insurmountable. Lawmakers would have to understand enough chemistry to ban classes of chemical compounds. Moreover, there is little agreement on what kinds of compounds and analogs would be included.  Finally, there are decades of research and scores of chemical compounds know to create stimulant and psychoactive substances out there to be put on the market the instant another ban is put in place. 

The problem is that we have a market that wants a legal high and a world full of knowledge to serve that market without scruples. 

"The drug war isn’t only being lost," Bell concludes "it’s being made obsolete."

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