Prisoner Health Update: K2
by Eike Blohm, MD
Drugs are ubiquitous behind prison walls, but screening of items sent to prisoners and random drug testing incentivizes the use of substances difficult to detect and easy to conceal. Synthetic cannabinoids, known under numerous monikers such as K2 and Spice, fill that niche.
Originally synthesized by Dr. J.W. Huffman of Clemson University in search of pharmaceuticals that mimic the beneficial effects of THC (tetrahydrocannabinol, the psychoactive Phyto cannabinoid of marijuana), synthetic cannabinoid receptor agonists (SCRAs) gained popularity among soldiers who sought an “undetectable” high.
They soon spread to the general population and were sold in head shops and gas stations thinly disguised as “plant food” or “incense,” since labeling them “not for human consumption” moved them outside of FDA jurisdiction. After the first SCRA (JWH-018) was finally banned, its replacement (JWH-073) hit the market within a week. Producers have played a cat-and-mouse-game with regulators ever since by slightly chemically modifying the compounds.
Why are SCRAs so hard to detect on drug screens?
Common urine drug tests are immunoassays, meaning they use antibodies that recognize a certain chemical compound and trigger a chemical reaction (color change) when that compound is encountered. Often, the recognized target is not the drug itself but a metabolite. For example, the test for benzodiazepines looks for nordiazepam, a breakdown product of most benzodiazepines. These antibody tests take a while to develop, but the prevalent SCRA available to users changes so quickly and often that test developers simply cannot keep up.
Is there a way to detect SCRAs?
Absolutely, but it is expensive. Using a sophisticated test call gas chromatography / mass spectroscopy (GC/MS), SCRAs can be detected with the appropriate reference library. This means the GC/MS test must already know the spectroscopy pattern of a specific compound to recognize it. This is the case of all but the newest SCRAs.
What are adverse health effects of K2 use?
Although THC is often used to alleviate nausea, SCRAs often produce the opposite effect and cause profound emesis (vomiting). Forceful retching can produce tears in the esophagus, ranging from benign Mallory-Weiss Tears to fatal Boerhaave’s syndrome. In addition, stomach acid over time erodes tooth enamel leading to dental decay.
Rigid catatonia (when the body “freezes”) is also common, but the cause is not entirely understood. It may be that SCRAs block dopamine signaling in the part of the brain responsible for initiating movement, thus producing a Parkinsons-like state. It is unknown whether prolonged SCRA use can lead to movement disorders such as tardive dyskinesia.
Rarer complications from SCRA use can be more serious. Various heart arrhythmias have been reported. Some required implantation of a pacemaker. Spasm of the arteries that feed the myocardium (heart muscle) can cause freak heart attacks in individuals who are otherwise young and healthy.
Psychosis is common, but fortunately extreme and dangerous psychosis is rare. A well-known case of suspected SCRA psychosis – never confirmed – involved a naked man eating the face off another. That 18-minute Miami attack in May 2012 left Ronald Poppo, 65, blind in both eyes – one bitten out of his head – and ended only when cops arrived and fatally shot his attacker, Rudy Eugene, 31.
A controversial diagnosis called Excited Delirium Syndrome (ExDS) has also been linked to SCRA use; however, ExDS is not a diagnosis recognized by the World Health Organization, the American Psychiatric Association, the American Medical Association or the American Academy of Emergency Medicine. There is general agreement that alleged victims of ExDA often die from hyperpyrexia (out-of-control body temperatures) and restraint asphyxiation. But both may just as well be caused by responding police piling on the victim to subdue him.
Is withdrawal from SCRAs dangerous?
Unlike withdrawal from alcohol, detox from SCRAs is typically not life-threatening. The most common symptoms are irritability and lack of appetite, both of which last for up to one week. At this time, no medication-assisted therapy (such as methadone for opioid addiction) is available for SCRAs.
Disclaimer: This column aims to educate prisoners about common health concerns but does not constitute medical advice. It is no substitute for evaluation by a trained medical professional.
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