Synthetic Legal Intoxicating Drugs
Over the past year, reports have increased regarding the use of K2 and bath salts. These substances are not what they appear to be. Marked by “not for human consumption” to avoid US Food and Drug Administration (FDA) regulation, they are psychoactive drugs that mimic the effects of street drugs, such as amphetamines and marijuana, except they may not be as detectable on routine drug screenings. Although the consumer is always unaware of what chemicals the package truly contains, the use of these drugs, termed synthetic legal intoxicating drugs (SLIDs) are continuing to rise in popularity.
K2, herbal incense products smoked as an alternative to marijuana, first appeared in Europe in 2004.1 Consumers initially believed that smoking herbal blends were a safe and legal alternative to smoking marijuana, as their high was natural.1 However, legal authorities suspected the herbal blends were not as “natural” as many believed and found that they were sprayed with a synthetic cannabinoid, which are not derived from the hemp plant but synthesized in laboratories.1 Most of the synthetic cannabinoids found in herbal incense products were produced for research purposes only, with no scientific data regarding their use on humans.1
It is not surprising, then, that many are increasingly seeking medical attention after using herbal incense products.1 In 2010, there were 2,906 calls to poison control centers across the United States, a number that rose to 6,959 calls in 2011. Serious complications, such as seizures and psychosis, are associated with the products’ use.1 Although there has been a ban on some of the more common synthetic cannabinoids, it may be futile as there are over 100 synthetic cannabinoids that have yet to even enter the market.1 When one is banned, another is created to take its place.
Similarly, bath salts are also not what they appear to be. Although they are also labeled “not for human consumption,” they contain several mind-altering substances that can be dangerous to humans but are becoming increasingly popular.1 Two of the most common ingredients are MDPV and mephedrone.1 MDPV is a dopamine and norepinephrine reuptake inhibitor that has no FDA-approved usage and acts as a powerful stimulant.1 Mephedrone, also a powerful stimulant, is closely related to cathinone, the active ingredient from the African khat plant. It’s structure is similar to amphetamine.1
The US government put a temporary ban on any substance containing MDPV, mephedrone, or methy-lone.1 However, like synthetic cannabinoids, it is difficult to regulate synthetic stimulants as there are many of the substances.1 As one is made illegal, another becomes available. However, bath salts have sent an increasing number of users to emergency rooms.1 In 2010, there were 303 calls to US poison control centers regarding bath salts, a number that rose to 4,720 by August 31, 2011.3 Some of the adverse effects reported were tachycardia, agitation, hallucinations, extreme paranoia, delusions, elevations in blood pressure, seizures, and psychotic symptoms.3
Medical professionals must be aware of how to treat patients in urgent care centers that are under the influence of synthetic cannabinoids or synthetic stimulants.1 Doctors should pay attention to patients acting in bizarre fashions, free of any psychiatric history, and consider the possibility of a SLID intoxication.1 Benzodiazepines, such as Ativan, are commonly used to treat agitation and seizures associated with SLID intoxication, and antipsychotics may be used to lower the seizure threshold.1 Routine laboratory tests should be completed, including a complete blood cell count, metabolic panel, and urine toxicology.1 Serial cardiac enzymes are given if a patient has chest pain.1
As SLIDs are becoming increasingly popular, it is important for the medical community to understand how to spot and treat patients in emergency care settings. It is also important for recovering patients to be educated on the harmful effects of SLIDs to deter them from using the substance again in the future.
 Jerry, J.; Streem, D.; and Collins, G. (2012). Synthetic legal intoxicating drugs: The emerging ‘incense’ and ‘bath salt’ phenomenon. Cleveland Clinic Journal of Medicine. Retrieved from http://www.ccjm.org/content/79/4/258.long
 Wehrman J. Fake marijuana spurs more than 4,500 calls to US poison centers. American Association of Poison Control Centers (AAPCC), May 12, 2011. http://www.aapcc.org/dnn/Portals/0/prrel/updatedk2-may112011.pdf.