Marijuana is enjoying a golden age of cultural advocacy, to such an extent that its medical benefits are exaggerated while the obvious impact on health is trivialized.

The health implications are unclear because a number of illnesses from marijuana may have been attributed to cigarettes or other products, but the dangers of synthetic marijuana, sometimes labeled as incense, potpourri, or herbal smoking blend, is more clear.  The products are sold in gas stations and convenience stores, under a variety of brand names including Black Mamba, K2 and Spice. It is a mixture of dried herbs and spices sprayed with chemicals that, when smoked, create a high that is supposed to be similar to THC, the main active ingredient in marijuana. In reality, these agents can cause much more severe symptoms than organic marijuana. and the package labels often warn that it is not for human consumption. 

In the fall of 2013, the Colorado Department of Public Health and Environment learned of an unusually large increase in emergency department visits related to synthetic marijuana use in the Denver metro area. Between Aug. 21 and Sept. 19, 263 people visited area emergency rooms with similar symptoms including altered mental status, irregular heart beat and seizures. Approximately 10 percent were admitted to intensive care breathing with the assistance of a ventilator.


The U.S. should prepare for more outbreaks of illness and possible deaths from synthetic marijuana and other designer drugs, according to new research in the New England Journal of Medicine.

"These substances are not benign," said the paper's lead author Andrew Monte, MD, an assistant professor in emergency medicine and medical toxicology at
the University of Colorado Denver
 School of Medicine. "You can buy designer drugs of abuse at convenience stores and on the Internet. People may not realize how dangerous these drugs can be -- up to 1,000 times stronger binding to cannabis receptors when compared to traditional marijuana." In addition, synthetic marijuana has effects on serotonin and other stimulant receptors in the brain which can lead to delirium, seizures and strokes.

"Synthetic marijuana is illegal under DEA law, but companies that make it are a step ahead with new chemicals and packaging on standby all the time." said Monte. He says there has been a significant increase in the use of synthetic marijuana in the last 5 years.  Determining which substance made people in Colorado ill required significant resources from hospitals, Poison Control, Colorado Department of Public Health and Environment, law enforcement agencies and the Centers for Disease Control.

"Outbreaks like this are likely to keep happening," Monte said. "We need better testing to identify these substances, open communication with public health officials when outbreaks occur and we need to make sure physicians ask patients the right questions about their drug use."


Citation: Andrew A. Monte, M.D., Alvin C. Bronstein, M.D., Dazhe J. Cao, M.D., Kennon J. Heard, M.D., Ph.D., Jason A. Hoppe, D.O., Christopher O. Hoyte, M.D., Janetta L. Iwanicki, M.D., Eric J. Lavonas, M.D., 'An Outbreak of Exposure to a Novel Synthetic Cannabinoid', N Engl J Med 2014; 370:389-390January 23, 2014 DOI: 10.1056/NEJMc1313655