New case studies link smoking synthetic marijuana with stroke in healthy, young adults
Add stroke to the list of severe health hazards that may be associated with smoking synthetic marijuana, popularly known as spice or K2, a University of South Florida neurology team reports.
An advance online article in the journal Neurology details case studies by the USF neurologists of two healthy, young siblings who experienced acute ischemic strokes soon after smoking the street drug spice. Ischemic strokes occur when an artery to the brain is blocked.
Seizures, abnormal heart rhythms, heart attacks, psychosis, hallucinations and other serious adverse effects have been associated with smoking synthetic pot. Medical journals have also begun to report a growing number of strokes potentially related to the use of natural (non-synthetic) marijuana.
“Since the two patients were siblings, we wondered whether they might have any undiagnosed genetic conditions that predisposed them to strokes at a young age. We rigorously looked for those and didn’t come up with anything,” said senior author W. Scott Burgin, MD, professor of neurology at the USF Health Morsani College of Medicine and director of the Comprehensive Stroke Center at Tampa General Hospital.
“To the best of our knowledge, what appeared to be heart-derived strokes occurred in two people with otherwise healthy hearts. So more study is needed.”
USF vascular neurology fellow Melissa Freeman, MD, was lead author of the paper.
What Is Synthetic Marijuana And How Does It Compare To Traditional Marijuana?
Much like Frankenstein’s monster, synthetic marijuana was created in a lab and resulted in a perversion of its original subject: the effects of THC, the component of marijuana that provides the “high” sensation. Like marijuana, the drug is smoked, though unlike marijuana it comes in small packets usually labeled “not for human consumption” and has names like “Spice,” “Black Mamba,” “K2,” “Fake Marijuana,” “Sexy Monkey” and hundreds of others.
The chemicals in synthetic marijuana are also harder to detect than marijuana in drug tests, and the drug is the second most used illicit drug among high school seniors, behind marijuana itself according to the National Institute on Drug Abuse. While certain chemical compounds of synthetic marijuana were banned in Colorado in 2011, there are possibly hundreds more anonymous compounds that haven’t been identified yet and thus, aren’t illegal.
Just being known as “synthetic marijuana” has angered pot activists because, it’s effects are nothing like that of marijuana. Synthetic marijuana’s non-cannabis herbs sprayed with lab-created chemicals which are said to give users a stronger high than THC can lead to seizures, hallucinations and convulsions as well as profoundly negative psychological effects.
Even John W. Huffman, the scientist who is often credited with creating synthetic marijuana on a federal drug grant to study the effects of drugs on receptors in the brain on lab animals, has recommended that people don’t ingest the compounds.
“These things are dangerous - anybody who uses them is playing Russian roulette,” Huffman said to the Los Angeles Times in 2011.
Recently, the Drug Enforcement Administration’s Denver division, located in Centennial, has been working to establish synthetic marijuana’s link to three deaths in Colorado and a host of hospitalizations across the state. The DEA has said that it estimates the synthetic cannabinoids that are suspected of making Coloradans sick is at least 100 times more potent than naturally-occurring THC, but adds that they’re still waiting on the toxicology results.
Synthetic marijuana refers to a mixture of herbs, often resembling lawn clippings, that have been sprayed or soaked with a solution of designer chemicals intended to produce a high similar to cannabis when consumed. Spice can be much more potent than conventional marijuana because of the more complete way the psychoactive ingredient in the synthetic product binds to the brain’s cannabinoid receptors, Dr. Burgin said.
People who smoke spice expose their brains to unidentified chemicals untested on humans.
“You don’t know what you’re getting when you smoke synthetic marijuana,” Dr. Burgin said. “It’s like the Wild West of pharmaceuticals, and you may be playing dangerously with your brain and your health.”
Spice, Stroke, and Brain Damage
This is actually the second time a tragic story involving a teen and permanent damage from spice has made headlines. In February, 16-year-old Emily Bauer of Cyprus, Texas, suffered a series of strokes and was put into an induced coma after ingesting Spice at a party. CNN covered the case after Emily Bauer’s sister, Blake Harrison, wrote a desperate plea on CNN’s iReport detailing her sister’s story and pleading with news organization to alert parents to the potential tragic results of spice use among teens.
Even after months of treatment, Emily Bauer is still blind, partially paralyzed, and suffers from severe cognitive impairment. The family has launched a charitable organization, Synthetic Awareness for Emily (SAFE) to focus attention on the issue.
Spice and Kidney Damage
These cases aren’t isolated, though. Also in February, the CDC issued an alert describing 16 cases of kidney damage from synthetic marijuana. The first warning came from Wyoming, where three patients were hospitalized with sever kidney damage; others came from Oregon, New York, Rhode Island, Oklahoma and Kansas. The kidney damage from many of these cases was very severe, five to the point of requiring dialysis.
In December, 2012, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a report showing that synthetic marijuana was responsible for 11,400 emergency room visits in one year. The vast majority of those admitted were between the ages of 12 and 29. Worse, the data used in the report were from 2010, when Spice didn’t have anywhere near the popularity it has now.
Not identified in standard toxicology screens, spice has become the second only to natural marijuana as the most widely used illicit drug among high school seniors, according to a 2011 survey sponsored by the National Institute on Drug Abuse. In Florida, it is a third-degree felony to sell, manufacture, deliver or possess with the intent sell these synthetic drugs, so they are more difficult to buy at convenience stores or smoke shops, but still readily available online.
More physicians need to be more aware of the potentially toxic effects of recreational synthetic drugs, especially when seeing conditions like heart attack or stroke not as common in young patients, Dr. Burgin said. “Be willing to ask about pot and spice use, because it’s not something patients are inclined to volunteer and synthetic marijuana does not show up on routine drug tests.”
An editorial in Neurology accompanying the USF cases studies urges caution in interpreting “anecdotal reports,” noting that cases of marijuana-related stroke are still few given the illicit drug’s widespread use.
“In any event, if marijuana can cause ischemic stroke, and if anything pot can do spice can do better, neurologists will likely encounter increasing numbers of spice-associated strokes in the years ahead,” concluded John C. M. Brust, MD, professor of clinical neurology at Columbia University College of Physicians and Surgeons.
Why Is Spice So Dangerous?
Synthetic marijuana resembles its natural counterpart in the sense that it looks like a handful of green leaves and twigs – but that’s where the similarity ends. The leaves and twigs don’t come from Cannabis plants – they can be just about any herb (tea is often used) which has then been sprayed or soaked with a solution of synthetic chemicals. Spice hasn’t been associated with the extreme violence associated with the other news-making synthetic drug, Bath Salts, but by causing hallucinations and paranoia it can lead to dangerous behavior.
Citation:
Ischemic stroke after use of the synthetic marijuana “spice,” Melissa J. Freeman, MD; David Z. Rose, MD; Martin A. Myers, MD; Clifton L. Gooch, MD; Andrea C. Bozeman, MS, ARNP-C; and W. Scott Burgin, MD; Neurology; published online before print November 8, 2013, doi: 10.1212/01.wnl.0000437297.05570.a2
-USF Health-
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