Spice, Bath Salts: The new wave of Synthetic Drugs

The recent wave of synthetic drugs witnessed by many countries all over the world including the UAE is unprecedented and profoundly alarming. Marketed as legal highs, these drugs are very easy to obtain over the internet and from head shops. They elude detection by our available standard lab methods and require a highly sophisticated, expensive and time-consuming toxicology. The mixture of herbs and chemicals in each makes it very hard to link the clinical effects to a particular chemical in the mix. The recent surge in emergency room visits by patients who consumed these products and calls to poison center by clinicians who are at loss of what they are dealing with make this a very alarming situation.

Spice :or K2 is made of a mixture of herbs like “wild dagga” (a South African plant with marijuana like effects) sprayed with synthetic cannabinoid chemical compounds. These compounds were originally manufactured by pharmaceutical companies in search of products that would behave similarly to the active marijuana natural chemical THC, for possible use as medicines for analgesia, and for improving appetite in cancer or HIV patients.

Psychiatric effects of spice include anxiety, paranoia, agitation, psychosis, and suicide. Physical effects include increase heart rate and blood pressure, excessive sweating, seizures, electrolyte disturbance. Heavy prolonged use can lead to the development of tolerance and withdrawal symptoms, presenting as irritability, nightmares, tremors, nausea and craving.

The treatment of acute symptoms is better managed in a medical setting, mostly in emergency rooms, including supportive care and benzodiazepines.

There is no cross reactivity with the natural substance in marijuana (THC), and laboratory detection requires GC-MS.

Bath Salts :These compounds contain synthetic cathinones. Cathinone is the active chemical naturally present in khat, which is responsible for the mild stimulant like properties and mild euphoria associated with khat chewing.

Examples of the most common synthetic cathinones are mephedrone, 3,4-methylenedioxypyrovalerone (MDPV), and methylone. These compounds work similarly to amphetamines.

Users describe sense of energy and euphoria and increased sexual arousal and the need to continue to use to prolong the effects. Emergency reports describe bizarre behavior, sever aggression, self-mutilation, cannibalism and severe psychosis.

Physically symptoms include increased heart rate, and blood pressure, psychomotor agitation, hyperthermia, seizures and death.

Treatment is symptomatic with supportive care for hypertension, hyperthermia and seizure control with benzodiazepine.

Reports of addiction including tolerance, craving and withdrawal symptoms akin to stimulants withdrawal have also been reported.

Urine detection is not possible on routine kits, however cross reactivity with amphetamines is possible and false positive screen for methamphetamine may result. Testing kits for the most common ones are commercially available.

In summary, these new synthetic mimetics have been flooding the drug scene as legal highs particularly now with the availability of the internet stores. They have been able to elude and outpace the regulatory authorities. Toxicological techniques required to detect these drugs are very expensive and very time consuming.