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Fantegrossi WE, McCain KR, Moran JH, Hoffman RS.
“Not simply synthetic tetrahydrocannabinol”.
J Pediatr. 2013 Oct 16.
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Abstract
“K2” and “bath salts” continue to cause harm among users and represent difficult cases for health care providers. Despite educational efforts, the unfamiliar chemical nomenclature and ever-changing composition of these drugs continue to cause confusion. The retrospective analysis by Wood1 of US poison center exposures from 2009 to 2012 unfortunately contributes to this confusion in 2 major ways.
First, “bath salts” and “K2” are merely marketing names, and without analytical testing it is impossible to determine active constituents of these drug products. “Bath salts” may contain cathinone analogues but may also include synthetic cannabinoids, hallucinogenic-like drugs, or any number of other compounds.2 Likewise, scores of distinct agents have been identified in “K2” products.2 Because poison center data are largely self-reported or second-hand, there is inherent weakness and methodological bias with regard to the largely analytically unconfirmed exposures found in National Poison Control Data System data, which limits the accurate characterization of specific drug exposure.3
Second, it is inaccurate to label synthetic cannabinoids as “synthetic tetrahydrocannabinol (THC).” Dronabinol (synthetic THC) has been approved for medicinal use in the US since 1985. In contrast, emerging synthetic cannabinoids in abuse-ready preparations have never been approved for human use and, compared with THC, display much higher potency, affinity for and efficacy at cannabinoid receptors.4 In fact, most of these compounds are not even chemical analogs of THC. Further, the acute and chronic biological effects of these powerful synthetics are largely unknown, although clinical reports of their toxicity are accumulating.5 Although understandable, the tendency to conflate these dangerous agents with US Food and Drug Administration-approved synthetic THC contributes to continued difficulties in understanding and controlling the phenomenon of synthetic drug abuse and leads to an underestimation of the hazards associated with their use. These drugs are not simply safe “marijuana alternatives,” and language that casts them in this light should be avoided.
References
1
K.E. Wood
Exposure to bath salts and synthetic tetrahydrocannabinol from 2009 to 2012 in the United States
J Pediatr, 163 (2013), pp. 213–216
2
W. Żukiewicz-Sobczak, J. Zwoliński, J. Chmielewska-Badora, E. Krasowska, J. Piątek, P. Sobczak et al.
Analysis of psychoactive and intoxicating substances in legal highs
Ann Agric Environ Med, 19 (2012), pp. 309–314
3
R.S. Hoffman
Understanding the limitations of retrospective analyses of poison center data
Clin Toxicol (Phila), 45 (2007), pp. 943–945
4
K.A. Seely, J. Lapoint, J.H. Moran, L. Fattore
Spice drugs are more than harmless herbal blends: a review of the pharmacology and toxicology of synthetic cannabinoids
Prog Neuropsychopharmacol Biol Psychiatry, 39 (2012), pp. 234–243
5
E.W. Gunderson, H.M. Haughey, N. Ait-Daoud, A.S. Joshi, C.L. Hart
“Spice” and “K2” herbal highs: a case series and systematic review of the clinical effects and biopsychosocial implications of synthetic cannabinoid use in humans
Am J Addict, 21 (2012), pp. 320–326
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