View source for Synthetic cannabinoids

== Also known as ==

x, tai high hawaiian haze, spice, mary joy, exodus damnation, ecsess, devil's weed, clockwork orange, bombay blue extreme, blue cheese, black mamba, annihilation, amsterdam gold, K2, fake weed, bliss, bombay blue, genie, zohai, yucatan fire, skunk, moon rocks blaze, blueberry haze, dank, demon passion smoke, hawaiian hybrid, magma, ninja, nitro, ono budz, panama red ball, puff, sativah herbal smoke, ultra chronic, voodoo spice

== Classification ==

Hallucinogen 
[[Category:Hallucinogenics]]

== Overview ==

Synthetic cannabinoids are chemicals that have been developed to act like the main psychoactive chemical in cannabis, tetrahydrocannabinol ([[THC]]) which acts on cannabis receptors in the brain.

Since synthetic cannabinoids act like cannabis the effects - good and bad - are similar to cannabis. Some users will feel happy and relaxed, may get the giggles, feel hunger pangs and become very talkative. Others mainly feel ill or paranoid.

Because synthetic cannabinoids react more strongly with the brain's cannabis receptors so they're more potent than natural cannabis. This means it's easier to use too much and experience unpleasant and harmful effects. Synthetic annabinoids are usually sold in 'herbal' smoking mixtures. Sometimes these smoking mixtures have been found not to contain any synthetic cannabinoids at all!

There are lots of different types of synthetic cannabinoids. Some were previously illegal and some weren't, but since 26 May 2016 when the Psychoactive Substances Act came into effect, none of these drugs are legal to produce, supply or import for human consumption.

In their pure form, synthetic cannabinoids are either solids or oils. They are then added to dried herbs, vegetable matter or plant cuttings to make a smoking mixture (so that it looks more like real herbal cannabis).

The smoking mixtures are packaged in small, often colourful sachets with labels describing the contents as incense or herbal smoking mixture and usually stating 'not for human consumption'.

There are many different names given to herbal smoking mixtures, some of the most common are listed in the 'Also known as' section at the top of the section.

There are many different brand names for smoking mixtures, but it is not uncommon for different brands to contain the same synthetic cannabinoids <ref name="1a">'''Synthetic Cannabinoids''', 2016, http://www.talktofrank.com/drug/synthetic-cannabinoids</ref>.

Synthetic cannabis is a new psychoactive substance that was originally designed to mimic or produce similar effects to cannabis and has been sold online since 2004. However, some of the newer substances claiming to be synthetic cannabis do not actually mimic the effects of [[THC]] (delta-9 tetrahydrocannabinol, the active ingredient in cannabis).

Reports suggest it also produces additional negative effects. These powdered chemicals are mixed with solvents and added to herbs and sold in colourful, branded packets. The chemicals usually vary from batch to batch as manufacturers try to stay ahead of the law, so different packets can produce different effects even if the name and branding on the package looks the same <ref name="2a">'''Synthetic cannabis''', 2016, http://www.druginfo.adf.org.au/drug-facts/synthetic-cannabis</ref>.

Synthetic cannabinoids have been on the market since around 2008, but for a while their presence hadn't been detected. 'Herbal smoking mixtures' such as Spice or Aztec Gold were sold by head-shops and on-line sellers as an alternative to cannabis.

This, in turn was nothing new. Head-shops had, for years been selling 'smoking mixtures', usually a mixture of plant material with loosely psychoactive properties. Such mixtures had generally resulted in a headache, sore throat and a house that smelt like an autumnal bonfire. The newer compounds like Spice were different - they actually worked and so interest and use started to increase.

Analysis of samples of Spice revealed that, rather than being a blend of herbal smoking mixtures, the products were actually some inert plant material, which had been sprayed with a synthetic cannabinoid - a chemical which mimicked the action of [[THC]] or [[CBD]] at cannabinoid receptors in the brain <ref name="3a">'''Drug Facts : Synthetic Cannabinoids''', 2017, http://www.kfx.org.uk/drug_facts/drug_facts_syntheticcannabinoids.php</ref>.

== What does it look like? ==

In the pure state, these substances are either solids or oils. Smoking mixtures are usually sold in metal-foil sachets, typically containing 3g of dried vegetable matter to which one or more of the cannabinoids have been added. Presumably, a solution of the cannabinoids has been sprayed onto the herbal mixture. A number of plants are often listed on the packaging, but it appears that many are not present. However, large amounts of tocopherol (Vitamin E) have been detected, possibly to mask analysis of the active cannabinoids. The presence of several cannabinoids in some samples may also be intended to confound forensic-chemical detection <ref name="4a">'''Synthetic cannabinoids and 'Spice' drug profile''', 2015, http://www.emcdda.europa.eu/publications/drug-profiles/synthetic-cannabinoids</ref>.

K2 is typically sold in small, silvery plastic bags of dried leaves and marketed as incense that can be smoked. It is said to resemble potpourri <ref name="5a">'''K2 - Spice (synthetic marijuana)''', 2017, http://www.drugfree.org/drug-guide/k2-spice/</ref>.

Synthetic cannabinoids start off in their raw form as crystalline white powder though this is not the most common form at a street level. This is the form in which it is usually imported in to the UK.

This would be very potent and would in turn be mixed with tobacco or another smoking mixture for consumption. There are few reports of attempts being made to snort it or inject it.

More common is for the cannabinoids to be dissolved in a solvent, and sprayed onto an organic herbal material for sale. These will generally be greenish-brown in colour. Some resinous forms may also be available, looking more like cannabis resin.

Prior to the introduction of the Psychoactive Substances Act most of the packaged drugs were then sold in printed foil ziplock packages. There were hundreds of brands on sale prior to the ban.

It was sold in a liquid form suitable for use in E-cigarettes. There is not much evidence that this is widely available post ban.

Post-ban, product is still sold in printed bags. There is also a lot of stock being sold in un-labelled jiffy bags, as left-overs or newly-compounded stock is sold in unbranded forms.

Prisons have also reported [[SCRA]]s smuggled in sprayed on to paper, which can then be smoked <ref name="3a"/>.

Synthetic marijuana is a mixture of dried leaves from traditional herbal plants.

They are various colours including green, brown, blonde and red. They are sold in small packets approximately 2 by 3 inches. The packets are foil packs or plastic zip bags <ref name="6a">'''Effects of Synthetic Marijuana or 'Fake Weed' Unknown''', 2016, https://www.verywell.com/effects-of-synthetic-marijuana-or-legal-bud-unknown-69523</ref>.

== Source ==

Before the legislative changes raw powder was primarily imported from China. It was made in to batches in the UK and sold on-line, via headshops, resold on the streets and smuggled in to prisons.

Post-ban, it is unclear if [[SCRA]]s are still being imported in significant quantities. Some of the product currently being sold is probably old stock that pre-dates the ban. Anecdotally powder drugs are still being batched up in the UK so at present there is a mix of old stick and newly-compounded unlabeled stock <ref name="3a"/>.

== Prevalence ==

Little is known about the extent to which smoking mixtures containing synthetic cannabinoids have replaced cannabis.

However, a 2009 survey conducted among 1,463 students aged between 15 and 18 years at schools providing general and vocational training in Frankfurt found that around 6% of respondents reported having used 'Spice' at least once <ref name="4a"/>.

== Street price ==

Sachets of smoking mixtures (3g), sufficient for around eight joints, can be purchased for EUR 26 to 30 from Internet sites or specialist shops <ref name="4a"/>.

Pre-ban [[SCRA]]s typically sold for £10/g, £15 3/g.

Since the legal changes prices have gone up significantly with some street agencies saying there's been a 300% increase in costs.

Product in prison is much more expensive, retailing at £50/g or more <ref name="3a"/>.

== Why take it? ==

=== Sought after effects ===

* happy and relaxed (in moderate doses),
* synesthetic (one type of stimulation evokes the sensation of another sense) effects <ref name="7a">'''Synthetic cannabinoids (spice, K2)''', 2017, http://www.release.org.uk/drugs/synthetic-cannabinoids-salvia-spice-k2</ref>.

=== Undesired effects ===

* drowsiness,
* problems with coordination,
* [[paranoia]] and forgetfulness is possible but not known whether it exists for all these chemicals,
* dose/potency concerns <ref name="7a"/>.

== Pharmacology ==

The cannabinoid receptor agonists mimic the effects of [[THC]] and anandamide (the endogenous ligand for cannabinoid receptors in the central nervous system and other organs) by binding to the CB1 and CB2 receptors in the brain and nervous system.

Very little is currently known about the detailed pharmacology and toxicology of the active ingredients within synthetic cannabis products. Very few formal human studies have been published on only a proportion of the newly discovered synthetic cannabinoid-type chemicals.

Some of these cannabinoids may have considerably shorter or longer half-lives than the more recognised ones (such as [[THC]]) and/or may have differing effects on the neurotransmitter systems that they act so it is not clear how much lesser or greater effect they will have on the body.

Most synthetic compounds are lipophilic (soluble in fat, and so are distributed into the brain and fatty tissues). The active ingredients in most synthetic cannabis products appear to be metabolised in the liver and excreted in the urine and faeces <ref name="7a"/>.

[[THC]] is one of the naturally-occurring chemicals present in herbal cannabis and cannabis resin. It is involved in the euphoria associated with cannabis use, but may also be involved in less pleasant effects such as panic, paranoia and mental health problems. In 'traditional' strains of cannabis, [[THC]] is present alongside other cannabinoids including [[CBD]], which is believed to play an important role in the anxiety-reducing, relaxing effects of cannabis.

[[THC]] and [[CBD]] bind to and activate cannabinoid receptors in the brain - CB1 and CB2 receptors. Synthetic cannabinoids occupy the same receptors. However, they may be far more potent than 'natural' [[THC]] - with some synthetics believed to be 100 x the strength of [[THC]]. They may also have different affinities - binding more selectively to receptors in one part of the brain or body rather than others.

We don't know that much about how these newer compounds work. There is some concern that they may also affect other brain chemicals such as serotonin, which may contribute to observed symptoms such as overheating and [[hallucinations]] <ref name="3a"/>.

=== Lethal dosage ===

Unlike cannabis, there have been multiple deaths <ref name="8a">Brents, L. K. and Reichard, E. E. and Zimmerman, S. M. and Moran, J. H. and Fantegrossi, W. E. and Prather, P. L., '''Phase I hydroxylated metabolites of the K2 synthetic cannabinoid JWH-018 retain in vitro and in vivo cannabinoid 1 receptor affinity and activity''', ''PLoS One'', 2011, 6, 7, 21917, https://doi.org/10.1371/journal.pone.0021917, https://www.ncbi.nlm.nih.gov/pubmed/21755008</ref>, <ref name="9a">Coffman, K., '''Colorado probes three deaths possibly linked to synthetic marijuana''', 2013, http://www.reuters.com/article/us-usa-colorado-spice-idUSBRE98516A20130906</ref>, <ref name="10a">'''Synthetic cannabinoids in Europe''', 2016, http://www.emcdda.europa.eu/topics/pods/synthetic-cannabinoids</ref>, <ref name="11a">Westin, A. A. and Frost, J. and Brede, W. R. and Gundersen, P. O. and Einvik, S. and Aarset, H. and Slørdal, L., '''Sudden Cardiac Death Following Use of the Synthetic Cannabinoid MDMB-CHMICA''', ''Journal of Analytical Toxicology'', 2016, 40, 1, 86-87</ref>, <ref name="12a">Trecki, J. and Gerona, R. R. and Schwartz, M. D., '''Synthetic Cannabinoid–Related Illnesses and Deaths''', ''New England Journal of Medicine'', 2015, 373, 103-107, https://doi.org/10.1056/NEJMp1505328, http://www.nejm.org/doi/full/10.1056/NEJMp1505328</ref>, associated with the repeated abuse of synthetic cannabinoids as well as serious side-effects resulting from its long-term use <ref name="13a">Vardakou, I. and Pistos, C. and Spiliopoulou, C., '''Spice drugs as a new trend: mode of action, identification and legislation''', ''Toxicology letters'', 2010, 197, 3, 157-162, https://doi.org/10.1016/j.toxlet.2010.06.002, https://www.ncbi.nlm.nih.gov/pubmed/20566335</ref>, <ref name="14a">Auwärter, V. and Dresen, S. and Weinmann, W. and Muller, M. and Putz, M. and Ferreirós, N., ''''Spice' and other herbal blends: harmless incense or cannabinoid designer drugs?''', ''Journal of Mass Spectrometry'', 2009, 44, 5, 832-837, https://doi.org/10.1002/jms.1558, http://onlinelibrary.wiley.com/doi/10.1002/jms.1558/abstract</ref>, <ref name="15a">Kronstrand, R. and Roman, M. and Andersson, M. and Eklund, A., '''Toxicological Findings of Synthetic Cannabinoids in Recreational Users''', ''Journal of Analytical Toxicology'', 2013, 37, 8, 534-541, https://doi.org/10.1093/jat/bkt068, https://academic.oup.com/jat/article/37/8/534/777811/Toxicological-Findings-of-Synthetic-Cannabinoids</ref>.

=== Toxicity ===

Although there is no valid data on the toxicity of synthetic cannabinoids so far, there is concern that the naphthalene group found in THJ-018 and some other synthetic cannabinoids may be [[toxic]] or [[carcinogenic]] <ref name="16a">'''Naphthalene - CAS 91-20-3''', 2017, https://www.epa.gov/sites/production/files/2016-09/documents/naphthalene.pdf</ref>, <ref name="17a">Lin, C. Y. and Wheelock, A. M. and Morin, D. and Baldwin, R. M. and Lee, M. G. and Taff, A. and Plopper, C. and Buckpitt, A. and Rohde, A., '''Toxicity and metabolism of methylnaphthalenes: comparison with naphthalene and 1-nitronaphthalene''', ''Toxicology'', 2009, 280, 1-3, 16-27, https://doi.org/10.1016/j.tox.2009.03.002, https://www.ncbi.nlm.nih.gov/pubmed/19464565</ref>, <ref name="18a">'''Synthetic cannabinoids in herbal products''', 2011, https://www.unodc.org/documents/scientific/Synthetic_Cannabinoids.pdf</ref>, <ref name="19a">Morris, H., '''Napthalene is so over''', 2010, http://hamiltonmorris.blogspot.co.uk/2010/06/napthalene-is-so-over.html</ref>, <ref name="20a">'''Synthetic cannabinoid''', 2017, https://psychonautwiki.org/w/index.php?title=Synthetic_cannabinoid&_=</ref>.

== Mode of use ==

Synthetic cannabinoids are normally used in a similar way to cannabis -

* they can be mixed with tobacco, rolled up into a 'spliff' or 'joint', and then smoked, 
* they can be smoked without tobacco using of pipe or bong.
* as e-cigarettes have become more available, there are reports of some people using ecig technology for synthetic cannabinoids and that e-liquids containing synthetic cannabinoids have been produced which can be used with normal e-cigs.
* they can also be swallowed, eaten with food or made into a drink <ref name="1a"/>.

Like cannabis, the herbal mixtures containing cannabinoids are most often smoked. However, some user reports also suggest that 'Spice' can be ingested as an infusion <ref name="4a"/>.

It's most commonly smoked and is sometimes drunk as a tea <ref name="2a"/>.

K2 products are smoked in joints or pipes, but some users make it into a tea <ref name="5a"/>.

Most user reports indicate that synthetic cannabinoids are being smoked in the same way as spliffs - mixed in with tobacco and smoked. As very small quantities of synthetic material are required to achieve intoxication, smoking 'straight spliffs' of smoking mixture alone without tobacco is not recommended, though users with a high tolerance will often be doing so.

Synthetic cannabinoids and are also used in pipes and bongs. Given their relative potency and the small quantities needed to achieve intoxication, care is needed when using pipes or bongs to avoid unpleasant overdose experiences.

There have been reports of [[SCRA]]s being snorted, swallowed and injected. As the latest products seem to have poor solubility in water, it is unclear how effective such routes would be <ref name="3a"/>.

== Signs of usage ==

* restlessness,
* red or irritated eyes,
* pale complexion,
* confused behaviour <ref name="21a">Rudlin, K., '''Warning Signs of a Teen Abusing K2 or Spice''', 2016, https://www.verywell.com/warning-signs-of-a-teen-abusing-k2-2611202</ref>.

== Effects ==

Synthetic cannabinoids act like [[THC]], the active substance in natural cannabis, but are often more potent, so it's easier to use too much and experience unpleasant and harmful effects <ref name="1a"/>.

Typical effects include -

* Feelings of being happy, euphoric and relaxed with some people gettings the giggles, feeling hunger pangs and become very talkative, while others get more drowsy.
* Mood and perception can change and concentration and co-ordination may become difficult. Synthetic cannabinoids, possibly because of their potency, are more likely to be associated with [[hallucinations]] than natural cannabis.
* Some will have quite bad reactions, such as paranoia, panic attacks and forgetfulness <ref name="1a"/>.

=== Short-term effects ===

==== Physical effects ====

* increased agitation,
* pale skin,
* seizures,
* vomiting,
* profuse sweating,
* uncontrolled / spastic body movements,
* elevated blood pressure,
* heart rate and palpitations <ref name="5a"/>.

==== Cognitive effects ====

* dysphasia,
* severe [[paranoia]],
* delusions,
* [[hallucinations]] <ref name="5a"/>.

=== Physical effects ===

* muscle tremors and spasms,
* limb twitching,
* paralysis (rigid and flaccid),
* convulsions,
* elevated heart rate (160 bpm + for extended periods),
* nausea,
* respiratory distress,
* loss of basic functions,
* kidney problems,
* tolerance,
* high body temperature,
* sweating <ref name="3a"/>.

=== Cognitive effects ===

* anxiety,
* paranoia,
* panic,
* extreme fear reactions,
* detachment,
* derealisation,
* depersonalisation,
* auditory, visual, tactile hallucinations,
* delusions,
* short lived or persistent psychosis,
* fear-generated aggression,
* loss of insight,
* amnesia,
* impulsive behaviour <ref name="3a"/>.

=== Smoking effects ===

* headaches,
* increased heart rate,
* anxiety,
* dizziness,
* disorientation,
* elevated blood pressure,
* fatigue,
* vomiting,
* nausea,
* some reported cases of tremors or seizures,
* some reports of hallucinations at high doses <ref name="21a"/>. 

== Risks ==

The risks of synthetic cannabinoids are similar to natural cannabis, but because synthetic cannabinoids are more potent, it is easy to use too much and experience the unpleasant and harmful effects. This higher potency also means that the effects may last for longer.

Also, because many synthetic cannabinoids are new, they may have unknown effects too. We know that there have been a number of deaths that have been associated with the use of synthetic cannabinoids, either on their own or with other substances. There may also be risks from smoking the plant material itself - as occurs with tobacco and cannabis smoking <ref name="1a"/>.

Reported side-effects from using synthetic cannabinoids include -

* feelings of light-headedness, dizziness, confusion and tiredness,
* feeling excited, agitated and aggressive,
* mood swings,
* anxiety and paranoia,
* suicidal thoughts,
* memory problems and amnesia,
* nausea and vomiting,
* hot flushes,
* increased heart rate and blood pressure, which may cause chest pains and damage your heart and even cause a heart attack,
* excessive sweating,
* fingers, toes or muscles feel numb and tingly,
* tremors, seizures and fits <ref name="1a"/>.

Other risks for synthetic cannabinoids include -
 
* synthetic cannabinoids, are more likely to be associated with [[hallucinations]] than natural cannabis, possibly because of their potency.
* use of synthetic cannabinoids can cause psychotic episodes, which in extreme cases could last for weeks,
* regular use could cause a relapse of mental health illness or increase the risk of developing a mental illness especially if you have a family history of mental illness.
* research suggests that they may be an association between using synthetic cannabinoids and acute kidney injury.
* many synthetic cannabinoids have a chemical structure that is similar to serotonin, a natural chemical found in body, and it's been suggested that there's a risk that synthetic cannabinoids could overstimulate the serotonin system (called serotonin syndrome), which can result in high fever, rapid pulse, sweating, agitation, confusion, convulsions, organ failure, coma and even death,
* because of the way that smoking mixtures are made, there can be differences in the concentration of synthetic cannabinoids in individual packets and between different batches and you can never be 100% sure how powerful a dose you are going to take <ref name="1a"/>.

=== Short-term ===

The chemical composition and ingredients of herbal products like 'Spice' are changing all the time, and there are a wide range of possible synthetic cannabinoids that could be used, which is why you can never be sure what you're getting or how it will affect you <ref name="22a">'''Synthetic Cannabinoids''', 2017, http://knowthescore.info/drugs-a-z/synthetic-cannabinoids</ref>.

=== Long-term ===

Regular use of products containing stronger synthetic cannabinoids may increase the risk of later developing [[psychotic]] illnesses including schizophrenia.

Experts are concerned that 'Spice' products containing synthetic cannabinoids have the potential to be more harmful than cannabis due to the way they are made and because the compounds present and there potency will be unknown to the user <ref name="22a"/>.

== Purity ==

Any dried herbs, vegetable matter or plant cuttings can be mixed or sprayed with synthetic cannabinoids to make smoking mixtures. A number of different plants are often listed on the packaging of smoking mixtures, but these might not actually be present in the mixture.

It is also possible that the dried herbs, vegetable matter or plant cuttings themselves may produce an unwanted effect or be covered in a toxic substance, such as a pesticide or there may be residues of the solvents, such as acetone and methanol, used in the mixing/spraying process, remaining on the smoking mixture.

There have been a few studies carried out on the level of synthetic cannabinoids present in smoking mixtures which suggest that there can be differences in the concentration of synthetic cannabinoids in between different batches and packets. This could be because the mixing or spraying missed some of the smoking mixture or over-sprayed some of it.

The chemical composition of synthetic cannabinoids and the ingredients of smoking mixtures are changing all the time, so you can never be sure what you're getting, how powerful it is and how it could affect you <ref name="1a"/>.

Few quantitative studies have been carried out to determine the amount of synthetic cannabinoids present in smoking mixtures. Because of the difficulty in making a homogeneous mixture of dried vegetable matter and small quantities of synthetic additives, it is likely that there could be considerable inter-batch differences in the concentration of cannabinoids <ref name="4a"/>.

Some of the fake marijuana products sold commercially claim to contain herbs traditionally used for medicinal purposes, including beach bean (''canavalia maritima''), blue Egyptian water lily (''nymphaea caerulea''), dwarf skullcap (''scutellaria nana''), Indian warrior (''pedicularis densiflora''), Lion's tail (''leonotis leonurus''), Indian lotus (''nelumbo nucifera'') and honeyweed (''leonurus sibiricus'').

However, one study revealed that some of the herbal ingredients listed by the manufacturers could not be found in the products. As far as we know, some of these products may contain nothing but lawn clippings <ref name="6a"/>.

== Addiction ==

=== Can you get addicted ===

Research suggests that you can become dependent on synthetic cannabinoids, especially if you use them regularly. Whether or not you're dependent will be influenced by a number of factors, including how long you've been using it, how much you use and whether you are just more prone to become dependent.

If you have used synthetic cannabinoids regularly you could find it difficult to stop using and you might experience psychological and physical withdrawals when you do stop. The withdrawals can include cravings for synthetic cannabinoids, irritability, mood changes, loss of appetite, weight loss, difficulty sleeping and even sweating, shaking and diarrhoea <ref name="1a"/>.

When compared to cannabis, the chronic use of synthetic cannabinoids can be considered more moderately addictive with a high potential for abuse and is capable of causing psychological dependence among certain users. When addiction has developed, cravings and withdrawal effects may occur if a person suddenly stops their usage <ref name="23a">Zimmermann, U. S. and Winkelmann, P. R. and Pilhatsch, M. and Nees, J. A. and Spanagel, R. and Schulz, K., '''Withdrawal Phenomena and Dependence Syndrome After the Consumption of "Spice Gold"''', ''Deutsches Ärzteblatt International'', 2009, 106, 27, 484-487, https://dx.doi.org/10.32382Farztebl.2009.0464, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719097/</ref>, <ref name="20a"/>.

== Withdrawal ==

It has been reported that some people who use synthetic cannabis heavily on a regular basis may experience withdrawal symptoms when they try to stop, including -

* [[insomnia]],
* [[paranoia]],
* panic attacks,
* agitation and irritability,
* anxiety,
* mood swings,
* rapid heartbeat <ref name="24a">Barratt, M., '''Kronic appeal: Patterns of synthetic cannabinoid use in Australia''', 2012, http://www.ydhf.org.au/data/Barratt-Kronicstudy.pdf</ref>, <ref name="25a">Zawilska, J. and Wojcieszak, J., '''Spice/K2 drugs - more than innocent substitutes for marijuana''', ''International Journal of Neuropsychopharmacology'', 2014, 17, 3, 509-525, https://doi.org/10.1017/S1461145713001247, https://www.ncbi.nlm.nih.gov/pubmed/24169044</ref>, <ref name="26a">'''Drug Facts : Synthetic Cannabinoids''', 2017, http://www.kfx.org.uk/drug_facts/drug_facts_syntheticcannabinoids.php</ref>,
* significant craving,
* physical pain on stopping,
* serious stomach cramps,
* nausea,
* delusions and psychosis,
* neural pain,
* fluctuating body temperature,
* joint pain,
* sweating,
* headaches <ref name="3a"/>.

== Harm reduction advice ==

At present, without much more detailed information about specific synthetic cannabinoids it is not possible to suggest if any of the various substances on the market are more or less safe than others. Likewise, we can't speak with any certainty as to how safe or unsafe products may prove to be in the medium to long term

In lieu of more detailed information only the broadest of harm reduction messages can be offered, including the following -

* potency is hugely variable: start with a very small dose (match-head size or less) and only escalate dose cautiously, giving time for previous doses to wear off, 
* some people report blends containing a mix of different chemicals can have more unpleasant side-effects and should only be used with great caution, 
* be VERY cautious about using such compounds in bongs or pipes - it is harder to regulate intake and easy to take too much, 
* don't get into bouts of competitive use (e.g. in bucket bongs etc) as there is a high risk of overdosing, 
* if sourcing pure powder synthetic cannabinoids, only use very small doses, calculated using scales and thoroughly mixed in to smoking material, 
* don't use in conjunction with other drugs, especially other forms of cannabis, alcohol or stimulants, 
* there may be a risk of heart problems - you are best off avoiding these compounds if you have an existing heart problem or are using alongside stimulants, 
* as synthetic cannabinoids may exacerbate anxiety and paranoia only use in an environment in which you feel safe, with people who you trust. Avoid using if prone to anxiety or have existing mental health problems, 
* in the event of panic or anxiety, often treating as for panic attack will help resolve symptoms - sitting down, head down, regular breathing and reassurance. However more serious symptoms, including delusional behaviour or respiratory distress may require medical assistance, 
* if you experience a sustained period of fast heart rate, or experience chest pains call an ambulance, 
* use can cause a comedown, development of tolerance, dependence and withdrawal symptoms. If using these compounds, don't use constantly and take breaks from use, 
* don't drive or operate machinery when using these compounds <ref name="3a"/>.

Some people report being accidentally or deliberately exposed to [[SCRA]]s without intending to use them. This includes -

* buying herbal cannabis which is mixed with [[SCRA]]s,
* sharing spliffs, buying pre-rolled spliffs,
* smoking dog-ends,
* using e-cigs <ref name="3a"/>.

To reduce risks of this sort of exposure, try to purchase from reliable sources, and inspect all cannabis for unusual smells or consistency. Exercise care with sharing spliffs and cigarettes <ref name="3a"/>.

It is important to be aware that many of the synthetic cannabinoids are considerably stronger than those found naturally occurring in the cannabis plant. Some sellers advertise products up to 20 times more potent than [[THC]]. It is very difficult to assess the accuracy of these claims, and this means it is hard to judge portion sizes if you're used to traditional cannabis measures. It is important to bear in mind that your tolerance levels for cannabis will not necessarily directly translate to a synthetic product.

There appears to be some toxicity in certain synthetic cannabinoid groups, with illness and even death reported as a result of using some products; the compound JWH-122, for example, has been linked to a number of hospitalisations <ref name="7a"/>.

* try to find out as much information as you can about what's actually in the product using drug forums websites such as erowid or drugs forum, 
* dose carefully - start with small amounts until you know your limits,
* try to use with friends or people you trust, or at the very least make sure someone knows where you are when you're using, 
* make sure you (or someone you're with) has access to a phone and is able to call '''999''' if you start experiencing difficulties <ref name="7a"/>.
* there is no way of knowing what is in spice, or how strong the batch you buy will be. So every time you take it you are playing guinea pig, and have no idea what effect it will have on your body and mind,
* '''don't take''' spice if you have a history of mental illness. Anyone with mental health issues usually find using psychoactive drugs make their problems worse, 
* '''don't trust''' the labelling of a supposed 'legal' version of spice. Be aware that you don't know what is in your packet without forensic testing. It may still contain illegal synthetic cannabinoids, and if you are caught with it you could be facing a hefty jail sentence <ref name="27a">'''Spice''', 2015, http://www.themix.org.uk/drink-and-drugs/drugs-a-z/spice-10007.html</ref>.

Use of synthetic cannabis is likely to be more dangerous when -

* taken in combination with alcohol or other drugs, particularly stimulants such as crystal methamphetamine ('ice') or ecstasy,
* driving or operating heavy machinery,
* judgment or motor coordination is required,
* alone (in case medical assistance is required),
* the person has a mental health problem,
* the person has an existing heart problem <ref name="26a"/>.

=== Being careful what, and how much, you are taking ===

* it is difficult to predict the strength and effects of synthetic cannabis (even if it has been taken before) as its strength varies from batch to batch, 
* trying a very small dose first (less than the size of a match head) could help gauge the strength and possible effects. dose size should only be increased slowly - time should be given for the previous dose to wear off, 
* taking synthetic cannabis on its own without a 'mixer' such as tobacco or dried parsley should always be avoided. Similarly, inhaling the drug via bongs or pipes can increase the risk of an overdose or bad reaction <ref name="26a"/>. 

== Legality ==

* Although some synthetic cannabinoids have been legal in the past, many have been illegal for some time. A large number of synthetic cannabinoids and any mixtures that contain illegal drugs, including brands like Black Mamba and Annihilation, are Class B drugs and are illegal to have, give away or sell.  
* And it's important to realise that since 26 May 2016, when the Psychoactive Substances Act came into effect, none of these drugs are legal to produce, supply or import (even for personal use, e.g. over the internet) for human consumption. 
* The synthetic cannabinoids that were made illegal under the Misuse of Drugs Act, are still covered by that legislation. All other psychoactive substances not currently covered by the Misuse of Drugs Act now fall under the Psychoactive Substances Act <ref name="1a"/>.

=== What if you're caught? ===

* If the Police catch you with synthetic cannabinoids, they are likely to take some action. This could include a formal caution, arrest and prosecution.
* A conviction for a drug-related offence could have a serious impact. It can stop you visiting certain countries - for example the United States - and limit the types of jobs you can apply for <ref name="1a"/>.

=== Did you know? ===

* Like drinking and driving, it's illegal to drive if your driving has been impaired by taking drugs. With some drugs, you can even remain unfit to drive the next day. As well as this drug-impaired-driving offence, it's now illegal in England and Wales to drive over set levels for any of 17 named drugs (legal and illegal) in your body, whether or not you are impaired. Very low limits have been set for some common illegal drugs such as cannabis, cocaine and MDMA. You can get a heavy fine, be disqualified from driving or even go to prison. 
* Allowing other people to supply drugs in your house or any other premises is illegal. If the police catch people supplying illegal drugs in a club they can potentially prosecute the landlord, club owner or any person concerned in the management of the premises <ref name="1a"/>.

== Mixing with other drugs ==

Mixing synthetic cannabinoids with alcohol or other drugs can be especially dangerous. It can increase the risks of both drugs and can lead to an greater risk of accidents or death.
 
Also, because synthetic cannabinoids can overstimulate the serotonin system, it is important to avoid mixing them with antidepressants, such as Prozac, as they both stimulate serotonin activity in the brain, which can lead to serotonin syndrome, causing high fever, rapid pulse, sweating, agitation, confusion, convulsions, organ failure, coma and even death <ref name="1a"/>.

== Paraphernalia ==

* incense,
* eye drops,
* dried plants,
* dried herbs,
* pipe,
* rolling papers,
* suspicious packages arriving in the mail <ref name="21a"/>.

== History ==

The British company 'The Psyche Deli' (no longer trading) launched the 'Spice' brand in London in 2004. The term eventually became used generically for all similar products (much like 'Hoover' for vacuum cleaner), especially after the original company stopped trading c.2009, so many products will be advertised as 'the latest Spice' or 'new Spice product'.

The synthetic cannabinoids were first successfully replicated at Clemson University in South Carolina, USA in around 1984 by Professor John W. Huffman, who has since spoken publically about his regret over his role in the development of the commercial products. A number of products (notably JWH-018, his 18th experimental substance) have even borne his initials. A talk he gave to the Carolina Cannabinoid Cooperative was entitled 'JWH-018 - A Good Compound Gone Bad'. Hoffman has been vocal in condemning the products sold under the 'Spice' label, warning that their health implications have not been fully appreciated. He has been quoted as saying ''We had no idea that anyone would be stupid enough to use it […] If you want to get high, marijuana is easily available'' <ref name="7a"/>.

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== References ==

<references />
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