Spice a hundred times more potent than cannabis

Text: Frida Wennerholm, first published in Swedish the magazine Medicinsk Vetenskap no 2, 2015.

At the outset a specific brand, ‘Spice’ has now become a collective name for herbal smoking blends that contain synthetic cannabinoids. The spice problem was first noticed at the end of 2008, after patients showing symptoms of cannabis use tested negative for cannabis. People then started to realise that items being sold openly and marketed as legal ‘herbal blends’ on the internet were actually drugs.

The active substance in spice, which is categorised as an internet drug, is mass-produced in Asia before being sent to Europe in powder form where distributors create smoking mixes that are then sold on.

“The sellers often don’t realise how potent the substances are and how much there is in each smoking blend,” says Anders Helander, Adjunct Professor at Karolinska Institutet’s Department of Laboratory Medicine. “People who buy spice have to go online themselves to get information about the product and how much you can smoke without risking an overdose, but such information is unreliable.”

New varieties of drugs

In autumn 2014, there was a sharp increase in cases of poisoning when some unusually strong varieties of spice came onto the market.

“These substances were between 50 and 100 times stronger than THC, the active ingredient of natural cannabis, which means that anyone having a puff would be getting the equivalent of 50-100 puffs of marijuana. The result was lots of overdoses and cases of acute kidney failure, liver problems and respiratory arrest,” says Helander.

One problem is that new varieties of drugs are coming out all the time, so it is problematic to study the consequences or any lasting damage.

“That makes it difficult to say anything about long-term risks,” says Helander.

However, statistics produced by the Swedish National Board of Health and Welfare show that the number of young people aged between 15 and 24 who have been given in-patient care for mental health disorders caused by cannabis or a combination of drugs has doubled since 2005. This diagnosis was given to over 1,800 young people in 2013.

It has previously been shown that young people who use cannabis can have permanent problems with intelligence levels.

“The brain is not fully developed until the age of 25 and cannabis inhibits the neural connections that are supposed to develop while growing up,” says Helander. “Studies from Australia show that those who have used cannabis have a lower IQ. It is very likely that this is also the case for synthetic cannabinoids. They do have the same biological effects and some of them are also a lot stronger.”

A better overview

To date there have only been a few individual cases in which spice has been identified as the direct cause of death. Most drug-related deaths are put down to mixed poisoning, i.e. the user had used a combination of drugs.

Most cases of poisoning involve men, but the proportion of women is steadily increasing from every fifth case a few years ago to almost a third today. Most users are between 15 and 30, but last year saw positive tests for an 11-year-old and a 71-year-old.

In order to get a better overview of the new internet drugs, for the last six years Anders Helander has been running STRIDA, a national collaborative project involving Karolinska Institutet, Karolinska University Laboratory and the Swedish Poisons Information Centre. Analysis of blood and urine samples from intoxicated patients is combined with clinical information so as to link symptoms with substances.

“This is a unique combination,” says Helander. We work with all the different internet drugs, and when we started we had about two poisoning cases requiring hospitalization a week in Sweden; now we have two a day. But STRIDA probably still only sees about half of all cases.”

The project uses a very sensitive analytical method – high resolution mass spectrometry. The results of the analysis are kept in a data file so that new drugs can also be identified in patient samples at a later date.

Internet forums and websites

The project has enabled the researchers to identify hundreds of new internet drugs in Sweden, with the result that the Poisons Information Centre is able to provide doctors and care staff with more accurate advice. In addition, the health and social care sector gets a greater insight into which internet drugs are circulating in the country.

“We also keep an eye on internet forums and websites. If a new substance turns up we need to get access to reference material so that we are ready with our analysis if poisoning cases start arriving at emergency departments,” says Helander.

Several other countries have shown an interest in STRIDA and are in the process of starting up similar projects of their own. The reason why spice is often first choice for internet drug purchasers is because the smoking blends are easy and cheap to get hold of; they can be quickly and discreetly sent to your home. The drugs don’t need to be injected either. Another important factor is that they are marketed as being legal.

“The authorities are always one step behind,” says Helander.