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Have you ever heard of K2, and Spice or Charge Plus and Hurricane Charlie? They are labels given to substances within two categories of the hundreds of synthetic drugs sold in the U.S. K2 and Spice are two of the many names used for synthetic cannabinoids sold as "herbal incense" or "potpourri." Charge Plus and Hurricane Charlie represent a sampling of the names given to synthetic cathinones sold as "bath salts" or "jewelry cleaner" according to the Office of National Drug Control Policy (ONDCP).

The ONDCP states these substances are sometimes labeled as "not fit for human consumption," so why should we be concerned? The labeling is clear. Unfortunately, the labeling serves only to allow manufacturers and distributors to escape Food and Drug Administration regulations, but does nothing to prevent them from marketing these drugs. Synthetic cannabinoids are often smoked or consumed as tea; synthetic cathinones are ingested, snorted, smoked or injected.

These substances may be attractive because many are legal and easily available through the Internet and community shops. These facts contribute to people believing synthetic substances are harmless and natural when this is far from true — they are manufactured chemicals. For example, synthetic cannabinoids consist of chemicals sprayed onto plant products.

Packaging fuels the misunderstanding of synthetic substances by using labelling such as "premium natural blend" or "herbal burnables." There has been much work done by the federal government and individual states toward banning these substances, but the constant creation of newer formulations makes them difficult to control.

Synthetic cannabinoids, according to the Center for Disease Control (2016), can be up to 100 times stronger than tetrahydrocannabinol (THC, the active component in marijuana) and are addictive. In July of this year, in response to an increase of visits to emergency departments due to reactions from synthetic cannabinoids, New York City officials issued an advisory on synthetic drugs of abuse. The CDC refers to synthetic cannabinoids as poison, explaining it is not like marijuana but is in fact "unpredictable." People brought into medical facilities for treatment following use of synthetic cannabinoids suffer from a range of effects including psychiatric, heart and kidney problems. The CDC describes some people becoming delirious, hallucinating or falling into a coma. It has also contributed to a few people dying.

Synthetic cathinones, according to the National Institute on Drug Abuse (NIDA), are similar to stimulants such as amphetamines and cocaine. Although they can cause an increase in energy, this comes at the cost of agitation, and elevations in pulse and heart rate. Other effects can include paranoia, panic attacks and hallucinations. NIDA states synthetic cathinones are addictive, sometimes causing intense cravings and symptoms of withdrawl. There are no known medications to treat this addiction and therapies such as cognitive-behavioral therapy, are recommended.

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The attraction of synthetic drugs is heightened by their low cost and the difficulty of detection through testing. Although lab testing for these substances does exist, it is challenged by frequent new formulations. The formulations are changed in an effort to escape notice. At times this makes it harder for emergency departments when the exact nature of the symptoms of poisoning cannot be detected.

The cartoons brightly decorating the foil packaging of these substances serves to attract preteens and adolescents. The labels include catchy phrases. Synthetic cannabinoids, in addition to K2 and Spice are also known as Joker, Black Mamba, Kush, Kronic, Geeked Up, Smacked, Scooby Snax, Green Giant, Red Giant, M. Bad Guy, Trippy, Ice Dragon, AK-47, Bliss and Kick.

Synthetic cathinones, in addition to Charge Plus and Hurricane Charlie are also known as, N-bomb, Ivory Wave, Ocean Snow, Flakka, Bloom, Cloud Nine, Lunar Wave, Vanilla Sky, White Lightning and Scarface. Neither list of names is all inclusive.

There are several more synthetic substances of abuse than the two discussed in this article. Their danger lies in the rapid manufacturing of new formulations making the full impact unknown, and their availability for legal purchase creating greater access to children. We do know the toxic symptoms are wide ranging and life threatening.

Just how easy is it to get them? Check out your local gas station or convenience store. You may find them there, available for purchase by any shopper of any age.

Carolyn Sacco, RN has worked as a nurse in psychiatry since 1985, in inpatient hospital, outpatient clinic, and home settings. Jeffrey Geller, MD. MPH is professor of psychiatry at the University of Massachusetts Medical School. He also treats in- and outpatients.


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