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TeresahRN
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Drug-Related Emergency
Department Visits Involving
Synthetic Cannabinoids
Synthetic cannabinoids are substances that are designed to affect the
body in a manner similar to marijuana but that are not derived from
the marijuana plant.1 Because they can be purchased with no age
restrictions, their popularity among young people has grown.2
Synthetic cannabinoids are known by a variety of names, such
as “Spice” or “K2,” and sometimes are referred to as “synthetic
marijuana” or “fake marijuana” because they are marketed with claims
that their effects mimic those of marijuana. Synthetic cannabinoids
are typically sprayed onto herbal products, many of which are listed as
inactive on the product packaging.2
Although certain synthetic cannabinoids and/or specific chemicals
contained in these preparations were made illegal in some States,
a comprehensive national ban was not enacted until July 2012.3
Therefore, products containing synthetic cannabinoids were frequently
marketed as “legal” and “not for human consumption” and could be
purchased online and in legal retail outlets such as convenience stores.1
Because products marketed as synthetic cannabinoids contain
different ingredients from each other, it is difficult to identify which
physical effects are caused by synthetic cannabinoids.4 They have been
reported to cause agitation, anxiety, nausea, vomiting, tachycardia,
elevated blood pressure, tremor, seizures, hallucinations, paranoid
behavior, and nonresponsiveness.2,5 These products are relatively new,
and related clinical and public health outcomes have not been fully
examined. Synthetic cannabinoids are not currently identified using
routine screening tests, and the creation of new products of this type
makes it difficult to detect these chemicals or regulate these products.
The Drug Abuse Warning Network (DAWN) first detected a
measurable number of emergency department (ED) visits involving
synthetic cannabinoids in 2010, and this report presents data related
to these visits.6 DAWN is a public health surveillance system that
monitors drug-related ED visits in the United States. To be a DAWN
Drug-Related Emergency
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TeresahRN
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case, an ED visit must have involved a drug, either as
the direct cause of the visit or as a contributing factor.
Of the approximately 2,300,000 ED visits that involved
drug misuse or abuse in 2010, synthetic cannabinoids
were specifically linked to an estimated 11,406 visits. This
issue of The DAWN Report examines ED visits involving
synthetic cannabinoid products in 2010 among patients
aged 12 to 29. The report focuses on this age group
because ED visits involving synthetic cannabinoids are
concentrated in this age range (8,557 visits, or 75 percent
of all visits involving synthetic cannabinoids, were made
by patients aged 12 to 29 in 2010).
Gender and Age
For patients aged 12 to 29, males made more than three
quarters (78 percent) of ED visits involving synthetic
cannabinoids in 2010 (Figure 1). The rates of visits per
100,000 population for patients aged 12 to 17, 18 to 20,
and 21 to 24 were similar (14.9, 13.9, and 11.8 visits per
100,000 population, respectively) (Table 1). However,
the rate for those aged 25 to 29 (4.1 visits per 100,000
population) was lower than those for patients aged 12 to
17 (14.9 visits per 100,000 population) and those aged
18 to 20 (13.9 visits per 100,000 population
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TeresahRN
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Drug Combinations
In the majority (59 percent) of ED visits involving
synthetic cannabinoids for patients aged 12 to 29,
no other substances were involved (Figure 2). This
differs from ED visits involving other illicit drugs
or nonmedical use of pharmaceuticals, in which the
majority of visits involved multiple drugs.7 Synthetic
cannabinoids were used in combination with one
other substance in 36 percent of visits related to
their use, but were rarely used in combination with
two or more substances (6 percent). The types of
drugs most frequently used in combination with
synthetic cannabinoids were marijuana (17 percent),
pharmaceuticals (17 percent), and alcohol (13 percent).
Disposition of ED Visits
Among ED visits involving synthetic cannabinoids
made by patients aged 12 to 29 in 2010, it appears that
the majority (76 percent) did not receive follow-up care
(admission to the hospital, transfer to another health
care facility, or referral to a detoxification/treatment
program). Most of the 2,077 visits resulting in followup
care involved synthetic cannabinoids in combination
with other substances (75 percent).
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TeresahRN
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Because synthetic cannabinoids have been marketed as
a legal alternative to marijuana, this section will provide
a brief comparison of the patient characteristics of ED
visits between marijuana and synthetic cannabinoids.
Marijuana-related ED visits outnumber synthetic
cannabinoid-related visits (461,028 vs. 11,406 visits).
The average patient age for marijuana-related visits
was 30 years and the average patient age for synthetic
cannabinoid-related visits was 24 years. The age
distribution also differed between the two drugs.
Synthetic cannabinoid-related visits were concentrated
in the younger age groups: 75 percent of the visits
involved patients aged 12 to 29, with 33 percent of the
patients aged 12 to 17. In comparison, 58 percent of
marijuana-related visits involved patients aged 12 to 29,
with 12 percent in the 12 to 17 age group (Figure 3).
When patients in the 12 to 29 age range were
compared, synthetic cannabinoid-related ED visits
were more likely to involve male patients than were
marijuana-related visits (78 vs. 66 percent) (Figure 4).
Further, synthetic cannabinoids were more likely to be
the only drug implicated in the visit, whereas marijuana
was more frequently combined with other drugs (59 vs.
31 percent, respectively; data not shown).
Discussion
As synthetic cannabinoids have become more
available, the number of ED visits involving synthetic
cannabinoids has increased. The higher proportion of
ED visits in younger age groups, especially in patients
aged 12 to 17, combined with results from a national
survey of high school seniors revealing that 11 percent
reported using “synthetic marijuana” in 2011, is cause
for concern.8 Because it is difficult to regulate these
products that are easily available online, synthetic
cannabinoids may be more accessible to young people
than marijuana.9 Educators can help prevent use of
synthetic cannabinoids by addressing use of these
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TeresahRN
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substances in programs designed to prevent use of illicit
drugs. Parents can also discuss the dangers of these
drugs with their children and use parental controls for
online purchases.
Because of limited availability of tests for synthetic
cannabinoids, data collection efforts in the ED may
have missed visits in which they were involved.
However, even in the absence of positive drug
test results, health care providers can remain alert
to symptoms that may be attributed to synthetic
cannabinoids and, when appropriate, inquire about
their use.4 Further monitoring will be necessary to
determine whether synthetic cannabinoid-related
health problems continue to be reported. This
monitoring can help improve awareness among
health care professionals of the possible adverse health
effects of these substances. Because most synthetic
cannabinoid-related ED visits result in discharge
from the ED, a patient’s time in the ED is a valuable
opportunity for intervention and education.
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