Synthetic cannabinoids (SC) are marketed on the black market in the UK and around the world under names such as Spice, Mamba, and K2. SCs were designed to mimic the effects of cannabis by targeting the same receptors in the brain as the plant. These synthetic substances are often sprayed onto organic materials such as herbs and smoked in joints that are mixed with tobacco, or simply smoked in a rudimentary bong. 

Users report feelings that are similar to cannabis but often much stronger. The harmful side effects of SCs are often extreme, with reports of nausea, palpitations, paranoia, intense anxiety, vomiting, confusion, poor coordination, and even seizures. The Office of National Statistics doesn’t collect data specifically on SCs, they include them with the New Psychoactive Substances (NPS) data. In 2021 there were 284 recorded deaths from NPS, an almost ten times increase compared to 2011, where there were 31.

Since the rise in SC use, multiple reports from around the UK, especially in town and city centres, mention people who appear to be frozen or to be walking around like zombies after taking synthetic cannabinoids. SCs are very addictive, with one user telling Wales Online, “It’s worse than heroin. Once you’re hooked on it, you’re f***ed basically.” Another user from Derby, who spoke anonymously said “I went back on the smack to get off spice as it was so addictive and so harmful, I felt like it was killing me”. The problem is aggravated by the relatively cheap price, with dealers selling SCs for as little as £5, making it attractive to those who live on the margins of society. 

The dangerous drug is easy to make. There have been multiple convictions of people producing smokable SCs, distributing them from kitchens and garden sheds. Synthetic cannabinoids can be sprayed onto paper, making them hard to detect and easy to transport, resulting in what prison officers have called an epidemic in prisons. The problem was quelled when prisons started testing for SCs via their drug testing regime in 2017, it is still however a big problem that places a huge strain on resources both inside the prison and on the ambulance and A&E services that have to deal with overdoses. There were so many ambulance call-outs to prisons before more thorough testing was introduced that staff and inmates alike dubbed emergency responders as mambalances. 

SCs are also a big problem on the streets and in the prisons of the USA, with reports claiming that prisons are swimming in spice. News reports often document people overdosing and even dying on the streets. The Centers for Disease Control and Prevention (CDC) reported that deaths from SCs tripled between 2014 and 2015. 

There may be light at the end of the tunnel, however, as a recent study shows that US states that adopted a ‘more permissive’ legal system, allowing medicinal and or recreational adult use, saw a reduction in use and the harm associated with the use of synthetic cannabinoids. 

The study, published in the Journal of Clinical Toxicology, states, “A total of 7600 exposures were reported during the study period. Overall, reported synthetic exposures declined over time. Most reported exposures (64.8%) required medical attention, and 61 deaths were documented. State implementation of medical cannabis law was associated with 13% fewer reported annual exposures. Adoption of permissive state cannabis policy was independently and significantly associated with 37% lower reported annual synthetic exposures, relative to restrictive policies”.

Interestingly the study produced data that shows medicinal cannabis being made legal in a state only had a minimal effect on the reduction of use and harm of SC when compared to a state that allowed full adult use alongside medicinal use.

“What our study adds is the finding that adoption of permissive cannabis law can be associated with significant reductions in synthetic cannabinoid exposures. While medical cannabis alone did not show a statistically significant impact on synthetic cannabinoid poisonings, the magnitude and direction of change were similar in both of our models consistent with a hypothesised dose-response relationship between a more permissive cannabis law overall and fewer reported synthetic cannabinoid poisonings. Because synthetic cannabinoid use has no legitimate medical benefit, and medical cannabis markets are not readily accessible to people who may be using synthetic cannabinoids as an alternative to natural cannabis for non-medical purposes, it is not surprising that medical cannabis availability alone showed weaker association with reported cannabinoid exposures.”

The researchers who worked on the study concluded, “The gradual reduction of prohibitions against plant-based cannabis offers an opportunity to study the use of cannabis and powerful synthetic analogues that may have been used as natural cannabis substitutes. Our study identified an association between more liberal policies (legalisation) for natural cannabis and declines in reported synthetic cannabinoid poisonings. This finding suggests a potential effect of policy change on substance use behaviours that may have long-term public health implications.”