Spice (synthetic cannabinoids) Addiction

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The National Institute on Drug Abuse reports that synthetic cannabinoids are a number of mind-altering chemicals that are manmade. They are either sold as liquids that are vaporized and inhaled in e-cigarettes and other similar devices, or they are sprayed on dried plant material in order to be smoked. They are often referred to as herbal incense when they are marketed as dried plant material or as liquid incense when marketed as products to be smoked or vaped.

The chemicals are classified as cannabinoids because they are chemically related to substances that are found in cannabis (marijuana). This leads to these chemicals being incorrectly referred to as fake marijuana or synthetic marijuana, and also erroneously offered as safe and legal alternatives to cannabis products in areas where cannabis remains illegal or hard to get. The majority of individuals who use these products are adolescents or young adults.

These particular chemicals are numerous and are often manufactured in China, India, or Pakistan. Some common names for these synthetic cannabinoids include Spice, skunk, and K2.

These drugs were developed rapidly in a number of different chemical formulations in order to be marketed “legally” in the United States. Whenever one particular chemical formulation was deemed illegal, the manufacturers would simply alter the formula slightly and then remarket the drug. The use of these drugs increased dramatically between the years 2011 and 2013, but as states begin to legalize marijuana for medical uses and in some cases for personal use, the popularity of these drugs declined somewhat.

In 2014, The United States Drug Enforcement Administration (DEA) listed a number of these different chemical combinations, their trends of abuse, and their dangers. Synthetic cannabinoids like Spice are still marketed to younger individuals who may not be able to obtain marijuana legally even in states where its personal use has been legalized.

What Does Spice Do?

The effects of Spice and related synthetic cannabinoids are designed to reproduce or approximate the effects of smoking cannabis products; however, the effects that they produce are often much more intense in their delivery. The National Institute on Drug Abuse and DEA report that the overall effects include:

  • Mild to moderate euphoria
  • Sedation and relaxation
  • Changes in perception
  • Psychosis

The perceptual changes that occur with using synthetic cannabinoids like Spice include alterations in the sense of time, the perception of objects, and even in the perception of oneself. This perception can present as psychotic behavior, which includes delusions (fixed beliefs that are irrational), hallucinations (seeing or hearing things that are not really there), and dissociative experiences, such as feeling as if one is not attached to one’s body or as if nothing is real. In addition, a number of severe physical changes that can occur as a result of using these substances include:

  • Rapid heartbeat (tachycardia)
  • Changes in blood pressure (most often elevated blood pressure)
  • Nausea
  • Vomiting
  • Agitation
  • Delirium (severe mental confusion, disorientation, and severe agitation or lethargy)
  • Violent behaviors
  • Suspiciousness or full-blown paranoia
  • Thoughts of harming oneself
  • Seizures (in rare cases)
  • The syndrome of physical dependence

It should be noted that because of the large number of different chemical formulas being marketed as synthetic cannabinoids and sold under the names Spice and K2, the actual effects that an individual experiences can be quite variable from person to person.

Physical dependence on synthetic cannabinoids is significantly more severe than the physical dependence that occurs in some individuals to actual cannabis products, such as marijuana.

Physical Dependence on Spice

To date, one of the most complete descriptions of the syndrome of physical dependence that occurs in individuals who abuse synthetic cannabinoids was published in 2014. The description was based on a number of case studies documenting the withdrawal process, observed in a number of people who had severe substance use disorders as a result of their abuse of synthetic cannabinoids. The development of physical dependence on synthetic cannabinoids is uncommon and was reported to occur in about 9 percent of cases.

Overall, the symptoms documented from the case studies mimicked the withdrawal symptoms that often occur as a result of real cannabis use or abuse, but they were more intense. The symptoms were:

  • Nausea
  • Vomiting
  • Diarrhea
  • Muscle cramps
  • Aches and pains
  • Irregular heart rate
  • Cravings for Spice
  • Headache
  • Depressive symptoms
  • Anxiety
  • Irritability
  • Alterations in mood (mood swings)
  • Extreme cravings for Spice

The timeline associated with withdrawal from Spice and others synthetic cannabinoids is not well described, and the symptoms in the case studies occurred rather quickly once the person had discontinued the drug (often within 24 hours). The symptom severity typically peaked between 2-3 days and lasted about a week.

Issues with depression, anxiety, and mood swings may continue for as long as four weeks in some individuals. The withdrawal syndrome from synthetic cannabinoids does not appear to be potentially physically dangerous; however, individuals suffering from psychosis (hallucinations and delusions), depression, or anxiety are at risk to harm themselves due to making poor decisions or even becoming suicidal. As many users of synthetic cannabinoids are younger, individuals who are emotionally immature, it is extremely important that they be closely monitored when withdrawing from synthetic cannabinoid drugs.

Indications of Spice Abuse

The signs and a person may be abusing synthetic cannabinoids can include the following:

  • Spending a great deal of time using Spice or recovering from its use
  • Spending a great deal of time and energy trying to get Spice
  • Frequent cravings for Spice
  • Displaying issues with controlling use of Spice
  • Finding containers for herbal marijuana or liquid marijuana
  • Ordering Spice online
  • Being confronted about use of Spice
  • Becoming defensive or aggressive regarding use
  • Using increasingly larger amounts of Spice
  • Experiencing withdrawal symptoms when without the drug

Treatment Issues

Clients should be monitored very closely in the initial stages of the recovery to ascertain if they might be undergoing withdrawal. Since it appears that the withdrawal syndrome from Spice occurs rather quickly in most individuals, this close period of monitoring and supervision should likely last several days to a week.

Even if an individual does not undergo physical withdrawal symptoms, there is a good chance that they will undergo issues with mood and experience significant cravings for the drug. These can be addressed with a combination of medical management (using medications) and substance use disorder therapy to help the individual control their cravings, identify triggers to cravings, and develop strategies to deal with these issues. A person who begins to experience physical withdrawal symptoms may need to be administered medications to control the symptoms and be monitored closely for issues with depression.

A formal plan to address the individual’s substance use disorder should include therapy (meeting with a licensed therapist who specializes in substance use disorders), participation in 12-Step groups or other social support groups, and additional supports or interventions as applicable to the individual’s case.

Because many individuals with substance use disorders are at risk for co-occurring mental health disorders, such as depression, trauma and stress-related disorders, anxiety disorders, etc., or for other co-occurring substance use disorders (e.g., alcohol use disorders, prescription medication use disorders, etc.), it is extremely important that the person is initially assessed for any other co-occurring issues, and these are treated concurrently with the individual’s abuse of synthetic cannabinoids. Trying to ignore co-occurring disorders and only focusing on one particular substance use disorder is not a strategy conducive to recovery and does not address the individual as an entire person.

The therapeutic approach to the treatment of substance use disorders is typically dominated by Cognitive Behavioral Therapy (CBT) where an individual’s dysfunctional belief system and behaviors are addressed. Because the majority of individuals who abuse synthetic cannabinoids are younger, family therapy using CBT is a viable option or addition to individual therapy. There are often a number of family issues that need to be addressed in conjunction with the person’s substance use disorder.

In addition, because the majority these individuals are younger, it is important for them to develop positive relations with peers who can encourage their recovery and even participate in it. Often, these peers are members of group therapy sessions or social support groups. Because many adolescents with substance use disorders typically associate with other adolescents who abuse drugs or alcohol, it is important that these individuals change their peer group. Helping the person to change their entire lifestyle is the focus of recovery and often a long-term process.

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