Synthetic drugs used to refer to chemicals that were synthesized from organic drugs. For example, morphine is a synthetic opioid derived from opium, and LSD is a synthetic hallucinogen derived from ergot, a fungus that grows on some grains and can cause hallucinations if consumed in large quantities. Now, the term refers to several kinds of chemicals that are distantly related to known substances but have unpredictable effects because they have not been researched thoroughly.
Some of these drugs are based on research chemicals, meaning they were briefly studied as potential pharmaceutical drugs but not patented or applied for development. Recently, clandestine laboratories manufacturing dangerous intoxicants have found these chemical formulas online and are manufacturing harmful substances to mimic opioids, marijuana, cocaine, and hallucinogens. Other drug labs are making new psychoactive substances (NPS) that simply change the chemical formula of a known intoxicant, so they are unpredictable in effect but still can get past state or national drug laws. Synthetic drugs in this dangerous new category also may be called “legal highs.”
Many synthetic drugs like bath salts and Spice began appearing in the United States around 2009. They became especially popular among adolescents because they could legally be purchased in stores. While nearly every state has officially banned most synthetic drugs, and the federal government has passed legal controls on several of these substances, most clandestine labs make small changes to chemical formulas to bypass legislation. Between 2009 and 2013, for instance, law enforcement reported more than 200 new substances.
Mostly called Spice or K2, synthetic drugs in this group are chemically related to tetrahydrocannabinol (THC), the intoxicating drug found in marijuana. These drugs were originally manufactured to study different effects caused by different chemical compounds in marijuana when binding to various cannabinoid receptors in the brain.
Synthetic pot and cannabinoids are sometimes packaged to look like marijuana, so the chemical may be sprayed onto dried plant matter; sometimes, they are packaged as crystals or powder. In all cases, these drugs will be labeled “not for human consumption,” and might be called incense, air freshener, or jewelry cleaner. However, the intention is that the substance is snorted, smoked, or vaped to get the user high. Sometimes, the dried plant material is brewed into a tea.
Like other drugs in the NPS category, there are few studies on how synthetic cannabinoids affect the brain, but the effects are generally like those of marijuana but more intense. Synthetic cannabinoids bind more strongly to the brain’s cannabinoid receptors, leading to specific effects, such as:
Although marijuana can cause some psychotic symptoms or anxiety, typically called a “bad trip,” these effects and adverse physical side effects are more likely to happen with synthetic marijuana. There are also potentially harmful, long-lasting negative effects associated with these synthetic substances. They include:
It is difficult to overdose on naturally occurring THC, but overdosing on synthetic marijuana or cannabinoids is more likely than attaining a relaxing high. Someone overdosing on synthetic cannabinoids will be agitated, aggressive, paranoid, and often disconnected from reality. These drugs were associated with more than 11,000 emergency room admissions in 2010 alone, and 75 percent of those admissions were for individuals between the ages of 12 and 29.
Synthetic cannabinoids are believed to be addictive. They can lead to physical dependence because people who abuse these drugs show signs of compulsive behaviors to take more, and they report withdrawal symptoms if they do not take the drugs. Withdrawal symptoms include:
These synthetic drugs are stimulants that are chemically similar to cocaine or amphetamines. Synthetic cathinones are most often known as bath salts, but there are many related chemicals in this family that have other names. Cathinone is the stimulant chemical found in the khat plant, which is native to East Africa and Southern Arabia.
Like synthetic cannabinoids, these drugs are labeled “not for human consumption” and often called glass cleaner, plant food, jewelry cleaner, or phone screen cleaner. Synthetic cathinones are a white-brown crystalline powder, and they are intended to be smoked, snorted, or even injected to cause an intense stimulant high.
Since these dangerous drugs are fairly new, their long-term effects are not well understood. In the short-term, many synthetic cathinones’ effects are intense, physically harmful, and feel more like a drug overdose than a high. One study reported that 3,4-methylenedioxypyrovalerone (MDPV), a chemical common in several synthetic cathinones, works on the brain like cocaine, but it is 10 times more powerful. This means that synthetic cathinones like bath salts are very difficult to dose without causing extreme psychological and physical harm. Various effects can occur when these drugs are used.
Because these drugs lead to more overdose-related hospitalizations than addiction treatment, it is hard to know how addictive the substances are. However, people who abuse these drugs often develop some dependence on them, which can lead to withdrawal symptoms, including:
Overdose effects are like those of cocaine, including hallucinations, delusion, aggression, and psychosis. Synthetic cathinones were responsible for around 20,000 ER admissions in 2011, and bath salts specifically were associated with around 9,000 calls to poison control centers between 2010 and 2012. .
These synthetic drugs mimic hallucinogens like shrooms or LSD, and they are typically found as powder, liquid, laced edibles, or soaked onto blotter paper. The most infamous names of these substances include Smiles and N-bomb.
Rather than being sold in head shops or convenience stores, synthetic phenethylamines are sold like other illicit drugs, including online. Because these drugs have such unpredictable effects, even small doses can cause heart attack or failure, respiratory arrest, seizures, and death.
Some new synthetic sedatives are extremely potent benzodiazepine drugs. These are designed to have the anti-anxiety and sedative effects of medications such as Valium, Klonopin, and Xanax, but they bind to receptor cells in the brain for much longer. They are much more potent and more likely to lead to an overdose on their own. Names of these substances include etizolam, pyrazolam, and flubromazepam.
Addiction is a chronic disease of the brain, and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists 11 criteria used by clinicians to diagnose a Substance Use Disorder and determine its severity. If a person meets at least two of these criteria during a 12-month period, they have a mild substance use disorder; four to five criteria, a moderate substance use disorder; and six or more criteria, a severe substance use disorder. The criteria are:
The long-term dangers of any NPS or synthetic drug are not clear because these drugs have not been abused by a large enough population for long enough to understand how they affect the brain and body. While many of these chemicals were developed legally in laboratories for experiments to understand intoxication, few true medical studies have been conducted on the drugs, so even the original medical information on the chemicals gives little information on their potential impact.
The main problem with synthetic drugs is that their effects are unpredictable and more likely to be harmful, causing psychosis and overdose symptoms rather than an addictive high. The United Nations Office on Drugs and Crime (UNODC) reports that synthetic substances are widespread, especially in the United States, Europe, Australia, Russia, Asia, and South America.
UNODC found that more than 60 countries had passed some legislation to control synthetic drugs, with ongoing amendments as new chemical compounds emerged. The office notes that laws can vary widely between countries and regions within countries. It is important to remember that the legal status of synthetic drugs does not matter as much as their effects on the brain and body, which can be extremely detrimental and lead to death.
Because these dangerous chemicals are constantly reformulated to get past laws, they are easily accessible to teenagers and young adults who cannot legally purchase other drugs. The Monitoring the Future Survey (MTF) for 2017 reported that teenagers were most likely to abuse synthetic cannabinoids, after marijuana: among 12th-graders, 37.1 percent reported abusing marijuana at least once in the past year, and 3.7 percent reported abusing synthetic cannabinoids.
Abuse of synthetic drugs is primarily a problem among adolescents and young adults in their 20s, but it has been reported in people up to middle age.
Adverse health problems reported in synthetic drug-related hospitalizations include hyperthermia or high body temperature, which can lead to kidney damage; rapid and irregular heart rate, which can cause a heart attack or stroke; high blood pressure, which can lead to cardiovascular damage; enlarged or tender liver; nausea and vomiting; psychosis; paranoia; aggression; hallucinations; and seizures.
As long as a person is treated immediately for toxic effects from synthetic drugs, it is possible for the person to survive. However, there are no specific antidotes for synthetic drug poisoning, partly because the chemical foundation of these drugs continues to change, so the actual drugs involved in poisoning and overdose are hard to determine.
For many people admitted to emergency treatment, the severe level of their illness requires ongoing hospitalization in critical care units. The person may have permanent heart, stomach, lung, brain, muscle, kidney, and liver damage, which will require ongoing medical treatment.
Clinicians, counselors, and social workers are increasingly talking about detox and rehabilitation with people who have been hospitalized for synthetic drug abuse. This approach is called brief intervention, in which a medical professional or associated addiction specialist discusses the problems their patient has experienced because of drug use and offers specific solutions. It is believed that long-term treatment, potentially including residential treatment, may be necessary for people who abuse synthetic drugs – not just because there is a risk of other substance abuse in the individual’s past but also because the damage caused by synthetic drugs may require ongoing medical monitoring.
Supervised detox is needed for people who abuse synthetic drugs because they must be monitored for any number of psychological and physical effects that could become chronic illnesses. There are no medication-assisted treatments (MATs) for designer drugs or NPSs, but access to medical intervention, including psychiatric drugs and pain management, is crucial to safely detoxing from a substance. Long-term counseling and behavioral therapy also will be needed. For people who are medically stabilized, outpatient treatment could be the best approach. However, for people who have ongoing health struggles, residential or inpatient rehabilitation may be required. The direction addiction treatment takes for someone who has abused synthetic drugs will depend on their physical and psychological health.
It is important to know that synthetic drug abuse and addiction can be overcome, and your mental and physical health do not have to sustain damage from these dangerous drugs. There are many approaches to evidence-based treatment available, including safe detox procedures and behavioral therapy.
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