Spice Overdose, Withdrawal, And Detox

1. Spice Overdose
2. Spice Withdrawal
3. Symptoms of Spice Withdrawal
4. Treatment: Detox
5. Treatment: Medications
6. Finding a Rehab Program
7. How to Care for Someone Going Through Withdrawal

What is Spice?

Spice is a synthetic cannabinoid that can produce a wide variety of effects, including mild euphoria and hallucinations. Despite the dangers, many forms are still legal in the United States and continue to be sold in smoke shops, gas stations and on the Internet.

In 2011, the Drug Enforcement Agency (DEA) placed five synthetic cannabinoids on the Schedule I class of the Controlled Substances Act (CSA). Unfortunately, manufacturers are able to change a single molecule in the chemical makeup of Spice to produce a similar product that has not been placed on the DEA’s Schedule I list. In doing so, those producing these drugs are able to keep a slightly modified, yet similarly risky substance available for purchase on a legal market.

Spice Overdose

Many reported side effects from Spice are transient and, for the most part, mild. These include:

• Anxiety.
  
• Agitation.
  
• Abnormally fast heart rate.
  
• Increased blood pressure.
  

Because the effects of Spice can differ from person to person in intensity and severity, it may be difficult to determine if someone is experiencing overdose or just a strong reaction to the drug. The more serious side effects of Spice overdose include:

• Vomiting.
  
• Violent behavior.
  
• Confusion.
  
• Paranoia.
  
• Suicidal thinking or actions.
  
• Seizures.
  

Understanding the Causes of Spice Overdose

• 
  There is some evidence that Spice may have a higher potency than marijuana. Users may not realize how potent Spice is and may use it the same way they would use marijuana, which could place them at increased risk of overdosing.

• 
  Often, as a user’s tolerance increases, their Spice use increases to overcome it. This could potentially lead to a higher risk for suffering brain and nervous system damage. Psychoactive chemicals used in Spice are unregulated and constantly changing, so even if you use the same “brand” of Spice, you are not necessarily going to experience the same effects.

• 
  Spice’s psychoactive chemicals may also get distributed differently in the brain and body each time a person uses, making dosing unpredictable and increasing the dangers of overdose or other serious drug reaction.

You Are Not Alone
Browse a range of treatment options for Spice addiction, including rehab center amenities, specializations, and alumni reviews.

When to get Help/What to do in an Emergency

With known dangerous health effects resulting from Spice use, it is important to acknowledge the very real possibility of overdose. The most important thing to do if you suspect that someone may be experiencing Spice overdose is to call 911 and get them professional medical assistance as soon as possible.

There have been unfortunate cases of sudden heart attacks in Spice users three to seven days after using. Spice has also been associated with several deaths from other causes, including death by suicide. It is vital that Spice abuse and overdose be treated properly in order to avoid these potentially fatal consequences.

Spice Withdrawal

Mild to moderate Spice users are not likely to experience significant withdrawal symptoms, but may have mild anxiety and difficulty sleeping. The longer you use Spice, the more likely you are to experience withdrawal symptoms.

If you are a heavy user, withdrawal symptoms may be more severe and prolonged. Spice affects the cannabinoid 1 and 2 receptors (CB1R, CB2R) throughout the body, which are the same receptors that marijuana acts on.

• 

  CB1Rs are found in the brain, and are involved in neural processes implicated in:

  • Motor coordination.
    
  • Relaxation.
    
  • Sensory and perceptional distortions.
    
  • Appetite stimulation.
    
  • Analgesia.

• 
   On the other hand, CB2Rs are mainly located on white blood cells (specifically lymphocytes and leukocytes) and other bodily tissues such as the spleen, bone marrow, liver, and pancreas. They are primarily involved in regulating immune function.

  For each effect that Spice has, there is typically a counter-effect or reaction when Spice use is discontinued, leading to uncomfortable withdrawal symptoms. For example, Spice use can lead to relaxation, so discontinuing Spice use can leave the central nervous system in a state of rebound agitation. The intensity of Spice withdrawal is related to the magnitude of impact that it has had, over time, on the body and brain.

Symptoms of Spice Withdrawal

Symptoms of Spice withdrawal closely resemble those of cannabis withdrawal. Research into cannabinoid pharmacology has elucidated a few symptoms commonly experienced at the outset of Spice recovery:

• Headaches.
  
• Anxiety/nervousness.
  
• Coughing.
  
• Anger/irritability.
  
• Impatience.
  

The most uncomfortable withdrawal symptoms – such as sweating, nausea and vomiting – will typically resolve within a week.  Some longer-lasting residual symptoms have been noted, however, and can include:

• Insomnia.
  
• Internal restlessness.
  
• Tremors.
  
• Difficulty concentrating.
  
• Depression.
  
• Drug craving.
  

Withdrawal Symptom Severity

In some instances, an individual withdrawing from Spice can present with life-threatening complications. Seizures and breathing problems are such severe symptoms of Spice withdrawal, and in rare cases the patient may even require mechanical breathing assistance.

Professional monitoring during Spice withdrawal helps to mitigate these potentially life-threatening situations.

Treatment: Detox

Those who seek recovery from addiction can find hope in the many others who have successfully done so.  In 2012, for example, approximately 10%, or 23.5 million adults, in the US reported that they were in recovery from an alcohol or drug problem. Please call 1-888-993-3112Who Answers? to learn about recovery centers today.

Is Detox from Spice Dangerous?

• 

  Spice is a short-acting drug and seizures have been known to occur up to a few hours after using the substance. Supervised detoxification, as a part of a medically assisted treatment approach, can help to keep individuals going through withdrawal as safe and comfortable as possible.

  Beyond the risk of seizures, other synthetic cannabinoid withdrawal symptoms often resemble the more severe aspects of marijuana withdrawal, including anxiety, depressed mood, or changes in sleep or eating. 

What to Expect During Spice Detoxification

• 
  You can expect to experience acute withdrawal symptoms that last up to a week. Acute symptoms such as anxiety and insomnia can be treated with benzodiazepines to help ease the discomfort of withdrawal. Some with a long-standing history of heavy cannabinoid use – even after successfully completing detox – may continue to experience post-acute withdrawal symptoms that can last up to several months.

Spice Signs and Treatment are Complicated

Spice and other synthetic cannabinoids are only recently gaining attention as drugs of abuse. Many toxicology tests aren’t yet sophisticated enough to detect these substances, so they often pass undetected in urine drug screens. In addition, clinical signs of Spice use may be unspecific, making proper treatment protocol for this relatively new type of drug difficult to narrow down.

Treatment: Medications

There is limited data on Spice abuse recovery, but there has been promising research into the treatment of the most commonly experienced detox symptoms and the corresponding pharmacological treatments. Treatment options include:

• Phenobarbital for seizure precaution.
  
• Benzodiazepines for anxiety.
  
• Clonidine for high blood pressure.
  
• IV Fluids.
  

Other medications – including the antihistamine/sedative Vistaril and tricyclic antidepressant trazodone – can be used throughout treatment to help with post-acute withdrawal symptoms.

Naltrexone – an addiction pharmacotherapeutic agent utilized primarily for alcohol and opioid treatment – has shown promising results in reducing the withdrawal symptoms of anxiety and depression in recovering Spice users.

If you are considering a rehabilitation facility for your spice addiction, call 1-888-993-3112Who Answers?. Be sure to ask if they treat any co-occurring mental/physical health problems you may have, and ask if they offer any of the evidenced-based approaches noted above, like CBT, motivational interviewing, and relapse prevention skills training.

Finding a Rehab Program

Here is what you need to know about choosing a program that is right for you.

Inpatient Spice Treatment versus Outpatient Programs

• 
  Inpatient treatment is the most intensive type of treatment, primarily recommended if symptoms need to be medically managed around the clock. Personal characteristics like social support, level of danger or instability in the immediate environment, and history of previous treatment attempts also factor into evaluating the need for inpatient treatment.

  • Keep in mind that insurance companies are only recently starting to acknowledge a withdrawal syndrome associated with cannabis and cannabinoid use, so coverage for an inpatient program to treat Spice abuse may be limited.
    

• 
  Outpatient treatment can be an effective option if there is little or no associated health risks necessitating more time-intensive medical scrutiny. Furthermore, outpatient treatment offers the flexibility of attending counseling sessions and being monitored by a physician, while still being able to go to work and go home at the end of the day.

Find the Right Program.
Browse a wide range of treatment centers, including their amenities, specializations, and alumni reviews.

Choosing the Best Spice Detox Center

When trying to choose the best Spice detox center for yourself or your loved one, the following factors should be considered:

• Does the facility have on-site access to medical doctors, mental health care professionals and case managers?
  
• Is there round-the-clock medical supervision?
  
• Is medically assisted detox available?
  
• What are common detox medications administered?
  
• What are the participation expectations in treatment?
  
• Are referrals given for continuing care once detox is complete?
  
• What payment options are available (i.e. private insurance)?

Make sure to ask these questions to the rehab center you are considering.

How to Care for Someone Going Through Withdrawal

Supportive care should be provided to someone experiencing Spice withdrawal. Outside of a hospital or inpatient setting, maintaining support of the patient’s recovery and helping them stick to their treatment plan is the most helpful thing a friend or family member can provide.

This may include administering outpatient medications, keeping the environment quiet and stress-free, and regulating temperature. Emotional support is also a vital factor in providing a positive environment for recovery.

References

Brents, L.K. & Prather, P.L. (2014). The K2/Spice phenomenon: Emergence, identification, legislation and metabolic characterization of synthetic cannabinoids in herbal incense products. Drug Metabolism Reviews, 46(1), 72-85.

Castaneto, M. S., Gorelick, D. A., Desrosiers, N. A., Hartman, R. L., Pirard, S., & Huestis, M. A. (2014). Synthetic cannabinoids: epidemiology, pharmacodynamics, and clinical implications. Drug and alcohol dependence,144, 12-41.

Cha, H.J., Seong, Y.H., Song, M.J., Jeong, H.S., Shin, J., Yun, J., Han, K., Kim, Y.H., Kang, H.  & Kim, H.S. (2015). Neurotoxicity of synthetic cannabinoids JWH-081 and JWH-210. Biomolecules & Therapeutics, 23(6), 597-603.

Debruyne, D. & Le Boisselier, R. (2015). Emerging drugs of abuse: Current perspectives on synthetic cannabinoids. Substance Abuse Rehabilitation, 6, 113-129. Drug Enforcement Agency. Drug Fact Sheet: K2 or Spice. Retrieved from http://www.dea.gov/druginfo/drug_data_sheets/K2_Spice.pdf.

Fantegrossi, W.E., Moran, J.H., Randominska-Pandya, A. & Prather, P.L. (2014). Distinct pharmacology and metabolism of K2 synthetic cannabinoids compared to delta-9-thc: Mechanism underlying greater toxicity? Life Science, 97(1), 45-54.

Kamel, M. & Thajudeen, B. (2015). A case of acute kidney injury and calcium oxalate deposition associated with synthetic cannabinoids. Saudi Journal of Kidney Diseases and Transplantation, 26(4), 802-803.

Louh, I.K. & Freeman, W.D. (2014). A ‘spicy’ encephalopathy: Synthetic cannabinoids as cause of encephalopathy and seizure. Critical Care, 18(5), 553.

Nacca, N., Vatti, D., Sullivan, R., Sud, P., Su, M. & Marraffa, J. (2013). The synthetic cannabinoid withdrawal syndrome. Journal of Addiction Medicine, 7(4), 296-298.

Rodgman, C.J.C., Verrico, C.D., Worthy, R.B. & Lewis, E.E. (2014). Inpatient detoxification from a synthetic cannabinoid and control of postdetoxification cravings with Naltrexone. Primary Care Companion CNS Disorders, 16(4), doi: 10.4088/PCC.13I01594.

Rosenbaum, C.D., Carreiro, S.P. & Babu, K.M. (2012). Here today, gone tomorrow… and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, salvia divinorum, methoxetamine, and piperazines. Journal of Medical Toxicology, 8(1), 15-32.

Simmons, J., Cookman, L., Kang, C. & Skinner, C. (2011). Three cases of “spice” exposure. Clinical Toxicology, 49(5), 431-433.

Spaderna, M., Addy, P. H., & D’Souza, D. C. (2013). Spicing things up: synthetic cannabinoids. Psychopharmacology, 228(4), 525-540.

Srisung, W., Jamal, F. & Prabhakar, S. (2015). Synthetic cannabinoids and acute kidney injury. Proceedings (Baylor University Medical Center), 28(4), 475-477.

Ustundag, M.F., Ibis, E.O., Yucel, A. & Ozcan, H. (2015). Synthetic cannabis-induced mania. Case Reports in Psychiatry, doi: 10.1155/2015/310930.

Vandrey, R., Dunn, K.E., Fry, J.A. & Girling, E.R. (2012). A survey study to characterize use of Spice products (synthetic cannabinoids). Drug and Alcohol Dependence, 120(1-3), 238-241.

Zhao, A., Tan, M., Maung, A., Salifu, M. & Mallappallil, M. (2015). Rhabdomyolysis and acute kidney injury requiring dialysis as a result of concomitant use of atypical neuroleptics and synthetic cannabinoids. Case Reports in Nephrology, doi: 10.1155/2015/235982.