The Dangers of K2

By Danielle Jones
October 21, 2015

My name is Danielle Jones. I am a medical student with a bit of background in public health. I decided to write this article because I had little familiarity with K2 before I started my inpatient psychiatry rotation during my third year of medical school. During that rotation, I came into contact with several people who did K2. Some of them were schizophrenics. Others did not have an episode of psychosis before in their lives. I figured other students could benefit from more knowledge on the drug whether they are in public health or medicine in order to address this problem.
K2 is a new synthetic marijuana that is being produced in China and distributed across Europe and the United States. It first started being abused across Europe, particularly Russia, in the early 2000s. It was banned by Russia in 2010 under the name Spice. It then appeared in the US under the name K2. K2 has also been called Black Mamba, Scooby Snax, Fake Weed, Demon, Diablo, Mr. Bad Guy, Spice Gold, Tiger Leaf, AK-47, Dafuq, and many other titles.
K2 is a mix of herbs that are being sprayed with synthetic cannabinoids by either the manufacturer or the user. The synthetic cannabinoids are chemicals that work on the same receptors as marijuana. These receptors are found in the central nervous system and peripheral tissues. There are seven major structural groups, but they are different than THC, the active ingredient in marijuana. Yet, they have a higher binding affinity for the receptors. The increased binding leads to higher potency .
K2 has many similar side effects as marijuana, but with key differences. It can cause slurred speech, ataxia, conjunctival injection, and tachycardia just like marijuana . Yet, K2 consumers who show up to the emergency department may have agitation, tachycardia, and vomiting. Spice is also known to cause anxiety, paranoia, delusions, dystonia, hallucinations, delirium, dry mouth, and sweating. Rarely, it will cause severe psychomotor agitation, seizures, and psychosis. It is also associated with ischemic stroke, cardiotoxicity, acute liver damage, rhabdomyolysis, hyperthermia, and tachyarrhythmias. Finally, K2 can cause acute exacerbations of asthma, pneumomediastinum, and pneumothorax. The symptoms can last for several hours to several days. The time frame depends on what is in the mixture and the potency .
Due to the variety of compounds and symptoms associated with K2, it is treated symptomatically. In most cases, the doctor only knows that it is K2 due to the patient admitting what they consumed or by symptoms because the variety of compounds may not be able to be detected by the lab. Patients are given antipsychotics and benzodiazepines for aggression, benzodiazepines for agitation, seizures, and anxiety, and other supportive care.
The number of people who use K2 is unknown, but there are some statistics out there. In the summer of 2010, there were over a 1,000 cases within the continental United States. Most users of K2 are male. The median age is 37. Ninety-nine percent of K2 users are over the age of 18. K2 is the second most used drug among high school seniors according to a University of Michigan study. The number of variations of Spice has increased in the past few years along with usage. In the first six months of 2014, the number of emergency department visits related to synthetic marijuana went up 220 percent. In mid-April of this year, more than 160 people were hospitalized in the state of New York in under two weeks following usage of Spice.
The societal impact of K2 is high due to the cost. It is cheaper than marijuana and some variations of it are legal due to the frequency of the formulation changes. CBS in New York reported that it is sold for as little as $5 a pack, so it is accessible to the homeless, jobless, and youth. Vice magazine did an excellent piece on how EMTs are in and out of homeless shelters multiples times a day in Brooklyn in order to take people who are overdosing on K2 to Kings County hospital.
While K2 is not leaving anytime soon, I can give a few recommendations. The most obvious would be to not do drugs. If people must get high, people should stick to actual marijuana instead of the synthetic version. Spice has more side effects compared to marijuana. Finally, consumers should know what they are purchasing and only go to a trusted source.
The last statement is a word of caution due to the history of a patient that I met on an inpatient psychiatric ward. This young man was brought in because he tried to attack his roommate before he beat himself in the eye with a glass. His only psychiatric history before this incident was anxiety. He used marijuana regularly to relax. On this particular day, he decided to buy a premade blunt. When he retold his story, he could not say exactly what was in his blunt. Yet, his story is so similar to so many other stories that the hospital staff knew what it was just by his behavior.
Another example of the bad effects of K2 would be the story of 16-year-old Emily Bauer from Cyprus, Texas. She took a nap after smoking K2. When she woke up, she stumbled around slurring her words before she lapsed into violent outbursts with hallucinations. When she was taken to the hospital, she was restrained before being admitted to the ICU. After 24 hours, she was still trying to hurt others and herself. Her doctors decided to put her in an induced coma until the drug left her system. After a few days, an MRI revealed that she had several severe strokes. While in ICU, the blood vessels of her brain started to open back up which lead to a reperfusion injury. Afterwards, Bauer’s family was informed of extensive brain injury which led to her blindness and inability to move. As of May 2015, she cannot see much and sometimes has trouble processing her sight. She still cannot read or write. Finally, she needs to have a caregiver with her all day.
K2 is a new problem in the War on Drugs. I have seen the effects firsthand with some of the patients I have met on an inpatient psychiatry ward. Their self-harm and aggression led to their involuntary commitment when they had no history of schizophrenia, schizoaffective, or some other psychotic disorders. As members of the wider health community, we should be aware of what is ravaging our communities and educate the people around us.

Works Cited
CBS NYC. “What Is K2? 5 Facts About Synthetic Marijuana.” CBS New York. N.p., 26 Aug. 2015. Web. 12 Oct. 2015. <>.
Conti, Allie. “How Synthetic Weed Is Ravaging Brooklyn’s Homeless Population | VICE | United States.” VICE. N.p., 27 July 2015. Web. 12 Oct. 2015. <>.
Cuomo. “Governor Cuomo Issues Health Alert: Illegal Synthetic Marijuana Sends More Than 160 New Yorkers to the Hospital Since April 8.” Governor Andrew M. Cuomo. N.p., 17 Apr. 2015. Web. 12 Oct. 2015. <>.
DEA Public Information Officer. “ / Chicago News Releases, 05/28/15.” / Chicago News Releases, 05/28/15. DEA, 28 May 2015. Web. 12 Oct. 2015. <>.
Egelhof, Teresa. “Synthetic Cannabinoids (K2) Frequently Asked Questions for Consumers.” (n.d.): n. pag. NYC Health. NYC Health, 2015. Web. 10 Oct. 2015. <>.
Lapoint, J., J. P. James, L. S. Nelson, R. S. Hoffman, and J. H. Morgan. “Severe Toxicity Following Synthetic Cannabinoid Ingestion.” Clinical Toxicology (2014): n. pag. NIH. Web. 10 Oct. 2015.
Monte, Andrew A., Alvin C. Bronstein, Dazhe J. Cao, Kennon J. Heard, Jason A. Hoppe, Christopher O. Hoyte, Janetta L. Iwanicki, and Eric J. Lavonas. “An Outbreak of Exposure to a Novel Synthetic Cannabinoid.” New England Journal of Medicine N Engl J Med 370.4 (2014): 389-90. Web.
NYC Health Dept. “Health Department Warns New Yorkers of Dangers of Synthetic Cannabinoids.” Health Department Warns New Yorkers of Dangers of Synthetic Cannabinoids. N.p., 27 July 2014. Web. 12 Oct. 2015. <>.
Office of National Drug Control Policy. “Synthetic Drugs (a.k.a. K2, Spice, Bath Salts, Etc.).” N.p., n.d. Web. 12 Oct. 2015. <>.
Ortigo, Bridget. “Texas Teen Speaks against Using Synthetic Marijuana.” Longview News Journal. N.p., 28 May 2015. Web. 13 Oct. 2015. <>.
Rosenbaum, Christopher D., Stephanie P. Carreiro, and Kavita M. Babu. “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 J. Med. Toxicol. 8.1 (2012): 15-32. Web.
Wang, George Sam, MD. “Synthetic Cannabinoids: Acute Intoxication.” UptoDate (2015): n. pag. Uptodate. Web. 12 Oct. 2015.

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