Pubdate: Sat, 25 Apr 2015
Source: New York Times (NY)
Copyright: 2015 The New York Times Company
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Website: http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Alan Schwarz

POTENT SYNTHETIC DRUG FUELS RISE IN VISITS TO EMERGENCY ROOM

A sharp rise in visits to emergency rooms and calls to poison control 
centers nationwide has some health officials fearing that more potent 
and dangerous variations of a popular drug known as spice have 
reached the nation's streets, resulting in several deaths.

In the first three weeks of April, state poison control centers 
received about 1,000 reports of adverse reactions to spice - the 
street name for a family of synthetic substances that mimic the 
effects of marijuana - more than doubling the total from January 
through March, according to the American Association of Poison Control Centers.

The cases, which can involve spice alone or in combination with other 
substances, have appeared four times as often this year as in 2014, 
the organization said. On Thursday alone there were 172 reports, by 
far the most in one day this year.

Health departments in Alabama, Mississippi and New York have issued 
alerts this month about more spice users being rushed to hospitals 
experiencing extreme anxiety, violent behavior and delusions, with 
some of the cases resulting in death. Similar increases have occurred 
in Arizona, Florida, New Jersey and Texas.

The total number of fatalities nationwide this year is not available, 
health officials said. One person in Louisiana died Wednesday and two 
others were in intensive care, said Mark Ryan, the director of the 
Louisiana Poison Center.

"We had one hospital in the Baton Rouge area that saw over 110 cases 
in February. That's a huge spike," Dr. Ryan said. "There's a large 
amount of use going on. When one of these new ingredients - something 
that's more potent and gives a bigger high - is released and gets 
into distribution, it can cause these more extreme effects."

Experts were unsure whether the increase this month in spice-related 
emergencies reflected greater use of the drug or a particularly 
dangerous formulation. Dr. Ryan said a large portion of cases 
appeared to involve a form called mab-chminaca.

Law enforcement agencies, from the Drug Enforcement Administration to 
local police departments, have struggled to control the flow of 
synthetic cannabinoids, substances that look like marijuana that are 
sprayed with a hallucinogenic chemical and then smoked.

Those chemicals, typically imported from China by American 
distributors, come in hundreds of varieties; new formulations appear 
monthly, with molecules subtly tweaked to try to skirt the D.E.A.'s 
list of illegal drugs as well as drug-detecting urine tests.

Although the entire class of drugs is illegal because of the 
psychological effects, each new variety can present distinct health 
risks caused by its underlying chemistry or contaminants in renegade 
manufacturing facilities.

Experts warn that the popular term "synthetic marijuana" is a 
misnomer, as the substances merely resemble marijuana but can be 100 
times as potent.

The use of synthetic cannabinoids as well as calls to poison control 
centers had decreased from 2011 through 2014, as awareness of their 
danger and illegality has spread, national data indicates.

Still, about one in 20 high school students used the drugs in 2014; 
about one in 30 adults age 19 to 28 used them in 2013, the most 
recent data available for that age group.

More than 400 emergency-room visits in Mississippi were attributed to 
synthetic cannabinoids in April, according to the state health department.

Two of those cases involved Jeffrey and Joey Stallings of McComb, who 
spent several days in intensive care in medically induced comas, 
their mother, Karen, said in a telephone interview.

Ms. Stallings said that Jeffrey, 24, and Joey, 29, smoked a type of 
spice known as "mojo" that they received from a dealer.

She said that Jeffrey became delusional, thinking that a woman was 
bleeding in their hallway, and extremely violent; Joey became 
extremely agitated before she took them to the hospital.

Ms. Stallings said that her sons were released from the hospital 
after about a week and that doctors told her that Jeffrey might have 
permanent kidney damage. Efforts to reach the brothers for comment 
were unsuccessful.

"I told them, 'This is killing you and you don't see it,' " Ms. 
Stallings said. "There's no telling what that stuff was. There's no 
telling at all."

A unique case occurred earlier this year in Texas. The death of 
Kendrick Sneed, a soldier at Fort Hood, on Jan. 13 had been 
considered to be possibly caused by Ebola, because he had recently 
returned from deployment to a hot zone for the disease in West Africa.

The local police department, however, announced on April 16 that an 
autopsy determined the cause to be "synthetic cannabinoid intoxication."

The increases in cases in Mississippi and Alabama demonstrate the 
challenge facing law enforcement officials.

Last year, D.E.A. agents made about 40 arrests and seized more than 
400 pounds of synthetic drugs in those states as part of a wider 
national operation. Yet supply chains clearly remain.

"Is it frustrating? Yes, but when you're in this business what you 
come to understand is that total eradication of a drug threat just 
isn't going to happen," said Keith Brown, the special agent in charge 
of the D.E.A.'s New Orleans field division, which covers Alabama, 
Arkansas, Louisiana and Mississippi. "Until we can control the demand 
there's going to be someone with supply."

Mr. Brown added: "We had success last year, and now it's coming back. 
It's like a guy who tends a garden or tends a yard. It's impossible 
to eradicate weeds. They come back. They grow again."

Mr. Ryan said his Louisiana call center had fielded fewer calls in 
the past several years partly because emergency-room doctors had 
begun to recognize the effects of certain variations of spice and 
knew how to handle those cases themselves, leaving most of the calls 
from worried individuals. The tenor of recent calls has been 
different, he said.

"It's been more than 90 percent hospitals this year," Mr. Ryan said. 
"It's not, 'Hey, I smoked this thing and I don't feel well.' It's, 
'This guy's trying to tear up the E.R. and we have him locked down in 
restraints. We don't know what he's taken. What do we do?' "
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