Tuesday, May 17, 2011

New-Onset Psychosis Linked to "Spice," Synthetic Marijuana

By: M. ALEXANDER OTTO, Internal Medicine News Digital Network

New-Onset Psychosis Linked to Synthetic Marijuana Use

HONOLULU – Synthetic marijuana, known as "spice," appears to have induced psychosis in 10 young service members in the U.S. Naval Academy, according to a case series from the Naval Medical Center in San Diego.
"These are people who never had psychosis. They were so disorganized, so out of it, we had to lock them up [on our ward]. It’s pretty scary," Dr. Donald Hurst, lead investigator on the study, reported at the annual meeting of the American Psychiatric Association.
Psychotic symptoms resolved within 8 days in seven patients. One of those patients had a past diagnosis of attention-deficit/hyperactivity disorder; the others had no psychiatric histories. Most had been daily users for weeks, months, or up to a year.
The remaining three patients still suffer lingering paranoid delusions and dysthymia after 5 months. One has a history of substance abuse and a family history of schizophrenia and had been using spice daily for a year and a half; another has a history of depression and had been using spice daily for a month. The third patient, however, has no personal or family psychiatric history and had used spice about 20 times in two months.
The men were in their early 20s. They were each hospitalized 6-10 days. Some had used alcohol, marijuana, or both, with spice. It’s unknown how much the men used during each session.
Given the potential consequences, Dr. Hurst advises discussing spice with patients if there’s cause. "Tell them how bad" results of using the substance can be, said Dr. Hurst, a lieutenant commander and third-year psychiatry resident at the medical center.
The report is the first to link spice to new-onset psychosis in patients with no psychiatric histories. There is no way to know at present how common such reactions are, he said.
After they were admitted, 7 of the 10 patients in the case series got atypical antipsychotics, usually for 4 days. Since writing the report, Dr. Hurst and his colleagues have seen about 20 additional cases and have noticed that patients – if they are going to recover – seem to do so regardless of antipsychotic use.
Because of that, "we are starting on our ward not to give them anything. You may give them an antipsychotic because behaviorally they are out of control, and we need to tone it down. But if they’re calm, we are not giving them anything, and they are still clearing up in 4-8 days," he said.
In terms of presentation, "the most common theme is confusion" along with disorganized behavior and speech. Paranoid delusions also are common, but their focus can shift from minute to minute. Symptoms wax and wane as well, with patients cycling in and out of psychosis hour by hour, sometimes even quicker, Dr. Hurst said.
Auditory and visual hallucinations, flat affect, thought-blocking, alogia, suicidal ideation, insomnia, psychomotor retardation, agitation, and anxiety also were noted in the group.
"The role of spice in inducing these symptoms was determined by military command, friend, family member and/or patient report, as well as urine drug test," Dr. Hurst noted.
Synthetic marijuana is usually a mix of cannabinoid receptor agonists. They are generally full agonists, which distinguishes them from the active ingredient in actual marijuana, tetrahydrocannabinol (THC), which is a partial cannabinoid agonist, Dr. Hurst said.
The chemicals originally were developed to help locate cannabinoid receptors and as experimental pain relievers – uses that did not pan out, he said.
Plant material is dipped into the chemicals, or sprayed with them, and sold on the Internet or in drug paraphernalia shops as K2, Blaze, RedXdawn, and other brands. Spice is usually smoked, but is beginning to be sold as a crystalline powder. Users have no way of knowing how potent a particular product is, Dr. Hurst said.
On March 1, the U.S. Drug Enforcement Agency temporarily designated five synthetic cannabinoids as Schedule I substances, pending further action, "because they pose a threat to public health," according to the order. In January 2011, seven Navy midshipmen were discharged from the Naval Academy because of spice use. In 2008, the U.S. Marine Corps banned the substance because of concern about its increased use among service members.
Dr. Hurst said that he has no disclosures.


  1. Is the treatment of addiction to synthetic cannabinoids, to simply withdraw from use and detox for 4-8 days? This is not as easy when it is being sold at every store and on the internet.

  2. My son has used Spice, marketed in Columbus, Georgia, as "Darkness", numerous times in March to April 2012. His delusional thoughts and disorganization became pervasive, resulting in a psychotic break in the end of April. He has been hospitalized for 10 days, and counting, with the same behaviors described in the article. Improvement has been great but he isn't out of he woods yet.

  3. Hello Don,
    My thoughts are with you and your dear son. I can only hope your message is read by parents and kids alike.
    Always Tina

  4. I am a psychiatric RN and have witnessed the above scenario on a daily basis from adol to adults-for the past years. It has become increasingly more predominant and each MD has there own take on it-nevertheless it is sad to see that the label of psychosis seems to be labeled with predisposed factors excluding the synthetic THC-I hope drug awareness will begin to encompass these sequential outcomes which are devastating to family members related to pts that have used the synthetics for recreational or medicinal purposes-

  5. the word needs to get out to the teenagers about this stuff. my brother used spice in order to still get a high while on probation and pass his drug test, he is 16 and has been in a mental health hospital for now 6 months and counting, his pshycosis only seems to get worse and is not improving. he thinks the devil is trying to posses him. they call it a drug induced pshycosis and said that during one of his uses he had a stroke that damaged very important parts of his brain. teens need to be warned that this can happen to them and how easily, as for my brother, I pray every day that he can come back to us.

  6. I smoked spice non-stop everyday for about 8 months. I was unaware of the dangers it could cause. Since its legal, I assumed it couldn't be that dangerous. I ended up going into psychosis. I had suicidal ideations, physically began hurting myself, lost a ton of weight due to lack of eating, and became extremely paranoid and anxious. I completely lost my mind. I eventually had a seizure and went to the hospital. I told my mom everything and I checked into a residential rehab program for 35 days. This made it a lot easier to not just go out and buy more. Its a crazy and dangerous drug and needs to become illegal.

  7. currently dealing with the addiction,experiencing symptoms of psychosis,just dont know how to ask for help yet.

    1. Just reading this. Did you get help?