Spice: The Ongoing Public Health Emergency

Referred to by one English Police and Crime Commissioner as “the most severe public health issue we have faced in decades”, Spice is one of a group of synthetic cannabinoids whose notoriety is growing by the day.

Also known by a host of another brand names, this flaky mixture of herbs and synthetic laboratory-manufactured chemicals has been around since the mid-noughties. 

The drug contains variations of a synthetic compound developed in the 1980s, known as JWH-018. The latter was an experiment aimed at understanding the effects of cannabis on the brain. The main psychoactive chemical in cannabis being tetrahydrocannabinol (THC) which acts on particular receptors in the brain.

Despite its notoriety now, it is only really within the past couple of years that Spice and other synthetic cannabinoids have become a high-profile issue. Its prevalence is partly to do with its low cost. Less expensive because it is far more potent, meaning up to three times more THC can be found in one gram of Spice compared to the same amount of cannabis. Like cannabis, it can be smoked with tobacco, eaten and taken as a drink like herbal tea.

Synthetic cannabinoids do have some similar effects to cannabis, such as creating a feeling of contented euphoria, or physical reactions such as hunger or giggling. However, it can have far more damaging effects due to being much more addictive and, given the higher concentrations of THC, it is much easier to overdose. Marc Jones, the Police and Crime Commissioner for Lincolnshire quoted in the introduction to this piece, said he regularly witnessed Spice users in semi-conscious or aggressive states. Meanwhile, NHS researchers have reported heart attacks, strokes and even users with damaged organs such as the kidneys and liver. Psychosis is another side effect. 

In May 2016, the importing, supplying or selling of the drug was made illegal under the UK government’s new Psychoactive Substances Act.

Why synthetic cannabinoid addiction is harder to treat than ever 

The result of the ban, rather predictably, was to force the supply of the drug underground, making Spice far more difficult to trace for law enforcement agencies. It also means medical staff are unsure of what the drug contains (since Spice and other synthetic cannabinoids can often contain a number of different synthetic psychoactive substances, with its chemical make-up altering with each new batch). Recent reports revealed a batch of LSD had been found to have been dipped in Spice, for instance. A particularly powerful crystal form of the drug was also discovered last year.

Another challenge is that synthetic cannabinoid use tends to be most prevalent in groups who are more difficult to trace and treat such as homeless individuals and those in prison. The latter has become a breeding ground for Spice users, with some prison officers reporting up to 12 synthetic cannabinoid-related overdoses within a period of 24 hours.

The prevalence of synthetic cannabinoids and the damage done in comparison with cannabis is putting a huge strain on NHS resources. The ever-changing chemical makeup of the drugs batch-by-batch makes it incredibly challenging to treat people who have overdosed, and drug treatment services are hugely underfunded and therefore undertrained and ill-equipped to deal with the volume and complex needs of service users. The NEPTUNE clinical guidance on the treatment of club drugs and Novel Psychoactive Substances (like synthetic cannabinoids) is a fantastic resource, but staff need to be given the time to undertake the training. Greater funding provision is also needed to support innovation: the ‘manufacturers’ of synthetic drugs are constantly innovating and in this public health crisis, treatment providers can’t risk being left behind.