Fake it till you make it

It looks like cannabis, it has cannabis in the name, but is synthetic cannabis really cannabis? James Robinson investigates the health effects of and policy responses to fake pot.

It was 2009. Adam Winstock, a London-based addiction psychiatrist and author of the Global Drugs Survey and Drugs Meter, walked into a coffee shop. Next to the fruit juices were little shiny silvery packs of something called Spice, a synthetic cannabis product. This was new to him.

Winstock was a bit startled. He kept seeing synthetic cannabis after that. The packets claimed a high that was natural and harmless, but considering the effects it was claiming, the ingredients didn’t check out. Something didn’t feel right. As the old adage goes, if it sounds too good to be true, it probably is.

“It was not something I saw being used by my patients or smelled on the way to work but I saw it everywhere, and it was cheap,” Winstock said.

Even as an international drug addiction expert, his first reaction – confusion with a dash of intrigue – mirrors that of most people.

It looks like cannabis, is smoked like cannabis, acts on the brain in the same way as cannabis … but somehow isn’t technically cannabis, allowing for it to be bought over the counter without the risk of so much as a sideways glance from an officer of the law.

In short: pot is illegal, this isn’t. What gives? In science, as in life, to synthesise is to imitate. In the world of synthetic cannabis, cropping up in various guises and blends across the world since 2004, things both are and aren’t what they seem.

The short history of synthetic cannabis has shown us that, in a new era of drugs – defined by the quest for the legal, consequence-free high – complications are forever myriad. 

Okay, we get it. It’s a whole other thing to cannabis. But what is it then?

When someone smokes cannabis, the sensation of being high comes from compounds in the cannabis plant, the primary one being THC (considered a ‘cannabinoid’), reacting against two known ‘cannabinoid’ receptors in the brain. These receptors are part of an entire section of our wiring that regulates appetite, pain, mood and memory.

Cannabinoids occur naturally in the cannabis plant. Our body produces them. And, eventually, certain entrepreneurial chemists figured how to manufacture them.

As Dave Allsop, a lecturer at the National Cannabis Prevention and Information Centre at the University of New South Wales, describes, the receptors in the brain that cannabinoids interact with were only discovered in the 1980s. An explosion in research followed, examining how this part of the brain worked and the possibilities for new chemicals.

In 2013, there are thousands of synthetic cannabinoids, structurally similar to THC and affecting the same parts of the brain, sprayed over a benign mix of herbs and sold legally as synthetic cannabis, which is then rolled up and smoked in exactly the same manner as the old fashioned illegal stuff.

The first riddle with synthetic cannabis comes in its definition. Natural cannabis is a single defined thing with risks and effects that can be mapped and expected. Synthetic cannabis is a jumbled, mixed bag of chemicals that vary in impact and potency. 

I think I get it. But for how long have people been doing this?

Humans have been smoking cannabis since the discovery of Mother Nature and a sense of their own imagination. Synthetic cannabis is a newborn baby in comparison. According to Ross Bell, Executive Director of the New Zealand Drug Foundation, the first synthetic cannabis product, Spice, hit New Zealand in 2006. Our own Matt Bowden, considered the godfather of legal highs thanks to BZP, jumped into the market with Aroma.

In New Zealand, Bell said, Spice and Aroma slipped in under the radar. Concern lay more with BZP, legal ‘party pills’ that mimicked the effect of ecstasy.

“All attention was on BZP, and Spice wasn’t causing any problems. Control in the market has largely been driven by community concern,” Bell said.

The first visible signs of synthetic cannabis internationally were spied in Europe in 2004, according to Stephen Bright, who teaches addiction studies at Curtin University in Australia. Spice arrived on the market and became a popular subject on internet forums. It made the bold claim to get someone high solely through natural ingredients. The psychoactive ingredient was later revealed to be a synthetic cannabinoid named JWH018, a substance so nearly identical to THC in chemical structure and effect that it was outlawed in many countries, including New Zealand. 

How much harm could synthetic cannabis cause?

The history and prevalence of cannabis use over decades gives it little mystery. But in synthetic cannabis’s short history, there has been little time to study its impacts, and what we do know already isn’t great.

In the intervening years since discovering the drug, Winstock has helped to publish several pieces of research on the use and risk of synthetic cannabis. One part of this work, run in the journal Human Psychopharmacology, was a 12-month study on the adverse effects of synthetic cannabis. Winstock was shocked that one in 40 people surveyed who had used the drug had sought emergency medical attention because of it.

“That’s an insane hit rate.”

University of New South Wales’s David Allsop stresses we’re still getting to know what impact synthetic cannabis has, but certain assumptions can be made.

“I don’t think you get many people presenting to an emergency department with cannabis complications, but synthetic cannabis is bringing them in,” he said.

Allsop said part of the issue as he sees it is that the cannabinoids in synthetic cannabis completely activate the receptors in the brain that these drugs work against, whereas THC only partially activates them, making for more potent and incapacitating highs.

For Bright, it is distressing that synthetic cannabis is producing health risks that are not associated with cannabis use itself. He said early case reports have shown people reporting to emergency rooms experiencing psychosis or seizures, whereas cannabis contains a natural anti-psychotic, and THC works as an anti-convulsive.

“Cannabis has been used for

thousands of years. We know the effects. With the synthetic version, thousands of people have unwittingly become lab rats in this global mind experiment. To be sold like this, other drugs would have to have gone through thousands of hours of clinical trials.”

What attracts people towards these legal highs? Isn’t this just a market created by prohibition?

Synthetic cannabis is used by disparate sectors of the market.

Winstock said that, after synthetic cannabis jumped onto his radar in the UK, he started asking shopkeepers about who was purchasing it. Prisoners on weekend release would buy it, he was told, because it would not be detected in drug tests.

Synthetic cannabis sales were said anecdotally to spike when the cannabis supply dried up in town. Winstock saw synthetic cannabis had the potential to be attractive in rural and remote areas without organised crime and drug trade.

“When you ask people what are the reasons for smoking synthetic cannabis, the top four reasons are that there’s no other drugs, drugs are of poor quality, you can get them online or they’re better value for money. No one said they are buying these because they think they’re safer,” Winstock said.

Bright saw workplace drug testing as a huge driver of synthetic cannabis use. He remembered one of the first stories on synthetic cannabis in Australian media on Triple J FM, where people were calling in to discuss the drug. A number of callers talked about workers on mining sites smoking something similar to dope.

“People want drugs. They want legal drugs,” Bright said.

“Put simply, if tomorrow a government regulated cannabis, MDMA and magic mushrooms, there would be very little demand for products outside of that.”

Bell said a regulated synthetic drug market is always likely to exist, in line with the varied demands for drugs that don’t seem to be abating.

“There’s this smorgasbord of highs that people want,” he said.

The snag in this developing market is that people don’t really seem to enjoy smoking synthetic cannabis. Bell said he’d seen this talked about anecdotally on message boards where drug users share their experiences. Winstock said that, in a survey of 850 people who had smoked both real cannabis and the synthetic version, 93 percent said they preferred the real thing.

Use of synthetic cannabis also falls well behind the real thing. In Winstock’s research, he said, amongst people responding, the average amount of cannabis use was 16 days, where it was a day or two with synthetic cannabis.

“It’s easy to buy cannabis. It’s high potency. You kind of think, well, why would people want to smoke this other stuff?”

How have policy makers responded to all of this?

Internationally, response to synthetic cannabis has worked how drug policy has for a century. “We identify bad drugs and then we move to ban the drug,” Bright said.

But in 2013, chemists can make new derivatives of synthetic cannabis and bring them to market faster than they can be made illegal, creating what Bright labelled a “whack-a-mole effect”. You ban one and others pop up immediately, with the replacement versions often more potent and harmful than the ones before.

In 2009, European drug monitors identified 24 drugs. In 2012, that number was 72. “It is increasing rapidly,” he said.

It is against this backdrop that the 2013 Psychoactive Substances Act in New Zealand represents a new step in drug legislation. It seeks to regulate the market for synthetic cannabis and other new drugs that hit the market by forcing manufacturers to go through testing to prove the product is “low risk”. If that product was on the market 28 days before the law went into place, it is granted an interim licence while it undergoes the tests.

Bell said this Act is not the result of a progressive government, rather that New Zealand ran out of patience faster.

“We, like everyone else, went through a cycle of banning these. But the chemists will always be a step ahead of the legislators,” he said.

For Bell, defining harm is the big unknown. The law doesn’t determine the criteria. It creates a group of experts to do that who will set benchmarks to examine the risks of harm and addiction, a process that will likely involve a mix of lab tests, chemical analysis and animal and human trials.

“In theory, it is a good piece of law, but we haven’t had it under operation long enough yet to know.”

Successful implementation will be key to its success, Bell said. The Act needs to be enforced well, and local councils need to be on their game to utilise provisions in the Act giving them the power to take specific actions like banning sales near schools.

Why don’t we just move to shut all synthetic cannabis products down?

People first started experimenting with synthetic cannabinoids to explore the health benefits, UNSW’s David Allsop said. Research is still in its infancy, he said, but it is believed synthetic cannabis could one day have applications in treating cancer, multiple sclerosis, inflammation, posttraumatic stress disorder and anxiety.

Bright said that early evidence had shown that synthetic cannabinoids could help reduce the brain plaque that causes Alzheimer’s disease.

“But the consequence of everything that has happened so far is that research on these drugs has decreased because of the stigma around them,” he said.

Most importantly, though, in New Zealand, we’ve been afforded a chance through drugs like synthetic cannabis to re-examine how we think about the wider drug issue as a whole.

“If most New Zealanders are given the opportunity to get high, they’re going to take it. That’s the benefit of a regulated market. The industry comes clean about the chemicals, and groups like us, the New Zealand Drug Foundation, can get good prevention messages out,” said Bell.

“If we’d taken an approach more like this 40 years ago – looking at it through a health rather than a criminal mindset – things would have been different. Instead, up until now, we’ve been left with a smorgasbord of laws for a smorgasbord of drugs.”

James Robinson is a San Francisco-based journalist.