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Weeding Out The Imposters

Richard D. Donze, DO, MPH

You may applaud or mourn the way comedian, socio-political commentator and current radio show host Dennis Miller has changed his political views over the course of his career, but I've always enjoyed his funny-yet-poignant rant a few years back about drugs and drug abuse. Here are a few memorable excerpts:

"I don't do drugs; I'm not against them, I've just never found anything strong enough to quell my exquisite psychic pain."

In other words, forget safety and legality, and focus on the fact that none of these substances works well enough to completely negate whatever it is that is making us unhappy.

Here's another comment about how our distraction with some illegal substances leads us to disregard the reality that other legal ones are remarkably more hazardous:

"And you know, the war on drugs is more often than not fruitless and patently hypocritical. Be honest with yourselves now. What drugs are the most dangerous to the most Americans? It's a no brainer: cigarettes and alcohol. Those are the statistical champions by hundreds of thousands of deaths."

True enough. Smokes and booze and all their attendant health risks are readily available to anyone over age 21. In that context, the illegality of non-prescription cocaine and cannabinoids seems strikingly arbitrary, perhaps more related to what has historically been socially acceptable or stigmatizing than to a sober (pun intended) assessment of relative harm.

In addition to the hypocritical nature of the "war on drugs, here's Miller on its ultimate pointlessness:

"I'm not pro-drug, they obviously cause a lot of damage, but I am pro-logic and you're never going to stop the human need for release through altered consciousness. The government can take away all the drugs in the world and people will just spin around on their lawn until they fell down and saw God."

This is an observable reality, whether it was prehistoric cultures experimenting with fermenting recently-domesticated cereal grains and fruits to yield the earliest forms of beer and wine or the more modern use of so-called "fake pot."

Fake pot?

That's right. Some of the latest ways that the altered consciousness seekers are seeking it is with synthetic cannabinoids -- substances originally created in laboratories by legit scientists studying what certain cannabis-like chemicals do to certain brain receptors and behavior. Their official chemical names are a bit of a mouthful, so here are their short-hands: JWH-073, JWH-018, JWH-200, CP-47,497, and cannabicyclohexanol. A more familiar term for this class of substances is "k2."

Legal chemicals designed to relieve human emotional suffering are nothing new; just check the long line of antidepressant serotonin-level-tweakers. But the weed wannabes busted out of the lab a little prematurely to become the latest party drugs, simultaneously helping the partiers stay a step ahead of the law and the forensic laboratories that were still testing for the familiar tetrahydracannabinol (THC) found in marijuana.

Boomers that came of age in the 60's (many of whom are now in their 60's) may be crying "foul." Say what you will about marijuana, it at least had a "back to the earth" feel about it that felt right (in more ways than one) to that generation; I mean, you could grow it in your own back yard, cure it in your own home and roll it in your own paper. Easier in some ways than homemade beer and wine. The synthetic stuff is a far, artificial cry from that natural high, although the chemicals are often used to spike plant materials making them look like dried marijuana and earning them names such as "Herbal Incense" and "Spice."

Unfortunately, the high from using these drugs isn't always a sleepy mellow mood and intense pizza craving; poison control centers and emergency departments report a wide range of undesirable health effects, including but not limited to agitation, anxiety, vomiting, rapid heart rate, elevated blood pressure, seizures, hallucinations and psychotic episodes. Withdrawal, suggesting true dependence, can also be part of the picture.

The law is now catching up. The FDA has declared that the synthetic cannabinoids are not approved for human consumption; and earlier this year the federal Drug Enforcement Administration added them to their schedule of controlled substances, saying they had no legitimate medical uses and making it illegal to manufacture, sell or possess them.

Forensic laboratories are catching up, too, kind of; they can now test for some of the most commonly-used chemicals of the group, but not all of them. This means that only a positive test can confirm use, but a negative test does not rule it out. Another problem is that with such a large number of chemicals in this class, any given sample of k2 or Spice or Herbal Incense may contain different cannabinoids; if it happens to be one of the undetectables, the test will be negative. The bottom line is that uncovering synthetic cannabinoids in the tissues and body fluids of suspected users is still something of a work in progress, and not really ready for prime time.

Of course, these attempts to control the use of fake pot with laws and deterrent drug testing programs won't eliminate the quest for the undetectable high. Hoping that we can one day check synthetic cannabinoids off the list begs the question, "What will be next?" The answer is already here in the so-called "bath salts" -- synthetic stimulant crystals with hallucinogenic properties that resemble a bad combination of cocaine and methamphetamine. Like artificial marijuana, bath salts have lit up the poison center telephone lines and put users in E.R. beds all across the country, and the severe paranoid reactions and suicides have caused some states to outlaw them (the feds may do the same shortly).

If there's always an answer to "What's next?" some cynics might ask "What's the point?" (that is, of trying to control the yearning for "release through altered consciousness"). Here's Dennis Miller with one approach:

"If somebody wants to shoot up and die right in front of you, more power to him, you know? It's his call. And you know the herd always has a way of thinning itself out."

If there were no family and friends in pain and no healthcare system burden, this might be a way to deal with the individual user in the privacy of his bathroom or bedroom. Unfortunately, employers and occupational medicine physicians can't ignore someone attempting to make his/her contribution to herd-thinning before climbing behind the wheel of a tractor trailer or school bus or operating a crane or soldering a circuit board. Since we can't reliably or consistently distinguish responsible from irresponsible use, in that elusive balance between personal freedom and public good we have to err on the side of the latter at the expense of the former and assume all use is potentially dangerous.

The historical record supports Dennis Miller's assertion that the search for and creation of psychoactive substances are as old as human culture itself. In all likelihood, then, the pleasure-seekers will continue to seek while the law, laboratories, employers and their occupational health providers will continue to chase. It's the good fight for safety so we have to keep fighting it. And if some day the only formula for ecstasy is spinning around on the lawn, at least we can feel secure that the spinners will be too dizzy to drive.

Last Updated: 11/28/2011