By Elvia Malagon – Chicago Tribune
April 6th, 2018
Synthetic pot for years was sold under the guise of a cheaper alternative that allows users to dodge drug screenings.
And while there have been rashes of hospitalizations nationwide involving those who’ve ingested fake weed, experts say they’ve never seen the severe side effects — internal bleeding in particular — that have killed at least two and sickened dozens in the Chicago area and central Illinois in the past month. Investigators say that while users have been smoking different brands of the synthetic marijuana, the common ingredient that may be leaving people ill is rat poison.
The problems are the result of a cat-and-mouse game playing out among government entities passing laws to ban synthetic pot and manufacturers tweaking their recipes to keep the drug on the market — and money in their pockets, experts say.
The rat poison likely is to blame for the horrible side effects: internal bleeding, severe bloody noses and bleeding gums, according to the Illinois Department of Public Health. Officials and experts say this underscores the dangers of using synthetic cannabinoid products: Often the man-made drugs are manufactured and packaged under clandestine operations without being tested or otherwise scrutinized like legal medications that go through years of testing on animals and then people.
Typically, synthetic pot is created by spraying chemicals onto plant matter to make it look like real marijuana leaves. It is then packaged by manufacturers and, although bans are in place in Illinois and Chicago, it still makes its way to gas station and convenience store shelves. Officials say those sickened in Illinois were using different brands; still investigators are trying to trace whether it’s possible that the drug is from a single source.
The Centers for Disease Control and Prevention was sending a team to help the Illinois Department of Public Health in its medical investigation into the outbreak. Ninety-five people, two of whom died, have been hospitalized since early March as officials continued to seek answers in the outbreak, according to the state department. Most of the sick patients are 25 to 34 years old.
Synthetic cannabinoid is a man-made mixture of hundreds of chemicals that affect the same brain cell receptors as the active ingredient in marijuana — commonly known as tetrahydrocannabinol or THC — that causes people to get a euphoric high. Often sold and branded as “K2” and “Spice,” synthetic marijuana is typically sprayed on a plant material to be smoked, or it can be sold in a liquid form to be used in e-cigarettes or vaping devices, according to officials.
Many states, including Illinois, have passed laws to keep the substance off the shelves, but experts say manufacturers are constantly tweaking the formula to skirt laws that prohibit certain chemicals. In fewer than 10 years, the types of synthetic cannabinoid formulas jumped from two in 2009 to more than 80 in 2015, according to a report from the U.S. Department of Justice.
But once a law is created, manufacturers work to come up with a different formula in hopes of producing a drug that is legal in some cities and states, said Michael Baumann, a researcher who studies drug affects on the body for the National Institute on Drug Abuse. And manufacturers of the chemicals, often made without oversight overseas, consult scientific articles to see which compounds affect the same brain cell receptors as marijuana, he said.
“It’s hard to know exactly what substances are on the street at any given time,” Baumann said.
In Chicago, a city ordinance banning synthetic marijuana has been in place since 2011. The ordinance lists specific substances and then bans any other “non-prescription substance that has a chemical structure and/or pharmacological effect substantially similar to the active ingredient of marijuana, or tetrahydrocannabinol (THC).” There are also federal laws addressing synthetic drugs.
The Illinois Poison Center has continued to log cases of people becoming sick because of a synthetic cannabinoid product. There were 131 cases in 2015, 84 cases in 2016 and 51 in 2017, according to the agency. Since January, the agency has logged 101 cases statewide.
Chicago Ald. Edward Burke said he thinks the ordinance has been effective. In the wake of the outbreak, the city has made checks across the city at local retailers. But like any other illegal activity, Burke said there is a possibility of transactions happening from person to person.
“They’d be foolish to publicly advertise the products,” Burke said.
Chemists have been studying and developing synthetic cannabinoids as part of scientific research into how it could be used for medical purposes, said Paul Prather, a professor at the University of Arkansas for Medical Sciences. Prather, who has been studying the therapeutic use of synthetic cannabinoid, said the formulas haven’t been tested to determine side effects.
If you use “K2” or “Spice,” “You are the guinea pig ingesting it into your body to see what happens,” Prather said.
Prather said people use synthetic pot because it’s relatively cheap and isn’t detected on drug screenings, such as th
ose sometimes required by employers.
In the recent outbreak, multiple brands of synthetic marijuana products have so far been linked to those who became sick, the state department of health said. It’s possible that the tainted synthetic cannabinoids ended up in different packaging under various brand names, according to the agency.
The Illinois outbreak is the first time Baumann and Prather have heard of severe bleeding as a side effect. Baumann said the outbreak is a sign of the lack of oversight in the manufacture and packaging of the substances.
Of the dozens who fell ill in Illinois after using synthetic pot, at least nine tested positive for brodifacoum, more commonly known as rat poison, according to state officials.
Exposure to rat poison causes the body to block its natural use of vitamin K, which helps in the process of blood clotting, said Dr. Patrick Lank, a medical toxicologist who works at Northwestern Memorial Hospital. A person who has been exposed to this type of poison would have to take vitamin K for weeks to months to help manage their symptoms.
In Chicago, hospitalized users have tested positive for brodifacoum, said Dr. Allison Arwady, chief medical officer for the city’s department of public health.
Most of the Chicago patients have had blood in their urine and stool. Others have complained of abdominal pain, a possible sign of internal bleeding, Arwady said. Patients started seeing symptoms within days of using synthetic marijuana, but city officials are logging information about their use of synthetic marijuana for the past three months as they seek answers to the outbreak.
Most of the patients across Chicago smoked the fake pot, while others vaped the drug or drank it in tea, she said. Some bought the substance at a convenience store, some got it from a friend while others bought it from someone who sells other drugs.
Health officials and law enforcement officials have been talking to the patients as they try to piece together the network distributing the products.
Authorities have already charged in federal court the owner and two workers of the King Mini Mart at 1303 S. Kedzie Ave. in Lawndale after an undercover officer bought synthetic marijuana sold under names like “Blue Giant,” “Crazy Monkey” and “Matrix,” according to a federal complaint. Fouad Masoud, the owner of the mart, and employees Jamil Abdelrahman Jad Allah and Adil Khan Mohammed each face a federal charge of conspiracy to distribute a controlled substance. The store sold $10 packets containing 4 to 5 grams of synthetic pot, according to court records.
Investigators began looking into the Lawndale convenience store after someone who had purchased synthetic pot there got sick. Two of the seized products were sent to a laboratory operated by the U.S. Drug Enforcement Administration, which detected brodifacoum among the other chemicals, according to court records.
As the number of hospitalizations continued to increase, Arwady urged synthetic marijuana users to seek medical attention at the first signs of bleeding. Even minor bleeding can turn into something serious, she said.
“One person might get a very large dose, one person may get the small dose,” Arwady said. “And all of that would affect the time that it would take to notice the symptoms. We know that the folks coming into care might be only a small percentage of people who have been exposed to it.”