Tag: synthetic cannabinoids

08/31/18

A Spectacularly Bad Idea

 

credit: DEA photo

Fox News and The Washington Post reported that over the course of 24 hours in New Haven Connecticut on August 15, 2018, more than 70 people overdosed on synthetic marijuana. Most of the overdoses happened on the New Haven Green, a historic park bordering the Yale University campus. By late morning on Friday August 17th, the Hartford Courant reported the overdose figure had increased to 114. Some individuals were taken to the hospital four or five times for overdose treatment. After the number of overdoses reached thirty, the New Haven police chief told a local TV station to warn residents to not come down to the Green to purchase K2. Although his announcement makes good common sense, I wonder if a few individuals went down to the Green to see if they could get some K2 after hearing the warning to stay away.

The New Haven Fire Chief said even while they were trying help people, others nearby would pass out or fall to the ground. The situation was unlike anything the emergency workers had faced before. “This is the highest number of victims in the shortest amount of time.” The Washington Post reported that at one point, a shout interrupted a news conference with the fire chief to alert authorities of another overdose. Reporters were tweeting from the Green about the number of people falling “down of the green.” An EMT lieutenant said:

This was a particularly odd, rare occasion where (there was) call after call for man down, obviously with symptoms of some kind of overdose, and at the time of getting that patient packaged and transported to the hospital, we’d see another immediately fall down, right there. . . . At that point, we’d go help that patient, and while helping that patient, another person went down.

Most people were treated at local hospitals, but a few individuals refused to be transported. Fortunately, no deaths had been reported by late Wednesday. As people left the park Wednesday night, things quieted down. A police officer said most of the people who overdosed were lower-income or homeless (K2 is cheap). Officials speculated someone might have been passing around free samples. “One of our fears is that this isn’t over.”

By Thursday night, police had arrested three suspected dealers. The police chief said it appeared at least one individual was passing out free samples in an attempt to stir demand and build a clientele. Early reports said the K2 was mixed with fentanyl, but emergency medical personnel said some patients treated at the Green did not initially respond to naloxone, and had to be given a higher dose of the drug at the hospital. The police chief said Friday that samples they collected and tested contained Fubinaca, a novel synthetic cannabinoid. By midday Friday the 17th, new reports of overdoses had come to a halt.

AB-Fubinaca was originally synthesized by Pfizer in 2009 as an analgesic, but then never developed for human use. In 2012, it was found to be an ingredient in synthetic marijuana being sold and consumed in Japan. The U.S. designated Fubinaca as a Schedule I controlled substance in January of 2014. It has a similarly illegal status in the U.K. and Germany.

The physical effects from Fubinaca include sedation, loss of motor control, vertigo and a sense of falling, dehydration, dry mouth and nausea. Users can experience anxiety, paranoia, psychosis, auditory hallucinations or distortions. Negative cognitive effects can include unconstrained wandering thoughts (thought connectivity problems), thought deceleration, and difficulty processing information logically (analysis suppression).  There have been previous reports of multiple hospitalizations and deaths due to its use.

The New England Medical Journal published an article on a “zombie” outbreak caused by Fubinaca in Brooklyn on July 12, 2016. First responders reported bystanders described multiple persons at the scene as zombielike. Media reports said 33 persons were exposed to Fubinaca, 18 of whom were transported to two local medical centers. Pharmacologic studies indicate Fubinaca is 85 times as potent as THC and 50 times as potent as JWH-018, another synthetic cannabinoid found in earlier outbreaks of K2 products. “The potency of the synthetic cannabinoid identified in these analyses is consistent with strong depressant effects that account for the ‘zombielike’ behavior reported in this mass intoxication.”

The Harford Curant reported the Fubinaca-laced K2 was very short acting. People who used it went down fast, “almost right in their tracks.” Drug users who are regulars at the Green described what happens as “falling out.” Many of them had to be resuscitated, but the effects did not last long, and so they were quickly discharged from the hospital. “Which meant they were able to return to the green and seek another high.”

The Guardian reported the director of homeless care at a local health center, Phil Costello, often works in the Green from a temporary office in a tent. He said: “That batch that came in yesterday, with all the people falling out, has just made this basically a mass casualty incident.” Costello is a nurse, but is known as “Dr. Phil” by the hundreds of homeless who frequent the Green. “Everybody knows each other and they try to take care of each other the best they can.” He said on a normal day, perhaps one or two people would need emergency medical care because of drug use.

This is not just a New York and New Haven problem. In July of 2018 the FDA warned there were reports of severe illnesses and deaths from synthetic marijuana products containing brodifacoum, “a very long-acting anticoagulant commonly used in rat poison.” Brodifacoum poses a severe health risk because it can cause severe bleeding. Hundreds of individuals across 10 states—many in the Midwest—have been hospitalized or died. The Chicago Tribune reported on April 10, 2018 that more than 100 persons were sickened and at least three people died from synthetic marijuana containing brodifacoum. More than half the stricken people were from the Peoria area.

People using synthetic marijuana products should be vigilant for signs of bleeding and should immediately seek medical treatment. The FDA is also concerned with potential harm of donated blood products, as they have received several reports of donors who used synthetic cannabinoids containing brodiacoum. “Because of its long half-life, the bleeding risk from brodifacoum, which prevents vitamin K from being reused within the body, can persist for weeks.”

Scientifc American reported a brodifacoum expert said there have been previous reports in the scientific literature of drug users ingesting the rat poison to prolong their high with marijuana or cocaine. “The toxin ties up liver enzymes that metabolize drugs, extending their effects.” The adverse symptoms experienced by users indicate high levels of exposure to brodifacoum, making accidental contamination unlikely. “We don’t know the exact doses these people are getting, but it’s a lot.”

Authorities have arrested a convenience store owner in Chicago for allegedly selling some of the contaminated material linked to the current poisoning outbreak. Bruce Anderson, executive director of the Maryland Poison Center, says he was told the poisoned Maryland resident purchased the product that made them ill “at a local store.” He warns these substances are poorly understood, and can be perilous even when not tainted; the new cases comprise the latest chapter in an ongoing public health crisis, as people increasingly chase a buzz from numerous chemicals developed for scientific research and readily available on the internet or dark web. “None of these products have ever been tested on humans,” Anderson notes. “Using them is a spectacularly bad idea.”

03/24/17

Not Meant for Human Consumption

© dvarg | stockfresh.com

In September of 2015 federal and city authorities raided around 80 locations throughout NYC in a crackdown on the importation, distribution and sale of synthetic cannabinoids. Ten people were indicted and a minimum of 100 kilograms of illegal synthetic compounds was confiscated. This was enough to produce 260,00 retail packets with a street value of near $30 million. The operation imported the compounds in powdered form from China through commercial delivery services (like UPS and Federal Express). Then in a Bronx processing facility, the compounds were mixed with solvents and sprayed onto tea leaves.

Most of the ten individuals indicted were of Yemeni descent; four were still at large at the time of the raid. One of the indicted, but at large, individuals seems to have tipped off his operation in July of 2014 when he was stopped for using a cell phone while driving. He consented to a search of his vehicle, where DEA agents found $644,338 IN CASH. When his Queens home was searched, they found an additional $150,935.

The agents say they then read Deiban his Miranda rights but that he nonetheless told them the greater sum came from the sale of synthetic narcotics and was bound for a store in the Bronx. They also say Deiban said the smaller sum came from Bronx and Queens stores that sell his synthetic pot.

He also boasted about selling his products over eBay. He was questioned about a number of keys he had on his person, some of which he said belonged to a warehouse where he stored his synthetic marijuana. But he was not willing to tell DEA agents the warehouse’s address unless the DEA agents guaranteed he would not go to jail. The case was settled in November of 2014. Under the terms, Deiban did not admit to any of the allegations and he was repaid $477,163.80 of the seized money.

Instead of counting his blessings, Deiban allegedly sought to make more dough. The September 2015 complaint says that in the past year, Deiban and his cronies imported at least 220 pounds of banned powdered substances used to make K2 or “spice”—enough to manufacture at least 260,000 packets.

The above incidents really happened, even though they seem to be suspiciously like an Onion satire of really dumb drug dealers. You can read the Department of Justice announcement of the September 2015 indictments here. Additional information noted above can be found in an article on The Daily Beast here and a New York Daily News article here.

This isn’t the first time there has been a Yemeni connection to the sale and distribution of synthetic cannabinoids in the U.S. In 2014, a raid on a Birmingham Alabama warehouse found hundreds of thousands of Spice (synthetic marijuana) packets. Sales of the product were linked to $40 million in wire transfers to Yemen. Read more about this in “Strange Bedfellows: Terrorists and Drugs.”

If you aren’t too familiar with Spice and other so-called new psychoactive substances (NPS), here are some key facts from a World Health Organization “fact file on new psychoactive substances.” There are more than 500 different types of NPS recorded as of March of 2016. The number of NPS as of October 2015 was 602, 55% higher than in 2014. By December 2015, that total would rise to over 644, according to the UNODC Global SMART Update. The most common NPS are synthetic cannabinoids, which mimic the effects of THC, the main psychoactive ingredient in marijuana. “Collecting information on new psychoactive substances is difficult due to the sheer number and speed with which they appear on the market.”

The UN Office on Drugs and Crime (UNODC), the lead agency in international drug control, has identified nine groups of new psychoactive substances. These include synthetic cannabinoids, which mimic the effects of the main psychoactive substance of cannabis, THC; synthetic cathinones, which have stimulant properties and induce feelings of empathy; and phenthylamines, which have stimulant and hallucinogenic properties. Of new psychoactive substances reported in 2014, 39 per cent were synthetic cannabinoids; 18 per cent were phenethylamines and 15 per cent were synthetic cathinones.

UNODOC publishes a Global SMART (Synthetics Monitoring:  Analyses, Reporting and Trends) Update twice a year. Volume 16, published in September of 2016, said that synthetic drugs were one of the most significant global drug problems. As noted above over 644 NPS were reported from 102 different countries. “New NPS continue to emerge every year at an average rate of about one substance per week, making research and monitoring activities critical in improving understanding of the dynamic nature of the problem.” You can download a copy here.

NPS are diverse in terms of their effects and chemistry. Those identified so far seem to mimic the effects of the six main groups of substances controlled under international drug conventions. The six groups are: opioids, synthetic cannabinoid receptor agonists, dissociatives, like PCP, classical hallucinogens like LSD, sedatives/hypnotics like diazepam, and stimulants like cocaine and amphetamine-type stimulants. The following pie chart from the Global SMART Update illustrates the proportion of NPS by their pharmacological effect. The chart indicates how the three NPS noted above, synthetic cannabinoids, synthetic cathinones, and phenthylamines account for 88% of the total proportion of NPS indentified by December of 2015.

A major area of concern is with the unknown adverse health risks associated with using NPS. Obtaining health-related and toxicological data is crucial for making scheduling decisions with NPS. Synthetic cannabinoids have been linked to both fatal and non-fatal intoxications, along with seizures, tachycardia and hypertension. Synthetic cathinones like MDPV have been associated with severe agitation, violent behavior, tachycardia, psychosis paranoia and fatal intoxications. Dangers are accentuated by intentional mislabeling of products, as was noted above, as well as their unknown purity and composition.

The internet is an important distribution channel. It provides easy, anonymous and low-risk supply of NPS. Not to mention the high rewards to suppliers and retailers. Websites may be in different countries from those where the NPS are manufactured and/or where they are supplied. “The disparity of laws in various regions poses a challenge in adopting a comprehensive approach for the prosecution of violations.” Then there is the sale of products on the darknet, which is only accessed by anonymizing software.

The number of NPS and the rapidity with which new ones emerge presents a challenge to drug control systems. Placing a potentially harmful substance under legal control can be a lengthy process of evidence-gathering and a scientific review of its harms. This means there is a time lag between emergence of an NPS and when legal control is implemented. “NPS manufacturers o en exploit this inevitable me lag by developing and marketing alternative substances to circumvent established controls. “

In the U.S., the 2016 National Drug Threat Assessment (NDTA) reported that NPS are available throughout the U.S. The two most common are synthetic cannabinoids and synthetic cathinones. Although synthetic cannabinoids are usually ingested by smoking, they are also available as a liquid or oil to use in e-cigarettes or vape pens. In 2015, synthetic cannabinnoids were found in counterfeit Xanax bars. Calls to the AAPCC, the American Association of Poison Control Centers, totaled 7,779. This was a 111% increase over 2014. This was the highest number of calls recoded since the drugs first appeared on the market. See the following figure taken from the 2016 NDTA.

Inmates in prisons and jails use synthetic cannabinoids because they aren’t typically tested for in mandatory drug screens. “The drugs are also difficult to detect during screenings by prison officials and narcotics dogs.” Liquid cannabiniods are sprayed onto paper products, like greeting cards or letters, and then dried. When successfully smuggled into a prison, the drug-saturated pages are torn into small squares, then chewed or smoked. In October of 2015, the FBI issued a warning that synthetic cannabioids in prisons may result in inmates becoming agitated and aggressive.

The foil packets used to package synthetic cannabinoids can be purchased in bulk. The empty packets are already branded with various cartoon logos and brand names. The contents of the packets can vary widely. A DEA forensic lab tested 28 identical packets from one seizure in 2015. “The packets contained a total of seven different synthetic cannabinoids.” Many contained more than one variety of synthetic cannabinoid.

Ironically, the synthetic cannabinoid problem seems to have originated by classifying marijuana as a Schedule I controlled substance. In 1970, marijuana and its cannabinoids were given a Schedule I designation. This meant that marijuana was difficult to obtain for research on its therapeutic effects. Then John W. Huffman and his team of researchers at Clemson began developing cannabinoid compounds to aide in the research of multiple sclerosis, HIV/AIDS, and chemotherapy. Their research was funded by: the National Institute on Drug Abuse (NIDA).

Over the next twenty years, they developed 450 synthetic cannabinoid compounds. Some of those, including: JWH-018, JWH-073, JWH-210, JWH-250, and JWH-081 are among the dozens of synthetic cannabinoids on the streets today. Notice the compound names begin with Huffman’s initials: “JWH.” Like any self-respecting scientist, he published his research, which included step-by-step instructions on how to recreate the substances. Then around 2008, JWH-018 appeared in Germany as a recreational alternative for marijuana known as “Spice” and “K2.” Huffman said: “I always had a hunch that someday somebody would say, ‘Hey, let’s try smoking them.’ … These things are dangerous—anybody who uses them is playing Russian Roulette. . . . We never intended them for human consumption.”

11/8/16

This Stuff Is not Weed

38945846 - illustration of a not allowed icon with a marijuana leaf
© Juan Pablo Gonzalez | 123rf.com

Like a snowball that begins rolling down from the very top of a hill, negative consequences from synthetic drugs have been building momentum for several years. LiveScience posted an article based on a CDC report that highlighted the increase of synthetic-cannabinoid overdoses. Between 2010 and 2015 there were a total of 456 synthetic-cannabinoid intoxications recorded by 101 US hospitals and clinics included in the study. While the overdoses from these substances are still a fraction of all drug overdoses in the US, their percentage has increased every year since 2010.

The CDC report was based on data gathered from the Toxicology Investigators Consortium (ToxIC), a toxicology surveillance and research tool. The ToxIC Registry was established by the American College of Medical Toxicology in 2010. Of the 456 cases of synthetic-cannabinoid intoxication treated by physicians in the ToxIC, 277 reported synthetic cannabinoids were the only substance used. The findings of the CDC report are representative of what doctors in emergency departments from around the country are seeing.

Among the 456 cases, 70.6% were in persons aged 19-65 and 27.4% were in persons aged 13-18; 83.1% were male. The reported adverse effects were primarily cardiovascular-related (17.0%), pulmonary-related (7.6%) or central nervous system-related (66.1%).  The CNS symptoms included agitation, CNS depression or coma, and delirium/toxic psychosis. The annual percentage of cases increased significantly in all four US Census regions, except the South. “The largest overall increases during these periods took place in the Northeast, primarily driven by increases at the New York City sites.” See the chart below which was taken from the CDC report:

toxicThe CDC report mentioned a June 2015 Morbidity and Mortality Weekly Report (MMWR) for June 12, 2015 that found a 300% increase of telephone calls to poison centers related to synthetic cannabinoid use from January 2015 to April 2015. The report suggested that synthetic cannabinoids posed an emerging public health threat. The number of calls spiked dramatically in mid-April. Look at the report for a chart showing the spike from less than 100 calls per week in the third week of March 2015 to over 500 weekly in the third week of April 2015.

Then there are the “bath salts.” The New York Times published an article referring to Brooklyn users of K2, a synthetic cathinone (bath salts), as “zombies.” In an area around the subway station at Myrtle Avenue and Broadway, emergency workers transported 33 people with suspected K2 overdoses to the hospital in ONE DAY. Brian Arthur, who filmed and then posted what he saw on online said: “It’s like a scene out of a zombie movie, a horrible scene . . . . This drug truly paralyzed people.” While responders helped an unsteady man into an ambulance, another man nearby was slumped against a fire hydrant.

Pairs of police officers walked the blocks around Broadway and Myrtle Avenue, checking the vital signs of men they found unconscious. Anyone who was unresponsive was loaded onto a stretcher and taken away in an ambulance.

Keep in mind this was after legislation by The New York City Council last Fall banned synthetic cannabinoids and threatened businesses and owners who sold K2 with closings, hefty fines and jail time. So it seems that the synthetic drug trade in NYC simply switched to synthetic cathinones.

A 2012 article in the Journal of Medical Toxicology, “The Toxicology of Bath Salts,” provides some background information on the emergence of synthetic cathinones as a drug of abuse. Synthesis of cathinone derivatives occurred as early as the late 1920s. Methcathinone was synthesized in 1928 and mephedrene in 1929. While a few of the derivatives have been investigated for medical use, only bupropion (Wellbutrin, Zyban) have been approved for a medical use in the US and Europe. Wellbutrin is approved to treat depression; Zyban is used as a smoking-cessation aide.

Numerous synthetic cathinone derivatives have become popular for use as “legal highs.” Exactly when these derivatives gained popularity amongst club goers and others seeking new drugs of abuse is difficult to pinpoint, but mentions in Internet drug forums began in 2007.

In “Synthetic Cathinones: A New Public Health Problem,” Karila et al. described the major clinical effects of synthetic cathinones and their impact on public health. Together with synthetic cannabinoids they account for more than two thirds of the New Psychoactive Substances (NPS) available. Again, cardiac psychiatric and neurological adverse effects are the most common ones requiring medical care. “These drugs, still not controlled by international laws, are often produced and used to mimic the effects of controlled drugs such as cocaine, methylenedioxymethamphetamine (MDMA, ecstasy), and methamphetamine.”

If you’re skeptical about what I’ve written so far, try this article from High Times, “What’s in Synthetic Cannabis and Why Is It So Dangerous?” In order to study the endocannabinoid system in the body, scientists created these compounds for research purposes. The author is quick to point out that synthetic cannabis does not contain cannabis or synthetic cannabinoids. While the compounds bind to cannabinoid receptors in the brain, they only have a “slight relation” to natural THC. “Doctors do not fully understand how most of these compounds interact with the body, and some can be extremely harmful and even deadly.”

The author suggested they would be better named: synthetic cannabinoid receptor agonists (SCRA). THC is only a partial agonist of CB1 and CB2,the cannabinoid receptors, where SCRAs are designed to bind strongly to the receptors and exert THC-like effects. These effects can be 100 times more potent than cannabis. The unusually strong binding of SCRAs to cannabinoid receptors can produce unforeseen downstream effects in the brain and nervous system.

If you consume any of these chemicals, you are literally performing an experiment on your body, and a dangerous one at that. People have suffered from seizures, cardiac arrest, kidney failure, severe reduction in body temperature, etc. and doctors don’t know how it happens or who is more susceptible.

Not only are there many different classes of these compounds, each one of the general classes of compounds contains dozens of different related compounds. “Regulatory agencies play a game of cat and mouse with designer drug manufacturers as they constantly use different compounds to bypass laws.”  While the Us government continues to make different groups of SCRAs illegal, underground chemists seem to be one step ahead, making newer compounds that tend to be more toxic and harmful than the previous generation.

Steer clear of these dangerous substances, treat them like dangerous addictive drugs on par with methamphetamine, ecstasy pills and prescription narcotics. This stuff is not weed, and when your friends smoke it you should confront them about it and make them understand they are putting their lives at risk. Even if you need to pass a drug test, don’t use this stuff; even one toke of Spice can land you in intensive care and put you on a dialysis machine with kidney failure.

Let the fact sink in that what we just reviewed was a clear warning from High Times to avoid synthetic cannabinoids. Alternately, there are synthetic cathinones that can turn you into a zombie. Think about the consequences before you try some.

02/23/16

Emerging Public Health Threat

© imagination | 123f.com
© imagination | 123f.com

I’m almost positive that a guy I saw was high on Flakka. I’d been to Fort Lauderdale Florida for a training conference on relapse prevention. The conference finished early on Friday, so my friend and I decided to catch lunch down by the beach. We were getting a recommendation for lunch from a woman renting Segways, when a man walked by. He was barefoot, shirtless and wearing sweat pants cut off at the knees. He was also busy arguing with someone who wasn’t there. He walked right by us, caught up in his own world.

The reason I suspected he was high on Flakka, was because Fort Lauderdale is in Broward County Florida, which has been ground zero for Flakka. After I commented that I thought the guy was on Flakka, the woman told us that Clearwater was where most of the Flakka problems were at the time. She added that people high on Flakka usually kept to themselves and weren’t violent or aggressive. Then she added that Flakka caused problems because it opened (or activated) the third eye and users were then able to see into the future. We thanked her for her lunch recommendation and left. The guy on Flakka had moved on as well.

We are entering a brave new world of mind-altering substances with NPS—new psychoactive substances—coming to market faster than governments around the world can ban them. See “The New Frontier of Synthetic Drugs” and the “2014 Global Synthetic Drugs Assessment” for more information on the growing problem with NPS. Synthetic cannabinoids (synthetic marijuana), with names like K2 and Spice, are available everywhere. Sold online or in small retail outlets like convenience stores (I’ve heard there’s one that sells it within a mile of my home), synthetic marijuana is popular among younger drug users. After cannabis, synthetic marijuana was the most frequently reported illicit substance used by teenagers in 2012. No longer is finding a pipe in a teenager’s jeans an automatic indication that they are smoking cannabis, the marijuana of their parents’ generation.

The Synthetic Drug Abuse Prevention Act (SDAPT) was signed into law in 2012, but keeping up with the ever-changing chemical formulas used in the manufacturing process is difficult. “The chemical compositions of synthetic drugs are frequently altered in an attempt to avoid government bans.” SDAPT permanently placed 26 types of synthetic cannabinoids and cathinones into Schedule 1. The total number of NPS identified in 2012 was 158.

A CDC report in 2012 said that multiple states found there was an association between synthetic marijuana and unexplained acute kidney injury that was diagnosed after severe nausea, vomiting and flank or abdominal pain brought them to emergency departments. Additional side effects can include tachycardia (faster than normal heart rate) and hypertension.

Synthetic cannabinoid compounds originally were developed to facilitate study of cannabinoid receptor pharmacology, but in recent years have emerged as drugs of abuse. In 2005, SC products marketed as “Spice” first emerged in European countries, before appearing in the United States in 2009, where they were marketed initially as “K2.” Today, SC products are distributed worldwide under countless trade names and packaged in colorful wrappers designed to appeal to teens, young adults, and first-time drug users. Products often are packaged with disingenuous labels such as “not for human consumption” or “incense,” but health professionals and legal authorities are keenly aware that these products are smoked like marijuana. Despite federal and state regulations to prohibit SC sale and distribution, illicit use continues, and reports of illness are increasing.

A 2015 CDC report indicated that poison control centers had 3,572 calls related to synthetic cannabinoid use, which was a 299% increase over the same January-May period in 2014. The number of calls spiked in mid-April before decreasing to 2014 levels by the end of May. The number of reported calls stayed under 100 all throughout 2014. They rapidly increased to 500 calls by April 16th and did not decrease to near 100 until May 28th. See the figure in the 2015 CDC report.

The most commonly reported adverse health effects were: agitation (35.3%), tachycardia (29.0%), drowsiness or lethargy (26.3%), vomiting (16.4%), and confusion (4.2%). Eighty-three percent of the poison center calls had a medical outcome and 11.3% of those had a major adverse event—signs or symptoms that were life threatening or that could in substantial disability or disfigurement. There were 1,407 (47.5%) with a moderate effect—signs or symptoms were not life threatening, and no threat of disability or disfigurement, but did require some form of treatment. “A total of 1,095 (37.0%) had a minor effect (signs or symptoms that are minimally bothersome and generally resolve rapidly with no residual disability or disfigurement).” Fifteen deaths were reported.

This is a fast growing problem and we can’t afford to see it get out of hand. Synthetic cannabinoids were first reported to be in the US in December of 2008 when a shipment of “Spice” was seized by U.S. Customs and Border Protection in Dayton, Ohio. And now, the CDC is saying: “The increasing number of synthetic cannabinoid variants available, higher toxicity of new variants, and the potentially increased use as indicated by calls to poison centers might suggest that synthetic cannabinoids pose an emerging public health threat.”