A little-known synthetic cannabinoid, a class of compounds colloquially referred to as “K2” or “spice,” has been recently popping up in Toronto’s illicit opioid supply amid a national surge in fatal overdoses.
On June 15, the Canadian city’s drug checking service issued an alert warning about their unexpected identification of ACHMINACA in nine (or 30 percent) of examined heroin/fentanyl samples between May 20 and June 5. This K2 variant was found in “trace amounts,” or “less than five percent of the drug found,” the alert written by the Center on Drug Policy Evaluation (CDPE) noted, though its exact strength is unknown.
The uncertainty around this particular form of K2, which is generally far stronger than naturally-occurring THC, is a reason for caution for drug users in Toronto, the only place in Canada where it’s been reportedly found in heroin.
“Unlike cannabis, synthetic cannabinoids have been known to suppress breathing and other vitals during overdose situations. When synthetic cannabinoids and opioids are used together, the risk of dangerous suppression of vitals is increased,” wrote CDPE. Alone, K2 can cause panic attacks, paranoia, and nausea or vomiting. “Unfortunately, we don’t know much more about the effects of using opioids and synthetic cannabinoids together.”
This knowledge gap is ironic, given that synthetic cannabinoids were once researchers’ legal alternative to cannabis and THC, though they have since been made illegal, including in the United States, when former President Barack Obama signed a bill that placed them in Schedule I of the Controlled Substances Act.
Some light has recently been shone on this topic. Drexel University Emergency Department doctors evaluated eight cases from spring or summer 2018 that involved people experiencing overdoses later confirmed to involve opiates, fentanyl, and the then-novel K2 compound, 5F-MDMB-PINACA. They found that the successful reversal of the overdose with naloxone “triggered severe agitation and combative behavior,” which they presume to be caused by “the removal of the depressant effect of opioids.”
As the COVID-19 lockdown went into effect in spring 2020, Ontario—the province that includes Toronto—began seeing a leap in any-drug overdose deaths compared with the same period last year. The province’s coroner officer found a 25 percent increase in such fatalities from March to May 2020, from the same three months in 2019. K2 was not mentioned as a factor in the surge in deaths.
Since the introduction of synthetic cannabinoids to the United States in 2008, K2—sometimes itself adulterated with opioids—has been involved in large numbers of overdoses. In August and September 2018, New Haven, Connecticut and potentially Philadelphia, Pennsylvania saw K2-involved overdose numbers ranging from 95 to 200, respectively. Since at least 2014, other incidents have been reported in Brooklyn, New York, in rural Pennsylvania and in Dallas, Texas.
Photograph of a spice package by Lance Cpl. Damany S. Coleman via Wikipedia Commons/Public Domain