Stimulant Harm Reduction Should Include Synthetic Cannabinoids

    Usually “stimulants” refers to methamphetamine or cocaine, or prescription uppers like Adderall. But it’s really just a catch-all term for anything that makes the systems in your body and brain more active, and there is no universal definition or list of criteria that stimulants all have in common. From a harm reduction perspective, one way to think about what makes something a stimulant is whether it involves a specific kind of “overdose”—one that’s very different from the kind we associate with opioids.

    Stimulant overdose doesn’t cause physical harm nearly as often as people think, but it does cause serious harm all the time when law enforcement gets involved. This is why stimulant harm reduction fits synthetic cannabinoids as well as it fits coke or meth.

    Synthetic cannabinoid receptor agonists (SCRA) are known by a wide variety of nicknames across the country, but people are often familiar with them as either “K2” or “Spice.” Or “strips,” as they’re often known in prison drug supplies, though the term can describe papers coated with anything from Suboxone to meth to insecticide, or mystery substances that are sold as mysteries. SCRA don’t really have anything to do with the cannabis that comes from the plant; they just share the name because they both interact with your cannabinoid receptors.

    In some cases people use SCRA because they have legal access. Even though many SCRA have been progressively banned at federal or state levels, beginning with the Synthetic Drug Abuse Prevention Act of 2012, there are too many ever-evolving chemical compounds to ban them all. This means that SCRA can’t be easily identified with urine drug screens compared to most other banned substances, which is why they’re very often used by people who don’t have legal access to any drugs. People who are under some form of state supervision, such as methadone maintenance programs, drug-sentencing alternative programsparole/probation and especially incarceration.



    SCRA have been a mainstay in prison and jail drug supplies for several years. The Iron Law of Prohibition—“as law enforcement becomes more intense, the potency of prohibited substances increases”—often doesn’t apply to synthetic drugs entering the supply, because there are so many new kinds that the potency is all over the place. But the concept definitely applies to strips, and to any drugs being used inside prisons.

    “Start low, go slow” is common harm reduction advice because one of the main risks of using any unregulated drug is that people almost never know how much they’re using at a time. But it’s an especially big problem with SCRA strips. For a basic example, a strip that got one coat of SCRA might make someone hallucinate like a psychedelic high, while a strip that got two coats of the exact same thing might make them fall out like an opioid high.

    The effects can vary so much from one strip to the next, so it’s natural to assume that different strips contain different kinds of SCRA—especially if they came from different places. And sometimes the difference does have something to do with the chemical compounds themselves. But usually the reason some SCRA strips seem stronger or weaker than others, or act like “uppers” while others act like “downers,” has more to do with how much is on them, rather than what is on them. 


    Seizures and Passing Out

    SCRA can sometimes cause seizures. The important thing to know is that these almost always resolve on their own within a couple of minutes. It helps to stabilize the person’s head, and get any sharp objects out of the way.

    Seizures from meth or cocaine don’t cause any physical damage to the person experiencing them, and this generally appears to be the case with SCRA. But there is a lot more room for the unknown, since the effects of SCRA aren’t as well-established as they are with the drugs we typically think of as stimulants.

    Respiratory depression from using SCRA isn’t nearly as likely as it with opioids, but it is possible. A lot of substances that work as uppers, including stimulants, turn into downers when taken at higher doses. If someone falls out after using what they believed to be SCRA, the important thing is to monitor their breathing. If they’re breathing on their own, at least eight-ish breaths per minute, they’ll be alright to just sleep it off. Put them in the recovery position; SCRA toxicity does make people puke sometimes.


    “Bugging Out”

    The way “overdose” usually refers to opioids, and the slightly more niche “overamp” refers to stimulants, in prisons the term for SCRA toxicity is often “bug-outs,” or “epees” (short for “episode”). These often involve hallucinations and a break with reality, but only for relatively short periods—maybe 10 minutes or so.

    In both prison culture and outside culture, any kind of overdose is assumed to be a sign of addiction. But opioid overdose still prompts a certain amount of sympathy, even from those who view drug use as a moral failing. Stimulant overdose, including from SCRA, is where things diverge.

    Because the principal harms of these overdoses come from criminalization, harm reduction on the outside involves the fairly straightforward step of not calling the cops. In prisons, where people are already surrounded by cops all the time, there’s the potential for harm no matter what you do.

    If someone uses SCRA and starts loudly hallucinating, they’re likely to get beat up later by other prisoners in their living unit. Attracting the attention of corrections officers often gets others in the vicinity punished too, so it isn’t tolerated regardless of the outcome of an individual incident. 

    If someone’s cellie uses SCRA and starts puking or having a seizure, and they call an officer for help, they’re likely to get beat up for the exact same reason. It’s not uncommon for various groups in prisons, including gangs, to have explicit rules against calling officers for help when the situation involves drugs. Meanwhile, corrections departments often have rules that if someone is found to be using drugs, their cellie is guilty by association, unless the cellie was the one to report it.

    The best way to navigate this aspect depends entirely on the specifics of the facility and individual people involved. But it’s often just a no-win situation.



    Photograph via Pennsylvania Department of Corrections

    • Jonathan covers harm reduction and re-entry. He’s incarcerated at Washington Corrections Center, where he’s a Teacher’s Assistant for re-entry workshops and trains peer educators in HIV and hepatitis C harm reduction. His writing has been published by the AppealTruthoutJewish Currents and the Seattle Journal of Social Justice. His Washington State Department of Corrections ID is #716850, and until WDOC corrects a 29-year-old paperwork error his name in Securus is “Jonathon.”


      Kastalia is Filter‘s deputy editor. She previously worked at a number of other media outlets and wouldn’t recommend the drug coverage at any of them. When not at Filter, she works with drug users in NYC and drug checkers in North Carolina to track hyperlocal supply changes, and cohosts a national stimulant users call with Isaac Jackson. 

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