Russian Roulette in a Bag

On 2nd street NW between D and E streets in Washington, D.C., where a drab homeless shelter looms over a neighborhood of office buildings and hotels, they call June 5, 2015, “The Great Fallout.”

Around 10 a.m. that day, calls started pouring into 911 about people overdosing in that area. Police, EMTs and firefighters quickly set up a command center outside the Center for Creative Non-Violence with two ambulances and a fire engine company standing by. All told, 10 people were rushed to the hospital.

“It was almost a conga line of EMTs,” says Donald Page, the center’s administrative director.

Yet that alarming scene was just one component of the havoc wrought that day by a powerful new class of drugs called synthetic cannabinoids. A total of 23 people across D.C. were hospitalized on June 5 after taking them, followed by 15 the next day and another 24 a week later.

Sold for just a few dollars on the street or in smoke shops, liquor stores, gas stations and online, the shredded plant material is packaged in colorful pouches with names like “Mr. Nice Guy,” “Spice” and “Scooby Snax,” marketed as incense and winkingly labeled as not for human consumption. Rolled inside cheap cigar wrappings, the drug looks like and is often assumed to act like marijuana, but the chemicals lacing it—and often changing from dose to dose and product to product—can spawn much more dangerous effects, such as delirium, seizures, psychosis and hallucinations.

The New England Journal of Medicine published a list last summer of nearly 50 locations in the United States with clusters of health issues from synthetic cannabinoids between August 2011 and April 2015, from 220 cases in Denver to 41 cases and two deaths in Bryan, Texas. Washington, D.C., appears to be one of the epicenters of the crisis.

Local and federal agencies and public health officials are mobilizing to stamp out the burgeoning industry, but they can’t regulate what they don’t understand: What exactly is in these drugs? How are the substances changing? Where are they being found?

The University of Maryland’s Center for Substance Abuse Research (CESAR) is becoming the central resource to answer those urgent questions. From an unremarkable office on the outskirts of campus, it’s ringing the alarm bells perhaps loudest of all as it works with the federal government and studies what Vice media has called “the worst drug in the world.”

Longtime Expertise

Eric Wish, the director of CESAR, has a career spanning virtually the entire modern history of drugs in America—and that’s why synthetic cannabinoids have him so worried.

Wish fell into drug research in the 1970s while studying for his Ph.D. at Washington University in St. Louis, just as the field was swimming in new funding. He studied under early innovators and helped on a seminal study about how American soldiers serving in Vietnam stopped using narcotics once they returned home.

While working with Narcotic and Drug Research Inc. in New York, Wish was an early proponent of using urinalysis—then a new tool—to gauge drug use, rather than relying on self-reports from users. It had two major benefits: First, Wish says, it’s much more accurate, and second, the criminal justice system collects plenty of samples for urinalysis—samples from people whose behavior frequently predicts future drug use in the general community.

“An illegal drug oftentimes will be embraced first by people doing other illegal behaviors,” says Wish, noting research showed the heroin outbreak in 1970s D.C. was discovered 12 to 18 months earlier in the criminal population. “They are the tip of the iceberg.”

He has been with CESAR since it was founded in 1990, in the aftermath of UMD basketball superstar Len Bias’ death from cocaine intoxication four years earlier. State officials began to look for ways to address drug and alcohol abuse, and a state commission, noticing a paucity of reliable information on the problem, recommended the creation of a research center at UMD.

The office functions as a central resource for research, training, program evaluation and statistics on drug and alcohol problems, sending out a weekly bulletin with the latest information on substance abuse—the “CESAR Fax”—to more than 6,000 subscribers around the world.

So Wish has seen a lot, from heroin to crack to prescription painkillers, but nothing like synthetic cannabinoids and their chameleon-like nature.

“It is a whole new generation of drugs,” he says.

Finding the Drugs

ronically, the Dr. Frankenstein in this story is government and higher education research.

In the 1980s and 1990s, scientists created chemical compounds to help them study the brain receptors stimulated by THC, the active ingredient in marijuana. One of those compounds—named JWH-108 after John W. Huffman, a Clemson University chemist whose research was funded by the National Institute on Drug Abuse—made the leap from academic journals into Europe’s underground drug markets and arrived in the United States in 2008.

That compound is so simple, Huffman once told ABC News, that it “can be made by a halfway decent undergraduate chemistry major.”

While the federal government has made more than 20 types of synthetic cannabinoids like JWH-108 illegal, outlawing the specific compound in a drug born in a laboratory has proven to be a weak strategy. Suppliers—mostly labs in China—can simply tweak the molecules to avoid breaking the law and create something brand new.

“That’s the scary part. That chemist has no idea what it will do to the human brain,” Wish says. “The person who takes it is playing Russian roulette.”

Since 2012, CESAR has been working in cooperation with the White House Office of National Drug Control Policy on the Community Drug Early Warning System (CDEWS), a project that aims to identify emerging drugs in a quick and cost-efficient manner. So far, CDEWS has completed two studies by salvaging urine samples ready to be discarded by criminal justice agencies and testing for a more expansive amount of drugs, including synthetic cannabinoids.

The first study, published in September 2013 based on samples from Prince George’s County, Md., Chesterfield, Va., and Washington, D.C., found that people who had passed the normal criminal justice drug screen—which looks for standard substances from drugs like marijuana, cocaine and methamphetamines—were just as likely to have used synthetic cannabinoids as those who had failed. Almost 40 percent of samples taken from D.C. men ages 26 to 30 tested positive for synthetic cannabinoids, and the vast majority of positive tests would have been missed if two newly discovered substances hadn’t been added to the tests at the last minute.

The second study, published in April, used samples from D.C., Denver and Tampa, Fla., and found significant variety in the synthetic cannabinoids being used. While juveniles in Tampa tested positive for only one substance, adults in Denver and juveniles in D.C. did for as many as 10. One synthetic cannabinoid metabolite, PB-22, was found in a remarkable 41 percent of adult D.C. parolees and probationers who had tested positive for them.

Wish and his staffers, who are based in the College of Behavioral and Social Sciences, work to stay on top of the changing nature of the problem, and keep in touch with a dozen specialists around the world to find out what new substances have been discovered. Sometimes they even have to wait for the government to figure out what exactly its agents have seized.

“It’s almost impossible for us to test our way out of this,” Wish says.

Responding to the Problem

ith public opinion cooling toward the war on drugs, Wish, who is heading a third CDEWS study that branches all the way out to Hawaii, and others have been accused of fear mongering.

But in his interviews with media like The Washington Post and NPR, Wish is not saying that everyone who takes synthetic cannabinoids will get sick or die. After all, nearly 6 percent of high school seniors reported using synthetic cannabinoids in 2014 (down from about 8 percent in 2013 and 11 percent in 2012), a number that would have overwhelmed the public health system had they all been hospitalized. Instead, he’s emphasizing the continuing mystery of the drugs’ contents and unpredictability of their effects.

“It’s a huge public health problem because we don’t know who is going to get hurt,” he says.

In D.C., the number of synthetic cannabinoid cases has skyrocketed. From fall 2012 to spring 2014, the D.C. Fire and Emergency Medical Services Department averaged about 17 cases a month that were connected to synthetic cannabinoids. But starting in May 2014, incidents climbed into the dozens, then leaped into the hundreds, reaching a high of 611 in September. Although there were only 173 cases in November, possibly due to colder temperatures, that’s still a tenfold increase from a typical month several years ago.

High-profile incidents of violence have been linked to these drugs. In August, a woman who had been using synthetic drugs mixed with PCP was shot by a D.C. police officer after she refused to drop a knife; in September, a Maryland man was found guilty of involuntary manslaughter for shooting his stepfather 18 times after smoking synthetic drugs in 2013. Police also suspect that the man accused of fatally stabbing a fellow Metro passenger on July 4 was high on synthetic drugs. D.C. Mayor Muriel Bowser has called synthetic cannabinoids “a clear and present danger to the public,” and emergency legislation was passed last year in an effort to increase penalties for stores found selling the drugs. As of December, two businesses had been closed for 96 hours under the legislation, which is being considered for permanent implementation. The D.C. attorney general’s office has also proposed a bill to classify synthetic cannabinoids on their chemical class rather than individual compounds, in order to better prosecute the manufacturers who make drugs that are one step ahead of the law.

D.C.’s health department is collecting data from eight hospitals to monitor the trend, and has developed new urine and blood screenings to test patients suspected of using synthetic cannabinoids. As of Dec. 2, 337 specimens had been tested; 108 were positive for synthetic and common drugs, and 102 were positive for only synthetic ones.

Responding to the CDNEWS findings, D.C.’s pretrial services also purchased new equipment so it can test for these drugs.

“In just an hour’s time on the street last week, I saw three overdoses,” D.C. Police Chief Cathy Lanier said in the summer. ”We don’t want to go back to the crack cocaine days.”

A few months later, D.C. police seized 265 pounds of synthetic cannabinoids—at least $2.3 million worth of “Bizarro”—in a raid on a warehouse in Northwest Washington.

Saving Lives in a Circus

mild fall morning presents an uneasy mix of people near the Center for Creative Non-Violence, as eager tourists, harried office workers and fresh-faced law students make their way from the Judiciary Square Metro station past shambling loners and huddled smokers. Police cars race by every few minutes; one officer on a bicycle methodically stops and talks to each gathering on stoops and sidewalks.

A park, sandwiched between the shelter and the U.S. Tax Court, is pristine and kept that way with its fences, padlocks and signs listing what is banned on federal property. Outside of it, the curb is littered with cheap cigar wrappers, a telltale sign of synthetic cannabinoid use.

According to Page, most of the people hanging around the neighborhood are homeless but not current shelter residents, some because they failed the organization’s drug test. They are the customer base for the synthetic cannabinoid dealers hawking in broad daylight, attracted by the bargain price of a dollar for a joint and by their effectiveness in dulling the senses. Plus, an erroneous rumor persists that drug tests can’t pick them up.

The unpredictability of synthetic cannabinoids also doesn’t seem to curb their popularity. In the summer, Page saw a new variant hit the streets, one that caused some users to shake violently.

Sitting in a shelter classroom, Page, a former client, says he is skeptical of D.C.’s tactic of targeting businesses. He thinks the solution lies in going after the users. Cutting off local suppliers, he says, will just make the dealers get drugs from other states or online.

Although it sounds punitive, this prescription comes from a charitable impulse. Page is dealing with a vulnerable population that needs courage just to ask for help, let alone accept it in an area oozing temptation.

“To see the circus around the shelter is just another reason not to go there,” he says.

The shriek of sirens regularly washes over the neighborhood, located just a few blocks from a fire station. But until there is an answer for synthetic cannabinoids—will their popularity fizzle on its own? Is there a limit to how inventive chemists can be? Is there an innovation just waiting to be discovered through legislation?—Page will wonder with each alarm if The Great Fallout has come back, even stronger. TERP