I have previously written on the risk of stroke associated with ingesting marijuana. It appears to be a quite rare but devastating event. It’s also not yet proven to be an adverse drug effect among pot smokers. Over the last several years there has emerged some disturbing evidence that supports the role that pot may increase stroke risk in heavy users. However, further studies are desperately needed to confirm this.

There are many other variables that may be contributing to this dangerous disorder. For example, if the relationship is real, scientists currently cannot explain why an entire generation of Baby Boomers haven’t stroked out yet since many of them are regular pot users. It remains a mystery for now.

However, it’s a completely different story when we look at synthetics. Here the literature supports an overwhelming role that some SYNTHETIC cannabinoids are contributing to increased risk for stroke, psychotic breaks, kidney failure and birth defects, among abusers of these dangerous compounds.

WHAT ARE SYNTHETIC CANNABINOIDS?

There are both good and bad synthetic cannabinoids. They are NOT natural compounds, they are made in a laboratory. Many major pharmaceutical houses are falling over each other trying to create synthetic cannabinoid agonists and antagonists hoping to patent a lucrative “Holy Grail” disease-treating compound. Synthetic analogues of CBD for example are being created for treating refractory seizure disorders, or the now shelved CB antagonist Rimonabant for weight loss.

BLACK MARKET

Then there are clandestine labs, black market labs that are involved in the manufacture of cannabis analogues. Here the goal is to make a potent recreational THC-like material. The major difference is that some of the black market cannabinoids appear to be extremely toxic and dangerous.

Reports are appearing worldwide that a certain powerful THC-like drug, one called “Spice,” is driving users into emergency departments like corn through a mill.

SPICE

No folks this is not the heady, mind-expanding precipitate, and the greatest treasure in the universe[ref]Princess Irulan, Frank Herbert’s Dune (2000). (https://en.wikipedia.org/wiki/Arrakis) 05/21/2015[/ref] found only on Arrakis in the Dune Trilogy. No, far from it. This particular drug, also called Spice, contained the powerful schedule I synthetic cannabinoid JWH-018. While Dune’s Spice permitted interdimensional travel, the only transport JWH-018 sanctions is an underwhelming visit to the nearest emergency facility.

CASE REPORT

A 2013 article published in Neurology, the official journal of the American Academy of Neurology, discussed two young and otherwise healthy siblings who experienced acute, embolic-appearing strokes.[ref]Neurology December 10, 2013 vol. 81 no. 24 2090-2093[/ref]

The siblings, patient A is the 21-year-old brother, and patient B is the 19-year-old sister of A. Each developed an embolic stroke, at different times, temporally associated with smoking Spice.

An embolus (in this case) is a piece of a blood clot that breaks off somewhere upstream, possibly from the heart, to occlude a distal artery in the brain causing an ischemic (lack of blood flow and oxygen) stroke.

Patient A was brought to the ED with complaints of sudden-onset inability to speak and weakness of the right face and arm.

Patient B, at a later undisclosed date, arrived in the ED with nearly the exact same complaints as her brother had. Both suffered from a blocked middle cerebral artery (MCA) which can be devastating and often times irreversible.

Although both patients tested positive for regular cannabis and had in the past smoked conventional marijuana, each reported that they had smoked spice shortly prior to onset of the stroke and that they had obtained the drug from the same supplier.[ref]IBID[/ref]

The authors cite tachycardia, vomiting, agitation, confusion, and hallucinations as common side effects of smoking spice. We may now add stroke to the list.

IS SPICE THE CULPRIT?

There are always confounding variables. For example, it could be that the siblings both have a hidden genetic trait that predisposes them to embolic strokes when under the influence of Spice. There is also the very real possibility that contaminants within the Spice preparation were toxic. Or Spice itself is toxic, or any combination of the above.

To further complicate the issue, black market chemists constantly create new, slightly different, molecular analogues to stay one-step ahead of the law. Therefore, any product called Spice last year may now contain different chemical analogues other than the one listed above. Moreover, with a constantly changing chemical makeup it becomes very difficult and frustrating for researchers to glean details on the pathophysiologic effects of “Spice.”

Regardless of where the chips fall, in this particular case I would suggest that readers never partake of black market cannabinoids. The devastating consequences of stroke, heart attack, and many other dangerous complications isn’t worth the risk.