K2 is an unregulated mixture of dried herbs that are sprayed with a synthetic cannabinoid-like substance to mimic tetrahydrocannabinol, the psychoactive ingredient of marijuana. Street names for this product include Spice, K2, RedX Dawn, Paradise, Demon, Black Magic, Spike, Mr. Nice Guy, Ninja, Zohai, Dream, Genie, Sence, Smoke, Skunk, Serenity, Yucatan, Fire, Skooby Snax, and Crazy Clown. They are often marketed and sold under the guise of herbal incense or potpourri.
K2 is most often smoked in a pipe, water pipe or rolled in cigarette papers. Poison Control Centers have reported several adverse reactions in patients between the ages of 14 and 27 years after smoking K2. Signs and symptoms include:
- Tachycardia
- Hypertension
- Anxiety
- Agitation
- Hallucinations
- Pallor
- Numbness and tingling
- Tremors and seizures
This constellation of signs and symptoms may suggest that K2 is contaminated with other unknown chemicals in addition to synthetic cannabinoid. Another possibility is that K2 is used in combination with other legal and illegal substances.
It is important to realize that K2 does not cross-react with tetrahydrocannibinol (THC) and is not detected by most drug screens performed in hospital laboratories. Reference laboratories can detect synthetic cannabinoids using liquid chromatography tandem mass spectrometry in urine at a threshold of 1.0 ng/mL. Specimen requirement is 10 mL of urine collected in a plastic container without preservative.
References
Spice/K2, Synthetic Marijuana, December 2024; https://www.dea.gov/factsheets/spice-k2-synthetic-marijuana
De Oliveira MC et al. Toxicity of Synthetic Cannabinoids in K2/Spice: A Systematic Review. Brain Sci. 2023;13(7):990
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