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What to Know About Synthetic Marijuana (Fake Weed) Use

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Synthetic cannabinoids, also called synthetic marijuana or fake weed, have been used by many as an alternative to marijuana since products were first introduced in 2002. Despite the fact that these man-made products were created in laboratories to help scientists study the cannabinoid system in the human brain, they often claim to be made of “natural” material from a variety of plants.

Hundreds of synthetic cannabinoids exist and the effects can be unpredictable and even life-threatening.

Also Known As: There are countless fake weed products being sold as herbal smoking blends, legal bud, herbal smoke, marijuana alternatives, fake weed, or herbal buds. This makes it difficult for parents and other adults to identify them. Some of the brand names include Blaze, Blueberry Haze, Dank, Demon Passion Smoke, Genie, Hawaiian Hybrid, K2, Magma, Ninja, Nitro, Ono Budz, Panama Red Ball, Puff, Sativah Herbal Smoke, Skunk, Spice, Ultra Chronic, and Voodoo Spice.

Drug Class: Synthetic marijuana products are classified as new psychoactive substances (NPS), or unregulated mind-altering substances intended to produce the same effects as illegal drugs.  

Common Side Effects: Side effects of the drug include elevated mood, relaxation, altered perception, symptoms of psychosis, extreme anxiety, confusion, paranoia, hallucinations, violent behavior, suicidal thoughts, rapid heart rate, raised blood pressure, vomiting, kidney damage, and seizures.

How to Recognize Fake Weed

Synthetic marijuana often contains a mixture of dried leaves from traditional herbal plants. They are various colors, including green, brown, blonde, and red, and often sold in small packets approximately two by three inches. The packets are often colorful foil packs or plastic zip bags. Some online sellers of legal fake weed products do so with disclaimers like “not for human consumption.”

What Does Synthetic Marijuana Do?

Fake weed works on the same brain cell receptors as THC or delta-9-tetrahydrocannabinol (the psychoactive ingredient in marijuana that gets you high). It is typically smoked, brewed in tea, or vaped.   Many of these products are legally marketed as “herbal incense” or “potpourri”.

Some people who use herbal buds say that it produces a high similar to that of marijuana, but it doesn’t last as long. Others experience a relaxed feeling, rather than the “head high” that real marijuana produces. Also of note is the “harsh” taste, which people say “makes your throat burn and your lungs ache” long after you smoke.

Since there are no standards for making, packaging, or selling synthetic weed, it’s impossible to know the type and amount of chemicals in each product as well as what the fake weed will do to you.

What the Experts Say

Although they are often marketed as “100% organic herbs,” none of the fake weed products on the market are completely natural. They have all been found to contain various synthetic cannabinoids, or chemicals produced in laboratories.

Originally, fake marijuana products contained a chemical called HU-210, which has a molecular structure very similar to THC. Because HU-210 is listed as a Schedule I controlled substance in the United States, these fake weed products were manufactured and sold only in Europe.

Since then, new synthetic cannabinoid agonists have been created. They are too numerous to list. Some are similar in structure to THC; others are not. Some are classified as controlled substances. By using different synthetic marijuana mixtures, manufacturers are able to continue to legally market their products in the United States when another formulation becomes illegal.

According to the DEA, the majority of these chemical compounds are produced in Asia with no regulations or standards.   They are then smuggled into the United States where they are sprinkled onto “plant material,” packaged and ultimately sold in tobacco shops, convenience stores, and the like.

Some of these chemicals are still legal. However, since synthetic marijuana first hit the market, more than 20 of these compounds have become controlled in some way at the federal level.   At the same time, they noted that more than 75 additional compounds have been identified but are not currently controlled.  

In 2015, the DEA listed 15 varieties of synthetic marijuana as Schedule I controlled substances in the Drugs of Abuse resource guide. This places them in the same federal category as heroin, crack cocaine, and marijuana.

Many people buy into the idea that fake marijuana products are safe since the chemicals are “legal” and contain “natural” ingredients. However, this has proven to be false with multiple cases of severe, unexplained bleeding or bruising, and some deaths.   Other reports show an increase in emergency room visits due to rapid heart rate, vomiting, violent behavior, suicidal thoughts, kidney damage, and seizures.

Off-Label Uses

Some of the fake marijuana products sold commercially claim to contain herbs traditionally used for medicinal purposes, including:

  • Beach bean (Canavalia maritima)  
  • Blue Egyptian water lily (nymphaea caerulea)
  • Dwarf skullcap (scutellaria nana)
  • Indian warrior (pedicularis densiflora)  
  • Lion’s tail (leonotis leonurus)
  • Indian lotus (nelumbo nucifera)
  • Honeyweed (leonurus sibiricus)

However, one study revealed that some of the herbal ingredients listed by the manufacturers could not be found in the products.

Beyond the synthetic cannibinoid HU-210, which is used by scientists to identify cannibinoid receptors in the brain and study the effects Δ-9-tetrahydrocannabinol (Δ-9-THC), there are no approved or off-label medical uses for synthetic marijuana.

Common Side Effects

While research is advancing, the effect synthetic marijuana products may have on the human body is largely unknown. To date, few studies have been published testing the effects of the chemicals on users. Within the DEA report, they note overdoses that have caused fatal heart attacks.   Similarly, acute kidney injury resulting in hospitalization and dialysis have been connected to these synthetics.

One study compared the level of impairment for drivers who were arrested for intoxicated driving.   One group had smoked synthetic cannabinoids and those in the other group were high on marijuana. The study found a significant increase in confusion, disorientation, and incoherence in the synthetic marijuana group. Slurred speech, a side effect not normally associated with natural cannabis use, was also reported among the synthetic cannabinoid users.

Beyond the short-term effects mentioned, an increase in blood pressure, as well as seizures, tremors, and anxiety, have been noted in synthetic marijuana users.

Whether these observed symptoms will have lasting effects, particularly on adolescents and young adult users, is not yet known. Of course, smoking any substance could have negative effects on the lungs.

“The problem with JWH-018 (a synthetic cannabinoid compound) is that absolutely nothing is known regarding its toxicity or metabolites,” says John Huffman, who helped develop the JWH-018 chemical. “Therefore, it is potentially dangerous and should not be used.” JWH-018 is also known as 1-Pentyl-3-(1-naphthyl) indole and is one of the Schedule I controlled substances listed with the DEA.

Recently, a version of synthetic marijuana was laced with rat poison, causing uncontrolled bleeding in hundreds of people and killing several others who ingested the tainted products.

If you or a loved one has used synthetic marijuana and begin experiencing severe, unexplained bleeding or bruising, call 911 or asked a loved one to take you to the hospital immediately. These are all signs of contaminated cannabinoid products.

Signs of Use

If you are a parent of a young adult, it pays to know the behaviors and physical effects of using fake weed. While exhibiting one or two of these signs might not mean that your child is using, they are all strong indicators of drug use and should be taken seriously.

  • Burning incense
  • Buying or using eye drops
  • Possessing dried plants or herbs
  • Having rolling papers or vape pens
  • Receiving suspicious packages in the mail
  • Displaying unusual or secretive behaviors
  • Restlessness  
  • Red or irritated eyes
  • Pale complexion  
  • Acting confused

Myths and Common Questions

Perhaps one of the biggest misconceptions about herbal bud is that it is “natural marijuana.” It is not; it is created from any of several hundred man-made synthetic chemicals that are sprayed onto the chopped plant material.

Synthetic marijuana is also far more potent, containing TCH analogs or synthetic cannabinoids that can be up to 600 times more potent than THC found in marijuana.   Often, additives, toxic impurities, and other types of drugs are also found in fake weed products.

Tolerance, Dependence, and Withdrawal

Regularly using “fake weed” can result in increased tolerance, or needing more and more of the drug to experience the same high. If you regularly use synthetic cannabinoids, you can also become both physically and psychologically dependent. This means if you stop abruptly, you’ll likely experience withdrawal symptoms.

Since the chemical composition of fake weed is unknown and can change from batch to batch, tolerance, dependence, and withdrawal may also vary.

How Long Does Fake Weed Stay in Your System?

How long synthetic cannabinoids stay in your system depends on several factors, including the type, how it is administered (i.e., inhaled or ingested), amount consumed, and frequency of use. Since these synthetic drugs don’t trigger a positive result on most standard urine drug tests   , many people turn to these drugs in an attempt to avoid positive drug screens for employment, rehab, or legal reasons.

Addiction

Long-term, regular use of synthetic cannabinoids can lead to addiction. If you have a history of mental illness or a substance use disorder, the risk of addiction is even greater.

In addition to building up a tolerance and experiencing symptoms of withdrawal, other signs of synthetic cannabinoid addiction can include:

  • You use more than intended, even after telling yourself that you’ll only “take a few hits.”
  • You are unable to cut down or stop and have likely failed numerous times at quitting.
  • You spend lots of time getting high, often at the expense of spending time with loved ones or doing activities you once enjoyed.
  • You continue to use despite any problems with family and friends, employment, or legal troubles.
  • You depend on the drug to “relax” or for creativity.

Withdrawal

Symptoms of synthetic weed withdrawal can range from mild to severe, depending on how frequent and how long you have been using, and include the following:

  • Headache  
  • Severe anxiety
  • Depression  
  • Irritability

How to Get Help

If you suspect that someone you love is using synthetic marijuana, the most important thing you can do is spend time with them, communicate the dangers of fake weed, and watch for any signs of use. While behavioral therapies and medications have yet to be specifically tested for the treatment of synthetic cannabinoid addiction, a health care professional can work with you and your loved one to safely detox from the drug as well as identify and treat any co-occurring mental illness.

In addition to getting a recommendation from a trusted health care professional, the Partnership at DrugFree.org has a helpline and tips so families know what to ask when vetting a rehab.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

Learn what experts have to say about synthetic marijuana or "fake weed" as well as common side effects, myths, signs of use, and risk for addiction.

“Smoking Wet”

Abstract

Reports have suggested that the use of a dangerously tainted form of marijuana, referred to in the vernacular as “wet” or “fry,” has increased. Marijuana cigarettes are dipped into or laced with other substances, typically formaldehyde, phencyclidine, or both. Inhaling smoke from these cigarettes can cause lung injuries.

We report the cases of 2 young adults who presented at our hospital with respiratory failure soon after they had smoked “wet” marijuana cigarettes. In both patients, progressive hypoxemic respiratory failure necessitated rescue therapy with extracorporeal membrane oxygenation. After lengthy hospitalizations, both patients recovered with only mild pulmonary function abnormalities.

To our knowledge, this is the first 2-patient report of severe respiratory failure and rescue therapy with extracorporeal oxygenation after the smoking of marijuana cigarettes thus tainted. We believe that, in young adults with an unexplained presentation of severe respiratory failure, the possibility of exposure to tainted marijuana cigarettes should be considered.

Numerous reports on alternative forms of tetrahydrocannabinol (THC) can be found in multiple media forums. 1–5 Several reports indicate the increased use of marijuana cigarettes, the ingredients of which have been tainted in a potentially harmful fashion. 1–4 This altered form of marijuana, referred to in the vernacular as “wet,” “illy,” or “fry,” was first reported in the 1970s and can now be procured rather readily. “Wet” cigarettes are conventional marijuana cigarettes that have been dipped into various fluids or laced with additional substances. The precise ingredients involved in this augmentation process may or may not be known by the end user. The most frequently reported method involves the dipping of marijuana into embalming fluid or formaldehyde that has been mixed with phencyclidine (PCP). 3

The exact origin of tainted marijuana cigarettes is unknown. The “wet” cigarettes reported on in the 1970s were probably laced with PCP. At that time, PCP was referred to by marijuana users and dealers as “embalming fluid.” It is postulated that drug dealers subsequently and mistakenly began using genuine embalming fluid to augment marijuana cigarettes, and that this has led to the current formulation with embalming fluid, PCP, or both. 3

Cannabis is not typically considered to be a drug that causes respiratory failure. However, exposure to tainted marijuana cigarettes potentially precipitates organ failure, including respiratory failure. Exposure to PCP can increase the prevalence of life-threatening events. 3,5 Other reports about tainted marijuana cigarettes chiefly discuss their impact on the central nervous system. The effects include hallucinations, disorientation, impaired coordination, paranoia, sexual disinhibition, and visual disturbances. 3–5 We present the cases of 2 young adults who presented with severe respiratory failure—thought to be related to “wet cigarette” exposure—that necessitated therapy with extracorporeal membrane oxygenation (ECMO).

Case Reports

Patient 1

A 27-year-old woman presented at another hospital with respiratory failure and seizures. Her medical history included chronic depression and alcohol and marijuana abuse, but no prior seizures. After transfer to our hospital, she was placed on mechanical ventilation at a low tidal volume, in accordance with the Acute Respiratory Distress Network (ARDSNet) protocol. 6 Drug-screening tests were positive for THC and PCP. Chest radiographs revealed bilateral, diffuse pulmonary infiltrates. Computed tomograms showed areas of diffuse consolidation as well as ground-glass attenuation with superimposed inter- and intralobular septal thickening. Empiric antibiotic therapy for presumed pneumonia was started. However, investigations for infectious and noninfectious causes, including a bronchoalveolar lavage, yielded negative results. Echocardiograms showed normal cardiac function and structure. During the next 10 days, progressive respiratory failure with persistent bilateral, diffuse pulmonary infiltrates developed ( Fig. 1 ) despite attempted rescue therapies, including neuromuscular blockade, open lung ventilation, inhaled prostacyclin, and high-frequency-oscillation ventilation. Refractory hypoxemic and hypercapnic respiratory failure (Murray Lung Score, 7 4/4/2/3 = 3.25), along with evidence of distributive shock, prompted the implementation of venoarterial ECMO. The patient’s tidal volumes were 4 cc/kg with plateau pressures ranging from 40 to 45 cm H2O just before ECMO was initiated. Despite the low tidal volume and ECMO support, the patient’s course was complicated by recurrent pneumothorax and by a hemothorax that necessitated thoracotomy. After 35 days, she was weaned from ECMO support and was again placed on conventional mechanical ventilation. Tracheostomy enabled the patient to breathe room air, and she was discharged to an inpatient rehabilitation unit 65 days after her initial hospital admission. After being discharged from the rehabilitation unit, she was able to resume all activities of daily life.

Fig. 1 Patient 1. Chest radiograph at the time of ECMO cannulation shows diffuse pulmonary infiltrates bilaterally.

Six months after the patient’s initial hospitalization, she underwent pulmonary-function testing to evaluate her severe acute respiratory distress syndrome (ARDS). Spirometry revealed mild deficiencies in forced expiratory volume in 1 second (FEV1) (60%), in total lung capacity (TLC) (62%), and in diffusing capacity of carbon monoxide (DLCO) (70%). A chest radiograph revealed unilateral basilar scarring, consistent with the location of her recurrent pneumothoraces and hemothorax.

It was learned that the patient had been in her usual state of health before the initial hospital admission. On the night before admission, she had smoked marijuana cigarettes that had been dipped in PCP and embalming fluid.

Patient 2

A 20-year-old man with no past medical problems presented at another hospital with disorientation and hypoxemic respiratory failure. He was intubated and hemodynamically stable upon his transfer to our hospital. Chest radiographs revealed bilateral, diffuse pulmonary infiltrates. Echocardiograms showed normal cardiac function and structure. Drug-screening tests were positive for THC. Investigations for infectious and noninfectious causes yielded negative results. Bronchoscopic evaluation showed mildly edematous airways and yielded a neutrophil-predominant lavage. Ventilation at low tidal volume was used, in accordance with the ARDSNet protocol. 6 During the next 11 days, progressive hypoxemic respiratory failure (Murray Lung Score, 7 3/4/3/4 = 3.5) and persistent bilateral, diffuse pulmonary infiltrates developed ( Fig. 2 ) despite neuromuscular blockade, inhaled prostacyclin therapy, open lung ventilation, and recruitment maneuvers. The patient’s tidal volumes were 5 cc/kg, with plateau pressures ranging from 30 to 35 cm H2O just before venovenous ECMO support was initiated. After 10 days, the patient was placed on conventional mechanical ventilation. He was transferred to an inpatient rehabilitation unit 35 days after his hospital admission.

Fig. 2 Patient 2. Chest radiograph at the time of ECMO cannulation shows diffuse pulmonary infiltrates bilaterally.

To follow up on the patient’s severe ARDS, his pulmonary function was tested 3 months after his discharge from the hospital. Spirometry revealed a mildly abnormal FEV1 (73%), normal TLC (84%), and normal DLCO (81%). A chest radiograph showed no evidence of parenchymal lung disease. Further information confirmed the patient’s history of marijuana abuse and his having smoked tainted marijuana cigarettes just before his initial hospitalization.

Discussion

To our knowledge, these are the first reported cases of severe respiratory failure and the necessity of ECMO use in relation to the smoking of “wet” marijuana cigarettes.

Inhalation Toxicity of Tainted Marijuana Cigarettes

We think that inhalation exposure was the chief culprit in our patients’ respiratory failure, given the temporal relationship of their use of tainted marijuana and their similar clinical presentations. Both presented with progressive, severe ARDS without any obvious inciting event. Although respiratory failure relating to smoking tainted marijuana cigarettes has not been previously described, some medical literature supports the adverse effects of the typical ingredients on the respiratory system.

Marijuana use by itself has not been linked to respiratory failure; however, it has been associated with chronic respiratory problems, such as bronchitis, obstructive lung disease, and histopathologic airway changes. 8–10 The inhalation of embalming fluid has been linked to bronchitis, lung damage, and airway ulcerations. Pulmonary complications have rarely been reported in association with PCP use. 11

The most commonly reported pulmonary symptoms from formaldehyde exposure are acute bronchospasm and occupational asthma. 12–14 We found only one report of formaldehyde exposure’s causing respiratory insufficiency: Dr. John Porter described his own experience and hospital course after prolonged exposure to formaldehyde. 15 While preparing an anatomic specimen with formaldehyde, he developed progressive chest tightness and dyspnea that necessitated hospitalization and oxygen supplementation. Chest radiographs showed interstitial markings that were interpreted to be pulmonary edema. He slowly recovered with corticosteroid therapy and was without subjective symptoms 5 weeks after his hospital admission. 15

Formaldehyde exposure has toxic effects at the cellular level. Inhalation exposure results in impairment of self-repair mechanisms 16 ; in rats, varying degrees of respiratory epithelium hyperplasia and metaplasia have occurred, along with focal necrosis and epithelial thickening. 13,14,17 It is hypothesized that inhalation of formaldehyde promotes mast-cell degranulation and disrupts nitric oxide regulation. 16 This disruption may cause an alteration in both airway and vascular-tone homeostasis. The varying amounts of formaldehyde in embalming fluid, along with the varying degrees and areas of injury, might explain the range in clinical symptoms from bronchial hyperreactivity to noncardiogenic pulmonary edema. 18

Specific interactions between formaldehyde and the ingredients in marijuana smoke might also warrant consideration in the pathogenesis of combined exposure. Chronic marijuana inhalation has been identified as a promoter of airway inflammation in human beings. 9,10 This underlying chronic inflammation and epithelial disruption could predispose marijuana users to further airway injury from irritants such as formaldehyde; however, the literature describing such a phenomenon is sparse.

Extracorporeal Oxygenation in Severe Respiratory Failure

Our case reports yield evidence of the value of ECMO support in severe respiratory failure. We propose that patients can recover from severe lung injury after inhaling smoke from tainted marijuana cigarettes, and we recommend fairly aggressive therapy—which might include ECMO—in patients who present with single-organ failure and potentially surmountable lung injury.

Long-term pulmonary outcomes in ARDS survivors have often included abnormal pulmonary function test results, such as mild diffusion and restriction limitations. In our female patient, pulmonary tests 6 months after her hospital discharge disclosed only mild abnormalities. In our male patient, tests 3 months after his hospital discharge revealed relatively normal lung function, except for a mild decrease in spirometric values. These results appear similar to or even better than other long-term pulmonary function follow-up data in ARDS patients.

Conclusion

Our patients had similar presentations after similar temporal exposure to tainted marijuana cigarettes. We believe that smoke from tainted marijuana cigarettes could be an unrecognized cause of respiratory failure in young adults who present with an otherwise unclear origin of respiratory failure and ARDS. According to the available literature, the varying quantity and quality of ingredients in marijuana cigarettes can lead to presentations that range from cough and bronchospasm to severe respiratory failure. We recommend that the inhalation of smoke from tainted marijuana cigarettes be considered as the cause of ARDS in young adults, when the clinical context suggests it.

Footnotes

Address for reprints: Christopher R. Gilbert, DO, Pulmonary, Allergy, & Critical Care Medicine, Penn State Milton S. Hershey Medical Center, 500 University Dr., MCH041, Hershey, PA 17033

“Smoking Wet” Abstract Reports have suggested that the use of a dangerously tainted form of marijuana, referred to in the vernacular as “wet” or “fry,” has increased. Marijuana cigarettes are