Here today, gone tomorrow…and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, Salvia divinorum, methoxetamine, and piperazines.
Journal of medical toxicology : official journal of the American College of Medical Toxicology March 1, 2012 Christopher D Rosenbaum, Stephanie P Carreiro, Kavita M Babu 356 citations
Many new drugs of abuse available online remain unfamiliar to healthcare providers. Herbal marijuana alternatives like K2 or Spice contain synthetic cannabinoids mixed with plant matter. Synthetic cathinones ("bath salts") have caused nationwide emergency visits for severe agitation, sympathomimetic toxicity, and death. Kratom, from Mitragyna speciosa, has opioid-like effects and is used for chronic pain and opioid-withdrawal symptoms. Salvia divinorum is a hallucinogen with therapeutic potential but banned in many states due to psychiatric concerns. Methoxetamine is marketed as "legal ketamine." Piperazine derivatives (e.g., BZP, TMFPP) reemerge as "legal Ecstasy." These drugs are often perceived as safe but can cause life-threatening adverse effects. The paper covers background, pharmacology, clinical effects, detection, and management of these exposures.