Updated: K2 Emergency Calls Continue to Rise

Update Tuesday, June 9: More K2 cases were called in Monday night, bringing the total for this past week and a half to 147 calls.

Update Monday, June 8, 12 p.m. ATCEMS reports that K2-related emergency calls continued to come in frequently over this weekend.

Original story from Thursday, June 4: Since Friday, Austin/Travis County EMS has responded to 56 incidents involving 64 people who’d taken K2, the synthetic cannabinoid that comes up in the news periodically when there’s a sudden dramatic uptick in emergency calls, like this one.

“When you’re running 26 incidents involving 31 patients in a three-day period, that is an acute increase,” says Michael Benavides of ATCEMS. “It’s not out of the range of possibility that we may have run one or two calls [related to K2 use] two weekends ago. But we surely didn’t run an average of 8 to 12 per day, that is not something we normally see as a trend.”

What's in a name?

The substance is referred to as K2, in the past it’s also gone by "spice."  It started popping up in the last decade, selling in corner stores, head shops, bodegas, often marketed as incense, or potpourri, and labeled "not for human consumption." It was supposed to mimic the effects of marijuana. But since it wasn’t marijuana, technically, it was legal. The "Not for Human Consumption" label was supposed to protect the shopowners selling it. K2 was originally a brand name for a specific type of synthetic marijuana; the name's since been adopted by law enforcement and the media as a catch-all term for any unnamed synthetic drug. 

As with most street drugs, users run the risk of the substance not being the thing it’s supposed to be. And since K2 is constantly changing in order to skirt regulations, or because of the availability or cost of certain chemicals, or who knows why else, with K2 that risk is practically a guarantee.

“It's difficult to say exactly why the hospitalizations occur in batches. With synthetic cannabinoids constantly changing in structure, it's hard to know exactly how people may react to them. Most of these chemicals are applied by spraying the substance onto some kind of plant material or potpourri at a clandestine laboratory. It's hard to know the exact dosage or amount being applied to the plant material,” says Ryan Forsyth, a forensic chemist with Austin Police Department.

Shifting symptoms

So instead of producing effects similar to marijuana or any one particular known regulated substance, Benavides says they’ll see a range and variety of symptoms in those who’ve taken K2.

“Overstimulation of the central nervous system, which can lead to elevated body temperatures, seizures or blackouts, hallucinations, paranoia, anxiety, violent or aggressive behavior, chest pain, increased heart rate, self-destructive behavior,” he ticks off.

But then, over this past week, he says that symptoms in the cases EMS has responded to are not what they usually see.

“With this current outbreak of K2 utilization…we’re seeing a switch. Some of the patients are presenting with low blood pressure and low heart rate, which is a removal from what we’ve seen historically.”

So, Benavides says, he released a memo to ATCEMS staff to let them know to add "low heart rate" and "low blood pressure" to a list of potential symptoms that already includes "increased heart rate" and "high blood pressure."

Benavides says that when they get calls on this, they're often either from bystanders or law enforcement dealing with a person who's unconscious or acting violently or erratically. With these latest cases, he says some people have called because they felt they were going to pass out, or that something just wasn't right.

When stories of the erratic behaviors exhibited by users first started getting media coverage, lawmakers started enacting ordinances prohibiting the sale and manufacture of "synthetic cannabinoids" in many municipalities across the country, and the "Not for Human Consumption" loophole was closed in many places, making it illegal to sell it.

But the definition of "synthetic cannabinoids" is slippery. Lawmakers have attempted to regulate the drug’s sale, but as soon as they try to name the substance — "synthetic marijuana, synthetic cannabinoid, synthetic analog" — the drug’s manufacturers change its chemical structure just enough so it becomes technically unregulated again.

“It's been my experience that as soon as one substance, or group of substances, become controlled, they diminish greatly and new ones start to show up," says Forsyth. "Those manufacturing these substances will continue to look for new alterations they can make, and loopholes in the wording of the law.”

Predicting the unpredictable

Several bills looking to regulate K2 sales and manufacture in Texas were taken up this legislative session, but only one was signed into law: SB 173, which tries to regulate both the substances that have already been seen on the streets, and any future permutations of those substances.

“The language in the bill is definitely addressing many of the variations of synthetic cannabinoids that we see in street samples, but there's no way to cover every possible permutation,” Forsyth says.

While the wording of the law signed by the Governor should regulate whatever’s been manufactured so far, it’s still tough to know what will eventually come out, and whether or not it will fall under the category of “analog” — especially since whether a substance qualifies as an analog is determined by whether it causes effects similar to another known drug. Let's say someone argues that K2 is an analog because it causes effects similar to marijuana. But 65 people are hospitalized from a batch that causes, say, aggressive behavior not normally associated with marijuana use, then would that substance qualify under the law?

Furthermore, one of the initial problems with the drug was that it was being sold “legally” out of shops. But it’s unclear whether that’s still the case.

Benavides couldn’t confirm one way or the other, but he says he doesn’t “believe it’s available in corner stores or anything like that.”

Lieutenant Pat Connor with APD says that today, a "stick" of K2, which is about the size of a cigarette, goes for about $5 to $10 on the street. He says that's cheap, compared to say, a crack rock. But, because users will often buy a stick at a time, and smoke it, and then it's gone, it's not always easy to collect samples to test the substance. And throughout this recent outbreak, Connor says he isn't sure whether they've been able to collect any samples at all. 

So, K2 may have become just another, albeit highly unpredictable, and cheap, street drug. Benavides says most of the calls they get are from people in Austin’s downtown corridor, though there have been calls from all over the county.