Spice, Bath Salts, and the US Military: The Emergence of Synthetic Cannabinoid Receptor Agonists and Cathinones in the US Armed Forces

Designer drugs are synthetic compounds that contain modified molecular structures of illegal or controlled substances. They are produced clandestinely with the intent to elicit effects similar to controlled substances while circumventing existing drug laws. Two classes of designer drugs that have risen to recent prominence are "spice," synthetic cannabinoid receptor agonists that mimic the effect of tetrahydrocannabinol, the active ingredient in cannabis, and "bath salts," synthetic cathinones, stimulants structurally related to amphetamines that have effects similar to cocaine and methamphetamine. Although these substances have only gained prominence recently, service members of the U.S. armed forces have not been immune to spice and bath salt abuse. These substances are often perceived as safe and are available via the Internet, in head shops and from dealers. Spice and bath salt abuse is increasingly associated with serious medical and psychiatric problems. Military health care providers must be familiar with these important new classes of drugs. This article discusses the background, current civilian and military legal status, clinical effects, pharmacology, and clinical management of synthetic cannabinoid receptor agonists and synthetic cathinones.