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  1. A Al-khazraji,
  2. B Garrido,
  3. H Alkhawam
  1. Internal Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), Elmhurst, New York, United States


Cannabis is one of the most commonly elicited substances abused. It is easily accessible, inexpensive, and the ultimate gateway drug. Synthetic cannabinoid has been known to be packaged under numerous trade names such as “K2, spice, AK-47, Geeked up, Smacked, and Green Giant..etc”. K2 Abuse has been rising more recently in New York State, especially among lower socioeconomic areas and among younger male individuals. Clinicians should be educated and awareness should be increased regarding patient presentation, treatment, as well as management. Although, treatment is ultimately supportive therapy, long term management to prevent future abuse is of prime importance. Death is rare but there can be serious risks associated with K2 abuse.

Case presentation Patient is a 36-year-old male with unknown PMH who presented with bizarre behavior and anxiety. Patient was uncooperative and portraying repetitive tangential thoughts. He was found agitated, screaming “I am king of the world, and I feel good”. The patient admits to waking up this morning and smoking marijuana and his last memory since then was being in the ambulance. The patient denies any psychiatric medical history but is unable to provide any further details. The patient's family reports unusual behavior in the past few days such as religious connotations, nonsensical rantings, and repetitive thoughts causing them to contact emergency medical services. The family also admits to depressive episodes as well as suicidal ideations found in his personal written lyrics. He admits to drinking 1 pint of various types of liquor well as 6+ beers per day for >15 years. He denies any history of smoking, although he does smoke marijuana daily as per family.

On physical exam his vital signs were normal. Patient was tearful and exhibiting repetitive thoughts, despite having a somnolent general affect. The rest of the physical exam was within normal limits. Patient received intravenous crystalloid fluids, Haldol 5 mg IV, and Benzodiazepine IV. Pertinent laboratory findings is significant for elevated lactate 3.4, hypokalemia 2.2, and an elevated ammonia 53. Other laboratory findings were within normal limits. CXR and Head CT showed no significant findings and EKG was within normal limits.

Hospital course complicated with aspiration pneumonia. Patient received a full course of antibiotic therapy. Blood and urine culture showed no growth through admission. Social worker and case manager were involved and patient was offered referral to chemical dependency programs which he refused. Patient was discharged in stable condition and asked to follow up with primary care physician.

Discussion The recreational use of synthetic cannabinoids such as K2 has been on the rise especially in younger male individuals and in lower socioeconomic status neighborhoods. In turn, the number of admissions secondary to acute intoxication has been increasing in hospitals all over the nation. More recently, since the advent of synthetic cannabinoids, there has been two reported confirmed deaths in New York City associated with K2 abuse. This can be attributed the drugs widespread accessibility. Synthetic marijuana has been legally available in the internet, local smoke shops, and even convenience stores. K2 has been advertised as the new, legal, and more cost effective way to get “high”. The popularity of this new class of drug “fad” is increasing in popularity as an alternative to marijuana and will continue to be a growing health concern.

The use of K2 and other synthetic forms of recreational substances has become an escalating problem in many institutions nationwide. Increasing awareness will allow for improved preparedness as well as provide further data on this situation. .

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