The Worst Drug on Earth Runs Rampant in Jails and Prisons

For the first five years of my EMS career, I worked in a community that was, even before the current housing crisis bubbled over, known for a disproportionately high homeless population, including an on-and-off assignment first due to a homeless shelter. While high call volumes were the norm (like everywhere), every now and then an ambulance and its crew would disappear for hours on end, heard from only in clipped responses to the next dispatch from the shelter. When it finally let up, they’d return haggard, hungry and with shattered nerves, capable of only—and needing only—four words of explanation:

“…bad batch of spice.“

“Spice“ is one of many street names for a collection of drugs known as synthetic cannabinoids, both a technically accurate and a deeply deceptive name. Created as a legal (or at least undetectable) alternative to marijuana, their effects instead produced horror-movie-like symptoms. They have few competitors, however, on price and ease of delivery, and for populations with limited options like the incarcerated, that makes them popular. Now, corrections facilities from coast to coast are overrun, and evidence suggests it’s even slipped through the cracks in death row.

A Brief Pharmaco-History of Synthetic Cannabinoids

To (over)simplify a lot of pharmacology, most drugs work by binding to receptors in the nervous system, either agonizing (encouraging) or antagonizing (blocking) the receptor’s reaction. The cannabinoid receptors, named for their most notorious agonist, promote a host of functions in the body, most notably relieving anxiety. As we learned more about the cannabinoid receptor system (their existence was largely theoretical until 1988), pharmaceutical pioneers on both sides of the law began figuring workarounds for the receptors’ biggest waste of potential—namely, that the best-known cannabinoid receptor agonist (THC, the active ingredient in cannabis) was and is illegal throughout most of the world.

Not long after the endocannabinoid system was identified, an organic chemistry professor began work synthesizing compounds that might trigger its beneficial aspects. While these compounds worked on the same receptors that marijuana did—a boon for both medicine and recreational use—they were commonly found in legally sold products and, since typical screening panels only tested for the presence of THC, they were undetectable by most drug tests.

Not all the endocannabinoid system’s effects are positive, though. Links between marijuana and psychosis had been observed for many years, along with deleterious effects on the heart, kidneys and liver. Most marijuana users were protected from these effects both by protective compounds that come with natural cannabis and the facts that THC is only partially agonizes the cannabinoid receptors. Newly identified cannabinoids came with neither of these caveats.

The difference would become apparent soon enough: one study reported over 60% of patients developed psychosis, seizures, or other neurological symptoms from K2, along with delirium that makes patients a nightmare to treat in any healthcare setting, let alone on the street. Nor were effects limited to the nervous system: synthetic cannabinoids were linked to dangerously high tachycardia, often leading to otherwise rare heart attacks in pediatric patients.

Spice Goes to Jail—and Even to Death Row

Even as regulators woke up to the threats posed by synthetic cannabinoids, they started finding their way into the carceral system. In addition to whack-a-mole legal status and detection hurdles, drug smugglers face only a fairly simple process of lacing the liquified compounds into paper is fairly simple, after which prisoners can smoke or eat the paper for the desired (and undesired) effects. Overdoses and psychotic episodes are rising from Massachusetts to California, with prison officials struggling to keep up—when they care to. A federal prison in Minnesota responded to an advocacy group’s warnings about inmate spice use with generic corporate-speak, just before seven of its inmates were sent to the hospital with overdoses. New Jersey responded to a spike in overdoses by clamping down on mail delivery, a rent-seeker-friendly move that does nothing to curb the overwhelming leader among smuggling routes into prisons and jails—the staff themselves.

At least one case study in synthetic cannabinoid smuggling can’t be blamed on the inmates themselves: Kenneth Smith, Alabama’s guinea pig for its disastrous nitrogen execution program. After months of absurd excuses, Friend of the Project Beth Shelburne managed to obtain a copy of Smith’s autopsy and generously shared it with me, shocked as I was at the finding of synthetic cannabinoid MDMB-4en-PINACA in his tox screen.

The report doesn’t answer a lot of important questions for our purposes, and probably shouldn’t be expected to (as pathologist and lethal injection inventor Jay Chapman pointed out, they’re “expert[s] in dead people, but not how they got that way”). While MDMB-4en-PINACA has a half-life of fewer than 10 minutes, with Smith’s autopsy occurring more than 12 hours after death, the report doesn’t say how much was in his system except to confirm it was above the test’s detection limit, which tells us little about when he might have taken it. However, Alabama’s condemned are moved to an execution chamber holding cell a full week before execution; a fairly moderate half-milligram-per-kilogram dose becomes undetectable after seven hours. As a layman in pathology—an expert in keeping them from getting that way, if you will—it’s hard to come to any other conclusion than that Kenneth Smith had a dangerous drug smuggled in by the death watch staff.

As someone who’s always ready to call a moral panic how I see it, this is not one: synthetic cannabinoids are what fentanyl checks for under the bed at night. Though I can’t be sure, longtime readers have heard the harrowing story of what I’ve always suspected was another “bad batch.” The safety risks to incarcerated people and those in their care are incalculable, and America’s jails and prisons need to get real—and get uncomfortable—about what stopping the scourge looks like.

The Alabama Department of Corrections had not responded to a request for comment at publication time.