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Withdrawal from Synthetic Drugs

What drugs are synthetic?

Any drug that is man-made is synthetic; however, the term “synthetic drugs” is typically used to describe man-made substances that are specifically designed to mimic the effects of other known drugs such as marijuana.1

In some cases, these drugs are engineered to have chemical structures that differ enough from those of their known illicit counterparts to circumvent the laws and restrictions placed on controlled substances.

What Are Synthetic Drugs?

While there are many drugs that are technically synthetic or semi-synthetic and produced legally (like certain opioid medications), authorities like the National Institute on Drug Abuse (NIDA) typically identify a specific subset of manmade substances as "synthetic drugs".

These include: 2-5,8,15

Some substances are made in labs.These synthetic drugs are produced in laboratories, often in clandestine or underground facilities, and sold in illegal markets worldwide. A number of synthetic drugs are believed to be manufactured overseas. The primary users of synthetic drugs tend to be quite young—teens and young adults—in part because these substances are often cheap and relatively easy to access, especially online.2

In many cases, synthetic drugs can be at least as addictive and dangerous as the drugs they are designed to imitate (such as naturally occurring substances like marijuana or cocaine).2 One of the main dangers of synthetic drugs is that a user can never be exactly sure of what they are taking due to the fact that many of these substances are laced with other dangerous compounds. For example, people who think they are taking pure MDMA may actually be using a substance that contains cocaine, ketamine, methamphetamine, or bath salts.6

Can They Cause Withdrawal?

Various causes of withdrawal.The answer to this question isn’t a definite yes or no; it will depend on the specific substance. Some synthetic drugs are associated with physiological dependence, which develops when your body has adapted to the presence of the drug. As such, you might suffer withdrawal symptoms if you suddenly stop using the drug. Some synthetic drugs are also associated with tolerance, a condition that occurs due to repeated substance use, which means that you need more of the drug to experience previous results.

Both synthetic cannabinoids (Spice/k2) and synthetic cathinones (bath salts) have been shown to cause dependence and withdrawal.2,4  MDMA’s potential for eliciting withdrawal symptoms is still under debate; however, some people have reported experiencing withdrawal symptoms like depression, when they stop using.6

For the most part, hallucinogens are not associated with physiological dependence; however, it’s difficult to say whether drugs like 2C-B are associated with this phenomenon because of a lack of research and also the fact that users can never be completely sure what these drugs contain.7 Both the intoxicating effects and the potential for withdrawal are unclear.

What Are Signs and Symptoms?

The signs and symptoms of synthetic drug withdrawal can vary by substance but can include:3, 4, 6

  • Anxiety.
  • Depression.
  • Sleep disturbances.
  • Fatigue.
  • Paranoia.
  • Headache.
  • Loss of appetite.
  • Difficulty concentrating.
  • Tremors.
  • Cravings for the substance.

The exact duration of symptoms can vary by substance, frequency of use, amount used, and your unique individual makeup. All of these specific factors and consequent symptoms are still being examined by researchers.2

Synthetic Cannabinoids

Effects of synthetic marijuana.One study reported that users of synthetic cannabinoids can experience withdrawal symptoms as soon as 15 minutes after last use. Immediate withdrawal symptoms such as cravings and relapse can occur as soon as withdrawal sets in. A case report on one regular user indicated that she would wake up every 45 minutes throughout the night to smoke in order to alleviate her withdrawal symptoms.3 For some users, withdrawal symptoms (such as depression) can persist for weeks or even months.9

People who chronically abuse synthetic cannabinoids may experience serious withdrawal symptoms, such as:10

  • Rapid heart rate.
  • Seizures.
  • Palpitations.
  • Chest pain.
  • Breathing difficulties.

Bath Salts

While more study is needed on the typical onset and exact effects of withdrawal from bath salts, one study reports that people who use bath salts may experience paranoia, along with auditory and visual hallucinations, for up to 4 weeks after the last use.11 These symptoms might need to be managed in a supervised detox to protect the health of the patient attempting to quit and move forward with recovery.

MDMA

Signs of MDMA use.In cases of MDMA abuse, withdrawal effects usually start shortly after the last use and appear to have a relatively short duration. Withdrawal symptoms can include depression, anxiety, restlessness, irritability, and sleep disturbances.12

Synthetic Hallucinogens

Not much is known about the withdrawal syndrome of drugs like 2C-B and 2C-E, but what is known about their dangers is enough to provide a very compelling reason to quit.

Intoxication from these drugs may cause serious symptoms like nausea, vomiting, rapid heart rate, breathing problems, seizures, and a phenomenon called excited delirium, which is characterized by agitation, episodes of violence, high blood pressure, and hyperthermia (high body temperature).16 People suffering from these symptoms may require focused medical attention in a hospital environment.

If you or someone you know is intoxicated by one of these synthetic drugs, things can go wrong quickly. Don’t attempt to wait for these potentially dangerous symptoms to go away on their own. Get help and then seek the advice of your physician about the best course of addiction treatment and whether medical detox is needed.

Can You Detox Alone?

The dangers of detoxing alone.Detoxing from synthetic drugs on your own can carry a number of risks. For example, without proper support, it can be difficult to abstain from continuing drug use; many people relapse as a way of preventing unpleasant withdrawal symptoms. Additionally, detoxing on your own can be dangerous if you develop medical or psychiatric symptoms that require immediate attention; at home, you won’t have access to qualified medical staff who can address your symptoms and provide the care you need.

Detoxing on your own can be dangerous if you develop medical or psychiatric symptoms that require immediate attention.

Medical risks of home detox can vary by substance and individual factors. Co-occurring medical or psychiatric issues (such as depression or bipolar disorder), level of social support, and certain environmental conditions (such as where you live and whether you have easy access to drugs) can all potentially influence your well-being and safety if you choose to detox at home. For example, if you experience chest pain or breathing difficulties, you’ll have to call 911 and wait for EMTs to arrive or hope that your symptoms subside. This can be both frightening and risky, especially if you are experiencing an actual medical emergency. Psychological risks are similar—if you experience a panic attack (which can feel like a heart attack), you’ll have to experience the fear and panic without the support of professional staff and you may not know whether or not you’re actually having a medical emergency. You might also experience depression or suicidal thoughts and be left alone with the support you need.

Generally speaking, detox can be a difficult undertaking if you are dependent on or addicted to any substance. Because it is not uncommon for withdrawal to be accompanied by medical complications, you should be screened by health professionals to prevent or address any potential medical crises.13 This is especially important if you abuse more than one substance, as the complications of each drug may arise, creating a volatile situation that could require medical management.

What Are My Options for Treatment?

DSeeking treatment in an inpatient setting.etoxification is a set of interventions designed to help you remain safe and comfortable as you withdraw from a drug. This step is a necessary one to stabilize your mind and body so that you can begin addiction treatment safely and with a clear head. Medical detox facilities offer detoxification services that are supervised by physicians and other substance abuse professionals. They provide you with the necessary support and supervision and can also help address any medical or psychiatric conditions that need attention. You may receive specific medications to help manage certain medical or mental health symptoms, such as depression, though there are currently no medications that are approved specifically to treat withdrawal from bath salts, synthetic cannabinoids, or MDMA.4,6,10

If you choose an inpatient detox facility, you will have round-the-clock access to medical staff who can attend to your needs. If your doctor gives the okay, you might also be able to complete a medical detox on an outpatient basis, but you will need to ensure that your doctor is available to accommodate frequent appointments, especially during the acute withdrawal phase.14

To ensure your recovery and cement your foundation for continued sobriety, consider transferring to some form of professional substance abuse treatment once you complete detox.

Some of the recovery options for synthetic drug addiction include:13

  • Inpatient treatment. You live at a residential drug treatment facility, usually for up to 90 days, although it can be longer if necessary. You receive 24/7 care and support and participate in treatments such as individual counseling, group therapy, and 12-step groups.
  • Outpatient treatment. You live at home but travel on a regular schedule to an outpatient facility for treatment and support. Many people transition to some form of outpatient treatment after they have completed inpatient rehab to continue their therapy and prevent relapse.
  • Partial hospitalization program (PHP). This is an intense form of outpatient treatment for people who require a higher level of support but are unable to attend (or have already completed) inpatient treatment. You live at home but receive treatment in an acute care setting, such as a hospital, for the majority of the day.
  • Intensive outpatient program (IOP). This involves fewer hours than partial hospitalization but is still more intensive than some standard outpatient treatment regimens. You generally attend treatment sessions for 2-3 hours per day, 3 days per week, although this can vary by facility.

Synthetic drug abuse doesn’t just impact your health and overall well-being, it also affects the lives of those around you, including family and friends. If not properly addressed, synthetic drug abuse can take over your life and cause long-term problems such as divorce or job loss. If you or someone you love is struggling with an addiction to synthetic drugs, don’t wait until it’s too late to seek help. Obtaining professional detox and addiction treatment is one of the most beneficial ways to take back control of your life and ensure your best chances of recovery.

References:

  1. New York State Bureau of Narcotic Enforcement. (N.D.). Synthetic Drug Frequently Asked Questions.
  2. Community Anti-Drug Coalitions of America. (N.D.). Synthetic Drugs.
  3. Cooper, Z. D. (2016). Adverse Effects of Synthetic Cannabinoids: Management of Acute Toxicity and WithdrawalCurrent Psychiatry Reports18(5), 52.
  4. National Institute on Drug Abuse. (2018). DrugFacts: Synthetic Cathinones ("Bath Salts").
  5. National Drug Intelligence Center. (2001). Information Bulletin 2C-B (Nexus) Reappears on the Club Drug Scene.
  6. National Institute on Drug Abuse. (2016). DrugFacts: MDMA (Ecstasy/Molly).
  7. Department of Health & Human Services, State Government of Victoria. (2015). Hallucinogens.
  8. Latt, N. (2009). Addiction Medicine. New York: Oxford University Press.
  9. National Institute on Drug Abuse. (2017). Frequently Asked Questions: What is Withdrawal? How Long Does it Last?
  10. Centers for Disease Control and Prevention. (2017). About Synthetic Cannabinoids.
  11. Hohmann, N., Mikus, G., & Czock, D. (2014). Effects and Risks Associated with Novel Psychoactive Substances: Mislabeling and Sale as Bath Salts, Spice, and Research ChemicalsDeutsches Ärzteblatt International111(9), 139–147.
  12. National Institute on Drug Abuse. (2007). The Neurobiology of Ecstasy (MDMA): 1: Short-Term Effects After Ecstasy is Gone from the Body.
  13. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. 3. An Overview of Psychosocial and Biomedical Issues During Detoxification. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  14. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. 2. Settings, Levels of Care, and Patient Placement. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  15. National Institute on Drug Abuse. (2013). Dangerous Synthetic Drugs.
  16. Dean, B. V., Stellpflug, S. J., Burnett, A. M., & Engebretsen, K. M. (2013). 2C or Not 2C: Phenethylamine Designer Drug ReviewJournal of Medical Toxicology, 9(2), 172–178.
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