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Adolescent drug abuse is a common problem worldwide. In the 15- to 24-year-old age group in the United States, intentional and unintentional poisonings are the second leading cause of injury and death, accounting for approximately 5700 deaths in 2016.1 However, the annual prevalence of all illicit drug use (exempting marijuana) has been declining in the United States among teens, from a high of 30% in the late 1990s, to 13% among 12th graders in 2017. Lifetime prevalence of any illicit drug abuse (exempting marijuana) in the same group was 20% in 2017. In contrast, annual use of marijuana among 12th graders in 2017 was nearly 40% and has been on the rise since 2006.2
A “honeymoon period” for a new drug has been described. This period occurs when an illicit drug becomes available, supposed benefits of the drug are spread by word of mouth, Internet, and social media, and drug use rises. In contrast, information about adverse effects takes longer to disseminate, as this evidence is not immediately apparent. The use of e-cigarettes and vaping may currently be in this “honeymoon period.”2 Synthetic cannabinoids and “bath salts” may have been subject to this phenomenon as well.
Following an illustrative case, this article will review what is known about synthetic cannabinoids, amphetamines, and opioids, and the practice of “vaping.” Acquisition by adolescents of the all the substances described here is often facilitated by use of the Internet. For a short time, loopholes in US drug laws allowed sales of synthetic cathinones and synthetic cannabinoids, all legally purchased at stores, “head shops,” or via the Internet. These drugs were collectively called “legal highs.” A common disclaimer on packaging was the phrase “not intended for human consumption,” labeled to circumvent the Federal Analog Act, a section of the US Controlled Substances Act. Currently, many synthetic drugs of abuse can easily be acquired online through the “darknet,” or the deliberately hidden portions of the Internet accessed only with software that guarantees encryption and anonymity.
CaseA 15-year-old male adolescent was found unresponsive at a teen house party and 911 was called. His friends reported to EMS that he used “acid,” and medics witnessed a generalized tonic clonic seizure en route to the hospital. His initial vital...