Intended for healthcare professionals


Spice and all things nasty: the challenge of synthetic cannabinoids

BMJ 2016; 355 doi: (Published 24 October 2016) Cite this as: BMJ 2016;355:i5639
  1. Nicola J Kalk, NIHR clinical lecturer1,
  2. Alastair Boyd, associate specialist in addiction psychiatry2,
  3. John Strang, professor1,
  4. Emily Finch, clinical director of the addictions clinical academic group2
  1. 1National Addictions Centre, King’s College London, London SE5 8BB, UK
  2. 2South London and Maudsley NHS Foundation Trust, London, UK
  1. Correspondence to: N J Kalk nicola.kalk{at}

An evolving problem that is difficult to detect and treat

The Psychoactive Substances Act 2016, which came into force in May, signals a new approach to drug controls in the UK. For the first time, the basis for illegality is pharmacological action rather than chemical structure. The act made it illegal to produce or supply “spice” or synthetic cannabinoids and to possess them in a custodial setting.

Synthetic cannabinoids are a group of structurally unrelated compounds that act at the cannabinoid receptors CB1 and CB2. Spice is the commonest UK term, but there are more than 500 other street names, including black mamba and annihilation.1 The chemicals are synthesised in a laboratory, dissolved in a solvent, then sprayed onto plant material, which is smoked or, less commonly, taken orally or injected. Previous attempts to ban synthetic cannabinoids failed because compounds with novel structures could be produced quickly. The clinical challenge of these substances mirrors the legislative challenge in that the severity of harms demands a substantial response while their chemical variety makes monitoring …

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