THC Vape Warning

Synthetic cannabinoids (SCRA) mis-sold as ‘THC vape’/ ‘cannabis oil’/ ‘THC vape pens’, briefing for professionals .

Greater Manchester Wide Alert

The number of incidents involving what is believed to be synthetic cannabinoids (SCRA) mis-sold as ‘THC vape’ / ’cannabis oil’ / ’THC vape pens’ this year has led to the Greater Manchester Drug Alert Panel to investigate. The panel have decided to issue a public alert, but before this is issued it was decided local professionals should be briefed on the situation and some of the confusion around products sold as THC or cannabis oils. We have also produced a shorter briefing for schools.

Incidents in Bury, Oldham and Rochdale Schools

Since the start of the year there have been a dozen or so reports of incidents in schools and amongst school age children in Bury, Rochdale and Oldham involving substances that were reportedly sold as either ‘THC vape’/‘THC vape pens’/‘THC oil’ or ‘cannabis oil’. The reports usually indicate the substance was vaped in an electronic-cigarette device (Greater Manchester Local Drug information System, 2019).

Some of these reported incidents have led to pupils collapsing and to ambulances being called. A recent incident in the Oldham area received extensive media coverage (Mirror, 2019). A number of other incidents have been reported in Bury, Oldham and Rochdale (Greater Manchester Local Drug information System, 2019).

Recent incidents in Oldham and Bury have involved ambulances being called. Samples involved in these incidents were tested by MANDRAKE (the GMP/MMU drug testing scheme) (Greater Manchester Police, 2018). Neither samples tested contained THC, CBD or any natural cannabis products. The Bury sample contained the SCRA (synthetic cannabinoid) 5F-MDMB-PICA (also known as 5F-MDMB-2201). The Oldham sample came as a ready filled cartridge for a vape pen that contained the SCRA (synthetic cannabinoid) 4F-MDMB-BINACA (also known as 4F-MDMB-BUTINACA).

Appearance and smell of samples tested in Bury and Oldham

The Bury sample was sold in a standard 10ml e-liquid bottle (see image below). Similar samples have been seen both with or without home-made labels. The Oldham sample was in the form of a cartridge that fits into a ready filled vape pen, similar to the e-cigarette system ‘Blu’ (Blu UK, 2019). The liquids reported have varied in colour. The liquids in both tested samples contained a commercially produced flavoured e-liquid (vegetable glycerine, propylene glycol and flavourings) to which a small amount of an SCRA had been added. In the samples tested by MANDRAKE this equated to around 2% of the liquid in the Bury sample and 1.3% of the liquid in the Oldham sample. There does not appear to be any distinguishing synthetic cannabinoid smell, rather the flavour and smell appears to be from the commercial e-liquid used.

Effects and risks from mis-sold ‘THC Vape’ product containing SCRA

The effects described by those who sent in the WEDINOS samples are typical of an SCRA. These included both positive effects: euphoria, increased energy, enhanced senses, relaxation. And negative effects: irregular heartbeat, confusion, paranoia, panic attack, insomnia. Visual hallucinations were also described (which can be either positive or negative depending on what the user was expecting).

Real high potency THC vape oils/liquids are among a group of substances known as ‘cannabis concentrates’ and there are known risks with using these (Chan, 2017; Meier, 2017; Raber, 2015). However, the risk of unknowingly vaping an SCRA is considerably greater, particularly for young people with no experience or tolerance to SCRAs who are unwittingly vaping it in the belief it is a form of cannabis.

Street brought herbal ‘Spice’ has an inconsistent ratio of plant material to SCRA and the SCRAs used in the ‘Spice’ mix may change from batch to batch. It is difficult for even experienced users to judge dosage and unintentionally administering a toxic dose is common. Severe poisoning is more common with SCRAs than with cannabis. In some cases, this poisoning may even be fatal (Trecki, 2015). Last year there were 24 recorded deaths in England and Wales associated with SCRAs, although not one single death occurred without other substances being involved (Office for National Statistics, 2018).

Liquid SCRA may be added by the end users to an e-liquid which would give some measure of control, as was the case before the introduction of the Psychoactive Substances Act (PSA), when liquid SCRA (known as c-liquid) were commercially and at the time legally available. But, if as appears to be the case in the Greater Manchester incidents, the product is brought ready-made, judging dosage would be near impossible.

Before the introduction of the PSA, it was common for young people to be initiated into ‘Spice’ use by friends (‘for a laugh’) who would give them doses they knew would lead to collapse and unpleasant experiences (Linnell, et al., 2015). The effect for a young person with no tolerance of inhaling even a single dose of a potent SCRA in an e-liquid mix, is highly likely to lead to negative physical and mental effects, particularly if they are expecting a cannabis like effect.

The reported incidents in Greater Manchester have already led to collapse and ambulances being called (Greater Manchester Local Drug information System, 2019). It is therefore difficult to see there is much in the way of useful harm reduction advice that can be given other than not using alone and ensuring friends seek help in case of an adverse reaction.

Messages to young people about ‘THC vape’

Those young people still using ‘Spice’ tend to have a multitude of other issues. The stigma of being labelled a ‘Spice head’ is felt by some professionals to make the transition into patterns of drug use seen among adult rough sleepers more likely (MMU, 2019). However, with careful consideration of the risk of increasing stigma further, the messages to young people appear to be relatively straight forward as the image of ‘Spice’/SCRA is so negative.

The major difficulty around messaging is explaining the complex and confusing range of cannabis/THC oils that are often misleadingly marketed or mis-sold. ‘THC vape’ appears to have a very positive image among many young people, whereas ‘Spice’ has a very negative image (see appendix). Products often misleadingly sold as ‘THC vape’/’THC oil’/’Cannabis oil’ etc if they contain mostly CBD and a very low dose of THC (see CBD legality) have no psychoactive effect. Medicinal ‘cannabis oils’ in the form of cannabis based medicinal products (CBMP) are not at present even available to those people with a legitimate medical condition.

The incidents in Greater Manchester appear to be a straightforward case of mis-selling of a controlled drug. The young people thought they were purchasing a highly desirable ‘THC oil/THC vape’ but were being ripped off and sold a cheaper, undesirable and more dangerous substance (SCRA/’Spice’) that they would most likely not consider purchasing if they knew what it was.

Progress - National Consortium of Consultant Nurses in Dual Diagnosis & Substance Use