The Q&A: Daniel Ostermayer

With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week's subject:

Dr. Daniel Ostermayer is an assistant professor of emergency medicine at the UTHealth McGovern Medical School. We spoke with him recently about synthetic marijuana, a dangerous drug very unlike its namesake, and how the community at large should respond. 

Editor's note: This interview has been edited for length and clarity.

Trib+Health: Could you explain what K2 is and how it is different than marijuana? And what makes it so dangerous?

Daniel Ostermayer: So K2 comes by a lot of different names: K2, spice, synthetic marijuana, mambo, kush — kush is probably the most common that people hear locally in Texas.

It is a series of compounds developed by an organic chemist when they were studying how they could look for some of the health benefits of marijuana. These compounds went unnoticed for a long period of time, and they were only being used within the medical community experimentally with animals.

And then eventually, all those compounds got a popular resurgence when a few of them were discovered to be easy to manufacture.

Those went under many different marketing terms to become what is now known as this big class of drugs known as the synthetic marijuanas. They are all sort of related to THC, which is the active ingredient that produces the euphoric effects you get from smoking marijuana. 

Besides some very subtle similarities in how they look, in terms of their similarities to the THC molecule, they really have nothing in common with actual marijuana.

And their effects are far more dangerous than your garden variety "pot" that people have known for a long time.

The reason they're so dangerous is because they have a lot of amphetamine-like effects. They have a significant amount of stimulant-like properties. On top of that, because there are so many different variations of these compounds … the effects are very unpredictable.

So some of them — the brand name is the same, but the chemical structure that is being sold to people under the same brand may be vastly different than what it was many months ago. And those effects usually have some stimulant properties, like bath salts or amphetamines, which make people really hyped-up, really energetic. They also can cause pretty bad psychoses, aggression, and people that have underlying heart conditions or blood pressure issues can experience severe health effects related to the amphetamine-like effects. 

And on top of that, they often produce violent hallucinations and generally in unpredictable quantities because of the varying levels of compounds that are being sold, even though the brand name is the same.

Trib+Health: Why do the properties of these brands change so dramatically? 

Ostermayer: With synthetic marijuana, the reason the compounds are always changing, or the concentrations are always different, is that the people selling them are constantly, actively trying to avoid regulation.

So there is regulation in the state of Texas that is targeted specifically at this family of compounds and compounds that are similar to this family … anyone selling something related to this original compound can have it deemed illegal. 

And the same on the DEA level — those families of compounds are also being made illegal.

But most of the chemicals are being constantly modified so that they are slightly different than the original illegal substances. That way, they can still remain in business, still sell their compounds, still produce a similar effect as the people who are purchasing are used to, but have it structurally different enough.

Trib+Health: How do you treat patients exposed to synthetic marijuana?

Ostermayer: We ultimately have to let the substance, in a sense, run its course. We often don't know what a person used, and so we treat them based on how they're presenting.

If someone is agitated, we help calm them down. If someone is aggressive, we help keep them safe. If someone is unresponsive and needs more aggressive therapy, then we respond to their unresponsiveness in a supportive fashion.

We don't have an antidote — there is none for synthetic marijuana. In a sense, we don't know for sure that they used synthetic marijuana. All we know is we get many patients with a constellation of symptoms: some agitation, aggressiveness, or depressed level of consciousness, mixed with what looks like some psychiatric disease. All of that together at least gives us, generally, an agitated patient that we need to support and keep calm.

Often times that's enough, as the patient metabolizes the substance they took, which is ultimately unknown, unless they actually had it on their person when they present to the ER. 

But even then, we’re still not exactly sure what is in the packet that they took, because it goes back to how many different variations of these compounds and varying quantities of compound that is on the plant material that these people usually ingest. Because it's so variable we usually treat the constellation of symptoms.

Trib+Health: How are people obtaining this drug? 

Ostermayer: It should be increasingly not available. In theory, they are now illegal within the state of Texas, this family of compounds.

However, since the Internet is such a great marketplace … they are just being purchased in bulk generally, from international suppliers, shipped through the USPS or through international mail, and then they're arriving in the U.S. and being distributed for incredibly cheap.

They're a low quality drug, and because it's a low quality drug, it's very inexpensive. So then it becomes widely used for people who want something and don't have the money to pay for a more traditional drug.

Trib+Health: What should be done to prevent the spread of this drug? 

Ostermayer: It speaks to the fact that all efforts should be focused on education, because there's no way to effectively control what people buy on the Internet. 

Ultimately, you can't stop people from buying things on the Internet — it will be the continuous cat-and-mouse game we've played with all drugs up until this point.

Most of it is all about education. If people understand the dangers of these drugs, they may be less likely to use them.