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What can marijuana be laced with and how to recognize laced weed?

You won’t believe what people are prepared to put in cannabis! Hair sprays, pesticides, glass, and detergents are just some of the many substances used for lacing cannabis

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    No one has ever died from using marijuana. In fact, cannabis has helped countless numbers of people cope with anxiety, depression, epilepsy, and many other conditions and symptoms.

    Laced weed, however, is a completely different story.

    What can marijuana be laced with and how to recognize laced weed? Back to video

    Combining pot with other drugs and substances can be dangerous. Despite what some prohibitionists and scaremongers might want you to think, laced weed is actually rare and unusual to find. When the production and distribution of cannabis is regulated by the law (for either medical or recreational purposes), there’s usually no need to buy weed on the black market. That’s why, for example, Canada does not have as many problems with laced weed as some states in the U.S. and UK. However, not all of us have safe access to cannabis. In this article, we’ll investigate substances that are used for lacing pot, the effects of smoking laced weed, and how to tell if your weed is laced.

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    What is laced weed?

    Laced weed is a cannabis flower that has been combined with other chemicals: drugs, inorganic substances or additives. You won’t believe what people are prepared to put in cannabis—hair sprays, pesticides, glass, and detergents are just some of the substances used for lacing cannabis.

    At this point, you might be asking yourself why on earth anyone would mix this powerful and healing herb with anything else? Well, there are a few obvious reasons. Shady dealers would do anything to sell you low-quality weed to make more profit. That’s why they would want to make it appear as high-quality and heavy as possible. Besides masking the low quality, lacing weed with other stronger drugs is a way for dealers to gradually get people addicted to the drug without them being aware of it, so they always come back for more.

    Another reason for lacing weed is actually no reason at all other than getting high. Some people like to sprinkle their weed intentionally with other drugs to make it more potent or to produce effects that weed normally does not have.

    If you suspect your weed has been laced with glass, just rub the bud on the surface of a CD. If the weed contains glass, it will leave scratches on it. Regular cannabis will not leave any scratches.

    Substances used for lacing weed

    Marijuana can be laced with almost any drug. Some dealers will intentionally lace weed with another drug to produce a different, more potent high. Let’s go through the most common drugs used for adulterating marijuana, what the effect would be if you consumed it, and why dealers and users do it.

    Cocaine

    A packed bowl or a joint rolled with cocaine-laced weed is informally called Primo. People usually lace their weed with cocaine to induce the stimulant effect of cocaine and sedative effect of weed at the same time. Weed laced with cocaine can be dangerous. It affects your lungs, heart, and brain at the same time. If you have smoked a primo joint, you’ll probably have a sleepless night and a lack of focus, which will leave you feeling numb, which could result in paranoia. Tense muscles and an increased heart rate caused by the constricted blood vessels can, unfortunately, lead to fatal consequences: stroke, heart attack or even cardiac arrest.

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    A joint laced with LSD is known as a rainbow joint. LSD or acid is a potent hallucinogenic drug that alters our awareness of surroundings, sensations, images, and feelings. Usually, it’s not addictive. The method for lacing weed with this potent hallucinogenic stimulant is different than other drugs. Rainbow joints are made by dabbing the end of marijuana cigarette into LSD, so when you put the joint filter tip on your lips and mouth, you absorb the substance. And that’s when the powerful hallucinogenic effects start. Even in smaller doses, this type of weed produces effects that can last up to 12 hours.

    Phencyclidine, better known as PCP or angel dust, is a strong hallucinogenic drug known for its mind-altering effects. Dealers usually add PCP to weed to induce a stronger psychoactive effect. This kind of marijuana is sold under different names such as dusted weed, wet weed, fry, and super weed.

    Smoking just small amounts of this compound can make you feel detached from your surroundings. This can eventually lead to aggressive behaviour with strong hallucinations, delusions, and even seizures, with the possibility of developing neurological damage.

    Heroin

    As one of the most addictive drugs out there, heroin is among the most dangerous substances on this list. Unfortunately, heroin-laced weed is not uncommon nowadays. Heroin is a yellowish, brown powder which smells like rubber or vinegar. By smoking pot mixed with this substance, you’ll become extremely relaxed and euphoric, but not like when you use regular weed. The high produced by weed laced with heroin produces a slow heart rate, slowed breathing and confusion that is almost unbearable.

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    Ketamine

    As ketamine became one of the favorite club drugs, it also found its way into rolled joints. It’s primarily used as an anesthetic in medicine, and it’s used recreationally because of its sedative effects. Ketamine can be very dangerous—dehydration, overheating, and confusion are just some of the symptoms.

    Methamphetamine

    Methamphetamine is a strong and powerful neuro-stimulant medical drug used for treating ADHD and obesity, but it’s also abused for recreational purposes. It can cause serious effects, including hallucinations, delusions, and even seizures.

    Embalming fluid/formaldehyde

    Embalming fluid is a mixture of solvents (including formaldehyde), which is used to preserve dead bodies. Formaldehyde smells like pickles and has no color, and it’s usually added to synthetic weed. If you smoke weed laced with these substances you might experience pain in your chest, headaches and an increased heart rate, nausea and/or diarrhea, with severe hallucinations and paranoia.

    Fentanyl

    Fentanyl is an opioid drug used as a painkiller and anesthetic. It’s relatively cheap and is 50 times stronger than heroin. Fentanyl is a very dangerous opioid, and it would be more than stupid to mix it with any drug including marijuana.

    If you suspect you smoked a joint laced with PCP and you notice you talk indistinctly, blink a lot and look disoriented and paranoid, the best thing you can do is to seek medical help immediately. Photo by LARS HAGBERG/AFP/Getty Images

    Other substances marijuana can be laced with

    Believe it or not, weed can be laced with other materials and substances because they are much cheaper than some drugs and can easily make the weed appear more appealing to the eye.

    You won’t believe what people are prepared to put in cannabis! Hair sprays, pesticides, glass, and detergents are just some of the many substances used for…

    “Smoking Wet”

    Abstract

    Reports have suggested that the use of a dangerously tainted form of marijuana, referred to in the vernacular as “wet” or “fry,” has increased. Marijuana cigarettes are dipped into or laced with other substances, typically formaldehyde, phencyclidine, or both. Inhaling smoke from these cigarettes can cause lung injuries.

    We report the cases of 2 young adults who presented at our hospital with respiratory failure soon after they had smoked “wet” marijuana cigarettes. In both patients, progressive hypoxemic respiratory failure necessitated rescue therapy with extracorporeal membrane oxygenation. After lengthy hospitalizations, both patients recovered with only mild pulmonary function abnormalities.

    To our knowledge, this is the first 2-patient report of severe respiratory failure and rescue therapy with extracorporeal oxygenation after the smoking of marijuana cigarettes thus tainted. We believe that, in young adults with an unexplained presentation of severe respiratory failure, the possibility of exposure to tainted marijuana cigarettes should be considered.

    Numerous reports on alternative forms of tetrahydrocannabinol (THC) can be found in multiple media forums. 1–5 Several reports indicate the increased use of marijuana cigarettes, the ingredients of which have been tainted in a potentially harmful fashion. 1–4 This altered form of marijuana, referred to in the vernacular as “wet,” “illy,” or “fry,” was first reported in the 1970s and can now be procured rather readily. “Wet” cigarettes are conventional marijuana cigarettes that have been dipped into various fluids or laced with additional substances. The precise ingredients involved in this augmentation process may or may not be known by the end user. The most frequently reported method involves the dipping of marijuana into embalming fluid or formaldehyde that has been mixed with phencyclidine (PCP). 3

    The exact origin of tainted marijuana cigarettes is unknown. The “wet” cigarettes reported on in the 1970s were probably laced with PCP. At that time, PCP was referred to by marijuana users and dealers as “embalming fluid.” It is postulated that drug dealers subsequently and mistakenly began using genuine embalming fluid to augment marijuana cigarettes, and that this has led to the current formulation with embalming fluid, PCP, or both. 3

    Cannabis is not typically considered to be a drug that causes respiratory failure. However, exposure to tainted marijuana cigarettes potentially precipitates organ failure, including respiratory failure. Exposure to PCP can increase the prevalence of life-threatening events. 3,5 Other reports about tainted marijuana cigarettes chiefly discuss their impact on the central nervous system. The effects include hallucinations, disorientation, impaired coordination, paranoia, sexual disinhibition, and visual disturbances. 3–5 We present the cases of 2 young adults who presented with severe respiratory failure—thought to be related to “wet cigarette” exposure—that necessitated therapy with extracorporeal membrane oxygenation (ECMO).

    Case Reports

    Patient 1

    A 27-year-old woman presented at another hospital with respiratory failure and seizures. Her medical history included chronic depression and alcohol and marijuana abuse, but no prior seizures. After transfer to our hospital, she was placed on mechanical ventilation at a low tidal volume, in accordance with the Acute Respiratory Distress Network (ARDSNet) protocol. 6 Drug-screening tests were positive for THC and PCP. Chest radiographs revealed bilateral, diffuse pulmonary infiltrates. Computed tomograms showed areas of diffuse consolidation as well as ground-glass attenuation with superimposed inter- and intralobular septal thickening. Empiric antibiotic therapy for presumed pneumonia was started. However, investigations for infectious and noninfectious causes, including a bronchoalveolar lavage, yielded negative results. Echocardiograms showed normal cardiac function and structure. During the next 10 days, progressive respiratory failure with persistent bilateral, diffuse pulmonary infiltrates developed ( Fig. 1 ) despite attempted rescue therapies, including neuromuscular blockade, open lung ventilation, inhaled prostacyclin, and high-frequency-oscillation ventilation. Refractory hypoxemic and hypercapnic respiratory failure (Murray Lung Score, 7 4/4/2/3 = 3.25), along with evidence of distributive shock, prompted the implementation of venoarterial ECMO. The patient’s tidal volumes were 4 cc/kg with plateau pressures ranging from 40 to 45 cm H2O just before ECMO was initiated. Despite the low tidal volume and ECMO support, the patient’s course was complicated by recurrent pneumothorax and by a hemothorax that necessitated thoracotomy. After 35 days, she was weaned from ECMO support and was again placed on conventional mechanical ventilation. Tracheostomy enabled the patient to breathe room air, and she was discharged to an inpatient rehabilitation unit 65 days after her initial hospital admission. After being discharged from the rehabilitation unit, she was able to resume all activities of daily life.

    Fig. 1 Patient 1. Chest radiograph at the time of ECMO cannulation shows diffuse pulmonary infiltrates bilaterally.

    Six months after the patient’s initial hospitalization, she underwent pulmonary-function testing to evaluate her severe acute respiratory distress syndrome (ARDS). Spirometry revealed mild deficiencies in forced expiratory volume in 1 second (FEV1) (60%), in total lung capacity (TLC) (62%), and in diffusing capacity of carbon monoxide (DLCO) (70%). A chest radiograph revealed unilateral basilar scarring, consistent with the location of her recurrent pneumothoraces and hemothorax.

    It was learned that the patient had been in her usual state of health before the initial hospital admission. On the night before admission, she had smoked marijuana cigarettes that had been dipped in PCP and embalming fluid.

    Patient 2

    A 20-year-old man with no past medical problems presented at another hospital with disorientation and hypoxemic respiratory failure. He was intubated and hemodynamically stable upon his transfer to our hospital. Chest radiographs revealed bilateral, diffuse pulmonary infiltrates. Echocardiograms showed normal cardiac function and structure. Drug-screening tests were positive for THC. Investigations for infectious and noninfectious causes yielded negative results. Bronchoscopic evaluation showed mildly edematous airways and yielded a neutrophil-predominant lavage. Ventilation at low tidal volume was used, in accordance with the ARDSNet protocol. 6 During the next 11 days, progressive hypoxemic respiratory failure (Murray Lung Score, 7 3/4/3/4 = 3.5) and persistent bilateral, diffuse pulmonary infiltrates developed ( Fig. 2 ) despite neuromuscular blockade, inhaled prostacyclin therapy, open lung ventilation, and recruitment maneuvers. The patient’s tidal volumes were 5 cc/kg, with plateau pressures ranging from 30 to 35 cm H2O just before venovenous ECMO support was initiated. After 10 days, the patient was placed on conventional mechanical ventilation. He was transferred to an inpatient rehabilitation unit 35 days after his hospital admission.

    Fig. 2 Patient 2. Chest radiograph at the time of ECMO cannulation shows diffuse pulmonary infiltrates bilaterally.

    To follow up on the patient’s severe ARDS, his pulmonary function was tested 3 months after his discharge from the hospital. Spirometry revealed a mildly abnormal FEV1 (73%), normal TLC (84%), and normal DLCO (81%). A chest radiograph showed no evidence of parenchymal lung disease. Further information confirmed the patient’s history of marijuana abuse and his having smoked tainted marijuana cigarettes just before his initial hospitalization.

    Discussion

    To our knowledge, these are the first reported cases of severe respiratory failure and the necessity of ECMO use in relation to the smoking of “wet” marijuana cigarettes.

    Inhalation Toxicity of Tainted Marijuana Cigarettes

    We think that inhalation exposure was the chief culprit in our patients’ respiratory failure, given the temporal relationship of their use of tainted marijuana and their similar clinical presentations. Both presented with progressive, severe ARDS without any obvious inciting event. Although respiratory failure relating to smoking tainted marijuana cigarettes has not been previously described, some medical literature supports the adverse effects of the typical ingredients on the respiratory system.

    Marijuana use by itself has not been linked to respiratory failure; however, it has been associated with chronic respiratory problems, such as bronchitis, obstructive lung disease, and histopathologic airway changes. 8–10 The inhalation of embalming fluid has been linked to bronchitis, lung damage, and airway ulcerations. Pulmonary complications have rarely been reported in association with PCP use. 11

    The most commonly reported pulmonary symptoms from formaldehyde exposure are acute bronchospasm and occupational asthma. 12–14 We found only one report of formaldehyde exposure’s causing respiratory insufficiency: Dr. John Porter described his own experience and hospital course after prolonged exposure to formaldehyde. 15 While preparing an anatomic specimen with formaldehyde, he developed progressive chest tightness and dyspnea that necessitated hospitalization and oxygen supplementation. Chest radiographs showed interstitial markings that were interpreted to be pulmonary edema. He slowly recovered with corticosteroid therapy and was without subjective symptoms 5 weeks after his hospital admission. 15

    Formaldehyde exposure has toxic effects at the cellular level. Inhalation exposure results in impairment of self-repair mechanisms 16 ; in rats, varying degrees of respiratory epithelium hyperplasia and metaplasia have occurred, along with focal necrosis and epithelial thickening. 13,14,17 It is hypothesized that inhalation of formaldehyde promotes mast-cell degranulation and disrupts nitric oxide regulation. 16 This disruption may cause an alteration in both airway and vascular-tone homeostasis. The varying amounts of formaldehyde in embalming fluid, along with the varying degrees and areas of injury, might explain the range in clinical symptoms from bronchial hyperreactivity to noncardiogenic pulmonary edema. 18

    Specific interactions between formaldehyde and the ingredients in marijuana smoke might also warrant consideration in the pathogenesis of combined exposure. Chronic marijuana inhalation has been identified as a promoter of airway inflammation in human beings. 9,10 This underlying chronic inflammation and epithelial disruption could predispose marijuana users to further airway injury from irritants such as formaldehyde; however, the literature describing such a phenomenon is sparse.

    Extracorporeal Oxygenation in Severe Respiratory Failure

    Our case reports yield evidence of the value of ECMO support in severe respiratory failure. We propose that patients can recover from severe lung injury after inhaling smoke from tainted marijuana cigarettes, and we recommend fairly aggressive therapy—which might include ECMO—in patients who present with single-organ failure and potentially surmountable lung injury.

    Long-term pulmonary outcomes in ARDS survivors have often included abnormal pulmonary function test results, such as mild diffusion and restriction limitations. In our female patient, pulmonary tests 6 months after her hospital discharge disclosed only mild abnormalities. In our male patient, tests 3 months after his hospital discharge revealed relatively normal lung function, except for a mild decrease in spirometric values. These results appear similar to or even better than other long-term pulmonary function follow-up data in ARDS patients.

    Conclusion

    Our patients had similar presentations after similar temporal exposure to tainted marijuana cigarettes. We believe that smoke from tainted marijuana cigarettes could be an unrecognized cause of respiratory failure in young adults who present with an otherwise unclear origin of respiratory failure and ARDS. According to the available literature, the varying quantity and quality of ingredients in marijuana cigarettes can lead to presentations that range from cough and bronchospasm to severe respiratory failure. We recommend that the inhalation of smoke from tainted marijuana cigarettes be considered as the cause of ARDS in young adults, when the clinical context suggests it.

    Footnotes

    Address for reprints: Christopher R. Gilbert, DO, Pulmonary, Allergy, & Critical Care Medicine, Penn State Milton S. Hershey Medical Center, 500 University Dr., MCH041, Hershey, PA 17033

    “Smoking Wet” Abstract Reports have suggested that the use of a dangerously tainted form of marijuana, referred to in the vernacular as “wet” or “fry,” has increased. Marijuana cigarettes are