Dawn Ruzich of the Gateway Foundation and Maya Doe-Simkins of the Heartland Alliance contributed to this article.

Introduction

Synthetic drugs, also known as designer drugs, have become an increasing public health concern to criminal justice practitioners. Synthetics are often cheaper and more readily available than cannabis and amphetamines, making them attractive alternatives to other illicit drugs. Also challenging is that their chemical formulas are constantly changing, making them difficult to regulate and control. The chemical makeup of synthetic drugs can be easily modified, creating regulation obstacles for law enforcement, prosecutors, and lawmakers. As chemical compounds are identified and banned by authorities, producers swiftly adapt with new elements to create other technically legal synthetic drugs.[1]

An added challenge to addressing synthetic drug use, particularly among those involved in the criminal justice system, is that synthetic drugs are not always detected with commonly used drug tests. Standard tests typically screen for a limited number of substances.[2] More advanced drug panel screenings can detect synthetic drugs, but they are more expensive and not always available to criminal justice practitioners. This is compounded by the constant modifications in chemical make-up.[3] As a result, little is known about the actual prevalence and use of synthetic drugs among those involved in the criminal justice system. To examine the issue, Authority researchers partnered with WestCare Foundation to conduct a study on synthetic drug use among individuals enrolled in substance abuse programs within two state correctional facilities. Major findings from the study, including reported prevalence of use, reasons for use, how the drugs were obtained, and their effects are described here.

What are synthetic drugs?

Synthetic marijuana, also called spice, herbal incense, potpourri, and K2, typically originate in China and are sent to U.S. processing labs in homes and warehouses.[4] THC, the psychoactive ingredient in marijuana, is synthetically produced and then diluted with acetone or alcohol to create a liquid solution that is sprayed on a mixture of herbal leaves, which are then dried, packaged, and sold.[5]

Synthetic cathinones, commonly referred to as bath salts or plant food, are similar both chemically and in appearance to methamphetamine, cocaine, and ecstasy, mimicking their stimulant effects.[6] Synthetic drugs are sold in convenience stores, gas stations, and on the Internet in packages lacking ingredient lists making the compounds difficult to identify.[7] Though similar in name and sometimes appearance, these “bath salts” are not those sold in bath and body shops.

Danger of synthetic drugs

The synthetic chemical compounds used to manufacture synthetic marijuana have a potency between four and 100 times that of marijuana.[8] Other psychoactive compounds have been found in synthetic marijuana samples, such as synthetic opioids.[9] Synthetic marijuana typically affects the body’s central nervous system and cardiovascular system, as well as gastrointestinal areas.[10] Psychoactive effects of synthetic marijuana include cognitive impairment, behavioral disruptions, such as violent behavior and suicidal thoughts, drastic mood changes, paranoia, delusions, and hallucinations.[11] Physical effects may include seizures, psychosis, increased heart rate, cardiotoxicity (weakening of the heart muscles), drowsiness, and vomiting.[12] Synthetic marijuana or bath salt use to intoxication can be associated with injury or death.[13]

Bath salt use may result in a variety of symptoms similar to those of mental illness, including aggressive and violent behavior, extreme paranoia, acute psychosis, delusions or delirium, and panic attacks. Users also may suffer an increased heart rate and vomiting.[14] In 2011, an estimated 51,435 emergency room visits were linked to the abuse of synthetic drugs in the United States—55 percent of those due to synthetic marijuana and 45 percent due to bath salts.[15] Further, in 2014, a total of 3,682 human exposures to synthetic marijuana were reported to poison control centers (American Association of Poison Control Centers, 2015).[16]

Prevalence among criminal justice-involved individuals

Few studies have documented use of synthetic drugs within the criminal justice population. Researchers at the Center for Substance Abuse Research (CESAR) examined the Community Drug Early Warning System (CDEWS) for information on synthetic drug use.[17] CESAR tested CDEWS’s ability to identify trends in newly available drugs. Researchers at CESAR analyzed urine specimens collected from participants to identify synthetic marijuana use in several criminal justice programs in Washington, D.C., Chesterfield, Va., and Prince George’s County, Md.[18] A total of 1,064 specimens were tested. Positive screens for synthetic marijuana among the following populations were found via CDEWS despite testing negative on other criminal justice drug screening panels:

  • 37 percent at the Washington, D.C., parole and probation site.
  • 28 percent at Washington, D.C., lockup.
  • 21 percent at the Washington, D.C., pretrial surveillance site.
  • 19 percent at Chesterfield probation.
  • 13 percent at Prince George’s County Drug Court.[18]

The likelihood of testing positive for synthetic marijuana was the same within the population regardless of basic drug testing outcomes.[19]

The study was replicated (CDEWS-2) with juveniles and adults in Washington, D.C.; Denver, Colo.; and Tampa, Fla., and 1,026 urine specimens were collected. More than half of male probationers aged 21 to 30 years old tested positive for synthetic marijuana in Washington, D.C., despite passing the more limited criminal justice system drug screening panels (limited number of drugs screened). Additionally, 20 percent of juveniles aged 13 to 17 years old tested positive for synthetic marijuana in Washington, D.C.[20] At the Denver Drug Court CDEWS site, a small portion of urine specimens tested positive for synthetic marijuana—8 percent of those who were positive on the limited drug panels and 3 percent of those who tested negative on the limited drug panels.[21] Nine percent of juveniles’ urine specimens tested positive for synthetic marijuana; however, a majority of these specimens also tested positive for marijuana on the limited panels.[22]

Most recently, the study was replicated in Hawaii (CDEWS-3) with specimens from individuals in Hawaii’s Opportunity Probation Enforcement (HOPE) program and general supervision populations in Honolulu.[23] Out of the 194 HOPE and 143 general supervision specimens tested, 2 percent from HOPE and 1 percent from general supervision tested positive for synthetic marijuana. Those that tested positive for synthetic marijuana also tested negative for any drug in limited panels panels.[24]

Motivations underlying use

There are multiple reasons why individuals may try drugs, including the desire to take risks and try new things, and/or help deal with potential social or emotional problems—as relaxation or escape.[25] In addition, drug availability, peer use, and family use are also factors that may influence an individual to engage in substance use.[26] Other reported motivations for substance use include feeling better or feeling good, increasing self-confidence, decreasing boredom, satisfying curiosity, and enhancing other activities.[27]

In a study of homeless, intravenous drug users in San Diego, Calif., 7 percent of the respondents reported trying bath salts and 30 percent reported trying synthetic marijuana. Of those who reported trying bath salts, the primary motivation to use was out of curiosity (58 percent). Those reporting synthetic marijuana use also indicated they were motivated by curiosity (49 percent). Further, individuals who had used synthetic marijuana were also motivated by availability, with 20 percent of respondents indicating synthetic marijuana was more available than other drugs.[28]

While that study found curiosity and availability were the primary motivators, some individuals reported unknowingly using synthetic drugs. An estimated quarter of those who had taken bath salts thought they were using another drug, such as methamphetamine.[29] The study found a high rate of intravenous bath salt users within the sample, possibly because those individuals were already using drugs intravenously.[30] Further, both bath salt and synthetic marijuana users were more likely to report other drug use within the previous six months.[31] This is consistent with research suggesting synthetic drug use is associated with general polysubstance use.[32]

Synthetic drug availability in Illinois

In 2016, the Authority completed a drug threat assessment survey of police chiefs and county sheriffs in Illinois. More than half of law enforcement respondents (n=82) reported high or moderate availability of synthetic marijuana (55 percent) and 35 percent reported high or moderate availability of bath salts in their jurisdictions (Figure 1).[33] The perceived availability and demand for synthetic marijuana and bath salts was higher in the central and southern regions of Illinois.[34] On the national level, synthetic marijuana and bath salts are moderately available compared to previous years. Further, the Chicago Drug Enforcement Agency Field Division reported lower availability in 2014 compared to 2013.[35]

Illinois took steps to prevent access to and distribution of synthetic drugs with the Bath Salts Prohibition Act of 2016 [720 ILCS 542], prohibiting the sale or offer of sale of bath salts at any retail establishment within the state. Violation of the Act is a Class 3 felony that may result in a fine of up to $150,000 and revocation of the retailer’s license.

Figure 1

Availability of synthetic drugs by type, reported by police chiefs and county sheriffs (n=82)

Figure 1
Source: ICJIA Illinois Drug Threat Assessment, 2016

Illinois law enforcement respondents reported perceived increases in synthetic drug transportation, distribution, demand, and availability within the past 12 months (Figure 2). Drug transportation refers to the movement of synthetic drugs from one place to another, such as into Illinois from other states or other countries.

Figure 2

Percent of responding police chiefs and county sheriffs indicating an increase in synthetic drugs (n=82)

Figure 2
Source: ICJIA Illinois Drug Threat Assessment, 2016

Indicating increased encounters with synthetic drugs use also has been indicated in emergency room visits. According to the Illinois Poison Center, between 2010 and 2011, bath salt cases increased 2,522 percent and synthetic marijuana cases increased 557 percent.[36] More than half of the patients visiting emergency rooms for synthetic marijuana abuse were between the ages of 12 and 20 (56 percent).[37] In Illinois, 85 percent of cases reported to the Illinois Poison Control Center that involved synthetic drugs in 2011 involved teens and young adults under the age of 30.[38]

Current study

In April 2016, Authority researchers administered a paper survey to male inmates in two Illinois correctional facilities: Sheridan Correctional Center and the Adult Transition Center-Crossroads. All individuals surveyed were participating in substance abuse treatment with WestCare Foundation. The survey was designed to collect demographics and drug availability, prevalence/use, effects, and treatment.[39] The final sample size was 562 individuals who completed the question regarding bath salt use and 558 individuals who completed questions regarding synthetic marijuana use.[40] In total, 204 individuals reported any synthetic drug use.

In addition, WestCare and Authority researchers matched survey participants with WestCare data. WestCare data consists of inmate clinical data reported by WestCare clinicians within the correctional facilities. The data includes inmate demographics as well as information from inmates’ Addiction Severity Index (ASI) assessment. The assessment was completed through one-on-one interviews with a WestCare clinician to develop a diagnostic impression of the client’s severity of substance use, potential treatment problems, and other areas that may be affected by substance use. These areas included medical, employment, alcohol and drug, legal, family/social, and psychiatric problems. The ASI severity scores used for this analysis were developed by the Treatment Research Institute and are valid and reliable to measure severity ratings (extent of problem in each area) based on composite scores for each area of the ASI.[41] WestCare clinician estimates of respondents’ need for treatment (ASI severity score) ranged from 0 (no treatment necessary) to 9 (treatment needed to intervene in life-threatening situation) based on severity scores calculated from the ASI treatment and manual guide.[42]

Several limitations to this study are worth noting. First, individuals surveyed may have had difficulty recalling synthetic drug use prior to incarceration, particularly if it was not frequently used or not a drug of choice. Second, respondents may not always have known what drugs they were using and whether they were synthetic drugs. Third, participants may have been hesitant to provide truthful information because they were surveyed while residing in prison. Although participants were informed of their rights as human subjects and the confidential nature of their participation, some participants may have still had concerns over disclosing past illegal behaviors. Fourth, terms used in the survey, such as synthetic cathinones (bath salts) and synthetic cannabinoids (synthetic marijuana), may not have been fully understood by respondents, despite being provided with the definitions. Finally, the sample obtained was a convenience sample of those individuals at the two correctional facilities that were enrolled in substance abuse treatment with the WestCare Foundation; therefore, the findings are not generalizable to other populations.

Sample population characteristics of synthetic drug users

Respondents who identified using synthetic marijuana and/or bath salts ranged in age from 19- to 56-years old, with an average age of 30-years old. Thirty-nine percent of the sample identified as Black/African American, 10 percent identified as Hispanic, and 35 percent identified as White/Caucasian. Respondents, on average, first tried drugs or alcohol at around age 13, and most frequently identified marijuana and alcohol as the first substances they ever tried, at 45 percent and 28 percent, respectively.

Alcohol use. Respondents had an average ASI alcohol severity score of 3.36 and a median score of 4.0, with a score of 5.0 as the most frequently reported score. This suggests that, on average, those who have used synthetic marijuana and/or bath salts were most frequently identified as having a slight to moderate problem with alcohol. Respondents reported a median of five days of alcohol use within the previous 30-day period prior to incarceration. Over 60 percent of respondents reported no problem with alcohol within the 30 days prior to incarceration; however, 16 percent reported problems related to alcohol for the full 30 days prior to incarceration. Most respondents reported having no previous treatment for use of alcohol. Twenty-four percent of respondents indicated that alcohol treatment was extremely important, while 35 percent indicated it was not important at all.

Drug use. Respondents had an average ASI drug severity score of 4.45 and median score of 5.0, with a score of 5.0 as the most frequently reported score. This suggests that, on average, those who have used synthetic marijuana and/or bath salts were most frequently identified as having a moderate problem with drugs. Half of respondents reported having no problems with drugs in the 30 days prior to incarceration; however, 29 percent reported problems for the full 30-days prior to incarceration. The majority of respondents, 73 percent, indicated they had had no voluntary period of abstinence (in years). Most respondents reported having no previous treatment for drug use. Thirty-four percent of respondents identified that drug treatment was extremely important, while 14 percent of respondents identified that drug treatment was not important at all.

Survey results on synthetic drug use

Prevalence of use

Thirty-five percent of respondents reported using any synthetic drugs 12 months prior to incarceration (n=204). Of those surveyed, 29 percent reported use of synthetic marijuana (n=166), 1 percent reported use of bath salts (n=6), and 6 percent reported using both bath salts and synthetic marijuana (n=32). (Figure 3). In total, 198 respondents reported any synthetic marijuana use and 38 respondents reported any bath salt use.

Figure 3

Percent of respondents who reported synthetic drug use use within 12 months prior to incarceration (n=204)

Figure 3
Data Source: ICJIA and WestCare prisoner survey, 2016.

Methods of use

Respondents (n=204) were asked to report the method(s) of synthetic drug use in the 12 months prior to incarceration. Smoking was the primary method of use reported for both synthetic marijuana and bath salts within the 12 months prior to incarceration. Almost all respondents who self-reported using synthetic marijuana smoked it (94 percent). Fifty percent of respondents who reported bath salt use in the 12 months prior to incarceration reported smoking it and 55 percent reported snorting it (Figure 4).

Figure 4

Reported methods of synthetic cathinones or bath salt use in 12 months prior to incarceration (n=38)

Figure 4
Data Source: ICJIA and WestCare prisoner survey, 2016.

Reasons for use

Of the 204 respondents who reported synthetic marijuana and/or bath salt use, the most commonly reported reasons for synthetic drug use were curiosity (n=133), to avoid positive drug tests (n=108), because they liked the effect (n=50), and to relax (n=59). These findings are consistent with the findings of other synthetic drug use studies, as more than half of respondents in a study of intravenous drug users reported using synthetic drugs out of curiosity (Figure 5 and Figure 6).[43] Less than 10 percent of respondents reported using synthetic drugs in order to stop using other drugs or because of peer pressure or health benefits.

Figure 5

Reported reasons for synthetic cathinone/bath salt use within 12 months prior to incarceration (n=38)

Figure 5
Data Source: ICJIA and WestCare prisoner survey, 2016. Note: Respondents could identify multiple reasons for synthetic drug use

Figure 6

Reported reasons for synthetic marijuana use within 12 months prior to incarceration (n=198)

Figure 6
Data Source: ICJIA and WestCare prisoner survey, 2016. Note: Respondents could identify multiple reasons for synthetic drug use

Respondents most commonly identified curiosity (54 percent), avoiding positive drug tests (47 percent), and relaxation (26 percent) as motivation to use (n=198). Those who self-reported any bath salt use (n=38) said curiosity (70 percent) and avoiding positive drug tests (35 percent) were their motivations.

Obtaining synthetic drugs

Within the 12 months prior to incarceration, respondents (n=204) most frequently reported obtaining bath salts and synthetic marijuana from friends or relatives and from gas stations. Less than 20 percent of respondents reported using the Internet to obtain synthetic drugs.

Respondents who said they had used synthetic marijuana in the year prior to incarceration reported obtaining it from gas stations (54 percent) and friends or relatives (37 percent) (n=198). Of the 38 respondents who reported bath salt use in the year prior to incarceration, 60 percent said they were obtained from gas stations and 40 percent got them from friends or relatives. (Figure 7 and Figure 8).

Figure 7

Reported methods of obtaining synthetic drugs within 12 months prior to incarceration - Synthetic cathinones/bath salts (n=38)

Figure 7
Data Source: ICJIA and WestCare prisoner survey, 2016.

Figure 8

Reported methods of obtaining synthetic drugs within 12 months prior to incarceration - Synthetic marijuana (n=198)

Figure 8
Data Source: ICJIA and WestCare prisoner survey, 2016.

Reported effects

Respondents who reported synthetic marijuana use said the drug made them feel dizzy or lightheaded (55 percent), gave them a “pleasant high” (44 percent), and made them feel nervous/anxious (35 percent) (n=198). Respondents who reported bath salt use said it made their heart race (58 percent), gave them a “pleasant high” (55 percent), made them feel anxious/nervous (47 percent), and made them feel energized/stimulated (47 percent) (n=38). (Figure 9 and Figure 10).

Figure 9

Reported effects from use of synthetic drugs within 12 months prior to incarceration-Synthetic cathinones/bath salts (n=38)

Figure 9
Data Source: ICJIA and WestCare prisoner survey, 2016. Note: Respondents could identify multiple effects for synthetic drug use.

Figure 10

Reported effects from use of synthetic drugs within 12 months prior to incarceration-Synthetic marijuana (n=198)

Figure 10
Data Source: ICJIA and WestCare prisoner survey, 2016. Note: Respondents could identify multiple effects for synthetic drug use.

Respondent characteristics of reported synthetic drug use

Chi-square and t-tests were performed to analyze the relationship between individual characteristics among surveyed inmates and the likelihood of synthetic drug use.[44] Researchers matched 476 of 556 clients with information and responses within the merged data and performed chi-square and t-tests. T-test and chi-square tests only included reported synthetic marijuana use as there were too few reports of bath salt use to measure.

A relationship between client age and synthetic drug use was noted. Clients who were younger were more likely to report synthetic drug use than clients who were older. In addition, a relationship was seen between ASI drug severity score and synthetic drug use. Inmates with higher ASI drug severity scores were more likely to report synthetic drug use than those with lower ASI drug severity scores. Each of these characteristics had a moderate or noticeable effect on reported synthetic drug use.[45]

In addition, an association was noted between race/ethnicity and reported synthetic drug use. White individuals were more likely to report synthetic drug use than Black and Hispanic individuals. While these analyses identified associations between these characteristics and reported synthetic drug use, they were relatively weak.[46]

PTSD and probable PTSD severity scores also had a relationship to reported synthetic drug use. Those who reported synthetic drug use, on average, had a higher PTSD severity score than those who did not report synthetic drug use. A relatively weak association was seen between probable PTSD and reported synthetic drug use.

Table 1 shows the results of the chi-square and t-tests on relationships between individual characteristics and reported synthetic drug use.

Table 1

Relationship between respondent characteristics and reported synthetic drug use within 12 months prior to incarceration

Summary

More than one-third of surveyed Sheridan Correctional Center and Adult Transition Center-Crossroads residents reported synthetic drug use in the 12 months prior to incarceration. On average, these individuals were around 30 years old, first tried drugs around the age of 13, and most frequently reported polysubstance use. In addition, most respondents reported trying or using synthetic drugs out of curiosity. These study results are consistent with other research findings on synthetic drug use.[47] Research indicates a subset of the criminal justice population pass drug screening panels with a limited number of drugs tested while continuing to use synthetic drugs.[48] In one study, active probation/parole status was highly associated with use of synthetic marijuana.[49] In several comprehensive CESAR studies on the CDEWS program, identification of synthetic marijuana in criminal justice-involved individuals rarely occurred. However, individuals who tested negative for any drug on the limited criminal justice drug panel screenings were more likely to test positive for synthetic marijuana via CDEWS.[50] It should be noted that CDEWS studies involve urine specimens taken from a population already at high risk for drug use and, therefore, may not be representative of the larger criminal justice population.[51]

While some criminal justice-involved individuals do, in fact, evade detection of substance use by using synthetic drugs, some consideration for the cost of full drug screening panels is needed prior to changing policies and procedures.[52] Full panels can be costly. For example, one-, five-, and six-panel drug test kits cost around $22, $52, and $54 for a set of 25, respectively; 10- and 12-panel drug test kits cost around $91 and $112 dollars for a set of 25, respectively.[53] It is important for community policymakers, stakeholders, and criminal justice professionals to consider the extent of synthetic drug use within their communities and weigh the costs and benefits of incorporating new policies and procedures to increase synthetic drug detection. The more sophisticated drug screens may be best left for those suspected of synthetic drug use, or they may be used sparingly to let individuals know of the potential for testing.[54]

  1. Drug Enforcement Administration. (2016). National drug threat assessment summary 2015. Washington, D.: Author. ↩︎

  2. Vimont, C. (April 6, 2016). “Drug testing misses synthetic cannabinoids: Expert.” Partnership News Service. 6 April 2016. Retrieved from https://drugfree.org/learn/drug-and-alcohol-news/drug-testing-misses-synthetic-cannabinoids-expert/ ↩︎

  3. National Institute on Drug Abuse. (2015). DrugFacts: Synthetic cannibinoids: K2/spice. Retrieved from: https://www.drugabuse.gov/publications/drugfacts/synthetic-cannabinoids-k2spice; National Institute on Drug Abuse. (2016). DrugFacts: Synthetic cathinones: Bath salts. Retrieved from https://www.drugabuse.gov/publications/drugfacts/synthetic-cathinones-bath-salts ↩︎

  4. Drug Enforcement Administration. (2015). National drug threat assessment summary 2014. Washington, D.C.: Author. ↩︎

  5. Wahl, M. (2012). Synthetic drugs. Chicago, IL: Illinois Poison Center. ↩︎

  6. Wahl, M. (2012). Synthetic drugs. Chicago, IL: Illinois Poison Center. ↩︎

  7. Sacco, L. N., & Finklea, K. (2014). Synthetic drugs: Overview and issues for congress. Retrieved from https://fas.org/sgp/crs/misc/R42066.pdf; Drug Enforcement Administration. (2013). National Drug Threat Assessment Summary. Retrieved from https://www.dea.gov/sites/default/files/2018-07/DIR-017-13%20NDTA%20Summary%20final.pdf ↩︎

  8. Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). SAMHSA advisory: Spice, Bath Salts, and behavioral health. HHS Publication No. (SMA) 14-4858. Retrieved from www.samhsa.gov ↩︎

  9. Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). SAMHSA advisory: Spice, Bath Salts, and behavioral health. HHS Publication No. (SMA) 14-4858. Retrieved from www.samhsa.gov ↩︎

  10. Bernock, K. (2015). Education and tools to address the rising prevalence of synthetic marijuana abuse. Consultant, 55 (9), 692-700.; Winstock A., & Barratt, M. Synthetic cannabis: a comparison of patterns of use and effect profile with natural cannabis in a large global sample. Journal on Drug and Alcohol Dependence, 131 (1-2), 106-111. ↩︎

  11. Drug Enforcement Administration. (2013). National drug threat assessment summary. Retrieved from https://www.dea.gov/sites/default/files/2018-07/DIR-017-13%20NDTA%20Summary%20final.pdf↩ ↩︎

  12. Cottencin, O., Rolland, B., & Karil, L. (2014). New designer drugs (synthetic marijuana and synthetic cathinones): A review of literature. Current Pharmaceutical Design, 20 (25), 4106-4111. ↩︎

  13. National Institute on Drug Abuse. (2012). Science spotlight: New research stresses the potential health dangers of “bath salts.” Retrieved from https://archives.drugabuse.gov/news-events/news-releases/2012/10/new-research-stresses-potential-health-dangers-bath-salts; National Institute on Drug Abuse. (2014). Science spotlight: Review summarized research on health effects of K2/Spice. Retrieved from https://archives.drugabuse.gov/news-events/news-releases/2014/09/review-summarizes-research-health-effects-k2spice. Note: Injury or death may be the result of engaging in high-risk behavior and/or increased blood pressure and kidney damage. ↩︎

  14. Drug Enforcement Administration. (2013). National Drug Treat Assessment Summary. Retrieved from https://www.dea.gov/sites/default/files/2018-07/DIR-017-13%20NDTA%20Summary%20final.pdf ↩︎

  15. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2014). The CBHSQ report: Update: drug-related emergency visits involving synthetic cannabinoids. Rockville, MD: Department of Health and Human Services.; Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2013). The DAWN report: “bath salts” Were involved in over 20,000 drug related emergency department visits in 2011. Rockville, MD: Department of Health and Human Services. ↩︎

  16. American Association of Poison Control Centers. (2015). Synthetic marijuana data. ↩︎

  17. Wish, E.D., Artigiani, E.E. and Billing, A. S. (2013). Community drug early warning system: The CDEWS pilot project. Office of National Drug Control Policy. Washington, D.C.: Executive Office of the President. ↩︎

  18. Bernock, K. (2015). Education and tools to address the rising prevalence of synthetic marijuana abuse. Consultant, 55 (9), 692-700.; Winstock, A, & Barratt, M. Synthetic cannabis: a comparison of patterns of use and effect profile with natural cannabis in a large global sample. Journal on Drug and Alcohol Dependence, 131 (1-2), 106-111. ↩︎

  19. Wish, E.D., Billing, A.S., & Artigiani, E.E. (2015). Community drug early warning system: The CDEWS‐2 replication study. Office of National Drug Control Policy: Washington, D.C… ↩︎

  20. Wish, E.D., Billing, A.S., & Artigiani, E.E. (2015). Community drug early warning system: The CDEWS‐2 replication study. Office of National Drug Control Policy: Washington, D.C… ↩︎

  21. Wish, E.D., Billing, A.S., & Artigiani, E.E. (2015). Community drug early warning system: The CDEWS‐2 replication study. Office of National Drug Control Policy: Washington, D.C… ↩︎

  22. Wish, E.D., Billing, A.S., & Artigiani, E.E. (2015). Community drug early warning system: The CDEWS‐2 replication study. Office of National Drug Control Policy: Washington, D.C… ↩︎

  23. Wish, E.D., Billing, A.S., & Artigiani, E.E. (2016). Community Drug Early Warning System (CDEWS‐3): Honolulu, Hawaii – Site 1 of 4. Office of National Drug Control Policy. Washington,DC: Executive Office of the President. ↩︎

  24. Wish, E.D., Billing, A.S., & Artigiani, E.E. (2016). Community Drug Early Warning System (CDEWS‐3): Honolulu, Hawaii – Site 1 of 4. Office of National Drug Control Policy. Washington,DC: Executive Office of the President. ↩︎

  25. Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2013). Monitoring the Future national results on adolescent drug use: Overview of key findings. Bethesda, MD: National Institute on Drug Abuse, 2013. Available at www.monitoringthefuture.org ↩︎

  26. National Institute on Drug Abuse. (2014). Principles of adolescent substance use disorder treatment: A research-based guide. Retrieved from https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/introduction ↩︎

  27. Boys, A., Marsden, J., & Strang, J. (2001). Understanding reasons for drug use amongst young people: A functional perspective. Health Education Research, Theory & Practice, 16 (4), 457-469.; Australian Drug Foundation. (2016). Why do people use alcohol and other drugs? State Government of Victoria, Australia. ↩︎

  28. Wagner, K.D., Armenta, R.F., Roth, A.M., Maxwell, J.C., Cuevas-Mota, J., & Garfein, R.S. (2014). Use of synthetic cathinones and cannabimimetics among injection drug users in San Diego, California. Journal on Drug and Alcohol Dependency, 141, 99-106. ↩︎

  29. Wagner, K.D., Armenta, R.F., Roth, A.M., Maxwell, J.C., Cuevas-Mota, J., & Garfein, R.S. (2014). Use of synthetic cathinones and cannabimimetics among injection drug users in San Diego, California. Journal on Drug and Alcohol Dependency, 141, 99-106. ↩︎

  30. Wagner, K.D., Armenta, R.F., Roth, A.M., Maxwell, J.C., Cuevas-Mota, J., & Garfein, R.S. (2014). Use of synthetic cathinones and cannabimimetics among injection drug users in San Diego, California. Journal on Drug and Alcohol Dependency, 141, 99-106. ↩︎

  31. Wagner, K.D., Armenta, R.F., Roth, A.M., Maxwell, J.C., Cuevas-Mota, J., & Garfein, R.S. (2014). Use of synthetic cathinones and cannabimimetics among injection drug users in San Diego, California. Journal on Drug and Alcohol Dependency, 141, 99-106. ↩︎

  32. Wish, E.D., Billing, A.S., & Artigiani, E.E. (2015). Community drug early warning system: The CDEWS‐2 replication study. Office of National Drug Control Policy: Washington, D.C… ↩︎

  33. Gleicher, L., & Reichert, J. (in press). The Illinois Drug Threat Assessment. Chicago, IL: Illinois Criminal Justice Information Authority. ↩︎

  34. Gleicher, L., & Reichert, J. (in press). The Illinois Drug Threat Assessment. Chicago, IL: Illinois Criminal Justice Information Authority. ↩︎

  35. Drug Enforcement Agency. (2016). National drug threat assessment. U.S. Department of Justice, Washington DC: USDOJ. ↩︎

  36. Wahl, M. (2012). Synthetic drugs. Chicago, IL: Illinois Poison Center. ↩︎

  37. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2013). The DAWN report: “bath salts” Were involved in over 20,000 drug related emergency department visits in 2011. Rockville, MD: Department of Health and Human Services. ↩︎

  38. Wahl, M. (2012). Synthetic drugs. Chicago, IL: Illinois Poison Center. ↩︎

  39. Survey questions were adapted from the synthetic drug survey conducted by Dr. Patrick S. Johnson at Johns Hopkins University. See Johnson, P. S., & Johnson, M. W. (2014). Investigation of “bath salts” use patterns within an online sample of users in the United States. Journal of Psychoactive Drugs, 46 (5), 369-348. ↩︎

  40. In addition, questions regarding traumatic life events and Post-Traumatic Stress Disorder symptoms (PTSD) were asked using questions from the Life Events Checklist (LEC) and the PTSD Checklist-Civilian version (PCL-C). The LEC is a self-report tool to measure possible traumatic life events in an individual’s life. The PCL-C is a standardized, self-report tool to help identify potential PTSD symptoms. The PCL-C and LEC tool and scoring guide can be found at the National Center for PTSD http://www.ptsd.va.gov/. In order to calculate probable PTSD, a PTSD severity score was calculated by adding up all items for a total severity score. There was also a relationship between PTSD severity score and synthetic drug use—individuals with higher PTSD severity scores were more likely to report synthetic drug use than those who had lower PTSD severity scores. ↩︎

  41. McGahan, P. L., Griffith, J. A., Parente, R., & McLellan, A. T. (1986). Addiction severity index: Composite scores manual. Philadelphia, PA: The University of Pennsylvania-Philadelphia Veteran’s Administration Center for Studies of Addiction. ↩︎

  42. Treatment Research Institute. (1990). Addiction severity index: Manual and question by question guide. Philadelphia, PA: University of Pennsylvania-Philadelphia, Veterans Administration Center for Studies of Addiction. ↩︎

  43. Wagner, K. D., Armenta, R.F., Roth, A. M., Maxwell, J. C., Cuevas-Mota, J., & Garfein, R. S. (2014). Use of synthetic cathinones and cannabimimetics among injection drug users in San Diego, California. Journal on Drug and Alcohol Dependency, 141, 99-106. ↩︎

  44. Reported synthetic drug use in the t-test and chi-square analyses only uses reported synthetic marijuana use, as there were too few reports of bath salts use alone (n=6) for meaningful analysis. ↩︎

  45. Cohen’s d cutoffs are as follows: .2=“small,” .5=“medium,” .8=“large” ↩︎

  46. Weak associations are identified as those with Phi coefficients at .30 or below ↩︎

  47. Sacco, L. N., & Finklea, K. (2014). Synthetic drugs: Overview and issues for congress. Retrieved from https://fas.org/sgp/crs/misc/R42066.pdf ↩︎

  48. Office of National Drug Control Policy. (2012). Synthetic drugs. Retrieved from https://www.whitehouse.gov/sites/default/files/page/files/synthetic_drugs_fact_sheet_455_2_15_12.pdf; Perrone, D., Helgesen, R. D., & Fischer, R. G. (2013). United States probation and legal highs: How drug testing may lead cannabis users to spice. Drugs: Education, Prevention, and Policy, 20 (3), 216-224. ↩︎

  49. Wagner, K. D., Armenta, R. F., Roth, A.M., Maxwell, J. C., Cuevas-Mota, J., & Garfein, R. S. (2014). Use of synthetic cathinones and cannabimimetics among injection drug users in San Diego, California. Journal on Drug and Alcohol Dependency, 141, 99-106. ↩︎

  50. Wish, E. D., Artigiani, E. E. & Billing, A. S. (2013). Community Drug Early Warning System: The CDEWS Pilot Project. Washington, D.C.: Executive Office of the President, Office of National Drug Control Policy; Wish, E. D., Billing, A. S., & Artigiani, E. E. (2016). Community Drug Early Warning System (CDEWS‐3): Honolulu, Hawaii – Site 1 of 4. Washington, D.C.: Executive Office of the President, Office of National Drug Control Policy. ↩︎

  51. Wish, E. D., Billing, A. S., & Artigiani, E. E. (2015). Community drug early warning system: The CDEWS‐2 replication study. Washington, D.C.: Office of National Drug Control Policy. ↩︎

  52. Vimont, C. (April 6, 2016). Drug testing misses synthetic cannabinoids: Expert. Partnership News Service. Retrieved from https://drugfree.org/learn/drug-and-alcohol-news/drug-testing-misses-synthetic-cannabinoids-expert/ ↩︎

  53. Pricing information comes from the Lifeloc Technologies website. This is an example, and does not concretely identify what criminal justice agencies in Illinois pay for drug testing kits—particularly as they tend to be bought in larger bulk. Retrieved from http://www.lifeloc.com/ ↩︎

  54. Wish, E. D., Artigiani, E. E., & Billing, A. S. (2013). Community Drug Early Warning System: The CDEWS Pilot Project. Washington, D.C.: Executive Office of the President, Office of National Drug Control Policy.; Wish, E. D., Billing, A. S., & Artigiani, E. E. (2016). Community Drug Early Warning System (CDEWS‐3): Honolulu, Hawaii – Site 1 of 4. Washington, D.C.: Executive Office of the President, Office of National Drug Control Policy. ↩︎