Drug-soaked paper strips in jails contained synthetic cannabinoids and caused severe toxicity including one death
Among 18 incarcerated individuals hospitalized after using drug-soaked paper strips, most experienced severe central nervous system depression and bradycardia, with strips containing synthetic cannabinoids and benzimidazole opioids. One person died.
Quick Facts
What This Study Found
All 18 patients had suspected strip exposure. Central nervous system depression occurred in 94%, bradycardia in 61%, agitation in 33%, and seizures in 22%. Two patients required intubation and one died from hypoxic ischemic encephalopathy. Chemical analysis confirmed synthetic cannabinoid receptor agonists (SCRAs) and benzimidazole opioids.
Key Numbers
18 patients (all male, median age 27.5); 94% CNS depression; 61% bradycardia; 33% agitation; 22% seizures; 2 intubated; 1 death; strips contained SCRAs and benzimidazole opioids; no household cleaners or pesticides detected
How They Did This
Retrospective case series of 18 incarcerated individuals from a county jail in Atlanta who presented to an emergency department with suspected strip exposure (August 2022 to November 2023). Strip and serum samples were analyzed using gas chromatography and liquid chromatography mass spectrometry.
Why This Research Matters
Drug-soaked paper strips represent an emerging and particularly dangerous mode of drug use in correctional settings, with severe clinical presentations that can mimic other conditions.
The Bigger Picture
The combination of synthetic cannabinoids and potent synthetic opioids on paper strips creates an especially dangerous product that is difficult to detect and intercept in correctional facilities.
What This Study Doesn't Tell Us
Small case series from one facility; cannot determine exact doses absorbed from strips; clinical presentations may be influenced by poly-drug use; retrospective design; may not capture all strip exposures that did not result in ED visits
Questions This Raises
- ?How widespread is strip use across correctional facilities nationally?
- ?What detection and prevention strategies would be most effective?
- ?How can emergency clinicians better identify strip intoxication?
Trust & Context
- Key Stat:
- 94% CNS depression, 61% bradycardia, 1 death
- Evidence Grade:
- Small retrospective case series from a single facility with chemical confirmation of substances, providing important safety signal data.
- Study Age:
- 2024 study analyzing 2022-2023 cases
- Original Title:
- Identification and Health Risks of an Emerging Means of Drug Use in Correctional Facilities.
- Published In:
- JAMA network open, 7(12), e2451951 (2024)
- Authors:
- Kuai, David, Rivera Blanco, Liz Eneida, Krotulski, Alex, Walton, Sara, Denn, Max, Kelly, Byron, Kiernan, Emily, Steck, Alaina, Carpenter, Joseph
- Database ID:
- RTHC-05442
Evidence Hierarchy
Watches what happens naturally without intervening.
What do these levels mean? →Frequently Asked Questions
What are drug-soaked paper strips?
Paper strips are soaked in liquid drug solutions and dried, creating a product that can be smuggled into correctional facilities and consumed. In this study, analysis revealed they contained synthetic cannabinoid receptor agonists and benzimidazole opioids (potent synthetic opioids), but not household chemicals as sometimes speculated.
How dangerous are these strips?
Very dangerous. Of 18 hospitalized patients, nearly all had severe CNS depression, most had abnormally slow heart rates, and about one in five had seizures. Two required breathing tubes and one died from brain damage caused by oxygen deprivation. The combination of synthetic cannabinoids and opioids is particularly hazardous.
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Cite This Study
https://rethinkthc.com/research/RTHC-05442APA
Kuai, David; Rivera Blanco, Liz Eneida; Krotulski, Alex; Walton, Sara; Denn, Max; Kelly, Byron; Kiernan, Emily; Steck, Alaina; Carpenter, Joseph. (2024). Identification and Health Risks of an Emerging Means of Drug Use in Correctional Facilities.. JAMA network open, 7(12), e2451951. https://doi.org/10.1001/jamanetworkopen.2024.51951
MLA
Kuai, David, et al. "Identification and Health Risks of an Emerging Means of Drug Use in Correctional Facilities.." JAMA network open, 2024. https://doi.org/10.1001/jamanetworkopen.2024.51951
RethinkTHC
RethinkTHC Research Database. "Identification and Health Risks of an Emerging Means of Drug..." RTHC-05442. Retrieved from https://rethinkthc.com/research/kuai-2024-identification-and-health-risks
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.