Drug-soaked paper strips in jails contained synthetic cannabinoids and caused severe toxicity including one death | Research

The takeaway

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.

Emergency physicians, correctional health providers, and toxicologists

94% CNS depression, 61% bradycardia, 1 death

What the researchers 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.

Why it 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 numbers in context

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 the study worked

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.

What this study cannot 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

How to read the evidence

Small retrospective case series from a single facility with chemical confirmation of substances, providing important safety signal data.

When this study was published

2024 study analyzing 2022-2023 cases

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.

Questions still open

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?

Common 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.

Read the original research

Identification and Health Risks of an Emerging Means of Drug Use in Correctional Facilities.

JAMA network open, 7(12), e2451951

View on PubMed ↗Publisher’s paper ↗

Citation

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