A Young Man Developed Dependence and Physical Withdrawal From the Synthetic Cannabis Product "Spice Gold" | Research

The takeaway

A 20-year-old who smoked Spice Gold daily for 8 months developed tolerance, cognitive impairment, and a physical withdrawal syndrome resembling cannabis withdrawal, including elevated blood pressure (180/90 mmHg) and heart rate (125 bpm).

Read this if you want to understand the risks of synthetic cannabis products like Spice or K2.

Blood pressure 180/90 and heart rate 125 during withdrawal from synthetic cannabinoids

What the researchers found

A 20-year-old patient smoked Spice Gold daily for 8 months, developing classic signs of dependence: tolerance with dose escalation to 3 grams per day, continuous drug craving, continued use despite cognitive impairment, and neglect of professional duties.

On hospital days 4-7 after cessation, he developed withdrawal symptoms: inner restlessness, drug craving, nightmares, profuse sweating, nausea, tremor, headache, elevated blood pressure (180/90 mmHg), and tachycardia (125 bpm).

The patient reported experiencing a similar syndrome during a previous involuntary abstinence period, which resolved when he resumed use.

Urinary drug screens were negative, as standard tests did not detect synthetic cannabinoids. The withdrawal syndrome closely resembled cannabis withdrawal.

The authors attributed the syndrome to synthetic cannabinoids (JWH-018, CP 47497) that had been found in Spice products and were banned in Germany in January 2009.

Why it matters

This was among the earliest clinical documentation of dependence and physical withdrawal from synthetic cannabinoid products, which had been marketed as "legal" and "natural" alternatives to cannabis.

The numbers in context

Age 20. Daily use for 8 months. Dose escalated to 3 g/day. Blood pressure peak: 180/90 mmHg. Heart rate: 125 bpm. Withdrawal days 4-7. Urine drug screens negative.

How the study worked

Single case report documenting clinical features of dependence and withdrawal from Spice Gold, a herbal product containing undeclared synthetic cannabinoids. Clinical observations included vital signs, subjective symptoms, and drug screening.

What this study cannot tell us

Single case report. The exact synthetic cannabinoids in the patient's Spice Gold supply were not analytically confirmed. Individual variation in withdrawal severity is expected. Cannabis withdrawal itself was still debated at the time.

How to read the evidence

Single case report providing clinical documentation but unable to establish generalizability.

When this study was published

Published in 2009, early in the synthetic cannabinoid epidemic. Subsequent years saw many more cases and deaths from these products.

The bigger picture

This case report was an early warning about synthetic cannabinoids, which would become a major public health concern in subsequent years. The negative drug screens highlighted a dangerous gap: users and clinicians could not detect these substances with standard testing.

Questions still open

Are synthetic cannabinoid withdrawal symptoms more severe than natural cannabis withdrawal? Does the full agonist activity of synthetic cannabinoids (vs THC partial agonism) produce more dependence? How should clinicians manage synthetic cannabinoid withdrawal?

Common questions

What is Spice Gold?

Spice Gold was an herbal product marketed as incense but used as a cannabis substitute. It was later found to contain undeclared synthetic cannabinoids (JWH-018, CP 47497) that are more potent than THC and act as full agonists at cannabinoid receptors.

Why is synthetic cannabinoid withdrawal potentially worse than cannabis withdrawal?

Synthetic cannabinoids are typically full agonists at CB1 receptors (THC is a partial agonist), meaning they produce stronger receptor activation. This can lead to greater dependence and more severe withdrawal, including cardiovascular symptoms not typically seen with natural cannabis withdrawal.

Read the original research

Withdrawal phenomena and dependence syndrome after the consumption of "spice gold".

Deutsches Arzteblatt international, 106(27), 464-7

View on PubMed ↗Publisher’s paper ↗

Citation

Zimmermann, Ulrich S; Winkelmann, Patricia R; Pilhatsch, Max; Nees, Josef A; Spanagel, Rainer; Schulz, Katja. (2009). Withdrawal phenomena and dependence syndrome after the consumption of "spice gold".. Deutsches Arzteblatt international, 106(27), 464-7. https://doi.org/10.3238/arztebl.2009.0464