What Is Spice Addiction

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Spice (K2) addiction is:

A diagnosis of Synthetic Cannabinoid Use Disorder, depending on the number of DSM-5 criteria present (e.g. mild = 2 - 3 vs severe = 6+), including persistent urges to use spice [1]
Memory loss due to overstimulated CB1 receptors and disrupted hippocampal neurotransmission after using 1-7g of spice daily [1]

Physical Indicators Of Spice Addiction

Muscle Rigidity

Muscle rigidity is a physical sign of spice addiction because the overstimulation of CB1 receptors in the basal ganglia, cerebellum, and motor cortex leads to muscle pain, weakness, jerking or involuntary twitching, and cramps for up to 6 days after consumption [2][3].

Kaneko (2017) described 93 cases of spice-induced vehicle collisions caused by slow movements and abrupt acceleration without braking or controlling the steering wheel in users experiencing muscle rigidity in the extremities (e.g. hands, feet) after drug-taking [4].

Lu et al. (2016) investigated a 23-year-old who experienced bilateral upper and lower extremity muscle cramps and tenderness after smoking 1 – 2 blunts of spice daily for 1 year, although symptoms resolved within 1 month of abstinence and IV fluid hydration [5].

Disjointed Walking Patterns

An ataxic gait is a physical indicator of spice addiction because grey matter in the insula is reduced by 8% after ≥ 1 year of use, resulting in 43% feeling 'clumsy' for up to 13 hours due to disrupted sensory integration, balance control, and internal body awareness [6][7].

Phillips, Lim, & Hsu (2017) investigated a 53-year-old who was observed by bystanders walking into traffic after smoking an unknown quantity of spice earlier that day, resulting in an unsteady gait, a lack of decision-making capacity, and lethargy after drug-taking [8].

Labay et al. (2016) studied a 58-year-old man who walked with a wavering gait and collapsed in a car park after smoking spice, and a 31-year-old woman who became drowsy, walked to a fire escape, and fell over a barrier after eating a brownie mixed with spice [9].

Sudden Fainting

Sudden fainting is a physical indicator of spice addiction because cerebral blood flow is reduced by up to 30% due to hypotension (BP <90/60 mmHg) and cardiac arrhythmias, i.e. tachycardia (HR >100 BPM) or bradycardia (HR <60 BPM) in up to 76% of users [3][10].

10% develop vasovagal reactions (e.g. dizziness, fainting) after 3 - 24 months of spice consumption, and 26% have 'blackouts' triggered by panic attacks and a fear of death within 6 days of drug-taking, as cerebral blood flow is restricted whilst hyperventilating [11][12].

Kane et al. (2016) investigated a 56-year-old woman who required emergency medical treatment after having a syncopal episode triggered by severe bradycardia (HR = 56 BPM) and hypotension (BP = 65/44 mmHg) after smoking 6 bags of spice [13].

Alhadi et al. (2013) studied a 21-year-old who was hospitalised after having a syncopal episode for the second time whilst driving, triggered by an elevated heart rate (118 BPM) and blood pressure (182/108 mmHg) after consuming spice every day for 4 months [14].

Dry Heaving

Dry heaving is a physical indicator of spice addiction because the chemoreceptor trigger zone is activated within 30 – 60 minutes of consumption, and the vomiting reflex is triggered as emetogenic toxins (i.e. spice) are detected in the blood and cerebrospinal fluid [11].

Up to 33% of heavy spice users (e.g. 4 times daily) experience nausea and vomiting after consuming the drug via cigarettes, vaporisation, and oral or rectal ingestion, and retching after vomiting typically lasts up to 48 hours after drug-taking [7][15].

Hopkins & Gilchrist (2013) studied a 30-year-old man who developed Cannabinoid Hyperemesis Syndrome after smoking K2 on an hourly basis for 6 months, leading to “crampy abdominal pain with intractable nausea and vomiting” for 2 – 3 days at a time [16].

Young & Melina (2018) studied an 18-year-old man who experienced severe retching, coughing fits, and vomiting for over 24 hours after inhaling spice from a water pipe due to the activation of the emetic reflex and raised intra-abdominal pressure [17].

Uncontrollable Drooling

Uncontrollable drooling is a physical indicator of spice addiction caused by parasympathetic hyperactivity and a 50 - 80% decrease in spontaneous swallowing after spice binds to CB1 receptors, exacerbated by nausea and retching in 33% within 2 hours of use [7][18].

Douglass et al. (2024) studied a 56-year-old woman who was admitted to the hospital for 14 days due to excessive drooling and disorientation after consuming spice from a vape purchased from a local store 4 days earlier [19].

Kaneko (2017) described two cases of spice-induced motor vehicle collisions involving a 19-year-old and a 37-year-old who appeared to be drooling with impaired consciousness, whilst claiming to have no memory of the incident when found by the police [4].

Burns Around The Mouth And Fingertips

Burns around the mouth and fingertips are physical indicators of spice addiction because glass pipes are used to take 5 - 8 ‘hits’ per session and reach temperatures of up to 1400°C when heated for around 15 seconds each time [7][20].

Heavy spice users (e.g. 4x daily) may develop blackened hyperkeratotic linear or circular lesions on the fingers or palms and thermal burns on the thumb pads after repeatedly holding a hot glass pipe to consume 1 – 2 grams of product during a single episode [7][21].

Those addicted to spice are 4 times more likely to need medical treatment for burn injuries compared to non-users after having direct contact with hot smoking devices (e.g. pipe, bong, foil) and impaired sensory integration when using spice up to 20 times a day [7][22].

Psychological Indicators Of Spice Addiction

Psychosis

Psychosis is a psychological indicator of spice addiction because synthetic cannabinoids increase extracellular dopamine and glutamate levels by 145 - 150% in the nucleus accumbens and prefrontal cortex within 2 hours of drug-taking, resulting in [23][24]:

Hallucinations in 25% of regular users who consume around 1.6 grams of spice between 8 ‘hits’ during a single episode, and 43% experience paranoia for up to 13 hours after drug-taking [7]
Delusions of grandiosity, dissociation, and racing thoughts in up to 66% of 15 – 55-year-olds who consume spice via cigarettes around 4 times a day [12]

Psychosis is likely to be exacerbated after heavily abusing spice (e.g. 400g monthly for 5 years) due to a 7% reduction of grey matter in brain regions (e.g. inferior frontal gyrus, precuneus) responsible for consciousness, social cognition, and language processing [6][25].

Alternating Between Emotional Numbness And Explosive Aggression

Alternating between emotional numbness and explosive aggression is a psychological sign of K2 abuse caused by neurochemical imbalances (e.g. +145% glutamate within 2 hrs of use) in brain regions responsible for emotional regulation (e.g. prefrontal cortex) [23].

Up to 30% of those who use spice experience mood swings whilst intoxicated and in the following 24 hours after drug-taking, as some users claim, “I used it daily, and my temper went up and down. I also became sad and depressed for nothing" [26].

Cohen et al. (2020) found that having a long-term addiction to spice (≥ monthly use for 3 years) leads to impaired emotional processing, as spice users have reduced sensitivity (-17%) to anger, sadness, neutrality, fear, and happiness in comparison to non-users [27].

Cycles of emotional numbness and aggression may be exacerbated in up to 48% of spice users with mood, personality, or psychotic disorders (e.g. depression, BPD, schizophrenia) who already struggle with mood instability and emotional dysregulation [28].

Fragmented Speech Patterns

Fragmented speech patterns are a psychological indicator of spice misuse caused by neurotoxicity in brain regions involved in language processing and speech production (e.g. grey matter is reduced by 6% in the inferior frontal gyrus) after 5 years of spice use [6].

Cohen et al. (2020) found that heavy spice users (e.g. 200 times in 1 year) scored 116–236% higher on the disorganisation subscale of the Schizotypal Personality Questionnaire (e.g. “I use words in unusual ways”) compared to cannabis users and non-drug users [29].

Up to 50% of regular spice users feel “stimulated and energetic” whilst intoxicated, often presenting with spontaneous speech, self-talk, an accelerated thought speed, and a lack of reasoning and insight after taking up to 8 hits per session to produce a 3-hour 'high' [7].

Roberto et al. (2016) studied an 18-year-old with disorganised speech, thought insertion, broadcasting, and derailment (e.g. abrupt topic changes) after 4 weeks of daily spice smoking, followed by intermittent mutism, stuttering, and mumbling, whilst only responding with “yes” or “no” [30].

Hypersexual Or Violent Intrusive Thoughts

Intrusive thoughts about inflicting harm on others or engaging in sexual acts with strangers are psychological indicators of spice misuse caused by a 150% spike in dopamine after drug-taking, exacerbated by paranoia and hallucinations in up to 43% of users [7][24].

Spice users with hypersexual/violent intrusive thoughts may behave inappropriately (e.g. sexual innuendos) due to compulsions and poor impulse control caused by structural changes in the brain (e.g. a 7% decrease of grey matter in the PFC) after 5 years of use [6].

Ergelen et al. (2018) found that spice users had higher rates of sexual (6% vs 3%), physical (82% vs 60%) and verbal (e.g. 89% vs 70%) violence compared to opioid users due to a 7% increase in attentional, motor, and non-planning impulsivity [31].

Auditory Hallucinations

Auditory hallucinations of ‘hollow’ voices that sound like being ‘passed through a tube’ are psychological signs of synthetic cannabinoid addiction because [32]:

Auditory processing skills (e.g. attention, registration) are reduced by 11% due to the constant overstimulation of CB1 receptors in the hippocampus, auditory, and prefrontal cortex after consuming 1 - 7g of spice a day [1]
Synthetic cannabis users are 11 times more likely to have “distressing” auditory hallucinations at least 5 times a week compared to natural cannabis users due to a 4-fold higher affinity at the CB1 receptor [25][33].

Up to 58% of daily spice users experience auditory hallucinations, including threatening monologues or dialogues from ‘somewhere behind the wall or the back’, whilst trying to escape/hide from the perceived ‘enemies’ [12][32].

Long-term Effects Of Spice Addiction

Memory Loss And The Inability To Make New Memories

Memory loss/inability to form new memories is a long-term impact of spice abuse because synthetic cannabinoids in the drug's preparations (e.g. HU-210) reduce the firing activity of hippocampal neurons by 50% and block neural encoding episodes in the brain [34].

Using 3 neurocognitive tests (e.g. MoCA), Sant (2022) found that 19–50-year-old spice users had difficulty learning and retrieving new information from memory after consuming around 3g daily for 4 – 12 years:

Immediate recall abilities were reduced by 25% when users were asked to recall a list of 10 unrelated words that were presented orally 5 minutes previously to measure initial encoding and the learning of verbal information
Delayed recall abilities were reduced by 19% when users were presented with a list of 20 words and asked to state which 10 were presented earlier in the day to measure long-term memory encoding, retrieval, and the ‘rate of forgetting’ over time [1]

Around 43% of heavy spice users (e.g. smoked 4 times a day) “have trouble remembering things”, and deficits in episodic memory retrieval are exacerbated by a 6 – 8% loss of grey matter in the insula, inferior frontal gyrus, and precuneus after 5 years of use [6][7].

Permanent Motor Dysfunction/ Paralysis

Permanent motor dysfunction is a long-term effect of K2 addiction caused by the overstimulation of CB1 receptors in the central nervous system and a 6% reduction in total grey matter volume after consuming >400g a month for 5 years [6].

Demir et al. (2016) reported the case of a 48-year-old man who developed paraplegia within 6 months of using synthetic cannabinoids and initiated medical treatment due to leg weakness and numbness after becoming unable to stand independently:

Examinations revealed that the upper extremities had bilateral vague paresis (muscle strength 4/5), and the lower extremities were paraplegic after the patient ignored initial ‘pains and aches’ when first using the drug
The protein level of cerebrospinal fluid (CSF) was 6 times higher than average (299 mg/dl vs normal range = 15-45mg/dl), and spinal MRIs showed a symmetrical, non-contrast-enhancing lesion
The patient was able to walk with support after receiving physical rehabilitation and 10 days of intravenous Methylprednisolone treatment, although muscle weakness remained due to pyramidal tract lesions [35]

Inventing False Memories

Inventing false memories is a long-term effect of K2 addiction caused by a 50% reduction in neuronal firing in brain regions (e.g. hippocampus) responsible for memory formation and retrieval, following the overactivation of CB1 receptors in the CNS whilst intoxicated [34].

Sant (2022) found that confabulation (e.g. unconsciously creating false/distorted memories) rates were 74% higher in chronic spice users (3g daily for 4-12 years) compared to controls, due to a 33% reduction in memory abilities (e.g. recognition) after drug-taking [1].

Söyler et al. (2022) compared 25- to 27-year-old spice and cannabis users with ≥ 12 months of drug use, and found that spice users scored 7 – 10% higher on the false recall and recognition domains of the Ö-SBST when asked to remember 15 words correctly [36].

Heart Failure

Heart failure is a long-term impact of spice misuse caused by weakened heart muscles after chronic CB1R activation in the heart and blood vessels triggers tachycardia (HR = 140 -180 BPM vs normal HR = 60 -100 BPM) in 76% of users for up to 6 days at a time [3].

Spice use increases the risk of requiring emergency medical treatment (EMT) by 30-fold due to the consequences (e.g. heart failure, sudden cardiac death, blood clots) of cardiac arrhythmias (e.g. severe sinus tachycardia, i.e. HR = >180) after daily use [3][37]:

Alhadi et al. (2013) reported the case of a 21-year-old who was hospitalised with acute coronary syndrome, tachycardia (118 bpm), hypertension (182/108 mmHg), and Tachypnea (45 breaths/min) after smoking synthetic cannabis daily for 16 weeks [14]
Orsini et al. (2015) studied a 41-year-old who was admitted to an intensive care unit after developing congestive heart failure due to transient myocardial ischemia and a 30% decrease in the left ventricular ejection fraction (LVEF) after regular use [38]
Sherpa et al. (2015) described the case of a 45-year-old man who received EMT due to sinus tachycardia (HR = 127 BPM), a first-degree atrioventricular block, myocardial infarction, and cardiomyopathy after using K2 via a bong device two times a day [39]

Who Is More Likely To Develop A Spice Addiction?

Demographic	Why?
Pre-existing Trauma	Those with PTSD are more likely to use spice (6% vs 1%) for relaxation and tension-reduction [40] Drug-taking continues after experiencing a ‘floating’ feeling, providing temporary relief for trauma symptoms (e.g. intrusive thoughts) [7]
Mental Health Disorders	12% smoke spice up to 4x daily to cope with ‘sadness’, e.g. “I was sad, depressed. I used it daily. My temper went up and down.” [12][26] Up to 8 ‘hits’ per session are taken to create/prolong ‘uncontrollable laughter’ to mask low mood and persistent sadness exacerbated by spice use [7][26]
Homelessness	Spice is most commonly used in homeless populations (62%) due to being 3x cheaper than cannabis and non-detectable on drug tests required in shelters/hostels [12] Up to 7g is taken daily to facilitate sleep in public places (e.g. car parks) by “Knocking you out” and “Making life on the streets bearable, like you’ve got a warm blanket around you” [41]
15 - 25 Year Olds	15 - 25 year olds are 25% more likely to consume spice than 35 - 45 year olds [12] Up to 32% claim spice abuse is attributed to ‘money shortage’ and ‘friends’ after earning lower wages (e.g. NMW = £7.55 p/hr at 16 - 17 yrs old) and being susceptible to peer pressure [12]
Those In Prison	Up to 50% use spice to avoid detection, alleviate boredom, or as an alternative when the ‘usual substance’ (e.g. heroin, cocaine) is unavailable in prison [12][42] Spice is odourless and can be smuggled into prison via letters, books, and clothing to be taken regularly via 1 -3 cm2 paper-based preparations, unlike cannabis, due to a strong “earthy smell” [42]

Spice Mechanism Of Action

Spice’s mechanism of action involves acting as a full agonist at the CB1 and CB2 receptors to inhibit glutamate and GABA neurotransmission in the brain, resulting in:

A 150% increase in extracellular dopamine levels in brain regions (e.g. nucleus accumbens) responsible for reward, motivation, and pleasure within 40 minutes of drug-taking, lasting up to 3 hours after use of spice [24]
The activation of the brain’s reward circuitry whilst “Laughing uncontrollably, feeling energetic, or in a dream-like state” for up to 13 hours after consumption, leading to habitual K2 use after the brain associates the drug with pleasure/reward [7]

How Do Different Forms Of Spice Change Spice Addiction?

Form	How It Changes Addiction	Why It Changes Addiction
Vaping (As Oils)	Under 18s consume vapes laced with spice instead of tobacco/THC, and continue after positive effects May lead to thrombotic thrombocytopenic purpura + a 72% risk of severe ADAMTS13 deficiency [19]	Typically marketed towards under-18s using bright coloured vape pens to appear attractive and ‘harmless’ Unpredictable potency and used despite labels stating ‘not for human consumption’ [19]
Oral Ingestion	Contributes to 10% of spice-related poisonings [25] Use is reinforced as the brain associates the eating experience with positive effects, e.g. ‘giggling’	Can be homemade with varied amounts, with effects lasting up to 24 hours Typically mixed into ‘feel-good’ foods (e.g. brownies, cakes) to stimulate the release of dopamine
Snorting	Intensified high and adverse effects (e.g. severe tachycardia, i.e. HR = >180, mucosal damage) Mixed with toxic solvents + cutting agents (e.g 20% Benzocaine)	Fast onset (5 - 15 mins) after bypassing the digestive system and entering the brain Purchased on the internet and cut/diluted with other substances to become cheaper to produce/sell
Sprayed On Tobacco	Mainly used on the streets (64%) and contributes to 4% of spice overdoses [12] Habitual drug-taking occurs, and users become addicted to both drugs (spice + nicotine) [12]	50% re-dose up to 4x daily to get the ‘initial effect’ using an ‘unknown’ dose in cigarettes [12] Nicotine dependence develops around age 14, followed by spice via cigarettes between 18 - 28 [12]
Mixed With Cannabis	27% use both drugs at least 1x weekly = excessive CB1R stimulation [33] Intensified psychological symptoms (e.g. paranoia) + emotional dysregulation	Psychologically dependent on both substances + spice = a full agonist + THC = a partial agonist Spice alone increases the risk of psychosis and depression by 7-11-fold, and cannabis by 2-3-fold [33]
Infused As Drinks	Less common (e.g. 3%) [3] Easy to disguise addiction as drinking a standard ‘herbal tea’ (e.g. chamomile)	Slower onset of action (e.g. 1 hour) = ‘less intense’ high + users dislike the taste of ‘burned plastic’ Drug effects (e.g. drowsiness, relaxation) may be mistaken as a benefit of drinking herbal teas for sleep

References

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[31] Ergelen, Mine, et al. “The Comparison of Violence, and the Relationship with Childhood Trauma in Turkish Men with Alcohol, Opiate, and Synthetic Cannabinoid Use Disorder.” Neuropsychiatric Disease and Treatment, vol. Volume 14, Nov. 2018, pp. 3169–78. Accessed 22 May 2025.“Table 2.”
[32] V. Yu. Skryabin, and M. A. Vinnikova. “Clinical Characteristics of Synthetic Cannabinoid-Induced Psychotic Disorders: A Single-Center Analysis of Hospitalized Patients.” Journal of Addictive Diseases, vol. 37, no. 3-4, Taylor & Francis, Oct. 2018, pp. 135–41. Accessed 23 May 2025.“I heard my voice inside my head, it sounded hollow, much as it passed through the tube.”
[33] Hotham, James, et al. “Association of Cannabis, Cannabidiol and Synthetic Cannabinoid Use with Mental Health in UK Adolescents.” British Journal of Psychiatry, vol. 223, no. 4, July 2023. Accessed 23 May 2025.“Table 2.”
[34] Robinson, L., et al. “The Synthetic Cannabinoid HU210 Induces Spatial Memory Deficits and Suppresses Hippocampal Firing Rate in Rats.” British Journal of Pharmacology, vol. 151, no. 5, July 2007, pp. 688–700. Accessed 23 May 2025 “Exposure to HU210 did not result in a complete silencing of hippocampal neurons; rather, frequency and duration of burst firing, as well as firing within bursts, were reduced by approximately 50%, ... Thus, reduced baseline activity and attenuated burst firing would block neural encoding episodes.”
[35] Demir, Serkan, et al. “An Important Paraplegia Case due to Synthetic Cannabinoid Bonsai Abuse.” Medical Science and Discovery, vol. 3, no. 6, June 2016, pp. 266–69. Accessed 23 May 2025.“He explained that after six months of using Bonsai, he started to feel numbness in his legs, ... He had certain pains and aches in his extremities when he first started using the drug, but ignored them, ... CSF protein level was 299 mg/dl (normal range 15-45 mg/dl).”
[36] Söyler, Hande Çelikay, et al. “How Do Cannabis and Synthetic Cannabinoids Affect Neurocognitive Functions?” Turkish Journal of Psychiatry, vol. 33, no. 4, 2022, pp. 233–47. Accessed 26 May 2025.“Table 5.”
[37] Hancox, Jules C., et al. “Synthetic Cannabinoids and Potential Cardiac Arrhythmia Risk: An Important Message for Drug Users.” Therapeutic Advances in Drug Safety, vol. 11, Jan. 2020, pp. 1–4. Accessed 26 May 2025.“However, there is a reported 30-fold odds (a per event risk of 0.0006017) of requiring emergency medical treatment following SCRA use.”
[38] Orsini, Jose, et al. “The Wide and Unpredictable Scope of Synthetic Cannabinoids Toxicity.” Case Reports in Critical Care, vol. 2015, 2015, pp. 1–5. Accessed 26 May 2025.“Emergency Medical Services (EMS) staffing reported finding a bag of K2 at the scene, ... On arrival to ED his vital signs were as follows: blood pressure of 98/63 mmHg, heart rate of 118 beats/minute, ... A new transthoracic echocardiogram (TTE) showed markedly decreased left ventricular ejection fraction of 30% (55–65).
[39] Sherpa, Dolkar, et al. “Synthetic Cannabinoids: The Multi-Organ Failure and Metabolic Derangements Associated with Getting High.” Journal of Community Hospital Internal Medicine Perspectives, vol. 5, no. 4, Jan. 2015, p. 27540. Accessed 26 May 2025.“We report the case of a 45-year-old African American male with ST-elevation myocardial infarction, subarachnoid hemorrhage, reversible cardiomyopathy, ... He had been smoking cannabinoids regularly for 15 years and had recently started using K2 via a bong device twice daily 3 weeks prior to presentation.”
[40] Grant, Sean, et al. “Associations of Posttraumatic Stress Disorder Symptoms with Marijuana and Synthetic Cannabis Use among Young Adult U.S. Veterans: A Pilot Investigation.” Journal of Studies on Alcohol and Drugs, vol. 77, no. 3, May 2016, pp. 509–14. Accessed 26 May 2025.“Table 1.”
[41] Gray, Paul, et al. “The Use of Synthetic Cannabinoid Receptor Agonists (SCRAs) within the Homeless Population: Motivations, Harms and the Implications for Developing an Appropriate Response.” Addiction Research & Theory, vol. 29, no. 1, Mar. 2021, pp. 1–10. Accessed 26 May 2025.“Now I’m up to smoking seven grams [a day]” - (U39, male, mid 20s, supported housing), ... “Spice [SCRAs] makes this life [on the streets] bearable.”
[42] Craft, Sam, et al. “Synthetic Cannabinoid Use in an Adult Male Prison in the UK.” International Journal of Drug Policy, vol. 122, Dec. 2023. Accessed 26 May 2025.“Figure 3.”

About the author

Mischa Ezekpo

Mischa Ezekpo has a Bachelors degree in Psychology from Northumbria
University, and a Masters degree in Childhood Development and
Wellbeing, from Manchester Metropolitan University. Since 2018, Mischa
has written and published work on Addiction, Mental Health, Depression, and Eating Disorders. Content reviewed by Laura Morris (Clinical Lead).

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Last Updated: October 24, 2025