If you follow the news, you are well aware of our country’s heroin epidemic and the skyrocketing abuse of prescription painkillers. But if you’re like many parents, you may know much less about another growing drug epidemic – this one involving synthetic marijuana, or “fake weed.”

Fake is right, because synthetic marijuana isn’t really marijuana at all. It’s actually a group of chemicals, more accurately termed synthetic cannabinoids: laboratory chemicals that mimic the mind-altering effects of cannabis. Illegal drug makers spray these chemicals onto dried plant matter or herbs and sell them, usually at a fraction of the cost of real marijuana. Some are available in liquid form for vaping.

Known by street names such as Spice, K2, Cowboy Kush and Scooby Snax, synthetic cannabinoids are used mostly by young men in their 20's and 30's. But use of these drugs by high school and even middle school students has been rising sharply. Emergency room visits involving kids ages 12 to 17 using synthetic cannabinoids doubled from 2010 to 2011, to more than 7,000 visits nationwide, according to a 2014 report by the Substance Abuse and Mental Health Services Administration (SAMHSA). For 18- to 20-year-olds, ER visits quadrupled during that period, to more than 8,000.

These drugs are marketed by street sellers as a safe, legal high. Often sold in colorful packages sporting cartoon characters, synthetic cannabinoids are easy to find on the Internet. When you add to the easy access the fact that marijuana is being decriminalized in many areas around the country, kids may think that the synthetic version is safe.

The reality is that “fake weed” is more potent than its namesake – and can even be life-threatening.

As a pediatrician and former pharmacist working in adolescent health, I counsel teens and pre-teens in my office often and I always look for the opportunity to discuss their thoughts and experiences with using drugs. That’s because no matter how responsible they are or which school they attend, many teens are going to encounter some form of recreational drug use. In recent years, I’ve started sounding the warning bell among my young patients about the risks associated with synthetic cannabinoids. For you as a parent, it’s important to understand what these synthetic drugs are and what makes them so dangerous.

Too many unknowns

THC, the component in natural marijuana that produces a “high” or pleasant feeling, is highly predictable and rarely toxic. Synthetic marijuana, on the other hand, is not just one single drug. Drug producers are choosing from among more than 50 chemicals to create synthetic cannabinoids, and the number is growing. The degree of toxicity depends on the chemicals used and there is no way for teens, or anyone else, to know the combination – or concentrations – of these chemicals in the product they are buying.

In small doses, these chemicals can cause the desired relaxation and improved mood. In moderate doses, they can cause fever, delirium, rapid heartbeat, vomiting, seizures, elevated blood pressure, tremors, even hallucinations and paranoia. Sometimes, they even kill. According to the Centers for Disease Control and Prevention (CDC), 15 people died in the first five months of 2015 as a result of synthetic marijuana. They also seem to be addictive: After regular use, some people have exhibited withdrawal signs and symptoms.

So how can synthetic cannabinoids be legal? They started entering the United States nearly 10 years ago, and were sold legally until 2012, when the federal Synthetic Drug Abuse Prevention Act went into effect, banning certain cannabinoid chemicals. The problem is that manufacturers keep dodging the law by creating new chemicals not covered by the ban. Moreover, because the chemicals typically don’t show up in toxicology screens, it’s hard to outlaw them. If you cannot test for it, you cannot prosecute for it.

What you can do

As a parent, it’s crucial for you to educate your children and dispel misconceptions they might have about fake marijuana. Don’t wait for signs of drug use before having the conversation. Talk to your teen who makes straight A’s, talk to your young athlete who seems to do everything right. They might not even realize what’s inside one of those innocent-looking packages is a drug. Of course, watch for the classic signs of drug use: losing motivation to succeed, not being communicative, withdrawing, spending excess time away from home and family and lying about where they have been, losing academic status and avoiding what used to be routine extracurricular activities at school.

Be sure to keep open the lines of communication on the subject, so that if they do make a mistake or feel tempted, they feel comfortable coming to you. If you do discover your child is using any drug, including synthetic marijuana, for a non-medical purpose, talk to your pediatrician or an adolescent medicine specialist. They can counsel you and assess whether other health care services are necessary for appropriate treatment, based upon the individual needs of your child and family. They might also recommend behavioral health professionals, including those specializing in chemical dependency and addiction in young adults, teens and pre-teens.

A good source of information about synthetic cannabinoids and other drugs is the SAMHSA. website.

For those in Virginia, the Grab a Life Ring section of the Drug Free Virginia Site provides a list of regional drug programs and resources.

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Carol Forster, MD, is the Physician Director, Pharmacy & Therapeutics/Medication Safety with the Mid-Atlantic Permanente Medical Group in the Washington, D.C., area. She sees patients at the Kaiser Permanente Reston Medical Center.