Introduction: We describe three cases with confirmed exposure to "spice" by detection of the metabolites JWH-018 and/or JWH-073 in urine. All cases had a negative urine drug screen. Case 1. A 25-year-old male with possible seizure, tachycardia, acidosis, and unresponsiveness, presented to a local emergency department (ED) after smoking a "spice" product. His symptoms resolved with benzodiazepines, fluid, and observation. His urine tested positive for JWH-018 and negative for JWH-073 metabolites. Case 2. A 21-year-old male was found unresponsive after smoking "spice." He had hypertension, was agitated, and had a Glasgow Coma Score of 7; the patient was intubated. The skin was warm and dry. His symptoms resolved with IV fluids and he was discharged home after 24 h. His urine tested positive for metabolites of JWH-018 and JWH-073. Case 3. A 19-year-old male was brought to the ED 1 h after smoking a "spice" product and having paranoia and delusions. His urine tested positive for JWH-018 and JWH-073 metabolites. He was discharged asymptomatic after observation for a few hours.
Discussion: Spice products are new and abused for their psychogenic effects and mood alteration. These cases exhibited changes consistent with either an anticholinergic or sympathomimetic agent that resolved following general supportive care.