THE PACKAGE DEAL
by Monzur Ahmed
“He who controls the Spice, controls the Universe.” Baron Harkonnen, Dune
In the science fiction world of Frank Herbert’s “Dune,” the drug, Spice, was the most essential and valuable commodity in the universe. Found only on the desert planet Arrakis, the drug gave the user a longer life span, greater vitality, and heightened awareness; it could also unlock prescience in some humans, depending upon the dosage and the consumer's physiology. In real life, Spice or the “Zombie drug” seems to have similar importance in UK prisons. Here is a case from our hospital of a Spice smuggling prisoner who was admitted handcuffed and chained to a prison officer...
A 28 year old male prisoner had a history of epilepsy, personality disorder and drug abuse. Eleven days ago he swallowed drug package containing “Spice” (synthetic cannabinoid) with a street value of £1000. The package did not pass through his system as he intended. So, 5 days ago, he swallowed an USB stick and one AA battery to push the package along! Unfortunately this strategy did not work and he presented to hospital one day ago because the package still had not come out the other end. The initial AXR and CXR showed a AA sized battery and a USB stick in the stomach. In addition there was an oval shaped outline of what could have been the drug package in the fundus of the stomach. An urgent out of hours OGD was performed by a colleague. A battery and a large oval package were visible in the stomach but it was not possible to extract the package with a snare because the package would not pass through the upper oesophageal sphincter. An overtube was then used, but again the procedure was unsuccessful. The next day, the surgeons were preparing to take him to theatre but asked me to have a last ditch attempt at endoscopic extraction (see video)… The procedure was performed with the prisoner still handcuffed and chained to one of the two accompanying prison officers!
Spice is the name given to a synthetic cannibinoid (SCB) which emerged around 2013. SCB are highly potent CB1 cannabinoid receptor agonists falsely marketed and sold as safe and legal drugs. Recreational use of SCB is an increasing public health problem specifically in Western societies, with teenagers, young adults, and the prison population being the most affected. Some of these SCB are analogs of tetrahydrocannabinol, aminoalkylindoles, and other phytocannabinoid analogs have been detected in herbal preparations generically called "Spice." Spice, "K2" or "fake cannabis" is a general term used for variable herbal mixtures of unknown ingredients or chemical composition. Few drugs have achieved such notoriety in so little time, wreaking chaos within the prison service and placing huge pressures on the emergency services. In every town centre, spice users can be found begging for the small amount of loose change they need to buy their next fix. Spice started life as a “legal high” – a laboratory-engineered chemical that claimed to mimic the effects of cannabis but has since been banned, but post-ban, the drug continues to devastate the lives of two of society’s most vulnerable – and ignored – groups who don’t show up in the official figures: the street homeless and prisoners, with membership of one group often conferring membership of the other.
1.Davidson C, Opacka-Juffry J, Arevalo-Martin A et al,Adv Pharmacol. 2017;80:135-168. Spicing Up Pharmacology: A Review of Synthetic Cannabinoids From Structure to Adverse Events
2.Spaderna M, Addy PH, D’Souza DC,Psychopharmacology (Berl),2013 Aug;228(4):525-40. Spicing things up: synthetic cannabinoids
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Monzur Ahmed, Consultant Gastroenterologist