Duluth ER doctor disputes notion of 'harmless' synthetic marijuana

We recently aired a story about a business in Duluth called The Last Place on Earth. People line up outside the store every day to buy a synthetic form of marijuana despite a state law that bans the product. Jim Carlson, who owns the store, is challenging the law in court. He says people aren't having problems with the drugs.

But Duluth emergency room doctors dispute that claim. They're seeing an increasing number of people show up with serious medical conditions after using synthetic marijuana and synthetic ecstasy. Carlson's store no longer sells the synthetic ecstasy, which is labeled as bath salts.

Dr. Beth Bilden, a medical toxicologist and emergency room physician for Essentia Health St. Mary's Medical Center in Duluth, spoke with MPR's Morning Edition about her concerns.

Cathy Wurzer: How big of a problem is this?

Dr. Beth Bilden: It is a big problem with regard to the clinical effects that it causes. Patients can end up in the emergency department, and of course we'll see cases where patients are very, very sick. They require an emergency assessment and treatment, so it's not somebody who can just walk into the emergency department and you say, 'OK, let's check their blood pressure and heart rate.' These patients come in and they have a fast heart rate, their blood pressure is high, they can have a very high fever, agitation is one of the biggest problems and this delirium people get and so it becomes not only a medical issue but a safety issue for the patient and staff.

Wurzer: What are you hearing from patients about these drugs?

Bilden: That they're easy to get and that they are cheap, for some of them cheaper than regular marijuana, so they're accessible, and that they like the high that they provide.

Wurzer: Are these younger people coming into the ER or people of all ages?

Bilden: It can be any age, but certainly it is younger people. Then of course who does it affect, not only the individual but the parents who are bringing the child in. It's really kind of a younger crowd we're seeing.

Wurzer: Is synthetic marijuana more dangerous than non-synthetic marijuana?

Bilden: There are differences in the effects of them. They both work in the areas of the brain where marijuana would work. The effects make them more dangerous. We don't see a lot of patients in the emergency department who come in on a yearly basis because they're smoking marijuana. But we do see them coming in because they're smoking the synthetic version or ingesting the synthetic version. These can cause some of the differences — nausea and vomiting, but more importantly, hallucinations, paranoia, seizures have been reported with these.

Wurzer: I would presume there are challenges in trying to figure out what's going on. Do you have to go through a guessing game to figure that out or do you know?

Bilden: Both can happen. If they're acutely delirious, we're not going to be able to get a report from them. It's not uncommon, though, to have family members or friends who bring the patient in or who have called the ambulance to help provide a history. But it's not uncommon, either, to really not know. When we look and try to assess patients, as a toxicologist I look and try to see if the patient has a high blood pressure, a fast heart rate, a high fever. That's not going to be an overdose from a sedating medication.

Wurzer: When did you start seeing patients come in with these problems?

Bilden: Probably about a year and a half ago, but it might be a little bit longer because we saw patients that were actually transferred here to the Duluth area before it was being reported generally around the state. And I work at the Hennepin Regional Poison Center as well, and so comparing notes and figuring out where this is occurring in the state, it really is across the state but we did see some very early cases here.

Wurzer: How much has this been a drain on health care resources in northeastern Minnesota?

Bilden: With the number of people it takes immediately to help care for a patient like this who's acutely agitated, it's not again uncommon when patients come in sick from these two classes of medicines they can end up on a ventilator in the intensive care unit and those are really high costs. They're not weeks of stay in the hospital but they could stay for days in the hospital.

Interview transcribed by MPR reporter Elizabeth Dunbar.

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