In 2009, the harmful effects of a man-made drug with names such as Spice, K2, Kush, Bliss, Joker, Mr. Nice Guy and hundreds of others, started eliciting widespread health-related reports. Synthetic marijuana contains far more powerful chemicals than marijuana, with varying amounts of the pharmacological agent, depending on the lab and batch. In 2015, the U.S. Drug Enforcement Administration\u2019s National Forensic Laboratory Information System identified 84 new synthetic cannabinoids in that year alone. Synthetic cannabinoids are not detectable on most standard in-house hospital drug screens, including those for tetrahydrocannabinol (THC). In January 2018, poison centers received reports of 135 cases of synthetic marijuana exposure, although the final tally for the month may be higher. In 2013, 2,668 such calls were made to poison centers. By 2015, this number increased nearly threefold, with 7,794 exposures. In 2014, a teenager who used the drug died after slipping into a coma. On one summer day in July 2016, 33 people were stumbling around Brooklyn, New York like zombies. The mind-altering effects of K2 were blamed for sending these users to NYC emergency rooms. John W. Huffman, the man who invented synthetic cannabis solely for studying the structure and function of cannabinoids receptors, likened using these drugs to playing Russian roulette. Dangerous Effects on the Brain The true dangers of synthetic marijuana are linked to the way they impact the brain. In natural marijuana, the active ingredient THC is low binding, acting as a partial agonist, although higher potency cannabis plants are associated with some of the same detrimental effects as synthetic marijuana. THC activates cannabinoid receptors (CB1 and CB2), affecting memory, pleasure, movements, thinking, concentration, coordination and sensory\/time perception. The THC-like man-made chemical in synthetic marijuana is a full agonist, made specifically to hit these receptors with maximum efficacy. The potency can be at least 100 times greater than THC, leading to life-threatening side effects. Synthetic Marijuana and Seizures CB receptors are plentiful, existing in nearly every region of the brain. Synthetic marijuana is a strong-binding, long-lasting compound, with the potential to impact all these receptors. Synthetic marijuana has been linked to psychosis, rapid heartbeat and seizures, none of which are typically seen after marijuana use. Conversely, marijuana has been shown to have anticonvulsant properties and was used for centuries before antiepileptic drugs were developed. The location of impacted CB receptors dictates the effects of synthetic marijuana. The presence of these receptors in seizure initiation areas in the temporal cortex can lead to seizures, while receptors in the prefrontal cortex are more likely associated with cases of psychosis. Spice Case Studies A 24-year-old male with a history of paranoid schizophrenia and hypertension presented to the ER after experiencing a 3-5 minute generalized tonic-clonic seizure (GTC). After admission, he had a second GTC seizure lasting one minute. Although he tested positive for two prescribed medications Lexapro (escitalopram) and hydrocodone, he admitted to smoking funky monkey Spice the same day. A 36-year-old female with a history of polysubstance abuse in remission, depression and migraine headaches experienced a GTC seizure that progressed to status epilepticus. A drug screen showed no signs of alcohol, opiates, THC, amphetamines or cocaine. Twelve hours after admission and being extubated, she admitted to smoking black mamba Spice for the first time immediately prior to the seizure. At six-month follow-up, she reported no seizure activity or Spice use. In both of these cases, extensive neurological testing, including MRI imaging, cerebrospinal fluid analysis and EEG testing failed to reveal a valid alternate cause for the seizures. Long-Term Use Linked to Chronic Seizures Coby O\u2019Brien-Emerick, a 27-year-old Des Moines man, shared his story to spread awareness and offer hope to anyone struggling with an addiction to synthetic marijuana. O\u2019Brien-Emerick experienced chronic seizures every three months for five years, landing him in the hospital for weeks on end. He started smoking synthetic cannabis as an alternative to marijuana while on probation, to prevent positive drug tests. Due to its low cost and availability, he quickly developed a daily habit. The first time he experienced a seizure surrounded by friends, they did not call 911 for fear of reprisal. Although he quit more than three years ago, his five-year Spice habit caused residual medical effects he is still dealing with today.