Even though the specific compounds found in spice can vary, synthetic cannabinoids all operate on the cannabinoid system. The symptoms of spice withdrawal are due to cannabinoid system dysregulation, so the symptoms of spice withdrawal may vary in intensity between different compounds but they usually exhibit very similar symptoms. These symptoms are most intense in the week or so after the last time someone used spice. The level of intensity may vary from very minor to extremely severe and potentially life-threatening. Of special concern is the risk of psychosis and hallucinations, as these may lead to indirect and very serious negative outcomes. Self-harm of harm to others may result from psychotic states or hallucinations. These symptoms usually dissipate over the following days or weeks, but post-acute symptoms may be present for quite some time. The timeline for spice withdrawal may also exhibit substantial variability between people, as the different potencies of the compounds found in spice can result in different levels of neurotransmitter downregulation.
Within hours to days of the last spice use, the symptoms of spice withdrawal will begin to appear. Often, the first ones to emerge are headaches, increased anxiety, sweating, and reduced appetite. Within a day or so of the first symptoms, these may be joined by intense cravings for spice, irritability, insomnia, and stomach pain. Energy levels often fall to a point of fatigue and lethargy, often followed by depression. Shaking and tremors may emerge and the period of highest risk for psychosis or hallucinations is between 3 to 5 days after symptoms appear. Towards the end of the week, symptoms may be near their peak intensity.
Some of the symptoms of spice withdrawal that may be experienced during the first week can include:
The beginning of the second week is usually quite rough. Symptoms are often near their peak severity and days of little to no sleep will contribute to an uncomfortable mental state. Usually, towards the middle of the week, some of the physical symptoms may begin to resolve. Stomach pain, shaking, and headaches may be the first to resolve and appetite usually increases shortly after. Energy levels often remain low and the psychological symptoms may still be present at fairly high levels. Once someone begins sleeping more regularly, they may notice that they have uncharacteristically vivid dreams or nightmares, and this may persist for some time.
Some symptoms that may persist into the second week of spice withdrawal can include:
The third week of spice withdrawal may mark the first sign of relief. The physical symptoms are often mostly resolved by now, and someone may experience some minor improvement in their energy levels. Anxiety, depression, and cravings for spice are usually still present and fairly intense. While it is common for someone to remain quite irritable, this may be improved from the previous weeks. Mood swings are usually common as well, although not as frequent or intense as they may have been in acute withdrawal. The fourth week of spice withdrawal is often improved from the third week. Sleep is often more restful as dreams may become somewhat less vivid, resulting in fewer sleep disturbances. Irritability has often improved by this time as well, although someone may be slightly more on-edge than normal. That being said, the psychological symptoms of depression, cravings, and anxiety are usually still present, and will often persist for many more weeks or months to some degree. In some cases, these symptoms may last for years, but they typically resolve over time and become less intense the longer someone goes without using spice. Further treatment is usually recommended, as the risk of relapse is real, and while the worst symptoms of spice withdrawal may have passed, there are still some challenges ahead.
Some symptoms of spice withdrawal that may linger until the third or fourth weeks may include:
While not as intense as the initial phase of spice withdrawal, the post-acute phase may nevertheless be very disruptive to someone’s life and their chances of recovery. These symptoms are strictly psychological in nature, and while they may not produce direct physical effects, they may lead to very negative physical consequences, in particular, the increased risk of suicidal ideation or suicide attempts. Needless to say, these risks are very severe, and while this may not necessarily be common, the consequences of suicide are extremely serious and must be treated with great care.
Some of the post-acute symptoms of spice withdrawal include:
These symptoms are usually much less severe than during the acute phase of withdrawal, but they can often last for months or even years in some cases. Medications and therapy may help reduce the severity of these symptoms, but for permanent relief, continued abstinence from spice or other cannabinoids is required.
The exact way that spice works is difficult to pin down, particularly because spice is not a single chemical entity, rather it is a group of synthetic cannabinoids. Because of the sometimes lengthy process required to regulate drugs and chemicals, it can take some time for regulatory bodies to identify, analyze, and pass legislation on the chemicals in spice. Because of the delay in regulation and the large number of synthetic cannabinoids available (and the many more that are possible), the manufacturers of spice can switch out the psychoactive compounds as needed to sidestep legal restrictions. In 2015 alone, the DEA identified 84 new synthetic cannabinoids. Due to this, there is no single compound that can be accurately referred to as spice. That being said, we can examine synthetic cannabinoids in general to illustrate a broad and general overview of the way cannabinoids work, and how they can produce addiction.
The way that spice compounds work in general is by stimulating the endocannabinoid system of the brain and body. This system is responsible for a variety of functions including memory, judgment, perception, reaction time, appetite, anxiety, and pain relief. The endocannabinoid system also produces downstream effects in other neurotransmitter systems including the serotonin, dopamine, and opioid systems. Through chronic spice use, the brain will begin to make changes to maintain balance. Since spice strongly stimulates cannabinoid receptors, the brain will undergo a process known as downregulation. This is the act of reducing the sensitivity of cannabinoid receptors, and once this begins a further process known as neurological remodeling will take place.
When someone stops using spice, the downregulation that occurred to cannabinoid receptors means that the natural endocannabinoids produced by the body will have a reduced ability to stimulate these receptors. While downregulation is responsible for the short-term and most intense symptoms of spice withdrawal, the process of neurological remodeling is responsible for the strictly psychological and longer-lasting post-acute symptoms of withdrawal.
While the effects of spice withdrawal may not always be dangerous, there are certain circumstances that indicate a spice detox center may be necessary to safely and successfully complete withdrawal. Spice withdrawal is almost never fatal, but the psychological effects can increase the risks of secondary injury or complications. This is mainly due to an increased risk of suicide or psychotic episodes, and there are certain people who may be at an increased risk of experiencing these effects.
It should be noted that this has been the case up until now, although new synthetic cannabinoids are always being developed and introduced to users. Additionally, it should be clarified that there is a great deal of uncertainty regarding spice, as it is still so new, and there are literally dozens of compounds that fall under the umbrella term “spice”. Finally, there may be a substantial amount of adulteration of spice with other, more addictive drugs by dealers or distributors to increase the addictive potential of the drug and, therefore, profits from spice sales. This means that someone may think they are going through withdrawal from spice, but there could be other, more dangerous drugs that they have become addicted to through spice use. Due to this, entering a spice detox center is highly recommended due to the uncertainty regarding the specific compounds someone may have become addicted to and, subsequently, the severity and duration of withdrawal symptoms they will face.
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