Spice: A New "Legal" Herbal Mixture Abused by Young Active Duty Military Personnel

Spice is an herbal mixture smoked for euphoria and mixed with synthetic cannabinoids that are undetected on urine drug screens. Spice use has increased in the military because it is considered legal and is not detected on urine drug screen. The authors describe 3 cases of Spice use in military members. Case 1: 19-year-old male presented with paranoia, agitation, and visual hallucinations after smoking the "Space" brand of Spice. Urine thin-layer chromatography (TLC) and gas chromatography-mass spectrometry (GC-MS) were negative. Case 2: 19-year-old female presented with sedation, amnesia, and agitation. She smoked the "Space" brand. She was alert within 3 hours of arrival. Urine GC-MS detected levorphanol. Case 3: 23-year-old male presented with delusions and paranoia. He complained of "monsters on his back." His symptoms improved in the emergency department (ED). His urine TLC and GC-MS were negative. All cases were admitted and evaluated by a toxicologist; all 3 had their history corroborated by family or friends, or with drug paraphernalia. Spice is a new herbal mixture that is increasingly used in the military. Expected effects are similar to cannabis, but may include more paranoia and hallucinations, and may differ for each brand.