by Dr Alexander Lawson
Recent research has revealed a dangerous and hidden threat in vape products used by teenagers. Dr Alexander Lawson, Consultant Clinical Scientist and Medico-Legal Expert Witness at McCollum Consultants is warning clinicians and parents alike following a rise in hospital admissions linked to synthetic cannabinoids, often missed by standard drug testing.
At the end of 2024, a research group from the University of Bath published findings indicating that up to 1 in 6 vapes confiscated from UK schools contained synthetic cannabinoid receptor agonists (SCRAs), compounds more commonly known as synthetic cannabinoids or, colloquially, Spice or Mamba.
In early 2025, several patients have presented to emergency departments with seizures of unclear origin. On further investigation, direct analysis of their vape devices and vape fluids revealed the presence of SCRAs, strongly suggesting a causal link. Notably, these patients were all young men with no prior drug history, a demographic that differs significantly from the traditional users of Spice (e.g. the homeless community or prison inmates).
SCRAs
SCRAs are a large and chemically diverse group of novel psychoactive substances (NPS). Traditionally, Spice has been manufactured by spraying SCRAs onto plant material that mimics cannabis and is then smoked. However, more recently, pure liquid forms of SCRAs have been consumed via vape devices.
These compounds act on the same CB1 receptor targeted by THC, the active component in cannabis. While low doses can mimic cannabis-like effects (e.g. euphoria, relaxation, increased appetite), SCRAs are significantly more potent and bind with higher affinity, making their effects less predictable and often far more dangerous.
Common symptoms of SCRA intoxication include:
- Tachycardia, agitation, nausea/vomiting
- Psychosis, cardiac arrhythmias, seizures
- In some cases, death, either from cardiotoxicity or high-risk behaviour
Typically, SCRA use has been largely limited to vulnerable populations such as the homeless or incarcerated individuals. Recreational use among young people is rare and often not suspected.
Clinical and Toxicological Practice
Toxicology testing plays a crucial role not only in clinical decision-making but also in coronial investigations and criminal cases. The presence, or absence of certain substances can significantly influence how a case is understood, interpreted, and acted upon in both medical and legal contexts.
Understanding the scope and limitations of the toxicology screen performed is essential. Without targeted testing, particularly for novel psychoactive substances like SCRAs, important evidence may be missed—potentially affecting the accuracy of diagnoses, the determination of cause of death, or the outcome of legal proceedings.
While SCRA testing is not routinely required and is typically reserved for populations with known exposure (such as homeless individuals or prisoners), the recent emergence of SCRAs in vapes used by school-age children and young adults challenges this approach.
Therefore, in any young patient presenting with seizures, psychosis, or other unexplained neuropsychiatric symptoms, and with an otherwise negative drug history, clinicians, toxicologists, and legal professionals should actively consider whether SCRA testing was included in the toxicological analysis.
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