J. DRUG EDUCATION, Vol. 43(3) 353-363, 2013
REASONS FOR SYNTHETIC THC USE AMONG COLLEGE STUDENTS
REBECCA A. VIDOUREK, PH.D., CHES KEITH A. KING, PH.D., MCHES MICHELLE L. BURBAGE, B.A. University of Cincinnati
ABSTRACT
Synthetic THC, also known as fake marijuana, is used by college students in the United States. The present study examined reasons for recent synthetic THC use among college students (N = 339). Students completed a 3-page survey during regularly scheduled class times. Results indicated students reported using synthetic THC for curiosity, to get high, and the fun of feeling high. No significant differences in reasons for use were found based on sex and grade. College students reported most often obtaining synthetic THC from head shops. Study findings may be beneficial to college health professionals and others working with college students. High rates of lifetime use may suggest that educational and intervention programs are needed.
INTRODUCTION Synthetic THC, commonly known as spice, K2, or fake weed, is increasing in popularity among college students. Current research demonstrates a steady rise in synthetic THC intake (Coppola & Mondola, 2012). In fact, Hu, Primack, Barnett, and Cook (2011) discovered that 1 in 10 college students used K2 in their lifetime. In 2011, the Center for Substance Abuse Research (CESAR) found that 8% of students in one study sample reported using synthetic THC in their lifetime whereas additional research found 14% of undergraduate students used synthetic THC (CESAR, 2013). 353 Ó 2013, Baywood Publishing Co., Inc. doi: http://dx.doi.org/10.2190/DE.43.4.d http://baywood.com
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On average, males are approximately twice as likely as females to use synthetic THC (NIDA, 2012). In 2010, 77.5% of synthetic THC related ER visits involved males, whereas 22.5% of the visits involved females (NIDA, 2013). Prevalence rates are also higher among early college students as opposed to upper classmen (Hu et al., 2011). Regarding age of initiation, many synthetic THC users first initiate use while in high school (NIDA, 2012). CAESAR (2013) reported that the average age of initiation for Synthetic THC use is approximately 18 years of age. Recent research indicates that synthetic THC is the second most popular illegal drug among high school seniors, with marijuana being the number one most widely used illegal drug (NIDA, 2012). Contrary to many other drugs, synthetic THC use is rapidly increasing among young adults (Forrester & Haywood, 2012). Several reasons may have contributed to increases in synthetic THC use, including ease of access and perceived safety. Synthetic THC is readily available through various retail outlets. Synthetic THC can be found at multiple venues including head shops (which are retail stores specializing in tobacco products), convenient stores, gas stations, and the internet (NIDA, 2012). Adding to this substance’s growing popularity, synthetic THC yields similar effects like that produced by marijuana (Fattore & Fratta, 2011). These psychoactive effects on individuals include relaxation, elevated mood, and distorted perception (Hu et al., 2011; NIDA, 2012). A comprehensive review of the literature revealed multiple negative side effects of synthetic THC. Short-term effects include relaxation, elevated mood, distorted perceptions of reality, and distortion of senses (Hu et al., 2011; NIDA, 2012). Many psychological consequences are possible from synthetic THC and include paranoia, hallucinations, and anxiety (NIDA, 2013). Physical side effects of synthetic THC include rapid heart rate, high blood pressure, vomiting, confusion, muscle spasms, seizures, and suicidal ideation (American Association of Poison Control Centers, 2012; Quan, Haase, and Levitan, 2011). Not surprisingly, in 2010 there were approximately 12,000 visits to the ER due to synthetic THC (DAWN, 2012). More than 75% of these visits were attributed to adolescents and young adults. Unfortunately, young adults and adolescents often perceive synthetic THC as harmless. This may be attributed to the fact that synthetic THC is typically labeled as natural and safe (NIDA, 2012). In addition, distributors often claim Synthetic THC is a harmless blend of herbs (Fattore & Fratta, 2011; NIDA, 2012). Misleading labels fail to mention active synthetic compounds are present in the product. Therefore, this deceptive marketing technique influences young adults’ perceptions of synthetic THC as a safe drug alternative. Purpose of the Present Study Limited research has been conducted which investigates synthetic THC use among college students. In addition, there is a lack of existing literature regarding specific reasons college students use synthetic THC. Therefore, this study seeks to
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fill these gaps by investigating the extent of Synthetic THC use among college students, age of initiation, and specific reasons students use. Specifically, the following research questions were examined: 1. What is the extent of recent (past 30 days) and lifetime synthetic THC use among college students? 2. What is age of first use among college students? 3. What are reasons for using synthetic THC? 4. What are sources of synthetic THC? 5. What are common negative effects of synthetic THC? 6. Does age of initiation differ based on sex and grade? 7. Do reasons for use differ based on sex and grade? METHODS Participants Students from a public university enrolled in Health, Physical Activity, and Leisure classes were recruited as participants for this study. Participants were notified that involvement in the study was voluntarily and all responses would be kept anonymous and confidential. None of the students declined participation. All students who were presented a survey elected to complete it. Instrumentation A 3-page survey, developed based on a comprehensive review of the literature, was created to assess the research questions. A panel of experts (N = 5) in health education, substance use, and survey research were provided the survey and asked for suggestions in order to establish content validity. The panel’s recommendations were considered by the research team and included in the final survey instrument. The survey consisted of several sections: 1. 2. 3. 4. 5.
Extent of Synthetic THC Use; Reasons for Synthetic THC Use; Sources of Synthetic THC; Side Effects of Synthetic THC; and Demographics.
Extent of Synthetic THC Use included three items and assessed lifetime use, recent use (past 30 days), and age of initiation. Students answered by filling in the blank and checking the appropriate box. Reasons for Synthetic THC consisted of 11 items assessing potential reasons for use and requested students to answer based on a 5-point scale (1 = Strongly Disagree; 5 = Strongly Agree). Sources of THC included 12 items examining common locations for purchasing synthetic
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THC and requested students to check all that apply. Side Effects of Synthetic THC consisted of 12 items assessing potential negative health consequences experienced from using synthetic THC and requested students to check all that apply. All scales were developed based on a comprehensive review of the literature. Lastly, demographics consisted of 10 items including sex, age, grade level, housing location, etc., and requested students to check the appropriate box and fill in the blank. In order to establish stability reliability of the survey, the survey was distributed to a convenience sample of college students (N = 15). Students were administered the survey on two different occasions 7 days apart. Kendall’s tau-b correlation coefficients were calculated for nonparametric subscales and were greater than >.80. Similarly, Pearson correlation coefficients were calculated for the parametric subscales and yielded coefficients >.85. Procedures Upon obtaining approval from the university institutional review board, a convenience sample of students enrolled in health, physical activity, and leisure classes were administered surveys. All students were surveyed in their classrooms during one academic semester. Students were enrolled in a variety of majors and included a diverse sample of grade levels. No incentives were offered for participation. In the classroom, a research assistant trained on survey administration explained the purpose of the study, ensured confidentiality and anonymity of responses, and requested participation. All students were provided with a research information sheet, which included the purpose of the study, contact information of the research team, and additional information about the survey and study. All surveys were collected by the research assistant, sealed in an envelope, and returned to the primary investigator for data entry and analysis. Data Analysis SPSS statistical software package (Version 21.0) was used to perform data analysis. Student background characteristics, perceptions of synthetic THC use, and age of initiation were examined via frequency distributions, means, standard deviations, and ranges. A series of Analysis of Variance (ANOVA) and Multivariate Analysis of Variance (MANOVA) were conducted to examine the research questions. The alpha level of significance was set a priori at .05. RESULTS Demographic Characteristics A total of 339 students at a major public university completed surveys (100% response rate). Over half of the students were female (N = 200, 59.2%) as opposed
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to male (N = 138, 40.8%). Participant’s ages ranged from 18-36. Grade levels of undergraduates varied within the sample that included 20.9% (freshman), 19.8% (sophomore), 25.4% (junior), and 31.3% (senior). Graduate students (2.4%) represented only a small portion of the study. Of the participants, 81% were white, 7.7% African American, 6% Asian, 3.3% self-reported as “other,” and 1.5% Hispanic. The majority of the participants lived off campus (60.9%) as opposed to those who lived on campus (22.1%), lived at home (15.2%), or listed “other” (1.8%). Over half of the participants (57.8%) were involved in campus organizations as opposed to not being involved (39.8%) in campus associations. Extent of Synthetic THC Use Of all students, 17.1% reported having ever used synthetic THC in their lifetime whereas 3.0% reported recent use (past 30 days) of synthetic THC. The majority of students (97.1%) reported having not recently used (past 30 days) Synthetic THC. Of the students, 1.5 % reported using Synthetic THC the day before the survey was distributed, .9% within the last 2 days, .3% within the last 15 days, and .3% within the last 30 days. Age of Initiation of Synthetic THC Use Results found no significant differences in students’ use based on age of initiation, F(1, 338) = .960, p = .331. However, results indicated that females had a significantly younger average age of initiation (M = 17.81) than males (M = 18.42; F(1, 338) = 4.509, p = .034). It was revealed that the average age in which freshmen and sophomores first used Synthetic THC was 16.85 years. Juniors, seniors, and graduate students reported a later initiation age of 18.82 years. Significant differences in students’ use was found based on grade level (F(1, 338) = 10.812, p = .002). More specifically, freshmen and sophomores reported a significantly earlier age of initiation than juniors, seniors, and graduate students. Reasons for Synthetic THC Use Results indicated that various reasons contributed to students’ use of Synthetic THC (Table 1). It was revealed that the three major motivations included curiosity, to get high, and the fun of feeling high. Curiosity (19.2%) regarding synthetic THC was cited as the top reason for using the substance. With 17.4%, the second highest reason for using the drug was for the purpose of getting high. Results also indicated that 10.6% of students reported the fun of feeling high was a main factor contributing to use. Of the students who used Synthetic THC, social factors were the least likely to influence their use of the product. Results revealed that 4.1% of the students felt that they used these drugs to “fit in” whereas 3.8% used Synthetic THC due to peer pressure. The results indicated that 2.7% of the students were unsure why they use
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Synthetic THC. No significant differences of students’ use was found based on reason for use in relation to sex (F(1, 338) = .602, p = .827; Table 2) and grade level (F(1, 338) = .911, p = .530; Table 3). Sources of Synthetic THC and Effects of Synthetic THC The findings indicated that the students obtained Synthetic THC from a myriad of locations. The majority of the students reported their source of Synthetic THC
Table 1. Reasons for Using Synthetic THC N (%)
Reason for Using Synthetic THC Curious Get High Getting High is Fun Friends were Using Adventure Relieve Stress Did Not Think it Would Harm Escape Fit in Peer Pressure Do Not Know Why
65 (19.2) 59 (17.4) 36 (10.6) 34 (10.1) 29 (8.5) 27 (8.0) 22 (6.5) 18 (5.3) 14 (4.1) 13 (3.8) 9 (2.7)
Note: N = 339. Missing values excluded from analyses.
Table 2. Reasons for Using Synthetic THC Based on Sex
Item Get High Curious Adventure Getting High is Fun Fit in Friends were Using Escape Relieve Stress Peer Pressure Did Not Think it Would Harm Do Not Know Why
Males
Females
M (SD)
M (SD)
F
p
2.51 (1.330) 2.59 (1.277) 2.28 (1.153) 2.39 (1.229) 2.04 (1.024) 2.26 (1.129) 2.09 (1.104) 2.27 (1.156) 1.99 (1.057) 2.17 (1.057) 1.99 (1.029)
2.36 (1.318) 2.39 (1.314) 2.17 (1.165) 2.22 (1.173) 1.95 (1.031) 2.14 (1.139) 1.99 (1.063) 2.08 (1.079) 1.95 (1.043) 2.09 (1.099) 1.95 (1.036)
1.186 1.974 .769 1.774 .675 .926 .728 2.466 .169 .410 .140
.277 .161 .381 .184 .412 .336 .394 .117 .681 .523 .709
Note: N = 339. Missing values excluded from analyses.
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Table 3. Reasons for Using Synthetic THC Based on Grade
Item
Get High Curious Adventure Getting High is Fun Fit In Friends were Using Escape Relieve Stress Peer Pressure Did Not Think it Would Harm Did Not Know Why
Freshmen/ Sophomores
Juniors/Seniors /Graduate Students
M (SD)
M (SD)
F
p
2.24 (1.310) 2.33 (1.297) 2.07 (1.163) 2.15 (1.196) 1.92 (1.068) 2.05 (1.161) 1.99 (1.120) 2.07 (1.125) 1.88 (1.043) 2.00 (1.081) 1.84 (.996)
2.55 (1.322) 2.47 (1.298) 2.32 (1.150) 2.38 (1.193) 2.04 (.999) 2.29 (1.109) 2.06 (1.052) 2.21 (1.105) 2.03 (1.049) 2.21 (1.076) 2.05 (1.050)
4.405 2.769 3.599 2.974 1.017 3.507 .338 1.246 1.638 2.952 3.156
.037 .097 .059 .086 .314 .062 .562 .265 .201 .087 .077
Note: N = 339. Missing values excluded from analyses.
was from head shops (7.4%). Friends (6.8%) and tobacco shops (6.2%) where also reported as being main sources of Synthetic THC as opposed to hemp shops (4.4%), Internet (3.8%), gas stations (3.8%), convenience stores (2.4%), and “other” locales (.9%). The results indicated that the students experienced several negative effects from using Synthetic THC. The main effect reported from using this substance was racing heartbeat (6.8%). Students also listed nervousness (5.6%), paranoia (5.0%), nausea (5.0%), headaches (4.7%), and dilated pupils (3.5%) as negative effects they suffered. The findings revealed fewer cases of hallucinations (2.1%), vomiting (1.5%), high blood pressure (1.2%), “other” effects (1.2%), and tremors (.9%) were experienced due to Synthetic THC use. DISCUSSION The present study found that 17% of students reported lifetime use of synthetic THC and 3% of students reported recent use. Research studies indicate synthetic THC is a popular drug of choice among high school students (NIDA, 2012). Perhaps this research may explain the low rate of recent use among college students. This finding may indicate that high school students are more likely to use synthetic THC than college students. Studies focusing on high school use as well as reasons why high school students report greater rates of recent use than college students may be warranted. In addition, future studies should explore college students’ perceptions of synthetic THC use during the college years. Perhaps college
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students perceive synthetic THC as a drug of choice for younger students thereby decreasing use. Results indicate that the average age of initiation is younger for females than males. Females were found to first use this substance at 17.81 years of age as opposed to males, who first use synthetic THC at 18.42 years of age. The mean age of initiation is supported by past literature as the average age of first use is typically 18 years of age, with many users being adolescents or young adults (CAESAR, 2013; Hu et al., 2011; NIDA, 2012). However, previous research found males are significantly more likely than females to report synthetic THC use (CAESAR, 2013). Although not significant, the present study was comprised of more females than males. This may explain study findings that females had an earlier age of initiation than males. Future research with an equal number of males and females may be necessary to explore sex differences in age of initiation. Based on study findings, it appears senior year of high school and the first year of college is the primary time for initiating use of synthetic THC. Perhaps, targeting middle and high school students with educational programs on the negative effects of synthetic THC is needed to prevent initiation and regular use. Previous research indicates substance abuse prevention programs are effective for this age group (Botvin, 2000; Froeschle, Smith, & Ricard, 2007). Additionally, programs focusing on reducing positive attitudes towards drug use significantly reduced substance use among middle and high school students (Froeschle et al., 2007; Valentine, Griffith, Ruthazer, Gottlieb, & Keel, 1998). Prevention and educational programs targeting this age group may be an effective strategy for decreasing initiation of synthetic THC. Underclassmen in this study were more likely than upperclassmen to initiate use. This could be due to the rising trend of synthetic THC use in high schools (NIDA, 2012). As use of synthetic THC is a recent trend, current underclassmen may have initiated use while in high school. In the present study, freshmen and sophomores were more likely to use than juniors and seniors. As use of synthetic THC may begin during the high school years, this may explain the difference between grade levels. Perhaps, first and second year college students used during their high school years, possibly explaining this finding. In the present study, students reported three primary reasons for using synthetic THC. Curiosity was the number one reason for use followed by for the purpose of getting high and pleasure from obtaining the high. Social factors such as peer pressure were the least cited reasons for use. These findings are consistent with previous research that also found curiosity and pleasure as the major reasons for uses (Vandrey, Dunn, Fry, & Girling, 2012). Similarly, previous research found social influences were not primary motivating factors to use synthetic THC. This is contrary to many studies of substance abuse among youth which found social factors such as the peer group tend to influence overall use of substances including alcohol, marijuana, and other illicit drugs (Duncan, Tildesley, Duncan, & Hops,
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1995; Jackson, 1997; Marcoux & Shope, 1997). Additional research is needed to explore the role of social influences on synthetic THC use. Regarding access, most students reported obtaining synthetic THC from head shops. Friends and tobacco shops were also cited as common sources. Although slightly less common, students also reported obtaining synthetic THC via hemp shops, the internet, gas stations, and convenience stores. Previous research found similar results, with specialty shops being primary purchase points for synthetic THC (Fattore & Fratta, 2011; Forrester & Haywood, 2012). These findings should be considered in prevention and intervention programs. The negative health effects of synthetic THC use are commonly seen in U.S. emergency rooms (Wiegand, 2012). In this study, students reported experiencing multiple negative health effects from synthetic THC. Racing heartbeat was the number one negative health effect reported. Students also cited nervousness, paranoia, nausea, and headaches as adverse effects experienced while using. These findings are consistent with previous research, which found headaches, nausea, and paranoia as being negative symptoms of synthetic THC use (Fattore & Fratta, 2011; Vandrey et al., 2012). Implications from this finding should be noted. First, research indicates that human consumption, safety, and toxicity data from synthetic THC are lacking (Nichols, 2011). Studies should be conducted examining these variables and determining baseline data for these drugs. In addition, educational prevention programs should be implemented in order to raise awareness of the negative health effects associated with synthetic THC consumption. Presenting the potential negative consequences of synthetic THC may deter use among some students. As many students perceive these drugs as safe, enhancing perceived risk through prevention programs may be warranted. Limitations The following study limitations should be noted. The study sample consisted of students from one Midwestern university. Therefore, caution should be exercised in generalizing results to other populations. Next, monothematic nature of the survey instrument may have resulted in a response set bias. Also, although stability reliability of the survey was statistically strong, it should be noted that the sample size for test-retest procedures was small (N = 15). Lastly, all data was self-reported by participants. Socially desirable responses may have been reported by some individuals. CONCLUSIONS The present study found high rates of lifetime use and low rates of recent use of synthetic THC. This may indicate that students were more likely to use as high school students rather than as current college students. Perhaps targeting high
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school students with educational and prevention programs would decrease use of synthetic THC. In addition, students reported negative side effects of using synthetic THC. Educational programs educating students about the negative health effects of synthetic THC are warranted to reduce use.
REFERENCES American Association of Poison Control Centers. (2012). Synthetic marijuana. Retrieved from http://www.aapcc.org/alerts/synthetic-marijuana/ Botvin, G., (2000). Preventing drug abuse in schools: Social and competence enhancement approaches targeting individual-level etiologic factors. Addictive Behaviors, 25, 887-897. Center for Substance Abuse Research (CESAR). (2011). Nearly one in ten college students have ever used synthetic marijuana; Nearly all also report using marijuana, cigarettes, and hookah. Retrieved October 14, 2013, from CESAR Web site: http://www.cesar. umd.edu/cesar/cesarfax/vol20/20-45.pdf Center for Substance Abuse Research (CESAR). (2013). Study finds that 14% of undergraduate Students at a southeastern university report synthetic cannabinoid use; Users more likely to be male and identify as LGBT. Retrieved October 14, 2013, from CESAR Web site: http://www.cesar.umd.edu/cesar/cesarfax/vol22/22-20.pdf Coppola, M., & Mondola, R. (2012). Synthetic cathinones: Chemistry, pharmacology and toxicology of a new class of designer drugs of abuse marketed as “bath salts” or “plant food”. Toxicology Letters, 211, 144-149. Retrieved from www.ncbi.nlm.nih.gov/ pubmed/22459606 Drug Abuse Warning Network (DAWN). (2012). The DAWN report: Drug-related emergency department visits involving synthetic cannabinoids. Rockville, MD: Substance Abuse and Mental Health Services Administration. Duncan, T. E., Tildesley, E., Duncan, S. C., & Hops, H. (1995). The consistency of family and peer influences on the development of substance use in adolescence. Addiction, 90, 1647-1660. Fattore, L., & Fratta, W. (2011). Beyond THC: The new generation of cannabinoid designer drugs. Frontiers in Behavioral Neuroscience, 5(60), Retrieved from http://www. frontiersin.org/behavioral_neuroscience/10.3389/fnbeh.2011.00060/full Forrester, M. B., & Haywood, T. (2012). 1. Geographic distribution of synthetic cannabinoid exposures reported to Texas poison centers . The American Journal of Drug and Alcohol Abuse, 38(6), 603-608. Retrieved from www.ncbi.nlm.nih.gov/pubmed/ 22571605_3130 154 Froeschle, J. G., Smith, R. L., & Ricard, R. (2007). The efficacy of a systematic substance abuse program for adolescent girls. Professional School Counseling, 10, 498-505. Hu, X., Primack, B. A., Barnett, T. E., & Cook, R. L. (2011). College students and use of k2: An emerging drug of abuse in young persons. Substance Abuse Treatment, Prevention, and Policy, 6(16). Retrieved from http://www.biomedcentral.com/content/ pdf/1747-597X-6-16.pdf Jackson, C. (1997). Initial and experimental stages of tobacco and alcohol use during late childhood: Relation to peer, parental and personal risk factors. Addictive Behaviors, 22, 685-698.
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Marcoux, B. C., & Shope, J. T. (1997). Application of the theory of planned behavior to adolescent use and misuse of alcohol. Health Education Research, 12, 323-331. National Institute on Drug Abuse (NIDA). (2012, December). Drug facts: Spice (synthetic marijuana). Retrieved July 2, 2013, from NIDA Web site: http://www.drugabuse.gov/ publications/drugfacts/spice-synthetic-marijuana National Institute on Drug Abuse (NIDA). (2013). Synthetic marijuana lands Thousands of young people in the ER, especially young males. Retrieved October 24, 2013, from NIDA Web site: http://www.drugabuse.gov/related-topics/trends-statistics/infograph ics/synthetic-marijuana-lands-thousands-young-people-in-er-especiall Nichols, D. (2011). Legal highs: The dark side of medicinal chemistry. Nature, 469(7328), 7. Quan, D., Haase,D., & Levitan, R. (2011). Legal drugs of abuse. Emergency Medicine Reports, 32(20), 237-247. Valentine, J., Griffith, J., Ruthazer, R., Gottlieb, B., & Keel, S. (1998). Strengthening causal inference in adolescent drug prevention studies: Methods and findings from a controlled study of the urban youth connection program. In J. Valentine, J. A. Dejong, & N. J. Kennedy (Eds.), Substance abuse prevention in multicultural communities (pp. 127-145). New York, NY: Haworth Press. Vandrey, R., Dunn, K. E., Fry, J. A., & Girling, E. R. (2012). A survey study to characterize use of spice products (synthetic cannabinoids). Drug and Alcohol Dependence, 120(1-3), 238-241. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21835562 Wiegand, T. (2012). Designer drugs: Focus on cathinones (bath salts) and synthetic cannabinoids (K2 or spice). Emergency Medicine Reports, 33(26), 305-315.
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REASONS FOR SYNTHETIC THC USE AMONG COLLEGE STUDENTS
REBECCA A. VIDOUREK, PH.D., CHES KEITH A. KING, PH.D., MCHES MICHELLE L. BURBAGE, B.A. University of Cincinnati
ABSTRACT
Synthetic THC, also known as fake marijuana, is used by college students in the United States. The present study examined reasons for recent synthetic THC use among college students (N = 339). Students completed a 3-page survey during regularly scheduled class times. Results indicated students reported using synthetic THC for curiosity, to get high, and the fun of feeling high. No significant differences in reasons for use were found based on sex and grade. College students reported most often obtaining synthetic THC from head shops. Study findings may be beneficial to college health professionals and others working with college students. High rates of lifetime use may suggest that educational and intervention programs are needed.
INTRODUCTION Synthetic THC, commonly known as spice, K2, or fake weed, is increasing in popularity among college students. Current research demonstrates a steady rise in synthetic THC intake (Coppola & Mondola, 2012). In fact, Hu, Primack, Barnett, and Cook (2011) discovered that 1 in 10 college students used K2 in their lifetime. In 2011, the Center for Substance Abuse Research (CESAR) found that 8% of students in one study sample reported using synthetic THC in their lifetime whereas additional research found 14% of undergraduate students used synthetic THC (CESAR, 2013). 353 Ó 2013, Baywood Publishing Co., Inc. doi: http://dx.doi.org/10.2190/DE.43.4.d http://baywood.com
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On average, males are approximately twice as likely as females to use synthetic THC (NIDA, 2012). In 2010, 77.5% of synthetic THC related ER visits involved males, whereas 22.5% of the visits involved females (NIDA, 2013). Prevalence rates are also higher among early college students as opposed to upper classmen (Hu et al., 2011). Regarding age of initiation, many synthetic THC users first initiate use while in high school (NIDA, 2012). CAESAR (2013) reported that the average age of initiation for Synthetic THC use is approximately 18 years of age. Recent research indicates that synthetic THC is the second most popular illegal drug among high school seniors, with marijuana being the number one most widely used illegal drug (NIDA, 2012). Contrary to many other drugs, synthetic THC use is rapidly increasing among young adults (Forrester & Haywood, 2012). Several reasons may have contributed to increases in synthetic THC use, including ease of access and perceived safety. Synthetic THC is readily available through various retail outlets. Synthetic THC can be found at multiple venues including head shops (which are retail stores specializing in tobacco products), convenient stores, gas stations, and the internet (NIDA, 2012). Adding to this substance’s growing popularity, synthetic THC yields similar effects like that produced by marijuana (Fattore & Fratta, 2011). These psychoactive effects on individuals include relaxation, elevated mood, and distorted perception (Hu et al., 2011; NIDA, 2012). A comprehensive review of the literature revealed multiple negative side effects of synthetic THC. Short-term effects include relaxation, elevated mood, distorted perceptions of reality, and distortion of senses (Hu et al., 2011; NIDA, 2012). Many psychological consequences are possible from synthetic THC and include paranoia, hallucinations, and anxiety (NIDA, 2013). Physical side effects of synthetic THC include rapid heart rate, high blood pressure, vomiting, confusion, muscle spasms, seizures, and suicidal ideation (American Association of Poison Control Centers, 2012; Quan, Haase, and Levitan, 2011). Not surprisingly, in 2010 there were approximately 12,000 visits to the ER due to synthetic THC (DAWN, 2012). More than 75% of these visits were attributed to adolescents and young adults. Unfortunately, young adults and adolescents often perceive synthetic THC as harmless. This may be attributed to the fact that synthetic THC is typically labeled as natural and safe (NIDA, 2012). In addition, distributors often claim Synthetic THC is a harmless blend of herbs (Fattore & Fratta, 2011; NIDA, 2012). Misleading labels fail to mention active synthetic compounds are present in the product. Therefore, this deceptive marketing technique influences young adults’ perceptions of synthetic THC as a safe drug alternative. Purpose of the Present Study Limited research has been conducted which investigates synthetic THC use among college students. In addition, there is a lack of existing literature regarding specific reasons college students use synthetic THC. Therefore, this study seeks to
SYNTHETIC THC USE /
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fill these gaps by investigating the extent of Synthetic THC use among college students, age of initiation, and specific reasons students use. Specifically, the following research questions were examined: 1. What is the extent of recent (past 30 days) and lifetime synthetic THC use among college students? 2. What is age of first use among college students? 3. What are reasons for using synthetic THC? 4. What are sources of synthetic THC? 5. What are common negative effects of synthetic THC? 6. Does age of initiation differ based on sex and grade? 7. Do reasons for use differ based on sex and grade? METHODS Participants Students from a public university enrolled in Health, Physical Activity, and Leisure classes were recruited as participants for this study. Participants were notified that involvement in the study was voluntarily and all responses would be kept anonymous and confidential. None of the students declined participation. All students who were presented a survey elected to complete it. Instrumentation A 3-page survey, developed based on a comprehensive review of the literature, was created to assess the research questions. A panel of experts (N = 5) in health education, substance use, and survey research were provided the survey and asked for suggestions in order to establish content validity. The panel’s recommendations were considered by the research team and included in the final survey instrument. The survey consisted of several sections: 1. 2. 3. 4. 5.
Extent of Synthetic THC Use; Reasons for Synthetic THC Use; Sources of Synthetic THC; Side Effects of Synthetic THC; and Demographics.
Extent of Synthetic THC Use included three items and assessed lifetime use, recent use (past 30 days), and age of initiation. Students answered by filling in the blank and checking the appropriate box. Reasons for Synthetic THC consisted of 11 items assessing potential reasons for use and requested students to answer based on a 5-point scale (1 = Strongly Disagree; 5 = Strongly Agree). Sources of THC included 12 items examining common locations for purchasing synthetic
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THC and requested students to check all that apply. Side Effects of Synthetic THC consisted of 12 items assessing potential negative health consequences experienced from using synthetic THC and requested students to check all that apply. All scales were developed based on a comprehensive review of the literature. Lastly, demographics consisted of 10 items including sex, age, grade level, housing location, etc., and requested students to check the appropriate box and fill in the blank. In order to establish stability reliability of the survey, the survey was distributed to a convenience sample of college students (N = 15). Students were administered the survey on two different occasions 7 days apart. Kendall’s tau-b correlation coefficients were calculated for nonparametric subscales and were greater than >.80. Similarly, Pearson correlation coefficients were calculated for the parametric subscales and yielded coefficients >.85. Procedures Upon obtaining approval from the university institutional review board, a convenience sample of students enrolled in health, physical activity, and leisure classes were administered surveys. All students were surveyed in their classrooms during one academic semester. Students were enrolled in a variety of majors and included a diverse sample of grade levels. No incentives were offered for participation. In the classroom, a research assistant trained on survey administration explained the purpose of the study, ensured confidentiality and anonymity of responses, and requested participation. All students were provided with a research information sheet, which included the purpose of the study, contact information of the research team, and additional information about the survey and study. All surveys were collected by the research assistant, sealed in an envelope, and returned to the primary investigator for data entry and analysis. Data Analysis SPSS statistical software package (Version 21.0) was used to perform data analysis. Student background characteristics, perceptions of synthetic THC use, and age of initiation were examined via frequency distributions, means, standard deviations, and ranges. A series of Analysis of Variance (ANOVA) and Multivariate Analysis of Variance (MANOVA) were conducted to examine the research questions. The alpha level of significance was set a priori at .05. RESULTS Demographic Characteristics A total of 339 students at a major public university completed surveys (100% response rate). Over half of the students were female (N = 200, 59.2%) as opposed
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to male (N = 138, 40.8%). Participant’s ages ranged from 18-36. Grade levels of undergraduates varied within the sample that included 20.9% (freshman), 19.8% (sophomore), 25.4% (junior), and 31.3% (senior). Graduate students (2.4%) represented only a small portion of the study. Of the participants, 81% were white, 7.7% African American, 6% Asian, 3.3% self-reported as “other,” and 1.5% Hispanic. The majority of the participants lived off campus (60.9%) as opposed to those who lived on campus (22.1%), lived at home (15.2%), or listed “other” (1.8%). Over half of the participants (57.8%) were involved in campus organizations as opposed to not being involved (39.8%) in campus associations. Extent of Synthetic THC Use Of all students, 17.1% reported having ever used synthetic THC in their lifetime whereas 3.0% reported recent use (past 30 days) of synthetic THC. The majority of students (97.1%) reported having not recently used (past 30 days) Synthetic THC. Of the students, 1.5 % reported using Synthetic THC the day before the survey was distributed, .9% within the last 2 days, .3% within the last 15 days, and .3% within the last 30 days. Age of Initiation of Synthetic THC Use Results found no significant differences in students’ use based on age of initiation, F(1, 338) = .960, p = .331. However, results indicated that females had a significantly younger average age of initiation (M = 17.81) than males (M = 18.42; F(1, 338) = 4.509, p = .034). It was revealed that the average age in which freshmen and sophomores first used Synthetic THC was 16.85 years. Juniors, seniors, and graduate students reported a later initiation age of 18.82 years. Significant differences in students’ use was found based on grade level (F(1, 338) = 10.812, p = .002). More specifically, freshmen and sophomores reported a significantly earlier age of initiation than juniors, seniors, and graduate students. Reasons for Synthetic THC Use Results indicated that various reasons contributed to students’ use of Synthetic THC (Table 1). It was revealed that the three major motivations included curiosity, to get high, and the fun of feeling high. Curiosity (19.2%) regarding synthetic THC was cited as the top reason for using the substance. With 17.4%, the second highest reason for using the drug was for the purpose of getting high. Results also indicated that 10.6% of students reported the fun of feeling high was a main factor contributing to use. Of the students who used Synthetic THC, social factors were the least likely to influence their use of the product. Results revealed that 4.1% of the students felt that they used these drugs to “fit in” whereas 3.8% used Synthetic THC due to peer pressure. The results indicated that 2.7% of the students were unsure why they use
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Synthetic THC. No significant differences of students’ use was found based on reason for use in relation to sex (F(1, 338) = .602, p = .827; Table 2) and grade level (F(1, 338) = .911, p = .530; Table 3). Sources of Synthetic THC and Effects of Synthetic THC The findings indicated that the students obtained Synthetic THC from a myriad of locations. The majority of the students reported their source of Synthetic THC
Table 1. Reasons for Using Synthetic THC N (%)
Reason for Using Synthetic THC Curious Get High Getting High is Fun Friends were Using Adventure Relieve Stress Did Not Think it Would Harm Escape Fit in Peer Pressure Do Not Know Why
65 (19.2) 59 (17.4) 36 (10.6) 34 (10.1) 29 (8.5) 27 (8.0) 22 (6.5) 18 (5.3) 14 (4.1) 13 (3.8) 9 (2.7)
Note: N = 339. Missing values excluded from analyses.
Table 2. Reasons for Using Synthetic THC Based on Sex
Item Get High Curious Adventure Getting High is Fun Fit in Friends were Using Escape Relieve Stress Peer Pressure Did Not Think it Would Harm Do Not Know Why
Males
Females
M (SD)
M (SD)
F
p
2.51 (1.330) 2.59 (1.277) 2.28 (1.153) 2.39 (1.229) 2.04 (1.024) 2.26 (1.129) 2.09 (1.104) 2.27 (1.156) 1.99 (1.057) 2.17 (1.057) 1.99 (1.029)
2.36 (1.318) 2.39 (1.314) 2.17 (1.165) 2.22 (1.173) 1.95 (1.031) 2.14 (1.139) 1.99 (1.063) 2.08 (1.079) 1.95 (1.043) 2.09 (1.099) 1.95 (1.036)
1.186 1.974 .769 1.774 .675 .926 .728 2.466 .169 .410 .140
.277 .161 .381 .184 .412 .336 .394 .117 .681 .523 .709
Note: N = 339. Missing values excluded from analyses.
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Table 3. Reasons for Using Synthetic THC Based on Grade
Item
Get High Curious Adventure Getting High is Fun Fit In Friends were Using Escape Relieve Stress Peer Pressure Did Not Think it Would Harm Did Not Know Why
Freshmen/ Sophomores
Juniors/Seniors /Graduate Students
M (SD)
M (SD)
F
p
2.24 (1.310) 2.33 (1.297) 2.07 (1.163) 2.15 (1.196) 1.92 (1.068) 2.05 (1.161) 1.99 (1.120) 2.07 (1.125) 1.88 (1.043) 2.00 (1.081) 1.84 (.996)
2.55 (1.322) 2.47 (1.298) 2.32 (1.150) 2.38 (1.193) 2.04 (.999) 2.29 (1.109) 2.06 (1.052) 2.21 (1.105) 2.03 (1.049) 2.21 (1.076) 2.05 (1.050)
4.405 2.769 3.599 2.974 1.017 3.507 .338 1.246 1.638 2.952 3.156
.037 .097 .059 .086 .314 .062 .562 .265 .201 .087 .077
Note: N = 339. Missing values excluded from analyses.
was from head shops (7.4%). Friends (6.8%) and tobacco shops (6.2%) where also reported as being main sources of Synthetic THC as opposed to hemp shops (4.4%), Internet (3.8%), gas stations (3.8%), convenience stores (2.4%), and “other” locales (.9%). The results indicated that the students experienced several negative effects from using Synthetic THC. The main effect reported from using this substance was racing heartbeat (6.8%). Students also listed nervousness (5.6%), paranoia (5.0%), nausea (5.0%), headaches (4.7%), and dilated pupils (3.5%) as negative effects they suffered. The findings revealed fewer cases of hallucinations (2.1%), vomiting (1.5%), high blood pressure (1.2%), “other” effects (1.2%), and tremors (.9%) were experienced due to Synthetic THC use. DISCUSSION The present study found that 17% of students reported lifetime use of synthetic THC and 3% of students reported recent use. Research studies indicate synthetic THC is a popular drug of choice among high school students (NIDA, 2012). Perhaps this research may explain the low rate of recent use among college students. This finding may indicate that high school students are more likely to use synthetic THC than college students. Studies focusing on high school use as well as reasons why high school students report greater rates of recent use than college students may be warranted. In addition, future studies should explore college students’ perceptions of synthetic THC use during the college years. Perhaps college
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students perceive synthetic THC as a drug of choice for younger students thereby decreasing use. Results indicate that the average age of initiation is younger for females than males. Females were found to first use this substance at 17.81 years of age as opposed to males, who first use synthetic THC at 18.42 years of age. The mean age of initiation is supported by past literature as the average age of first use is typically 18 years of age, with many users being adolescents or young adults (CAESAR, 2013; Hu et al., 2011; NIDA, 2012). However, previous research found males are significantly more likely than females to report synthetic THC use (CAESAR, 2013). Although not significant, the present study was comprised of more females than males. This may explain study findings that females had an earlier age of initiation than males. Future research with an equal number of males and females may be necessary to explore sex differences in age of initiation. Based on study findings, it appears senior year of high school and the first year of college is the primary time for initiating use of synthetic THC. Perhaps, targeting middle and high school students with educational programs on the negative effects of synthetic THC is needed to prevent initiation and regular use. Previous research indicates substance abuse prevention programs are effective for this age group (Botvin, 2000; Froeschle, Smith, & Ricard, 2007). Additionally, programs focusing on reducing positive attitudes towards drug use significantly reduced substance use among middle and high school students (Froeschle et al., 2007; Valentine, Griffith, Ruthazer, Gottlieb, & Keel, 1998). Prevention and educational programs targeting this age group may be an effective strategy for decreasing initiation of synthetic THC. Underclassmen in this study were more likely than upperclassmen to initiate use. This could be due to the rising trend of synthetic THC use in high schools (NIDA, 2012). As use of synthetic THC is a recent trend, current underclassmen may have initiated use while in high school. In the present study, freshmen and sophomores were more likely to use than juniors and seniors. As use of synthetic THC may begin during the high school years, this may explain the difference between grade levels. Perhaps, first and second year college students used during their high school years, possibly explaining this finding. In the present study, students reported three primary reasons for using synthetic THC. Curiosity was the number one reason for use followed by for the purpose of getting high and pleasure from obtaining the high. Social factors such as peer pressure were the least cited reasons for use. These findings are consistent with previous research that also found curiosity and pleasure as the major reasons for uses (Vandrey, Dunn, Fry, & Girling, 2012). Similarly, previous research found social influences were not primary motivating factors to use synthetic THC. This is contrary to many studies of substance abuse among youth which found social factors such as the peer group tend to influence overall use of substances including alcohol, marijuana, and other illicit drugs (Duncan, Tildesley, Duncan, & Hops,
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1995; Jackson, 1997; Marcoux & Shope, 1997). Additional research is needed to explore the role of social influences on synthetic THC use. Regarding access, most students reported obtaining synthetic THC from head shops. Friends and tobacco shops were also cited as common sources. Although slightly less common, students also reported obtaining synthetic THC via hemp shops, the internet, gas stations, and convenience stores. Previous research found similar results, with specialty shops being primary purchase points for synthetic THC (Fattore & Fratta, 2011; Forrester & Haywood, 2012). These findings should be considered in prevention and intervention programs. The negative health effects of synthetic THC use are commonly seen in U.S. emergency rooms (Wiegand, 2012). In this study, students reported experiencing multiple negative health effects from synthetic THC. Racing heartbeat was the number one negative health effect reported. Students also cited nervousness, paranoia, nausea, and headaches as adverse effects experienced while using. These findings are consistent with previous research, which found headaches, nausea, and paranoia as being negative symptoms of synthetic THC use (Fattore & Fratta, 2011; Vandrey et al., 2012). Implications from this finding should be noted. First, research indicates that human consumption, safety, and toxicity data from synthetic THC are lacking (Nichols, 2011). Studies should be conducted examining these variables and determining baseline data for these drugs. In addition, educational prevention programs should be implemented in order to raise awareness of the negative health effects associated with synthetic THC consumption. Presenting the potential negative consequences of synthetic THC may deter use among some students. As many students perceive these drugs as safe, enhancing perceived risk through prevention programs may be warranted. Limitations The following study limitations should be noted. The study sample consisted of students from one Midwestern university. Therefore, caution should be exercised in generalizing results to other populations. Next, monothematic nature of the survey instrument may have resulted in a response set bias. Also, although stability reliability of the survey was statistically strong, it should be noted that the sample size for test-retest procedures was small (N = 15). Lastly, all data was self-reported by participants. Socially desirable responses may have been reported by some individuals. CONCLUSIONS The present study found high rates of lifetime use and low rates of recent use of synthetic THC. This may indicate that students were more likely to use as high school students rather than as current college students. Perhaps targeting high
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school students with educational and prevention programs would decrease use of synthetic THC. In addition, students reported negative side effects of using synthetic THC. Educational programs educating students about the negative health effects of synthetic THC are warranted to reduce use.
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