In July 2016, an unusual mass intoxication in Brooklyn, New York, attracted international attention after witnesses described affected people as behaving in a “zombie-like” manner.
The phrase produced dramatic headlines, but there was no mysterious infectious disease and certainly no actual “zombie outbreak.”
Researchers subsequently identified the cause: exposure to an extremely potent synthetic cannabinoid called AMB-FUBINACA.
The incident became an important example of the dangers associated with substances commonly referred to as synthetic cannabinoids, K2, Spice or synthetic marijuana.
These substances are not simply artificial versions of cannabis. Their chemical composition and potency can be unpredictable, and some have been associated with severe poisoning, seizures, psychosis, cardiovascular problems, kidney injury and death.
Understanding what happened in New York helps explain why synthetic cannabinoids remain a public-health concern.
What Happened in New York in 2016?
On 12 July 2016, emergency medical services responded to a mass-intoxication incident in the Bedford-Stuyvesant area of Brooklyn, New York City.
According to the subsequent scientific investigation, 33 people were reportedly exposed to an initially unknown substance.
Eighteen were transported to two local medical centres.
Witnesses and emergency personnel described people displaying severely altered mental states.
Some affected individuals were reported to:
- stare blankly
- move unusually slowly
- respond slowly to questions
- appear severely lethargic or confused.
Media reports began referring to the event as a “zombie” outbreak or “zombieland.”
These descriptions referred only to the appearance and behaviour of severely intoxicated people.
What Actually Caused the Outbreak?
Researchers investigated biological samples from eight patients who had been taken to hospital.
They also analysed a sample of the herbal product associated with the incident.
The product was sold as “AK-47 24 Karat Gold.”
Laboratory analysis identified a synthetic cannabinoid called:
AMB-FUBINACA
It is also known by names including MMB-FUBINACA and FUB-AMB.
Researchers detected a metabolite of AMB-FUBINACA in serum or whole-blood samples from all eight patients tested.
The findings strongly linked the synthetic cannabinoid to the mass intoxication.
What Is AMB-FUBINACA?
AMB-FUBINACA is a laboratory-created chemical that acts on cannabinoid receptors in the body.
These receptors are part of the same biological system affected by THC, the principal intoxicating cannabinoid naturally present in cannabis.
However, this does not mean AMB-FUBINACA and cannabis have the same safety profile.
Laboratory research reported in the investigation found AMB-FUBINACA to be a highly potent activator of the CB1 cannabinoid receptor.
The researchers described it as an example of an emerging class of ultrapotent synthetic cannabinoids.
Its strong central-nervous-system effects were consistent with the profound sedation and unusual behaviour observed during the Brooklyn incident.
What Are Synthetic Cannabinoids?
Synthetic cannabinoids are human-made chemicals designed to interact with cannabinoid receptors in the body.
Products containing these chemicals have been sold under many names, including:
- K2
- Spice
- synthetic marijuana
- fake weed
- herbal incense.
However, calling these substances “synthetic marijuana” can be misleading.
They are not cannabis plants, and their pharmacological effects can differ considerably from naturally occurring cannabis.
Some synthetic cannabinoids stimulate cannabinoid receptors much more strongly than THC.
This can make their effects far more difficult to predict.
How Are Synthetic Cannabinoids Sold?
Synthetic cannabinoids have historically been applied to dried plant material, which may then be smoked.
They have also been sold in liquid forms intended for vaping.
Packaging may make products appear commercially manufactured or suggest that they are herbal products.
However, appearance does not provide reliable information about their chemical composition or potency.
The ingredients can change substantially between products and batches.
Why Are Synthetic Cannabinoids So Unpredictable?
There is no single substance called “K2” or “Spice.”
These terms have been applied to products containing many different synthetic cannabinoid chemicals.
Manufacturers may alter chemical formulations over time.
As a result, two packets sold under the same or similar branding may not necessarily contain the same substances or concentrations.
Even within a batch, chemicals may not always be distributed uniformly.
That creates an important problem: a person may have little reliable way of knowing exactly what chemical they are taking or how potent it is.
Are Synthetic Cannabinoids the Same as Cannabis?
No.
Synthetic cannabinoids and cannabis should not be treated as interchangeable substances.
Cannabis contains naturally occurring cannabinoids, including THC.
Synthetic cannabinoids are laboratory-produced chemicals that interact with cannabinoid receptors.
Some synthetic cannabinoids can activate these receptors more strongly than THC and produce very different effects.
This can result in severe and sometimes life-threatening poisoning.
What Symptoms Can Synthetic Cannabinoids Cause?
The effects vary according to the particular chemical, dose, other substances involved and individual factors.
Possible neurological and psychological effects include:
- confusion
- dizziness
- severe drowsiness
- agitation
- anxiety
- paranoia
- hallucinations
- delusions
- psychosis
- impaired coordination
- seizures.
Some people become extremely agitated.
Others may become unusually sedated or unresponsive.
That variation makes synthetic cannabinoid poisoning particularly unpredictable.
Physical Health Effects
Synthetic cannabinoids can also affect other parts of the body.
Reported effects include:
- nausea
- vomiting
- rapid heartbeat
- irregular heartbeat
- high blood pressure
- chest pain
- breathing problems
- excessive body temperature
- muscle injury
- kidney injury.
Serious cardiovascular and neurological complications have also been reported.
Severe poisoning can be life-threatening.
Can Synthetic Cannabinoids Cause Seizures?
Yes.
Seizures have been reported following synthetic cannabinoid exposure.
Anyone experiencing a seizure after suspected drug use needs urgent medical attention.
Do not put anything in the person's mouth during a seizure.
Protect them from nearby hazards and contact the appropriate emergency medical service in your country.
Can Synthetic Cannabinoids Cause Psychosis?
Yes.
Synthetic cannabinoid intoxication has been associated with:
- hallucinations
- paranoia
- delusions
- severe agitation
- psychotic symptoms.
Some people may behave unpredictably and can pose a danger to themselves or others.
A person experiencing severe confusion, hallucinations or dangerous behavioural changes after taking an unknown substance should receive urgent medical assessment.
Can Synthetic Cannabinoids Damage the Kidneys?
Acute kidney injury has been reported with some synthetic cannabinoid exposures.
Other severe complications can include muscle breakdown, cardiovascular problems and neurological effects.
The precise risk depends partly on which chemical or mixture has been consumed.
Can Synthetic Cannabinoids Be Fatal?
Yes.
Deaths associated with synthetic cannabinoid use have been reported.
This does not mean every exposure results in severe poisoning.
However, the unpredictability of the chemicals and concentrations makes it difficult for users to know how their body will respond.
A product used previously without a severe reaction may not necessarily have the same composition the next time.
Why Did the People in New York Appear “Zombie-Like”?
The unusual appearance of people during the 2016 Brooklyn incident was largely associated with profound central nervous system depression.
The index patient described in the scientific report was slow to respond to questions and displayed a blank stare.
Researchers concluded that the potency of AMB-FUBINACA was consistent with the strong depressant effects observed.
The word “zombie” therefore described outward behaviour during intoxication.
It was not a medical diagnosis.
How Did Scientists Identify AMB-FUBINACA?
Identifying emerging synthetic drugs can be challenging.
Standard drug-testing methods generally need to know what they are looking for.
But illicit drug markets continually introduce new chemical compounds.
Researchers investigating the Brooklyn incident used advanced analytical techniques, including liquid chromatography coupled with high-resolution mass spectrometry, to examine patient specimens and the suspected product.
They found the de-esterified acid metabolite of AMB-FUBINACA in biological samples from all eight patients who were tested.
AMB-FUBINACA itself was also identified in the herbal product linked to the outbreak.
This provided strong scientific evidence connecting the substance with the mass intoxication.
Why Can New Synthetic Drugs Be Difficult to Detect?
Synthetic drug markets can change rapidly.
When a new chemical appears, routine toxicology screening may not initially include it.
Scientists may need:
- specialised laboratory equipment
- updated chemical libraries
- appropriate analytical reference standards
- information from hospitals and poison centres
- collaboration between public-health and forensic laboratories.
This can create a race between the emergence of new psychoactive substances and scientists' ability to identify them.
The 2016 New York investigation demonstrated how advanced toxicological methods can help identify previously difficult-to-detect substances.
Does a Normal Drug Screen Rule Out Synthetic Cannabinoids?
Not necessarily.
Routine hospital or workplace drug screens do not detect every synthetic cannabinoid.
The chemicals used in these products change over time, and specialised testing may be necessary to identify particular compounds or their metabolites.
Doctors therefore often have to consider symptoms, circumstances and reported exposure when assessing a suspected poisoning.
What Should You Do If Someone Has Taken Synthetic Cannabinoids?
If someone has taken a suspected synthetic cannabinoid, monitor them carefully.
Seek urgent medical care if the person:
- collapses
- becomes unconscious or difficult to wake
- has a seizure
- has difficulty breathing
- develops severe chest pain
- becomes extremely confused
- develops severe agitation or psychosis
- becomes dangerously violent
- develops other severe or rapidly worsening symptoms.
Contact your local emergency medical service for life-threatening symptoms.
Where available, a poison-information service can also provide advice about suspected poisoning.
Do Not Assume Someone Can “Sleep It Off”
Severe drowsiness after taking an unknown drug should not automatically be treated as ordinary sleep.
If someone is difficult to wake, breathing abnormally or losing consciousness, seek emergency medical assistance.
Do not leave an unconscious person alone.
If they are unconscious but breathing and there is no reason to suspect a spinal injury, placing them in the recovery position may help keep their airway open while emergency assistance is being obtained.
Should You Make Someone Vomit?
No.
Do not deliberately make someone vomit after suspected synthetic cannabinoid poisoning unless a qualified poison specialist or healthcare professional specifically instructs you to do so.
Inducing vomiting can create additional risks, particularly if the person is drowsy or confused.
What Information Can Help Healthcare Professionals?
If it can be done safely, information about the suspected substance may help clinicians.
Useful information can include:
- what the person reportedly took
- approximately when it was taken
- whether other substances were involved
- the packaging or product name, if available.
Do not handle unidentified powders or chemicals unnecessarily.
Medical treatment should never be delayed while trying to determine exactly what substance was taken.
How Is Synthetic Cannabinoid Poisoning Treated?
There is no single universal antidote for synthetic cannabinoid poisoning.
Treatment generally focuses on supportive care and managing complications.
Depending on symptoms, medical teams may need to monitor or support:
- breathing
- heart rate and rhythm
- blood pressure
- body temperature
- neurological function
- kidney function
- hydration.
Seizures, severe agitation and other complications may require specific medical treatment.
Can People Become Dependent on Synthetic Cannabinoids?
Yes.
Regular use of some synthetic cannabinoids can lead to dependence.
People who use them frequently and then stop may experience withdrawal symptoms.
Reported symptoms can include:
- anxiety
- headaches
- sweating
- difficulty sleeping
- nausea
- vomiting.
More serious symptoms have also been reported.
Someone who regularly uses synthetic cannabinoids and wants to stop should consider discussing this with an appropriately qualified healthcare or addiction professional.
Why the Term “Zombie Drug” Can Be Problematic
Dramatic language attracts attention, but it can obscure the real health issue.
People experiencing drug poisoning are experiencing a medical emergency, not turning into zombies.
Terms such as “zombie drug” can also stigmatise people affected by substance-use disorders.
The scientifically useful lesson from the New York incident is that an extremely potent synthetic cannabinoid produced severe intoxication in dozens of people and required a coordinated medical and laboratory investigation.
What the 2016 New York Incident Taught Researchers
The Brooklyn incident demonstrated several important things.
First, synthetic cannabinoid products can contain extremely potent chemicals.
Second, serious outbreaks can occur when a particularly dangerous product enters a community.
Third, conventional drug screening may struggle to identify newly emerging substances.
Finally, collaboration among emergency services, clinicians, toxicology laboratories and public-health authorities can be essential for identifying emerging drug threats.
The Bottom Line
The so-called New York “zombie outbreak” of 2016 was actually a mass drug intoxication involving a potent synthetic cannabinoid called AMB-FUBINACA.
Thirty-three people were reportedly affected, and 18 were transported to hospitals.
Researchers tested biological samples from eight hospitalised patients and detected an AMB-FUBINACA metabolite in all eight. They also identified AMB-FUBINACA in the herbal product associated with the incident.
The episode highlights a broader health concern.
Synthetic cannabinoids sold under names such as K2 and Spice can contain unpredictable chemicals with potentially powerful effects on the brain, heart, kidneys and other organs.
Severe poisoning can cause seizures, psychosis, unconsciousness, cardiovascular problems and, in some cases, death.
Anyone who develops severe symptoms after taking a synthetic cannabinoid or unknown recreational substance should receive urgent medical attention.
Medical Disclaimer
This article provides general health education and is not a substitute for professional medical diagnosis, emergency treatment or personalised advice. Drug poisoning can be life-threatening. If someone collapses, has difficulty breathing, has a seizure, becomes unconscious or develops other severe symptoms after taking an unknown substance, contact your local emergency medical service immediately.
Sources and Further Reading
New England Journal of Medicine — “Zombie” Outbreak Caused by the Synthetic Cannabinoid AMB-FUBINACA in New York
https://www.nejm.org/doi/full/10.1056/NEJMoa1610300
U.S. Centers for Disease Control and Prevention — Cannabis Frequently Asked Questions (includes K2/Spice information)
https://www.cdc.gov/cannabis/faq/
CDC Archive — About Synthetic Cannabinoids
https://archive.cdc.gov/www_cdc_gov/nceh/hsb/envepi/outbreaks/sc/About.html
CDC Archive — Synthetic Cannabinoids: Overview for Healthcare Providers
https://archive.cdc.gov/www_cdc_gov/nceh/hsb/envepi/outbreaks/sc/healthcare.html
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