The patient's heart rate might be elevated or it might be low. He or she could be shaking, anxious and difficult to control or entirely unconscious. The patients are often brought in because of unexplainable, bizarre or even psychotic behavior.
Though the symptoms vary widely, the underlying cause is often the same: The patient has smoked a synthetic version of marijuana known as spice.
When patients with these symptoms started coming in a few years ago, many local physicians hadn't even heard of spice, said St. Luke's Director of Emergency Medicine Dr. Matthew Larsen.
For most drug overdoses there's an obvious course of action and medication to counteract the effects. For spice, it's different.
Without medication to reverse the effects, hospital staff must treat spice reactions symptomatically.
"Sometimes vital signs are not stable," Larsen said.
Often, patients who are believed to have smoked spice are given anti-anxiety medication and have to be calmed. Doctors also must tease out whether symptoms like paranoia are a result of underlying mental health issues or an acute drug reaction, Larsen said.
"We stabilize and wait to see," he said. "It's a matter of hoping that everything resolves itself."
That's an option Idaho lawmakers don't have. The state's easily skirted ban on synthetic marijuana has done little to keep the lightly researched drug out of circulation. And with increasing reports of severe reactions with its use, spice has evolved from what some saw as a 2010 fad to what some now call an "insidious" influence on Idaho youth.
If you believe most products' packaging, spice is intended to be used as incense or potpourri and is generally labeled not for human consumption. But the plant matter is sprayed with a manmade version of THC, the naturally occurring chemical that gives marijuana smokers a high.
Locally, Twin Falls businessman Allen Nagel produces and sells a legal brand of the substance called Hayze, but nationally, similar substances — both legal and banned — are most widely known by the brand names Spice and K2.
Due to holes in an Idaho ban passed last year, legal versions of spice are sold in smoke shops and several other Gem State businesses. This hasn't stopped the sale of illegal spice, though.
Possession of legal versions of the product won't get an adult arrested, but driving after smoking it, selling or giving it to a minor or adulterating it with an illegal substance are all citable offenses.
Due to the patchwork of criminal charges that spice use can be charged under — inhalation of intoxicants is another option — it's difficult to definitively quantify the drug's impact on Idaho's court system. But charges out of Twin Falls County alone paint a picture of a drug that's been both a commercial success and a danger to its users' health.
On Feb. 7, Joey Trevino, 21, was charged with manufacturing a controlled substance and possession with intent to deliver. According to police, he was selling a version of synthetic marijuana that was mixed with "bath salts" another relatively new synthetic drug that mirrors methamphetamine use.
Despite a readily available supply of legal versions of spice in Twin Falls, 47-year-old Robert Skinner was recently charged for selling a banned version. Police say Skinner carried several business cards that stated, "We spice up your life. A Hay Ride Delivery Service 24/7."
And on Jan. 5, 22-year-old Richard Gremler Jr. was charged with injury to a child for providing spice to a 17-year-old girl police say they found lying in a Twin Falls street, screaming.
Police say Gremler and the minor had smoked a type of spice labeled "Trainwreck Ultra." According to court records, it took four police officers and hospital staff members to physically control the girl.
"She was unconsciously straining, writhing and had body tremors," the records state. After resisting treatment for more than three hours, she was eventually moved to the intensive care unit.
Spice use has perhaps been most visible in Idaho's treatment diversion courts and probation and parole programs, where participants have found it to be one option to skirt the system.
"It's an ongoing battle for us at this point," said Marsha Stallones, director of Twin Falls County juvenile drug court.
Recently, eight juvenile offenders in one of the treatment court's most highly monitored groups were tested for spice. Five had chemicals used in spice in their system, Stallones said.
"Word on the street is it's everywhere and 'everyone' is doing it," she said.
While Stallones said she doesn't believe that spice use has become a teen pandemic, she thinks there's a perception that it's a legal, safe alternative to marijuana. That's something she disputes.
"The high is not anything like natural THC," she said. "It's nothing like marijuana at all."
The youth in her programs often report an increased heart rate, along with feeling breathless, sweaty and jittery, Stallones said.
"Most of them will tell you it's not great," she said. "Lots of kids say you'll never know if it will be a good trip or bad."
Among drug court participants, Stallones estimates spice is more popular to use than marijuana because it's easier to get, cheaper, and there's a perception that it's undetectable. While police currently lack a field test for spice, there is a lab test for the banned substances.
Until recently, a lack of onsite testing meant an eight-day wait before the drug court received the results of a test. Now Stallones said, she has ordered tests that can be done in-house to detect three common chemicals used in spice. But at $35 each, it won't be cheap to test kids once a week, she said, and the results will still need to be sent to a lab for verification.
The drug diversion program is for first-time offenders, and kids are routinely testing positive for spice, she said.
"They give up marijuana, drugs, booze," she said, but they still smoke spice.
"It's just out there. It's pretty insidious. It's being promoted as a kind of safe alternative and it's not safe," she said. "Anything you buy in ounces and grams speaks for itself."
At Filer High School, students witnessed firsthand two of their peers' troubling reactions to spice, once at an early fall football game and again at the beginning of a school day last November. In both instances, students were hospitalized after losing balance and shaking uncontrollably.
"It had a profound effect, but it hasn't stopped it," Filer High School Principal Leon Madsen said of spice use among Filer's student body.
Madsen has worked with Filer police, school staff and parents to raise awareness about the drug's possible effects.
Filer Police Sgt. Bill Deetz gave the community a nuts-and-bolts presentation about what spice is made of, what it looks like and the effects of smoking it, Madsen said.
"It was good information for not only the kids but a lot of our parents," he said. "They had no real deep understanding."
Information about spice use was also added to the school's advisory period curriculum for four weeks.
Before Deetz's presentation and the informational classes, two or three kids a month were showing up at the school's office under the influence of spice, Madsen said. Since the classes there have been none.
Twin Falls Schools are also working to dispel myths about spice for parents and students.
Superintendent Wiley Dobbs sent information out to principals, teachers and parents about a workshop that happened Friday which included information about how to identify spice and its symptoms.
Dobbs said he worries about students losing control of themselves and ending up in situations where they must rely on others to take care of them.
"We're taking it very seriously and we're very concerned about it," he said. "The health of our students is involved here. We'll do anything to put ourselves between this product and our students."
At Twin Falls High School, administrators still see more instances of students using marijuana than spice, Principal Ben Allen said.
"I'm sure there's some here," he said. "We just haven't caught a lot of kids under the influence."
In general, Allen said it's difficult to keep up with the constantly changing substances that students choose to try or abuse.
"It goes in spurts," he said. "Once they find out it's dangerous, then it dies down."
The Magic Valley has bigger drug concerns than spice, even among youth.
Twin Falls County Prosecutor Grant Loebs said that marijuana and prescription drug abuse are more common among area youth. But Idaho has clearly defined laws to make illegal the use or possession of marijuana, and abuse of prescription drugs. Not so with spice, at least not yet.
"The big problem with it in general is the people who manufacture it change the compounds from time to time," he said. "They kind of skirt the law and the intent of the law."
Last year, the Idaho Legislature passed a bill to add several chemicals commonly used in spice formulas to the state's controlled substances list. But by altering the chemical compounds, spice producers were able to evade the law and keep their products, only slightly altered, on the shelves.
That's led legislators to pitch a more inclusive spice ban this year.
On Feb. 29, the House unanimously passed House Bill 502 to add additional compounds to the state's list of controlled substances. The bill was presented to the Senate Health and Welfare Committee March 1.
The new bill states "any compound" derived from synthetic cannabis formulas will be banned.
At the end of February, the U.S. Drug Enforcement Administration extended control of five common chemicals used in spice for six more months while the group determines whether the compounds should be permanently added as a controlled substance.
Of course, a state ban won't rid Idaho of spice, but only drive it underground. A patchwork of state laws means the products will still be legally produced, shipped and sold in other states. But the hope is that the drug will lose some of its luster with teens if it's only available on a black market that's more difficult for them to navigate.
Right now, educators and law enforcement agree that education about the product is essential to parents and youth alike.
Fifth District Judge Mark Ingram, who serves as the juvenile judge for five Magic Valley counties, hopes to create a film to raise awareness about the prevalence and health effects of synthetic marijuana. The purpose of the film wouldn't be to scare viewers into submission, but rather to educate them.
In his court, Ingram often hears of how a juvenile offender thought spice was legal or because it is legal it must be harmless, he said.
"I am very convinced it's way worse than the general public thinks it is," Ingram said.
Information from: The Times-News