On Friday afternoon, a crowd gathered around a man struggling to sit upright outside Bean's Cafe in downtown Anchorage. Emergency responders, employees and clients of the soup kitchen circled around the man as he swayed unsteadily on a bench.
It was the second medical call related to the synthetic drug Spice at Bean's Cafe that day, client services supervisor Tracy Saakvitne said as she watched the scene unfold.
A few minutes later, an ambulance arrived. The man was led away, his body limp and his head rocked forward. Two responders flanked him, one on either side, and held him upright.
As the crowd watched him shuffle away, another Bean's client, George Shoogukuwrk, stood up and turned to the group.
"It's killing you, don't you know that?" Shoogukuwrk shouted. "You don't know what they're putting in there. It's stupid, man. Get it through your brain, cause you don't need that Spice."
Since late July, Anchorage has seen a surge in the number of Spice-related medical emergencies.
Between July 31 and Aug. 13, the Anchorage Fire Department made 110 medical transports for "known or suspected" Spice use across Anchorage, said Erich Scheunemann, assistant chief of emergency medical service operations. It's the most he's ever seen in such a short span of time.
Many of the cases occurred downtown, and many involved people Anchorage police call "high-risk" -- chronic inebriates, homeless people and people suffering from drug addictions.
Bean's Cafe, which provides social services to Anchorage's homeless, has been hit hard by the spike in Spice-related emergencies. Executive director Lisa Sauder called the scene at the organization a "war zone" during a rash of hospitalizations in early August. She believes the synthetic drug is to blame for at least some of the deaths of seven clients in past weeks.
"I can't even tell you. We're exhausted," Saakvitne said Friday as medics helped the man struggling to remain upright.
Spice is a synthetic drug that is typically made by spraying psychotropic compounds onto plant materials. It's a cheap high that is difficult to regulate, because manufacturers will often switch ingredients as soon as a chemical compound is made illegal. Police said they believe those recently hospitalized may have used Spice that was combined "with flora that has 'hemlock-like' characteristics."
In January 2014, the Assembly passed a new law that banned Spice based on its packaging and a list of labeling criteria. Later that year, a similarly worded statewide ban went into effect. Within weeks, Spice was nowhere to be found on store shelves, although police said last week they have heard rumors of some stores selling the drug behind the counter.
Clients at Bean's say "Zero Gravity" is the brand causing the rash of medical emergencies. Like many brands, it's packaged as "potpourri." Smoking Spice gives you spins, a few of the clients said. It makes you hallucinate. It's like you're drunk. It makes you angry.
Outside Bean's Cafe, Shoogukuwrk's eyes were swelling with tears as he pleaded with others to avoid the drug. "Every single day, the fire department and medics are down here for the purpose of Spice," Shoogukuwrk said.
The reason people use Spice is the same as other mind-altering substances, Shoogukuwk said. "The people that are doing Spice are hurting, same as alcohol."
'I guess it was just a matter of time'
Nationwide, medical issues stemming from the drug appear to be increasing.
U.S. poison control centers are reporting an uptick in calls related to the drug. Through Aug. 11, there have been 5,220 calls related to exposure to synthetic marijuana nationwide this year, the American Association of Poison Control Centers writes. That already far surpasses the number of calls for both 2013 (2,668 calls) and 2014 (3,682 calls). However, the 2015 total has yet to top 2011, when poison control centers fielded just under 7,000 calls.
In April, calls to poison centers spiked dramatically before leveling off at numbers similar to 2014, the Centers for Disease Control and Prevention reported in July. Most calls came from men who averaged 26 years old. Reports from New York City have noted a marked increase in emergency room visits in recent months.
In Alaska, the increase appears to be confined to Anchorage, wrote Jason Grenn, public information officer for the Alaska Department of Health and Social Services.
Spice-related emergency calls "typically come in as seizures, overdoses, unconscious, difficulty breathing," said Scheunemann.
Despite the hospitalizations, police are limited in how they can respond.
Possessing and selling Spice is not a crime. Anchorage Police Department acting deputy chief Garry Gilliam compared the fine to a traffic violation -- it's a civil offense. If you are caught with Spice, you are fined $500 per packet.
That means police only hand out tickets for the violation unless they can "prove criminal intent," Gilliam said.
"Say, for instance, that someone either sells or shares with or gives Spice to somebody else and they get sick and die from it. The question is: Did they do that knowingly?" Gilliam said.
So far police have identified eight suspects who may have been tied to the recent outbreak, Gilliam said, but whether any arrests will eventually be made remains to be seen.
Since early July, one person has been cited for possessing and possibly selling Spice. Adburrihiam Harris was cited on Aug. 6 for possession and was singled out by a Bean's Cafe client as a possible seller. Days later, he was cited again for possessing five packets of Spice, a $2,500 fine.
"Our goal here is to try to identify the supplier, because we lack teeth to do anything criminally," APD spokeswoman Jennifer Castro said.
Do the cases represent a rise in use? "I don't have a definitive answer for that," Gilliam said. "Maybe … this is just a bad batch … or maybe it's a new chemical element" in the drug.
"They're constantly changing the compounds so they can stay ahead of the laws," Gilliam said later. "They keep manipulating the compounds and I guess it was just a matter of time. It's like Russian roulette."
'Were hoping to save some lives at the end of this'
While the police and fire department continue their response work, the state and the Anchorage Department of Health and Social Services are working to identify what in the drug is making people sick, where the drug is coming from and how to characterize the outbreak, said Dr. Joe McLaughlin, state epidemiologist and chief of the Alaska Section of Epidemiology.
In the coming weeks, toxicology reports will be done on six of the Bean's clients who died recently. Hopefully, that will shed light on whether Spice was a factor in their deaths, McLaughlin said.
While McLaughlin noted the Zero Gravity brand was suspected as the one responsible for medical emergencies, "that may be just one of many different products that is causing people to become ill," he said.
For Nancy Burke, Anchorage's newly assigned homeless coordinator, these incidents are "another reason we want to get people into homes," she said.
Homeless people and chronic inebriates are "the market" for the drugs, Burke said.
"Everything's about safe housing … if we can get people engaged in different goals, then they don't get caught up in the cycle," Burke said.
Between the deaths and the hospitalizations, Bean's Sauder said there may be a small silver lining for the organization: a "marked increase" in the number of chronically homeless clients who are now are seeking a home.
"We are seeing an increased willingness to really look at their situation in life and ask for help," Sauder said. "We're hoping to save some lives at the end of this."