St. John Barned-Smith & Gabrielle Banks, Houston Chronicle
The tremors started moments after his second puff, as he sat perched on a wooden sign outside a park in Midtown.
His brown eyes lost focus. He swayed back and forth.
"Why don't you come down from there before you fall?" a bystander warned, catching him as he tried to step down.
In less than a minute, the man was sprawled on the sidewalk as cars rolled past on South Main.
"I can't believe my partner's on the ground like this," his girlfriend fumed, then dismissed him with a quick, "He'll be all right."
The cigarillo the man had been smoking was laced with Kush, a synthetic cannabinoid that is cheap and plentiful. It left him unconscious for almost 20 minutes before he staggered upright and walked off. Others have fared worse, as overdoses have led to hospitalization and, in at least five cases, death.
Kush is today's go-to drug, a growing problem for law enforcement, emergency responders, city leaders and social service providers. Clusters of overdoses continue to flare up in cities across the country, from Los Angeles to Houston to New York.
In Houston, emergency responders blame Kush for nearly half the 3,000 overdose calls they've run in the past 10 months, punctuated by the mass overdose of 16 people in one afternoon last month in Hermann Park.
In many cases, it wasn't even illegal.
Kush, Spice, Kronic, Klimax, Yucatan Fire, Marley, White Tiger - the lightning-bolt letters flash the names across small foil packages sold in convenience stores.
They're marked "not for human consumption," but that doesn't fool anyone.
The synthetic cannabinoid - often wrongly called synthetic marijuana - is a mixture of leaves doused with a chemical compound that can mimic the effects of tetrahydrocannabinol, or THC, the active ingredient in marijuana.
The envelopes may cost $20 in a store, but the contents can be divided up and repackaged into joints or packets that run just a few dollars each on the streets.
The potency varies from one batch to the next, or even among envelopes in a single batch. One dose might induce a mellow high. The next might make a person agitated or nauseated. At its worst, the drug can cause convulsions, hallucinations, psychosis or heart failure.
On a recent afternoon just south of downtown Houston, users regarded the perils with casual indifference.
"It's not the flip-eyed drug for everybody," one man said, slurring slightly as he leaned against a building at Wheeler and Main. He smokes Kush instead of marijuana, he said, because he is on probation and doesn't want to fail court-ordered drug tests.
Several other men lay supine on nearby sidewalks, drifting in and out of consciousness. Clumps of tobacco littered the area, dumped from cigarillos to make room for the chemical-laced leaves.
One man clung to a signpost, trying not to fall over.
A few blocks away on Richmond Avenue, another man spoke to the potent effects of Kush after paying $5 for a baggie filled with enough for two squares, or joints.
"It suffocates your brain; it's like going to another world," he said, pushing his bicycle down the road. "That's how I jump out and be in space."
Some smokers, though, acknowledged the risks.
"You're buying in the blind," said Curtis, 51, who declined to provide his last name. "You don't know until you try it."
Over the course of an hour in just that area, ambulance crews responded to at least five calls.
Frances Daniel was freshening the flowers at her son's grave when a woman caught her eye.
Daniel crossed the thick grass of the Baytown cemetery and introduced herself. Their daughters were loosely acquainted. And because Baytown is small, Daniel knew the woman's late son, Julio Herrera, died in his 20s like the son she'd buried a month ago, Arthur Steven Luna IV.
The men died within a week of each other last November, both from overdoses of Kush.
"I understood her pain because I was going through the same thing," Daniel said.
It had been a long, downward spiral for Daniel's son. He lost interest in high school and was arrested on a burglary charge. Jail followed, then prison, after he violated terms of his release. He began smoking Kush at 23.
Kush was his drug of choice because it didn't show up on urinalysis tests, his mother said.
Sometimes, Kush made him ravenous and then sleepy. Other times, it induced vivid, paranoid hallucinations. Little people were watching him, he told his mom.
He'd already been hospitalized twice in two months for Kush overdoses when he slipped out the back door of his home on the morning of Nov. 15, while his mother and aunt waited for him in the front room to go shopping.
His family drove the streets of Baytown looking for him, as they had before, then went home to wait.
People eventually spotted him vomiting on the steps of a local drug hangout and called 911. That afternoon, a police officer went to the house with Luna's wallet and sent Daniel to Houston Methodist San Jacinto Hospital.
Staff led her and her sister into a private room, where a doctor confirmed her worst fears.
Deaths from Kush are rare, according to public health experts. Since 2010, Harris County officials have recorded four deaths due to synthetic cannabinoids, all between November 2015 and January 2016. A fifth habitual Kush user died at home in Chambers County, surrounded by bags of the drug.
"It's like playing Russian roulette," said Aaron Crowell, a Baytown detective who has participated in state and local efforts to outlaw the drug. "You'll have a hard-core addict who may have been smoking it for three years and hasn't had a problem. They get a bad batch one time, and the next thing you know they're in the ICU hooked up to a ventilator."
Cracking down on Kush and copycat drugs has challenged law enforcement and lawmakers.
Legislators have struggled to formulate wording that criminalizes the ever-shifting family of chemicals used in the mixtures. Even as new laws made one batch illegal, manufacturers altered recipes to avoid prosecution.
So far, the federal government has identified more than a half-dozen synthetic cannabinoid compounds as controlled substances, giving agents authority to treat those drugs as they would heroin, LSD or mescaline.
In a landmark case in May out of Houston, federal agents indicted 16 people - including a popular University of Houston-Victoria professor - on charges they participated in a $35 million international ring that made, distributed and sold at least 9.5 tons of Kush.
The ring is accused of smuggling the chemicals disguised as cosmetics into the United States and laundering the financial proceeds.
The charges are pending in federal court.
"These substances really do pose a serious public health danger to our communities. That cannot be overemphasized," said Wendell Campbell, a local spokesman for the Drug Enforcement Administration.
Defense attorney Dick DeGuerin, who is representing the professor, said the federal case may mark the beginning of a wave of synthetic cannabinoid indictments, since it's easier for prosecutors to get convictions under the new law.
"I think it's going to be a push across the country for arresting the dealers, the smoke shops, the retail dealers - they're the easy ones who have the street involvement here," he said. "Historically, (investigators) start at the street level and work their way up."
In 2015, Texas lawmakers passed new legislation aimed at closing loopholes that had made prosecutions difficult.
Prosecutors say the new law appears to be working. Investigators haven't found any new chemical compounds that skirt the law since it went into effect Sept. 1.
Houston, too, has outlawed possession, marketing and sale of synthetic drugs, making the crime a misdemeanor punishable by a fine of up to $2,000 for each packet.
Local officials also are targeting distributors and storefronts selling the drugs for everyday consumption.
Between July 2015 and June 2016, the Harris County Attorney's Office obtained injunctions against nine local convenience stores and smoke shops to stop the sale of Kush or other synthetic cannabinoids, shutting down three of them entirely, according to Assistant County Attorney Kristen Lee.
Investigators seized approximately 10,000 packets of the substance from the nine businesses, she said.
Other cities also are struggling to control the drug use. In New York City, police recently raided five bodegas in Brooklyn after 33 people overdosed on synthetic cannabinoids. In Los Angeles, 10 people were hospitalized in April after suspected overdoses in Skid Row.
The mass overdose at Hermann Park sparked outrage from community leaders.
Houston police immediately launched an investigation into the June 23 incident because of the concentration of cases at the park, though no one died.
A few days later, Mayor Sylvester Turner announced renewed efforts to crack down. Plans include creating a 50-person downtown police patrol division, transferring 175 officers to patrol beats, adding an overtime program to fund roving bike and golf-cart patrols in city parks, and hiring 13 rangers to patrol parks often frequented by Kush smokers.
The Hermann Park incident is part of a bigger problem, city officials say.
Emergency responders began collecting data on drug overdoses last September and found Kush was responsible for 1,396 of the 3,000 overdose-related calls through June 30, said Dr. David Persse, the city's director of Emergency Medical Services.
Of those, 129 people had to be transported to hospitals more than once.
"There are areas of the city where this is really concentrated," Persse said recently. "They're going out on these calls again and again and again. … It is a strained system, and these calls don't help."
Ben Taub Hospital sees about four to five emergency admissions a day and an occasional death related to synthetic drugs, said Dr. Spencer Greene, director of medical toxicology at Baylor College of Medicine and attending emergency physician at Ben Taub.
Kush smokers also have caused problems at the Central Library and in downtown parks, prompting the city to pass an ordinance banning smoking on library property, said John Middleton, assistant director for the Houston Public Library.
In recent months, problems have escalated, Middleton said.
"We have had many more calls for EMS from people overdosing," he said.
Marc Eichenbaum, the mayor's deputy special assistant on homelessness, worries about Kush's impact on the homeless population but said many users of the drug aren't homeless.
Dealers are infiltrating the city's homeless and peddling the drug to them, he said, adding that while the total population of users is fairly small, they're highly visible and concentrated in specific areas of the city.
"Unfortunately a lot of people do drugs but - unlike Kush - not publicly in the middle of Main Street or a park in broad daylight," Eichenbaum said recently, as he walked through some of the areas popular with Kush users. "It's a very social drug."
Shere Dore, who works with a local advocacy group for the homeless, said activists now search for Kush users to urge them to get help, and confront store owners still selling the drugs.
"What we're seeing is people seizing out, on the roads," she said. "It's almost like walking zombies."
Other communities have been dealing with similar challenges since the drug first arrived in Texas in 2010 after spreading across Eastern Europe.
Use of synthetic cannabinoids in the state more than doubled between 2013 and 2014, according to the Texas Poison Center Network. Last year, a bad batch of the drug sickened more than 100 people in Travis County, and synthetic drug users showed up at emergency rooms four times more frequently in 2015 than 2014, according to the American Association of Poison Control Centers.
On a searing hot day in downtown Houston recently, more than a dozen people gathered around a young man sprawled on the ground near Gray at South Main.
He'd started seizing and vomiting before bystanders called for an ambulance.
"I deal with this every day, 24/7," a frustrated security guard said, as EMTs evaluated the man, plying him with water and talking to him before he finally got to his feet and walked off.
"They have no control of what they're doing," another security guard said. "They don't remember anything."
Other popular hot spots for Kush users appear to have been cleared, at least for now.
Dore said she saw far fewer vagrants when she last visited Hermann Park.
"If they're just being moved from corner to corner - which is what's happening … where's the help?" Dore said.
Eichenbaum, too, said many areas have been cleared or improved since the city's shift in strategy.
"It's nice to have this increased focus," he said.
Vincent Dickson, an activist and member of the People's New Black Panther Party, however, is skeptical of Turner's new plan to combat Kush.
"Because 16 people in Hermann Park had to go to the hospital - he can't turn a blind eye to that," he said.
He became concerned about Kush when he almost ran over a man walking in the middle of the street by the Wheeler Transit Center late one night several months ago.
Dickson initially thought the man was drunk. Since then, he's seen more and more people under the effects of the drug.
"We're in the middle of an epidemic," he said, watching EMTs attend to the man who overdosed.
The EMS crew departed a few minutes later, leaving the man behind. Guards cast a watchful eye as passengers streamed in and out for fast food, headed to and from the Greyhound Bus Station.
A crew of vagrants loitered around, occasionally asking for money to buy a joint.
"Give me $5," one promised, "and I'll show you what it does."