There’s a reason Baltimore City banned stores from selling so-called synthetic marijuana in 2016. The substance, often branded as “K2” or “Spice” and sold at gas stations and corner stores, is usually made with a potpourri of leaves and various unknown chemicals designed to mirror marijuana’s effects. It’s been known to induce severe physical problems, such as heart attacks, kidney failure and extreme bleeding.

In light of the synthetic weed scare, Baltimore Health Commissioner Dr. Leana Wen issued a reminder and a warning about the stuff on Tuesday. She noted three of Maryland’s four cases have been patients from the Baltimore area.

“Synthetic cannabinoids have been touted as natural, but are extremely dangerous because they contain untested chemical compounds that can have devastating effects for users,” Wen said in a statement. “Scientists call taking these substances ‘playing Russian Roulette,’ because the user does not know what one is ingesting, and that substance could harm or kill.”

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