On Dec. 1, 2015, Dalon White woke up in the hospital, unsure how he got there. The last thing he remembered was smoking a "stick" of Spice he'd bought for $5 in downtown Anchorage.

"Next thing you know, the world's spinning and I was falling over," White said.

White, then 21, was charged with a crime that day, but he didn't realize it. He faces a misdemeanor drug charge, one of about 50 that have been issued since Anchorage criminalized Spice six months ago.

At the time, the city was overwhelmed by a public health crisis. Spice, a synthetic drug with hundreds of chemical variations, had been causing overdoses en masse in Anchorage. At its peak, medics responded to 25 suspected Spice calls for ambulances a day.

Spice users — many of whom police say are homeless and targeted by dealers — clogged emergency rooms. Medics scrambled to treat catatonic or convulsing users, who sometimes fought bitterly with emergency responders while under the drug's intense influence.

Downtown, at the joint campus of Bean's Cafe and Brother Francis Shelter, employees watched a nightmare unfold on the nonprofits' doorsteps as ambulances arrived in waves day after day.

"Doing nothing wasn't an option," Anchorage Mayor Ethan Berkowitz said of the crisis in an interview earlier this month.

In November, five months after the crisis took hold, the Anchorage Assembly unanimously passed a law making the use, possession and sale of Spice a misdemeanor crime.

Now, six months later, reports of Spice-related medical emergencies have plummeted. City officials point to the law as a likely factor in the decline. Correlation isn't causation, they acknowledge, but the downward trend is a good sign.

But others say the law has had unintended consequences that continue to drain resources and cycle a vulnerable population through the court system.

For this story, 52 cases — representing all the Spice charges that the Anchorage municipality has prosecuted as of May 23 — were reviewed and cataloged.

Overwhelmingly, the cases play out in the same way. They start with a medical emergency and end with a plea deal. Jail time is common. In the most extreme case, one man spent 53 days in jail — at a cost to the state of $7,473 — stemming from a $250 citation.

No longer the drug of choice

By all accounts, Spice is no longer wreaking havoc on the city's emergency responders.

In October, at the height of the crisis, 1 in 5 medical transports were for suspected Spice use symptoms. By March and April, according to Anchorage Fire Department tallies, that number had dropped to 1 in 20.

"Taken in the best light, it suggests (the law had) some impact," city prosecutor Seneca Theno said of the declining numbers.

Police, the mayor and the Anchorage Fire Department medical director agree that the law likely was one factor in the decline, whether through changing user behavior or deterring dealers who had been targeting the vulnerable homeless population.

Not everyone believes the law has deterred people from using the drug.

"My guess would be no," said Justin Tapp, a defense attorney who has handled some of the cases.

At Bean's Cafe, clients say Spice is no longer the drug of choice.

People have begun to avoid the drug that has garnered such a bad reputation, Dalon White said. Six deaths outside the Brother Francis Shelter last summer reverberated throughout the homeless community and are frequently invoked when people discuss the drug.

During lunch one afternoon, Bean's clients Duane Culleum and Vernita Tinker both said they stopped using the drug when they wound up in the hospital, Culleum said.

Now people are "going back to what God made," Culleum said, referring to marijuana, a common sentiment of people interviewed for this story. Others say they simply prefer alcohol.

Spice has been around for years but it wasn't until this last summer that a huge spike in medical calls was attributed to the drug. No one is quite sure why.

White says that over the years Spice has changed from a mellow high to an "intense" experience. Manufacturers continue to tweak the formula in an effort to thwart bans on specific compounds. When one compound is criminalized, another appears in its place.

In California, Spice is still sending scores of people to the ER, according to recent reports. Other cities have seen a dizzying spike and decline similar to Anchorage's.

In New York, emergency calls are down 85 percent, reports say, after a law was made that criminalized only the sale of Spice. In South Florida, another synthetic drug known as Flakka has all but disappeared. The report credits a local education campaign and the arrests of 151 people by the DEA last October in a massive synthetic drug ring bust as two likely reasons for the decline.

Meanwhile, in China — the country where much of the manufacturing of Spice is believed to occur — the government banned 116 types of synthetic cannabinoids in October.

‘We use citations … to change behavior’

In Anchorage, only three cases so far have been prosecuted for selling or distributing Spice, although leading into the drug's criminalization police repeatedly said that dealers were the main targets.

The first two cases were Mark Purcella and Carol Halley, who were charged with selling Spice and meth from a trailer downtown.

The third, Stewart Tocktoo, was charged with distributing Spice in December. Officers found him in a homeless camp alongside a person who had overdosed on Spice. Tocktoo told police he had supplied the Spice and police found a plastic baggie stuck to his pant leg with what was presumed to be the drug.

Users were charged in the remaining 49 cases. Theno said. "There was never a question" the users would be cited.

At Bean's Cafe, employees recognize most of the names of those charged with a Spice crime. Many list their address as either Bean's or Brother Francis on court documents, or simply write "homeless." Every person charged with Spice use has a prior criminal history.

Those arrested for Spice possession and use are often picked up downtown. The downtown transit center appears frequently in court documents. Halfway houses also generate Spice calls.

Most Spice emergencies don't end in a criminal charge. Between Nov. 10 and March 15, when the fire department stopped keeping detailed data, only about 9 percent of Spice emergency calls ended with a drug charge.

"We issue citations to educate and change behavior," said Anchorage Police Department Capt. Kenneth McCoy.

Citations are used in place of arresting someone, a common practice for many low-level offenses, McCoy said.

Despite this, Spice users charged with a crime "almost always end up in jail," said defense attorney Tapp.

The beginning: A medical emergency

Nearly every Spice charge begins with a medical emergency.

Spice users are found in various states of distress: "vomiting and could not stand"; "banging his head against a wall"; "on the floor shaking"; "in a catatonic state"; "lost consciousness"; "screamed and acted belligerent," various charging documents say.

During these emergencies, the patient often admits to using Spice. Medics may also tell police that a person appears to be on Spice. A drug presumed to be Spice is also found on the person as medics and police conduct searches, although that drug is never laboratory-tested to prove that it's Spice, except in the case of Purcella and Halley, charged with selling the drug.

Spice isn't the only substance that will get someone charged with a crime during a medical emergency. In DUIs and some other drug cases, people will be charged at the scene. Beyond that, "I can't think of too many," McCoy said.

Gary Shawn Iyatunguk was issued his citation after police found him in front of the Anchorage Museum, unable to walk and saying he had been beaten up — though police said he had no visible injuries.

He lost consciousness in the back of an officer's car. His "eyes were rolled back into his head, and he did not respond to verbal stimuli," the charges say. At some point, he admitted to smoking Spice.

As the new law was being debated, police said it would help them go after the dealers.

"We know who they are," police Lt. Sean Case said of the dealers in November, adding that charging users who wind up in emergency rooms on Spice would be "pretty ridiculous."

But in April, police said that they had to apply the law equally, whether someone is homeless or hospitalized or otherwise.

"If there's evidence, we react to that," McCoy said.

The middle: Court

Iyatunguk, who is identified as homeless in the court documents, didn't show up for his court date one month later. It's a familiar pattern for those charged with Spice use.

The citations look like traffic tickets but they represent a misdemeanor drug charge. Anchorage police aren't permitted to arrest someone for a low-level offense like a Spice crime; they issue citations instead, according to McCoy.

"I remember getting some form of paperwork," said White, the man charged in December. "I had no idea I was charged with anything, really. I didn't know what was happening at the time."

At the bottom of each citation is a court date listed about a month out.

During an initial interview, McCoy said the standard for citing someone with Spice use or possession is having Spice on their person. Along with the physical evidence, witness accounts and symptoms, police "paint a picture" of what's gone on, McCoy said.

In most cases, that's true. But in 13 of the cases, charging documents describe no physical evidence. Instead, there's only an admission of use, or behavior that medics and police have come to recognize as being linked to Spice.

When asked to respond to those facts, McCoy said that he had been speaking generally.

"There are not too many absolutes in law enforcement. Officers have a wide range of discretion and have to use their best judgment," he wrote in an email.

Tapp says that's a problem. If police don't find the substance on the person, there's no way to verify that they actually used the drug.

"It is a lot easier to charge a … Spice case than it is to actually prove it beyond a reasonable doubt," he wrote in an email.

Lack of possession has been grounds for dismissal in some of his cases, he said, though he declined to say which ones. Most of these cases don't get to a point where someone challenges the lack of evidence, though. Instead, people take a plea deal.

The end: Plea deal

When someone misses a court date, an arrest warrant is issued. This is common in the court system, said Theno, the city prosecutor.

In October, Theno said she hoped the new law would not increase the number of homeless people spending time in jail. But that's what has happened.

Whether days or months later, many Spice users with warrants are eventually picked up. Sometimes they are arrested for committing another crime, like assault or trespassing. In some cases, those warrants remain outstanding.

Once they are picked up, Spice defendants may be in jail for only an afternoon — or they might be there for weeks.

Iyatunguk was arrested less than a week after his warrant was issued. He spent 12 days in jail before the charges against him were dismissed.

Peter Post Richard was found at the downtown bus station slurring his speech and slumped over when he was cited for Spice. He didn't show up for his court hearing on Dec. 30. Almost two months later, police picked him up. He spent seven days in jail before taking a plea deal with a $200 fine and all jail time suspended.

The longest jail stay solely for Spice was 53 days. Joseph Albert was cited for using Spice twice in one week. The first time, he was found outside Nordstrom arguing with "a parking sign or himself," speaking gibberish and eventually passing out, according to charging documents.

The second time, he was found outside the Egan Center, banging his head against a wall, mumbling and swiping at bugs. He didn't show up for court, was later arrested and spent 53 days in custody awaiting a mental health evaluation. He eventually pleaded no contest and was given a suspended jail sentence.

Spice users charged only with a Spice crime have spent a total of 159 days in custody, not including times when someone spent an afternoon in jail. That represents a cost of $22,419, according to the Department of Corrections.

For most cases, people accept the plea deal with all jail time suspended, sometimes a $250 fine and a varying number of years of probation.

Lacking money for bail, "people usually just take the offer because they want to get out of jail," Tapp said.

This cycle — in and out of the court system, with nothing gained — isn't unique to Spice, says Nancy Burke, the city's homelessness coordinator.

"That's the cycle that happens to (trespassers), that's the cycle that happens for all of these. That's the symptom of homelessness," she said.

Does the drug law criminalize or protect the homeless?

Whether the law has criminalized or protected a vulnerable population is disputed among those familiar to the problem.

"The entire system criminalizes them. People are so trapped in homelessness. There just is no out," said Burke.

Tapp agreed: "The bottom line is you're not going to fix the issues … by just throwing people in jail and saying, 'Do better next time.'"

Berkowitz argues that the law "disproportionately protected" the homeless, given Spice's subsequent decline and the reduction in medical emergencies. Berkowitz said that for those cases where people do serve more extensive jail time, the judge could move to release the person from custody. People should be treated proportionally to the crime, he said.

Theno, the city prosecutor, believes that a case should not be dismissed simply due to a person's time in jail, as the goal is to hold people accountable, she said.

"I don't care whether they served 0 days in jail or 100 days in jail," Theno said.

For Theno, the Spice cycle represents a failure of personal responsibility. Defendants — especially those who have criminal histories and are familiar with the court system — should know to appear in court, she said. The choice to not appear, and wind up getting arrested, is on them, she says.

"Are the cards stacked against them? I don't know. We can't have a different system for people in a different life circumstance," Theno said.

Every official agrees that additional measures are needed to alleviate the underlying causes of drug use. For Burke, it's housing. She points to results from the city's Karluk Manor, where many of the city's chronic inebriates are housed.

Eighty percent of Karluk Manor residents have retained their housing, Burke says. "That stability represents a whole bunch of court time that's gone away."

To this end, Berkowitz has put much of Anchorage's surplus toward services for the homeless and plans to start a work program for some of the city's transient population.

For Tapp, treatment is the solution: "You've got to address the root issue or you're just plugging the holes without fixing the leak."

White's case bucks the trend. In May, he was admitted to Anchorage's Mental Health Court, available to Anchorage residents diagnosed with mental illness who have been charged with a misdemeanor crime.

White will undergo an 18-month program that includes regular appearances before a judge and support from a case coordinator. If he completes the program, his charge, which is dismissed, will remain that way.

Meanwhile, a few outstanding Spice cases still remain to be played out. At Bean's Cafe, employees say that heroin has moved back into the forefront for many among Anchorage's transient population.

For now, the Spice crisis has largely subsided in Anchorage, leaving only some pending criminal charges in its wake.