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BACKGROUND: Though synthetic marijuana can cause severe illness and death, its use has become increasingly popular among teenagers and young adults. Synthetic marijuana is dried plant material sprayed with various synthetic cannabinoids, and smoked as an alternative to marijuana. On August 30, 2013, Colorado Department of Public Health and Environment (CDPHE) was notified of a statewide increase in the number of patients presenting to emergency departments with altered mental status after using synthetic marijuana. By September 19, 2013, 263 patient visits and one death suspected to be related to synthetic marijuana exposure were reported to CDPHE. CDPHE and Centers for Disease Control and Prevention (CDC) conducted an epidemiological investigation to characterize the outbreak and prevent further morbidity and mortality.
METHODS: We defined a probable case as any illness resulting in a patient visit to Colorado emergency departments within 24 hours of suspected synthetic marijuana use from August 1–September 18, 2013. We abstracted patient medical charts from a convenience sample of two large, urban hospital emergency departments from the Denver area. We conducted a retrospective chart review for cases reported on August 1–September 11, 2013 and a prospective chart review for cases reported on September 12–18, 2013. We used Microsoft Excel and SAS 9.3 (© 2002-2010 SAS Institute Inc., Cary, NC) to calculate frequencies and proportions for demographic and illness-related characteristics for all cases that met the probable case definition.
RESULTS: Of the 60 patient charts that were abstracted, 52 were classified as probable cases. For the 52 probable cases, median age was 25 years (Range: 13–60 years), 35 (67%) patients were aged < 30 years, and 47 (90%) were male. Of the Clinical features that were evaluated, the following were the most common: heart rate >100 beats per minute (21, 40%), systolic blood pressure >140 mmHg (19, 37%), somnolence (18, 35%), and aggressive behavior (9, 17%). Forty-one patients (79%) were treated and discharged from the emergency department; 6 (12%) were admitted due to complications related to synthetic marijuana exposure. No deaths were found among the medical records we reviewed.
CONCLUSIONS: Colorado hospital emergency departments reported increased numbers of patients presenting with illnesses associated with synthetic marijuana exposure. Clinical effects observed were consistent with the medical literature. Teenagers and young adults were most affected by this emerging environmental issue. We recommend messaging regarding dangers of synthetic marijuana be targeted to this population.