Increase in Synthetic Cannabinoid-Related Emergency Department Visits Detected By Syndromic Surveillance — New York City, 2014

BACKGROUND:  Syndromic surveillance was originally developed to identify events of bioterrorism and monitor infectious diseases. Using syndromic surveillance data, the New York City Department of Health and Mental Hygiene (DOHMH) developed drug specific syndromes to monitor changes in drug-related emergency department (ED) visits.  Synthetic cannabinoids, which has only recently been described as a public health problem, may be particularly well suited for monitoring by syndromic surveillance, given the timeliness of the data and adverse health events associated with synthetic cannabinoid use. The presentation will highlight the use of syndromic surveillance to validate the synthetic cannabinoid syndrome definition and confirm the increase in synthetic cannabinoid-related ED visits.

METHODS:  DOHMH developed a syndrome to monitor synthetic cannabinoid-related visits in early 2014. Based on an increase in synthetic cannabinoid-related ED visits detected by syndromic surveillance and provider reports, a field investigation was initiated to: 1) confirm the suspected increase in synthetic cannabinoid-related visits; 2) determine the characteristics of the increase, and 3) recommend control measures. During a three day period defined by provider reports and confirmed by syndromic surveillance, a total of 23 suspected emergency department visits were identified.  Medical chart review was conducted of ED visits involving suspected ingestion of synthetic cannabinoids. A case was defined as an ED visit which occurred during July 24–27, 2014 in which synthetic cannabinoids (or one of its known street names) was included in the medical record documentation. 

RESULTS:  Of the 23 emergency department visits initially identified through provider reports, poison control data, and syndromic surveillance involving suspected ingestion of synthetic cannabinoids, 16 met the case definition. All of the ED visits identified by syndromic surveillance (n=10) met the case definitions; 46% of ED visits identified via medical providers and PCC met the case definition (6 of 13 ED visits). The demographic characteristics of the population identified by syndromic surveillance: predominately male, middle-aged, and undomiciled were confirmed by medical chart review.

CONCLUSIONS:  The field investigation described synthetic cannabinoid-related ED visits among the same clustered subpopulation identified by syndromic surveillance; the field investigation confirmed the positive predictive value of the synthetic cannabinoid syndrome. Syndromic surveillance can be used to monitor trends in drug-related morbidity over time and serve as an early warning system for drug-related morbidity, including changes in emerging drugs.