On April 13, 2015, the Alabama Department of Public Health was contacted by the Mississippi State Department of Health about an increase in synthetic cannabinoid (also known as Spice) related emergency room (ER), hospital admissions and deaths in MS. The Epidemiology Division immediately contacted field surveillance staff to determine whether Alabama emergency rooms and hospitals were experiencing increased ER visits and admissions with signs and symptoms consistent with synthetic cannabinoid use. Based on the initial calls made, an outbreak investigation was initiated on April 14, 2015.
METHODS:
Health care providers statewide were advised via a Health Alert Network (HAN) message to consider exposure to synthetic cannabinoids for signs and symptoms consistent with use. ADPH requested weekly reporting by hospitals of the number of emergency room visits and hospitalizations consistent with case definitions included in the HAN. In addition to reports from hospitals, BioSense and Emergency Medical Services (EMS) data was reviewed and analyzed. Selected medical records were reviewed.
RESULTS:
Between March 17 and May 26, at least 1,046 patients were seen in Alabama ERs with 259 hospitalized as a result of suspected exposure to synthetic cannabinoids. Five deaths were reported and medical records were reviewed. The five deaths were consistent with synthetic cannabinoid use with the ages of the deceased ranging from the 20s through 40s.
The Office of Emergency Medical Services assisted in data analysis of emergency runs made for spice-related exposure. Of the 798 emergency calls made in 2015 for spice-related exposure, 693 occurred in April and May. Of the 693 demographically, patients were overwhelmingly male (82.5 percent, 572 patients). The average (mean) age of the patients was 31 years and the median age was 27 years, with patients ranging in age from 9 years old through their 60s. Patients were identified as black or African American (71.7 percent, 497), white (25.7 percent, 178), and other races or ethnicities (2.6 percent, 18).
CONCLUSIONS:
ADPH found the use of the Emergency Medical Services data to be a valuable additional surveillance tool. The use of multiple data sources allowed for a more comprehensive determination of the extent of this event. Based on the results of the analysis of EMS data, ADPH continues to pursue additional uses of this data to better inform and alert us to emerging infectious and non-infectious threats and events.