On August 30, 2013, the Colorado Department of Public Health and Environment (CDPHE) was notified by multiple local health departments of an increase in Emergency Department (ED) visits and hospitalizations among patients using synthetic cannabinoids. Synthetic cannabinoids are man-made chemicals smoked as an alternative to marijuana. In response to the increase, CDPHE asked all Colorado EDs to report, mainly through web-based reporting, any patients examined on or after August 21 with altered mental status after use of a synthetic marijuana product. Serum and urine specimens from patients also were requested. The objective was to characterize the outbreak, determine the source, and to identify measures to mitigate further morbidity.
METHODS:
An initial review of 58 charts from 5 hospitals was conducted, and 9 patients were interviewed, in order to develop a case definition. A probable case was defined as any illness resulting in a visit to a Colorado ED during August 21–September 18, 2013, by a patient with suspected synthetic marijuana use in the 24 hours preceding illness onset. Investigators then reviewed all submitted reports to determine which met case definition. In addition, among probable cases, a convenience sample was selected for more thorough medical record review to understand clinical symptoms. Laboratory testing efforts were coordinated with the Colorado Bureau of Investigation to identify involved synthetic cannabinoid variants.
RESULTS:
A total of 263 patient visits were reported to CDPHE, and of those, 221 (84%) represented probable cases. The majority were male, under 30, and from the Denver metro area or Colorado Springs. Four establishments were identified by cases as purchase sources. Among the 221 probable cases, a convenience sample of 127 (58%) patients were selected for enhanced record review; common symptoms included elevated blood pressure (64%), tachycardia (57%), somnolence (35%), aggressive or violent behavior (32%), and confusion (25%). A novel variant of synthetic cannabinoid was identified through laboratory testing. However, patients identified multiple brand names, likely due to repackaging. CDPHE launched a focus group-tested, prevention campaign, “Fake Pot, Real Danger,” in targeted zip codes, emphasizing that no brand was safe.
CONCLUSIONS:
The use of synthetic cannabinoids can have dangerous public health consequences, as illustrated by this outbreak. Further prevention messaging should be disseminated, to avoid future outbreaks.