In April 2014, New York City Department of Health and Mental Hygiene (DOHMH) syndromic surveillance data identified an increase in synthetic cannabinoid-related emergency department (ED) visits. Since then, DOHMH conducted multiple public health investigations of synthetic cannabinoid-related morbidity to describe the epidemiology of the outbreak and inform public health interventions.
METHODS:
DOHMH performs routine, daily surveillance of drug and alcohol related ED visits and monitors trends in ED visits by drug type, age, gender, and neighborhood of residence. Three rounds of medical chart review were performed during three periods (July 2014, April 2015, and July 2015) of sharp increases in synthetic cannabinoid-related ED visits. Qualitative interviews were performed with six medical providers and six individuals with a synthetic cannabinoid-related ED visit following the July 2014 increase in synthetic cannabinoid-related ED visits.
RESULTS:
Between 2014-2015, there were more than 7,500 synthetic cannabinoid-related ED visits in New York City. Synthetic cannabinoid-related ED visits peaked in July 2015, with more than 1,200 ED visits. Following multi-pronged public health and public safety interventions, synthetic cannabinoid-related ED visits decreased 53% between July 2015 and November 2015; however, synthetic cannabinoid-related ED visits remain elevated compared to November 2014.
Syndromic surveillance of synthetic cannabinoid-related ED visits identified that nearly 90% were male and 99% were 18 or older with a median age of 37 years. Medical charts were reviewed for 39 ED encounters. Histories of mental illness and/or homelessness were documented in the majority (n=31, 79%) of synthetic cannabinoid-related medical charts reviewed.
In qualitative interviews, affected users reported regular urine toxicology monitoring by a variety of criminal justice and social service programs. Circumventing urine toxicology was uniformly described as the primary motivation for synthetic cannabinoid use; many individuals noted a preference for marijuana.
CONCLUSIONS:
Synthetic cannabinoid-related ED visits decreased following joint public health and public safety interventions; however, remain elevated compared to the previous year.
Morbidity associated with synthetic cannabinoid use remains concentrated within a vulnerable subpopulation. Residents of shelters and individuals with a psychiatric illness disproportionately bear the burden of adverse health events associated with synthetic cannabinoid use. In New York City, harm reduction and public health messaging should focus on this subpopulation most likely to experience harms from synthetic cannabinoid use.