During July 2015, hospital staff, emergency medical services (EMS) personnel, and local media in the Municipality of Anchorage (MOA) reported an increased number of persons requiring medical care after synthetic cannabinoid (SC) use. The Alaska Division of Public Health investigated to characterize this increase and describe clinical outcomes.
METHODS:
We queried emergency department (ED) electronic medical records (EMRs) from the three non-military hospitals in the MOA for discharge diagnoses associated with SC use (involving altered mental status and substance abuse) during July 15–September 30, 2015. We abstracted demographic and clinical outcomes data from charts for ED visit identified by the query by using a standardized form. We defined cases as ED visits among patients who self-reported SC use or were suspected of SC use by EMS or hospital staff assessment, as documented in EMRs. A convenience sample of product and paraphernalia collected from SC users by ED staff was tested to identify ingredient profiles (as characterized by SC molecules) circulating in the MOA during the investigation by using liquid chromatography quadruple time-of-flight mass spectrometry.
RESULTS:
We identified 167 cases (34.4%) among 488 ED visits from 2 MOA hospitals; 74 self-reported and 93 suspected of SC use. Data were unavailable from the third hospital. The 167 cases represented 128 persons; 25 persons had multiple SC-related ED visits (mean: 2.6; range: 2–5). Most patients were male (85%); average age was 36.6 years (range: 12–62 years). Sixty-six (40%) SC-associated ED visits involved patients classified as being homeless. Daily ED volume ranged from 0–12 cases (mean: 2.1). Of 167 cases, 26 (16%) involved physical restraint of patient, 17 (10%) involved patient hospitalization, and 11 (7%) involved patient intubation. During transport to, and treatment in the ED, 55 cases (33%) involved agitated patients, 115 (69%) involved lethargic patients; 37 (22%) involved patients exhibiting agitation and lethargy. All seventeen of the 25 (68%) SC-positive samples contained multiple chemically distinct SC molecules; eleven chemically distinct SC molecules were detected.
CONCLUSIONS:
Our investigation identified 167 cases of SC-related ED visits, representing 128 persons. Consistent with investigations of SC-related illness in other states, patients exhibited a range of clinical presentations. A variety of ingredient profiles was identified in SC samples. SC use in the MOA is ongoing, and this investigation highlights the need for systematic surveillance and community cooperation to more fully characterize the public health burden and/or health effects of synthetic cannabinoids.