Synthetic cannabinoids (SCs), an evolving class of illicit drugs, cause nonspecific clinical effects and are not detected by routine drug screens. On April 5, 2015, a clinician at the University of Mississippi Medical Center (UMMC) in Jackson, Mississippi (MS) notified the Mississippi State Department of Health (MSDH) of an unusual number of patients seeking emergency care after using SCs. We sought to identify causative SCs and describe associated illnesses
METHODS:
MSDH issued a statewide Health Action Network (HAN) alert on April 5, requesting healthcare providers to report suspect cases of SC-related illness to the MS Poison Center (PC). A suspect case was defined as any individual with known or suspected synthetic cannabinoid use presenting with at least two of the following symptoms: sweating, severe agitation, or psychosis. A second HAN alert was issued on April 13, which included a line list for providers to fax daily to the PC. Using PC surveillance data, we identified and reviewed medical charts of UMMC patients who met case criteria, defined as any person with at least two of the following symptoms during April 2–May 1, 2015 after reported SC use: sweating, severe agitation, or psychosis. Blood samples were analyzed by liquid chromatography–quadrupole time-of-flight mass spectrometry, a method capable of identifying unknown toxins (University of California, San Francisco).
RESULTS:
Of the 721 statewide cases reported to the PC, including 9 deaths, we abstracted records from 119 UMMC patients, including 3 deaths. Patients were predominately male (85%); median age was 29 (range: 14–62) years. Common clinical effects were aggression (32%) and agitation (30%). Intensive care unit admission and death were associated with histories of mental illness (odds ratio [OR]: 4.4; 95% confidence interval [CI]: 1.4–14.9) and substance abuse (OR: 4.9; CI: 1.5–17.3). Laboratory analysis identified SCs in 39/55 (71%) UMMC patients, with 30/39 (77%) testing positive for MAB-CHMINACA or one of its metabolites.
CONCLUSIONS:
Accelerating emergence of novel SCs poses a public health threat; the outbreak associated with MAB-CHMINACA was unprecedented in magnitude and severity. Strengthened epidemiologic surveillance and laboratory capacity are needed to quickly detect clusters of illness and identify new SCs as they emerge.