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Life-threatening condition associated with synthetic cannabinoids use

Okeechobee News - 5/31/2018

The Centers for Disease Control and Prevention (CDC) is providing information on: the current status of a multistate outbreak of coagulopathy from exposure to synthetic cannabinoid products containing a vitamin K-dependent antagonist agent, such as brodifacoum; signs and symptoms of presenting patients from this outbreak and which patients are at risk; laboratory testing options that are available to help identify and classify cases; available resources that may help clinicians make decisions; and to whom to report possible cases.

Synthetic cannabinoids are not one drug. Hundreds of different synthetic cannabinoid chemicals are manufactured and sold. New ones with unknown health risks become available each year. These chemicals are called cannabinoids because they act on the same brain cell receptors as tetrahydrocannabinol (THC), the main active ingredient in marijuana; however, synthetic cannabinoids may affect the brain in different and unpredictable ways compared to THC (2). Synthetic cannabinoids are used in a variety of ways including: sprayed onto plant material and then smoked; used in electronic nicotine delivery devices (such as e-cigarettes); or ingested when added to herbal tea or food.

Synthetic cannabinoids are widely available. Consumers can buy synthetic cannabinoids in convenience stores, from individual drug dealers, friends, or online as incense or natural herbal products. They are sold under many different brand names, but are commonly referred to as synthetic marijuana, fake weed, legal weed, K2, and Spice. Adverse effects from synthetic cannabinoids use vary and can include neurological (e.g., agitation, confusion), psychiatric (e.g., hallucinations, delusions), and other physical (e.g., tachypnea, tachycardia, gastrointestinal distress) signs and symptoms.

In March 2018, the Illinois Department of Public Health reported cases of unexplained bleeding among patients who reported using synthetic cannabinoids. Subsequent testing of drug and biological samples from case-patients detected the presence of brodifacoum, a long-acting vitamin K-dependent antagonist that is used as a rodenticide.

CDC is currently coordinating national surveillance activities for possible cases of vitamin K-dependent antagonist coagulopathy associated with synthetic cannabinoids use. Since the index case was identified in Illinois on March 3, 2018, state health departments have reported 202 cases, including five deaths, to CDC. Case patients have been identified in nine states with the majority being reported from Illinois.

Maryland has reported 20 cases. Florida, Indiana, Kentucky, Missouri, Pennsylvania, Virginia, and Wisconsin have reported six or fewer cases per state. More than 95 of case-patient biological samples have tested positive for brodifacoum. The current working hypothesis is that brodifacoum was mixed with synthetic cannabinoids products.

Case-patients from this outbreak have presented with a variety of signs and symptoms of coagulopathy (e.g., bruising, nosebleeds, excessively heavy menstrual bleeding, hematemesis, hemoptysis, hematuria, flank pain, abdominal pain, and bleeding gums or mouth). In addition, some patients have been asymptomatic or presented with complaints unrelated to bleeding but have had numerical coagulopathy that may put them at risk for bleeding complications resulting from injuries and invasive or surgical procedures. Patients should be considered high-risk for coagulopathy if they have reported use of or are suspected of using synthetic cannabinoids.

The most helpful and commonly available laboratory test to help identify cases is the International Normalized Ratio (INR) that is part of a routine coagulation profile. Case confirmation requires detection of brodifacoum in blood, serum, plasma, or urine, as determined by reference laboratory testing. Clinicians and healthcare providers should work with their healthcare facility's laboratory to determine what options are available to them for brodifacoum testing.

CDC recommends that people do not use synthetic cannabinoids. Synthetic cannabinoids are always dangerous because it is impossible for people to know what chemicals are in the product, how much they are being exposed to, and how their body will react to the chemicals. The synthetic cannabinoid products associated with this outbreak are especially dangerous because they contain brodifacoum, a chemical used as rat poison that can cause uncontrolled bleeding.

People who have used synthetic cannabinoids in the past three months and are concerned about their health should contact their healthcare provider. Synthetic cannabinoids users who develop any unusual bruising or bleeding should seek medical attention immediately.