LAC DPH Health Alert: Outbreak of Synthetic Cannabinoid (“Spice”) Overdoses

 

 

 

 

This message is intended for emergency departments, urgent care clinics, behavioral health providers, and other health care facilities and professionals caring for patients at risk for substance misuse and abuse. 

Please distribute as appropriate

Key Messages

  • There is an outbreak of “Spice” (aka: synthetic cannabinoid) overdoses in the Skid Row area of downtown Los Angeles leading to numerous hospitalizations.
  • “Spice” can lead to unpredictable and life-threatening health effects.

Suspected “Spice” cases should be referred to the nearest emergency department and reported to the Los Angeles County Department of Public Health (LAC DPH).

 

Situation

This health alert describes a recent outbreak of “Spice” (synthetic cannabinoid, K2) overdoses in the Los Angeles area that have led to numerous hospitalizations.

On Friday, August 19, 2016, the City of Los Angeles Emergency Medical Services transported 17 homeless individuals from 5th Street and Wall Street in Los Angeles to seven area hospitals.  The patients reportedly exhibited symptoms of altered mental status, ataxia, and decreased consciousness, consistent with a sympathomimetic toxidrome.  Preliminary diagnoses suggest exposure to “Spice” as the potential offending agent.  Another 9 cases with similar presentations were transported to 4 area hospitals on Monday, August 22, 2016.

 

Actions Requested of Providers

  • Actively communicate risk of “Spice” to individuals at-risk for substance misuse and abuse.
  • Maintain a high index of suspicion for “Spice” toxicity when treating an unknown overdose, particularly in patients presenting with a sympathomimetic toxidrome, and consult Poison Control, as needed.
  • Report all suspected and confirmed “Spice” overdoses to LAC DPH Substance Abuse Prevention and Control (see below for contact information).

 

Background

“Spice” refers to illegal, synthetic, mind-altering chemicals that are typically sprayed on dried plants, such as oregano or basil, so they can be smoked or they are sold as liquids to be vaporized and inhaled.

 

Clinical Presentation

The chemicals comprising “Spice” can vary significantly and thus may result in a wide range of health effects, including:

  • Altered mental status
  • Loss of consciousness
  • Euphoria / addiction
  • Extreme anxiety
  • Suicidality
  • Psychosis (e.g., paranoia & hallucinations)
  • Agitation / violence
  • Dilated pupils
  • Nausea / vomiting
  • Sweating
  • Hyperthermia
  • Ataxia
  • Rapid heart rate
  • High blood pressure
  • Renal failure
  • Arrhythmias
  • Seizures
  • Death

 

Diagnosis / Laboratory Testing

Standard urine and drug toxicology screens are unable to reliably detect “Spice” and the rapid evolution of the synthetic analogues of the drug’s compounds hinder laboratory identification.  “Spice” toxicity is typically identified via a clinical diagnosis based on clinical history and presenting symptoms, which are oftentimes consistent with a sympathomimetic toxidrome (e.g., hyperthermia, palpitations, agitation, dilated pupils, etc.)

 

Treatment

There is no specific antidote available to treat “Spice” toxicity. As such, supportive treatment is recommended

 

Prevention

Given the unpredictability of the chemicals in “Spice” and the fact that exposure may lead to severe and life-threatening health effects, individuals should be advised to avoid consuming “Spice,” as well as other illegal drugs and substances.

While no deaths have been reported from this recent outbreak of “Spice” toxicity, LAC DPH is concerned about further health impacts of this drug in communities across the County.  LAC DPH recommends that health professionals be aware of the risks of “Spice”, particularly among individuals at-risk for substance misuse and abuse, and encourages health care facilities and providers to report all suspected and confirmed Spice overdoses to LAC DPH Substance Abuse Prevention and Control (see below for contact information).

 

Reporting

To report suspect cases in Los Angeles County:

Contact LAC DPH Substance Abuse Prevention and Control: 626-299-3504

To report suspect cases in Long Beach:

Contact the City of Long Beach Health Department: 562-570-4302

To report suspect cases in Pasadena:

Contact the City of Pasadena Public Health Department: 626-744-6089

 

Additional Resources

 

This Health Alert was sent by Gary Tsai, MD, Medical Director and Science Officer, Substance Abuse Prevention and Control, Los Angeles County Department of Public Health

 

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