CDC on May 25 released a health advisory regarding a life-threatening bleeding disorder associated with the usage of synthetic cannabinoid products containing a type of rodent poison.

Synthetic cannabinoids.

Since March 7, the Illinois Department of Public Health reported 164 cases, including four deaths, linked to synthetic cannabinoid. Patients reported severe bleeding after using these products, which are commonly found on the open market. Subsequent testing confirmed the presence of brodifacoum, a long-acting rodenticide that prevents blood from coagulating.

CDC is currently coordinating national surveillance activities for possible cases of coagulopathy, a bleeding disorder that affects the way blood clots, associated with synthetic cannabinoids use.

State health departments in nine states have reported a total of 202 cases, including five deaths, to the CDC since the first case was identified in Illinois on March 3, 2018. The majority of the cases – 81 percent – are from Illinois. Ten percent or fewer cases have been reported in Maryland, Florida, Indiana, Kentucky, Missouri, Pennsylvania, Virginia and Wisconsin. No cases have been reported in Iowa.

Patients affected by this outbreak have a variety of signs and symptoms of coagulopathy, including bruising, nosebleeds, excessively heavy menstrual bleeding, flank pain, abdominal pain, bleeding gums or mouth, and blood in urine and sputum. Some patients have shown no symptoms or presented complaints unrelated to bleeding.

In 2011, Iowa outlawed the sale, manufacture or possession of synthetic cannabinoids, and classified them as Schedule One Controlled Substances in the state. Similar federal legislation was enacted in 2012.

Despite the ban, convenience stores, smoke shops and online retailers still sell synthetic cannabinoids as incense or natural herbal products.

Synthetic cannabinoids are marketed under a variety of brand names, but are commonly referred to as synthetic marijuana, fake weed, legal weed, K2 or Spice. They may contain hundreds of different synthetic chemicals that act on the same brain cell receptors as tetrahydrocannabinol (THC), the main active ingredient in marijuana. However, synthetic cannabinoids affect human health in different and unpredictable ways compared to THC.

Adverse effects from synthetic cannabinoids can include agitation or confusion, hallucinations or delusions, rapid heartbeat or breathing, and gastrointestinal distress.

Clinicians are asked to be on alert for suspected cases of vitamin K-dependent antagonist coagulopathy in patients with a history of using synthetic cannabinoids and report any cases to the CDC via NCEHOutbreak@cdc.gov. Public health officials may contact CDC for classification criteria, reporting guidelines, case investigation forms and other questions at the same email address.