scholarly journals Synthetic cannabinoid-related ED visit trends in Maryland using ESSENCE, 2013-2018

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Adejare Atanda ◽  
Jessica C. Goodell ◽  
Sherry Adams ◽  
Veronica Black
Keyword(s):  
Synthetic Cannabinoids ◽  
Case Definition ◽  
Synthetic Cannabinoid ◽  
Free Text ◽  
Washington County ◽  
Related Event ◽  
Baltimore City ◽  
Control And Prevention ◽  
Ed Visits ◽  
Text Query

ObjectiveDevelop a free text query to track synthetic cannabinoid-related ED visits.Assess trends in synthetic cannabinoid use from 2013-2018 using spatial and time-series analysis.IntroductionMaryland utilizes ESSENCE for identification of emerging public health threats, including non-fatal overdoses. Synthetic cannabinoids are heterogeneous psychoactive compounds identified as substances of abuse.[1] In March 2018, the Illinois Department of Public Health received reports of unexplained bleeding in patients who reported using these products.[2] As a result, CDC initiated coordination of national surveillance activities for possible cases of coagulopathy associated with synthetic cannabinoids use. By May 2018, state health departments reported 202 cases, including five deaths. [3]On April 3, 2018, Maryland reported its index case - a female in her 20’s who presented to an ED with nausea, blood in her stool, vaginal bleeding, bruising, an elevated internal normalized ratio (> 12.2), and bleeding oral ulcers after quitting use of a synthetic cannabinoid. She was successfully treated with Vitamin K. The first reported mortality in a Maryland resident was a male in his 30’s who called EMS for fever and blood in his urine but subsequently went into cardiac arrest and was unable to be resuscitated. The patient was known to use synthetic cannabinoids. Brodifacoum exposure was confirmed by laboratory testing. As of September 2018, the Maryland Poison Control Center had received reports of 43 cases, and 3 deaths linked to the outbreak.MethodsTo support surveillance and timeliness of synthetic cannabinoids reporting, we developed a case definition by conducting key word searches to identify terms/phrases used by providers in Maryland ED’s to document synthetic cannabinoid visits. This process yielded the following terms: “synthetic marijuana”, “spice”, and “K2”.Subsequently, we created a free text query based on the case definition and variations of the terms/phrases. This query allowed us to capture data on ED visits for synthetic cannabinoid use in the chief complaint (CC), discharge diagnosis (DD), and clinical impression (CI) fields of ESSENCE data.Finally, descriptive and geographic spatial analyses were conducted of synthetic cannabinoid-related morbidity (ED visits) for 2013-2017 (data for 2018 is incomplete); and time trends analyzed for 2013-2018.ResultsFrom 2013 to 2017, a total of 1,097 ED visits across Maryland were synthetic cannabinoid-related (Table 1). The overall crude synthetic cannabinoid-related ED visit rate was 20 per 100,000 population. The number of synthetic cannabinoid-related ED visits increased 8-fold, from 40 in 2013 to 353 in 2017. Females made the most synthetic cannabinoid-related ED visits (n = 861, 78%). Adults aged 15-24 and 25-34 made 349 (32%) and 367 (33%) visits respectively to an ED for a synthetic cannabinoid-related event. Whites and blacks made 466 (42%) and 498 (45%) visits respectively to an ED for a synthetic cannabinoid-related event. People who were non-Hispanic (n= 988, 90%), black (n = 498, 45%), female (n = 861, 78%), and aged 25-34 (367, 33%) visited an ED for a synthetic cannabinoid-related event more than any other demographic group.Time trend analysis shows an increase from baseline in synthetic cannabinoid-related ED visits starting from July 2014 (Figure 1). Three spikes are noted thereafter in April, July, and September 2015 respectively. Consequently, ED visits for synthetic cannabinoid-related events dropped to a new baseline value in December 2015. Two spikes are also noted for synthetic cannabinoid-related ED visits in May and September 2017 respectively with a new baseline established starting January 2018.Spatial analysis shows geographic clustering of synthetic cannabinoid-related morbidity in three Maryland jurisdictions; Baltimore City, Fredrick County, and Washington County (Figure 2).The top five Maryland counties with crude synthetic cannabinoid-related ED visit rates included Allegany, Baltimore City, Frederick, St. Mary’s and Washington; ranging from 87 in Washington county to 38 in St. Mary’s county. The top ten crude synthetic cannabinoid-related ED visit rates per 100,000 population from 2013 to 2017 among all Maryland ZIP codes ranged from 87 in Washington county to 38 in St. Mary’s county.Spatial analysis also shows that hospitals with the greatest burden of synthetic cannabinoid-related ED visits were close to ZIP codes of communities with high crude synthetic cannabinoid-related ED visit rates (Figure 3).ConclusionsData from the ESSENCE program can be considered acceptable for monitoring synthetic cannabinoid-related ED visits in Maryland. It is useful for obtaining near real-time data about synthetic cannabinoid-related events, and as we have shown in our analysis, for the identification of key groups and geographic locations most in need of targeted interventions to reduce morbidity and mortality. Finally, it also provides us with the ability to retrospectively identify outbreaks, and to link data trends to ongoing interventions.References[1] Riederer, Anne et al. Acute Poisonings from Synthetic Cannabinoids — 50 U.S. Toxicology Investigators Consortium Registry Sites, 2010–2015. Centers for Disease Control and Prevention. MMWR. July 2016. Retrieved from: https://www.cdc.gov/mmwr/volumes/65/wr/mm6527a2.htm[2] Horth, Roberta. Notes from the Field: Outbreak of Severe Illness Linked to the Vitamin K Antagonist Brodifacoum and Use of Synthetic Cannabinoids — Illinois, March–April 2018[3] Centers for Disease Control and Prevention. Outbreak of life-threatening coagulopathy associated with synthetic cannabinoids use. May 2018. Retrieved from: https://emergency.cdc.gov/han/han00410.asp

scholarly journals Validation of a Syndromic Case Definition for Detecting Emergency Department Visits Potentially Related to Marijuana

2017 ◽  
Vol 132 (4) ◽  
pp. 471-479 ◽  
Author(s):  
Kathryn DeYoung ◽  
Yushiuan Chen ◽  
Robert Beum ◽  
Michele Askenazi ◽  
Cali Zimmerman ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Health Impact ◽  
Case Definition ◽  
Emergency Department Visits ◽  
Free Text ◽  
Search Term ◽  
Diagnosis Codes ◽  
Ed Visits ◽  
The Impact

Objectives: Reliable methods are needed to monitor the public health impact of changing laws and perceptions about marijuana. Structured and free-text emergency department (ED) visit data offer an opportunity to monitor the impact of these changes in near-real time. Our objectives were to (1) generate and validate a syndromic case definition for ED visits potentially related to marijuana and (2) describe a method for doing so that was less resource intensive than traditional methods. Methods: We developed a syndromic case definition for ED visits potentially related to marijuana, applied it to BioSense 2.0 data from 15 hospitals in the Denver, Colorado, metropolitan area for the period September through October 2015, and manually reviewed each case to determine true positives and false positives. We used the number of visits identified by and the positive predictive value (PPV) for each search term and field to refine the definition for the second round of validation on data from February through March 2016. Results: Of 126 646 ED visits during the first period, terms in 524 ED visit records matched ≥1 search term in the initial case definition (PPV, 92.7%). Of 140 932 ED visits during the second period, terms in 698 ED visit records matched ≥1 search term in the revised case definition (PPV, 95.7%). After another revision, the final case definition contained 6 keywords for marijuana or derivatives and 5 diagnosis codes for cannabis use, abuse, dependence, poisoning, and lung disease. Conclusions: Our syndromic case definition and validation method for ED visits potentially related to marijuana could be used by other public health jurisdictions to monitor local trends and for other emerging concerns.

scholarly journals Identification and Analytical Characterization of a Novel Synthetic Cannabinoid-Type Substance in Herbal Material in Europe

Molecules ◽  
2021 ◽  
Vol 26 (4) ◽  
pp. 793
Author(s):  
Emmanouil D. Tsochatzis ◽  
Joao Alberto Lopes ◽  
Margaret V. Holland ◽  
Fabiano Reniero ◽  
Giovanni Palmieri ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Cannabinoid Receptor ◽  
Analytical Data ◽  
Synthetic Cannabinoids ◽  
Synthetic Cannabinoid ◽  
Gas Chromatography Mass Spectrometry ◽  
New Psychoactive Substances ◽  
Synthetic Cannabinoid Receptor Agonists ◽  
Analytical Laboratories

The rapid diffusion of new psychoactive substances (NPS) presents unprecedented challenges to both customs authorities and analytical laboratories involved in their detection and characterization. In this study an analytical approach to the identification and structural elucidation of a novel synthetic cannabimimetic, quinolin-8-yl-3-[(4,4-difluoropiperidin-1-yl) sulfonyl]-4-methylbenzoate (2F-QMPSB), detected in seized herbal material, is detailed. An acid precursor 4-methyl-3-(4,4-difluoro-1-piperidinylsulfonyl) benzoic acid (2F-MPSBA), has also been identified in the same seized material. After extraction from the herbal material the synthetic cannabimimetic, also referred to as synthetic cannabinoid receptor agonists or “synthetic cannabinoids”, was characterized using gas chromatography-mass spectrometry (GC-MS), 1H, 13C, 19F and 15N nuclear magnetic resonance (NMR) and high-resolution tandem mass spectrometry (HR-MS/MS) combined with chromatographic separation. A cheminformatics platform was used to manage and interpret the analytical data from these techniques.

scholarly journals Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Lauren Alexis De Crescenzo ◽  
Barbara Alison Gabella ◽  
Jewell Johnson
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Interrupted Time Series ◽  
Emergency Department Visits ◽  
Control And Prevention ◽  
Icd 10 ◽  
Ed Visits ◽  
The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

scholarly journals Outbreak of ED visits related to the use of synthetic cannabinoids, Mayotte Island

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Pascal Vilain ◽  
Salamta Bah-Assoumani ◽  
Ali-Mohamed Youssouf ◽  
Laurent Filleul
Keyword(s):  
Public Health ◽  
Behavioral Disorders ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Adverse Reactions ◽  
Health Agency ◽  
Case Definition ◽  
Syndromic Surveillance System ◽  
Ed Visits ◽  
Mental And Behavioral Disorders

ObjectiveTo confirm and to characterize the increase in emergency department (ED) visits related to the use of synthetic cannabinoids (SC)IntroductionOn October 2016, the Indian Ocean Regional Health Agency was alerted about an increase in ED visits related to adverse reactions associated with use of SC on Mayotte Island. In this context, an investigation based on a syndromic surveillance system was implemented by the regional unit of the French national public health agency.MethodsAn extraction of anonymized records routinely collected by the syndromic surveillance system (1) was carried out from January 1st, 2012 to October 30, 2016. ED visits related to the consumption of SC were identified from ICD-10 codes of the principal diagnostic according to two levels of confidence:- a probable case was defined as ED visit coded X69 (Intentional self-poisoning by and exposure to other and unspecified chemicals and noxious substances). This code has been implemented specifically by ED physicians since august 2015;- a suspect case was defined as ED visit coded: F11 (Mental and behavioral disorders due to use of opioids), F12 (Mental and behavioral disorders due to use of cannabinoids), F16 (Mental and behavioral disorders due to use of hallucinogens), F18 (Mental and behavioral disorders due to use of volatile solvents), F19 (Mental and behavioral disorders due to multiple drug use and use of other psychoactive substances).Based on these data, an epidemic curve and a descriptive analysis of ED visits were carried out.ResultsIn total, 146 ED visits related to adverse events associated with use of SC were registered from January 1st, 2012 to October 30, 2016. The epidemic curve shows two waves between 2015 and 2016 with a particularly high peak in August 2015 (Figure 1). In total, 49% (n=72/146) of these ED visits were probably related to adverse reactions associated to use SC and 51% (n=74/146) meet to the suspect case definition. On the surveillance period, men represented 84% of the patients (n=122) and median age (min – max) was 23 (8-62) years old. When the severity score variable was filled (n = 138), a vital emergency was reported for 4% (n = 5) of patients and 19% of patients were hospitalized.ConclusionsData from syndromic surveillance system allowed to confirm an increase in ED visits related to adverse reactions associated with use of SC in Mayotte Island. To our knowledge, it’s the first time that an outbreak related to use SC is described in the Ocean Indian areaThis phenomenon was particularly marked in 2015 with a peak of ED visits on August 2016.After this outbreak, the regional unit of the French national public health agency recommended the pursuit of the coding X69 in principal diagnosis with the following case definition: any patient with an adverse reaction attributed to synthetic cannabinoid use whether suspected by the medical team or declared by the patient himself or if the patient is in possession of the substance; and to raise awareness ED physicians to the notification of these poisonings to the Regional Addictive Surveillance Center.In conclusion, the young population, weakened by a precarious socio-economic situation, is a target for new synthetic drugs and a threat to public health. This emerging risk in Mayotte must be taken into account and must be actively monitored. In this context, collaborative work with the emergency services must continue in parallel with targeted prevention measures.References1. Vilain P, Maillard O, Raslan-Loubatie J, Abdou MA, Lernout T, Filleul L. Usefulness of Syndromic Surveillance for Early Outbreak Detection in Small Islands: The Case of Mayotte. Online Journal of Public Health Informatics. 2013;5(1):e149.

scholarly journals Activity-Based Detection of Cannabinoids in Serum and Plasma Samples

2018 ◽  
Vol 64 (6) ◽  
pp. 918-926 ◽  
Author(s):  
Annelies Cannaert ◽  
Jolien Storme ◽  
Cornelius Hess ◽  
Volker Auwärter ◽  
Sarah M R Wille ◽  
...  
Keyword(s):  
Cannabinoid Receptors ◽  
Cannabinoid Receptor ◽  
Synthetic Cannabinoids ◽  
Receptor Activation ◽  
Synthetic Cannabinoid ◽  
New Psychoactive Substances ◽  
Simple Liquid ◽  
Analytical Sensitivity ◽  
Monitoring Centre ◽  
Screening Strategies

Abstract BACKGROUND Synthetic cannabinoids are the largest group of new psychoactive substances monitored by the European Monitoring Centre of Drugs and Drug Addiction. The rapid proliferation of novel analogs makes the detection of these new derivatives challenging and has initiated considerable interest in the development of so-called “untargeted” screening strategies to detect these compounds. METHODS We developed new, stable bioassays in which cannabinoid receptor activation by cannabinoids led to recruitment of truncated β-arrestin 2 (βarr2) to the cannabinoid receptors, resulting in functional complementation of a split luciferase, allowing readout via bioluminescence. Aliquots (500 μL) of authentic serum (n = 45) and plasma (n = 73) samples were used for simple liquid–liquid extraction with hexane:ethyl acetate (99:1 v/v). Following evaporation and reconstitution in 100 μL of Opti-MEM® I/methanol (50/50 v/v), 10 μL of these extracts was analyzed in the bioassays. RESULTS Truncation of βarr2 significantly (for both cannabinoid receptors; P = 0.0034 and 0.0427) improved the analytical sensitivity over the previously published bioassays applied on urine samples. The new bioassays detected cannabinoid receptor activation by authentic serum or plasma extracts, in which synthetic cannabinoids were present at low- or sub-nanogram per milliliter concentration or in which Δ9-tetrahydrocannabinol was present at concentrations &gt;12 ng/mL. For synthetic cannabinoid detection, analytical sensitivity was 82%, with an analytical specificity of 100%. CONCLUSIONS The bioassays have the potential to serve as a first-line screening tool for (synthetic) cannabinoid activity in serum or plasma and may complement conventional analytical assays and/or precede analytical (mass spectrometry based) confirmation.

Health Risk Behaviors With Synthetic Cannabinoids Versus Marijuana

2017 ◽  
pp. 5-14
Author(s):  
Heather B. Clayton ◽  
Richard Lowry ◽  
Carmen Ashley ◽  
Amy Wolkin ◽  
Althea M. Grant
Keyword(s):  
Substance Use ◽  
Risk Behaviors ◽  
Synthetic Cannabinoids ◽  
Health Risk Behaviors ◽  
Synthetic Cannabinoid ◽  
Self Report ◽  
Behavioral Risk ◽  
Substance Use Prevention ◽  
The Past ◽  
Nationally Representative

BACKGROUND AND OBJECTIVES Data are limited on the behavioral risk correlates of synthetic cannabinoid use. The purpose of this study was to compare the behavioral risk correlates of synthetic cannabinoid use with those among marijuana users. METHODS Data from the 2015 Youth Risk Behavior Survey, a cross-sectional survey conducted in a nationally representative sample of students in grades 9 through 12 (N = 15 624), were used to examine the association between self-reported type of marijuana use (ie, never use of marijuana and synthetic cannabinoids, ever use of marijuana only, and ever use of synthetic cannabinoids) and self-report of 36 risk behaviors across 4 domains: substance use, injury/violence, mental health, and sexual health. Multivariable models were used to calculate adjusted prevalence ratios. RESULTS Students who ever used synthetic cannabinoids had a significantly greater likelihood of engaging in each of the behaviors in the substance use and sexual risk domains compared with students who ever used marijuana only. Students who ever used synthetic cannabinoids were more likely than students who ever used marijuana only to have used marijuana before age 13 years, to have used marijuana ≥1 times during the past 30 days, and to have used marijuana ≥20 times during the past 30 days. Several injury/violence behaviors were more prevalent among students who ever used synthetic cannabinoids compared with students who ever used marijuana only. CONCLUSIONS Health professionals and school-based substance use prevention programs should include strategies focused on the prevention of both synthetic cannabinoids and marijuana.

Synthesis of the 5-Fluoro-4-hydroxypentyl Side Chain Metabolites of Synthetic Cannabinoids 5F-APINACA and CUMYL-5F-PINACA

Synthesis ◽  
2018 ◽  
Vol 50 (23) ◽  
pp. 4683-4689 ◽  
Author(s):  
Mark Trudell ◽  
Ryan McKinnie ◽  
Tasneam Darweesh ◽  
Phoebe Zito ◽  
Terrell Shields
Keyword(s):  
Efficient Method ◽  
Synthetic Cannabinoids ◽  
Synthetic Cannabinoid ◽  
Protecting Groups ◽  
Side Chain ◽  
Hydroxy Metabolites

An efficient method for the construction of the 5-fluoro-4-hydroxypentyl side chain common to a number of synthetic cannabinoid metabolites was developed. A series of hydroxyl protecting groups was examined to assess the viability as orthogonal protecting groups for epoxidation and regioselective hydrofluorination. The 1-[5-fluoro-4-(diphenyl-tert-butylsilyloxy)]pentyl tosylate was prepared in 67% overall yield (six steps) from pent-4-en-1-ol and was employed for the synthesis of the 4-hydroxy metabolites of the synthetic cannabinoid 5F-APINACA and CUMYL-5F-PINACA.

Emerging Synthetic Cannabinoids: Development and Validation of a Novel Liquid Chromatography Quadrupole Time-of-Flight Mass Spectrometry Assay for Real-Time Detection

2019 ◽  
Vol 44 (3) ◽  
pp. 207-217 ◽  
Author(s):  
Alex J Krotulski ◽  
Amanda L A Mohr ◽  
Barry K Logan
Keyword(s):  
United States ◽  
Mass Spectrometry ◽  
Liquid Chromatography ◽  
Real Time ◽  
Synthetic Cannabinoids ◽  
Time Of Flight ◽  
Forensic Toxicology ◽  
The United States ◽  
Synthetic Cannabinoid ◽  
Flight Mass Spectrometry

Abstract Synthetic cannabinoids pose significant threats to public health and safety, as their implications in overdose and adverse events continue to arise in United States and around the world. Synthetic cannabinoids have seen several generations of chemically diverse structural elements, impacting potency and effects. These factors create new analytical challenges for forensic laboratories. This report describes an efficient liquid chromatography/quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) assay for the identification of synthetic cannabinoid parent compounds and metabolites, including real-time identification of emergent compounds, using a SCIEX TripleTOF® 5600+ with non-targeted SWATH® acquisition. Method validation evaluated precision/accuracy, limits of detection, interferences, processed sample stability and carryover, for which 19 parent compounds and 19 metabolites were tested. To demonstrate feasibility, de-identified blood sample extracts were acquired from a large forensic toxicology laboratory and analyzed using the validated LC-QTOF-MS assay. In mid-2018, 200 blood extracts were analyzed, demonstrating a 19% positivity rate with &gt; 94% agreement rate with original testing. In addition, three newly discovered synthetic cannabinoids were identified, including 5F-MDMB-PICA, 4-cyano CUMYL-BUTINACA and 5F-EDMB-PINACA. These synthetic cannabinoids were previously unreported in forensic toxicology casework in the United States. 5F-MDMB-PICA has become the most prevalent synthetic cannabinoid in United States, as of early 2019. These results demonstrate the effectiveness of this assay and workflow in the identification and characterization of synthetic cannabinoids, as well as the usefulness of sample-mining using non-targeted mass acquisition by LC-QTOF-MS for the discovery of NPS. High resolution mass spectrometry should be considered when developing new or novel assays for synthetic cannabinoids.

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