A Common Source Outbreak of Severe Delirium Associated with Exposure to the Novel Synthetic Cannabinoid ADB-PINACA.
BACKGROUND
Since 2009, synthetic cannabinoid (SC) use has emerged as a growing public health threat in the United States (US). Several outbreaks of unexpected, severe toxicity linked to SC use have been reported since 2012. Reports of varied and significant morbidity after SC use are expected to increase because newer compounds enter the marketplace more frequently as manufacturers attempt to circumvent regulatory efforts.


METHODS
We report a cluster of 7 patients who experienced a spectrum of anxiety, delirium, psychosis, and aggressive behaviors after smoking the same SC-containing product at a party. An 8th patient with the same exposure source presented with delayed onset seizures. Biologic samples were analyzed for novel, newly identified SCs belonging to the FUBINACA family of compounds. A previously unknown SC, N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-pentyl-1H-indazole-3-carboxamide (ADB-PINACA) was identified in biologic samples from 7 of the individuals. ADB-PINACA was identified in the SC-containing product ("Crazy Clown") seized by law enforcement and identified as the product smoked by the 8 patients in the reported cluster. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The information compiled using this cluster of cases, and a similar reported outbreak of altered mental status in Colorado, implicating the same SC (ADB-PINACA) and brands of SC-containing products, aided the US Drug Enforcement Administration in its temporary scheduling of ADB-PINACA and three other SCs. In this outbreak, close cooperation between public health and law enforcement allowed for a rapid intervention, which halted the outbreak by interrupting the common source and accelerated regulatory efforts to prevent further morbidity and mortality.
Centers for Disease Control and Prevention, National Center for Environmental Health, Office of Environmental Health Emergencies, Atlanta, Georgia.
Michael D
MD
Schwartz
Drug Enforcement Administration, Office of Diversion Control, Drug and Chemical Evaluation Section, Springfield, Virginia.
Jordan
J
Trecki
Centers for Disease Control and Prevention, Epidemiology Program Office, Atlanta, Georgia.
Laura A
LA
Edison
Georgia Poison Center, Atlanta, Georgia.
Alaina R
AR
Steck
Georgia Poison Center, Atlanta, Georgia.
Justin K
JK
Arnold
Department of Laboratory Medicine, University of California-San Francisco, San Francisco, California.
Roy R
RR
Gerona
D000138:Acidosis / Q000139:chemically induced; D000293:Adolescent; D000328:Adult; D000374:Aggression / Q000187:drug effects; D001007:Anxiety / Q000139:chemically induced; D002186:Cannabinoids / Q000506:poisoning*; D003693:Delirium / Q000139:chemically induced* / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced; D007008:Hypokalemia / Q000139:chemically induced; D007191:Indazoles / Q000506:poisoning*; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D012640:Seizures / Q000139:chemically induced; D013610:Tachycardia / Q000139:chemically induced; D014839:Vomiting / Q000139:chemically induced; D055815:Young Adult
D002186:Cannabinoids; D007191:Indazoles; C586093:N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-pentyl-1H-indazole-3-carboxamide
ADB-PINACA; DEA scheduling; K2; cluster; delirium; outbreak; spice; synthetic cannabinoid