Jan 28, 2014

Outbreak of exposure to a novel synthetic cannabinoid known as "black mamba."

An outbreak of exposure to a novel synthetic cannabinoid was rapidly controlled in Colorado, according to a letter to the editor published in the 23 Jan 2014 issue of the New England Journal of Medicine. Andrew A Monte, MD, from the University of Colorado School of Medicine in Aurora, and colleagues discuss an outbreak of exposure to a novel synthetic cannabinoid known as "black mamba."

The researchers identified 263 cases that met the Colorado Department of Public Health and Environment case definition between 21 Aug and 19 Sep 2013. A total of 76 patients presented to emergency departments at 2 teaching hospitals where exposure was confirmed. Most cases involved single-agent ingestions. The patients were mainly young men, and symptoms included altered mental status, tachycardia followed by bradycardia, and seizures. For most patients, care was managed in the emergency departments, although 10 patients were admitted to intensive care units. The outbreak ended abruptly, with only 10 cases reported from 13 Sep to 25 Oct 2013.

The novel synthetic cannabinoid molecule, ADB-PINACA, was identified consistently in multiple brand products. Exposure to ADB-PINACA correlated with neurotoxicity and cardiotoxicity. Dissemination of case management guidelines by the poison center and public health outreach efforts were successfully implemented to limit the outbreak.

"Medical toxicologists, public health officials, and law enforcement officials worked together to determine the cause of symptoms, develop the most effective treatment, and limit the distribution of this novel and potentially dangerous synthetic cannabinoid," the authors write. 

Monte AA, Bronstein AC, Heard KJ, Iwanicki JL: An Outbreak of Exposure to a Novel Synthetic Cannabinoid. N Engl J Med 2014; 370(4): 389-90; <http://www.nejm.org/doi/full/10.1056/NEJMc1313655>.