IDPH Update on Synthetic Cannabinoid (SC) (K2/spice) Outbreak

The Illinois Department of Public Health (IDPH), along with local health departments, continue to investigate an outbreak of severe bleeding among individuals who have recently used synthetic cannabinoids, often called Spice, K2, or fake weed.  As of today, IDPH has reports of 89 people, including two deaths. Several of these cases have positive blood tests for brodifacoum, a lethal anticoagulant often used as a rodenticide, or rat poison.  

Clinical presentations: Cases have presented with various forms of bleeding, including persistent nose bleeds, blood in the urine or stool, vomiting blood, significant bruising, heavy menstrual periods, as well as with intra-cranial bleeding.  Some cases have been hemodynamically stable, whereas others have been critically ill at presentation.  Patients have required prolonged hospitalizations, and continue to require vitamin K at time of discharge.

Demographic summary: The majority of the cases are male (77%) and white, non-Hispanic (57%). The mean age of case is 34 years old with a range of 18 to 65 years old. Patients have been reported in the following public health jurisdictions: Chicago, Cook, DuPage, Fulton, Kane, Kankakee, McLean, Peoria, Tazewell, and Will.  Daily case counts, geographic distribution of cases, and other updates can be found at the IDPH website. 

IDPH provides the following recommendations:

• If a patient presents with unexplained bleeding, they should be asked about SC use in the past 3 months. Terms for these products may include K2, spice, synthetic marijuana, fake weed/legal weed, and genie, among others.
• If SC use is reported/suspected, an INR level should be checked prior to patient discharge.
• If an individual has unexplained bleeding and an elevated INR with reported/suspected SC use, we recommend that you contact the Illinois Poison Center (IPC) at 1-800-222-1222. The IPC has developed clinical guidance for the management of these complex cases, which they are continuously reviewing and updating.
• In areas with a high burden of cases, consider implementing protocols to screen for SC use and check INR values before invasive procedures, surgeries, or births.

Please contact the Illinois Poison Center at 1-800-222-1222 for questions regarding diagnostic testing and treatment regimens for these patients. Providers are asked to report suspect cases to their local health department (LHD). If the LHD is not available, please notify the Illinois Department of Public Health at 217-782-2016 or 800-782-7860 after hours.