Attached is a word document with multiple syndromes that we have found useful during the coagulopathy cluster situation. Most used queries are highlighted in yellow.
These queries were created in response to marijuana, particularly synthetic marijuana, tainted with anticoagulants often found in rodent poisons.
Maryland 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.
Objective: Develop 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.
Conflicting activities related to marijuana at state and federal levels raise questions as to whether a new federal/state legal relationship concerning marijuana legalization is forthcoming.
Timely access to Emergency Department (ED) Chief Complaint (CC) data, before the definitive diagnosis is established, allows for early outbreak detection and prompt response by public health officials.BioSense 2.0 is a cloud-based application that securely collects, tracks, and shares ED data from participating hospitals around the country. Denver Health (DH) is one of several Colorado hospitals contributing ED Chief Complaint data to BioSense 2.0. In August 2013, ED clinicians reported an increase in patients presenting with excited delirium, possibly related to synthetic marijuana (SM). We used this event to test the use of CC field of ED data for detection of a novel public health event (i.e., serious adverse events related to synthetic marijuana use) not currently categorized in the BioSense syndromic surveillance library.
Objective
The aims of this presentation is to use ED chief complaint data, to test BioSense 2.0 for detection of a novel public health event (i.e., serious adverse events related to synthetic marijuana use) not currently categorized in the BioSense syndromic surveillance library.
SCRAs are accessible and affordable, sold online, in gas stations, and in “head” shops for $5-30 per package.[1] While marijuana is a schedule 1 narcotic, unavailable for any use, SCRAs navigate the legal landscape with marketing as non-consumable and frequent modifications to the active ingredients that outpace lawmakers’ updates. When consumed, SCRAs bind the same receptor as the active ingredient in marijuana with 10-1000 times the affinity. Physical reactions to marijuana use include breathing problems, increased heart rate, hallucinations, paranoia, lower blood pressure, and dizziness. [2] Health departments have reported varying clinical presentations in response to SCRAs, including extreme agitation and tachycardia. Ongoing reports of SCRA reactions and rising marijuana legalization emphasize the imperative to leverage syndromic surveillance to monitor trends, detect emerging outbreaks, and observe changes in clinical presentations or user demographics.
Objective
Use syndromic surveillance to identify and monitor adverse health events resulting from synthetic cannabinoid receptor agonists (SCRAs) or marijuana. Characterize the current trend of SCRAs and marijuana use among emergency department (ED) and urgent care center (UCC) visits in Virginia to determine whether findings align with utilization trends identified by other states from poison control center calls and ED visits.
NSSP, a Centers for Disease Control and Prevention (CDC) surveillance system, allows timely detection of emergency department (ED) trends by matching chief complaint (CC) text or diagnosis (DX) codes to established syndrome criteria [1, 2]. No CDC syndrome definition currently exists for marijuana-related visits. Accidental child ingestions and over-consumption of edible products are an emerging concern [3, 4]. A validated marijuana syndrome will allow health departments with access to ED data to measure relative trends and disparities in marijuana-related ED visits.
Objective
To evaluate methods of measuring marijuana-related emergency department visits at Denver metropolitan area hospitals participating in the National Syndromic Surveillance Program (NSSP).
Assessing health disparities and access to healthcare has been an important issue for emergency preparedness and response efforts in the Denver metropolitan area. There have been several high profile MJ-related illness outbreaks in the US over the past 2 years. The legalization and retail sale of recreational MJ in Colorado necessitates enhanced surveillance for adverse effects from MJ use. TCHD and DPH coordinated to use syndromic surveillance data to provide situational awareness and timely outbreak detection related to MJ, including health disparities and overall impacts on population health.
Objective
Adverse health effects related to marijuana (MJ) use may disproportionately impact populations based on age or gender. To explore whether disparities exist among persons seeking emergency department (ED) care related to MJ use, Tri-County Health Department (TCHD) and Denver Public Health (DPH) developed MJ use case definitions, described patient demographics, mapped patients’ geographic distribution relative to marijuana dispensary locations, evaluated access to healthcare, and investigated the potential impact of MJ on pediatric health.
Eighteen states have adopted Limited Access Marijuana Product Laws permitting only low (or zero) Tetrahydrocannabinol (THC) and high Cannabidiol (CBD) products to treat several, often specified conditions, usually uncontrolled epilepsy disorders. THC is the psychoactive substance in marijuana that alters users’ senses and cause mood changes, and can lead to changes in behavior. Cannabidiol, however, has mild psychoactive effects.
This resource, developed by the Network for Public Health Law and released on July 17, 2017, provides a brief overview of jurisdictions with statutory and regulatory provisions legalizing medical marijuana use. The survey compiles key information concerning legal provisions for medical marijuana in 29 states and the District of Columbia that have passed or enacted Comprehensive Medical Marijuana Programs.
Abstract
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.