Poison Control

Synthetic cannabinoids include various psychoactive chemicals that are sprayed onto plant material, which is then smoked or ingested to achieve a “high.” These products are sold under a variety of names (e.g., synthetic marijuana, spice, K2, black mamba, and crazy clown) and are sold in retail outlets as herbal products and are often labeled not for human consumption. Law enforcement agencies regulate many of these substances; however, manufacturers may frequently change the formulation and mask their intended purpose to avoid detection and regulation.

On April 6, 2015, automated surveillance algorithms via surveillance through the National Poison Data System (NPDS), a web-based surveillance system of all calls to United States (US) poison centers (PCs), identified an increase in calls to PCs related to synthetic cannabinoid use. To identify risk factors and adverse health effects, CDC analyzed all calls to PCs about synthetic cannabinoid use from January to May, 2015.

Objective

The Centers for Disease Control and Prevention analyzed all calls to poison centers about synthetic cannabinoid use from January to May 2015 to identify risk factors and adverse health effects related to this emerging public health threat.

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.

NPDS is a near real-time surveillance system and national database operated by the American Association of Poison Control Centers. NPDS receives records of all calls made to the 55 regional US poison centers (PCs). The Centers for Disease Control and Prevention (CDC) use NPDS to 1) provide public health surveillance for chemical, radiological and biological exposures and illnesses, 2) identify early markers of chemical, radiological, and biological incidents, and 3) find potential cases and enhance situational awareness during a known incident. Anomalies are reviewed daily by a distributed team of PC medical and clinical toxicologists for potential incidents of public health significance (IPHS). Information on anomalies elevated to IPHS is promptly relayed to state epidemiologists or other designated officials for situational awareness and public health response.

Current NPDS surveillance algorithms utilize the Historical Limits Method, which identifies a data anomaly when call volumes exceed a statistical threshold derived from multiple years of historical data. Alternative analysis tools such as those employed by ESSENCE and other computerized data surveillance systems have been sought to enhance NPDS signal analysis capability. Technical improvements have been implemented in 2013 to expand NPDS surveillance capabilities but have not been thoroughly tested. Moreover, other data aberration detection algorithms, such as temporal scan statistics, have not yet been tested on real-time poison center data.

Objective

To compare the effectiveness of current surveillance algorithms used in the National Poison Data System (NPDS) to identify incidents of potential public health significance with 1) new algorithms using expanded NPDS surveillance capabilities and 2) methods beyond the NPDS’ generalized historical limits model.

Healthcare seeking behavior is important to understand when interpreting public health surveillance data, planning for healthcare utilization, or attempting to estimate or model consequences of an adverse event, such as widespread water contamination. Although there is evidence that factors such as perceived susceptibility and benefits affect healthcare seeking behavior, it is difficult to develop accurate assumptions due to a lack of published research on this topic. Current conceptual behavior models, such as the health belief model, are not easily translated into quantifiable terms.

Objective

This paper describes analyses of health seeking behaviors from two surveillance datastreams: Poison Control Center (PCC) calls and Emergency Department (ED) visit records. These analyses were conducted in order to quantify behaviors following the development of symptoms after water contamination exposure and to understand the motivation, decision-making and timing behind healthcare seeking behaviors.

The APCC hotline fields daily calls regarding potential animal intoxications from the US, its territories, and Canada. We explored the value of these data for identifying increased occurrences of intoxications related to livestock and poultry species, toxicant product categories, clinical syndromes, and illness severity. These data proved valuable for identifying risks of toxicant exposures by species, product category, and season. In addition to identifying intoxication risks to animal health, these data could be used to monitor for infectious outbreaks that may initially be confused for intoxications.

Objective

To describe the value of the American Society for the Prevention of Cruelty to Animals (ASPCA) Poison Control Center (APCC) livestock animal calls as a passive data stream for biosurveillance of number of calls, species affected, toxicant exposures, and clinical syndromes.

In New Jersey, real-time emergency department (ED) data are currently received from EDs by Health Monitoring Systems Inc.’s (HMS) EpiCenter, which collects, manages and analyzes ED registration data for syndromic surveillance, and provides alerts to state and local health departments for surveillance anomalies.

EpiCenter receives pre-diagnostic chief complaint data from 78 of 80 acute care and satellite EDs. The need for more specific information raises the possibility that other data elements from EDs such as triage notes can be of utility in detecting outbreaks without a significant delay. This study evaluates the inclusion of triage notes in EpiCenter to detect a recent increased usage of synthetic cannabinoids. At the time of this evaluation, three New Jersey hospitals were providing triage notes in their EpiCenter data.

Objective

Describe the inclusion of triage notes into a syndromic surveillance system to enhance population health surveillance activities.

CPC provides the 24/7/365 poison hotline for the entire state of North Carolina and currently handles approximately 80,000 calls per year. CPC consultation services that assist callers with poison exposure, diagnosis, optimal patient management, therapy, and patient disposition guidance remain indispensable to the public and health care providers. Poison control center data have been used for years in syndromic surveillance practice as a reliable data source for early event detection. This information has been useful for a variety of public health issues, including environmental exposures, foodborne diseases, overdoses, medication errors, drug identification, drug abuse trends and other information needs. The North Carolina Department of Health and Human Services started formal integration of CPC information into surveillance activities in 2004. CPC call data are uploaded in real time (hourly), 24/7/365, to the NC DETECT state database.

Objective

To describe Carolinas Poison Control Center (CPC) calls data collected in the NC DETECT syndromic surveillance system.