Dozens of Florida residents have been hospitalized with uncontrolled bleeding and at least two have died after they took synthetic cannabinoid products, local health officials reported this week. The outbreak bears an uncanny resemblance to a string of bleeding cases across the country that occurred in 2018, which were ultimately tied to designer drugs laced with a common ingredient used in rat poison. But it’s not yet clear whether the same ingredient is responsible for these newer cases.
Officials from the Florida Department of Health in Hillsborough County were the first to sound the alarm over the weekend, followed by Florida Poison Control officials. As of this afternoon, according to poison control officials, at least 41 people are known to have been hospitalized with symptoms after having taken a synthetic cannabinoid product, while two have died.
“The typical symptoms that patients present with is bleeding in different areas of their body. Patients state that they notice bleeding in their gums, blood in their stool and urine as well,” said William Amarquaye, a clinical pharmacist who has helped manage some of these cases at Brandon Regional Hospital, where three patients have been treated. “So far none of our patients have ended up in critical condition or died,” Amarquaye wrote to Gizmodo in an email.
In March 2018, some people in Illinois began to come down with similar symptoms of bleeding from almost every bodily orifice, including their eyes and ears. By the end of the year, over 300 cases of the condition, which came to be known as synthetic cannabinoid-associated coagulopathy, were reported in the U.S. across 11 states, along with eight deaths. Though Illinois had the most cases reported, at least six were found in Florida.
Synthetic cannabinoids, commonly sold under brand names like Spice or K2, are chemicals meant to mimic the mind-altering effects of cannabis. They’re marketed as legal alternatives to cannabis, though many states have taken action to ban some of them. These unregulated drugs are often much more potent than the real thing, and they’re well known to cause symptoms like temporary psychosis, hallucinations, and sometimes death.
However, the bleeding cases were something new. They were eventually linked to products that had been adulterated with the chemical brodifacoum, a main ingredient in rat poison. Brodifacoum and similar agents are known as superwarfarins—a reference to the widely used blood thinner drug. These chemicals quickly deprive the body of vitamin K, which is essential for our body’s ability to properly clot blood. As a result, standard treatment requires lengthy and costly doses of vitamin K, and it can take patients months to fully recover.
At Brandon Regional Hospital, patients have been treated with vitamin K as well as blood products for those who continue to actively bleed. Because of the likely long-term course of treatment, medical providers there have already had to switch to different formulations of vitamin K to stave off possible shortages and cost issues, Amarquaye said. The monthly cost of treatment for past bleeding cases, including after discharge, has ranged from $20,000 to $50,000 per patient.
Following the initial burst of victims reported in early 2018 from Illinois, the number of cases slowed to a trickle by the end of the year. And though there may have been isolated reports in the years after, this batch of cases from Florida appears to be the first major outbreak of synthetic cannabinoid-associated coagulopathy reported in the U.S. since then.
At this point, though, it isn’t known whether brodifacoum is to blame for these specific cases. A representative from the Florida Department of Health in Hillsborough County told Gizmodo in an email that they haven’t yet been able to test for the presence of any added chemicals from these products. But they are working to obtain samples and to send them to a lab that can do the proper testing.
Currently, the only established connection between these cases is that individuals claim to have used products labeled Spice just before becoming sick. But little is known about the manufacturing and distribution process of these products, much less about the origins of the first bleeding cases in 2018. Health officials and doctors at the time speculated that brodifacoum may have been added on purpose to increase the potency of the drugs, but neither accidental nor intentional poisoning were ever ruled out as explanations.
While it’s not clear why these new cases have happened, many drug policy experts and medical professionals, including Amarquaye, argue that the continued popularity of illicit substances like synthetic cannabinoids can be traced to the ongoing prohibition of many drugs. Often, for instance, people will turn to these drugs in order to avoid testing positive for cannabis at their job.
“It is of my opinion that the more we continue to make drugs illegal, we will inevitably have more potent and dangerous drugs come up in the illicit market,” he said. “Instead of having a legal regulated framework where we have a safe supply of drugs where we know what is in them, we have a supply that is dangerous and laced with whatever nowadays. And people are paying the price of that with their life, which is sad.”