Cases of Severe Bleeding Associated with Synthetic Cannabinoids Continue to Mount

By Joe Elia

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Over 300 people have suffered severe coagulopathy associated with exposure to synthetic cannabinoids since early March, the CDC reports in an update on the continuing outbreak.

The update identifies a total of 324 cases, most in Illinois, Wisconsin, and Maryland; eight deaths have resulted. The adulterant responsible is brodifacoum, a "superwarfarin" used as rat poison.

The CDC recommends oral vitamin K1 as therapy and cautions that some patients have shown evidence of repeated use of the contaminated products. In those cases, clinicians should consider increasing the dosage and duration of K1 therapy. At least one woman being receiving vitamin K1 treatment became pregnant. Women of childbearing age should be cautioned that brodifacoum, like its cousin warfarin, can cause birth defects.

A national helpline run by the federal Substance Abuse and Mental Health Services Administration is available for patients and families at 800-662-HELP.