四人死亡與合成大麻摻有毒鼠藥有關
資料來源：艾麗西亞·奧爾特 / 2022 年 10 月 11 日 / Medscape / 財團法人台灣紅絲帶基金會編譯
佛羅里達州衛生當局發布了一份新報告，其中四人因攝入摻有可滅鼠 (brodifacoum，又名溴鼠靈)（一種用於殺死老鼠的長效強力毒藥）的合成大麻而死亡。
這些死亡事件發生在 2021 年 11 月和 2021 年 12 月在佛羅里達州坦帕市及其周邊地區，是在縣衛生部門和當地醫院的急診科醫師和醫學檢查員進行調查後發現的。
10 月 6 日，美國CDC的《發病率和死亡率週報》公佈了這些發現，其中包括 43 例確診和 9 例可能的嚴重出血病例，這些病例與攝入摻有老鼠藥的合成大麻素有關。
重蹈2018年覆轍？
在佛羅里達州毒物信息中心坦帕通知州衛生部門後不久，調查就開始了，它收到了三名不明原因出血和有合成大麻素使用史者的報告。
他們的症狀和高危行為與 2018 年相似，當時至少有 160 名攝入合成大麻的人因不明原因的出血來到醫院。其中三名患者於當年死亡。
疾病控制和預防中心當時發出警報，警告使用合成大麻素如 K2、Spice 和 AK47 可能導致凝血障礙和嚴重的腹痛。美國食品和藥物管理局還警告這種物質的危險性，並表示擔心這種毒物可能會透過受污染的供體進入血液供應。
在 2021 年 12 月的患者病例中，年齡從 16 歲到 63 歲不等。全部住院，其中 4 人死亡。 47 人（87%）報告說他們使用過合成大麻；五人沒有報告這一點，儘管他們的毒鼠藥檢測呈陽性，並且他們的國際標準化比率（international normalized ratio , INR）（一種衡量出血的指標）升高了。
最常見的症狀是血尿（70% 的住院患者出現）、腹痛和嘔血。所有患者的 INR 測量值均升高（中位數為 12.8；範圍為 3.9 至 >15）。
佛羅里達州衛生當局表示，合成大麻的使用對衛生系統提出了挑戰，因為對毒鼠藥進行血液檢測的費用至少為 750 美元/份。
為了止血和清除毒物，必須給患者靜脈注射或口服維生素 K1。一些患者在住院後必須服用維生素 K1達 3 至 6 個月。報告稱，維生素 K1 供不應求，每月花費超過 65,000 美元。
佛羅里達州三分之二的患者沒有保險，無法支付住院和門診治療費用。
毒物控制中心繼續報告接觸合成大麻。 2021 年，佛羅里達毒物控制中心共報告了 94 起接觸事件。
據美國毒物控制中心協會 (the American Association of Poison Control Centers , AAPCC) 稱，佛羅里達州是發生大量報告的州之一。 AAPCC 表示，截至 2022 年 9 月 30 日，毒物控制中心已接到 182 個關於合成大麻素相關暴露的電話。
該協會報告說，其中 66 個電話在德克薩斯州，43 個在弗吉尼亞州，30 個在佛羅里達州，27 個在紐約。
參考文獻：MMWR Morb Mortal Wkly Rep. 2022 年 10 月 6 日線上發布。完整報告
Alicia Ault 是馬里蘭州路德維爾的一名自由記者，其作品曾出現在 JAMA 和 Smithsonian.com 等出版物上。你可以在 Twitter @aliciaault 上找到她。
Four Deaths Linked to Rat Poison–Laced Synthetic Pot
Alicia Ault / October 11, 2022 / Medscape
Florida health authorities have issued a new report of four deaths related to the ingestion of synthetic marijuana laced with brodifacoum, a powerful poison used to kill rats.
The deaths occurred in November and December 2021 in and around Tampa, Florida, and were discovered in the wake of an investigation by county health departments and emergency department physicians and medical examiners at local hospitals.
The findings, which included 43 confirmed and nine probable cases of serious bleeding linked to ingestion of synthetic cannabinoids laced with the rat poison, were announced October 6 in Morbidity and Mortality Weekly Report.
Repeat of 2018?
The investigation started soon after the Florida Poison Information Center Tampa notified the state health department that it had received reports of three people with unexplained bleeding and a history of synthetic cannabinoid use.
Their symptoms and high-risk behavior resembled those seen in 2018, when at least 160 individuals who had ingested synthetic marijuana came to hospitals with unexplained bleeding. Three of these patients died that year.
The Centers for Disease Control and Prevention issued an alert at that time, warning that use of synthetic cannabinoids such as K2, Spice, and AK47 could lead to coagulopathy and severe abdominal pain. The US Food and Drug Administration also warned about the dangers of the substance and said that it was concerned the poison might be entering the blood supply via contaminated donors.
The patients In the December 2021 cases ranged in age from 16 to 63. All were hospitalized, and four died. Forty-seven (87%) reported that they had used synthetic marijuana; five did not report this, although they tested positive for the rat poison and their international normalized ratio (INR), which is a measure of bleeding, was elevated.
The most common symptoms were hematuria (experienced by 70% of those hospitalized), abdominal pain, and vomiting of blood. INR measureements were elevated for all patients (median, 12.8; range, 3.9 to >15).
The Florida health authorities said that use of synthetic marijuana presents challenges to the health system, because the testing of blood for the rat poison costs at least $750 per specimen.
To stem the bleeding and clear the poison, patients must be given vitamin K1, either intravenously or orally. Some patients had to take vitamin K1 for 3 to 6 months after hospitalization. Vitamin K1 is in short supply and costs more than $65,000 per month, according to the report.
Two thirds of the Florida patients were uninsured and could not pay for inpatient and outpatient treatment.
Poison control centers continue to report exposures to synthetic marijuana. In 2021, the Florida Poison Control Center reported a total of 94 exposures.
Florida is among the states in which a high number of reports has occurred, according to the American Association of Poison Control Centers (AAPCC). As of September 30, 2022, poison control centers have fielded 182 calls regarding synthetic cannabinoid–related exposures, the AAPCC said.
Sixty-six of these calls were in Texas, 43 in Virginia, 30 in Florida, and 27 in New York, the association reported.
MMWR Morb Mortal Wkly Rep. Published online October 6, 2022. Full report
Alicia Ault is a Lutherville, Maryland-based freelance journalist whose work has appeared in publications including JAMA and Smithsonian.com. You can find her on Twitter @aliciaault.