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Collaboration Stopped “Crazy Clown” Drug Outbreak, Report Says

November 25, 2013

In August, 22 patients came to an emergency department in Brunswick, Ga., some dangerously ill after inhaling synthetic cannabinoids, also known as “spice” or “herbal incense.” Six of the patients were hospitalized, and five of them in the intensive care unit.

The drugs are smoked as an alternative to marijuana, and consumers can purchase them over the counter in smoke shops, convenience stores and on the Internet. But they can cause dangerous reactions, which can lead to hospitalization and even death. Synthetic cannabinoid use is particularly common among young people who have easy access to these drugs and are unaware of the risks associated with them.

Recently there have been increased reports of synthetic cannabinoid use and adverse effects from the drugs. Little is known about these drugs, and publishing adverse events is critical to building knowledge about them to understand how to treat and prevent such events.

Epidemiologists at the Georgia Department of Public Health (DPH) published a report detailing the outbreak in the Nov. 22 edition of the Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention. The report describes the details of the investigation, but also highlights the importance of public health surveillance and how rapid, close communication between state agencies, and between public health and the medical community, is a vital part of protecting the public.

When the patients began coming to the Brunswick emergency department, an astute doctor informed the Georgia Poison Center about the outbreak. The poison center notified the Georgia Drug and Narcotics Agency, which notified DPH. This communication allowed law enforcement officials to test the implicated product and get it quickly removed from the shelf, preventing additional users from becoming ill.

Georgia has a progressive law banning controlled substances. It allows categories of drugs to be considered banned, even before the specific compound is added to the Georgia code. Testing revealed that the drug, which was being sold under the name “Crazy Clown,” fell under one of those broad categories. Law enforcement officials were able to make an arrest, charging the implicated smoke shop owner with intent to distribute a Category 1 controlled substance. After the product was removed from stores, no additional patients were identified.

Despite Georgia’s progressive drug law and state agencies’ collaborative effort to prevent additional illness, these drugs continue to be available and easily purchased. Public health authorities can raise awareness of adverse events associated with the drugs and establish mechanisms for surveillance by partnering with poison centers, health care providers and law enforcement. Raising awareness about the risks of these drugs among drug users is also critical to preventing future outbreaks.