ISDS Annual Conference Proceedings 2018. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution,  
and reproduction in any medium, provided the original work is properly cited.

ISDS 2018 Conference Abstracts

Surveillance of a Synthetic Cannabinoid Overdose 
Outbreak using Syndromic & EMS Data
Peter J. Rock* and Michael D. Singleton
College of Public Health, University of Kentucky, Lexington, KY, USA

Objective
The aim of this project was to investigate anecdotal reports of an 

increase in synthetic cannabinoid (SynCan) overdoses in Lexington-
Fayette County area of Kentucky, using rapid surveillance systems 
including emergency department (ED) syndromic surveillance (SyS) 
and emergency medical services (EMS) data.

Introduction
In mid-2017, the Kentucky Injury Prevention and Research Center 

(a bonafide agent of Kentucky Department for Public Health-KDPH) 
was alerted by members of KDPH to anecdotal evidence of a possible 
increase of SynCan (primarily “Serenity”) overdoses. The situation 
presented an opportunity to demonstrate the capabilities of syndromic 
surveillance and emergency medical services (EMS) data systems to 
provide rapid situational awareness about SynCan overdoses.

Methods
SynCan cases were identified based on EMS emergency runs with 

narratives including mentions of ‘serenity|K2|spice’ and occurred 
in the Lexington-Fayette County. In ED SyS, SynCan cases were 
identified for Lexington-Fayette County area ED visits with a chief 
complaints of ‘serenity|K2|spice’ or diagnosis code of T40.7X[1-4]
A. The ICD code was included after analysis of diagnosis codes
in positive cases from a chief complaint only query revealed
T40.7X[1-4]A as a primary code assigned in these cases. Trends for
Lexington-Fayette County area were compared to state-wide total
to determine if the trend is unique or related to system-wide pattern
changes. EMS and ED SyS trend results were compared for internal
validity. EMS incident addresses were geocoded to point-level to
enable more granular analysis of geospatial patterns over time for
identification of hotspots/clustering.

Results
ED SyS and EMS results demonstrated a clear temporal increase in 

SynCan overdoses beginning around March of 2017[Fig 1]. Further 
analysis indicated that this increase was most dramatically centered in 
the Lexington-Fayette County area [Fig 2]. The vast majority of those 
overdosing were males (SyS: 88.1%) with average age 37 compared 
to 11.9% and 36.0 for females, respectively. These demographics are 
similar to those reported by the New York City Department of Health 
and Mental Hygiene for a K2 outbreak in New York City in 20141. 
Kernel density mapping demonstrated a strong clustering in a specific 
area of downtown Lexington. Additionally, analysis of EMS data 
revealed that a large portion of these overdoses were being admitted 
for observational care and thus not being captured in SyS data (based 
on the primary hospital’s submission types).

From a practical standpoint, the rapid surveillance results only took 
1-2 days to complete and highlight the utility of these data systems in 
preparing rapid data products. The results of the analysis were shared 
with local and state health department authorities, including the
local Emergency Medical Advisory Board. The geospatial analysis
provided local authorities with information to enable precise targeting
of public health and public safety messaging.

Conclusions
By analyzing data from these systems, we were able to quickly 

identify the geographic areas and demographic groups that were most 
affected, and to describe trends in SynCan overdoses over time. As 
a result, we were able to provide highly-detailed data to local public 
health and public safety authorities to inform their response.

Figure 1.

Figure 2.



ISDS Annual Conference Proceedings 2018. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution,  
and reproduction in any medium, provided the original work is properly cited.

ISDS 2018 Conference Abstracts

Keywords
Synthetic Marijuana; EMS; Geocoding; Surveillance; Serenity

Acknowledgments
We acknowledge and thank the following agencies for their support of this 
work: the Kentucky Department for Public Health, the Kentucky Health 
Information Exchange, Lexington-Fayette County Health Department, 
and the Kentucky Board of Emergency Medical Services.

References
1. Nolan, M. L., Allen, B., Kunins, H. V., & Paone, D. (2016). A

public health approach to increased synthetic cannabinoid-related
morbidity among New York City residents, 2014-2015. International 
Journal of Drug Policy, 34, 101–103. https://doi.org/10.1016/j.
drugpo.2016.05.014

*Peter J. Rock
E-mail: pjrock2@uky.edu

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 10(1):e174, 2018