Spontaneous Hemorrhage Associated With Synthetic Cannabinoid Use

Synthetic cannabinoids (SCBs) are a popular new class of designer drugs. In 2018, the Centers for Disease Control and Prevention advised that illicit products containing SCB compounds were laced with brodifacoum (BDF), a highly potent superwarfarin easily purchased as a rodenticide. Multiple outbreaks of bleeding from BDF exposure have since been reported. Patients with BDF toxicity present with bleeding ranging from mild epistaxis to life-threatening hemorrhage. Given the increasing popularity of SCBs as recreational drugs, outbreaks from BDF exposure are likely to continue, presenting a public health risk. The nurse practitioner has a vital role in the complex, ongoing management of this patient population. •Synthetic cannabinoids (SCBs) are a newer, popular class of designer drugs.•Brodifacoum is a long-acting anticoagulant rodenticide added to SCB compounds.•Brodifacoum has caused life-threatening bleeding outbreaks in several states.•The mainstay of treatment for brodifacoum toxicity is high-dose vitamin K.•The nurse practitioner has a vital role in the recognition, treatment, and follow-up of this population.