The Georgia Department of Public Health has been tracking a new trend in synthetic drug use. The Wisconsin Department of Public Safety felt it important to pass this information along: The Georgia Department of Public Health (DPH) has become aware of a dangerous, potentially lethal substance surfacing in convenience stores and smoke shops. When ingested or inhaled this neurotoxin can render a person motionless and/or unconscious and cause severe cardiac problems. In the last 24 hours, at least eight patients in Southeast Ga. have been hospitalized; some patients have been admitted to intensive care and are on life support. Two patients have been intubated.

The substance is marketed as "herbal incense," bath salts, or "roll-your-own" tobacco - similar to what public health and law enforcement have seen before containing cannabinoid receptor agonists (THC homologs), but there are now indications the chemicals or ingredients have been altered.

First responders have reported unusual strength, agitation and combativeness in some persons followed by sudden hypokalemia, flaccid paralysis, severe hyporeflexia and unconsciousness. Symptoms may present almost immediately after ingestion or inhalation, or may be delayed as users ingest more of the product. Mild to moderate intoxication can result in alterations in mood and perception, reddened conjunctiva, nausea, vomiting, xerostomia, weakness, cardiac abnormalities, hypertension, disorientation and an increase in pulse rate, similar to marijuana (THC).

DPH is working closely with the Georgia Bureau of Investigation and the Georgia Drugs and Narcotics Agency to collect these products and remove them from store shelves. Samples of the product have arrived at a secure laboratory and testing to identify the toxins is underway. At this time, lab tests are continuing and the composition of the product is unknown. Clinicians are advised to treat symptomatically as no specific treatment has been identified.

Brand names include Crazy Clown and Herbal Madness Incense.The products are typically sold at convenience and tobacco stores and may display a clown or "joker face" with the character's tongue out and/or "5X" in product labeling.

Clinicians requiring toxicology assistance should phone the Georgia Poison Center at 800-222-1222.

Thank you for all you do.

Very truly yours,

Brenda Fitzgerald, M.D. Commissioner

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