Kuai D, Eneida Rivera Blanco L, Krotulski A, Walton S, Denn M, Kelly B, Kiernan E, Steck A, Carpenter J
JAMA Open NetworkKey Points
Question What are the clinical manifestations, management, and outcomes associated with exposure to drug-soaked paper strips among incarcerated individuals, and which substances are present in these strips?
Findings In this case series of 18 male patients with strip intoxication, clinical manifestations included central nervous system depression (94%) and bradycardia (61%). Strips primarily contained synthetic cannabinoid receptor agonists, nitazene opioids, and other novel psychoactive substances.
Meaning These findings suggest that drug-soaked paper strips can cause severe health outcomes, and improved detection, management strategies, and further research are needed to understand this emerging public health threat.
Abstract
Importance Recreational use of drug-soaked paper strips (hereafter, strips) in correctional facilities poses a major public health risk owing to the diverse and potentially severe toxic effects of the substances they contain. Understanding the clinical manifestations and outcomes of exposure to these strips is important for developing effective management and prevention strategies.
Objective To characterize the clinical manifestations, management, and outcomes of intoxication from strips in a correctional facility population, and to identify the specific substances present in these strips.
Design, Setting, and Participants This is a case series with a retrospective medical record review and biospecimen analysis. Participants were incarcerated individuals from a county jail who presented to the emergency department of an urban hospital in Atlanta, Georgia, with suspected strip exposure between August 1, 2022, and November 1, 2023. Strip samples were tested using gas chromatography-mass spectrometry and liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS), and serum samples were analyzed via LC-QTOF-MS.
Exposures All patients had suspected exposure to strips, thought to contain opioids, synthetic cannabinoid receptor agonists (SCRAs), and other novel synthetic drugs.
Main Outcomes and Measures The primary outcomes were clinical manifestations of strip exposure, including clinical signs and symptoms, vital sign derangements, laboratory and imaging findings, treatments administered, and patient outcomes.
Results There were 18 patients (all male; median [IQR] age, 27.5 [18.0-45.0] years) in total. Bradycardia (11 patients [61%]) and central nervous system depression (17 patients [94%]) were the most common clinical findings. Other symptoms included agitation (6 patients [33%]) and seizures (4 patients [22%]). Treatment primarily involved supportive care, with 2 patients requiring intubation. One patient died as a result of hypoxic ischemic encephalopathy. Analysis of strip samples revealed the presence of synthetic cannabinoids and benzimidazole opioids, but no household cleaners or pesticides. Serum testing confirmed the presence of SCRAs and their metabolites.
Conclusions and Relevance In this case series study of strip intoxication among incarcerated individuals, severe and variable clinical manifestations were observed, predominantly associated with their SCRA content. Bradycardia in the context of major central nervous system depression was an indicator of severe SCRA toxic effects. Further research is needed to better understand strip use and to develop effective prevention and treatment strategies.
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