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State and federal health and law enforcement officials established a task force on December 11 to investigate cases and identify the source product. A suspected case was defined as the occurrence after October 1, 2017, of adverse reactions inconsistent with known CBD exposures after ingestion, inhalation, or sublingual consumption of a product labeled as CBD or hemp oil. Hospitals and law enforcement agencies or persons experiencing CBD-associated reactions were asked to report any CBD-associated cases to UPCC. Concomitantly, public health investigators searched UPCC’s database and Utah’s Syndromic Surveillance system as part of CDC’s National Syndromic Surveillance Program for CBD-related events. § UDOH interviewed patients by telephone, using a survey adapted from a synthetic cannabinoid investigation (4). Available blood and urine obtained at emergency departments and product samples obtained from patients were submitted for chemical analysis using liquid chromatography and tandem mass spectrometry at the Utah Public Health Laboratory and the Utah Department of Public Safety crime laboratory.

1 Epidemic Intelligence Service, CDC; 2 Utah Department of Health, Salt Lake City, Utah; 3 Utah Poison Control Center, Salt Lake City, Utah; 4 Utah Department of Health, Public Health Laboratory, Taylorsville, Utah; 5 Utah Department of Public Safety, Bureau of Forensic Services, Taylorsville, Utah; 6 Utah State Bureau of Investigation, Salt Lake City, Utah; 7 Utah Department of Public Safety, Statewide Information and Analysis Center, Sandy, Utah; 8 Salt Lake County Health Department, Salt Lake City, Utah; 9 Utah County Health Department, Provo, Utah.


§ The compound 4-CCB has been identified in Europe since 2016 when samples were intercepted as synthetic cannabinoids; 4-CCB is chemically related to other indazole-based synthetic cannabinoids, known as NACA derivatives, which are found in other synthetic cannabinoid clusters reported in the United States.

Conflict of Interest

† A Schedule I drug, defined by the U.S. Department of Justice Drug Enforcement Administration, is a drug with no currently accepted medical use and a high potential for abuse.