5559281 Health, Department of - Notice of Emergency and Proposed Rulemaking - Requires testing of patients exhibiting symptoms of synthetic cannabinoid use
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DISTRICT OF COLUMBIA DEPARTMENT OF HEALTH
NOTICE OF EMERGENCY AND PROPOSED RULEMAKING
The Director of the Department of Health (“DOH”), pursuant to the authority set forth in Section 5(a) of the Health-Care and Community Residence Facility, Hospice and Home Care Licensure Act of 1983 (“Act”), effective February 24, 1984 (D.C. Law 5-48; D.C. Official Code § 44-504(a) (2014 Supp.)), and in accordance with Mayor's Order 98-137, dated August 20, 1998, hereby gives notice of the adoption, on an emergency basis, of an amendment that adds a new Section 2039 to Chapter 20 (Hospitals) of Title 22 (Health), Subtitle B (Public Health and Medicine), of the District of Columbia Municipal Regulations (“DCMR”).
The emergency rulemaking (1) requires hospitals to collect urine samples from patients who present and have symptoms consistent with having taken a synthetic cannabinoid; (2) recommends that hospitals collect blood samples from patients who present and have symptoms consistent with having taken a synthetic cannabinoid; (3) requires that the urine and blood samples be stored in accordance with protocols provided by the Department of Health; and, (4) requires that the hospitals turn over the urine and blood samples for testing by the Office of the Chief Medical Examiner.
This emergency rulemaking action is necessary for the Department to immediately improve tracking the upward spike in the use of the illegal synthetic cannabinoid products commonly known as K-2, Spice, ScoobySnax, Bizarro, Synthetic Marijuana, and other names, which are readily available in District stores and on the District’s streets. K-2 is a mixture of herbs, spices or shredded plant material that is typically sprayed with a synthetic compound chemically similar to tetrahydrocannabinol, the psychoactive ingredient in marijuana, but with the potential for a much more powerful and unpredictable effect. The Partnership for Drug-Free Kids lists the effects of using K-2 as increased agitation, pale skin, seizures, vomiting, profuse sweating, uncontrolled/spastic body movements, elevated blood pressure, heart rate and palpitations. The National Institute on Drug Abuse reports that Spice abusers who have been taken to Poison Control Centers report symptoms that include rapid heart rate, vomiting, agitation, confusion, and hallucinations. Spice can also raise blood pressure and cause reduced blood supply to the heart (myocardial ischemia), and in a few cases it has been associated with heart attacks.
Regular users of synthetic cannabinoids may experience withdrawal and addiction symptoms.and often graduate to other, more powerful substances, such as MDMA (3, 4-methylenedioxy-methamphetamine), popularly known as Ecstasy or, more recently, as Molly, with potentially deadly consequences. Multiple incidents linked to use of a synthetic cannabinoids have been reported the District. The District needs determine the level of synthetic marijuana use in the District and how to best educate the community of the inherent dangers of synthetic marijuana and implement appropriate measures to treat those who have become habitual users. Enactment of these regulations will immediately allow the Department to better determine the level of use of synthetic marijuana in the District and to determine the locations where use is especially prevalent, in order to better protect the health, welfare and safety of residents of and visitors to the District.
DOH intends for the testing of the urine samples and the blood samples to be conducted by the Office of the Chief Medical Examiner (“OCME”) or its contractor. Because this is only a surveillance program, DOH does not want to receive any individually identifying information. For this reason, it is intended that the OCME will, upon receipt of the samples from the hospitals, assign a unique identifier to each sample to remove individually identifying information from test results that are shared with DOH. Therefore, under this surveillance program, DOH will not have access to any individually identifying information for the tested samples and will only receive de-identified information, which DOH will use solely for surveillance purposes.
This emergency rulemaking was adopted on July 10, 2015 and became effective on that date. The emergency rulemaking will remain in effect for up to one hundred twenty (120) days after the date of adoption, expiring on November 7, 2015, or upon earlier amendment or repeal by the Director or publication of a final rulemaking in the D.C. Register, whichever occurs first.
The Director also hereby gives notice of the intent to take final rulemaking action to adopt these proposed rules in not less than thirty (30) days after the publication of this notice in the D.C. Register and after approval by the Council of the District of Columbia, as specified in Section 5(j) of the Act (D.C. Official Code § 44-504(j)).
Chapter 20, HOSPITALS, of Title 22-B DCMR, PUBLIC HEALTH AND MEDICINE, is amended by adding the following new Section 2039 as follows:
2039 TESTING FOR SYNTHETIC CANNABINOID SURVEILLANCE
2039.1 When a patient presents to a hospital with a reported or witnessed use of a synthetic cannabinoid and with signs and symptoms of overdose for which the treating clinician would otherwise order a standard urine drug screen, the hospital shall require the treating clinician to order a urine sample to be taken from the patient at or near the time of arrival at the emergency room.
2039.2 When a patient presents to a hospital with a reported or witnessed use of a synthetic cannabinoid and with signs and symptoms of overdose for which the treating clinician would otherwise order a standard urine drug screen, the hospital may require the treating clinician to order a blood sample taken from the patient at or near the time of arrival at the emergency room.
2039.3 The hospital shall label each urine sample or blood sample collected pursuant to Subsection 2039.1 or 2039.2 with the following patient identifying information:
(a) Name;
(b) Date of birth;
(c) Observed race and gender;
(d) Hospital name or hospital number; and
(e) Medical record number.
2039.4 The hospital shall complete a Public Health Sample Submission Form created by the Office of the Chief Medical Officer for each urine sample or blood sample collected pursuant to Subsection 2039.1 or 2039.2.
2039.5 The hospital shall keep the Public Health Sample Submission Form with the urine sample or blood sample collected pursuant to Subsection 2039.1 or 2039.2.
2039.6 The hospital shall store each urine sample or blood sample arising from Subsection 2039.1 or 2039.2 according to protocols provided to the hospitals by the Department.
2093.7 The hospital shall be make each urine sample or blood sample collected pursuant to Subsection 2039.1 or 2039.2 available for pickup by an employee or authorized agent of the District who presents proper credentials or authorization from an appropriate District of Columbia official.
2039.8 The hospital providing the patient’s urine sample or blood sample arising from Subsection 2039.1 or 2039.2 shall have no responsibility for testing the sample or for advising the patient of the results of the test of the sample that was provided to the District.
2039.9 The hospital providing the patient’s urine sample or blood sample may request from the District the test results for a patient treated by the hospital.
2039.10 Nothing in this rule restrict the ability of the hospital to conduct other testing on the patient.
Copies of the proposed rulemaking can be obtained at www.dcregs.dc.gov or by contacting Phillip Husband, General Counsel of the District of Columbia Department of Health, 899 North Capitol Street, NE, 5th Floor, Washington, D.C. 20002. All persons desiring to file comments on the proposed rulemaking action should submit written comments via e-mail to Angli.Black@dc.gov or by mail to the District of Columbia Department of Health, Attn: Phillip Husband, General Counsel, no later than thirty (30) days after the publication of this notice in the D.C Register.
