PEORIA — When the first synthetic cannabis users started showing up with uncontrolled bleeding at Peoria area hospitals, it wasn’t a complete surprise.

“We had gotten a bulletin that the Illinois Department of Public Health has seen these cases and we were on the lookout,” said Dr. Leon Yeh, vice president chief medical officer of emergency services at OSF HealthCare. “We started seeing these cases about two to three weeks ago.”

The first IDPH memo went out March 23 reporting an unusual cluster of cases — four individuals with severe bleeding — in northeastern Illinois. All four people had reported using synthetic cannabis.

By March 28, multiple cases in the Peoria area prompted the Peoria City/County Public Health Department and UnityPoint Health to hold an emergency news conference to warn residents.

More than a week later, synthetic cannabis users are still showing up at area hospitals with uncontrolled bleeding. Every day this week the number of reported cases has risen locally and statewide. According to the IDPH, the Peoria area has reported the highest number of cases, with 44 as of 1:30 p.m. Thursday. Chicago and other parts of Cook County are second at 30. Statewide, there are currently 89 reported cases. Two people in the state have died, including a 22-year-old Peoria man whose cause of death is pending

So far, the outbreak seems to be limited to the Midwest, Yeh said.

“My understanding this is very much a Midwest outbreak. I’ve heard reports of a handful of cases in surrounding states,” he said.

The suspicion is that synthetic cannabinoid products have been laced with rat poisoning. Early in the outbreak, the IDPH reported nine patients had tested positive for brodifacoum, a lethal anticoagulant often used as a rodenticide.

Brodifacoum blocks the liver’s ability to take in Vitamin K, a nutrient that plays a key role in helping the blood to clot, said Dr. Gary Knepp, vice president and regional chief quality officer at UnityPoint Health. The way to stop the bleeding in people poisoned by brodifacoum is to give them lots and lots of Vitamin K.

“It’s taking massive amounts of Vitamin K to do this,” said Knepp.

Some patients have also needed transfusions, said Yeh. The severity of symptoms has varied greatly in patients who have been admitted to area hospitals. Some patients have been placed in the ICU.

Why some cases have been more severe than others could depend on how much of the poison was ingested, but the truth is, a lot is not fully understood, including how long it takes for bleeding to begin after using the tainted synthetic cannabis.

“It’s challenging to determine because sometimes patients don’t want to tell you,” said Yeh.

While bleeding can be internal, in most cases it’s been obvious.

“In the urine, a nose bleed, and the GI tract have been the most common presentation,” Yeh said.

Brodifacoum is not only highly potent, and it is also very long lasting, said Knepp.

“It will take weeks or months to clear out of the body,” he said. “They will have to take Vitamin K the whole time, and they will have to be monitored. If they don’t stay with their treatment plan, they can relapse right back to the same state.”

There are already concerns of an impending Vitamin K shortage in the wake of this issue, and the cost of the supplement is rising.

“These patients are taking an average of 10 tablets a day,” Jerry Storm, senior vice president of pharmacy services at OSF HealthCare. “Depending on the pharmacy, the monthly cost is about $18,000.”

With more patients coming in each day, Yeh and Knepp agree that we are not out of the woods yet.

“We are worried that there are individuals still using the product,” Knepp said. “And potentially people are still acquiring the product from some distribution channel.”

Even on a good day, using synthetic cannabinoid products is a risk. That risk has gotten significantly worse, according to Yeh.

“Synthetic cannabis products are dangerous in their own right, and even more so when they are laced with rat poison.”

Leslie Renken can be reached at 686-3250 or lrenken@pjstar.com. Follow her on Twitter.com/LeslieRenken, and subscribe to her on Facebook.com/leslie.renken.