ANCHORAGE, Alaska (AP) — A new state report on Anchorage’s spice problem confirms that spice-related emergency calls have spiked in the past year and that the synthetic drug may have led to at least four deaths.

The epidemiology bulletin released Wednesday looks at emergency room visits between related to the use of synthetic cannabinoids, also called spice.

The report includes data from electronic medical records from two of the three Anchorage hospitals between July 15 and Sept. 30.

October, the worst month for spice-related calls, is not included.

The report also does not take into account visits following a newly implemented law criminalizing the sale and possession of spice passed by the Anchorage Assembly in November.

Researchers found 167 records of patients who were self-identified or suspected spice users, making up 47 percent of all spice-related emergency room visits. The third hospital that didn’t participate in the report accounted for the remaining 53 percent.

The report also showed that synthetic cannabinoids were considered the main or contributing factor in four of ten death cases. The spice users identified in the report appeared to be mostly male, with a mean age of 37.

A spokesman for Providence Alaska Medical Center confirmed Wednesday that the hospital participated in the study. Alaska Regional Hospital and Alaska Native Medical Center could not be reached for comment Wednesday.

With a narrow time period and limited information from hospitals, the new report is not representative of spice’s full impact, said Louisa Castrodale, one of the report’s editors and a state epidemiologist.

“We believe this is an increase. But quantifying what kind of increase, because we don’t have this background, is hard,” she said.