Cannabinoid Poisoning Treatment & Management

10/3/2014

Cannabinoid Poisoning Treatment & Management

Cannabinoid Poisoning Treatment & Management Author: Ani Aydin, MD; Chief Editor: Robert G Darling, MD, FACEP more... Updated: Jul 11, 2013

Emergency Department Care In all patients, the use and abuse of cannabis should be addressed. The negative consequences on the patient’s professional and social life should be stressed. Speaking with the patient with empathy and without passing judgment is especially important. Treatment depends on the clinical presentation, the age of the patient, and the presence of other legal or illicit substances. Immediate management should be supportive, including cardiovascular and neurological monitoring, and placement in a quiet room. Gastric decontamination may be considered in children younger than 16 years with an acute ingestion less than 2 hours prior to presentation. Patients who are agitated or with psychosis should be treated with benzodiazepines. Patients with an acute psychotic episode should also undergo substance abuse counseling. Those patients who request counseling should be referred for treatment. Maladaptive behaviors associated with cannabis are more common in males, younger adolescents, patients in urban settings, patients presenting to emergency departments after midnight or on weekends, and patients with psychiatric comorbidities. These patients should be referred to substance abuse counseling.

Contributor Information and Disclosures Author Ani Aydin, MD Staff Physician, Department of Emergency Medicine, Bellevue Hospital/New York University Medical Center Ani Aydin, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine Disclosure: Nothing to disclose. Coauthor(s) Jessica A Fulton, DO Assistant Professor of Emergency Medicine, Assistant Residency Director, New York University and Bellevue Hospital Center; Medical Director of Chemical Biological Radiological Nuclear Explosives (CBRNE) Academy, Bellevue Hospital Center and New York City Department of Health and Mental Hygiene Jessica A Fulton, DO is a member of the following medical societies: American College of Medical Toxicology Disclosure: Nothing to disclose. Specialty Editor Board Suzanne White, MD Medical Director, Regional Poison Control Center at Children's Hospital, Program Director of Medical Toxicology, Associate Professor, Departments of Emergency Medicine and Pediatrics, Wayne State University School of Medicine Suzanne White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Clinical Toxicology, American College of Epidemiology, American College of Medical Toxicology, American Medical Association, and Michigan State Medical Society Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment Rick Kulkarni, MD Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine Disclosure: WebMD Salary Employment John D Halamka, MD, MS Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine Disclosure: Nothing to disclose. Chief Editor Robert G Darling, MD, FACEP Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

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10/3/2014

Cannabinoid Poisoning Treatment & Management

Disclosure: Nothing to disclose. Additional Contributors The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Gregory R Bell, MD, and Alan H Hall, MD, to the development and writing of this article.

References 1. Wells DL, Ott CA. The "new" marijuana. Ann Pharmacother. Mar 2011;45(3):414-7. [Medline]. 2. Forrester MB. Adolescent synthetic cannabinoid exposures reported to Texas poison centers. Pediatr Emerg Care. Oct 2012;28(10):985-9. [Medline]. 3. McGuinness TM, Newell D. Risky recreation: synthetic cannabinoids have dangerous effects. J Psychosoc Nurs Ment Health Serv. Aug 2012;50(8):16-8. [Medline]. 4. Kuepper R, van Os J, Lieb R, Wittchen HU, Höfler M, Henquet C. Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. BMJ. Mar 1 2011;342:d738. [Medline]. [Full Text]. 5. Fitzgerald KT, Bronstein AC, Newquist KL. Marijuana poisoning. Top Companion Anim Med. Feb 2013;28(1):8-12. [Medline]. 6. Wiegand TJ, Wax PM, Schwartz T, Finkelstein Y, Gorodetsky R, Brent J. The Toxicology Investigators Consortium Case Registry--the 2011 experience. J Med Toxicol. Dec 2012;8(4):360-77. [Medline]. 7. National Institute on Drug Abuse, National Institutes of Health, Centers for Substance Abuse Prevention and Treatment. National Conference on Marijuana Use: Prevention, VA. Treatment and Research. NIH publication. 1995: Arlington;38-49:no 96-4106. [Full Text]. 8. National Institute on Drug Abuse. InfoFacts: Marijuana. Updated April 2006. [Full Text]. 9. Pavarin RM, Berardi D. Mortality risk in a cohort of subjects reported by authorities for cannabis possession for personal use. Results of a longitudinal study. Epidemiol Prev. Mar-Apr 2011;35(2):89-93. [Medline]. 10. Adams IB, Martin BR. Cannabis: pharmacology and toxicology in animals and humans. Addiction. Nov 1996;91(11):1585-614. [Medline]. 11. Ashton CH. Adverse effects of cannabis and cannabinoids. Br J Anaesth. Oct 1999;83(4):637-49. [Medline]. 12. Ashton CH. Pharmacology and effects of cannabis: a brief review. Br J Psychiatry. Feb 2001;178:101-6. [Medline]. 13. Compton WM, Grant BF, Colliver JD, Glantz MD, Stinson FS. Prevalence of marijuana use disorders in the United States: 1991-1992 and 2001-2002. JAMA. May 5 2004;291(17):2114-21. [Medline]. 14. Degenhardt L, Hall W, Lynskey M. Exploring the association between cannabis use and depression. Addiction. Nov 2003;98(11):1493-504. [Medline]. 15. Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet. 2003;42(4):327-60. [Medline]. 16. Hall W, Solowij N. Adverse effects of cannabis. Lancet. Nov 14 1998;352(9140):1611-6. [Medline]. 17. Hall W, Solowij N, Lemon J:. The Health and Psychological Consequences of Cannabis Use. Monograph No 25. National Drug Strategy. Australian Government Publication Serv. 1994;15-20. 18. Herkenham M, Lynn AB, Little MD, Johnson MR, Melvin LS, de Costa BR, et al. Cannabinoid receptor localization in brain. Proc Natl Acad Sci U S A. Mar 1990;87(5):1932-6. [Medline]. 19. Huestis MA, Mitchell JM, Cone EJ. Detection times of marijuana metabolites in urine by immunoassay and GC-MS. J Anal Toxicol. Oct 1995;19(6):443-9. [Medline]. 20. Kalant H. Adverse effects of cannabis on health: an update of the literature since 1996. Prog Neuropsychopharmacol Biol Psychiatry. Aug 2004;28(5):849-63. [Medline]. 21. Khalsa JH, Genser S, Francis H, Martin B. Clinical consequences of marijuana. J Clin Pharmacol. Nov 2002;42(11 Suppl):7S-10S. [Medline]. 22. Kilpatrick DG, Acierno R, Saunders B, Resnick HS, Best CL, Schnurr PP. Risk factors for adolescent substance abuse and dependence: data from a national sample. J Consult Clin Psychol. Feb 2000;68(1):19-30. [Medline]. 23. Lynskey MT, Heath AC, Bucholz KK, Slutske WS, Madden PA, Nelson EC, et al. Escalation of drug use in early-onset cannabis users vs co-twin controls. JAMA. Jan 22-29 2003;289(4):427-33. [Medline]. 24. McGee R, Williams S, Poulton R, Moffitt T. A longitudinal study of cannabis use and mental health from adolescence to early adulthood. Addiction. Apr 2000;95(4):491-503. [Medline]. 25. McGuigan M. Cannabinoids. In: Goldfrank's Toxicological Emergencies. 8th ed. New York: McGraw-Hill Professional; 2006. 26. Pope HG Jr, Gruber AJ, Hudson JI, Huestis MA, Yurgelun-Todd D. Neuropsychological performance in long-term cannabis users. Arch Gen Psychiatry. Oct 2001;58(10):909-15. [Medline]. 27. Robson P. Cannabis. Arch Dis Child. Aug 1997;77(2):164-6. [Medline]. 28. Smith NT. A review of the published literature into cannabis withdrawal symptoms in human users. Addiction. Jun 2002;97(6):621-32. [Medline]. 29. Solowij N, Stephens RS, Roffman RA, Babor T, Kadden R, Miller M, et al. Cognitive functioning of long-term heavy cannabis users seeking treatment. JAMA. Mar 6 2002;287(9):1123-31. [Medline]. 30. Strang J, Witton J, Hall W. Improving the quality of the cannabis debate: defining the different domains. BMJ. Jan 8 2000;320(7227):108-10. [Medline]. 31. Vitale S, van de Mheen D. Illicit drug use and injuries: A review of emergency room studies. Drug Alcohol Depend. Mar 15 2006;82(1):1-9. [Medline]. 32. Wallace KL, Kunkel DB. Legal hemp products and urine cannabinoid testing. J Toxicol Clin Toxicol.

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Cannabinoid Poisoning Treatment & Management

1999;37(7):897-8. [Medline]. 33. Watson SJ, Benson JA Jr, Joy JE. Marijuana and medicine: assessing the science base: a summary of the 1999 Institute of Medicine report. Arch Gen Psychiatry. Jun 2000;57(6):547-52. [Medline]. Medscape Reference © 2011 WebMD, LLC

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