Skip to main content
Top
Published in: International Journal of Emergency Medicine 1/2021

01-12-2021 | Intoxication | Review

The emergency department care of the cannabis and synthetic cannabinoid patient: a narrative review

Authors: Kevin M. Takakuwa, Raquel M. Schears

Published in: International Journal of Emergency Medicine | Issue 1/2021

Login to get access

Abstract

Background

Cannabis is the most prevalent illegal drug used and the second most common cause of ED drug-related complaints in the USA. Recently, newer more potent strains, concentrated THC products, and consumption methods have become available.

Objective

Our first objective was to define cannabis use in the USA and provide a summary background on its current preparations, pharmacokinetics, vital sign and physical exam findings, adverse effects, and laboratory testing. Our second objective, using the aforementioned summary as relevant background information, was to present and summarize the care and treatment of the most commonly reported cannabis-related topics relevant to ED physicians.

Methods

We first performed an extensive literature search of peer-reviewed publications using New PubMed and Cochrane Central Register of Controlled Trials to identify the most commonly reported cannabis-related topics in emergency care. Once the six topic areas were identified, we undertook an extensive narrative literature review for each section of this paper using New PubMed and Cochrane Central Register of Controlled Trials from the inception of the databases to September 30, 2020.

Results

The six subject areas that were most frequently reported in the medical literature relevant to cannabis-related ED care were acute intoxication/overdose, pediatric exposure, cannabinoid hyperemesis syndrome, cannabis withdrawal, e-cigarette or vaping product use-associated lung injury (EVALI), and synthetic cannabinoids.

Conclusion

As cannabis becomes more widely available with the adoption of state medical cannabis laws, ED-related cannabis visits will likely rise. While cannabis has historically been considered a relatively safe drug, increased legal and illegal access to newer formulations of higher potency products and consumption methods have altered the management and approach to ED patient care and forced physicians to become more vigilant about recognizing and treating some new cannabis-related life-threatening conditions.
Literature
6.
go back to reference Gummin DD, Mowry JB, Spyker DA, et al. 2018 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 36th Annual Report. Clin Toxicol (Phila). 2019;57(12):1220–413 PubMed PMID: 31752545.CrossRef Gummin DD, Mowry JB, Spyker DA, et al. 2018 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 36th Annual Report. Clin Toxicol (Phila). 2019;57(12):1220–413 PubMed PMID: 31752545.CrossRef
15.
go back to reference ElSohly MA. Potency Monitoring Program quarterly report no 123 — reporting period: 09/16/2013-12/15/2013. Oxford: University of Mississippi, National Center for Natural Products Research; 2014. ElSohly MA. Potency Monitoring Program quarterly report no 123 — reporting period: 09/16/2013-12/15/2013. Oxford: University of Mississippi, National Center for Natural Products Research; 2014.
17.
go back to reference Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet. 2003;42(4):327–60.CrossRefPubMed Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet. 2003;42(4):327–60.CrossRefPubMed
18.
go back to reference Beaconsfield P, Ginsburg J, Rainsbury R. Marihuana smoking. Cardiovascular effects in man and possible mechanisms. N Engl J Med. 1972;287:209–12.CrossRefPubMed Beaconsfield P, Ginsburg J, Rainsbury R. Marihuana smoking. Cardiovascular effects in man and possible mechanisms. N Engl J Med. 1972;287:209–12.CrossRefPubMed
19.
go back to reference Gash A, Karliner JS, Janowsky D, Lake CR. Effects of smoking marihuana on left ventricular performance and plasma norepinephrine: studies in normal men. Ann Intern Med. 1978;89:448–52.CrossRefPubMed Gash A, Karliner JS, Janowsky D, Lake CR. Effects of smoking marihuana on left ventricular performance and plasma norepinephrine: studies in normal men. Ann Intern Med. 1978;89:448–52.CrossRefPubMed
20.
22.
go back to reference Vachon L, FitzGerald MX, Solliday NH, Gould IA, Gaensler EA. Single-dose effects of marihuana smoke. Bronchial dynamics and respiratory-center sensitivity in normal subjects. N Engl J Med. 1973;288(19):985–9.CrossRefPubMed Vachon L, FitzGerald MX, Solliday NH, Gould IA, Gaensler EA. Single-dose effects of marihuana smoke. Bronchial dynamics and respiratory-center sensitivity in normal subjects. N Engl J Med. 1973;288(19):985–9.CrossRefPubMed
23.
25.
go back to reference Zwillich CW, Doekel R, Hammill S, Weil JV. The effects of smoked marijuana on metabolism and respiratory control. Am Rev Respir Dis. 1978;118(5):885–91.PubMed Zwillich CW, Doekel R, Hammill S, Weil JV. The effects of smoked marijuana on metabolism and respiratory control. Am Rev Respir Dis. 1978;118(5):885–91.PubMed
27.
go back to reference Grotenhermen F. Effects of cannabis and the cannabinoids. In: Grotenhermen F, Russo EB, editors. Cannabis and cannabinoids: Pharmacology, toxicology, and therapeutic potential. Binghamton: The Haworth Press, Inc.; 2002. Grotenhermen F. Effects of cannabis and the cannabinoids. In: Grotenhermen F, Russo EB, editors. Cannabis and cannabinoids: Pharmacology, toxicology, and therapeutic potential. Binghamton: The Haworth Press, Inc.; 2002.
29.
go back to reference Wert RC, Raulin ML. The chronic cerebral effects of cannabis use. I. Methodological issues and neurological findings. Int J Addict. 1986;21(6):605–28.CrossRefPubMed Wert RC, Raulin ML. The chronic cerebral effects of cannabis use. I. Methodological issues and neurological findings. Int J Addict. 1986;21(6):605–28.CrossRefPubMed
33.
go back to reference Noble MJ, Hedberg K, Hendrickson RG. Acute cannabis toxicity. Clin Toxicol (Phila). 2019;57:735–42.CrossRef Noble MJ, Hedberg K, Hendrickson RG. Acute cannabis toxicity. Clin Toxicol (Phila). 2019;57:735–42.CrossRef
34.
go back to reference Hendrickson RG, Noble MJ. Cardiovascular effects of inhaled and ingested cannabis products. North American Congress of Clinical Toxicology (NACCT) Abstracts 2019. Clin Toxicol (Phila). 2019;57(10):1009. Hendrickson RG, Noble MJ. Cardiovascular effects of inhaled and ingested cannabis products. North American Congress of Clinical Toxicology (NACCT) Abstracts 2019. Clin Toxicol (Phila). 2019;57(10):1009.
37.
go back to reference Keup W. Psychotic symptoms due to cannabis abuse: A survey of newly admitted mental patients. Dis Nerv Syst. 1970;31(2):119–26.PubMed Keup W. Psychotic symptoms due to cannabis abuse: A survey of newly admitted mental patients. Dis Nerv Syst. 1970;31(2):119–26.PubMed
38.
go back to reference Andréasson S, Engström A, Allebeck P, Rydberg U. Cannabis and schizophrenia: A longitudinal study of swedish conscripts. Lancet. 1987;330:1483–6.CrossRef Andréasson S, Engström A, Allebeck P, Rydberg U. Cannabis and schizophrenia: A longitudinal study of swedish conscripts. Lancet. 1987;330:1483–6.CrossRef
40.
go back to reference Arseneault L, Cannon M, Witton J, Murray RM. Causal association between cannabis and psychosis: Examination of the evidence. Br J Psychiatry. 2004;184:110–7.CrossRefPubMed Arseneault L, Cannon M, Witton J, Murray RM. Causal association between cannabis and psychosis: Examination of the evidence. Br J Psychiatry. 2004;184:110–7.CrossRefPubMed
44.
go back to reference Di Forti M, Quattrone D, Freeman TP, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. Lancet Psychiatry. 2019;6:427–36.CrossRefPubMedPubMedCentral Di Forti M, Quattrone D, Freeman TP, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. Lancet Psychiatry. 2019;6:427–36.CrossRefPubMedPubMedCentral
47.
go back to reference Hawks RL, Chiang CN, editors. Urine testing for drugs of abuse. NIDA Research Monograph. Rockville MD; 1986. p. 73. Hawks RL, Chiang CN, editors. Urine testing for drugs of abuse. NIDA Research Monograph. Rockville MD; 1986. p. 73.
48.
go back to reference Verstraete AG. Detection times of drugs of abuse in blood, urine, and oral fluid. Ther Drug Monit. 2004;26:200–5.CrossRefPubMed Verstraete AG. Detection times of drugs of abuse in blood, urine, and oral fluid. Ther Drug Monit. 2004;26:200–5.CrossRefPubMed
49.
go back to reference Sharma P, Murthy P, Bharath MMS. Chemistry, metabolism, and toxicology of cannabis: Clinical implications. Iran J Psychiatry. 2012;7(4):149–56.PubMedPubMedCentral Sharma P, Murthy P, Bharath MMS. Chemistry, metabolism, and toxicology of cannabis: Clinical implications. Iran J Psychiatry. 2012;7(4):149–56.PubMedPubMedCentral
50.
go back to reference McGuigan MA. In: Nelson LS, Lewin NA, Howland MA, Hoffman RS, Goldfrank LS, Flomenbaum NE, editors. Cannabinoids, in Goldfrank's Toxicologic Emergencies. 9th ed. New York: McGraw Hill; 2011. p. 1181. McGuigan MA. In: Nelson LS, Lewin NA, Howland MA, Hoffman RS, Goldfrank LS, Flomenbaum NE, editors. Cannabinoids, in Goldfrank's Toxicologic Emergencies. 9th ed. New York: McGraw Hill; 2011. p. 1181.
53.
go back to reference American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington: American Psychiatric Association; 2013.CrossRef American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington: American Psychiatric Association; 2013.CrossRef
58.
go back to reference Hartung B, Kauferstein S, Ritz-Timme S, Daldrup T. Sudden unexpected death under acute influence of cannabis. Forensic Sci Int. 2014;237:e11–3.CrossRefPubMed Hartung B, Kauferstein S, Ritz-Timme S, Daldrup T. Sudden unexpected death under acute influence of cannabis. Forensic Sci Int. 2014;237:e11–3.CrossRefPubMed
59.
go back to reference Casier I, Vanduynhoven P, Haine S, Vrints C, Jorens PG. Is recent cannabis use associated with acute coronary syndromes? An illustrative case series. Acta Cardiol. 2014;69(2):131–6.CrossRefPubMed Casier I, Vanduynhoven P, Haine S, Vrints C, Jorens PG. Is recent cannabis use associated with acute coronary syndromes? An illustrative case series. Acta Cardiol. 2014;69(2):131–6.CrossRefPubMed
60.
go back to reference Bachs L, Mørland H. Acute cardiovascular fatalities following cannabis use. Forensic Sci Int. 2001;124:200–3.CrossRefPubMed Bachs L, Mørland H. Acute cardiovascular fatalities following cannabis use. Forensic Sci Int. 2001;124:200–3.CrossRefPubMed
62.
go back to reference Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation. 2001;103(23):2805–9.CrossRefPubMed Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation. 2001;103(23):2805–9.CrossRefPubMed
66.
go back to reference Pradhan RR, Pradhan SR, Mandal S, et al. A systematic review of marijuana use and outcomes in patients with myocardial infarction. Cureus. 2018;10:e3333.PubMedPubMedCentral Pradhan RR, Pradhan SR, Mandal S, et al. A systematic review of marijuana use and outcomes in patients with myocardial infarction. Cureus. 2018;10:e3333.PubMedPubMedCentral
67.
go back to reference Sidney S. Cardiovascular consequences of marijuana use. J Clin Pharmacol. 2002;42(11 Suppl):64S–70S.CrossRefPubMed Sidney S. Cardiovascular consequences of marijuana use. J Clin Pharmacol. 2002;42(11 Suppl):64S–70S.CrossRefPubMed
69.
go back to reference Aryana A, Williams MA. Marijuana as a trigger of cardiovascular events: Speculation or scientific certainty? Int J Cardiol. 2007;118:141–4.CrossRefPubMed Aryana A, Williams MA. Marijuana as a trigger of cardiovascular events: Speculation or scientific certainty? Int J Cardiol. 2007;118:141–4.CrossRefPubMed
79.
go back to reference Wang GS, Roosevelt G, Heard H. Pediatric marijuana exposures in a medical marijuana state. JAMA Pediatr. 2013;167:630–3.CrossRefPubMed Wang GS, Roosevelt G, Heard H. Pediatric marijuana exposures in a medical marijuana state. JAMA Pediatr. 2013;167:630–3.CrossRefPubMed
88.
go back to reference Allen JH, de Moore GM, Heddle R, et al. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut. 2004;53:1566–70.CrossRefPubMedPubMedCentral Allen JH, de Moore GM, Heddle R, et al. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut. 2004;53:1566–70.CrossRefPubMedPubMedCentral
90.
go back to reference Stanghellini V, Chan FK, Hasler WL, et al. Gastroduodenal disorders. Gastroenterology. 2016;150:1380–92.CrossRefPubMed Stanghellini V, Chan FK, Hasler WL, et al. Gastroduodenal disorders. Gastroenterology. 2016;150:1380–92.CrossRefPubMed
91.
go back to reference Suzuki H. The application of the Rome IV criteria to functional esophagogastroduodenal disorders in Asia. J Neurogastroenterol Motil. 2017;23(3):325–33.CrossRefPubMedPubMedCentral Suzuki H. The application of the Rome IV criteria to functional esophagogastroduodenal disorders in Asia. J Neurogastroenterol Motil. 2017;23(3):325–33.CrossRefPubMedPubMedCentral
128.
134.
go back to reference Monte AA, Calello DP, Gerona RR, et al. Characteristics and treatment of patients with clinical illness due to synthetic cannabinoid inhalation reported by medical toxicologists: a ToxIC Database study. J Med Toxicol. 2017;13(2):146–52.CrossRefPubMedPubMedCentral Monte AA, Calello DP, Gerona RR, et al. Characteristics and treatment of patients with clinical illness due to synthetic cannabinoid inhalation reported by medical toxicologists: a ToxIC Database study. J Med Toxicol. 2017;13(2):146–52.CrossRefPubMedPubMedCentral
137.
go back to reference Centers for Disease Control and Prevention (CDC). Notes from the field: severe illness associated with reported use of synthetic marijuana - Colorado, August-September 2013. MMWR Morb Mortal Wkly Rep. 2013;62(49):1016–7. Centers for Disease Control and Prevention (CDC). Notes from the field: severe illness associated with reported use of synthetic marijuana - Colorado, August-September 2013. MMWR Morb Mortal Wkly Rep. 2013;62(49):1016–7.
145.
go back to reference Law R, Schier J, Martin C, Chang A, Wolkin A. Notes from the field: Increase in reported adverse health effects related to synthetic cannabinoid use — United States, January–May 2015. MMWR Morb Mortal Wkly Rep. 2015;64(22):618–9.PubMedPubMedCentral Law R, Schier J, Martin C, Chang A, Wolkin A. Notes from the field: Increase in reported adverse health effects related to synthetic cannabinoid use — United States, January–May 2015. MMWR Morb Mortal Wkly Rep. 2015;64(22):618–9.PubMedPubMedCentral
152.
Metadata
Title
The emergency department care of the cannabis and synthetic cannabinoid patient: a narrative review
Authors
Kevin M. Takakuwa
Raquel M. Schears
Publication date
01-12-2021
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Emergency Medicine / Issue 1/2021
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI
https://doi.org/10.1186/s12245-021-00330-3

Other articles of this Issue 1/2021

International Journal of Emergency Medicine 1/2021 Go to the issue