Acute Cannabis Toxicity

Wong, Kei; Baum, Carl R.

doi:10.1097/pec.0000000000001970

Cited by 45 publications

(61 citation statements)

References 60 publications

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“…Despite its continued illegal federal designation as a Schedule I drug since 1970 [8], 36 US states have legalized it for medical and 15 US states plus DC for adult use [9]. As more US states legislate legal medical as well as adult-use/recreational cannabis, ED physicians should expect more cannabisrelated visits [10][11][12][13], particularly involving highly concentrated and unregulated products. In this article, we first provide a summary background on newer cannabis products, inhalation and ingestion pharmacokinetics, reported and expected vital sign and physical exam findings, adverse effects, and laboratory testing.…”

Section: Introductionmentioning

confidence: 99%

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

Takakuwa¹,

Schears

2021

Int J Emerg Med

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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.

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Section: Introductionmentioning

confidence: 99%

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

Takakuwa¹,

Schears

2021

Int J Emerg Med

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“…As widely discussed in literature, oral administration has a lower bioavailability (5-20%) than inhalation. Pharmacological effects range from 30 min to 3 h and the maximum concentration of cannabinoids in the blood is usually reached within 2 h. Despite this, oral administration is generally preferred, as it is easy to administer [26][27][28][29]. The use of the formulation developed during our studies, could therefore represent a promising option for the use in therapy.…”

Section: Discussionmentioning

confidence: 98%

“…Given that gastric juices may alter some of the components of the oil, such as CBD [26][27][28][29][30], further studies will address the issue of how to make the capsules containing oils prepared by the β-4 procedure gastro-resistant. Subsequently, an assessment will be performed of whether this type of formulation improves the bioavailability of the cannabinoids of interest.…”

Section: Discussionmentioning

confidence: 99%

Cannabis-Based Oral Formulations for Medical Purposes: Preparation, Quality and Stability

et al. 2021

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Current legislation in Italy provides that medical Cannabis may be administered orally or by inhalation. One of the fundamental criteria for the administration of oral formulations is that they deliver a known consistent quantity of the active ingredients to ensure uniform therapies leading to the optimisation of the risks/benefits. In 2018, our group developed an improved Cannabis oil extraction technique. The objective of the present work was to carry out a stability study for the oil extracts obtained by this method. Furthermore, in order to facilitate the consumption of the prescribed medical Cannabis therapy by patients, a standard procedure was defined for the preparation of a single-dose preparation for oral use (hard capsules) containing the oil extract; thereafter, the quality and stability were evaluated. The hard capsules loaded with the oil extract were analysed and found to be uniform in content. The encapsulation process did not alter the quantity of the active molecule present in the oil. The stability tests yielded excellent results. Since the capsule dosage form is easily transported and administered, has pleasant organoleptic properties and is stable at room temperature for extended periods of time, this would facilitate the adherence to therapy by patients in treatment.

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“…Drug abuse is an increasing phenomenon [13,14,22], also among the young people [5,24,27], with high involvement of the emergency department [17,21,25] and high hospitalization rates [28] and costs. [11] This growing "epidemic" is also spreading because of the misuse of prescribed medications, such as opioids and cannabinoids [15,16].…”

Section: Discussionmentioning

confidence: 99%

“…Cannabis is the most commonly used illicit drug in Europe, and it is generally considered to have low acute toxicity, but there have been reports of acute toxicity associated. The most adverse acute effects are hyperemesis, psychosis, anxiety [23,24]. For these symptoms, patients may seek first aid [25,26].…”

Section: Cannabismentioning

confidence: 99%

Risk Management in First Aid for Acute Drug Intoxication

Piccioni

Cicchinelli

Saviano

et al. 2020

IJERPH

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Drug abuse (cannabis, cocaine, opiates, and synthetic drugs) is an increasing phenomenon, especially in the younger population, thus leading to more cases of intoxication requiring evaluation in the emergency department and subsequent hospitalization. In 2017, 34.2% of students reported having used an illegal psychoactive substance in their lifetime, while 26% reported having done so over the past year. We made a review about the effectiveness of the role of the temporary observation unit in the emergency department to improve management of acute drugs intoxication. We checked medical literature from the last 10 years (2009–2019). The following electronic databases were systematically searched: MEDLINE-PubMed, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials. Then, a systematic review was carried out according to the Preferred Reporting Items for Systematic Review standards. Intoxicated patients usually display a favorable medical course, few diagnostic and therapeutic interventions, a short stay in the hospital, and, when hospitalization is needed, semi-intensive therapy is a feasible solution; therefore, intoxicated patients are ideal candidates for a temporary observation unit. The emergency department is very important to manage intoxicated patients; however, the hospitalization of these patients is often not necessary.

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Acute Cannabis Toxicity

Cited by 45 publications

References 60 publications

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

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

Cannabis-Based Oral Formulations for Medical Purposes: Preparation, Quality and Stability

Risk Management in First Aid for Acute Drug Intoxication

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