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

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.

Cannabinoid Acute Intoxication, Diagnosis, and Management

“…On the other hand, 9-carboxy-THC can be detected within 1 hour in the urine after TCH consumption [19]. Nonetheless, a positive urine test is non-specific and can indicate cannabis consumption from 1 hour to several weeks [19]. Additionally, certain substances were found to be associated with a false-positive urine test, such as help containing food, proton pump inhibitors, promethazine, dronabinol, some non-steroidal anti-inflammatory drugs, and efavirenz [19].…”

“…The emergency physician must start with an established good relationship with the patient to obtain further detailed history as possible. Ordinarily, a urine drug screen (USD) is the most commonly used method for cannabinoid intoxication screening, which is an immunoassay detecting Δ9-THC metabolites 11-nor-delta-9tetrahydrocannabinol-9-carboxylic acid (9-carboxy-THC) [19]. 9-carboxy-THC is usually detectable in plasma after THC inhalation within minutes but can take several hours if ingested [19].…”

“…Ordinarily, a urine drug screen (USD) is the most commonly used method for cannabinoid intoxication screening, which is an immunoassay detecting Δ9-THC metabolites 11-nor-delta-9tetrahydrocannabinol-9-carboxylic acid (9-carboxy-THC) [19]. 9-carboxy-THC is usually detectable in plasma after THC inhalation within minutes but can take several hours if ingested [19]. Typically, it is noticeable for 1-2 days up to 4 days in infrequent cannabis users but may last two weeks in daily users and over four weeks in longterm heavy cannabinoid smokers [18,19].…”

“…9-carboxy-THC is usually detectable in plasma after THC inhalation within minutes but can take several hours if ingested [19]. Typically, it is noticeable for 1-2 days up to 4 days in infrequent cannabis users but may last two weeks in daily users and over four weeks in longterm heavy cannabinoid smokers [18,19]. On the other hand, 9-carboxy-THC can be detected within 1 hour in the urine after TCH consumption [19].…”

“…Typically, it is noticeable for 1-2 days up to 4 days in infrequent cannabis users but may last two weeks in daily users and over four weeks in longterm heavy cannabinoid smokers [18,19]. On the other hand, 9-carboxy-THC can be detected within 1 hour in the urine after TCH consumption [19]. Nonetheless, a positive urine test is non-specific and can indicate cannabis consumption from 1 hour to several weeks [19].…”