Intermediate
Focus Session
Evan Schwarz, MD
Associate Professor of Emergency Medicine/ Section Chief Medical Toxicology
Washington University School of Medicine in Saint Louis
JoAn Laes, MD
Assistant Professor of Medicine
Hennepin Healthcare
Ross Sullivan, MD
Assistant Professor - Emergency Medicine. Director - Medical Toxicology/Emergency Addiction
SUNY Upstate Hospital
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Lewis Nelson, MD
Professor
Rutgers New Jersey Medical School
Americans’ views and perceptions of cannabis are changing. This is evidenced by recent legislation: nine states and the District of Columbia legalized recreational (adult-use) cannabis while 13 others decriminalized it, 30 states legalized medical cannabis, and in 16 states cannabidiol (CBD) is legal. As the laws and penalties surrounding cannabis relax, assumptions regarding its safety also change. As an example, the Monitoring the Future study demonstrates a decreasing perception of harm that is correlated with increasing use of cannabis in junior high and high school aged students. This is unfortunate as the National Academy of Sciences found that cannabis can negatively affect memory and learning and impair academic achievement.
Another consequence of legalization is the increasing concentration of tetrahydrocannabinol (THC) in available products. While historically cannabis contained approximately 3% THC and had limited clinical consequences beyond euphoria, THC concentrations of 20% or more are now available. Edible products, such as cookies, also contain unexpectedly high quantities of THC and non-commercial products, such as "wax," may have a concentration as high 98%. This has led to an increasing number of adverse medical consequences and emergency department (ED) visits for intoxication, something that almost never occurred in the past. In particular, there is a growing concern for unintentional exposure in the pediatric population. Additionally, reports of cannabis associated psychosis, cannabis withdrawal, cannabinoid hyperemesis syndrome, and motor vehicle collisions due to cannabis intoxication are increasingly prevalent. The recognition and management of cannabis related complications are essential in order to provide appropriate clinical management and reduce harms.
One reason for increased access to cannabis is the potential medicinal benefit. Cannabis as well as CBD are purported to treat a multitude of conditions including glaucoma to seizures to pain. While CBD has demonstrated some promise in treating rare childhood seizure disorders, as evidenced by the recent approval of Epidiolex®, the literature supporting medicinal cannabis is limited. Cannabis is also suggested to be a potential solution to the opioid crisis due to its postulated analgesic effects. Importantly, the reported association of a decrease in opioid prescribing, use, or overdose has not been causally implicated and is inconstant across studies.
In this session, we shall review the increasing number and variety of ED visits and acute medical conditions associated with cannabis use. We shall discuss the diagnosis and treatment of intoxication as well as the treatment of other effects related to cannabis use, including unintentional pediatric exposures. Lastly, we shall discuss the convergence of medical cannabis, cannabis legalization for recreational or adult-use, and the opioid epidemic, and what effect, if any, cannabis has had on opioid prescribing and overdoses.