Advertisement

Cannabis Use Disorders and Related Emergencies

  • S. Alex SidelnikEmail author
  • Theodore I. Benzer
Chapter
Part of the Current Clinical Psychiatry book series (CCPSY)

Abstract

Cannabis has a long history of human use for recreational and medicinal purposes. Recently, its legal status has been in transition with legalization of cannabis occurring in multiple US states and many more allowing its medicinal use. The marijuana plant has several psychoactive compounds, with the primary components being tetrahydrocannabinol (THC) and cannabidiol (CBD). Cannabis can be consumed in a variety of formulations, including those derived from the marijuana plant, as well as synthetic cannabinoid agents. Intoxication with cannabis typically presents with euphoria and perceptual changes, although psychotic and anxiety symptoms can also occur. Intoxication infrequently leads to psychiatric or medical admission, and distressing psychiatric symptoms often resolve with sobriety. In individuals with underlying psychiatric illness, including psychotic disorders, cannabis and synthetic cannabinoid use may contribute to onset, recurrence, or exacerbation of symptoms.

Keywords

Marijuana Cannabis Synthetic cannabinoids Emergency department THC Cannabis use disorder Cannabis intoxication Cannabis withdrawal Substance-induced psychotic disorder 

References

  1. 1.
    Pain S. A potted history. Nature. 2015;525(7570):S10–1.PubMedCrossRefGoogle Scholar
  2. 2.
    Mechoulam R, Parker LA. The endocannabinoid system and the brain. Annu Rev Psychol. 2013;64:21–47.PubMedCrossRefGoogle Scholar
  3. 3.
    Leggett T, United Nations Office on Drugs and Crime. A review of the world cannabis situation. Bull Narc. 2006;58(1):1–155.PubMedGoogle Scholar
  4. 4.
    United Nations Office on Drugs and Crime, World Drug Report 2016. Vienna United Nations.Google Scholar
  5. 5.
    Gomez-Ruiz M, Hernandez M, de Miguel R, Ramos JA. An overview on the biochemistry of the cannabinoid system. Mol Neurobiol. 2007;36(1):3–14.PubMedCrossRefGoogle Scholar
  6. 6.
    McGuire P, Robson P, Cubala WJ, Vasile D, Morrison PD, Barron R, et al. Cannabidiol (CBD) as an adjunctive therapy in schizophrenia: a multicenter randomized controlled trial. Am J Psychiatry. 2018;175(3):225–31.PubMedCrossRefGoogle Scholar
  7. 7.
    Blessing EM, Steenkamp MM, Manzanares J, Marmar CR. Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics. 2015;12(4):825–36.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Gunderson EW, Haughey HM, Ait-Daoud N, Joshi AS, Hart CL. “Spice” and “K2” herbal highs: a case series and systematic review of the clinical effects and biopsychosocial implications of synthetic cannabinoid use in humans. Am J Addict. 2012;21(4):320–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Barnett BOM. Synthetic cannabinoid use in a transitional housing shelter: a survey to characterize awareness of risks and reasons for use. Am J Psychiatry Residents’ J. 2016;11(10):4–6.CrossRefGoogle Scholar
  10. 10.
    Every-Palmer S. Synthetic cannabinoid JWH-018 and psychosis: an explorative study. Drug Alcohol Depend. 2011;117(2–3):152–7.PubMedCrossRefGoogle Scholar
  11. 11.
    700 Street Names for Synthetic Marijuana (Spice, K2, etc.).Google Scholar
  12. 12.
    Monte AA, Calello DP, Gerona RR, Hamad E, Campleman SL, Brent J, 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.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Tournebize J, Gibaja V, Kahn JP. Acute effects of synthetic cannabinoids: update 2015. Subst Abus. 2017;38(3):344–66.PubMedCrossRefGoogle Scholar
  14. 14.
    Lev-Ran S, Le Foll B, McKenzie K, George TP, Rehm J. Cannabis use and cannabis use disorders among individuals with mental illness. Compr Psychiatry. 2013;54(6):589–98.PubMedCrossRefGoogle Scholar
  15. 15.
    Conway KP, Compton W, Stinson FS, Grant BF. Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2006;67(2):247–57.PubMedCrossRefGoogle Scholar
  16. 16.
    Foti DJ, Kotov R, Guey LT, Bromet EJ. Cannabis use and the course of schizophrenia: 10-year follow-up after first hospitalization. Am J Psychiatry. 2010;167(8):987–93.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Subbaraman MS, Kerr WC. Simultaneous versus concurrent use of alcohol and cannabis in the National Alcohol Survey. Alcohol Clin Exp Res. 2015;39(5):872–9.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, D.C.: American Psychiatric Association; 2013.CrossRefGoogle Scholar
  19. 19.
    Ashton CH. Pharmacology and effects of cannabis: a brief review. Br J Psychiatry. 2001;178:101–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Ranganathan M, D’Souza DC. The acute effects of cannabinoids on memory in humans: a review. Psychopharmacology. 2006;188(4):425–44.PubMedCrossRefGoogle Scholar
  21. 21.
    Neavyn MJ, Blohm E, Babu KM, Bird SB. Medical marijuana and driving: a review. J Med Toxicol. 2014;10(3):269–79.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Rogeberg O, Elvik R. The effects of cannabis intoxication on motor vehicle collision revisited and revised. Addiction. 2016;111(8):1348–59.PubMedCrossRefGoogle Scholar
  23. 23.
    Adams AJ, Banister SD, Irizarry L, Trecki J, Schwartz M, Gerona R. “Zombie” outbreak caused by the synthetic cannabinoid AMB-FUBINACA in New York. N Engl J Med. 2017;376(3):235–42.PubMedCrossRefGoogle Scholar
  24. 24.
    Hurst D, Loeffler G, McLay R. Psychosis associated with synthetic cannabinoid agonists: a case series. Am J Psychiatry. 2011;168(10):1119.PubMedCrossRefGoogle Scholar
  25. 25.
    Radhakrishnan R, Wilkinson ST, D’Souza DC. Gone to pot – a review of the Association between Cannabis and Psychosis. Front Psych. 2014;5:54.Google Scholar
  26. 26.
    Blackstone M, Callahan J. An unsteady walk in the park. Pediatr Emerg Care. 2008;24(3):193–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Wang GS, Roosevelt G, Heard K. Pediatric marijuana exposures in a medical marijuana state. JAMA Pediatr. 2013;167(7):630–3.PubMedCrossRefGoogle Scholar
  28. 28.
    Bonkowsky JSD, Pomeroy S. Ataxia and shaking in a 2-year-old girl: acute marijuana intoxication presenting as seizure. Pediatr Emerg Care. 2005;21(8):527–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Appelboam A, Oades PJ. Coma due to cannabis toxicity in an infant. Eur J Emerg Med. 2006;13(3):177–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Boros CA, Parsons DW, Zoanetti GD, Ketteridge D, Kennedy D. Cannabis cookies: a cause of coma. J Paediatr Child Health. 1996;32(2):194–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Carstairs SD, Fujinaka MK, Keeney GE, Ly BT. Prolonged coma in a child due to hashish ingestion with quantitation of THC metabolites in urine. J Emerg Med. 2011;41(3):e69–71.PubMedCrossRefGoogle Scholar
  32. 32.
    Bonnet U, Preuss UW. The cannabis withdrawal syndrome: current insights. Subst Abus Rehabil. 2017;8:9–37.CrossRefGoogle Scholar
  33. 33.
    Budney AJ, Moore BA, Vandrey RG, Hughes JR. The time course and significance of cannabis withdrawal. J Abnorm Psychol. 2003;112(3):393–402.PubMedCrossRefGoogle Scholar
  34. 34.
    Hirvonen J, Goodwin RS, Li CT, Terry GE, Zoghbi SS, Morse C, et al. Reversible and regionally selective downregulation of brain cannabinoid CB1 receptors in chronic daily cannabis smokers. Mol Psychiatry. 2012;17(6):642–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Vandrey RG, Budney AJ, Hughes JR, Liguori A. A within-subject comparison of withdrawal symptoms during abstinence from cannabis, tobacco, and both substances. Drug Alcohol Depend. 2008;92(1–3):48–54.PubMedCrossRefGoogle Scholar
  36. 36.
    Allsop DJ, Copeland J, Norberg MM, Fu S, Molnar A, Lewis J, et al. Quantifying the clinical significance of cannabis withdrawal. PLoS One. 2012;7(9):e44864.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Levin KH, Copersino ML, Heishman SJ, Liu F, Kelly DL, Boggs DL, et al. Cannabis withdrawal symptoms in non-treatment-seeking adult cannabis smokers. Drug Alcohol Depend. 2010;111(1–2):120–7.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Macfarlane V, Christie G. Synthetic cannabinoid withdrawal: a new demand on detoxification services. Drug Alcohol Rev. 2015;34(2):147–53.PubMedCrossRefGoogle Scholar
  39. 39.
    Aryana A, Williams MA. Marijuana as a trigger of cardiovascular events: speculation or scientific certainty? Int J Cardiol. 2007;118(2):141–4.PubMedCrossRefGoogle Scholar
  40. 40.
    Dines AM, Wood DM, Galicia M, Yates CM, Heyerdahl F, Hovda KE, et al. Presentations to the emergency department following cannabis use – a multi-centre case series from ten European countries. J Med Toxicol. 2015;11(4):415–21.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Sun S, Zimmermann AE. Cannabinoid hyperemesis syndrome. Hosp Pharm. 2013;48(8):650–5.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Witsil JC, Mycyk MB. Haloperidol, a novel treatment for cannabinoid hyperemesis syndrome. Am J Ther. 2017;24(1):e64–e7.PubMedCrossRefGoogle Scholar
  43. 43.
    Hamadeh R, Ardehali A, Locksley RM, York MK. Fatal aspergillosis associated with smoking contaminated marijuana, in a marrow transplant recipient. Chest. 1988;94(2):432–3.PubMedCrossRefGoogle Scholar
  44. 44.
    Havakuk O, Rezkalla SH, Kloner RA. The cardiovascular effects of cocaine. J Am Coll Cardiol. 2017;70(1):101–13.PubMedCrossRefGoogle Scholar
  45. 45.
    Monte AA, Zane RD, Heard KJ. The implications of marijuana legalization in Colorado. JAMA. 2015;313(3):241–2.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Riederer AM, Campleman SL, Carlson RG, Boyer EW, Manini AF, Wax PM, et al. Acute poisonings from synthetic cannabinoids – 50 U.S. Toxicology Investigators Consortium Registry Sites, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65(27):692–5.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Cooper Z. Adverse effects of synthetic cannabinoids: management of acute toxicity and withdrawal. Curr Psychiatry Rep. 2016;18(5):52.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Sampson CS, Bedy SM, Carlisle T. Withdrawal seizures seen in the setting of synthetic cannabinoid abuse. Am J Emerg Med. 2015;33(11):1712.PubMedCrossRefGoogle Scholar
  49. 49.
    Huestis MA, Mitchell JM, Cone EJ. Detection times of marijuana metabolites in urine by immunoassay and GC-MS. J Anal Toxicol. 1995;19(6):443–9.PubMedCrossRefGoogle Scholar
  50. 50.
    Wohlfarth A, Scheidweiler KB, Castaneto M, Gandhi AS, Desrosiers NA, Klette KL, et al. Urinary prevalence, metabolite detection rates, temporal patterns and evaluation of suitable LC-MS/MS targets to document synthetic cannabinoid intake in US military urine specimens. Clin Chem Lab Med. 2015;53(3):423–34.PubMedCrossRefGoogle Scholar
  51. 51.
    Leweke FM, Gerth CW, Klosterkotter J. Cannabis-associated psychosis: current status of research. CNS Drugs. 2004;18(13):895–910.PubMedCrossRefGoogle Scholar
  52. 52.
    Leikin JB, Amusina O. Use of dexmedetomidine to treat delirium primarily caused by cannabis. Am J Emerg Med. 2017;35(3):524 e1–2.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of PsychiatryNYU School of Medicine, NYU Langone HealthNew YorkUSA
  2. 2.Harvard Medical School, Massachusetts General Hospital, Emergency DepartmentBostonUSA

Personalised recommendations