Pediatric emergency medicine trisk 3146 3146
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Benzodiazepines are the first-line agents for management of agitation and use of
antipsychotics may also be considered.
Cannabis and Synthetic Cannabinoid Receptor Antagonists
CLINICAL PEARLS
Cannabis poisoning in young children is due largely to edible products.
Adolescents may develop toxicity when exposed to unexpectedly
potent cannabis, or with too-rapid ingestion of multiple serving sizes of
edible products.
Synthetic cannabinoids are inherently more dangerous due to
unpredictable chemical content and clinical effects.
The toxicity of synthetic cannabinoids is distinct from cannabis toxicity.
Current Evidence
The unique characteristics of synthetic cannabinoids are discussed later in this
section.
With the exception of ethanol, marijuana remains the most popular
psychoactive drug of abuse. As legalization of recreational cannabis becomes
more common, poisoning exposures are likely to increase. The flowering tops of
the female Cannabis sativa plant contain the highest concentration of the primary
psychoactive constituent, tetrahydrocannabinol (THC). In the 1970s, most
marijuana contained approximately 1% to 2% THC by weight. More recently,
products may contain upward of 20% THC by weight, and may take users by
surprise, leading to a greater degree of altered mental status than previously.
Another growing dimension of cannabis exposures involves edible products,
which are responsible for the preponderance of poisonings in young children.
Marijuana is now sold in many different formulations. The bud, or flower, is
the most familiar and can be smoked in a variety of ways. Concentrates and
extracts are highly concentrated liquids produced by chemical and mechanical
extraction of alkaloids from the plant matter; these can be solidified into wax
folds, “dabs,” or resins. Marijuana may also be incorporated into various edible
products, including baked goods, and candies. Hashish is the concentrated resin
of marijuana. With the recent decriminalization of marijuana in a number of states
and the growth of the marijuana edibles industry, there has been a rise in the
number of unintentional exposures in young children. Marijuana is occasionally
laced with other psychoactive substances, including PCP and cocaine.
