Pediatric emergency medicine trisk 3148 3148
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Infants and toddlers passively exposed to marijuana smoke, or who ingest
edible cannabis, may develop profound lethargy or coma, occasionally with
tachycardia.
In most cases, the only treatment required is discontinuation of the drug. In the
adolescent patient with a psychotic reaction or acute toxic delirium, a
benzodiazepine may be necessary. These acute symptoms should improve with
drug abstinence over 4 to 6 hours. Young children ingesting high THC doses by
weight, or adults who unwittingly smoke or ingest a higher dose than intended,
may need sedation or respiratory support until intoxication resolves.
Synthetic Cannabinoids (Spice, K2)
The term synthetic cannabinoids describes a variety of compounds (often
structurally dissimilar to THC, and thus not picked up on standard urine drug
screens), with affinity for cannabinoid receptors. Although initially developed to
mimic the effects of cannabis on the brain, this class of compounds has evolved
in both complexity and availability in recent years, and cause clinical illness quite
different from that of cannabis.
Current Evidence. In the past decade, use of synthetic cannabinoids has gained
increasing popularity. Initially marketed as herbal incense or air fresheners and
labeled as “not for human consumption,” these compounds were sold in head
shops, convenience stores, and via the internet. Several of these compounds are
now regulated as a result of the Synthetic Drug Abuse Prevention Act of 2012,
but new derivatives continue to emerge.
Synthetic cannabinoids bind to cannabinoid receptors in the CNS and
peripheral tissues, often with significantly higher affinity than THC. It is
postulated that a combination of activity at other receptor types, active
metabolites, and unique effects of various herbal compounds often mixed with
synthetic cannabinoids may account for the higher reported rates of adverse
effects (i.e., seizures, tachycardia, GI upset) with these compounds as compared
to THC.
Users of synthetic cannabinoids typically report a faster onset of peak effects
and shorter duration of effects as compared to THC. However, given the number
of compounds that fall under the umbrella term of synthetic cannabinoids, there
are limited published data to allow us to fully characterize the pharmacodynamics
of this class of compounds.
Clinical Considerations. As compared to THC, use of synthetic cannabinoids is
more frequently associated with tachycardia, hypertension, agitation,
