Cannabinoid Poisoning Clinical Presentation

  • Author: Ani Aydin, MD; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Nov 17, 2011
 

History

  • Physicians rarely diagnose cannabis dependence because it is deemed an insignificant drug in comparison to others.
  • A motivational affect of heavy use is characterized by poor attention and goal-directed thinking or behavior.
  • Physicians should screen for cannabis use because it may be used in conjunction with other drugs. The CAGE questions used for alcohol dependence can also be used to screen for marijuana use. The acronym CAGE stands for the main words of the 4 questions: cut, annoyed, guilty, and eye opener. Two or more positive responses to the following CAGE questions suggests dependence:
    • Have you ever felt you ought to cut downon your use?
    • Have people annoyedyou by criticizing your use?
    • Have you ever felt guiltyabout your use?
    • Have you ever needed to use in the morning as an “ eye opener”?
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Physical

  • Typically, marijuana use can present with conjunctival injection, increased drowsiness, euphoria, nausea, increased appetite, dryness or irritation of the nasal or oropharynx, hypertension, tachycardia, tachypnea, hypotonia, tremors, impaired motor function, slurred speech, impaired short-term memory, inability to perform complex tasks, acute psychosis, agitation or bizarre behavior, urinary retention, impaired reaction time, or decreased intraocular pressure.
  • Less objective findings include the following:
    • Dose-dependent miosis may be present.
    • Balance or motor incoordination, as elicited by a positive Romberg sign, may be observed.
    • Impaired performance with cognitive functioning tasks, including serial addition/subtraction, and object recall may be observed.
    • Sensory function and pain perception appear to remain intact.
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Causes

  • Several factors are believed to contribute to the resurgence of cannabis use.
    • Perceived health risk and addiction from cannabis use among teenagers is falling.
    • Disagreeing authorities have different beliefs about the risks of cannabis use. Some physicians are calling for loosened sanctions against prescribing cannabis for medical purposes, and many experts debate the issues of cannabis dependence and withdrawal.
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Contributor Information and Disclosures
Author

Ani Aydin, MD  Staff Physician, Department of Emergency Medicine, Bellevue Hospital/New York University Medical Center

Ani Aydin, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Jessica A Fulton, DO  Assistant Professor of Emergency Medicine, Assistant Residency Director, New York University and Bellevue Hospital Center; Medical Director of Chemical Biological Radiological Nuclear Explosives (CBRNE) Academy, Bellevue Hospital Center and New York City Department of Health and Mental Hygiene

Jessica A Fulton, DO is a member of the following medical societies: American College of Medical Toxicology

Disclosure: Nothing to disclose.

Specialty Editor Board

Suzanne White, MD  Medical Director, Regional Poison Control Center at Children's Hospital, Program Director of Medical Toxicology, Associate Professor, Departments of Emergency Medicine and Pediatrics, Wayne State University School of Medicine

Suzanne White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Clinical Toxicology, American College of Epidemiology, American College of Medical Toxicology, American Medical Association, and Michigan State Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Gregory R Bell, MD, and Alan H Hall, MD, to the development and writing of this article.

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