Emergency Department Care
In all patients, the use and abuse of cannabis should be addressed. The potential negative consequences on the patient’s professional and social life should be stressed. Speaking with the patient with empathy and without passing judgment is especially important.
Treatment depends on the clinical presentation, the age of the patient, and the presence of other legal or illicit substances. Immediate management should be supportive, including cardiovascular and neurological monitoring, and placement in a quiet room.
Gastric decontamination is rarely indicated, but may be considered in children younger than 16 years with a large ingestion less than 2 hours prior to presentation.
Patients who are agitated, with psychosis, or with significant anxiety should be treated with benzodiazepines. Patients with an acute psychotic episode should also undergo substance abuse counseling. Those patients who request counseling should be referred for treatment.
Maladaptive behaviors associated with cannabis are more common in males, younger adolescents, patients in urban settings, patients presenting to emergency departments after midnight or on weekends, and patients with psychiatric comorbidities. These patients should be referred to substance abuse counseling.
Consultations
Patients with cannabis dependency should be referred to social services. Treatment programs differ for adolescents and young adults.
Adolescents should be counseled in a family-based approach with a well-defined but flexible intervention. Both outpatient and residential treatment facilities are effective in this age group. Home-based programs are an alternative to those families who do not wish to go to treatment centers.
Adults should be taught coping skills in situations that present a risk of use. In this population, group discussions related to cessation and support groups are more effective than one-on-one interventions.
-
Flowering top of cannabis plant.
