Emergency Department Guide to Managing Cannabis Intoxication and Hyperemesis | Research

The takeaway

A comprehensive review for emergency physicians covers the pathophysiology, clinical presentation, and best-practice management of both natural and synthetic cannabinoid intoxication, including emerging treatments for cannabinoid hyperemesis syndrome.

Emergency physicians, urgent care providers, toxicology specialists.

Three emerging CHS treatments covered: hot water bathing, early haloperidol, and topical capsaicin, for when standard antiemetics fail.

What the researchers found

Emergency departments are seeing increasing cannabinoid-related presentations. Key management considerations include distinguishing natural from synthetic cannabinoid intoxication, recognizing CHS as a diagnosis of exclusion, and utilizing emerging treatments (haloperidol, topical capsaicin, hot water bathing) when standard antiemetics fail.

Why it matters

As cannabis legalization expands and synthetic cannabinoid products proliferate, emergency physicians need practical, evidence-based guidance for managing the increasing number of cannabinoid-related presentations.

The numbers in context

Reviews both natural and synthetic cannabinoid presentations. Covers acute intoxication and chronic use complications. Discusses CHS treatments: hot water bathing, haloperidol, and topical capsaicin.

How the study worked

Comprehensive review of cannabinoid pathophysiology, clinical presentations, and current evidence for emergency department management.

What this study cannot tell us

Review covers a broad area with varying evidence quality. Some treatment recommendations are based on case reports. Rapidly evolving landscape may outdate some guidance.

How to read the evidence

Moderate - comprehensive clinical review synthesizing available evidence, though some recommendations are based on limited data.

When this study was published

Published in 2018.

The bigger picture

The increasing diversity of cannabinoid products (edibles, concentrates, synthetics) means emergency presentations are becoming more varied and complex. Physicians trained in an era of prohibition may lack familiarity with these presentations.

Questions still open

How should ED protocols change as cannabinoid presentations increase? Can point-of-care testing distinguish synthetic from natural cannabinoids? What is the optimal CHS treatment algorithm?

Common questions

How do doctors treat cannabis overdose in the ER?

This review outlines supportive care for most cannabis intoxication, with specific guidance for synthetic cannabinoid exposure (which can be more dangerous). For cannabinoid hyperemesis syndrome, hot water bathing, haloperidol, and topical capsaicin are emerging treatments.

How is synthetic cannabis different from natural cannabis in the ER?

Synthetic cannabinoids can produce more severe effects including psychosis, seizures, and organ damage. This review helps emergency physicians distinguish between natural and synthetic cannabinoid presentations and manage each appropriately.

Read the original research

Cannabinoids: emerging evidence in use and abuse.

Emergency medicine practice, 20(8), 1-20

View on PubMed ↗

Citation

Williams, Molly V. (2018). Cannabinoids: emerging evidence in use and abuse.. Emergency medicine practice, 20(8), 1-20.