Cannabis Related Emergencies

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the December 2025 Emergency Medicine Practice article, Diagnosis and Management of Cannabis-Related Emergencies

Episode Outline: [0:00] Introduction Welcome and show overview by Sam Ashoo Mention of resources at ebmedicine.net [0:46] Episode Start Hosts introduce themselves: Sam Ashoo and Dr. T.R. Eckler Dr. Eckler’s background and experience with cannabis cases in Colorado [1:16] Topic Introduction Focus on diagnosis and management of cannabis-related emergencies Prevalence and importance in emergency medicine [1:34] Legal Landscape Overview of cannabis legality across states Medicinal vs. non-medicinal use [3:03] Increase in ED Visits Statistics: ~1 million cannabis-related ED visits annually Demographics: younger population most affected [3:52] Synthetics and Challenges Discussion of synthetic cannabinoids and their risks Issues with detection and legality [4:50] Clinical Spectrum Range of presentations: from nausea/vomiting to psychosis and seizures Impact on different age groups [6:34] FDA-Approved Uses Cannabis-derived products approved for specific medical conditions [7:20] Physiology and Pathophysiology Cannabinoid receptors (CB1 and CB2) and their effects Differences between plant-derived and synthetic cannabinoids [9:10] Chronic Use and Withdrawal Downregulation of receptors, withdrawal symptoms, and persistent nausea [10:20] Product Forms and Delivery Methods Smoking, edibles, oils, tinctures, suppositories, topicals, etc. Risks associated with concentrated forms (e.g., wax, oils) [12:00] Clinical Effects by System Psychiatric: anxiety, psychosis, paranoia Cardiovascular: tachycardia, MI risk, QT prolongation Pulmonary, renal, metabolic, dental, and ocular effects [13:50] Cannabinoid Hyperemesis Syndrome (CHS) Phases: prodrome, hyperemesis, recovery Hot showers as a diagnostic clue [16:00] Withdrawal Syndrome Symptoms and timeline Exacerbation with synthetic cannabinoids [18:15] Counseling and Management Importance of cessation and patient education Timeline for symptom improvement [18:42] Differential Diagnosis Broad differential for persistent nausea/vomiting and abdominal pain Importance of considering other causes [20:55] Diagnostics and Testing Limitations of drug screens (false positives/negatives) Importance of EKG, labs, and imaging as indicated [23:10] Treatment Approaches First-line: benzodiazepines, antiemetics (ondansetron, metoclopramide) Second-line: butyrophenones (haloperidol, droperidol), olanzapine Capsaicin as adjunct therapy [29:50] Complications and Special Considerations Risks of undertreatment (e.g., Boerhaave syndrome, aspiration) Pediatric and pregnant populations: unique risks and reporting requirements [36:00] Five Practice-Changing Takeaways Elicit cannabis use history Know testing limitations Consider ECG and appropriate labs Use butyrophenones when indicated Admit if symptoms are refractory [39:00] Conclusion

Emergency Medicine Residents, get your free subscription by writing [email protected]