Skip to main content
SpringerLink
Log in

Cannabis and Cannabinoid Intoxication and Toxicity

  • Chapter
  • First Online:
Cannabis Use Disorders

Abstract

Adverse effects related to cannabis are an emerging health risk exemplified by reliable increases in calls to poison control centers and emergency department visits due to both unintentional and abuse-related exposures. Toxicity as a consequence of synthetic cannabinoid use (i.e., Spice, K2) has also become an apparent clinical issue with sometimes severe adverse consequences. This chapter will describe the prevalence of over-intoxication, or toxicity by cannabis, cannabis-derived products, and synthetic cannabinoids, with attention to understanding populations most at risk. The constellation of physiological and psychiatric symptoms of intoxication and severe adverse reactions according to cannabis, cannabis-derived products, and synthetic cannabinoids will be described. While there is currently no standard course of action to treat cannabis and cannabinoid exposures, the current treatments reported in the literature will be summarized. As cannabis availability grows and strength of products increases, clinician awareness of the signs and symptoms of cannabis toxicity is critical for undertaking the optimal course of patient treatment. Additionally, knowledge of the risks associated with synthetic cannabinoid use and most frequent treatment approaches will also prepare clinicians for the most effective strategies to addressing their physiological and psychiatric adverse effects.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

THC:

Delta-9-tetrahydrocannabinol

SC:

Synthetic cannabinoids

References

  1. AAPCC. Fake marijuana spurs more than 2500 calls to US poison centers this year alone. Alexandria: American Association of Poison Control Centers; 2010. http://www.scirp.org/(S(351jmbntvnsjt1aadkposzje))/reference/ReferencesPapers.aspx?ReferenceID=454173. Retrieved 5 Dec 2017.

  2. AAPCC, 2017. https://aapcc.s3.amazonaws.com/files/library/Syn_Marijuana_Web_Data_through_9.30.17.pdf. Retrieved 30 Nov 2017.

  3. Adams AJ, Banister SD, Irizarry L, Trecki J, Schwartz M, Gerona R. “Zombie” outbreak caused by the synthetic cannabinoid AMB-FUBINACA in New York. N Engl J Med. 2017;376:235–42.

    Article  CAS  Google Scholar 

  4. Alon MH, Saint-Fleur MO. Synthetic cannabinoid induced acute respiratory depression: case series and literature review. Respir Med Case Rep. 2017;22:147–1.

    Google Scholar 

  5. Anderson DM, Rees D. The role of dispensaries: the devil is in the details. J Pol Anal and Manag. 2014;33:235–40.

    Article  Google Scholar 

  6. Barrus DG, Capogrossi KL, Cates SC, Gourdet CK, Peiper NC, Novak SO, Lefever TW, Wiley JL. Tasty THC: promises and challenges of Cannabis edibles. Methods Rep RTI Press. 2016; https://doi.org/10.3768/rtipress.2016.op.0035.1611.

  7. Borodovsky JT, Crosier BS, Lee DC, Sargent JD, Budney AJ. Smoking, vaping, eating: is legalization impacting the way people use cannabis? Int J Drug Policy. 2016;36:141–7.

    Article  Google Scholar 

  8. Bhanushali GK, Jain G, Fatima H, Leisch LJ, Thomley-Brown D. AKI associated with synthetic cannabinoids: a case series. Clin J Am Soc Nephrol. 2013;8:523–6.

    Article  CAS  Google Scholar 

  9. Bick BL, Szostek JH, Mangan TF. Synthetic cannabinoid leading to cannabinoid hyperemesis syndrome. Mayo Clin Proc. 2014;89:1168–9.

    Article  Google Scholar 

  10. CDPHE (Colorado Department of Public Health and Environment). Monitoring health concerns related to marijuana in Colorado: 2016. https://www.colorado.gov/pacific/cdphe/marijuana-health-report. Accessed 30 Nov 2017.

  11. Cerda M, Wall M, Keyes KM, Galea S, Hasin D. Medical marijuana laws in 50 states: investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence. Drug Alc Dep. 2012;120:22–7.

    Article  Google Scholar 

  12. Claudet I, Le Breton M, Bréhin C, Franchitto N. A 10-year review of cannabis exposure in children under 3-years of age: do we need a more global approach? Eur J Pediatr. 2017;176:553–6.

    Article  Google Scholar 

  13. Cooper ZD. Adverse effects of synthetic cannabinoids: Management of acute toxicity and withdrawal. Curr Psychiatry Rep. 2016;18:52.

    Article  Google Scholar 

  14. Courts J, Maskill V, Gray A, Glue P. Signs and symptoms associated with synthetic cannabinoid toxicity: systematic review. Australas Psychiatry. 2016;24:598–601.

    Article  Google Scholar 

  15. Crippa JA, Derenusson GN, Chagas MH, Atakan Z, Martín-Santos R, Zuardi AW, Hallak JE. Pharmacological interventions in the treatment of the acute effects of cannabis: a systematic review of literature. Harm Reduct J. 2012;25(9):7.

    Article  Google Scholar 

  16. ElSohly MA, Mehmedic Z, Fosetr S, Gon C, Chandra S, Church JC. Changes in Cannabis Potency Over the Last 2 Decades (1995–2014): Analysis of Current Data in the United States. Biol Psychiatry. 2016;79:613–9.

    Article  CAS  Google Scholar 

  17. Galanter M, Kleber H, Brady K. The American Psychiatric Publishing textbook of substance abuse treatment. 5th ed. Washington DC: APPI; 2015.

    Google Scholar 

  18. Hajezi RA, McCallum RW. Cyclic vomiting syndrome: treatment options. Exp Brain Res. 2014;232:2549–52.

    Article  Google Scholar 

  19. Hasin DS, Sarvet AL, Cerdá M, Keyes KM, Stohl M, Galea S, Wall MM. US adult illicit cannabis use, cannabis use disorder, and medical marijuana laws: 1991–1992 to 2012–2013. JAMA Psychiatry. 2017;74(6):579–88.

    Article  Google Scholar 

  20. Hermanns-Clausen M, Kneisel S, Szabo B, Auwärter V. Acute toxicity due to the confirmed consumption of synthetic cannabinoids: clinical and laboratory findings. Addiction. 2013;108:534–44.

    Article  Google Scholar 

  21. Hopkins CY, Gilchrist BL. A case of cannabinoid hyperemesis syndrome caused by synthetic cannabinoids. J Emerg Med. 2013;45:544–6.

    Article  Google Scholar 

  22. Huestis MA, Boyd SJ, Heishman SJ, Preston KL, Bonnet D, Le Fur G, Gorelick DA. Single and multiple doses of rimonabant antagonize acute effects of smoked cannabis in male cannabis users. Psychopharmacology. 2007;194:505–15.

    Article  CAS  Google Scholar 

  23. Jinwala FN, Gupta M. Synthetic cannabis and respiratory depression. J Child Adolesc Psychopharmacol. 2012;22:459–62.

    Article  CAS  Google Scholar 

  24. Jones JD, Nolan ML, Daver R, Comer SD, Paone D. Can naloxone be used to treat synthetic cannabinoid overdose? Biol Psychiatry. 2017;81:e51–2.

    Article  Google Scholar 

  25. Kaar SJ, Gao CX, Lloyd B, Smith K, Lubman DI. Trends in cannabis-related ambulance presentations from 2000 to 2013 in Melbourne, Australia. Drug Alcohol Depend. 2015;155:24–30.

    Article  Google Scholar 

  26. Kasper AM, Ridpath AD, Arnold JK, Chatham-Stephens K, Morrison M, Olayinka O, Parker C, Galli R, Cox R, Preacely N, Anderson J, Kyle PB, Gerona R, Martin C, Schier J, Wolkin A, Dobbs T. Severe illness associated with reported use of synthetic cannabinoids – Mississippi, April 2015. MMWR Morb Mortal Wkly Rep. 2015;64:1121–2.

    Article  Google Scholar 

  27. Lam RPK, Tang MHY, Leung SC, Chong YK, Tsui MSH, Mak TWL. Supraventricular tachycardia and acute confusion following ingestion of e-cigarette fluid containing AB-FUBINACA and ADB-FUBINACA: a case report with quantitative analysis of serum drug concentrations. Clin Toxicol. 2017;55:662–7.

    Article  CAS  Google Scholar 

  28. Lapoint J, James LP, Moran CL, Nelson LS, Hoffman RS, Moran JH. Severe toxicity following synthetic cannabinoid ingestion. Clin Toxicol. 2011;49:760–4.

    Article  CAS  Google Scholar 

  29. Lavi E, Rekhtman D, Berkun Y, Wexler I. Sudden onset unexplained encephalopathy in infants: think of cannabis intoxication. Eur J Pediatr. 2016;175:417–20.

    Article  CAS  Google Scholar 

  30. Le Garrec S, Dauger S, Sachs P. Cannabis poisoning in children. Intensive Care Med. 2014;40:1394–5.

    Article  Google Scholar 

  31. Manseau MW. Synthetic cannabinoids. In: Compton M, editor. Marijuana and mental health. Arlington: American Psychiatric Publishing Inc.; 2016.

    Google Scholar 

  32. Manseau MW, Rajparia A, Joseph A, Azarchi S, Goff D, Satodiya R, Lewis CF. Clinical characteristics of synthetic cannabinoid use in a large urban psychiatric emergency setting. Subst Use Misuse. 2017;52:822–5.

    Article  Google Scholar 

  33. Mauro CM, Newswanger P, Santaella-Tenorio J, Mauro PM, Carliner H, Martins SS. Impact of medical marijuana laws on state-level marijuana use by age and gender, 2004–2013. Prev Sci; published online, 04 November 2017.

    Google Scholar 

  34. Mechoulam R, Shani A, Edery H, Grunfeld Y. Chemical basis of hashish activity. Science. 1970;169:611–2.

    Article  CAS  Google Scholar 

  35. Mehmedic Z, Chandra S, Slade D, et al. Potency trends of Δ9-THC and other cannabinoids in confiscated cannabis preparations from 1993 to 2008. J Forensic Sci. 2010;55:1209–17.

    Article  CAS  Google Scholar 

  36. Meijer KA, Russo RR, Adhvaryu DV. Smoking synthetic marijuana leads to self-mutilation requiring bilateral amputations. Orthopedics. 2014;37:391–4.

    Article  Google Scholar 

  37. Mir A, Obafemi A, Young A, Kane C. Myocardial infarction associated with use of the synthetic cannabinoid K2. Pediatrics. 2011;128:1622–7.

    Article  Google Scholar 

  38. Monte AA, Calello DP, Gerona RR, Hamad E, Campleman SL, Brent J, Wax P, Carlson RG. Characteristics and treatment of patients with clinical illness due to synthetic cannabinoid inhalation reported by medical toxicologists: a ToxIC database study. ACMT toxicology investigators consortium (ToxIC). J Med Toxicol. 2017;13:146–52.

    Article  CAS  Google Scholar 

  39. Moore TH, Zammit S, Lingford-Hughes A, Barnes TR, Jones PB, Burke M, Lewis G. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet. 2017;370:319–28.

    Article  Google Scholar 

  40. Mowry JB, Spyker DA, Cantilena LR Jr, McMillan N, Ford M. 2013 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 31st Annual Report. Clin Toxicol. 2014;52:1032–283.

    Article  Google Scholar 

  41. Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol. 2015a;53:962–1147.

    Article  CAS  Google Scholar 

  42. Mowry JB, Spyker DA, Brooks DE, Zimmerman A, Schauben JL. 2015 Annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 33rd annual report. Clin Toxicol (Phila). 2016;54(10):924–1109. https://doi.org/10.1080/15563650.2016.1245421.

    Article  CAS  Google Scholar 

  43. Oluwabusi OO, Lobach L, Akhtar U, Youngman B, Ambrosini PJ. Synthetic cannabinoid-induced psychosis: two adolescent cases. J Child Adolesc Psychopharmacol. 2012;22:393–5.

    Article  Google Scholar 

  44. Onders B, Casavant MJ, Spiller HA, Chounthirath T, Smith GA. Marijuana exposure among children younger than six years in the United States. Clin Pediatr. 2016;55:428–36.

    Article  Google Scholar 

  45. Pacula RL, Sevigny E. Marijuana liberalization policies: why we can’t learn much from policy still in motion. J Pol Anal and Manag. 2014;33:212–21.

    Article  Google Scholar 

  46. Pacula RL, Boustead AE, Hunt P. Words can be deceiving: a review of variation among legally effective medical marijuana Laws in the United States. J Drug Policy Anal. 2014;7:1–19.

    Article  Google Scholar 

  47. Richards JR, Gordon BK, Danielson AR, et al. Pharmacologic treatment of cannabinoid hyperemesis syndrome: a systematic review. Pharmacotherapy. 2017;37:725–34.

    Article  CAS  Google Scholar 

  48. Ries RK, Fiellin DA, Miller SC, Saitz R. Principles of addiction medicine. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2009.

    Google Scholar 

  49. Rowley E, Benson D, Tiffee A, Hockensmith A, Zeng H, Jones GN, Musso MW. Clinical and financial implications of emergency department visits for synthetic marijuana. Am J Emerg Med. 2017;35:1506–9.

    Article  Google Scholar 

  50. Schep LJ, Slaughter RJ, Hudson S, Place R, Watts M. Delayed seizure-like activity following analytically confirmed use of previously unreported synthetic cannabinoid analogues. Hum Exp Toxicol. 2015;34:557–60.

    Article  CAS  Google Scholar 

  51. Sevigny EL, Pacula RL, Heaton P. The effects of medical marijuana laws on potency. Int J Drug Policy. 2014;25:308–19.

    Article  Google Scholar 

  52. Sevinc MM, Kinaci E, Bayrak S, Yardimci AH, Cakar E, Bektaş H. Extraordinary cause of acute gastric dilatation and hepatic portal venous gas: chronic use of synthetic cannabinoid. World J Gastroenterol. 2015;21:10704–8.

    Article  CAS  Google Scholar 

  53. Smart R, Caulkins JP, Kilmer B, Davenport S, Midgette G. Variation in cannabis potency and prices in a newly legal market: evidence from 30 million cannabis sales in Washington state. Addiction. 2017;112(12):2167–77.

    Article  Google Scholar 

  54. Springer YP, Gerona R, Scheunemann E, Shafer SL, Lin T, Banister SD, Cooper MP, Castrodale LJ, Levy M, Butler JC, McLaughlin JB. Increase in adverse reactions associated with use of synthetic cannabinoids – anchorage, Alaska, 2015–2016. MMWR Morb Mortal Wkly Rep. 2016;65:1108–11.

    Article  Google Scholar 

  55. Sweeney B, Talebi S, Toro D, Gonzalez K, Menoscal JP, Shaw R, Hassen GW. Hyperthermia and severe rhabdomyolysis from synthetic cannabinoids. Am J Emerg Med. 2016;34:121.e1–2.

    Article  Google Scholar 

  56. Takematsu M, Hoffman RS, Nelson LS, Schechter JM, Moran JH, Wiener SW. A case of acute cerebral ischemia following inhalation of a synthetic cannabinoid. Clin Toxicol. 2014;52:973–5.

    Article  CAS  Google Scholar 

  57. Vandrey R, Raber JC, Raber ME, Douglass B, Miller C, Bonn-Miller MO. Cannabinoid dose and label accuracy in edible medical Cannabis products. JAMA. 2015;313:2491–3.

    Article  CAS  Google Scholar 

  58. Volkow ND, Baler RD, Compton WM, Weiss SR. Adverse health effects of marijuana use. N Engl J Med. 2014;370:2219–27.

    Article  Google Scholar 

  59. Ukaigwe A, Karmacharya P, Donato A. A gut gone to pot: a case of cannabinoid hyperemesis syndrome due to K2, a synthetic cannabinoid. Case Rep Emerg Med. 2014:167098.

    Google Scholar 

  60. Ustundag MF, Ozhan Ibis E, Yucel A, Ozcan H. Synthetic cannabis-induced mania. Case Rep Psychiatry. 2015;2015:310930.

    PubMed  PubMed Central  Google Scholar 

  61. United States Drug Enforcement Administration. Schedules of controlled substances: placement of five synthetic cannabinoids into Schedule I, 21 CFR Part 1308 [Docket No. DEA-345]. Fed Regist. 2012;77:12508–14.

    Google Scholar 

  62. United States Drug Enforcement Administration. DEA news: huge synthetic drug takedown. Washington, DC: United States Department of Justice; 2014. https://www.dea.gov/divisions/hq/2014/hq050714.shtml. Retrieved on 30 Nov 2017.

  63. United States Drug Enforcement Administration. Schedules of Controlled Substances: Temporary Placement of the Synthetic Cannabinoid MAB-CHMINACA Into Schedule I. Washington, DC: United States Department of Justice; 2015. http://www.deadiversion.usdoj.gov/fed_regs/rules/2015/fr0916_2.htm. Retrieved on 11 Nov 2017.

  64. Wang GS, Roosevelt G, Heard K. Pediatric marijuana exposures in a medical marijuana state. JAMA Pediatr. 2013;167:630–3.

    Article  Google Scholar 

  65. Wang GS, Le Lait MC, Deakyne SJ, Bronstein AC, Bajaj L, Roosevelt G. Unintentional Pediatric Exposures to Marijuana in Colorado, 2009-2015. JAMA Pediatr. 2016;170:e160971.

    Article  Google Scholar 

  66. Williams AR, Santaella-Tenorio J, Mauro C, Levin FR, Martins SS. The effect of medical marijuana laws and regulations on adolescent and adult recreational marijuana use and cannabis use disorder. Addiction. 2017;112:1985–91.

    Article  Google Scholar 

  67. Williams AR, Olfson M, Kim JD, Martins SS, Kleber HD. Older, Less Regulated Medical Marijuana Programs Have Much Greater Enrollment Rates. Health Aff. 2016;35:480–8.

    Article  Google Scholar 

  68. Williams AR. Medical and recreational marijuana policy: from prohibition to the rise of regulation. In: Compton M, editor. Marijuana and mental health. Arlington: American Psychiatric Publishing Inc.; 2016.

    Google Scholar 

  69. Zaurova M, Hoffman RS, Vlahov D, Manini AF. Clinical effects of synthetic cannabinoid receptor agonists compared with marijuana in emergency department patients with acute drug overdose. J Med Toxicol. 2016;12:335–40.

    Article  CAS  Google Scholar 

  70. Zawilska JB, Andrzejczak D. Next generation of novel psychoactive substances on the horizon – a complex problem to face. Drug Alcohol Depend. 2015;157:1–17.

    Article  CAS  Google Scholar 

  71. Zhu H, Wu LT. Trends and correlates of cannabis-involved emergency department visits: 2004 to 2011. J Addict Med. 2016;10:429–36.

    Article  Google Scholar 

  72. Zupan Mežnar A, Brvar M, Kralj G, Kovačič D. Accidental cannabis poisoning in the elderly. Wien Klin Wochenschr. 2016;128:548–52.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, New York, NY, USA

    Ziva D. Cooper & Arthur Robin Williams

Authors
  1. Ziva D. Cooper
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arthur Robin Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ziva D. Cooper .

Editor information

Editors and Affiliations

  1. Division of Pharma & Med Cons Drug Abuse, NIDA, NIH, Department of Health & Human Services, Bethesda, MD, USA

    Ivan D. Montoya

  2. Division of Extramural Research, National Institute on Drug Abuse Division of Extramural Research, Bethesda, MD, USA

    Susan R. B. Weiss

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Cooper, Z.D., Williams, A.R. (2019). Cannabis and Cannabinoid Intoxication and Toxicity. In: Montoya, I., Weiss, S. (eds) Cannabis Use Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-90365-1_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90365-1_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90364-4

  • Online ISBN: 978-3-319-90365-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation