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
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