Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 38–42: Marijuana & Synthetic Cannabinoids + Key Features Download Section PDF Listen +++ ++ The dried leaves and flowers of the Cannabis plant contain the psychoactive cannabinoid, delta-9-tetrahydrocannabinal (THC), which binds to endogenous cannabinoid receptors Toxicity is dose dependent but varies significantly by individual, prior experience, and degree of tolerance Synthetic cannabinoids ("Spice", "K2", "Black Mamba") are laboratory designed analogs of THC Onset of symptoms after smoking is usually rapid (minutes) with a duration of effect of approximately 2 hours Symptoms may be delayed after ingestion and can result in prolonged intoxication (up to 8 hours) + Clinical Findings Download Section PDF Listen +++ ++ Mild intoxication may result in Euphoria Palpitations Heightened sensory awareness Altered time perception Sedation More severe intoxication may result in Anxiety Visual hallucinations Acute paranoid psychosis Physical findings include Tachycardia Orthostatic hypotension Conjunctival injection Incoordination Slurred speech Ataxia Chronic heavy marijuana use is associated with the cannabinoid hyperemesis syndrome, which is characterized by Recurrent nausea Abdominal pain Vomiting Synthetic cannabinoids have become increasingly popular and are associated with a variety of adverse side effects including Seizures Kidney dysfunction Serious neuropsychiatric symptoms + Diagnosis Download Section PDF Listen +++ ++ Clinical history of marijuana use Blood testing is available to detect presence of the psychoactive cannabinoid, delta-9-tetrahydrocannabinal (THC): High levels indicate recent use Low levels may persist for hours or days Urine testing is available for non-psychoactive marijuana metabolites, most commonly, tetrahydrocannabinol carboxylic acid (THC-COOH): Urine test detection of THC-COOH varies from days to weeks after use, long after any psychoactive effect has passed Actual detection times for THC-COOH in urine depends on marijuana dose (use), frequency of use, and individual metabolism With single use, THC-COOH can typically be detected for ~3 days With moderate use (4 times weekly), for ~5 days With heavy (daily) use, for ~10 days With long-term heavy use, for ~30 days. + Treatment Download Section PDF Listen +++ ++ Consider activated charcoal early after ingestion of large quantities There is no specific antidote currently available Treat anxiety and paranoia with simple reassurance and placement into a calming environment Benzodiazepines such as lorazepam or diazepam may be used for more severe behavioral and psychomotor symptoms Hypotension and sinus tachycardia should be treated with intravenous fluids Topical capsaicin and haloperidol have been used with variable success for the treatment of acute vomiting in patients with cannabinoid hyperemesis syndrome