Cannabinoids and Legal Highs
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Cannabinoids and “Legal Highs”: Recognition and Management in the Emergency Department (Pharmacology CME)

This resource, delivered fully online, includes two courses and two audio presentations reviewing the recognition and management of intoxication emergencies in adults, adolescents, and children associated with cannabinoids, synthetic cannabinoids, and other synthetic “designer drugs,” including cathinones, phenethylamines, and methoxetamine. Presentations are discussed for both adult and pediatric patients. Complete this activity to earn 9 AMA PRA Category 1 Credits™, including 7 pharmacology credits.

Modules

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Authors

Mollie V. Williams, MD
Attending Physician, Residency Program Director, Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, NY
Rahul Shah, MD
Department of Pediatric Emergency Medicine, University of Connecticut School of Medicine, Farmington, CT
Carl R. Baum, MD, FAAP, FACMT
Professor of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT

Peer Reviewers

Joseph Habboushe, MD, MBA
Assistant Professor of Emergency Medicine, New York University/ Langone and Bellevue Medical Centers, New York, NY; CEO, MDAware
Nadia Maria Shaukat, MD, RDMS, FACEP
Director, Emergency and Critical Care Ultrasound, Department of Emergency Medicine, Coney Island Hospital, Brooklyn, NY
Michael Levine, MD
Associate Professor of Emergency Medicine, University of Southern California, Los Angeles, CA
Dan Quan, DO
Department of Emergency Medicine, Maricopa Integrated Health System; Clinical Associate Professor, Emergency Medicine, University of Arizona College of Medicine, Phoenix, AZ

Audio Presenter

Andrew C. Schmidt, DO, MPH
Assistant Professor, Department of Emergency Medicine, University of Florida College of Medicine – Jacksonville, Jacksonville, FL

Product Details

Publication Date: September 1, 2020

CME Expiration Date: June 1, 2021

CME Information: Included as part of the 9 credits, this CME activity is eligible for 7 Pharmacology CME credits, subject to your state and institutional approval. Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME. Credit Designation: EB Medicine designates this enduring material for a maximum of 9 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The “Cannabinoids: Emerging Evidence in Use and Abuse” journal issue of Cannabinoids and “Legal Highs”: Recognition and Management in the Emergency Department is approved by the American College of Emergency Physicians for 4 hours of Category I credit. Cannabinoids and “Legal Highs”: Recognition and Management in the Emergency Department is eligible for 8 Category 2-A or 2-B credit hours by the American Osteopathic Association.

Table of Contents

Course 1: Cannabinoids: Emerging Evidence in Use and Abuse + EMplify podcast audio summary

  1. Abstract
  2. Case Presentations
  3. Introduction
  4. Critical Appraisal of the Literature
  5. Etiology and Pathophysiology
    1. Synthetic Cannabinoids
    2. Current Indications for Cannabinoids
    3. Routes of Administration
    4. Clinical Findings Associated With Acute Use
      1. Neurologic Effects
      2. Psychiatric Effects
      3. Cardiovascular Effects
      4. Pulmonary Effects
      5. Renal Effects
      6. Metabolic Effects
      7. Oral/Dental Effects
      8. Ophthalmologic Effects
      9. Cannabinoid Hyperemesis Syndrome
    5. Withdrawal
  6. Differential Diagnosis
  7. Prehospital Care
  8. Emergency Department Evaluation
    1. History
    2. Physical Examination
  9. Diagnostic Studies
    1. Laboratory Testing
    2. Electrocardiogram
    3. Imaging
  10. Treatment
    1. Treatment for Acute Cannabis and Synthetic Cannabinoid Toxicity
    2. Treatment for Cannabinoid Hyperemesis Syndrome
  11. Special Populations
    1. Pediatric Patients
    2. Pregnant Women
  12. Controversies and Cutting Edge
    1. Legal Status of Cannabis/Cannabinoids
    2. Haloperidol for Cannabinoid Hyperemesis Syndrome Treatment
    3. Capsaicin for Cannabinoid Hyperemesis Syndrome Treatment
  13. Disposition
  14. Summary
  15. Risk Management Pitfalls for Management of Acute Cannabis Use
  16. Key Points
  17. Time and Cost-Effective Strategies
  18. Case Conclusions
  19. Clinical Pathway for Emergency Department Management of Cannabinoid Hyperemesis Syndrome
  20. Tables
    1. Table 1. Main Constituents of Cannabis Sativa
    2. Table 2. Peak Plasma Concentration Times of THC via Various Routes of Administration
    3. Table 3. Symptoms and Findings for Clinical Diagnosis of Cannabinoid Hyperemesis Syndrome
    4. Table 4. Differential Diagnosis for Suspected Cannabis Intoxication
    5. Table 5. Differential Diagnosis of Intractable Vomiting
    6. Table 6. Drugs Implicated in False-Positive Cannabinoid Screening
  21. References

Course 2: Synthetic Drug Intoxication in Children: Recognition and Management in the Emergency Department

  1. Abstract
  2. Case Presentations
  3. Introduction
  4. Critical Appraisal of the Literature
  5. Etiology and Pathophysiology
    1. Synthetic Cannabinoids
      1. Development and Consumption of Synthetic Cannabinoids
      2. Adverse Effects of Synthetic Cannabinoids
    2. Synthetic Cathinones
    3. Phenethylamines
  6. Differential Diagnosis
  7. Prehospital Care
  8. Emergency Department Evaluation
    1. History
    2. Physical Examination
      1. Synthetic Cannabinoids
      2. Synthetic Cathinones
      3. Phenethylamines
  9. Diagnostic Studies
    1. Screening Tests
    2. Imaging Studies
      1. Brain Imaging
      2. Radiographic Imaging
    3. Testing for Patients With Altered Mental Status and Myalgias
    4. Testing for Patients With Chest Pain
  10. Symptomatic Treatment
    1. Synthetic Cannabinoids
    2. Synthetic Cathinones and Phenethylamines
  11. Special Circumstances
    1. Body Packing of Drugs
    2. Planning for Large-Scale Dance Festivals
  12. Controversies and Cutting Edge
  13. Disposition
  14. Summary
  15. Risk Management Pitfalls in the Management of Pediatric Patients With Synthetic Drug Intoxication
  16. Time- and Cost-Effective Strategies
  17. Case Conclusions
  18. Key Points
  19. Clinical Pathway for Management of Intoxication After Consumption of Synthetic Drugs
  20. Tables and Images
    1. Table 1. Exposures to Synthetic Bath Salts and THC, by Age Range, for 2009-2012
    2. Table 2. Differential Diagnosis of Altered Level of Consciousness
    3. Table 3. Toxidromes, Complications, and Treatment Options for Poisoning from Drugs of Abuse
    4. Figure 1. Number of Calls Received by Poison Control Centers About Exposure to Synthetic Cannabinoids, 2009-2015
    5. Figure 2. Packages Of Synthetic Cannabinoids
  21. References
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