Diagnosis and Management of Cannabis-Related Emergencies (Substance Use Disorders CME and Pharmacology CME)

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Delivery Method:	Online
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Publication Date: December 2025 (Volume 27, Number 12)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 12/01/2028.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Substance Use Disorders CME credits and 4 Pharmacology CME credits, subject to your state and institutional approval.

Author

Peer Reviewers

Abstract

Despite current legal and medical controversies surrounding cannabinoids, it is a fact that emergency departments are seeing an increasing number of patients presenting with symptoms associated with the use of these drugs. This review outlines the pathophysiology of cannabinoids, the potential clinical findings associated with their use, and the current evidence for best-practice management of patients who present with signs of acute intoxication and chronic use. Differences between natural and synthetic cannabinoids are discussed, along with evidence for diagnosing and managing patients presenting with the intractable vomiting of cannabinoid hyperemesis syndrome. Emerging treatments for cannabinoid hyperemesis syndrome are presented as well as an update on the legal status of medical cannabinoid substances.

Case Presentations

A 25-year-old woman is found by bystanders at a bus stop after an apparent syncopal episode…

• The patient was observed to stumble and fall as she attempted to board a bus. Upon arrival to the ED, she said, “I feel fine, everything is OK. I just smoked a little pot and felt light-headed.”
• On evaluation, the patient is seated comfortably on the stretcher but nods off during questioning. She reports a past medical history of anxiety. Her vital signs are: temperature, 37.2°C; heart rate, 107 beats/min; blood pressure, 135/77 mm Hg; respiratory rate, 16 breaths/min while seated; and oxygen saturation, 98% on room air. Upon examination, you note conjunctival injection, dry oral mucosa, and tachycardia, but the examination is otherwise unremarkable, including neurologic assessment.
• At the end of your encounter, the patient says “thanks,” and requests to leave the ED for work. You consider whether she should have a syncope workup and be kept for observation. Because you suspect cannabis intoxication, perhaps she should be advised to not go to work…

EMS arrives with a 17-year-old previously healthy boy with tachycardia and violent behavior…

• His mother called 911 because she found him behaving strangely when she arrived home from work.
• The patient appears very agitated and is unable to remain seated on the stretcher during your examination. He reports chest pain and palpitations, and his vital signs are: temperature, 38°C; heart rate, 146 beats/min; blood pressure, 169/99 mm Hg; respiratory rate, 21 breaths/min; and oxygen saturation, 100% on room air. Fingerstick glucose is measured at 65 mg/dL.
• You suspect a toxic ingestion and wonder what diagnostic tests and/or interventions are indicated…

A 52-year-old man, writhing in pain and retching repeatedly, is wheeled in by the triage nurse…

• You note in his records that he has made frequent visits to the ED over the past 2 years for abdominal pain and intractable vomiting. His vital signs are unremarkable.
• The patient reports that his symptoms have become so severe over the last 2 months that he has had to visit the ED frequently to gain relief, and has lost approximately 10 pounds over the last month. He says that over that time, he has had multiple blood draws in the ED and by his primary care doctor, ultrasounds of the complete abdomen, 2 CT scans of the abdomen/pelvis, and an esophagogastroduodenoscopy, revealing chronic gastritis, with no evidence of peptic ulcer disease or Helicobacter pylori. The patient states that his symptoms are usually very difficult to control, and he is frequently admitted and later discharged home with a diagnosis of gastritis, only to return again the next month.
• You develop a differential for intractable vomiting and then ask the patient a key question that leads to the diagnosis…

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.