Points and Pearls Excerpt
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Marijuana is the most commonly used illicit substance in the United States. States that have legalized marijuana for medical and recreational purposes are showing increased rates of marijuana abuse and dependence.
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When there is concern for drug intoxication, the patient’s clothing should be searched on arrival for drugs and paraphernalia that could point to the substance used.
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The neuropsychiatric and addictive properties of cannabis are primarily due to delta-9-THC.
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The shortest duration to peak plasma levels of delta-9-THC is through the inhalational route. Effects can be seen within 3 minutes.
Most Important References
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Kim HS, Monte AA. Colorado cannabis legalization and its effect on emergency care. Ann Emerg Med. 2016;68(1):71-75. (Literature review; 21 studies) http://www.bumc.bu.edu/emergencymedicine/files/2016/08/MJ-legalization-and-impact-on-EM-care.pdf
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Baron EP. Comprehensive review of medicinal marijuana, cannabinoids, and therapeutic implications in medicine and headache: What a long strange trip it’s been... Headache. 2015;55(6):885-916. (Review)DOI: https://doi.org/10.1111/head.12570
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Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015;313(24):2456-2473. (Retrospective chart review; 4 cases)DOI: https://doi.org/10.1001/jama.2015.6358
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Tournebize J, Gibaja V, Kahn JP. Acute effects of synthetic cannabinoids: update 2015. Subst Abus. 2016:1-23. (Systematic review; 46 articles, 114 patients) DOI: https://doi.org/10.1080/08897077.2016.1219438
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Wallace EA, Andrews SE, Garmany CL, et al. Cannabinoid hyperemesis syndrome: literature review and proposed diagnosis and treatment algorithm. South Med J. 2011;104(9):659- 664. (Review) DOI: https://doi.org/10.1097/SMJ.0b013e3182297d57
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