What is Cannabinoid Toxicity?
Cannabinoids are a group of substances that interact with specific receptors in the body. They can be found naturally in plants like the cannabis plant, created synthetically in a lab, or produced within our bodies. The main source of harmful effects from cannabinoids comes from those derived from plants and synthetic sources, which activate these receptors in the body.
The Cannabis plant, particularly its Sativa and Indica species, contains more than 60 naturally occurring cannabinoids, the most notable of which is delta-9 tetrahydrocannabinol (THC) known for its mind-altering effects. Other naturally occurring cannabinoids include cannabidiol and cannabinol. The most common term for the crushed, dried leaves and flowers of the Cannabis plant is marijuana.
In recent years, reported cases of marijuana’s harmful effects have grown, especially in children. This increase is linked to the increasing legal use of marijuana for medical or recreational purposes. It’s important to note that the terms phytocannabinoids, marijuana, and cannabis are often used interchangeably.
Synthetic cannabinoids are man-made substances initially designed for medical research and treatments. Despite efforts to control these substances, they are now frequently misused and are available under various street names such as K2, Spice, and Black Mamba. These synthetic cannabinoids are generally more harmful than the ones derived from plants.
Prescriptions containing cannabinoids for medical use include dronabinol, or pure THC, nabilone, a synthetic cannabinoid, and cannabidiol or CBD. The use of cannabinoid medicines is an ongoing area of research.
What Causes Cannabinoid Toxicity?
Intoxication from cannabinoids, or the chemicals found in cannabis, can often happen through inhaling it, whether it’s being used for fun or for medicinal purposes. Overdosing on it usually happens when people use too much or accidentally eat too much cannabis, especially when it’s in edible forms like brownies or gummies. Sometimes, people can eat more than they realize because it can take a while for the effects to fully kick in.
This accidental overdose tends to happen often in children, who thanks to their curious nature, eat what looks like normal food but is really a cannabis product.
Nowadays, since cannabis is legal and widely available, it’s also being prepared in new ways, like in baked goods, candies, hash, and oils.
Even with more availability, most severe overdoses are likely caused by synthetic cannabinoids, or man-made forms of the chemicals found in cannabis. These are known to have more unwanted side effects compared to natural cannabis.
Risk Factors and Frequency for Cannabinoid Toxicity
Cannabis, or marijuana, is the most commonly misused illegal drug worldwide, especially among teenagers. Over 140 million people globally use marijuana. In the United States, there’s been an increase of incidents reported to poison control centers and emergency departments due to marijuana use, largely as a result of the current trend towards making it legal. These incidents usually occur from adults using too much, or from young children mistakenly consuming it. This trend has been noticeable, especially since the legalization of recreational marijuana use in Colorado and other states.
A specific variation of cannabis, known as synthetic cannabinoids, is highly abused and is the second most common drug misused by teenagers. Abuse and the harmful effects of these substances are on the rise as more synthetic cannabinoids are being produced. Over the past decade, new types of synthetic cannabinoids have been created to evade legal restrictions through slight changes in their chemical makeup. Some regions report high rates of use, harmful effects, and even deaths from these substances.
Despite the known dangers and the growing availability of marijuana, many people still abuse synthetic cannabinoids. Some reasons behind this include a cheaper cost compared to marijuana and the fact that standard drug tests typically can’t detect them.
Signs and Symptoms of Cannabinoid Toxicity
When consumed, cannabis can have several immediate effects on the body. This may include a decrease in blood vessel resistance and eye pressure, an increase in heart rate, eye redness, drowsiness, and slower thinking and physical coordination. Surprisingly, while it can speed up the heart rate in occasional users, among more regular users, it may slow it down.
In children, cannabis can be especially harmful. It may cause decreased muscle coordination, lethargy, seizures, and, in serious cases, loss of consciousness. “Artificial” or synthetic cannabis can give similar effects but could also lead to a racing heart, extreme restlessness, and severe seizures. Worst case scenarios include abnormally high body temperature, muscle breakdown, and kidney failure, especially as synthetic cannabis can contain undisclosed and potentially hazardous ingredients.
Moreover, the loosening of marijuana laws has resulted in more reported cases of a condition called ‘cannabinoid hyperemesis syndrome’. This condition is characterized by repetitive vomiting, which typically subsides with hot showers and ceasing cannabis use.
Long-term effects of cannabis use can include lung disease, an increased risk of heart conditions, reduced fertility, as well as difficulties with thinking and memory.
- ACUTE EFFECTS:
- Decreased blood vessel resistance and eye pressure
- Increased heart rate
- Eye redness
- Drowsiness
- Slower thinking and physical coordination
- IN CHILDREN:
- Decreased muscle coordination
- Lethargy
- Seizures
- Possible unconsciousness
- SYNTHETIC CANNABIS:
- Racing heart
- Acute restlessness
- Severe seizures
- Possibility of high body temperature, muscle breakdown, and kidney failure
- CANNABINOID HYPEREMESIS SYNDROME:
- Repetitive vomiting relieved by hot showers and ceasing cannabis use
- LONG-TERM EFFECTS:
- Lung disease
- Increased risk of heart conditions
- Reduced fertility
- Difficulties with thinking and memory
Testing for Cannabinoid Toxicity
The diagnosis for cannabinoid toxicity, like most poisonings, is usually based on the patient’s symptoms and medical history rather than specific tests. Doctors can often diagnose this condition by asking the patient questions about their symptoms and recent activities, as well as performing a physical examination.
In situations where the exposure to cannabinoids (the active ingredients in cannabis) was accidental, especially in young children, testing may be helpful. Hospitals can test for cannabinoid exposure by performing a urine drug screen. This test specifically looks for THC, a major active molecule in cannabis.
Usually, adults do not need to take this test as it doesn’t impact their treatment plan. However, in small children who might have eaten or drunk cannabis by accident, the test could be beneficial. It can help confirm the diagnosis and potentially prevent further expensive and invasive tests, such as brain scans or spinal taps.
The urine drug screen checks for a substance called THC-COOH, an inactive byproduct of your body breaking down THC. This substance can be found in your urine from as little as 6 hours to as long as 7 days if you used cannabis once, but up to a month if you’re a regular user. The test regards a level of 50 nanograms per milliliter (ng/mL) of THC-COOH as a positive result.
It’s worthy to note, though, that some medications can cause a false positive result. It means that the test might show you used cannabis when you actually didn’t – and this could happen with certain anti-inflammatory drugs, stomach acid reducers, and even riboflavin (a type of vitamin). However, this is quite rare, and second-hand smoke exposure is usually not strong enough to trigger a positive result in a urine test.
Blood tests for THC metabolites (byproducts of THC breakdown) are generally not done in an urgent healthcare setting. They are more often used in legal situations for confirmatory testing. Blood samples are sent to a specialized lab where they are analyzed using advanced techniques.
If the concern is about the use of synthetic cannabinoids (man-made drugs that act like THC), keep in mind that they are not usually detected by standard hospital urine drug screens due to their varied chemical structures. Instead, they would require a comprehensive drug screen at a specialized lab.
Treatment Options for Cannabinoid Toxicity
Treatment for cannabinoid toxicity, or poisoning from consuming too much of substances like cannabis, mainly involves managing the symptoms and general patient care. Some research suggests that most adults with cannabis poisoning get better with just observation and minimal intervention, and usually, hospital admission isn’t necessary. However, children may need more extended observation and support, including potentially involving social services to ensure safety at home. Also, toxicity caused by synthetic cannabinoids, which are man-made chemicals similar to those found in cannabis, can be more severe and may need stronger treatment.
Patients experiencing restlessness or sudden severe mental distress may be treated with calming medications, like benzodiazepines, or antipsychotic drugs such as haloperidol or olanzapine if needed. Rapid heart rate could be treated with calming medications and hydration, unless a specific heart rhythm disorder exists. It’s important to check patients for any existing conditions that could put more strain on their heart. A condition called acute coronary syndrome could occur, especially if conditions like coronary artery disease are already present. Acute coronary syndrome is a medical emergency that occurs when the blood supply to your heart muscle is blocked. An electrocardiogram, a test that measures the electrical activity of your heart, can be used to confirm or rule out any heart and rhythm problems.
Seizures are a well-documented risk with cannabis use in children and for individuals of all ages using synthetic cannabinoids. These can be treated with calming medications like benzodiazepines. In rare cases where seizures continue, more intensive treatment and management may be needed. A condition called Cannabinoid Hyperemesis Syndrome can happen due to chronic cannabis use. It’s characterized by cycles of severe nausea, vomiting, and dehydration. This can be treated by stopping the use of cannabis and may require the use of antiemetic medicine like haloperidol, which is used to control nausea and vomiting. Some studies suggest that applying capsaicin topically, a substance present in chili peppers, might help in relieving the symptoms.
In cases where a large quantity of cannabinoids has been consumed, gastrointestinal (GI) cleaning is usually not recommended because the poisoning is rarely life-threatening. Patients should be observed for up to 6 hours to see if symptoms resolve. Hospital admission would be necessary if patients have depressed central nervous system activity, altered mental status, multiple seizures, or persistently abnormal vital signs. If the cannabinoids were ingested via edible products, or if synthetic cannabinoids were used, the poisoning might last longer. When patients have responded to treatment and symptoms have subsided, further testing is not usually needed. However, it’s crucial that patients receive counseling to prevent future occurrences.
What else can Cannabinoid Toxicity be?
Possible conditions that can produce symptoms similar to alcohol intoxication include:
- Agent 15 poisoning
- Barbiturate toxicity
- Benzodiazepine toxicity
- LSD exposure
- Panic disorder
- Sedative-hypnotic toxicity
- Mushroom toxicity
- Tricyclic antidepressant toxicity
- Withdrawal syndromes