From the Guidelines
The treatment for severe symptoms of synthetic cannabinoid use primarily involves supportive care and symptom management, as there is no specific antidote. Initial management should focus on stabilizing vital signs, ensuring adequate hydration, and monitoring cardiac function, as highlighted in recent reviews 1. For severe agitation or psychosis, benzodiazepines such as lorazepam (1-2 mg IV) or diazepam (5-10 mg IV) are first-line treatments, which can be repeated as needed. Antipsychotics like haloperidol (2-5 mg IV/IM) may be used for persistent psychosis, though with caution due to potential lowering of seizure threshold. Seizures should be treated with benzodiazepines, progressing to other anticonvulsants if needed. For cardiovascular symptoms, standard protocols for hypertension or tachycardia apply, avoiding beta-blockers which might worsen hypertension through unopposed alpha effects. Severe nausea and vomiting can be managed with antiemetics like ondansetron (4-8 mg IV). Patients should be monitored for at least 24 hours due to the unpredictable nature of synthetic cannabinoids, with potential for delayed effects.
Key Considerations
- The unpredictable nature of synthetic cannabinoids necessitates a high index of suspicion for their use in patients presenting with severe symptoms after using what they believe to be standard cannabis or regulated hemp products 1.
- Understanding the concept of adulteration and its clinical implications is critical in safeguarding patients, as synthetic cannabinoids can be added to various products without the consumer's awareness 1.
- The management of synthetic cannabinoid-induced toxicity should be tailored to the patient's symptoms, with a focus on supportive care and symptom management.
Symptom Management
- Agitation or psychosis: benzodiazepines (e.g., lorazepam, diazepam) as first-line treatment, with antipsychotics (e.g., haloperidol) used cautiously for persistent psychosis.
- Seizures: benzodiazepines as initial treatment, with progression to other anticonvulsants if necessary.
- Cardiovascular symptoms: standard protocols for hypertension or tachycardia, avoiding beta-blockers.
- Nausea and vomiting: antiemetics like ondansetron.
Given the evolving landscape of synthetic cannabinoid use and adulteration, clinicians must remain vigilant and adapt their approach to managing severe symptoms, prioritizing patient safety and outcomes above all, as emphasized in recent studies 1.
From the Research
Treatment for Severe Symptoms of Synthetic Cannabinoid Use
The treatment for severe symptoms of synthetic cannabinoid use involves managing acute physical and psychiatric adverse effects, as well as implementing psychotherapeutic strategies to reduce use and/or harm 2.
- Management of Acute Physical and Psychiatric Adverse Effects: This may include addressing symptoms such as seizures, cardiotoxicity, and death, which are associated with synthetic cannabinoid use 2, 3.
- Psychotherapeutic Strategies: These strategies are recommended to reduce use and/or harm, and may involve counseling and other forms of therapy to address the underlying issues contributing to synthetic cannabinoid use 2.
- Diagnosis and Evaluation: Clinicians should suspect synthetic cannabinoid use if a patient presents with signs and symptoms consistent with cannabis use, has negative routine urine toxicology screens, or presents with otherwise unexplained sudden onset psychosis 4, 5, 6.
- Consideration of Synthetic Cannabinoid Use in Diagnostic Evaluation: Due to the variability in symptoms produced by synthetic cannabinoid use, clinicians are encouraged to consider synthetic cannabinoid use in the diagnostic evaluation, especially when patients present with psychotic symptoms or other negative mood changes 4, 5, 6.