What is the recommended treatment for accidental Tetrahydrocannabinol (THC) consumption?

Management of Accidental THC Consumption

For accidental THC consumption, the recommended treatment is supportive care with IV fluids for dehydration, topical capsaicin (0.1%) cream for symptom relief, and complete abstinence from further cannabis use to allow symptoms to resolve.

Initial Assessment

When evaluating a patient with accidental THC consumption, focus on:

• Determining the amount and form of THC consumed
• Time since consumption
• Current symptoms
• Pre-existing medical conditions
• Concurrent medications

Symptom Management

Acute Management

1. Supportive Care

   • IV fluids for dehydration 1
   • Monitor vital signs
   • Reassurance and calm environment

2. Nausea and Vomiting

   • Topical capsaicin (0.1%) cream applied to the abdomen 1
   • Hot showers/baths for symptom relief 1
   • Consider butyrophenones (haloperidol, droperidol) for severe cases 2
   • Avoid opioids as they can worsen nausea 1

3. Anxiety and Agitation

   • Reassurance and calm environment
   • Avoid benzodiazepines if possible due to potential drug interactions 2

4. Sedation

   • Monitor for excessive sedation, especially with high-potency THC products 3, 4
   • Ensure patient safety if sedated

Special Considerations

Cannabis Hyperemesis Syndrome (CHS)

For patients with severe, persistent vomiting after significant THC exposure:

• Complete cannabis cessation is the cornerstone of management 1
• Consider tricyclic antidepressants (particularly amitriptyline) starting at 25mg and titrating to 75-100mg for symptom relief 1
• Rule out other causes of vomiting through appropriate workup 1

Psychotic Symptoms

For patients experiencing psychotic symptoms:

• Monitor for disconnected thoughts, panic reactions, disturbing changes in perception, delusions and hallucinatory experiences 5
• Provide reassurance that symptoms are temporary
• Consider psychiatric consultation for severe or persistent symptoms 3

Duration of Effects and Follow-up

• Inhaled THC effects typically peak within 15-30 minutes and taper off within 2-3 hours 6
• Orally ingested THC effects begin 30-90 minutes after consumption, peak after 2-3 hours, and may last 4-12 hours 6
• High-potency THC products ("dabs," "wax") may cause more prolonged and severe effects 3

Prevention of Complications

• Ensure adequate hydration
• Monitor for drug interactions, as cannabinoids inhibit several Phase I and II metabolism enzymes 7
• Caution patients about driving or operating machinery until effects completely resolve 2

Common Pitfalls to Avoid

1. Underestimating potency: Modern cannabis products can have extremely high THC concentrations, especially concentrates like "wax" or "dabs" 3

2. Overlooking drug interactions: THC and CBD inhibit cytochrome P450 enzymes, potentially increasing exposure to other medications 2

3. Premature discharge: Effects of oral THC consumption may be delayed and prolonged, requiring extended observation 6

4. Missing cannabis hyperemesis syndrome: Consider this diagnosis in patients with recurrent vomiting who report regular cannabis use 1

5. Overuse of pharmaceuticals: In most cases of accidental consumption, supportive care alone is sufficient; avoid unnecessary medications 1

By following this approach, most cases of accidental THC consumption can be managed effectively with minimal complications.