Cannabis-Related Disorders and Toxic Effects: Insights from Gorelick’s Review

In December 2023, Dr. David A. Gorelick, M.D., Ph.D., published a comprehensive review article titled “Cannabis-Related Disorders and Toxic Effects.” This detailed examination sheds light on the acute and subacute effects, as well as potential disorders and toxicities associated with cannabis use.

Cannabis Intoxication: Acute Effects and Physical Manifestations

Cannabis use initiates a range of acute psychological and physiological effects, influenced by factors such as THC dosage, route of administration, and user tolerance. These effects encompass euphoria, relaxation, increased appetite, impaired short-term memory, and altered psychomotor coordination. However, higher doses may induce anxiety, panic attacks, or paranoia, and in rare cases, psychotic symptoms like hallucinations.

Physically, cannabis intoxication leads to impaired motor coordination, slurred speech, dry mouth, increased heart rate, and red eyes. Smoking cannabis exacerbates respiratory issues, including cough, wheezing, and asthma exacerbation. Importantly, cannabis use is linked to acute transient cardiac arrhythmias, with potential risks such as atrial fibrillation and tachycardia.

Furthermore, cannabis intoxication can impair driving ability, with cross-sectional surveys suggesting an increased risk of motor vehicle crashes, though significantly lower compared to alcohol-related risks.

Management of Cannabis Intoxication

Cannabis intoxication is typically mild and self-limited, with severe cases requiring treatment for anxiety, panic attacks, or psychosis. Benzodiazepines are utilized for agitation, while second-generation antipsychotic agents may be administered for psychosis. Notably, there is no specific FDA-approved medication for the treatment of cannabis intoxication.

Subacute Effects of Cannabis: Psychiatric Syndromes

Cannabis use is associated with four subacute psychiatric syndromes persisting beyond the initial 24 hours of acute intoxication. These include:

Cannabis-Induced Anxiety Disorder

Manifests as general anxiety or panic attacks, accounting for a substantial percentage of emergency department cases related to cannabis.

Cannabis-Induced Psychotic Disorder

Transient psychotic symptoms during intoxication are reported in 5 to 50% of adults, with potential long-term psychotic disorders developing in a significant proportion, especially in those using high-potency cannabis.

Cannabis-Induced Sleep Disorder

Cannabis alters sleep latency and duration, and withdrawal can lead to insomnia and disturbing dreams. Treatment options are limited, with some suggestion of improvement through sleep hygiene and cognitive-behavioral therapy.

Cannabis-Induced Delirium

Characterized by hyperactivity, agitation, autonomic instability, and disorientation, cannabis-induced delirium is poorly understood. Treatment may involve dexmedetomidine for hyperactive delirium.

Cannabis Withdrawal: Symptoms and Treatment

Heavy or long-term cannabis use can result in withdrawal symptoms, including psychological effects like depressed mood and anxiety, along with physical signs such as abdominal cramps and muscle aches. Treatment is typically psychosocial, with counseling or cognitive-behavioral therapy. Medications like benzodiazepines or CBD (dronabinol, nabilone, or nabiximols) may be considered in some cases.

Adverse Effects of Long-Term Cannabis Use

Long-term cannabis use, especially during pregnancy, may have adverse effects on neonates, including low birth weight and increased risk of admission to neonatal intensive care. Cannabis withdrawal symptoms can overlap with tobacco withdrawal, making differential diagnosis challenging. Additionally, cannabinoid hyperemesis syndrome, characterized by cyclical vomiting and abdominal pain, is a notable consequence of frequent and heavy cannabis use.

Dr. Gorelick's review provides a meticulous examination of the various disorders and toxic effects associated with cannabis use. The article underscores the need for a nuanced understanding of the acute and subacute effects of cannabis, as well as the importance of tailored interventions for individuals experiencing cannabis-related issues.

The review can be accessed here.