In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the December 2025 Emergency Medicine Practice article, Diagnosis and Management of Cannabis-Related Emergencies

Episode Outline:

[0:00] Introduction
Welcome and show overview by Sam Ashoo
Mention of resources at ebmedicine.net
[0:46] Episode Start
Hosts introduce themselves: Sam Ashoo and Dr. T.R. Eckler
Dr. Eckler’s background and experience with cannabis cases in Colorado
[1:16] Topic Introduction
Focus on diagnosis and management of cannabis-related emergencies
Prevalence and importance in emergency medicine
[1:34] Legal Landscape
Overview of cannabis legality across states
Medicinal vs. non-medicinal use
[3:03] Increase in ED Visits
Statistics: ~1 million cannabis-related ED visits annually
Demographics: younger population most affected
[3:52] Synthetics and Challenges
Discussion of synthetic cannabinoids and their risks
Issues with detection and legality
[4:50] Clinical Spectrum
Range of presentations: from nausea/vomiting to psychosis and seizures
Impact on different age groups
[6:34] FDA-Approved Uses
Cannabis-derived products approved for specific medical conditions
[7:20] Physiology and Pathophysiology
Cannabinoid receptors (CB1 and CB2) and their effects
Differences between plant-derived and synthetic cannabinoids
[9:10] Chronic Use and Withdrawal
Downregulation of receptors, withdrawal symptoms, and persistent nausea
[10:20] Product Forms and Delivery Methods
Smoking, edibles, oils, tinctures, suppositories, topicals, etc.
Risks associated with concentrated forms (e.g., wax, oils)
[12:00] Clinical Effects by System
Psychiatric: anxiety, psychosis, paranoia
Cardiovascular: tachycardia, MI risk, QT prolongation
Pulmonary, renal, metabolic, dental, and ocular effects
[13:50] Cannabinoid Hyperemesis Syndrome (CHS)
Phases: prodrome, hyperemesis, recovery
Hot showers as a diagnostic clue
[16:00] Withdrawal Syndrome
Symptoms and timeline
Exacerbation with synthetic cannabinoids
[18:15] Counseling and Management
Importance of cessation and patient education
Timeline for symptom improvement
[18:42] Differential Diagnosis
Broad differential for persistent nausea/vomiting and abdominal pain
Importance of considering other causes
[20:55] Diagnostics and Testing
Limitations of drug screens (false positives/negatives)
Importance of EKG, labs, and imaging as indicated
[23:10] Treatment Approaches
First-line: benzodiazepines, antiemetics (ondansetron, metoclopramide)
Second-line: butyrophenones (haloperidol, droperidol), olanzapine
Capsaicin as adjunct therapy
[29:50] Complications and Special Considerations
Risks of undertreatment (e.g., Boerhaave syndrome, aspiration)
Pediatric and pregnant populations: unique risks and reporting requirements
[36:00] Five Practice-Changing Takeaways
Elicit cannabis use history
Know testing limitations
Consider ECG and appropriate labs
Use butyrophenones when indicated
Admit if symptoms are refractory
[39:00] Conclusion

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