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Children eating the grown-ups ‘medicinal marijuana’ Gummy Bears, being not only sedated but experiencing a disease that affects brain structure and/or function. Encephalopathy causes altered mental state and confusion – Welcome to THC – and its analogues – use!
Sedation and Acute Encephalopathy in a Paediatric Patient Following Ingestion of Delta-8-Tetrahydrocannabinol Gummies
Abstract
BACKGROUND Delta-8 tetrahydrocannabinol (delta-8 THC) is an isomer of delta-9-tetrahydrocannabinol (delta-9 THC), the primary psychoactive cannabinoid in the marijuana plant. Typically found at lower concentrations in marijuana, delta-8 THC exhibits psychoactive properties similar to delta-9 THC. Products containing delta-8 THC are readily available across the US and currently there is a lack of available confirmatory testing specific to delta-8 THC as there is cross-reactivity to other naturally occurring cannabinoids in standard immunoassays. Paediatric exposures to this substance are on the rise.
CASE REPORT We present a case with laboratory confirmation of a previously healthy 2-year-old girl ingesting approximately 15 mg/kg of delta-8 THC gummies. The patient arrived minimally responsive and requiring intubation for encephalopathy. Laboratory confirmation of delta-8 THC exposure is not routinely available with common testing modalities. A urine drug screen preformed in the hospital was positive for delta-9 THC. With the collaboration of the Drug Enforcement Administration's Toxicology Testing Program, detection and confirmation of delta-8 THC was performed in the serum and urine using liquid chromatography-quadrupole time-of-flight mass spectrometry.
CONCLUSIONS: The prevalence of delta-8 THC-containing products in the illicit drug market is increasing rapidly. Delta-8 THC products are now available in gas stations and in headshops. The clinical presentation of delta-8 THC exposure is similar to known effects of delta-9 THC exposure. These similarities limit the clinicians' abilities to determine the specific substance ingested. Symptomatic and supportive care remains an effective treatment for cannabinoid toxicity.
(also Read FDA Issues Warning Letters to Companies Illegally Selling CBD and Delta-8 THC Products Violations Include Marketing Unapproved New Drugs, Misbranding, Adding Delta-8 THC to Food Products)
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Abstract: Evidence for an association between cannabis and psychosis has been documented in literature in many forms including experimental studies, epidemiological data, and case series. The association has implications for psychotic outcomes ranging from mild to severe and occurring over minutes to years. Due to the huge variety of exposures and outcome measures reported, creating a coherent account of all the available information is difficult. A useful way to conceptualize these wide-ranging results is to consider the association between cannabis and psychosis as it occurs within the context of widely used DSM-5 diagnoses. In the present review we examine cannabis/psychosis associations as they pertain to Cannabis Intoxication, Cannabis-Induced Psychotic Disorder, and Schizophrenia. This allows for an understanding of the cannabis and psychosis association along something approaching a continuum. Cannabis intoxication becomes Cannabis-Induced Psychotic Disorder once certain severity and duration criteria are met and Cannabis-Induced Psychotic Disorder is heavily associated with future schizophrenia diagnoses.
Other Associated Research
- Why do patients with psychosis use cannabis and are they ready to change their use?
- Understanding the Link Between Cannabinoids and Psychosis.
- The association between cannabis use and earlier age at onset of schizophrenia and other psychoses: meta-analysis of possible confounding factors.
- [Cannabis and psychosis: search of a causal link through a critical and systematic review].
- Clinical characteristics of primary psychotic disorders with concurrent substance abuse and substance-induced psychotic disorders: A systematic review.
- Mulling up Cannabis and psychosis – Lancet Warning on Cannabis and Psychosis
- Novel Insights on Cannabis and Psychosis
- Cannabis & Psychosis - Irrefutable
- C.I.P #CannabisInducedPsychosis - Prominent, Growing & Devastating
- Cannabis Library – Mental Health Impact
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https://doi.org/10.1016/j.jnma.2022.03.004Get rights and content
Highlights
- Many states and District of Columbia in the United States have legalized marijuana.
- One reason is to expect marijuana to help reduce opioid dependence and mortality.
- However, opioid deaths have increased more where marijuana was legalized.
- This correlation is highly statistically significant for all opioids and fentanyl subgroup.
- The COVID-19 pandemic increased marijuana use and worsened opioid mortality
Conclusion: Instead of supporting the marijuana protection hypothesis, ecologic associations at the national level suggest that marijuana legalization has contributed to the U.S.’s opioid epidemic in all major races/ethnicities, and especially in blacks. If so, the increased use of marijuana during the 2020–2022 pandemic may thereby worsen the country's opioid crisis.
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Abstract: Cannabidiol (CBD) is ubiquitous in state-based medical cannabis programs and consumer products for complementary health or recreational use. CBD has intrinsic pharmacologic effects and associated adverse drug events (ADEs) along with the potential for pharmacokinetic and pharmacodynamic drug–drug interactions (DDIs). Given CBD use among patients with complex conditions and treatment regimens, as well as its expanded consumer use, awareness of potential safety issues with CBD is needed.
Prescribing information for federally approved products containing CBD were reviewed. Data on ADEs and DDIs were extracted and summarized.
Nearly one-half of CBD users experienced ADEs, which displayed a general dose-response relationship. Common ADEs include transaminase elevations, sedation, sleep disturbances, infection, and anemia. Given CBD effects on common biological targets implicated in drug metabolism (e.g., CYP3A4/2C19) and excretion (e.g., P-glycoprotein), the potential for DDIs with commonly used medication is high. General clinical recommendations of reducing substrate doses, monitoring for ADEs, and finding alternative therapy should be considered, especially in medically complex patients. CBD is implicated as both a victim and perpetrator of DDIs and has its own ADE profile. These effects should be considered in the risk-benefit assessment of CBD therapy and patients and consumers made aware of potential safety issues with CBD use.
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Abstract: Tetrahydrocannabinol (THC) is the primary psychoactive ingredient in cannabis… ‘medical’ marijuana programs have increased exposure among medically complex individuals with comorbid conditions and many co-prescribed medications. Thus, THC should be recognized as a pharmacologically complex compound with potential for drug–drug interactions and adverse drug events…
THC also has broad interactions with drug-metabolizing enzymes and can enhance adverse effects of other medications. Pharmacodynamic interactions include neurological effects, impact on the cardiovascular system, and risk of infection. General clinical recommendations for THC use include starting with low doses and titrating to desired effects. However, many interactions may be unavoidable, dose-limiting, or a barrier to THC-based therapy…Meanwhile, clinicians should balance the potential risks of THC and cannabis and the lack of strong evidence of efficacy in many conditions with patient desires for alternative therapy.