Differences in clinical features associated with cannabis intoxication in presentations to European emergency departments according to patient age and sex.
Yasmin Schmid, Miguel Galicia, Severin B Vogt, Matthias E. Liechti, Guillermo Burillo Putze, Paul I Dargan, Alison M. Dines, Isabelle Giraudon, Fridtjof Heyerdahl, Knut Erik Hovda, David M Wood, Christopher Yates, Òscar Miró
Clinical Toxicology August 2022 DOI: 10.1080/15563650.2022.2060116 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational study (retrospective analysis of a multicentre emergency department registry) Peer reviewed |
|---|---|
| Sample size | 4,268 |
| Population | Patients presenting to emergency departments with acute cannabis intoxication as the only drug involved (except alcohol), from the Euro-DEN Plus dataset 2014-2019 |
| Topics | Cannabis |
| Keywords | Acute toxicity Drugs Emergency department Sex and age |
| Key findings | The prevalence of clinical features of acute cannabis intoxication differed by age and sex. Patients under 20 more frequently had vomiting, reduced consciousness, and headache and less frequently acute psychosis; patients over 49 more often had hypotension and less often vomiting, anxiety, agitation, and reduced consciousness. Males more frequently presented with hypertension, psychosis, chest pain, and seizures and less frequently with vomiting, anxiety, and hypotension. |
Abstract
To investigate if clinical features associated with acute cannabis intoxication in patients presenting to Emergency Departments for medical assistance differ according to patient age and sex. We analysed presentations in the Euro-DEN Plus dataset from 2014 to 2019 in which cannabis was the only drug involved (except for alcohol), and age, sex and alcohol co-ingestion had been recorded. Age was considered as categorical (five groups; <20, 20-29, 30-39, 40-49 and ≥50 years), and sex as binary variable (male/female). We evaluated 12 key clinical features recorded during emergency department (ED) care. Risks of presenting with each of these clinical features according to patient age and sex were calculated by logistic regression models, and adjusted for sex, age and alcohol co-ingestion. 4,268 of 43,633 Euro-DEN presentations (9.8%) fulfilled the inclusion criteria (median age: 26 years (IQR = 20-34), 70% male, 52% co-ingested alcohol). The frequency of clinical features was: anxiety 28%, vomiting 24%, agitation 23%, palpitations 14%, reduced consciousness 13%, acute psychosis 9%, hallucinations 9%, chest pain 7%, headache 6%, hypotension 4%, hypertension 3% and seizures 2%. Patients younger than 20 years more frequently had vomiting (34.7% of cases), reduced consciousness (21.5%), and headache (10.8%); and less frequently acute psychosis (5.5%). Patients older than 49 years more often had hypotension (6.5%) and less frequently vomiting (20%), anxiety (14%), agitation (14%) and reduced consciousness (10%). Males more frequently presented with hypertension (3.7 vs. 1.5%; OR = 2.311, 95%CI = 1.299-3.816), psychosis (10.4 vs 6.3%; 1.948, 1.432-2.430), chest pain (8.1 vs 4.5%; 1.838, 1.390-2.430) and seizures (2.5 vs 1.4%; 1.805, 1.065-3.060), and less frequently with vomiting (21.8 vs 28.2%; 0.793, 0.677-0.930), anxiety (25.4 vs 32.3%; 0.655, 0.561-0.766) and hypotension (2.9 vs 5.8%; 0.485, 0.350-0.671). The prevalence of some clinical features typically associated with acute cannabis intoxication differed according to age and sex. The causes for these differences should be further investigated in order to better understand the pathophysiology of cannabis-related acute toxicity, and they may be relevant particularly for developing prevention campaigns and for treatment in specific sex and/or age groups.
Comparable studies
Other observational and cohort studies on cannabis, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| High-potency cannabis and the risk of psychosis People with first episode of psychosis and healthy controls from the local population | 2009 | Case-control study | n = 454 |
| Ayahuasca-Assisted Therapy for Addiction: Results from a Preliminary Observational Study in Canada Rural aboriginal population | 2013 | Observational study | |
| Impaired cognitive performance in drug free users of recreational ecstasy (MDMA) Otherwise healthy young people | 2000 | Observational | |
| Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study Individuals from the general population in Germany aged 14-24 at baseline | 2011 | Observational cohort | n = 1,923 |
| Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: follow-up study of 535 incident cases Patients treated for cannabis-induced psychotic symptoms in Denmark between 1994 and... | 2005 | Observational cohort | n = 535 |
Citations in the library
Cites 8
- Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study BMJ March 1, 2011
- Emergency department presentations related to acute toxicity following recreational use of cannabis products in Switzerland. Drug and Alcohol Dependence 2020
- Psychosis associated with acute recreational drug toxicity: a European case series. BMC Psychiatry August 18, 2016
- Sex Differences in Cannabis Use and Effects: A Cross-Sectional Survey of Cannabis Users. Cannabis and Cannabinoid Research 2016
- Transdermal nicotine alters some of marihuana's effects in male and female volunteers. Drug and Alcohol Dependence August 1, 2005
and 3 more in the library