Management of emergencies related to cannabis, its derivatives, and synthetic cannabinoids: an update

Cannabis, cannabis-derived products, and synthetic cannabinoids cause a range of acute emergencies including anxiety, panic attacks, altered consciousness, psychomotor agitation, cannabinoid hyperemesis syndrome, and cannabis-induced psychosis. High-potency preparations, especially concentrates and edibles, can produce delayed or more severe intoxication. Synthetic cannabinoids, which often act as full agonists at cannabinoid receptors, carry higher risks of severe agitation, seizures, psychosis, cardiovascular instability, acute kidney injury, and death. Management is primarily supportive, following an A-B-C-D-E emergency framework with benzodiazepines for agitation and seizures, and antipsychotics for persistent psychosis.

Study at a glance

Abstract

Introduction: Cannabis use and the availability of high-potency cannabis-derived products and synthetic cannabinoids have increased worldwide, contributing to a growing burden of emergency presentations involving intoxication, agitation, psychosis, cardiovascular complications, and other acute toxic effects. Objective: This review aimed to update the clinical approach to emergencies related to cannabis, cannabis-derived products, and synthetic cannabinoids, while standardizing terminology across these three conceptually distinct categories. Methods: A structured literature review was conducted using PubMed, SciELO, EMBASE, and Cochrane databases. Eligible studies included systematic reviews, clinical trials, and observational studies, with no restrictions regarding language or publication date. The search strategy combined controlled vocabulary and free-text terms related to cannabis, cannabinoids, intoxication, poisoning, emergency care, psychiatric complications, and acute management. Results: Cannabis and cannabis-derived products are associated with a broad spectrum of acute manifestations, including anxiety, panic attacks, altered consciousness, psychomotor agitation, cannabinoid hyperemesis syndrome, and cannabis-induced psychosis. High-potency preparations, particularly concentrates and edible products, may produce delayed, prolonged, or more severe intoxication. Synthetic cannabinoids present a more unpredictable and potentially severe toxicological profile because many act as full agonists at cannabinoid receptors, increasing the risk of severe agitation, seizures, psychosis, cardiovascular instability, acute kidney injury, and death. Management is primarily supportive and should follow an A–B–C–D–E emergency framework, with continuous clinical reassessment, cardiovascular and neurological monitoring, correction of metabolic abnormalities, benzodiazepines for agitation, anxiety, and seizures, and antipsychotics when persistent psychotic symptoms are present. Conclusion: Emergencies related to cannabis, cannabis-derived products, and synthetic cannabinoids require early recognition, standardized terminology, risk-oriented clinical assessment, and integrated medical, psychiatric, and toxicological management. Specific protocols are essential to improve acute care, reduce complications, and guide prevention strategies.