Cannabis Intoxication

• The prevalence of cannabis intoxication is unknown.
• Most cannabis users will at some time meet criteria for cannabis intoxication.

• The effects of intoxication usually last 3 to 4 hours, with the duration being longer when ingested orally.
  • The effects may occasionally last longer or reoccur within a 24-hour period due to the slow release of active metabolites from fatty tissue or into enterohepatic circulation.
• Cannabis intoxication cause dysfunction at work, school, and/or social life.
• There can be a failure to role obligations, traffic accidents, and unprotected sexual activity.^[2]
• In rare instances, cannabis intoxication can trigger a cannabis-induced psychosis.

Recent use of cannabis.

Clinically significant problematic behavioural or psychological changes (e.g. - impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment, social withdrawal) that developed during, or shortly after, cannabis use.

At least 2 of the following signs or symptoms developing within 2 hours of cannabis use:

1. Conjunctival injection
2. Increased appetite
3. Dry mouth
4. Tachycardia

The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

• Intoxication is characterized by euphoria (“high”), giddiness, anxiety, dilated pupils, paranoid delusions, hallucinations, perception of slowed time, impaired judgment, social withdrawal, increased appetite, dry mouth, and conjunctival injection (red eyes).
• For some individuals, severe anxiety and/or dysphoria can occur
• Intoxication can occur within minutes if cannabis is smoked but may take several hours if the cannabis ingested orally.^[3]

• Cannabis-induced psychotic disorder
  • When hallucinations occur in the absence of intact reality testing, a cannabis-induced psychotic disorder should be considered.
• Other substance intoxication
  • Cannabis intoxication can resemble intoxication with other substances. However, in alcohol or sedative, hypnotic, or anxiolytic intoxication, there is decreased appetite, aggressive behavior, and nystagmus or ataxia.
  • Hallucinogens in low doses can also resemble cannabis intoxication. Phencyclidine can also cause perceptual changes but intoxication is much more likely to cause ataxia and aggressive behavior.
• Other cannabis-induced disorders
  • Cannabis intoxication is different from the other cannabis-induced disorders (e.g. - cannabis-induced anxiety disorder, with onset during intoxication) because the symptoms in these latter disorders predominate the clinical presentation and are severe enough to warrant independent clinical attention.

• Cannabis intoxication is managed conservatively if it is clinically distressing
• In cases of severe anxiety and dysphoria presenting to an emergency department, individuals may receive benzodiazepine to acutely treat the symptoms.