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Key Resources

Bottom Line Recommendations: Cannabis Intoxication  (2021)

Bottom Line Recommendations: Cannabis Intoxication

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Dr. Kaitlin Hogue, Dr. Neil Desai and TREKK Network

Dr. Kaitlin Hogue, Dr. Neil Desai and TREKK Network

Bottom line recommendations for cannabis intoxication. Published online: December 2021

Bottom line recommendations for cannabis intoxication. Published online: December 2021

Recommandations de Base: Intoxication au cannabis  (2022)

Recommandations de Base: Intoxication au cannabis

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Dr. Kaitlin Hogue, Dr. Neil Desai and TREKK Network

Dr. Kaitlin Hogue, Dr. Neil Desai and TREKK Network

Bottom Line Recommendations for treatment and management of cannabis intoxication. Published online March 2022. 

Bottom Line Recommendations for treatment and management of cannabis intoxication. Published online March 2022. 

Formulations and Methods of Delivery: Cannabis  (2021)

Formulations and Methods of Delivery: Cannabis

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Dr. Kaitlin Hogue, Dr. Neil Desai, Danica Irwin and TREKK Network

Dr. Kaitlin Hogue, Dr. Neil Desai, Danica Irwin and TREKK Network

Formulations and methods of delivery table for cannabis. Uploaded 2021-12-06

Formulations and methods of delivery table for cannabis. Uploaded 2021-12-06

Formes et modes de consommation du cannabis  (2022)

Formes et modes de consommation du cannabis

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Dr. Kaitlin Hogue, Dr. Neil Desai, Danica Irwin and TREKK Network

Dr. Kaitlin Hogue, Dr. Neil Desai, Danica Irwin and TREKK Network

Formulations andmethods of delivery table for cannabis. Uploaded online: March 2022

Formulations andmethods of delivery table for cannabis. Uploaded online: March 2022

Clinical guidelines

Clincal Practice Guildeline: Addressing Pediatric Cannabis Exposure  (2019)

Clincal Practice Guildeline: Addressing Pediatric Cannabis Exposure

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American College of Medical Toxicology

American College of Medical Toxicology

The purpose of this was to outline recommendations for clincians treating pediatric patients with actue cannabis intoxication.

The purpose of this was to outline recommendations for clincians treating pediatric patients with actue cannabis intoxication.

Systematic reviews

Systematic Review: Unintentional Cannabis Ingestion in Children: A Systematic Review  (2017)

Systematic Review: Unintentional Cannabis Ingestion in Children: A Systematic Review

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Richards JRS, N. E.; Moulin, A. K.

Richards JRS, N. E.; Moulin, A. K.

To analyze published reports of unintentional cannabis ingestions in children to determine presenting signs and symptoms, route of exposure, treatment, and outcome.

To analyze published reports of unintentional cannabis ingestions in children to determine presenting signs and symptoms, route of exposure, treatment, and outcome.

Systematic Review: Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatmenta Systematic Review  (2017)

Systematic Review: Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatmenta Systematic Review

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Sorensen, C. J., DeSanto, K., Borgelt, L., Phillips, K. T., & Monte, A. A

Sorensen, C. J., DeSanto, K., Borgelt, L., Phillips, K. T., & Monte, A. A

To summarize the available evidence on CHS diagnosis, pathophysiology, and treatment.

To summarize the available evidence on CHS diagnosis, pathophysiology, and treatment.

Key studies

Key Study: Cannabis Intoxication Case Series: The Dangers of Edibles Containing Tetrahydrocannabinol  (2018)

Key Study: Cannabis Intoxication Case Series: The Dangers of Edibles Containing Tetrahydrocannabinol

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Vo KTH, H.; Li, K.; Ho, R. Y.; Wu, A. H. B.; Lynch, K. L.; Smollin, C. G.

Vo KTH, H.; Li, K.; Ho, R. Y.; Wu, A. H. B.; Lynch, K. L.; Smollin, C. G.

Cannabis and its principal active constituent, 9-tetrahydrocannabinol (THC), are increasingly available as edibles resembling commercially available food products. In this case series, we describe a population of predominantly pediatric patients who were inadvertently exposed to a THC-containing product in San Francisco.

Cannabis and its principal active constituent, 9-tetrahydrocannabinol (THC), are increasingly available as edibles resembling commercially available food products. In this case series, we describe a population of predominantly pediatric patients who were inadvertently exposed to a THC-containing product in San Francisco.

Key Study: Unintentional Cannabis Intoxication in Toddlers  (2017)

Key Study: Unintentional Cannabis Intoxication in Toddlers

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Claudet IM, S.; Labadie, M.; Manin, C.; Michard-Lenoir, A. P.; Eyer, D.; Dufour, D.; Marie-Jeanne Study, Group

Claudet IM, S.; Labadie, M.; Manin, C.; Michard-Lenoir, A. P.; Eyer, D.; Dufo...

We sought to evaluate the French national trend of admissions for unintentional cannabis intoxication in children over an 11-year period (20042014).

We sought to evaluate the French national trend of admissions for unintentional cannabis intoxication in children over an 11-year period (20042014).

Key Study: Acute intoxication caused by synthetic cannabinoids 5F-ADB and MMB-2201: A case series  (2017)

Key Study: Acute intoxication caused by synthetic cannabinoids 5F-ADB and MMB-2201: A case series

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Barcelo BP, S.; Lopez-Corominas, V.; Gomila, I.; Yates, C.; Busardo, F. P.; Pellegrini, M.

Barcelo BP, S.; Lopez-Corominas, V.; Gomila, I.; Yates, C.; Busardo, F. P.; P...

Here, we report five cases of acute intoxication by synthetic cannabinoids 5F-ADB and MMB-2201 with analytical confirmation

Here, we report five cases of acute intoxication by synthetic cannabinoids 5F-ADB and MMB-2201 with analytical confirmation

Key Study: Acute intoxication caused by a synthetic cannabinoid in two adolescents  (2012)

Key Study: Acute intoxication caused by a synthetic cannabinoid in two adolescents

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Heath TSB, Z.; Thompson, A. J.; Tecklenburg, F. W.

Heath TSB, Z.; Thompson, A. J.; Tecklenburg, F. W.

In this report, we describe two adolescent patients admitted after they inhaled K2, resulting in loss of consciousness, tachycardia, and diffuse pain.

In this report, we describe two adolescent patients admitted after they inhaled K2, resulting in loss of consciousness, tachycardia, and diffuse pain.

Key Study: Ataxia and shaking in a 2-year-old girl: acute marijuana intoxication presenting as seizure.  (2005)

Key Study: Ataxia and shaking in a 2-year-old girl: acute marijuana intoxication presenting as seizure.

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Bonkowsky, J. L., Sarco, D., & Pomeroy, S. L

Bonkowsky, J. L., Sarco, D., & Pomeroy, S. L

This is a case study of a young girl experiencing cannabis usage.

This is a case study of a young girl experiencing cannabis usage.

Key Study: Increased Testing and Health Care Costs for Pediatric Cannabis Exposures  (2019)

Key Study: Increased Testing and Health Care Costs for Pediatric Cannabis Exposures

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Bashqoy FH, J. W.; Reiter, P. D.; Wang, G. S.; Borgelt, L. M.

Bashqoy FH, J. W.; Reiter, P. D.; Wang, G. S.; Borgelt, L. M.

This study aimed to evaluate the process of identifying marijuana exposure in a children's hospital emergency department and compare the cost of diagnostic testing and procedures.

This study aimed to evaluate the process of identifying marijuana exposure in a children's hospital emergency department and compare the cost of diagnostic testing and procedures.

Key Study: Acute cannabis toxicity  (2019)

Key Study: Acute cannabis toxicity

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Noble MJH, K.; Hendrickson, R. G.

Noble MJH, K.; Hendrickson, R. G.

We describe the clinical effects of, and products associated with, acute exposures to cannabis during the early legalization period of recreational cannabis in Oregon and Alaska.

We describe the clinical effects of, and products associated with, acute exposures to cannabis during the early legalization period of recreational cannabis in Oregon and Alaska.

Key Study: A 21st Century Problem: Cannabis Toxicity in a 13-Month-Old Child  (2019)

Key Study: A 21st Century Problem: Cannabis Toxicity in a 13-Month-Old Child

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Levene RJP-C, Elza; Wolfram, Sigrid

Levene RJP-C, Elza; Wolfram, Sigrid

We report the case of a 13-month-old female presenting with self-limiting altered mental status and lethargy, with a subsequent diagnosis of tetrahydrocannabinol exposure on confirmatory urine gas chromatography-mass spectrometry.

We report the case of a 13-month-old female presenting with self-limiting altered mental status and lethargy, with a subsequent diagnosis of tetrahydrocannabinol exposure on confirmatory urine gas chromatography-mass spectrometry.

Key Study: Intoxicacin por cannabis en menores de 3 aos  (2018)

Key Study: Intoxicacin por cannabis en menores de 3 aos

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Pinedo-Painous IG-R, Roser; Valls-Lafon, Anna; Muoz-Santanach, David; Martnez-Snchez, Lidia

Pinedo-Painous IG-R, Roser; Valls-Lafon, Anna; Muoz-Santanach, David; Martnez...

We present a retrospective, descriptive study of patients aged 3 years or younger who were treated for cannabis poisoning in a pediatric emergency department between 2012 and 2017.

We present a retrospective, descriptive study of patients aged 3 years or younger who were treated for cannabis poisoning in a pediatric emergency department between 2012 and 2017.

Key Study: A 10-year review of cannabis exposure in children under 3-years of age: do we need a more global approach?  (2017)

Key Study: A 10-year review of cannabis exposure in children under 3-years of age: do we need a more global approach?

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Claudet, I., Le Breton, M., Brhin, C., & Franchitto, N

Claudet, I., Le Breton, M., Brhin, C., & Franchitto, N

We carried out a retrospective cohort study of children admitted to a pediatric emergency department due to unintentional cannabis exposure over a 10-year period from 2004 to 2014.

We carried out a retrospective cohort study of children admitted to a pediatric emergency department due to unintentional cannabis exposure over a 10-year period from 2004 to 2014.

Key Study: Changes in Cannabis Potency Over the Last 2 Decades (19952014): Analysis of Current Data in the United States  (2016)

Key Study: Changes in Cannabis Potency Over the Last 2 Decades (19952014): Analysis of Current Data in the United States

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ElSohly, M. A., Mehmedic, Z., Foster, S., Gon, C., Chandra, S., & Church, J. C.

ElSohly, M. A., Mehmedic, Z., Foster, S., Gon, C., Chandra, S., & Church,...

This report examines the concentration of cannabinoids in illicit cannabis products seized by the U.S. Drug Enforcement Administration over the last 2 decades, with particular emphasis on (9)-tetrahydrocannabinol and cannabidiol.

This report examines the concentration of cannabinoids in illicit cannabis products seized by the U.S. Drug Enforcement Administration over the last 2 decades, with particular emphasis on (9)-tetrahydrocannabinol and cannabidiol.

Key Study: Non-Smoker Exposure to Secondhand Cannabis Smoke. I. Urine Screening and Confirmation Results  (2015)

Key Study: Non-Smoker Exposure to Secondhand Cannabis Smoke. I. Urine Screening and Confirmation Results

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Cone, E. J., Bigelow, G. E., Herrmann, E. S., Mitchell, J. M., LoDico, C., Flegel, R., & Vandrey, R

Cone, E. J., Bigelow, G. E., Herrmann, E. S., Mitchell, J. M., LoDico, C., Fl...

A systematic study was conducted of smoke exposure on drug-free participants.

A systematic study was conducted of smoke exposure on drug-free participants.

Key Study: Non-smoker exposure to secondhand cannabis smoke II: Effect of room ventilation on the physiological, subjective, and behavioral/cognitive effects.  (2015)

Key Study: Non-smoker exposure to secondhand cannabis smoke II: Effect of room ventilation on the physiological, subjective, and behavioral/cognitive effects.

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Herrmann, E. S., Cone, E. J., Mitchell, J. M., Bigelow, G. E., LoDico, C., Flegel, R., & Vandrey, R.

Herrmann, E. S., Cone, E. J., Mitchell, J. M., Bigelow, G. E., LoDico, C., Fl...

This report examines the concentration of cannabinoids in illicit cannabis products seized by the U.S. Drug Enforcement Administration over the last 2 decades, with particular emphasis on (9)-tetrahydrocannabinol and cannabidiol.

This report examines the concentration of cannabinoids in illicit cannabis products seized by the U.S. Drug Enforcement Administration over the last 2 decades, with particular emphasis on (9)-tetrahydrocannabinol and cannabidiol.

Key Study: Nonsmoker Exposure to Secondhand Cannabis Smoke. III. Oral Fluid and Blood Drug Concentrations and Corresponding Subjective Effects  (2015)

Key Study: Nonsmoker Exposure to Secondhand Cannabis Smoke. III. Oral Fluid and Blood Drug Concentrations and Corresponding Subjective Effects

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Cone, E. J., Bigelow, G. E., Herrmann, E. S., Mitchell, J. M., LoDico, C., Flegel, R., & Vandrey, R.

Cone, E. J., Bigelow, G. E., Herrmann, E. S., Mitchell, J. M., LoDico, C., Fl...

The study was designed to produce extreme cannabis smoke exposure conditions tolerable to drug-free nonsmokers

The study was designed to produce extreme cannabis smoke exposure conditions tolerable to drug-free nonsmokers

Key Study: The Pharmacologic and Clinical Effects of Medical Cannabis  (2013)

Key Study: The Pharmacologic and Clinical Effects of Medical Cannabis

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Borgelt, L. M., Franson, K. L., Nussbaum, A. M., & Wang, G. S.

Borgelt, L. M., Franson, K. L., Nussbaum, A. M., & Wang, G. S.

This article will describe the pharmacology of cannabis, effects of various dosage formulations, therapeutics benefits and risks of cannabis for pain and muscle spasm, and safety concerns of medical cannabis use.

This article will describe the pharmacology of cannabis, effects of various dosage formulations, therapeutics benefits and risks of cannabis for pain and muscle spasm, and safety concerns of medical cannabis use.

Key Study: Synthetic Cannabinoid Exposure in Adolescents Presenting for Emergency Care  (2018)

Key Study: Synthetic Cannabinoid Exposure in Adolescents Presenting for Emergency Care

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Gilley MB, J.; Calello, D. P.; Wax, P.; Finkelstein, Y.; Toxicology Investigators, Consortium

Gilley MB, J.; Calello, D. P.; Wax, P.; Finkelstein, Y.; Toxicology Investiga...

The objective of this study was to characterize the clinical picture and management of synthetic cannabinoid exposure in a cohort of adolescents.

The objective of this study was to characterize the clinical picture and management of synthetic cannabinoid exposure in a cohort of adolescents.

Key Study: Marijuana Misadventures in Children: Exploration of a Dose-Response Relationship and Summary of Clinical Effects and Outcomes  (2018)

Key Study: Marijuana Misadventures in Children: Exploration of a Dose-Response Relationship and Summary of Clinical Effects and Outcomes

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Heizer JWB, L. M.; Bashqoy, F.; Wang, G. S.; Reiter, P. D.

Heizer JWB, L. M.; Bashqoy, F.; Wang, G. S.; Reiter, P. D.

This study aimed to explore a dose-response relationship of delta-9-tetrahydrocannabinol (THC) in THC-nave children after unintentional acute exposure and compare clinical outcomes with non-nave children.

This study aimed to explore a dose-response relationship of delta-9-tetrahydrocannabinol (THC) in THC-nave children after unintentional acute exposure and compare clinical outcomes with non-nave children.

Key Study: Longitudinal associations of social cognition and substance use in childhood and early adolescence: findings from the Avon Longitudinal Study of Parents and Children  (2018)

Key Study: Longitudinal associations of social cognition and substance use in childhood and early adolescence: findings from the Avon Longitudinal Study of Parents and Children

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Fluharty, M. E., Heron, J., & Munaf, M. R

Fluharty, M. E., Heron, J., & Munaf, M. R

We investigated both directions of association within an adolescent birth cohort: the association of social cognition with subsequent substance use, and the association of early substance use with subsequent social cognition

We investigated both directions of association within an adolescent birth cohort: the association of social cognition with subsequent substance use, and the association of early substance use with subsequent social cognition

Key Study: Drug Misuse in Adolescents Presenting to the Emergency Department  (2017)

Key Study: Drug Misuse in Adolescents Presenting to the Emergency Department

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Finkelstein YG, G.; Hutson, J. R.; Armstrong, J.; Baum, C. R.; Wax, P.; Brent, J.; Toxicology Investigators, Consortium

Finkelstein YG, G.; Hutson, J. R.; Armstrong, J.; Baum, C. R.; Wax, P.; Brent...

Drug misuse is a disturbing, common practice among youth. One in 4 American adolescents reports consuming prescription medications without a clinical indication. We sought to explore current trends of drug misuse in adolescents.

Drug misuse is a disturbing, common practice among youth. One in 4 American adolescents reports consuming prescription medications without a clinical indication. We sought to explore current trends of drug misuse in adolescents.

Key Study: Detecting biomarkers of secondhand marijuana smoke in young children  (2017)

Key Study: Detecting biomarkers of secondhand marijuana smoke in young children

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Wilson, K. M., Torok, M. R., Wei, B., Wang, L., Robinson, M., Sosnoff, C. S., & Blount, B. C.

Wilson, K. M., Torok, M. R., Wei, B., Wang, L., Robinson, M., Sosnoff, C. S.,...

We studied children ages 1 mo to 2 y hospitalized with bronchiolitis in Colorado from 2013 to 2015.

We studied children ages 1 mo to 2 y hospitalized with bronchiolitis in Colorado from 2013 to 2015.

Key Study: Unintentional Pediatric Exposures to Marijuana in Colorado, 2009-2015  (2016)

Key Study: Unintentional Pediatric Exposures to Marijuana in Colorado, 2009-2015

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George SamWang,MD1,2; Marie-ClaireLe Lait,MS2; Sara J.Deakyne,MPH3; et al

George SamWang,MD1,2; Marie-ClaireLe Lait,MS2; Sara J.Deakyne,MPH3; et al

To compare the incidence of pediatric marijuana exposures evaluated at a children's hospital and regional poison center (RPC) in Colorado before and after recreational marijuana legalization and to compare population rate trends of RPC cases for marijuana exposures with the rest of the United States.

To compare the incidence of pediatric marijuana exposures evaluated at a children's hospital and regional poison center (RPC) in Colorado before and after recreational marijuana legalization and to compare population rate trends of RPC cases for marijuana exposures with the rest of the United States.

Key Study: Marijuana exposure among children younger than siz years in the United States  (2016)

Key Study: Marijuana exposure among children younger than siz years in the United States

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Onders B, Casavant MJ, Spiller HA, Chounthirath T, Smith GA

Onders B, Casavant MJ, Spiller HA, Chounthirath T, Smith GA

This study investigates marijuana exposures among children <6 years old in the United States using data from the National Poison Data System.

This study investigates marijuana exposures among children <6 years old in the United States using data from the National Poison Data System.

Key Study: Synthetic Cannabinoid Exposure  (2016)

Key Study: Synthetic Cannabinoid Exposure

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Adair AG, Spencer C.; Greeley, Christopher S.; Coleman, Ryan D.; Shekerdemian, Lara S.

Adair AG, Spencer C.; Greeley, Christopher S.; Coleman, Ryan D.; Shekerdemian...

We present 2 cases of actual or highly suspected synthetic cannabinoid exposure in 2 pediatric patients to demonstrate the wide range of symptoms that can be present in these patients.

We present 2 cases of actual or highly suspected synthetic cannabinoid exposure in 2 pediatric patients to demonstrate the wide range of symptoms that can be present in these patients.

Key Study: Treat plays trick on a 3-year-old boy  (2016)

Key Study: Treat plays trick on a 3-year-old boy

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Thuy Trang JNC, Arthur K.

Thuy Trang JNC, Arthur K.

Presents a case study of a 3 year old with acute cannabis intoxication.

Presents a case study of a 3 year old with acute cannabis intoxication.

Key Study: Accidental pediatric ingestions of medical marijuana: a 4-year poison center experience  (2015)

Key Study: Accidental pediatric ingestions of medical marijuana: a 4-year poison center experience

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Lovecchio, F., & Heise, C. W

Lovecchio, F., & Heise, C. W

A study of incidental pediatric cannabis consumption over a 4-year period.

A study of incidental pediatric cannabis consumption over a 4-year period.

Key Study: A cannabinoid-intoxicated child treated with dexmedetomidine: a case report  (2015)

Key Study: A cannabinoid-intoxicated child treated with dexmedetomidine: a case report

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Cipriani, F., Mancino, A., Pulitan, S. M., Piastra, M., & Conti, G.

Cipriani, F., Mancino, A., Pulitan, S. M., Piastra, M., & Conti, G.

To our knowledge, this is the first reported case of dexmedetomidine use to support a cannabis intoxicated patient.

To our knowledge, this is the first reported case of dexmedetomidine use to support a cannabis intoxicated patient.

Key Study: The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update  (2015)

Key Study: The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update

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Ammerman, S., Ryan, S., Adelman, W. P., & THE COMMITTEE ON SUBSTANCE ABUSE, T. C. O. A.

Ammerman, S., Ryan, S., Adelman, W. P., & THE COMMITTEE ON SUBSTANCE ABUS...

This technical report updates the 2004 American Academy of Pediatrics technical report on the legalization of marijuana

This technical report updates the 2004 American Academy of Pediatrics technical report on the legalization of marijuana

Key Study: Dangerous Relationships: Asthma and Substance Abuse  (2013)

Key Study: Dangerous Relationships: Asthma and Substance Abuse

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Caponnetto, P., Auditore, R., Russo, C., Alamo, A., Campagna, D., Demma, S., & Polosa, R

Caponnetto, P., Auditore, R., Russo, C., Alamo, A., Campagna, D., Demma, S., ...

The review emphasizes the importance for clinicians to be alert to the possibility of this substance as a precipitating factor for acute asthma.

The review emphasizes the importance for clinicians to be alert to the possibility of this substance as a precipitating factor for acute asthma.

Key Study: Drug use and screening in pediatric trauma  (2011)

Key Study: Drug use and screening in pediatric trauma

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Martin KLV, K. N.; Girotti, M. J.; Stewart, T. C.; Parry, N. G.

Martin KLV, K. N.; Girotti, M. J.; Stewart, T. C.; Parry, N. G.

This article will describe the pharmacology of cannabis, effects of various dosage formulations, therapeutics benefits and risks of cannabis for pain and muscle spasm, and safety concerns of medical cannabis use.

This article will describe the pharmacology of cannabis, effects of various dosage formulations, therapeutics benefits and risks of cannabis for pain and muscle spasm, and safety concerns of medical cannabis use.

Key Study: Sensitivity and Specificity of Urinary Cannabinoid Detection With Two Immunoassays After Controlled Oral Administration of Cannabinoids to Humans.  (2008)

Key Study: Sensitivity and Specificity of Urinary Cannabinoid Detection With Two Immunoassays After Controlled Oral Administration of Cannabinoids to Humans.

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Grauwiler, S. B., Drewe, J., & Scholer, A.

Grauwiler, S. B., Drewe, J., & Scholer, A.

This study aims to describe trends in substance use and screening in the Canadian pediatric trauma population.

This study aims to describe trends in substance use and screening in the Canadian pediatric trauma population.

Key Study: Urine drug screens in overdose patients do not contribute to immediate clinical management  (2001)

Key Study: Urine drug screens in overdose patients do not contribute to immediate clinical management

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Montague REG, R. F.; Lewis, J. H.; Shenfield, G. M.

Montague REG, R. F.; Lewis, J. H.; Shenfield, G. M.

A prospective study assessed whether routine urine drug screens might alter the management of overdose patients.

A prospective study assessed whether routine urine drug screens might alter the management of overdose patients.

Key Study: Substance abuse in adolescent trauma  (1993)

Key Study: Substance abuse in adolescent trauma

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Loiselle JMB, M. D.; Templeton, J. M., Jr.; Schwartz, G.; Drott, H.

Loiselle JMB, M. D.; Templeton, J. M., Jr.; Schwartz, G.; Drott, H.

To determine if there is a significant prevalence of drug or alcohol use among adolescents evaluated for significant acute trauma.

To determine if there is a significant prevalence of drug or alcohol use among adolescents evaluated for significant acute trauma.


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