Cannabis Use Disorder
Anorexia in patients with AIDS / Chemotherapy-induced N/V
FDA approved indications for Dronabinol
Patients report taking a log hot bath or shower helps manage symptoms
Key presenting symptom of CHS
Not life-threatening
Note about cannabis withdrawal
Take 30 minutes prior to a meal or on an empty stomach
Administration of Dronabinol
Mild (2-3 symptoms) / Moderate (4-5 symptoms) / Severe (6+ symptoms)
CUD Severity
Recent cannabis use / Behavioral or psychological changes / At least *two* that develop within 2 hours of cannabis use: Conjunctival injection, Increased appetite, Dry mouth, Tachycardia
Cannabis Intoxication DSM-V Criteria
Cessation of cannabis that is heavy and prolonged / At least *three* that develop within 1 week after cessation: Irritability, anger, or aggression, nervousness or anxiety, sleep difficulty, decreased appetite or weight loss, restlessness, depressed mood, physical discomfort symptoms
Cannabis Withdrawal DSM-V Criteria
Inhalation as smoke or vaporizable liquid or edible candy or snack / K2 or Spice
Cannabis preparations: Marijuana
Cannabinoid Hyperemesis Syndrome (CHS)
Cyclical vomiting in habitual marijuana users after cannabis dicontinuation
5 mg IV x1
Dose of Haloperidol for CHS Tx
TDD targeting 30-120 mg/day in divided doses (can titrate dose every 5-7 days)
Dosing of Dronabinol
100 mg po TID initially, then target 1200 mg/day in divided doses
Dosing of Gabapentin for CUD
Higher strength capsaicin cream (0.1%) applied to abdomen q4-6h prn
Dosing of Topical Capsaicin for CHS Tx
No criteria met for CUD for at least 3 months, but for less than 12 months
Early Remission of CUD
Patient *may* have concomitant CUD
Note about Cannabis Intoxication
IV fluids for hydration / anti-emetics for N/V / correct electrolyte abnormalities if present
First line Tx for CHS
Patient *will* have concomitant moderate or severe CUD
Note about Cannabis Withdrawal
Cannabinoid Hyperemesis Syndrome
Meaning of CHS
EKG for potential QTc prolongation
Monitoring of Haloperidol for CHS Tx
Abstinence from cannabis
Most effective treatment for CHS
CBT / MET / Combination of CBT and MET
Non-pharmacologic Tx for CUD
Disulfiram reaction occurs in patients receiving disulfiram or metronidazole / Should be DC 14 days prior to disulfiram initiation and can't administer for first 7 days after Dc of dronabinol
Note about oral solution of Dronabinol
Should be DC if seizures develop
Note about seizures and Dronabinol
Years (most cases are daily users)
Patients with CHS typically used cannabis for how long?
Capsule (Marinol) - CIII / Oral Solution (Syndros) - CII
Preparations of Dronabinol
Haloperidol or Topical Capsaicin
Second line Tx for CHS
No criteria met for CUD for at least 12 months
Sustained Remission of CUD
Schedule I
Synthetic Cannabinoids are what schedule drug?
Cannabis
What is the most common illicit drug use in the US?
Cannabinoid receptor agonists (Dronabinol and Nabilone)
What pharmacotherapy options are effective for improvement of withdrawal symptoms?
Gabapentin
What pharmacotherapy options are potentially effective for improvement of withdrawal symptoms and decreasing cannabis use?
