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?