Cannabis use disorder

Clinically significant problematic behavioral or psychological changes that develop during cannabis intoxication

anxiety, impaired judgment, impaired motor coordination, euphoria, social withdrawal

Cannabinoid receptor agonists

dronabinol, nabilone

How often can dronabinol be titrated

every 5-7 days

Decrease in cannabis use and improvement of withdrawal symptoms may be due to this tx but has conflicting evidence

gabapentin

MOA of topical capsaicin

interaction with TRVP1 or VR1

Which drugs should be avoided with use of Syndros (Dronabinol solution)

metronidazole or disulfiram within 14 days of dronabinol initiation

CNS risks with dronabinol

Exacerbate mental disorders (elderly especially), seizures

T/F: Cannabis withdrawal is life-threatening and needs to be aggressively treated

F

Target dose for gabapentin

1200 mg/day in divided doses

How many sx are needed and in what time frame to classify cannabis intoxication?

2 sx within 2 hrs of use

Cannabis withdrawal needs how many sx and in what time frame?

3 within and 1 physical sx causing significant discomfort ~1 week after use

How should dronabinol be taken

30 min prior to meal or on an empty stomach

Target daily dose for dronabinol for cannabis use disorder

30-120 mg/day (usually in divided doses)

Cannabinoid hyperemesis syndrome (CHS)

Cyclical vomiting in habitual marijuana users after cannabis discontinuation (typically daily users for years)

Difference between MET AND CBT

CBT- how to fix the problem MET- Motivation to make a change

Preparations of dronabinol

Capsule (marinol CIII) and solution (syndros CII)

Sx that may be present during cannabis intoxication

Conjunctival injection Increased appetite dry mouth tachycardia (DICT)

2nd line pcol tx for CHS

Dopamine agonists (haloperidol 5mg IV x1) topical capsaicin 0.1% applied to abdomen q4-6h PRN

If giving haloperidol for CHS, what needs to be monitored?

EKG

CV risks with dronabinol

Hypotension/HTN, syncope, tachycardia

First line Pcol tx for CHS

IV fluids for hydration and antiemetics, correct electrolytes if needed

Sx present during cannabis withdrawal may include

Irritability, anger, aggression nervousness or anxiety sleep difficulty Decreased appetite or weight loss restlessness depressed mood At least 1 physical sx: abdominal pain, shakiness/tremors, sweating, fever, chills, HA

Synthetic cannabinoids

K2 and spice

GI risks with dronabinol

N/V, abdominal pain, can induce CHS

Clinical presentation of CHS

Pts reporting taking long hot baths/showers to help)key sx) Severe N/V Vomiting recurs in a cyclic pattern over months Resolution of sx after stopping cannabis use

Which form of dronabinol can cause disulfiram rxns?

Solution

FDA approved uses for dronabinol

anorexia in pts with AIDS chemo-induced N/V

Clinical effects for cannabis use disorder include

reduce withdrawal sx reduce cravings improvement in sleep low abuse potential