Background: Unintentional ingestion of cannabis products among children and adolescents is well described, but we found no summary of presentations among adults.
Methods: We performed a scoping literature review of presenting symptoms, sources of exposure, and clinical courses of adults who seek medical care following unintentional ingestion of psychoactive cannabis or intentional ingestion of cannabidiol (CBD)/synthetic cannabinoids for nonpsychoactive purposes. We searched PubMed, Web of Science, and Ovid databases in October 2023 and June 2024.
Results: After removal of duplicates, we included 370 manuscripts in title/abstract review, 115 in full-text review, and extracted data from 20. Inclusion criteria were cases in adults ≥18 years involving unintentional ingestion of psychoactive cannabis or intentional ingestion of CBD or synthetic cannabinoids for non-psychoactive/recreational purposes. Most cases took place in the United States (n=13). Number of subjects ranged from 1 (n=6) to 28. The most common age group was 18-30 years of age (range: 18-30 to 91-100 years). Most cases involved unintentional consumption of THC-containing food products: baked cake/cookies/brownies (n=10) or candy (n=4). Two papers detailed multiple cases of consumption of THC-adulterated CBD oil as a health supplement. The most common presenting symptoms were dizziness/vertigo (n=11), vomiting (n=8), tachycardia (n=7), somnolence (n=6) and nausea (n=6). Several other common symptoms—confusion (n=5), gait issues (n=4), paresthesias (n=3), weakness (n=3) and speech difficulties (n=3) are often associated with stroke, and in several cases this was the primary differential diagnosis. One or more patients were admitted in 13 reports; duration ranged from 4 hours to 2 weeks. Treatment was generally supportive care (e.g., intravenous fluids, antiemetics). Elderly patients appeared to have more serious symptoms, possibly because of existing comorbidities and/or inadvertent consumption of large amounts of THC-containing food products (e.g., multiple multi-serving baked goods). Patients generally returned to baseline within 24 hours.
Conclusions: Implications for hospitalist practice include adding inadvertent cannabis consumption to the differential diagnosis when patients (particularly elderly patients) present with stroke-like symptoms without accompanying signs, and asking about consumption of candy or baked goods prepared by others or of unknown provenance or use of purportedly CBD-only supplements.