Background: As cannabis is legalized/decriminalized in more US jurisdictions, and social norms and perceptions around use change, many products for psychoactive, recreational use, and purported medical uses are available in edible and supplement formats. Rates of unintentional ingestion of cannabis products among children and adolescents have been described in the literature, but there is no extant summary of inpatient presentations of such ingestion among adults. Understanding what such cases looks like, what forms of treatment (including supportive care) are effective, how the hospital course progresses, and which potential sources of exposure to ask about can equip healthcare providers to identify and treat affected patients.
Methods: Scoping reviews are a form of “knowledge synthesis that uses a systematic and iterative approach to identify and synthesize an existing or emerging body of literature on a given topic.”1 We are performing a scoping review of the presenting symptoms, sources of exposure, and clinical courses of adults who present to hospitals following such ingestion in the literature. We worked with a Clinical Informationist to develop a search strategy and searched PubMed, EMBASE, Web of Science, CINAHL, and Ovid databases.
Results: We present interim results of our ongoing scoping review. We found an initial set of 657 papers and imported the search results into EndNote and Covidence collaborative review software; after removal of duplicates, we included 350 unique manuscripts. Inclusion criteria are reports of cases /series of cases in the US or Canada (since other nations have significantly different medicolegal contexts); among adults 18 years of age or older; and involved unintentional ingestion of psychoactive cannabis in edible goods or supplements, intentional ingestion of substances with cannabidiol (CBD) for non-psychoactive/recreational purposes that were unknowingly adulterated with the psychoactive compound tetrahydrocannabinol (THC), or intentional ingestion of synthetic cannabinoids for non-psychoactive/recreational purposes. Exclusion criteria are cases among children and adolescents; cases of intentional ingestion of cannabis or cannabinoid products for psychoactive/recreational purposes; and papers that do not present cases or case series (e.g., epidemiological studies of use patterns).Preliminary analysis shows very few published cases of unintentional ingestion of psychoactive cannabis products by adults; most describe children and adolescents, or cases of adults who overconsumed products ingested intentionally. Among the few cases we have found in the literature, most seem to have consumed CBD products marketed as supplements that were adulterated with THC. Moving forward, we will select studies for inclusion and exclusion based on collaboratively developed criteria through a systematic process of abstract/title screening, full text review, and data extraction using EndNote and Covidence software. We will extract data on exposures, presentations, and hospital course.
Conclusions: Unintentional ingestion of psychoactive cannabis products is a growing problem that internists are likely to see more frequently as laws and social mores around cannabis consumption change. We have found no systematic collection to date of sources of consumption and presentations among adults in the literature, and plan to use the results of our scoping review to produce such a resource for internists and hospitalists.