Differences in clinical features associated with cannabis intoxication in presentations to European emergency departments according to patient age and sex

Abstract

Objective

To investigate if clinical features associated with acute cannabis intoxication in patients presenting to Emergency Departments for medical assistance differ according to patient age and sex.

Methods

We analysed presentations in the Euro-DEN Plus dataset from 2014 to 2019 in which cannabis was the only drug involved (except for alcohol), and age, sex and alcohol co-ingestion had been recorded. Age was considered as categorical (five groups; <20, 20–29, 30–39, 40–49 and ≥50 years), and sex as binary variable (male/female). We evaluated 12 key clinical features recorded during emergency department (ED) care. Risks of presenting with each of these clinical features according to patient age and sex were calculated by logistic regression models, and adjusted for sex, age and alcohol co-ingestion.

Results

4,268 of 43,633 Euro-DEN presentations (9.8%) fulfilled the inclusion criteria (median age: 26 years (IQR = 20–34), 70% male, 52% co-ingested alcohol). The frequency of clinical features was: anxiety 28%, vomiting 24%, agitation 23%, palpitations 14%, reduced consciousness 13%, acute psychosis 9%, hallucinations 9%, chest pain 7%, headache 6%, hypotension 4%, hypertension 3% and seizures 2%. Patients younger than 20 years more frequently had vomiting (34.7% of cases), reduced consciousness (21.5%), and headache (10.8%); and less frequently acute psychosis (5.5%). Patients older than 49 years more often had hypotension (6.5%) and less frequently vomiting (20%), anxiety (14%), agitation (14%) and reduced consciousness (10%). Males more frequently presented with hypertension (3.7 vs. 1.5%; OR = 2.311, 95%CI = 1.299–3.816), psychosis (10.4 vs 6.3%; 1.948, 1.432–2.430), chest pain (8.1 vs 4.5%; 1.838, 1.390–2.430) and seizures (2.5 vs 1.4%; 1.805, 1.065–3.060), and less frequently with vomiting (21.8 vs 28.2%; 0.793, 0.677–0.930), anxiety (25.4 vs 32.3%; 0.655, 0.561–0.766) and hypotension (2.9 vs 5.8%; 0.485, 0.350–0.671).

Conclusions

The prevalence of some clinical features typically associated with acute cannabis intoxication differed according to age and sex. The causes for these differences should be further investigated in order to better understand the pathophysiology of cannabis-related acute toxicity, and they may be relevant particularly for developing prevention campaigns and for treatment in specific sex and/or age groups.

Keywords:

• Cannabis
• drugs
• sex and age
• acute toxicity
• emergency department

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The present study was in part possible due to a grant from the Generalitat de Catalunya [Catalan Government, GRC 2009/1385, 2014/0313 y 2017/1424], a grant from the DPIP/ISEC Programme of the European Union [JUST/2012/DPIP/AG/3591] and support from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).