The Treatment of Cannabis Toxicity

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he increasing prevalence and potency of cannabis following the legalization of recreational marijuana sales in a number of states have also increased the rate of emergency room visits associated with the drug. The Nationwide Emergency Department Sample (NEDS) reported over 1.5 million estimated ER visits associated with cannabis in 2017, over 1% of all visits to the ER during that year. Rates of cannabis-related visits were growing at an average of 13% per year and are expected to be higher now. (As originall posted on by Nate Guzowski)

The risks of acute cannabinoid intoxication (ACI) are real. Despite the perception that cannabis use poses few risks, perhaps due to the negligible risk of death from cannabis, there are multiple serious complications from its use, including psychiatric issues and gastrointestinal problems. 

Despite the increased burden from ACI, the treatment algorithm has remained largely unchanged for many years. The protocol largely consists of screening for comorbidities, e.g. ruling out infarction (which is at a 5x risk following smoked cannabis), respiratory depression, or the presence of other substances. Patients with severe psychiatric disturbances like psychosis need to be observed for at least 24 hours, and those with severe respiratory depression (or in the case of children, those at risk for respiratory depression) may need to be intubated.

Symptomatic treatment, if it is provided at all, typically consists of sedatives or anxiolytics to address psychiatric disturbances, or antiemetics to address vomiting. However, even this is rare with 58% of adults receiving no treatment at all. 

A More Direct Way of Treating Cannabis Toxicity

There are currently no approved treatments for the specific indications of ACI or cannabis toxicity, and there are no established restorative therapies. However, there is a previously discovered class of drugs called CB1 antagonists that can reverse the effects of cannabis. These drugs bind to the CB1 receptor and prevent THC or synthetic cannabinoids from engaging and activating the receptor. This is the same principle by which naloxone is use to prevent opiate overdose, albeit with a different (mu-opioid) receptor.

The company Anebulo Pharmaceuticals (NASDAQ:) is developing a CB1 antagonist for the treatment of ACI. The drug was previously developed by Vernalis Therapeutics, which performed Phase I dosing and safety studies, where effects were seen that are consistent with the class, suggesting on target CB1 antagonism. The company is planning on running a Phase II study in cannabis users starting in 2021. 


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