Approach to hallucinogen, inhalant, and cannabis use, intoxication, and overdose: Clinical sciences

Acute hallucinogen, inhalant, or cannabis intoxication causes a temporary state of altered consciousness as well as behavioral and psychological changes, impaired judgment, and physiological disturbances. These psychoactive recreational substances alter neurotransmitters and receptors within the central nervous system to produce various effects, including euphoria, distorted perceptions and thoughts, and sedation or psychomotor agitation.

Okay, if a patient presents with a chief concern suggesting hallucinogen, inhalant, or cannabis use, intoxication, or overdose; first perform an ABCDE assessment to determine if they are stable or unstable. If unstable, stabilize their airway, breathing, and circulation; and perform endotracheal intubation if your patient demonstrates shallow or ineffective respirations. Next, obtain IV access and consider starting IV fluids. Then, put your patient on continuous vital sign monitoring, pulse oximetry, and cardiac telemetry; and provide supplemental oxygen if needed. Additionally, if your patient is hyperthermic, provide cooling blankets; and if they are agitated, consider sedation.

Here’s a clinical pearl to keep in mind! Patients with significant hallucinogen, inhalant, or cannabis exposure may present with overdose, which may cause hemodynamic instability, severe psychosis, seizures, or even coma. Additionally, individuals with acute inhalant intoxication can develop life-threatening cardiac dysrhythmias requiring resuscitative measures.

Here’s a high-yield fact! 3,4-Methyl enedioxy methamphetamine, also known as MDMA, is a commonly abused recreational substance with serotonergic properties. Excessive ingestion can result in serotonin syndrome, characterized by elevated blood pressure; increased heart rate; myoclonus; hyperreflexia; diaphoresis; and seizures. If you suspect serotonin syndrome, immediately discontinue the offending substance and any serotonergic medications your patient might be taking.