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Clinical manifestations and serious adverse effects after cannabis use: role of age according to sex and coingestion of alcohol

Burillo-Putze G, Ibrahim-Achi D, Galicia M, Supervía A, Martínez-Sánchez L, Ortega Pérez J, Matos Castro S, Martín-Pérez B, López Hernández MA, Miró O

Universidad Europea de Canarias, Facultad de Ciencias de la Salud, Tenerife, Spain. Red de Investigaci√≥n en Atenci√≥n Primaria de Adicciones (RIAPAD). Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain. √Ārea de Urgencias, Hospital Cl√≠nic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain. Servicio de Urgencias, Hospital del Mar, Barcelona, Spain. √Ārea de Urgencias Pedi√°tricas, Hospital Sant Joan de D√©u, Barcelona, Spain. Servicio de Urgencias y Unidad de Toxicolog√≠a Cl√≠nica, Hospital Son Espases, Palma de Mallorca, Spain. Servicio de Urgencias y Unidad de Toxicolog√≠a Cl√≠nica, Hospital Universitario R√≠o Hortega, Valladolid, Spain.

Objectives. To study whether there are age-related differences in the clinical effects of cannabis poisoning and whether any age differences found are also related to sex or coingestion of alcohol.
Methods. Descriptive observational study of patients treated in 11 emergency departments for symptoms related to cannabis use. We collected data on 11 clinical manifestations and used a restricted cubic spline model to analyze their relative frequency according to age. We also looked for any interactions between the findings and patient sex or alcohol coingestion.
Results. A total of 949 patients were studied. The mean age was 29 years, 74% were males, and 39% had also consumed alcohol. We identified 3 symptom patterns related to age. One set of symptoms (vomiting, headache, convulsions, and hypotension) remained stable across all ages. Manifestations that increased in the middle of the age range studied were agitation and aggressivity, psychosis, palpitations and hallucinations. Chest pain and hypertension increased in older-aged patients. The frequencies of palpitations, vomiting, and headache differed according to sex. These manifestations held constant in males but were markedly higher in young-adult females. Coingestion of alcohol was associated with agitation and aggressivity (in 34.0% vs 23.4%, P < .001), fewer reports of palpitations (in 9.8% vs 15.6%, P = .01), less anxiety (in 20.7% vs 27.8%, P = .01), less psychosis (in 10.3% vs 16.6%, P = .007), and less chest pain (in 3.8% vs 9.5%, P = .001). The only significant interaction between age and alcohol coingestion occurred with respect to vomiting and psychosis.
Conclusions. There are age-related differences in the acute clinical manifestations of cannabis poisoning requiring emergency hospital care. Sex and coingestion of alcohol modify the relationship between age and frequency of some manifestations.

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