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Cannabis use disorder

What's new

Updated 2024 SAEM (GRACE-4) guidelines for the management of cannabinoid hyperemesis syndrome.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of cannabis use disorder are prepared by our editorial team based on guidelines from the Society for Academic Emergency Medicine (SAEM 2024), the American Society of Regional Anesthesia and Pain Medicine (ASRA 2023), the World Health Organization (WHO 2023), the Society of Obstetricians and Gynaecologists of Canada (SOGC 2022), the United ...
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Screening and diagnosis

Indications for screening: as per DoD/VA 2021 guidelines, insufficient evidence to recommend for or against screening for drug use disorders in primary care to facilitate enrollment in treatment.
I
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Medical management

Pharmacotherapy: as per DoD/VA 2021 guidelines, insufficient evidence to recommend for or against the use of pharmacotherapy in the treatment of CUD.
I
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  • Management of cannabinoid hyperemesis syndrome

Nonpharmacologic interventions

Brief intervention
As per WHO 2023 guidelines:
Offer screening and brief intervention in adults using cannabis. Include at least a single session, incorporating individualized feedback and advice on reducing or stopping cannabis consumption and the offer of follow-up care in the brief intervention.
B
Consider referring adult patients with hazardous cannabis use or CUD not responding to brief interventions for specialist intervention.
C
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  • Psychotherapy

  • Mindfulness-based therapies

  • Technology-based interventions

  • Recovery-oriented interventions

Perioperative care

Perioperative considerations, screening for cannabis use
As per ASRA 2023 guidelines:
Obtain universal screening for cannabinoids (including the type of cannabis or cannabinoid product, time of last consumption, route of administration, and amount and frequency of use) before surgery.
A
Do not obtain universal toxicology screening for cannabinoids preoperatively.
D
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  • Perioperative considerations (counseling)

  • Perioperative considerations (timing of surgery)

  • Perioperative considerations (cannabis dose tapering)

  • Perioperative considerations (anesthesia and analgesia)

  • Perioperative considerations (ventilation)

  • Perioperative considerations (monitoring)

  • Perioperative considerations (management of cannabis withdrawal)

Specific circumstances

Female patients, screening for cannabis use
As per SOGC 2022 guidelines:
Screen females for cannabis use
B
using appropriate screening tools
B
as for other substance use and obtain further exploration of its impact.
B
Use a trauma-informed care approach and harm reduction when inquiring about cannabis use.
B
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  • Female patients (counseling in cannabis users)

  • Elderly patients (screening for cannabis use)

  • Elderly patients (education and counseling)

  • Elderly patients (advice for avoidance)

  • Elderly patients (clinical assessment)

  • Elderly patients (management)

  • Pregnant patients (screening)

  • Pregnant patients (counseling)

  • Pregnant patients (advice for avoidance)

  • Pregnant patients (monitoring)

  • Breastfeeding patients