Marijuana: Proposed Treatment in Trauma Patients
Author(s):
B Phillips*, B Keath, J Wu, M Hartmann,W Weber, J O�Connor, and J A Asensio
Background: A standardized treatment approach for trauma patients who test positive for marijuana/THC does not currently exist in the literature. Several medications are recommended to treat withdrawal and the cannabinoid hyperemesis syndrome.
Methods: A literature search was conducted through Medline and PUBMED following PRISMA guidelines. Key phrases searched for included “marijuana treatment, trauma marijuana patients, and THC interactions with other medications”. Article selection was based on relevance, with focus on diagnosis and management of marijuana positive patients. All studies, regardless of publication date, were considered due to the paucity of published literature.
Results: Of the 1853 studies identified, 24 were selected to have material relevant and useful to this review. Both retrospective and prospective reports were identified in order toclosely examine the relationship between marijuana use and Injury Severity Scores, hospital length of stay, and related hospital costs.
Limitations: Limitations of this article are similar to all PRISMA-guided review articles: the dependence on previously published research and availability of references as outlined in our methodology.
Conclusion: Patients experiencing marijuana withdrawal should be evaluated for divalproex to reduce marijuana cravings; nefazodone to decrease anxiety and muscle pain; and lofexidine to improve sleep as well as help address withdrawal related stress. Administration of benzodiazepines can be considered to limit aggression. Lorazepam and haloperidol have been shown to be effective for cannabinoid hyper emesis syndrome. All trauma patients should receive tobacco, alcohol, and drug screening, followed by reflex confirmatory blood testing to increase accuracy. Patients testing positive for marijuana should be individually addressed, since cannabis and cannabinoids have been found to alter anesthetic potency. In addition, all marijuana/THC patients should undergo counseling in an effort to reduce use and prevent further morbidity and use related complications.