Pharmacological interventions in the treatment of the acute effects of cannabis: a systematic review of literature

To review the available scientific literature concerning pharmacological interventions for the treatment of the acute effects of cannabis.A search was performed on the Pubmed, Lilacs, and Scielo online databases by combining the terms cannabis, intoxication, psychosis, anxiety, and treatment. The articles selected from this search had their reference lists checked for additional publications related to the topic of the review.The reviewed articles consisted of case reports and controlled clinical trials and are presented according to interventions targeting the physiological, psychiatric, and cognitive symptoms provoked by cannabis. The pharmacological interventions reported in these studies include: beta-blockers, antiarrhythmic agents, antagonists of CB-1 and GABA-benzodiazepine receptors, antipsychotics, and cannabidiol.Although scarce, the evidence on pharmacological interventions for the management of cannabis intoxication suggests that propanolol and rimonabant are the most effective compounds currently available to treat the physiological and subjective effects of the drug. Further studies are necessary to establish the real effectiveness of these two medications, as well as the effectiveness of other candidate compounds to counteract the effects of cannabis intoxication, such as cannabidiol and flumazenil.Cannabis sativa has Δ9-tetrahydrocannabinol (Δ9-THC), isolated in the 1960s [1], as its main psychoactive compound. The concentration of Δ9-THC in the different presentations of cannabis (marijuana, hashish, skunk) is proportional to the intensity of its toxic effects. In cannabis, considered to be the most consumed illicit substance in the world [2], increased concentrations of Δ9-THC have been reported in recent years [3-5].At the same time, there has been an increase in the number of patients reporting to specialized services with complaints related to the use of cannabis. A survey in the USA revealed that between 1992 and 1998 the demand for treatment a