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• W4386565045 abstract "FigureFigureI spent the past weekend studying for recertification and noted a few interesting things about emergency medicine. Lots of issues concerning acute and chronic alcoholism popped up. But anyone who has spent any time in the ED is aware of that. We have all spent a considerable portion of our careers waiting for patients to sober up, evaluating patients with alcohol-induced ascites, occasionally tapping their bellies, dealing with alcoholics with bloody emesis, and, of course, caring for patient having withdrawals. But one “drug” doesn't seem to cause a ruckus in the ED—Cannabis. Sure, you get the occasional panic attack, usually from a novice user trying an edible. Or hyperemesis of unknown etiology that requires a number of workups and ends up being from chronic Cannabis overuse. Both situations are occurring with increasing frequency in states with recreational Cannabis legalization. (Perhaps that would change if we educate physicians on dosages and usage so patients have better advisors than the local budtender, but I digress.) What you don't see is chronic liver failure, dementia, COPD, or any chronic debilitating diseases that need monitoring and management for Cannabis users. That's not to say that we may not find long-term negative effects from this plant one day, but we haven't yet. This difference is reflected in the EM board exam and in practice for emergency physicians. We need to know how to work up and treat a drunk person and all the negative effects of being an alcoholic that result from the legal and socially promoted use of alcohol. Self-Care That leads me to self-care, which didn't really exist in my residency. We were taught alcohol. All residents across the hospital were taught to drink alcohol. Our residency retreats revolved around alcohol. Spouses and significant others were pushed out (unintentionally) because they didn't get what we were going through. I once even hosted a baby shower in which we drank beer out of baby bottles. We heard about how the original emergency physicians and surgeons used to snort cocaine to stay awake and vigilant during night shifts. We ate donuts and pizza in the middle of the night to deal with fear, emotional stress, and physical stress. We talked about how to use Ambien, Benadryl, or wine to help with sleep when flip-flopping between night and day shifts. We drank after pronouncing babies dead. What we didn't do is talk about it, mandate therapy, or think about healthy chemical and physical options we should be using. We need to rethink how we deal with stress in jobs that are literally dealing with life and death. And that was all before COVID-19. Colleagues recently asked me about CBD and Cannabis to help with post-shift self-care, AKA how to wind down. One colleague noted that he takes a 30 mg CBD gummy after shifts to help him unwind instead of reaching for a beer. Another colleague asked about using CBD daily because COVID-19 was exacerbating an already stressful career. This colleague asked many of the right questions: What about dose, frequency, side effects, and mixing with other medications? Post-Shift Wind-Down A common dose is 30 mg PO, though smaller people may want to consider 15-20 mg. These are general reference points because there is currently no standard dose for relaxation. One study recommends doses for public speaking. (Neuropsychopharmacology. 2011;36[6]:1219; https://bit.ly/32w4Mf6.) Other small studies have shown promise for treating anxiety in Parkinson's with 50-100 mg TID dosing. (Eur Arch Psychiatry Clin Neurosci. 2019;269:121.) These dosages are an easy starting point for those looking to relax without alcohol and for a substance without a propensity for addiction. Side effects at low doses like these are mostly related to dry mouth and eyes, mild constipation (although it can improve constipation for some), and drug-drug interactions. Do not use CBD if you are on immunosuppressants for a solid organ transplant because it may interact with your life-saving immunosuppressant levels. Where do you purchase CBD? The most difficult challenge in using CBD is where to get it and what to get. Products are popping up everywhere and are legally shipped across all 50 states. There are a couple key factors in finding good products. Look for a Certificate of Analysis (COA), which confirms thorough third-party testing of what is actually in the product. Look for mg dosing or concentration. Gummies vary in dosing standards from 5 mg to 30 mg. Oils vary from 50 mg/oz to 3000 mg/oz. Consider the cost. CBD is not cheap, especially in comparison with THC. This is in part due to the larger dosing requirements (2-5 mg THC v. 30 mg CBD as a “dose”). The terms “full spectrum,” “broad spectrum,” and “organic” have no consistent definition or requirement. These are essentially marketing tools. Most importantly, and take this seriously, if you need to talk to someone, therapy is valuable and underutilized. If you are not comfortable with that, start talking with colleagues about how they wind down. What meditation apps are helpful? How do they cope with kids (theirs and ED patients)? Who do they talk to after a code? How much are they drinking? Are a couple of beers or glasses of wine every day too much? Alcohol is a poor solution to self-care. Next month: More on self-care about sleep and Cannabis." @default.
• W4386565045 created "2023-09-10" @default.
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• W4386565045 date "2020-09-16" @default.
• W4386565045 modified "2023-10-16" @default.
• W4386565045 title "The Case for Cannabis" @default.
• W4386565045 doi "https://doi.org/10.1097/01.eem.0000717292.89718.8a" @default.
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