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Teachable Moment
November 29, 2021

Considering Cannabis Use in Differential Diagnosis: A Teachable Moment

Author Affiliations
  • 1Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
  • 2British Columbia Centre on Substance Use, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  • 3Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  • 4Collaborative Centre for Inclusion Health, University College London, London, United Kingdom
  • 5Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
JAMA Intern Med. 2022;182(1):66-67. doi:10.1001/jamainternmed.2021.6901

A young adult presented to the emergency department (ED) for the fourth time in 6 months with intermittent abdominal pain, nausea, and vomiting. During previous visits, cannabis use history was not obtained, and after undergoing a basic medical examination and receiving supportive treatment, the patient had been discharged without a diagnosis.

During the fourth ED presentation, the patient reported daily cannabis use, smoking approximately 8 to 10 joints per day, in addition to 1 to 2 alcoholic drinks per week; other substances use was denied. During the past month, the patient had begun taking hot showers of 40 minutes or longer duration to relieve abdominal symptoms. The patient’s medical and psychiatric histories were otherwise unremarkable. A physical examination revealed tachycardia, elevated blood pressure, and diffuse abdominal tenderness. Results of a noncontrast computed tomography scan of the abdomen were normal. Results of a urine drug screening were positive only for cannabis metabolites. The patient received intravenous fluids, diclofenac, and ondansetron in the ED.

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