I recently listened to DDx, a new podcast from Figure1. In their third episode, a 37-year-old man presents to the emergency department in the middle of the night with persistent vomiting and retching. He is highly vocal and agitated. Upon questioning, he reveals that he experiences these episodes frequently and previous investigations have all been inconclusive. His skin is noted to be flushed and his father explains that he has spent most of the day taking a hot shower. At this point, Dr. John Richards realizes the key piece of information other physicians may have overlooked. “Do you smoke marijuana?” he asks.
Interestingly, this reminded me of my very own experience with a young man who suffered from cannabinoid hyperemesis syndrome. He presented to the emergency department, as well, with retching and vomiting after having what he described as “one to two hits” of marijuana.
This ultimately led me to start thinking about legalization of marijuana and the recommendation of medical marijuana. I started to consider my role as a practitioner and how it has changed given recent state-based legislation. What exactly is my role as a pediatrician when it comes to counseling young patients about marijuana use now that several states have accepted it as legal? How does a physician navigate this acceptance while still honoring the federal classification of marijuana as a schedule 1 substance, making its distribution a federal offense? While I know no initiatives existed to legalize the recreational use of marijuana for minors, it still is worth learning about.
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