{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T04:24:57Z","timestamp":1782188697534,"version":"3.54.5"},"reference-count":37,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>In recent years, the potency of natural cannabis products (herb and resin) has increased with a higher delta\u2010 9\u2010tetrahydrocannabinol (\u03949\u2010THC) content, but there are limited data on trends on clinical presentation and severity of toxicity in cannabis users consulting the emergency department (ED) for acute intoxication. This study aimed to analyse the evolution over time of clinical findings and severity of presentations in a large series of patients presenting to European EDs with acute toxicity after lone cannabis use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Secondary analysis of data included in the Euro\u2010DEN Registry from 1 October 2013 to 31 December 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>40 EDs in 25 European countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants\/cases<\/jats:title>\n                    <jats:p>ED presentations reporting lone cannabis use. Presentations reporting concomitant use of, or having positive toxicological tests for, ethanol or other drugs were excluded. 3839 ED presentations reporting lone cannabis use were analysed (median age 25\u2009years, interquartile range= 20\u201333; 71% male).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Temporal trends of 14 pre\u2010defined clinical signs\/symptoms and 4 markers of severity, which included the need for ambulance transfer to the ED, hospitalisation, intensive care unit admission (ICU) and death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>The most frequent clinical features were anxiety (35%), agitation (22%), decreased alertness (drowsiness or coma, 21%) and vomiting (20%), while seizures, arrythmias and hyperthermia were observed in &lt;3% of cases. Statistically significant changes over time were only found in the frequency of hypotension [adjusted odds ratio (OR) = 1.239 per every subsequent year, 95% confidence interval (CI) = 1.107\u20131.386], hypertensive crisis (OR = 1.168, 95% CI = 1.070\u20131.274) and palpitations (OR = 0.922, 95% CI = 0.883\u20130.962). Nonlinear analyses detected statistically significant mid\u2010period increases for anxiety, agitation and arrhythmias that subsided by the end of the study, and showed increases in chest pain and decreases in seizures that became statistically significant in the latter half of the period. Regarding episode severity, 76% of cases were brought to the ED by ambulance, 13% required hospitalisation, 1% were admitted to the ICU and 0.1% died. No statistically significant changes were observed over time in either the linear or the nonlinear models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Very few changes in the clinical features of patients presenting to European emergency departments with lone acute cannabis toxicity were identified over 2013 to 2022, suggesting that despite the increase in potency of cannabis in Europe over this period, the severity of acute intoxication has remained unchanged.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70233","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T10:41:51Z","timestamp":1763030511000},"page":"316-330","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Changes in clinical features and severity in patients presenting to European emergency departments with acute cannabis toxicity over the 10\u2010year period from 2013 to 2022"],"prefix":"10.1111","volume":"121","author":[{"given":"\u00d2scar","family":"Mir\u00f3","sequence":"first","affiliation":[{"name":"Emergency Department Hospital Cl\u00ednic, Barcelona; IDIBAPS  Barcelona Catalonia Spain"},{"name":"Medical School University of Barcelona  Catalonia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5333-3090","authenticated-orcid":false,"given":"Miguel","family":"Galicia","sequence":"additional","affiliation":[{"name":"Emergency Department Hospital Cl\u00ednic, Barcelona; IDIBAPS  Barcelona Catalonia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul I.","family":"Dargan","sequence":"additional","affiliation":[{"name":"Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners London  UK"},{"name":"Clinical Toxicology, Faculty of Life Sciences and Medicine King's College London  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Wood","sequence":"additional","affiliation":[{"name":"Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners London  UK"},{"name":"Clinical Toxicology, Faculty of Life Sciences and Medicine King's College London  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison M.","family":"Dines","sequence":"additional","affiliation":[{"name":"Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners London  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fridtjof","family":"Heyerdahl","sequence":"additional","affiliation":[{"name":"Air Ambulance Department, Division of Prehospital Services Oslo University Hospital  Oslo Norway"},{"name":"Institute of Clinical Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Knut Erik","family":"Hovda","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine University of Oslo  Oslo Norway"},{"name":"Department of Acute Medicine, Medical Division Oslo University Hospital  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Giraudon","sequence":"additional","affiliation":[{"name":"European Union Drugs Agency (EUDA)  Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Yates","sequence":"additional","affiliation":[{"name":"SAMU 061 Balears Clinical Toxicology Workgroup Health Research Institute of the Balearic Islands (IdISBa)  Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Liechti","sequence":"additional","affiliation":[{"name":"Division of Clinical Pharmacology and Toxicology University Hospital and University of Basel  Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Odd Martin","family":"Vallersnes","sequence":"additional","affiliation":[{"name":"Department of General Practice University of Oslo  Oslo Norway"},{"name":"Oslo Accident and Emergency Outpatient Clinic City of Oslo Health Agency  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Eyer","sequence":"additional","affiliation":[{"name":"Department of Clinical Toxicology, TUM University Hospital Technical University of Munich  Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Burillo\u2010Putze","sequence":"additional","affiliation":[{"name":"Emergency Department Hospital Universitario de Canarias, Universidad de La Laguna  Tenerife Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.biopsych.2016.01.004","article-title":"Changes in cannabis potency over last two decades (1995\u20102014). 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