pph nationwidewebinar 09201748qbc13dv397vzass1iql2a1- · pdf file marijuana chocolate chip...

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Pet Poison Helpline ©20173600 Amer i can B l vd . W. , #725 B loom in g ton , MN 55431www.pe tpo i sonhe lp l i n e . com

Pot and Pets: Updates on Marijuana Intoxication in

Dogs and Cats

Ahna Brutlag, DVM, MS, DABT, DABVT Associate Director of Veterinary Services & Sr. Veterinary Toxicologist Pet Poison Helpline [email protected] & Adjunct Assistant Professor Dept. Veterinary Biomedical Sciences College of Vet. Med., University of Minnesota

September 19, 2017

Speaker Introduction Ahna G. Brutlag, DVM, 

MS, DABT, DABVT

Associate Director of Veterinary Services & 

Senior Veterinary Toxicologist Pet Poison Helpline

Minneapolis, Minnesota  &

Adjunct Assistant Professor  College of Veterinary Medicine University 

of Minnesota

What is Pet Poison Helpline? • 24/7 animal poison control center • Veterinary & human expertise

– 20 DVMs, 50 CVTs • DABVT, DABT • DACVECC • DACVIM

– 7 PharmDs • Case fee of $59 includes 

– Unlimited consultation – Fax or email of case report

• Educational center – Free webinars (archived) – Tox tools

• Wheel of Vomit • Pot of Poisons (toxic plants)

– Textbook – iPhone app – Newsletters for vet 

professionals – Free resources for clinics

• Videos • Electronic material • Clings

Email us for info!

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Pet Poison Helpline® and Nationwide® September, 2017

Nationwide® & PET POISON HELPLINE® working together

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Shared mission in highlighting the importance of preparing for accidents and poisonings in small animals

Addressing the cost of veterinary care Nationwide® covers the $59 Pet Poison Helpline® fee when an insured pet is brought in to your hospital for care

Enabling best medicine Pet owners with Nationwide® spend twice as much on their pets than those without pet insurance

Nationwide® pet insurance claims in 2016

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 Incidence rate of “poisonings of plant origin”

 1230 pets affected

 Average claim amount $562

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Nationwide’s Whole Pet® with Wellness!

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It’s serious coverage—which means serious business for you.

Coverage Highlights:

• One annual deductible—not per incident • 90% reimbursement on veterinary expenses • All veterinary exams including specialty and emergency visits • All hospitalization and surgeries including preventive and elective procedures • All injuries, illnesses, and cancer including hereditary and congenital conditions • All diagnostic testing including xrays, MRIs, CAT scans and ultrasounds • All prescribed medications, nutritional supplements and therapeutic diets • All preventive care including vaccinations, teeth cleaning and spay/neuter

90% reimbursement with $250 annual deductible

PET POISON HELPLINE

Objectives

• Marijuana poisoning in dogs & cats – Sources – Pharmacology/physiology – Clinical signs – Treatment

• CBD vs THC • FDA perspective

Audience  Poll 

PET POISON HELPLINE

Historical medical use

• Medical use first 2700 BCE

• First legit medical use in  U.S., 1851

• Marihuana Tax Act 1937

• Removed from USP in  1942

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PET POISON HELPLINE

Case #1

• “Max”: Vomited at home. Extreme sedation, HR 80‐90  with normal pulses but heart is “beating hard”

• “Scruff”: ataxic, dribbling urine, head bobbing

• Dogs alone all day, present ~4 pm • Owner denies “toxin” exposure

“Max”, 4 yo, 70 lb, MN  Labradoodle “Scruff”, 5 yo, 20 lb, MN 

mixed breed

PET POISON HELPLINE

PET POISON HELPLINE

Marijuana chocolate chip cookies!

3 dozen cookies total, ~2 dozen  missing

 1 ounce medical marijuana   10 ounces of Nestle 

chocolate chips

PET POISON HELPLINE

PET POISON HELPLINE

Marijuana Trends at PPH

• 448% increase in cases over 6 yrs

PET POISON HELPLINE

Food

Plant

Medical Unknown

SOURCE

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PET POISON HELPLINE

“Medibles”

• #1 source • 70% involve chocolate • Top sources

– Brownies & cookies – Chocolate bars/choc covered fruit – Gummi bears – Butter/coconut oil

• Risk – High concentration THC – Better bioavailability (butter/oil) – Co‐ingestants

PET POISON HELPLINE

PET POISON HELPLINE

Dried plants

• #2 source • Not your parent’s plants…

– Up to 30% THC – Joint = 15‐30 mg THC

• Vomiting common

Mature plant, courtesy of  Minnesota Medical Solutions

PET POISON HELPLINE

PET POISON HELPLINE

What is “medical cannabis”?

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PET POISON HELPLINE

THC Concentrates

• 50‐90% THC • Smoked or vaped • High risk to pets

http://honestmarijuana.com/trichomes/

PET POISON HELPLINE

PET POISON HELPLINE

Marijuana alternatives

• “K2” & “Spice” • Smoked • In 2010 became popular in US as “legal highs”

– Sold in gas stations, online, head shops, etc.  – Potency varies dramatically 

• Contain – Synthetic cannabinoids (hundreds of options)

• CB1 and CB2 agonists • +/‐ NMDA

– Variety (10+) herbs

PET POISON HELPLINE

Clinical Signs in Dogs/Cats • Common

• CNS depression  • Ataxia • Bradycardia (occasional tachycardia)  • Urinary incontinence • ~25%  develop agitation • Glazed expression 

• Less common • Vocalizing, vomiting, diarrhea, hypothermia,  hypersalivation, mydriasis, hyperesthesia, seizure  (?), coma 

PET POISON HELPLINE

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PET POISON HELPLINE

Marijuana Intoxication in Pets

PET POISON HELPLINE

Diagnostics • Signs + history

• Any tests? – CBC/chem/UA typically normal – Human urine drug test? – Best: Vet diagnostic lab

• GI contents • Urine/serum • Liver/kidney

PET POISON HELPLINE

Teitler JB. Evaluation of a human on‐site urine multidrug test for emergency use with  dogs. J Am Animal Hosp Assoc. 2009

PET POISON HELPLINE

Marijuana—Testing

• Dogs: Often false negative on OTC urine test

• False positives in humans caused by – Ibuprofen  – Naproxen – Pets too?

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PET POISON HELPLINE

Marijuana–Treatment • Decontaminate

– Emesis—may be  – difficult – Activated charcoal

• Supportive care! – No antidote – Monitor body temp – IV crystalloids for perfusion

• Agitation/seizures  – Diazepam – Acepromazine

• Monitor – Temp – Heart rate – Blood pressure

• Lipid therapy? – Fat soluble agent – 20% intravenous lipid  emulsion

PET POISON HELPLINE

DEA Drug Schedules • Schedule I

– No medical value. High potential for abuse. – Heroin, LSD, ecstasy

• Schedule II – Medical value. High potential for abuse. – Cocaine, hydromorphone, methamphetamine, Adderall, Ritalin

• Schedule III – Moderate to low potential for abuse.  – Ketamine, testosterone, anabolic steroids

• Schedule IV – Low potential for abuse/low risk of dependence – Tramadol, diazepam, alprazolam (Xanax)

• Schedule V – Lower potential for abuse than IV, sold in limited quantities – Robitussin AC (codeine), Lomotil, Lyrica

Audience  Poll 

PET POISON HELPLINE

PHARMACOLOGY & PHYSIOLOGY

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PET POISON HELPLINE

Endocannabinoids

• Naturally‐occurring substances that act  within the same signaling system as  exogenous cannabinoids 

• Two main “endocannabinoids” – Anandamide = N‐ arachidonoylethanolamine = AEA

– 2‐arachidonoylglycerol = 2‐AG

PET POISON HELPLINE

Endocannabinoids

• Produced on‐demand  in response to stress

• Largely inhibit  neurotransmitter  release

PET POISON HELPLINE

Cannabinoid receptors

CB1 • Primarily in CNS • Also in smaller 

concentrations other cells  such as lymphocytes, retinal  and endocrine cells.   

• Activation = psychoactive  effects

CB2 • Concentrated in the 

immune system and the  non‐nerve cells that support  the CNS  

• Primary effect is anti‐ inflammatory and  immunosuppressive

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PET POISON HELPLINE

Exogenous Phytocannabinoids

THC • Psychoactive • “Ideal” drug

– Lethal dose = 1000x effective  dose

– Fatalities are rare – Death seen 3‐9 gm/kg (do