Infants and toddlers passively exposed to marijuana smoke, or who ingest edible cannabis, may develop profound lethargy or coma, occasionally with tachycardia In most cases, the only treatment required is discontinuation of the drug In the adolescent patient with a psychotic reaction or acute toxic delirium, a benzodiazepine may be necessary These acute symptoms should improve with drug abstinence over to hours Young children ingesting high THC doses by weight, or adults who unwittingly smoke or ingest a higher dose than intended, may need sedation or respiratory support until intoxication resolves Synthetic Cannabinoids (Spice, K2) The term synthetic cannabinoids describes a variety of compounds (often structurally dissimilar to THC, and thus not picked up on standard urine drug screens), with affinity for cannabinoid receptors Although initially developed to mimic the effects of cannabis on the brain, this class of compounds has evolved in both complexity and availability in recent years, and cause clinical illness quite different from that of cannabis Current Evidence In the past decade, use of synthetic cannabinoids has gained increasing popularity Initially marketed as herbal incense or air fresheners and labeled as “not for human consumption,” these compounds were sold in head shops, convenience stores, and via the internet Several of these compounds are now regulated as a result of the Synthetic Drug Abuse Prevention Act of 2012, but new derivatives continue to emerge Synthetic cannabinoids bind to cannabinoid receptors in the CNS and peripheral tissues, often with significantly higher affinity than THC It is postulated that a combination of activity at other receptor types, active metabolites, and unique effects of various herbal compounds often mixed with synthetic cannabinoids may account for the higher reported rates of adverse effects (i.e., seizures, tachycardia, GI upset) with these compounds as compared to THC Users of synthetic cannabinoids typically report a faster onset of peak effects and shorter duration of effects as compared to THC However, given the number of compounds that fall under the umbrella term of synthetic cannabinoids, there are limited published data to allow us to fully characterize the pharmacodynamics of this class of compounds Clinical Considerations As compared to THC, use of synthetic cannabinoids is more frequently associated with tachycardia, hypertension, agitation,