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Cannabis

Critical Issues Related to Harms of Cannabis Exposure in Adult Patients Presenting to the Emergency Department, Cardiovascular Considerations

Scope of Application

This guideline is intended for physicians working in emergency departments (EDs).

Inclusion Criteria

This guideline is intended for patients aged 16 years and older presenting to the ED for CV events (including acute coronary syndrome and stroke).

Exclusion Criteria

This guideline is not intended for patients aged 15 years and under, pregnant patients, patients with accidental cannabis exposure, or patients using noncannabis substances such as synthetic cannabinoids.

Recommendations offered in this policy are not intended to represent the only diagnostic and management options that the emergency physician should consider. ACEP recognizes the importance of the individual physician’s judgment and patient preferences.

Critical Questions

  • Are people who have recently or chronically consumed marijuana at increased risk of CV effects requiring a visit to the ED compared with the overall population of ED visits?

    Recommendations
    Level A Recommendations

    None specified.

    Level B Recommendations

    None specified.

    Level C Recommendations

    Physicians may consider medical cannabis use a risk factor for CV events, including acute coronary syndrome and stroke.

    Level A Recommendations

    None specified.

    Level B Recommendations

    None specified.

    Level C Recommendations

    Physicians may consider medical cannabis use a risk factor for CV events, including acute coronary syndrome and stroke.

Download the Policy

PDF Icon Cannabis-Exposure-cp.pdf January 2026

Findings and Strength of Recommendations

Clinical findings and strength of recommendations regarding patient management were made according to the following criteria:
Level A recommendations
Generally accepted principles for patient care that reflect a high degree of clinical certainty (eg, based on evidence from 1 or more Class of Evidence I or multiple Class of Evidence II studies).
Level B recommendations
Recommendations for patient care that may identify a particular strategy or range of strategies that reflect moderate clinical certainty (eg, based on evidence from 1 or more Class of Evidence II studies or strong consensus of Class of Evidence III studies).
Level C recommendations
Recommendations for patient care that are based on evidence from Class of Evidence III studies or, in the absence of adequate published literature, based on expert consensus. In instances in which consensus recommendations are made, “consensus” is placed in parentheses at the end of the recommendation.
There are certain circumstances in which the recommendations stemming from a body of evidence should not be rated as highly as the individual studies on which they are based. Factors such as heterogeneity of results, uncertainty about effect magnitude, and publication bias, among others, might lead to a downgrading of recommendations.
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