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The risks to children from tobacco and tobacco with cannabinoids have been described following ingestion of cigarettes, cigarette butts, reefers and joints (Arena, 1974; Schvartsman, 1971; Dreisbach, 1980; Garcia-Estrada & Fischman, 1977). Tobacco cigarettes contain about 15-20 mg of nicotine but this is poorly absorbed following ingestion. 4-8 mg of nicotine may cause nausea, while the estimated oral lethal dose for adults ranges between 40-60 mg. Joints and reefers are estimated to have tetrahydrocannabinol (THC) content of 3.6-15 mg.

In 50 subjects, 32 cannabinoid abusers and 18 cyclohexamines abusers [5 phencyclidine (PCP) and 13 ketamine] the behavioral symptomatology indicative of these drugs intoxication was reported. Twelve in the cannabinoid group and eight in the cyclohexamines group (5 PCP and 3 ketamine) were admitted for emergency treatment (acute subgroup); 30 of the cannabinoid group and eight of the cyclohexamines group were followed as outpatients. In all the patients, qualitative plasma and urine analysis were carried out. Quantitative Δ9-THC and PCP plasma levels were determined in the acute cases. The behavioral symptomatology observed in all the cases was not pathognomonic but only indicative of the responsible drug. The true diagnosis can be reached only through blood and urine analysis. No correlation was observed in the acute cannabinoid group between the plasma Δ9-THC levels and the severity of the behavioral symptomatology. A rough correlation was observed in the acute PCP cases. Comparing the behavioral symptomatology among the two different groups some symptoms were found to be similar. However, concerning the severity of the symptoms PCP was usually more toxic than either ketamine or the cannabinoids. The behavioral symptoms provoked by the three drugs were analyzed and discussed.