Colorado Study on Cannabis-Linked ER Visits Exposes Dangers of Weed Edibles

In an infamous 2014 editorial, New York Times columnist Maureen Dowd said she ate marijuana candy in Denver and felt like she died. Her hallucinations and paranoia lasted for a night, and she learned the next day she ate more than the recommended dose. While it was easy for the internet to laugh, what happened to Dowd is increasingly commonplace in Colorado and can be very dangerous, as doctors in Denver reported on Monday.

Dowd’s experience, edible-linked deaths, and clinical observations working in an emergency department prompted Dr. Andrew Monte to take a close look at the effects of edibles on the health of Coloradans. On Monday, Monte and his team announced in the Annals of Internal Medicine that after recreational marijuana was legalized, there was a three-fold increase in cannabis-related emergency room visits.

Studying the records of 9,973 patients who came to the University of Colorado Hospital emergency department between 2012 and 2016, they found that the number of ER trips linked to THC-filled food was 33 times higher than they expected.

In Colorado, edibles make up just 0.32 percent of total cannabis sales, but edibles were behind 10.7 percent of emergency department visits, the team reports. People who wind up in the hospital after eating edibles present with cardiovascular symptoms, intoxication, and acute panic attacks, anxiety, and psychosis.

These results have forced Monte to re-examine his thoughts on the sale of recreational marijuana edibles. “While I’m a supporter of cannabis liberalization policy in general, having seen these data, and my own clinical experiences, I don’t think it should be available for recreational purposes,” he tells Inverse.

Monte’s study is the first clinical observation to show that consumption of edibles is correlated to ER visits for acute psychiatric events. It’s also one of the few studies to look at how the public is responding to edible versus inhaled cannabis exposure. People who show up at the ER after smoking cannabis, the authors note, often present with cannabinoid hyperemesis syndrome, a condition that leads to severe bouts of vomiting.

One major reason recreational edibles can cause problems is because the THC is absorbed more slowly when it’s ingested, and so people are more likely to overconsume them, as some studies have shown. In other words, people see a harmless-looking weed cookie and then eat too much of it when it doesn’t seem like it’s causing a high.

Despite Monte’s views on recreational edibles, he does think that cannabis should be consumed by people who want to use the drug medicinally. This is because the effects of edibles can last many, many hours, whereas the effects of smoking marijuana last only for about an hour. In other words, for the same reason that edibles can be dangerous, they can also be beneficial to people seeking treatment.

“An edible means that somebody isn’t going to have to smoke cannabis six to ten times a day in order to keep up a therapeutic amount,” Monte explains. “They can potentially use it twice a day. That’s a much better use of a kinetic profile for treatment purposes.”

Another issue with marijuana edibles is oversight of manufacturing practices and labeling standards. Monte thinks that Colorado could be better at defining the uses of medical marijuana and then regulating edibles under FDA guidelines. As of now, what’s available in the public is the same for people seeking it for either recreational or medical intent. Further exacerbating the problem is that the cannabis products available don’t correlate with the cannabis that are being studied: The typical joint in Colorado, says Monte, has 100 milligrams of THC — clinical trials on marijuana for back pain, meanwhile, only look at the effect of 5 to 10 milligrams.

“There’s been a real blurring of the lines between medical and recreational cannabis,” Monte says. “And the question has really become: Are edibles something we want available in the public?”

If the answer stays yes, Monte thinks the state needs to put some guardrails around edible products tominimize the risk of adverse drug events. Edibles are legal to buy for all people 21 years of age and older, but that doesn’t mean everyone’s bodies can handle the drug.

Abstract:

Background: Little is known about the relative harms of edible and inhalable cannabis products.

Objective: To describe and compare adult emergency department (ED) visits related to edible and inhaled cannabis exposure.

Design: Chart review of ED visits between 1 January 2012 and 31 December 2016.

Setting: A large urban academic hospital in Colorado.

Participants: Adults with ED visits with a cannabis-related International Classification of Diseases, Ninth or 10th Revision, Clinical Modification (ICD-9-CM or ICD-10-CM), code.

Measurements: Patient demographic characteristics, route of exposure, dose, symptoms, length of stay, disposition, discharge diagnoses, and attribution of visit to cannabis.

Results: There were 9973 visits with an ICD-9-CM or ICD-10-CM code for cannabis use. Of these, 2567 (25.7%) visits were at least partially attributable to cannabis, and 238 of those (9.3%) were related to edible cannabis. Visits attributable to inhaled cannabis were more likely to be for cannabinoid hyperemesis syndrome (18.0% vs. 8.4%), and visits attributable to edible cannabis were more likely to be due to acute psychiatric symptoms (18.0% vs. 10.9%), intoxication (48% vs. 28%), and cardiovascular symptoms (8.0% vs. 3.1%). Edible products accounted for 10.7% of cannabis-attributable visits between 2014 and 2016 but represented only 0.32% of total cannabis sales in Colorado (in kilograms of tetrahydrocannabinol) in that period.

Limitation: Retrospective study design, single academic center, self-reported exposure data, and limited availability of dose data.

Conclusion: Visits attributable to inhaled cannabis are more frequent than those attributable to edible cannabis, although the latter is associated with more acute psychiatric visits and more ED visits than expected.