Edible marijuana products are a small slice of cannabis sales in Colorado, but were linked to a large proportion of cannabis-related emergency room visits in the state, according to a study published on Monday. From January 2012 to December 2016, edibles accounted for 10.7% of emergency room visits attributable to cannabis use at the University of Colorado Health emergency department in Aurora, Colorado, though they only accounted for 0.32% of cannabis sales in that same period, according to the Annals of Internal Medicine study. This is not simply because people are taking larger numbers of edibles to compensate for how much longer it takes to feel the effects than when cannabis is inhaled, said lead researcher Dr Andrew Monte. “It was a striking thing,” Monte, an associate professor of emergency medicine at the University of Colorado, told the Guardian. “It wasn’t like these people were taking 100mg or 500mg of cannabis edibles. These were relatively lower doses.” Monte said the adverse impact of edibles can last longer and be more intense than people expect. “If you smoke and you have a brief amount of hallucination, but then it goes away pretty quickly, you may not come to the emergency department,” Monte said. “But if you develop psychosis and it’s lasting for hours, you might come to the emergency department.” Overall, visits tied to both inhaled and edible cannabis use were mostly for gastrointestinal issues, intoxication and psychiatric symptoms. Edible cannabis led to more acute psychiatric events and cardiovascular symptoms than inhaled cannabis. The rates at which people are hospitalized for cannabis use in Colorado are still far lower than alcohol-related hospitalizations. “Many, many people use cannabis without ending up in my emergency department,” Monte said. Colorado’s recreational marijuana market opened at the start of 2014, ushering in a new era of research on the impact of legal cannabis use. Monte said that increased availability of any drug will cause more adverse drug events. “So, this is us sort of learning what those adverse drug events are, which routes of exposure are more likely to lead to adverse drug events, so we can actually advise people on how to use cannabis safely,” Monte said. “And also potentially put some more guidelines around the things that are most dangerous and I would say that in this study, it’s edibles.”<doc-sep>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.” The effects of smoking marijuana don't last as long as eating it. Unsplash / Thought Catalog 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.<doc-sep>The new study found that though edibles represented less than one-third of 1 percent of the state’s total cannabis sales by weight of THC between 2014 and 2016, they accounted for 238 of the 2,432 cannabis-triggered visits to the UCHealth University of Colorado Hospital Emergency Department, or about 10 percent. The authors calculated that there was 309 times more THC sold in flower or smoked form compared with edible products during the three-year period examined. Symptoms also tended to vary depending on whether the pot was consumed as an edible or smoked. Nearly half of the emergency room patients who had consumed edibles complained of intoxication or altered mental status, often accompanied by anxiety, compared with less than a third of those who had smoked the pot. About a quarter of both the smokers and those who consumed edibles experienced psychiatric problems, but those who used edibles were more likely to exhibit acute psychiatric symptoms, while the smokers were more likely to complain of an exacerbation of a chronic condition like depression. In addition, 8 percent of edible users had cardiovascular symptoms, including rapid or irregular heart rate, compared with only 3 percent of pot smokers. Serious cardiovascular events, including heart attacks, occurred in both groups. Other studies have also reported on the emerging concern of cardiovascular problems being associated with pot use, Dr. Volkow said. Concerns about edibles are not new, and many states that have legalized recreational or medical cannabis, including Colorado, California, Rhode Island, Nevada and Oregon, require packaged edibles to carry a warning that the intoxicating effects may not be felt immediately, said Camille Gourdet, a researcher who studies state cannabis policies at RTI International, a nonprofit research organization. Many states also require edibles to be clearly marked with a symbol warning consumers that the products contain cannabis and are not regular food items, Ms. Gourdet said. Several states also require edibles to have even distribution of THC content throughout the product so it is not all concentrated in a single bite of a cookie or brownie. Dr. Monte, who sits on the Colorado Retail Marijuana Public Health Advisory Committee, said he does not think edibles should be available in the retail recreational market. He said the important message for consumers is that there are more adverse drug events associated with edibles than with inhaled products, and that edibles are more likely to trigger psychiatric illness. First-time users — a group that, in Colorado, often includes tourists, are at particular risk, he said.<doc-sep>
One of the primary arguments from opponents of marijuana legalization is that legal cannabis will endanger the youth of America and cause an exponential rise in injuries and fatalities. Needless to say, this is unlikely, to say the least; most evidence shows that if cannabis is consumed responsibly, one of the only significant health risks is that you may find Family Guy funny. But the key word here is “responsibly,” and apparently, some people are not being responsible when it comes to edibles consumption. According to a study published in the Annals of Internal Medicine on Tuesday, a surprisingly high number of emergency room visits during a four-year period in the state of Colorado were due to people ingesting marijuana in the form of edibles (i.e. candies or pastries). The researchers at the UCHealth University of Colorado Hospital assessed the frequency of cannabis-related emergency room visits in the state of Colorado after it passed a 2012 measure legalizing the sale of marijuana. Between the years of 2012 and 2016, the study looked at almost 10,000 emergency room visits at the hospital that patients said were related to cannabis, of which about a quarter were actually related to cannabis. Following the legalization measure, the number of cannabis-related emergency room visits increased almost three times. Although a majority of the visits were attributable to smoking pot the old-fashioned way (i.e. inhaling), about 10 percent of cannabis-related ER visits were attributable to edibles, even though edibles only comprised a very small percentage of overall cannabis sales. Consuming edibles also seemed to be more frequently linked to extreme side effects. About 18 percent of people who came in after ingesting edibles reported experiencing “acute psychiatric symptoms” such as panic attacks and psychosis, versus 10 percent who reported such symptoms after smoking pot. To an extent, none of this is particularly surprising: although data shows that marijuana use in Colorado has gone up consistently before and after legalization, it makes sense that legalization would increase the number of people willing to experiment with cannabis products — and that some of these people would use these products in excess, or consume them irresponsibly. This was originally lead author Andrew Monte’s explanation for the study’s results. “My initial hypothesis was that people were stacking doses and getting too high of a dose,” Monte said via email to Rolling Stone. “But after analyzing these data, I actually think it is that adverse symptoms from edible consumption last longer than when people smoke. This leads to more opportunity to say, ‘I need to go the the ER. '” But before you start panicking and throwing your latest batch of weed brownies down the garbage disposal, it’s worth noting that the study has some obvious limitations. For starters, Erik Altieri, the executive director of NORML, points out that the study focused on a single (albeit large) hospital in Colorado, “so it is far from a comprehensive analysis that could indicate a trend,” he tells Rolling Stone. And like many other studies that have pointed to a correlation between weed use and psychosis, this study did not establish causation, meaning that it did not differentiate between whether edibles can cause “acute psychiatric symptoms,” and whether people who are prone to such symptoms to begin with are simply at heightened risk of adverse effects. Additionally, Altieri says that such adverse effects, while they do happen, are both rare and extremely temporary. “While we support increased public education and enhanced labeling to inform consumers about how to responsibly consume edibles and in what doses, it is important to note that the overwhelming majority of ER cases related solely to marijuana result in the patient simply being hydrated and let go in an hour or two,” said Altieri. Ultimately, the takeaway from this study, as well as many others, is that more federally funded research is needed to determine the link between edibles and adverse psychiatric effects. Given that the U.S. Department of Justice is currently reportedly roadblocking such research, that seems unlikely for the time being, so in the interim, if you’re curious about edibles, just err on the side of caution and don’t gobble an entire batch of weed blondies in one sitting.