Acute Problems Associated With Cannabis Use Save

An observational study published in Annals of Internal Medicine finds that emergency department (ED) 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.

Following legalization of marijuana, Colorado has seen a steep increase in cannabis-related ER visits. In the timeframe between 2012 and 2016, inhalable cannabis resulted in a higher frequency of cannabis-attributable ED visits, although ED visits for acute psychiatric events and cardiovascular symptoms were more common use of edibles. 

Increased availability and use of marijuana in Colorado has led to an increase in emergency department visits attributable to the drug. Cannabis is most often purchased in flower form for smoking, but anecdotal evidence suggests that edible cannabis products may more frequently contribute to ED visits and may be more toxic than inhalable products.

Researchers from the University of Colorado School of Medicine reviewed health records for 9,973 patients presenting to the UCHealth University of Colorado Hospital ED from 2012 to 2016 to describe and compare visits related to edible and inhaled cannabis exposure.

The researchers found a more than 3-fold increase in cannabis-associated ED visits over the time period, with visits due to edible exposure much higher than expected. Specifically, their analysis showed that, although 10.7 percent of ED visits were attributable to edible cannabis, only 0.32 percent of total cannabis sales (in kilograms of tetrahydrocannabinol [THC]) were for edible products. Therefore, compared to inhaled cannabis, the observed proportion of cannabis-attributable ED visits with edible exposure was about 33 times higher than expected. The authors also noted that psychiatric ED visits were more common following edible exposure than inhaled cannabis products.

In an accompanying editorial the authors say that this research has important clinical and public health implications. They point out that the slow rate of absorption of orally ingested THC compared with inhalable THC makes it harder for users of edible cannabis to titrate the doses required to achieve the desired drug effects. In addition, the wide variety of innocuous looking edible preparations can lead to overconsumption. This can be compounded by inaccurate labeling of cannabinoid content in edible products.

They suggest that future research into the effects of cannabis should focus on THC and CBD content, route of administration, doses consumed, sex, age, body mass index, and the medical conditions for which cannabis might be prescribed. They also suggest greater oversight of manufacturing practices, labeling standards, and quality control of cannabis products marketed to the public.