Colorado emergency departments offer other states a glimpse into cannabis’ impact

Marijuana in glass jars and wooden bowl
The first studies looking at the public health effects of legalized recreational cannabis suggest a need for better education about the drug's potential adverse effects. (sand86 / iStock / Getty Images Plus)

It might not sound terribly surprising that researchers in Colorado found a disproportionately large number of emergency department visits for edible cannabis products.

But in a recent study of trends in Colorado—which was one of the first states to legalize marijuana in 2012—researchers found markedly different dynamics based on the route of exposure to the drug. Specifically, while patients using inhalable products accounted for the bulk of the visits, the proportion of patients presenting after exposure to edible products was significantly higher than the proportion of edibles sold.

Published in the Annals of Internal Medicine, the study tracked an increase in ED admissions of more than three times between 2012 and 2016.

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They are among the emergency department trends that could be a useful policy guide for the many other states considering or implementing their own legalization legislation, said lead author Andrew A Monte, M.D., Ph.D., of the University of Colorado School of Medicine. 

“The biggest bang for the health policy buck is to really actually educate people about adverse drug events,” he said.

Lessons for policy makers

For starters, to learn the appropriate lessons from Colorado’s experience, healthcare providers and policymakers need to make sure they keep everything in proper perspective, Monte said. For example, he points out that the overall increase in patients don’t represent a substantial strain on the healthcare system, as most patients get discharged rapidly.

RELATED: Most patients who use medical marijuana use it for chronic pain, study finds

Patients who experience psychiatric issues are an exception to that rule, but Monte said those patients generally remain in the hospital longer due to issues finding available psychiatric beds.

Complications from inhalable exposure led most frequently to gastrointestinal symptoms. Cannabinoid hyperemesis syndrome, usually seen among heavy users, represents the most dangerous of these since in many cases it doesn’t respond to normal treatments for nausea and vomiting.

By contrast, researchers found that edible products were more likely to produce psychiatric and cardiovascular symptoms than inhalable products were. Moreover, anecdotal evidence suggests patients experienced adverse events such as panic attacks when consuming relatively low doses of the drug in edible form.

“The biggest bang for the health policy buck is to really actually educate people about adverse drug events,” he said.

Among these, he recommends covering intoxication-related issues, cannabinoid hyperemesis syndrome, and psychiatric responses. Whether that information comes from healthcare providers or public health programs, however, Monte cautions that the key is to advise patients on the risks where they lie. That means having frank conversations and providing accurate information.

“The message here is ‘everything in moderation,’” he says, adding, “And we must be aware that there are adverse events, so start low and go slow as far as dosing goes.”

RELATED: Marijuana legalization leaves doctors wondering ‘What do we tell our patients?’

In Monte’s view, policymakers should also take a hard look at whether or not it makes sense to include edibles in the recreational marketplace to begin with. Since recreational users typically just want to get high as quickly as possible, the slow absorption rate provided by edibles—which can take two or three hours to reach peak intensity—can lead to dose stacking, overdose, or a greater probability of users mixing cannabis with other intoxicants.

From a broader perspective, Monte said policymakers should simply make sure to treat cannabis products like other pharmaceuticals. That means packaging them in unit doses and providing oversight and testing to ensure dosages are as advertised.

Unfortunately, he said, most states won’t have the resources and manpower necessary to test products. At the same time, shops themselves have few incentives to undertake proactive testing, for example, to ensure the milligram dosage of a product matches the manufacturer’s claims. That means the FDA will likely need to get involved sooner or later to help regulate products—an unlikely prospect over the near term, given that marijuana is still illegal at the federal level.

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