A new review published in the American Journal of Health-System Pharmacy determined the most common causes of cannabis-related emergency department (ED) visits, giving policy makers and industry leaders a compass for improvement. This analysis specifically looked at data from Colorado.
Cannabis legalization helps solves many problems: it eases the toll of the opioid epidemic; it creates jobs; it generates tax revenue; and it keeps cannabis out of the hands of minors. But for all the good cannabis does, we can’t lose sight of public health concerns that must be solved in order to successfully implant legalization across the U.S. and beyond.
This review provides us with five concerns to prioritize: accidental pediatric ingestion, acute intoxication, cannabinoid hyperemesis syndrome, synthetic cannabinoids, and injuries related to production of butane hash oil (BHO).
As previously stated, legalization has not led to higher rates of underage use, but this review found an increase in accidental pediatric intoxication. “Children are at particular risk of cannabis toxicity because cannabis-containing food products, known as edibles, look extremely similar to regular candy,” the authors wrote. “Also, we have found that the severity of symptoms from marijuana exposure has worsened due to the high THC concentration in edibles.”
States have taken several measures to reduce accidental consumption by children. Some policies mandate that:
- Packaging is childproof
- Packaging does not contain cartoons or other imagery attractive to children
- Edibles do not come in candies or other forms enticing to children
Guidelines like these may help to reduce accidental ingestion by children, but full responsibility falls in the hands of adults and parents. It may seem like an excessive measure, but lock your products away until you intend to take them. Kids can be incredible hack artists.
Acute intoxication refers to those who simply consumed too much cannabis. “The number of marijuana-related ED visits has nearly doubled since the drug’s use was legalized in Colorado,” authors wrote, “and the rate is higher for non-Colorado residents who are visiting the state.”
They also mention that acute intoxication has historically gone unreported, which helps to account for the notable increase. Naturally, people are more inclined to seek help for intoxication by a legal drug than one that is illicit.
Furthermore, with the uptick in cannabis tourism, this statistic is unsurprising: a tourist inexperienced in cannabis may lack the experience to know how much is too much. The review outlines a particular instance in which one man consumed three edibles before a flight “when he realized he could not take the brownies on the plane.”
Many Colorado dispensaries go above and beyond to educate their customers on the effects of cannabis, especially edibles. Continuing to get that message through, especially to out-of-town visitors, should remain a top priority of businesses in legal markets.
Cannabinoid Hyperemesis Syndrome
Cannabinoid Hyperemesis Syndrome (CHS) is a condition that is coming to light in the medical field – though its characterization has been somewhat controversial and divisive among professionals.
It’s primarily characterized by regular vomiting episodes, which is why it’s often assumed to be cyclical vomiting syndrome (CVS). The cause of CHS, researchers speculate, has to do with heavy, regular cannabis consumption in some individuals – a speculation that is supported by the fact that symptoms tend to resolve after cannabis cessation.
This review describes an instance of CHS recorded in Denver:
“A 32-year-old man came to the Denver Health Medical Center ED with a 12-hour history of intractable vomiting and epigastric pain. Throughout the interview the patient was retching uncontrollably. The patient reported several similar episodes over the past 2 months requiring medical care. Laboratory tests were conducted but unremarkable other than a THC-positive urine drug screen.”
While more cannabis specialized doctors are coming to acknowledge this condition’s existence, there’s overwhelming agreement that more research needs to be conducted on CHS.
Synthetic cannabinoids – also called SCs, Spice, K2, Scooby Snax, etc. – are not cannabis (and by that right shouldn’t even be on this list). They are chemical analogues intended to mimic the effects of natural cannabis, but because of their clandestine production and high affinity for receptor sites, synthetic cannabinoids can cause a laundry list of severe symptoms and, in worst cases, death. This report describes a 24-year-old man (who was of legal age to buy natural cannabis) who was admitted to the ED and suffered a seizure after consuming SCs purchased at a head shop.
The fact that synthetic cannabinoids had to be included in this report is disappointing. With legal cannabis widely available to adults over the age of 21, there’s no reason for anyone to turn to an unregulated, dangerous alternative. That being said, it’s clear that there’s much work yet to be done on the education front.
Home Extraction Injuries
Once again, when there’s a legal, safe alternative, it’s disheartening to read about the injuries sustained by individuals attempting to produce butane extracts themselves. Professional extractors use state-approved equipment and processes to greatly reduce the risks associated with BHO production, but some individuals will take it upon themselves to make their own, “blasting” BHO in their homes often with butane cans and glass extraction tubes. Improper airflow can lead to explosions, injuring the person performing the extraction as well as others in the vicinity.
“In July 2015, a law was passed that explicitly made manufacturing hash oil using flammable solvents illegal,” the authors wrote. “Anecdotally, the effect of this legislation has had minimal effect on the number of burn patients admitted to our institution.”
If you’re interested in extracting cannabis at home, choose a safe method that doesn’t use dangerous solvents. Rosin, for example, is a solventless extract that simply uses heat and pressure to extract cannabinoids. It can be produced safely and affordably with a pair of strong hands and a hair straightener.
The report ends with a single conclusory sentence: “Marijuana legalization in Colorado has been associated with an increase in marijuana-related ED visits.” In a young industry that attracts inexperienced consumers with novelty and newly gained legality, this report is not shocking.
But it’s important not to conflate this conclusion with “Legalization in Colorado caused an increase in public health issues.” Legalization may correlate with these increasing statistics, but it did not necessarily cause them. Cannabis legalization empowers people to report their emergencies. It’s also impossible to say that legalization is to blame for increases in synthetic cannabinoid use. It’s true that legalization invites more citizens to partake, but it’s up to us to assume responsibility and evolve cannabis – through education and research – in a direction that betters the lives of consumers and non-consumers alike.