Emergency Department

The number of cannabis-associate emergency department (ED) visits has risen sharply since marijuana was legalize in Colorado. New data show that is inhalable cannabis use accounts for most of these visits; edible cannabis is tied to a disproportionate number of visits, and patients present with different symptoms.
Although less frequent overall; so edible products lead to more acute psychiatric events and cardiovascular symptoms than inhaled exposure,” write Andrew A. Monte, MD, PhD, University of Colorado School of Medicine, Aurora, and colleagues. The researchers report their findings in an article published online today in the Annals of Internal Medicine.

Edible cannabis has been consider to be more toxic than inhalable cannabis; so particularly in light of accumulating poison center data on its associated adverse events (AEs) and anecdotal reports from adult users. In addition, the only deaths in Colorado that conclusively link to cannabis use have involved edible products. Nevertheless, the relative potential harms of inhalable and edible cannabis products have been poorly characterized.

Adult emergency department

With this in mind, Monte and colleagues conduct a study to compare adult emergency department visits relate to edible and inhalable cannabis use. Using chart review, the researchers tracked 9973 emergency department visits to the University of Colorado Health emergency department from 2012 through 2016 that include an ICD-9 or -10 code for cannabis use. Of those, they found that 2567 (25.7%) of the visits were relate to cannabis; with 238 of these (9.3%) link to edible products.
The most common causes of cannabis-link emergency department visits were gastrointestinal symptoms (30.7%); so intoxication (29.7%), and psychiatric symptoms (24.7%). Visits as a result of inhalable cannabis were more likely than those because of  edibles to involve gastrointestinal symptoms; hence the most common of which was cannabinoid hyperemesis syndrome.
If inhalable and edible cannabis were equally toxic and result in the same number of emergency department visits; so they would expect that 0.3% of cannabis-attributable visits would be due to use of edible products; Monte and colleagues say. The observe proportion of cannabis-attributable visits with edible exposure was about 33 times higher than expect (10.7% vs 0.32%) if both routes of exposure were equally toxic.
The authors note that because they can’t be sure that the edible cannabis sales in the Denver area are similar to the rate in the state overall; the proportion may be different in the region the hospital serves. Despite this and other limitations; so the authors suggest that other jurisdictions considering cannabis legalization might take into account the relative toxicity of edible products.

Minimize pediatric exposures

It may be best to limit edible products to medical indications in order to minimize pediatric exposures and mitigate the excessive rate of adult emergency department visits associate with these products. At the very least; hence users must be educate about the delay kinetic profile and the increase risk for acute psychiatric and adverse cardiovascular events associate with edible ingestion,” they write.
Because orally ingest THC is absorb more slowly than inhale THC; so people using the edible products find it harder to titrat the doses require to produce the desire effects. This is compound by the slower clearance of orally ingest THC from the body; which can result in accumulation in people who take extra doses in an attempt to achieve the desire drug effect more quickly.
In addition, the relatively harmless appearance of edibles (especially to children) and the variability in their labeling accuracy further contribute to over consumption of these products. Acknowledging that the complete range of potential adverse health consequences from cannabis consumption remain incompletely understood.
The editorialists suggest that future research into the adverse effects of cannabis should focus on THC and cannabidiol content, route of administration, doses consumed, sex, age, body mass index, and the medical conditions for which it might be used. The results of this recent study also underscore the urgent need for greater oversight of manufacturing practices; so labeling standards, and quality control of cannabis products market to the public.