With Recreational Marijuana, Edibles are Trouble

An analysis of Colorado emergency room visits before and after marijuana legalization suggests that “edibles” may be particularly risky.

This week, we get Rocky Mountain High with this study, appearing in the Annals of Internal Medicine, which examined the rates of Colorado Emergency Room visits for cannabis exposure over a 5-year period.

It will be news to none of you that Colorado legalized recreational marijuana use in 2014 – a single event that set epidemiologists salivating. Here was as close to a randomized trial of pot smoking that you’d ever get. Would the state plunge into chaos and ruin, or would a flourishing of libertarian capitalism propel it to new heights?

Well, the apocalyptic visions didn’t come to pass.

In fact, recent data suggests that pot use among teens has fallen more sharply in Colorado than the rest of the US, which goes to show you that once your parents start doing something, it isn’t cool anymore.

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But according to this study emergency room visits attributable to marijuana have ticked up – by about a factor of 3.

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Researchers performed direct chart review on over 10,000 ER admissions at a single, urban, Colorado center to figure out what role pot had to play in the presentation, and what type of pot was to blame.

Not pictured: ED visits associated with alcohol use. (It’s a bit higher).

Researchers started by filtering roughly 450,000 ED visits using ICD-9 codes associated with Marijuana – leaving 9,973 visits to directly review.

So right off the bat, we need to be careful here. The uptick in admissions after the 2014 legalization may be because more people were using marijuana, but may simply be due to the fact that people were more openly admitting it or providers were more comfortable asking about it – leading to increased medical coding.

Where the study really gets interesting is in the type of cannabis that brought people to the ED. Around 10% of the ED visits were from people ingesting so-called “edibles”.

Mmm…. Pie.

Ok for squares like me, you can get cannabis in a couple of ways. You can smoke the cannabis flowers – this is the standard method, or you can eat food with THC or cannabis baked in – “edibles”. Think pot brownies. And pot gummy bears.

Ok 10% of the ED visits were for edibles, but only 0.3% of Colorado cannabis sales were for edibles. This means that edibles were over-represented in the ED by a factor of 33. That’s crazy. But it might make sense.

Edibles have a delayed onset of action compared to smoked marijuana – typically 30 minutes compared to 10. And they stay in the system longer – around 12 hours compared to 4 hours with smoked marijuana. That means people might be “redosing” their edibles because they aren’t feeling it yet, only to get into trouble later.

We call it “the green mountain”.

We call it “the green mountain”.

There’s another little gem of data in this study.

Mmm… non-resident pie.

41% of the patients in the ED for edibles lived outside of Colorado, compared to just 6.6% out-of-staters for smoked marijuana. This implies that marijuana tourists, eager to try out the various forms of pot on display might be driving some of these findings.

So, what have we learned? The big take home for me is that edibles – those cute THC-filled gummy bears, the salted-caramel pot brownies, are potentially way more dangerous than the old-fashioned joints that were the staple of marijuana consumption prior to legalization. 

In other words, when it comes to recreational marijuana well, put that in your pipe and smoke it.

This commentary first appeared on medscape.com.