Health report from Colorado: Recreational marijuana harms

December 15, 2014

a Reader put me onto a new Viewpoint in JAMA:

Monte AA, Zane RD, Heard KJ. The Implications of Marijuana Legalization in Colorado.JAMA. 2014 Dec 8. doi: 10.1001/jama.2014.17057. [Epub ahead of print][JAMA; PubMed]

The authors are from the Department of Emergency Medicine, University of Colorado and the Rocky Mountain Poison and Drug Center. They set out to describe a few health stats from before and after the recreational legalization of marijuana.

Interesting tidbits:

However, there has been an increase in visits for pure marijuana intoxication. These were previously a rare occurrence, but even this increase is difficult to quantify. Patients may present to emergency departments (EDs) with anxiety, panic attacks, public intoxication, vomiting, or other nonspecific symptoms precipitated by marijuana use. The University of Colorado ED sees approximately 2000 patients per week; each week, an estimated 1 to 2 patients present solely for marijuana intoxication and another 10 to 15 for marijuana-associated illnesses.

This one is obviously frustratingly anecdotal in that there is no real measure of the rate before legalization.

The one on cyclic vomiting syndrome is better:

The frequent use of high THC concentration products can lead to a cyclic vomiting syndrome. Patients present with severe abdominal pain, vomiting, and diaphoresis; they often report relief with hot showers. A small study at 2 Denver-area hospitals revealed an increase in cyclic vomiting presentations from 41 per 113 262 ED visits to 87 per 125 095 ED visits (prevalence ratio, 1.92) after medical marijuana liberalization (A. A. Monte, MD, unpublished data, December 2014).

We’ve discussed the phenomenon of cannabis hyperemesis before on the blog. One thing we do have to be careful about is that since it has only been recently that the medical community has been alerted to the possibility of cannabis hyperemesis, we should expect the detection rate to increase. Thus, even against a stable rate of cannabis hyperemesis I would expect the reported rate to be increasing.

The University of Colorado burn center has experienced a substantial increase in the number of marijuana-related burns. In the past 2 years, the burn center has had 31 admissions for marijuana-related burns; some cases involve more than 70% of body surface area and 21 required skin grafting. The majority of these were flash burns that occurred during THC extraction from marijuana plants using butane as a solvent.

This is the e-cigarette and vape market at work people. In South Florida they apparently call it ‘Budda’.

Apparently some basic pharmacology 101 would be of help to the good citizens of Colorado.

Edible products are responsible for the majority of health care visits due to marijuana intoxication for all ages. This is likely due to failure of adult users to appreciate the delayed effects of ingestion compared with inhalation. Prolonged absorption complicates dosing, manufacturing inconsistencies lead to dose variability

Interesting. I recall the language in the original initiative was very vague about product testing, labeling, etc. Looks like this is a problem.

Ten to 30 mg of THC is recommended for intoxication depending on the experience of the user; each package, whether it is a single cookie or a package of gummy bears, theoretically contains 100 mg of THC. Because many find it difficult to eat a tenth of a cookie, unintentional overdosing is common. Furthermore, manufacturing practices for marijuana edible products are not standardized. This results in edible products with inconsistent THC concentrations, further complicating dosing for users. According to a report in the Denver Post, products described as containing 100 mg of THC actually contained from 0 to 146 mg of THC.8

Oh, and the children. Don’t forget about the children.

The most concerning health effects have been among children. The number of children evaluated in the ED for unintentional marijuana ingestion at the Children’s Hospital of Colorado increased from 0 in the 5 years preceding liberalization to 14 in the 2 years after medical liberalization.3 This number has increased further since legalization; as of September 2014, 14 children had been admitted to the hospital this year, and 7 of these were admitted to the intensive care unit. The vast majority of intensive care admissions were related to ingestion of edible THC products.

This Viewpoint certainly draws attention to the edibles/consumables products as being a problem. Seems pretty clear that maturation of product regulation would be a start, so that people are informed about what they are getting. This should probably be supplemented with some sort of public information campaign on the pharmacokinetics of ingested products compared with smoking marijuana. And, you know, keep it away from your kids.

16 Responses to “Health report from Colorado: Recreational marijuana harms”

  1. becca Says:

    Kids particularly have trouble eating 1/10th of a cookie.

    Good grief. Why can’t we get concentrations on this stuff?? Also, they should be making THC-Siracha Kale chips. It’s 1) the obvious marketing gimic and 2) should keep the younglings away better than rice krispy treats.

    To me, one clear benefit of legalization (as opposed to decriminalization) is that you ought to be able to know what you’re getting. If that’s not the case… *shakes head*


  2. Davis Sharp Says:

    OK, fine. I won’t bake my “special” brownies for the school bake sale. But they’ll have to sell a hell of a lot more regular brownies to buy those Chromebooks.


  3. Duke of Neural Says:

    @becca As I understand it, the pot industry is transitioning to a more professional culture, but it takes some time. Going into those places still feels like you’re walking into a speakeasy. In Denver, most still aren’t taking credit cards or debit cards.

    The types of people producing edibles now are still the types who were making them in their basements when it was illegal, convincing them they need to spend money to put numbers on their stuff is slow going.

    There’s also a bit of chicken and egg with the concentrations: they don’t want to invest in hiring real chemists and equipment or even standardizing batches until customers demand it, and customers aren’t demanding it because this is the way it has been so far.

    Another chicken and egg situation would be personnel: I’d wager there aren’t as many analytical chemists with experience measuring THC in chocolate as there are positions for such people.

    I’d further speculate that dosing will be legally standardized after consumers start asking for it and after they get ripped off a few times.


  4. Forensictoxguy Says:

    There should be product testing before anything goes to market. To not do so is negligent and if something and were to happen – grounds for a large lawsuit. If these manufacturers want to be treated as a legit business then employ proper QA/QC of your product.


  5. drugmonkey Says:

    I take it you are not familiar with the supplement industry 🙂


  6. Forensictoxguy Says:

    Oh I am. 🙂

    But we aren’t talking about that industry now. We are still talking about a federal schedule I substance, right?

    Honestly, I see an -unregulated- recreational marijuana/edibles, etc. industry as just as horrific as the “legal high”/synthetic cannabinoid industry.


  7. drugmonkey Says:

    I see much business opportunity for some enterprising soul who knows his or her way around a GC/MS analysis of THC content…..


  8. Comradde PhysioProffe Says:

    Eating weed is fucken stupid. There’s no way to titrate. One nice fucken hit of kind budde is plenty for hours.


  9. forensictoxguy Says:

    Yes, there are plenty of cannabis analytical labs out there now. Many even report what products they’ve tested and results online. Most test for more than THC – including CBN, CBD, CBC, THC-A, etc. Some even include services for pesticides, residual solvents, microbial testing, etc.


  10. becca Says:



  11. […] fields. Just saying) Climate change is threatening the existence of the world’s most amazing bird Health report from Colorado: Recreational marijuana harms NASA’s $349 million monument to its drift Waters Warm, and Cod Catch Ebbs in […]


  12. Hector Gonzalez Says:

    I’d volunteer for cannabis testing. I’d do it for $9 an hour. That’s all I can afford.


  13. DeeEmmm Says:

    Glad to see it. Knowledge that it is possible is everything.


  14. drugmonkey Says:

    Same authors but this 2015 study described in the CBS account is more focused on hyperemesis


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