Looking for an exceptionally risky way to consume marijuana? Try an edible.
This is the message from a new study on emergency room visits following the drug's legalization in Colorado.
For their work, published Monday in the Annals of Internal Medicine magazine, a team of doctors reviewed more than 2,500 marijuana-related emergency visits at a large public hospital in the state between 2012 and 2016.
Cannabis was clinically legalized in Colorado in 2009 and recreationally in 2014.
While the hospital has seen about 200 cannabis-related ER travel in 2012, that number jumped to around 800 in 2016, the study authors found. The increase was driven mainly by smoked marijuana, where people who presented with troubling symptoms, such as nausea and vomiting, tended to appear in the emergency department after chronic or heavy use.
Edibles were another big problem.
Brownies, biscuits and other sources of cannabis that are ingested can confuse patients and lead to problems like paranoia and intoxication. These problems are especially true for people who are new to marijuana, said Andrew Monte, lead author of the new study and associate professor of emergency medicine at the University of Colorado School of Medicine, to Business Insider.
"I do not think people are educated enough about how much cannabis they take and how long they wait," Monte said.
For his work, Monte and his team reported nearly 10,000 emergency visits to the Anschutz campus of the University of Colorado at Aurora, a large public hospital 30 minutes from Denver. Of all the visits, about a quarter, or about 2,500, were linked to marijuana. Of those that more than 10% were tied with edible.
Monte called the discovery "impressive," especially in light of how few cannabis foods are sold in Colorado compared to cannabis blossom, a term for the type of marijuana that is smoked.
Not all edibles are created equal
Compared with emergency visits for smoked marijuana, the proportion of visits to edible was "about 33 times higher than expected," Monte and his team wrote in their article.
Monte has several ideas on why this might be happening.
New and inexperienced marijuana users may be more likely to experience edibles, for example, because they perceive them to be safer or less intense. But in comparison to inhaled marijuana, whose effects appear in minutes and last for three to four hours, ingested cannabis may take hours to take effect. But these effects can also last up to 12 hours – putting the duration of the trip on par with that typically seen for psychedelic LSD.
"With cannabis inhaled, people feel good right away and usually know when to stop. If people eat something and do not feel it, they tend to try harder, and that makes things difficult," Monte said.
In addition, there may be large discrepancies in the actual cannabis content of edible products.
Part of the problem is the lack of standards around dosing and labeling with edible. A 2014 review of the Denver Post revealed that of dozens of products labeled with 100 milligrams of THC, some contained virtually zero milligrams of the ingredient, while others contained almost 150 milligrams.
"Can you imagine accepting this kind of inconsistency for any other product?" Monte said. "This is not something we would accept for any other food or medicine I could think of."
Still, Monte emphasized that emergency weed-related emergency visits do not overwhelm her hospital. In fact, he said he was quite accustomed to seeing an increase in emergency room visits when a new drug is introduced into a community. Based on your article numbers, if your team is seeing 300 ER patients every day, only one of those visits is related to marijuana, he said.
"The thing to remember here is that cannabis is not killing everyone, but it's not healing either," Monte said.