marijuana ED visits: edible products had more ED visits

A study in Colorado found a dramatic increase in ED visits for cannabis-related problems, more so with edibles (see marijuana edible ED visits AIM2019 in dropbox, or doi:10.7326/M18-2809).

Details:

-- Of 449,031 eligible visits in a large urban academic hospital in Colorado from 2012-2017, 9973 ED visits (2.2%) had ICD codes for cannabis use

-- Of these 9973 ED visits, 2567 (25.7%) were at least partially attributable to cannabis:

    -- 238 (9.3%) were related to edible cannabis

    -- 2194 were related to inhalation

Results:

-- a random review of 4800 records confirmed the accuracy of ICD coding for cannabis exposure

-- reasons for cannabis-attributable ED visits:

    -- GI symptoms: 788 (30.7%), most commonly cannabinoid hyperemesis syndrome (301 patients)

    -- intoxication: 762 (29.7%)

    -- psychiatric symptoms: 633 (24.7%), such as acute anxiety or acute psychosis

    -- chronic psychiatric conditions: 100 (15.8%), such as depression, schizophrenia, or psychosis

    -- exacerbations of underlying chronic disease: 94 (14.1%)

    -- cardiovascular: 92 (13.6%)

-- visits attributable to inhaled cannabis: 

    -- more likely to be for cannabinoid hyperemesis syndrome (18.0% vs 8.4%, p<0.001)

-- visits attributable to edible cannabis: 

    -- more likely to be due to acute psychiatric symptoms (18.0% vs 10.9%, p<0.001), intoxication (48% vs 28%) and cardiovascular symptoms (8.0% vs 3.1%, p<0.001, but with MIs and ventricular arrhythmias occurring in both groups)

-- edible cannabis products accounted for 10.7% of cannabis-attributable ED visits between 2014-2016, though this represented only 0.32% of total cannabis sales in Colorado during that period, a  33-fold relative increase associated with edible products

Commentary:

-- Marijuana was legal in Colorado in 2009 for medical use and 2014 recreationally

-- the incidence of ED visits at this hospital increased more than linearly from 2012 to 2016, for inhaled products from about 200 in 2012 to 800 in 2016 and edibles from essentially 0 to about 100.

-- one likely difference between the effects of inhaled vs edible cannabis products is the kinetics of their absorption

    -- inhaled cannabis results in clinical effects within 10 minutes, peak blood concentrations within 30-90 minutes, with clearance within 4 hours

    -- oral THC does not reach significant blood concentrations until at least 30 minutes, peaks at approximately 3 hours, with clearance after about 12 hours.

    -- so, people are likely to ingest greater quantities of the edible products in their quest for an immediate high

-- several studies have shown that THC is associated with acute psychiatric visits as well as exacerbation of psychoses and increased risk for violent behavior; cannabis is also a recognized risk factor for adverse cardiovascular events, including acute coronary syndromes, peripheral arterial symptoms (includeing Buerger-like diseases), cardiovascular deaths, heart failure and strokes

-- there are several limitations to the study: this represents a retrospective study of only one hospital, and it includes patient reports of cannabis use

so, a provocative study finding that edible cannabis products seem to lead to disproportionately more ED visits, with a significant skew of diagnoses to acute psychiatric symptoms, intoxication, and cardiovascular symptoms.  this is likely a result of the different kinetics of the marijuana products, with delayed "highs" with the edibles leading to increased consumption, but then delayed metabolism and potentially higher, longer-lasting effects/adverse effects.  And, all likely to increase as the legality/accessibility/increased societal normalization of marijuana spreads...

--for prior blogs of note: 

http://gmodestmedblogs.blogspot.com/2015/06/medical-use-of-marijuana.html for medical uses of marijuana

http://gmodestmedblogs.blogspot.com/2014/06/marijuana-adverse-effects-review.html  for a review of marijuana’s short-term and long-term adverse effects

http://gmodestmedblogs.blogspot.com/2018/11/teen-drug-use-in-us-2016-survey.html for the National Institute of Drug Abuse statistics on use by teens of marijuana (and other drugs) 

http://gmodestmedblogs.blogspot.com/2019/02/cannabis-use-in-teens-increases-risk-of.html for increased risk of teen depression, anxiety, and suicidality in young adults

http://gmodestmedblogs.blogspot.com/2015/07/marijuana-passing-through-generations.html for an interesting study in rats, finding that the epigenetic effects of marijuana can be passed to their offspring (I had thought that only genetic traits could be passed to offspring…)

geoff

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