With Recreational Marijuana, Edibles are Trouble

With Recreational Marijuana, Edibles are Trouble


Welcome to Impact Factor, your weekly hit
of commentary on a breaking medical study, I’m Perry Wilson. 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. But according to this study emergency room
visits attributable to marijuana have ticked up – by about a factor of 3. 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. 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”. 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. There’s another little gem of data in this
study. 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.

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