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How EMTs and Doctors Treat Cannabis Overconsumption

September 24, 2018
weed, marijuana, pot, overdose, how to treat weed overdoseToo much THC can lead to feelings of paranoia, anxiety, or helplessness. It's OK. Doctors say: Lie down, ride it out. It just takes time. (CSA-Printstock/iStock)
A few years ago, Morgan Rowe eagerly anticipated her first marijuana experience. Washington had just legalized adult-use sales, and Rowe, who lived in Seattle, had never gotten high.

After ingesting some carefully measured homemade brownies, “I was suddenly overcome with giggles,” recalled Rowe, who now lives in Maine. “And I was very conscious of how much I wanted to experience that particular phenomenon, being stoned like that. And that was super exciting.”

“I really thought I was going to have a heart attack. And I think that’s when we called the paramedics.”
Morgan Rowe, first-time edible eater

But not long afterward, she remembered, “I felt like something was terribly, terribly wrong. To me it was very physical. I felt like there was a very hot lava cube traveling through my nervous system.”

The person with her, an experienced cannabis consumer, reassured her. She was OK. But Rowe’s symptoms became worse.

“At the point where I felt the sensation get to my heart,” she told Leafly, “I really thought I was going to have a heart attack. And I think that’s when we called the paramedics.”

Emergency medical personnel came to Rowe’s residence and examined her. After determining she would be fine once the effects of the cannabis wore off, the EMTs left.

(Rowe’s account of her experiences, part of the Leafly series Tales of Terrifying Highness, can be read here.)

Her story is an illustration of the growing number of people who have found themselves in physical and/or mental distress after consuming too much cannabis.

Coming Soon to Canada

Over the past several weeks, as Canada prepares for the legalization of adult-use, recreational cannabis in October, Canadian media has been filled with cautionary articles about the risk of cannabis overconsumption.

CBC News reports that emergency room visits in Canada, for what some are calling cannabis “green-out,” have risen dramatically over the past several years. In Ontario, Canada’s most populated province, federal health officials say that ER visits due to so-cannabis overdoses have nearly tripled over the past five years.

Cannabis overdosing has been a big issue in the United States for several years now, as more states legalize recreational use.

And we should note that we are not talking about the growing crisis surrounding so-called synthetic marijuana, a manufactured drug often found in states where marijuana remains illegal. There have been terrifying reports about people overdosing on synthetic marijuana with life-threatening and sometimes lethal results.

Stronger Cannabis = Stronger Effects

In Colorado, which legalized recreational cannabis more than four years ago, doctors say they’ve seen a spike in the number of overconsumption cases among adults.

Dr. Eric Lavonas: 3-4 weekly cases

“We see a few a week,” said Dr. Eric Lavonas, an emergency physician and medical toxicologist at Denver Health Medical Center. He also works with the Rocky Mountain Poison and Drug Center, the poison control emergency contact for Colorado and five other states. “We don’t really keep numbers on it, but my best guess would be three or four a week.”

Lavonas told Leafly that the arrival of high-potency cannabis strains and high-concentration THC edibles over the past several years has been a game-changer.

“It’s just a different marijuana than what was easily available ten years ago,” he said. “And when you have a stronger drug, you have stronger drug effects.”

According to Lavonas, most of the cannabis overconsumption cases that doctors are seeing involve edibles. A common scenario: A first-time consumer eats an infused candy or cupcake but doesn’t feel any immediate effects. Out of frustration, they then consume more edibles, not realizing the first dosage is already working its way through their system and that the delayed effect of all that cannabis will hit them shortly.

“When people smoke pot, they get peak effect of the drug within a few seconds,” Lavonas noted, “which allows the user to self-regulate, to sort of get where you want to be.” With edibles, on the other hand, “when that train leaves the station, you don’t know where it’s going to go for 30 minutes to two hours.”

In metro Denver, the majority of patients coming into ERs due to cannabis overconsumption are tourists, often first-time consumers who took too many edibles. There are locals coming in as well, said Lavonas, but they’re mostly dealing with cannbinoid hyperemesis, the vomiting and abdominal pain syndrome sometimes associated with heavy, long-term cannabis use.

Symptoms and Treatments Vary

In the field, emergency medical service personnel treat cases of cannabis overconsumption based on the symptoms shown by the patients.

“If a patient were severely agitated, paramedics could administer a medication for sedation. For example, a benzodiazepine like midazolam,” Kristi Koenig, EMS medical director for California’s San Diego County, told Leafly via email.

“If the patient was experiencing nausea and vomiting, paramedics could give intravenous fluids for hydration and anti-nausea medications such as ondansetron,” Koenig added.

The paramedics also closely watch a patient’s vital signs, both at the scene and during transport to the hospital. But many of those suffering from too much cannabis, said Lavonas, are brought into emergency rooms by their family and friends, where patients are examined and treated by doctors.

Paranoia Isn’t a Myth

Some of the more common symptoms for cannabis overconsumption, he said, are anxiety and paranoia.

“Usually, in the milder cases, people are very aware that they’re anxious and paranoid—and come in saying, ‘I feel terrible,’” Lavonas added.

Paranoia and anxiety are the most common symptoms of overconsumption.

Less common but still an issue, Lavonas said, are the cases where someone has gone “way over the top” with edibles and are truly psychotic. At that point, he said, a patient is typically unable to understand that “what’s going on is a chemical reaction in the body. They’re unable to control that behavior. But that’s uncommon compared to people who just simply feel terrible and need a little help in getting over it.”

It’s Different With Teenagers and Kids

While few adults end up being admitted to hospital for cannabis overdose, the story can be quite different for children and teens.

Researchers at Children’s Hospital Colorado noted in a recent study that the number of teens diagnosed annually with cannabis overconsumption or testing positive for cannabis during drug screenings at the facility rose more than fourfold between 2005 and 2014, the year recreational cannabis became legal in Colorado.

And according to the study’s lead researcher, Dr. George Sam Wang, an emergency medicine physician and assistant professor of pediatrics at the University of Colorado Anschutz Medical Campus, the rate of ER and urgent-care visits by stoned teenagers more than doubled between 2009 and 2015.

Wang told Leafly that most pediatric cases of cannabis overdose can be attributed to cannabis edibles.

Symptoms with young children, Wang said in an email, can vary in their severity “from mild sleepiness to the extreme rare case of children requiring a ventilator or mechanical breathing assistance.”

Related

I’m a Cannabis-Using Mom. How Should I Talk to My Kids About Legalization?

Parents More Honest Now

Most of the children in these cases, he said, are brought in by their parents. And with legalization, it appears that many parents are also more forthcoming about how their kids got hold of the cannabis that made them ill.

Wang’s advice to parents who consume cannabis is to “treat marijuana products just like alcohol, cigarettes, prescription and OTC drugs, or dangerous household chemicals,” he said. “Keep them out of sight, reach, and locked away, and in child-resistant packaging.”

Time Is on Your Side

Stricter regulations in cannabis-legal states, with education campaigns and child-resistant packaging, have reportedly helped reduce cases of cannabis overconsumption.

Child-resistant packaging reduces minor access.

“It’s certainly something we talk about nationally and have tried to address,” said Dr. Kennon Heard, professor of emergency medicine at the University of Colorado School of Medicine. “Colorado is early on in the field, one of the first places you’d see this. We take our experiences and share, especially regarding pediatric cases.”

And according to Dr. Lavonas, experience has taught emergency medical personnel that time is the best antidote for most cannabis overconsumption cases. “Offhand I can’t think of an adult that I’ve had to admit (into the hospital) for this,” he said.

As with all such cases, he said, doctors need to make sure there aren’t other ailments that might complicate their treatments. “Just because you smoke marijuana doesn’t mean you can’t get pneumonia, so we’ve got to make sure there aren’t two problems.”

And then, he added, there’s the importance of “letting people know that they’re in good hands, that time is on their side and they’ll be OK. And then, if the reassurance alone isn’t getting them where they need to be, then a little bit of medicine to help them relax, something for anxiety, a little bit of fluids and just… time.”

Slow Down, Enjoy the Burger

One classic recent case at Denver Health, according to Lavonas, involved a man in a fast-food restaurant who’d been smoking marijuana.

The man felt himself choking, recalled Lavonas, “so he calls 911 and arrives in the ER still with his bag of (burgers) and his … soda. My adept senior resident meets the man … sizes up the situation, and figures out that he has really bad cottonmouth and some anxiety. And he has him drink his soda and eat his burger, reassures him, and sends him out.”

“In the end what we’re about is happy endings,” said Lavonas. “We don’t judge. We just take care of them, get them feeling better, and get them home safely.”

Bruce Kennedy's Bio Image

Bruce Kennedy

Bruce Kennedy is an award-winning reporter, editor, and producer based in Colorado. He has covered the legal cannabis industry since 2010.

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  • viper643

    legal age at 30 yrs. old. and synthetic THC should be banned.

    • NOTHING…should be banned. Its the prohibition mentality that has caused all of the drug problems that exist.
      Study the 18th and 21st Amendments to the Constitution and absorb what they teach.

  • RobertM. from Carlin

    There is still a lot of clinical work regarding toxicity that has been stifled by the government’s policies towards weed. I have faith as the beneficial properties of pot become apparent these other studies will fall into place .

  • “Cannabis Overconsumption”?

    Oh for fucks sake……😔

    • justadbeer

      Well… it can happen. I remember a few years back my kid had some NYC Diesel laying around (for my wife who has her card) and I decided to give it a try after decades of not smoking. It was not a pleasant experience. I think I gave that pipe 4-5 good hits. 20 minutes later I was couch-locked and having chest pain. My kid was like “dude, how much did you smoke”? And reminded me that it wasn’t that shit weed I smoked back in the day. I was fine of course, but I can see if someone eats an entire brownie or a handful of gummies how this can scare the shit outta them.

    • Ruth Hill

      Yes, it can happen. Everyone’s metabolism is different.

    • Amie Barilone England

      Happened to me. 3 times to be exact. If your sensitive or a new user and smoke or use too much you can surely get too high and feel very very terrible. Happend to me the other night. It literally feels like your gonna die. It’s bad

  • Steven Hagar

    I’ve a question. We hear that no one ever died by over dose using pot. If true, what is the difference between what happened to subjects in this article and over dosing? Seems like splitting hairs. I would’ve called the examples used in the piece overdoses. True no one died but over use of pot was the cause.

    • darkcycle

      Well, depends. We see the word “overdose” the picture we associate is a dead guy, still tied off, with a syringe still stuck in the vein. If a mildly upleasant experience is likewise described, it can be confusing to the naive. Which is the intent. Oh, and you are an idiot, and might want to stick to Kennedy assassination conspiracies. ’cause “helping” , this is not.

      • Links2

        The biggest idiot here is you.

    • Well, the article is bullshit. Ive been smoking weed for 45 years and never heard of such nonsense until now.
      One should not confuse “over consumption” with some lightweight that can’t handle their medicine. What a lightweight calls “too much” is a great buzz to the rest of us.

      Once one reaches the max high from what they smoke or eat, they can chain-smoke for the next hour and will not get any higher.
      “Over-consumption” does not exist.
      Bullshit articles on Leafly, however, do.

    • NekoMimi81

      You don’t need to be at risk of death to overdose. Feeling like you’re going to die or wanting to die to make the experience stop can be just as traumatic as taking too much heroin.

      You can’t die of cannabis toxcity but you can hace an experience that is indescribable to people that haven’t gone through it themselves.

    • I guess it’s like eating too much food. There’s eating till your stomach ruptures or eating till you have a tummy ache.

  • bill wa

    Cannabis is an oil based plant. Its seed contain Omega 3,6,9 fatty acids. Folks these days eat way too many carbs. Makes it hard to enjoy God’s gift loaded up on sugar and alcohol.
    Cannabis is completely broken down through liver enzymes. Sugar and alcohol are processed the same because the liver can’t tell the difference.
    Probably should eat more Cannabis. avoiding sugar and alcohol gets rid of paranoia and “heart checks.” God made pot to tell us how much sugar we’ve eaten.
    Weed has always mellowed us out and sugar makes us diabetic, jittery, and increases stress eapecially if you have a reserve of sugar fuel.
    Even herbivores seek fats, and avoid sugars themselves. Seems keto is key. Sugar will kill you faster than cannabis ever will. Sugar addicts are just as prevalent as alcoholics, and both are consumers of sugar.
    Want a more complete Cannabis experience? Don’t eat sugar, corn, corn syrup, grains, etc. If it has more than one ingredient don’t eat it. Have a hearty salad and a grass fed steak or free range chicken instead. Snack on nuts and seeds. Do this for two weeks then “get high.” You’ll find more control over your buzz, and enjoy it, no matter the path of consumption.
    Eating it lasts way longer than smoking. The liver actually converts 100% of the cannabis consumed and all its compounds are used by the body. Smoking is a faster route to the brain.
    Some folks get all weird after getting high because they’re all jacked up on SUGAR previously. Sugar is not a nutrient, neither is corn. Corn fed beef is hungry when It’s slaughtered for market, like most folks after dinner.
    One has to be in shape to handle Cannabis, if you are loaded up on sugar stay away from it, or learn about your mistakes. She’s a firm but loving teacher.

    • Casey

      Your body can only digest what you put in it. Anything that is edible contains Fats, Protein and Carbohydrates. What you are telling people is to not consume carbohydrates and freely indulge in fats and proteins. Fats congeal in the arteries and proteins are loaded with fats. Even the free range chicken and the grass fed cows are loaded with fats. Basically you told everyone to not eat bread, vegetables and fruits, cereals and just eat beef and free range chicken. Take a nutrition class because you don’t know anything and sound like a moron. I have some news for you bill wa, the marijuana leaf has all the essential amino acids your body will ever need, you don’t need to eat a cow or a pig and we both know what you can do with the free range chicken.

      • bill wa

        The reason why mmj and alcoholics don’t get along is because the mmj user comes from a family of alcoholics and chooses not to drink.
        Fats only congeal in the arteries because of the arterial damage brought on by drinking, or an equal sugar consumption.
        Folks who soley drink ethanol, and have poor diet also. You do know ethanol is also a food grade solvent, right?
        Not all herbivores solely eat plants for rufage, some plants like peanuts, acorns, filbert nut trees, etc contain fat.
        Not all edibles contains fats and proteins. Candy is pure sugar, soda- a close second, read labels.
        Sugar was never part of the human diet as it is today. The more sugar (sucrose) you eat, the more it sticks to you because you can’t produce enough insulin to process it.
        Realize, when chickens are “free range,” they are happiest doing the job nature intended, eating yard bugs gaining fat from “meat” and proteins for glucose production.
        If everyone around you is dying from sugar related diseases (cancers, diabetes complications, alcoholism, etc), wouldn’t you single out sugar as a killer?
        Some folks have Non-Alcoholic’s Fatty Liver Disease, and never drank a drop ever. Seems the liver can’t tell sugar from alcohol, if Doctors can’t tell if you’re a diseased non-drinker; same disease, two different social styles, hmm…
        Why don’t you give me a call when you see a cat dig up a carrot, or a cornstalk breastfeed mammals.
        The animals around here won’t eat soybeans either, why do humans? Red and Gray squirrels pass up soybeans, black tail deer do too. Rabbits won’t eat’em either, shrews too.
        Turn the food pyramid upside down, is all I’m sayin’. Mammals require sat fats! Avocado oil is a good one, cook with that! Coconut oil too!
        Sugar addicts never want to hear “give up sugar.” Life is so much better not racing around everywhere, and half-assin’ tasks because you forgot something buzzing around on a sugar rush. At least coffee improves accuracy.
        I stopped eating processed sugars and foods, I also stopped going to the Dr. for illness.
        Hemp oil is great in the kitchen too!
        I only drink once a year, and that’s even a maybe, and my last post wasn’t the time to drink. Poor assumption on your behalf.

        If you get knowledge from a book, there are other books out there. One-sidedness is never a fair arguement. Ketogenics don’t seem all that bad, but, unplugging from sugar means no more chocolate. There is no sugar cravings on keto. There is no spoon (for ice cream) either.
        We were also told saccharin and xylitol was safe too.

  • Samuel Rivard

    Iam a medical users in Canada
    The feeling of getting too high is really unpleasent and its so a unusual feeling (had nothing to do with how movies or video games depict the effects)

    Its a very physical sensation and you are consious about it

    But its a physical reaction
    Its just that your brain take these input as stress or danger signal while its is not

    It is more common with Sativa type usually because of the “boosting” effect

    Also if you take any others medication or coffee (coffeeine also from tea and chocolate) and sometime certain food (like Mango) can make the high or effect last longer and with a stronger hit

    I personnaly realise that when i get anxiety on cannabis usually its not the cannabis causing it but is me been AWARE iam anxious and its the acumulate stress iam feeling all at once

    I beleive those with anxiety (or very productive people who function on adrenaline) might get more of a shocking experiences

    Using trick from Somatic Therapy can really help overcoming a unpleasent high
    And remember
    IT WILL PASS

    • Casey

      Samuel Rivard, mango contains a terpene called myrcene which is also a terpene in some strains of Marijuana and relieves pain. Eating a mango can actually relieve pain, but can’t potentiate the effects of marijuana. Caffeine boosting the effect of Sativa is a joke, where did you get this nonsense. Chocolate is rich in fats which bind to the THC you ate, this allows more of the THC to be absorbed and give you a better effect. Caffeine has no synergistic or antagonistic effect with MJ. Your belief that people who suffer from anxiety/panic disorders can be compared to an A-type personality is ludicrous and insulting.
      The real problem is that novice users think they can dose themselves the same as old school users do, or what some idiot does on YouTube, then they want to try it. I got some news for you all you novice users of this great plant. When you have used as long as I have, the high is a side effect. Right now I’m smoking a joint that is 28.21%, which has 200 mg of THC in it. The buzz is only 5 minutes. The real med use is after the high wears off. Thats when the mental and physical relaxation occur. The marijuana plant has more uses than the corn plant does, corn has a lot of uses. Marijuana Prohibition is wrong and the morons who consume too much are uninformed users or just plain ignorant. If the first time you drank alcohol, you drank the better part of a 750 ml bottle (or 5th) of whiskey you are going to get violently sick and could die you. With Marijuana, people think it can’t kill me, so it will make me stronger, then dose liberally. They forget it’s a psychoactive drug and it can alter the way you perceive things. When you can’t comprehend what you are experiencing, your brain can’t deal with these new feelings and tries to shut them out. Thats when you loose control and the green out happens, your so scared that you can induce a panic attack and they can be chronic in duration. This usually causes the well intended user to never try it again. They don’t want others to live thru that experience and oppose the legal status. This is what was called REFFER MADNESS. Believe it or not, there are people who still believe that old factious fairytale.
      My Recommendation as a user since the early 70’s, take it slowly and enjoy the high while you can. Just because you want to try marijuana, doesn’t mean you have to smoke an 8th or eat a 500 mg candy bar or brownie or vape a gram of shatter. Just enjoy and relax.

      • Samuel Rivard

        I dont get how i
        “Your belief that people who suffer from anxiety/panic disorders can be compared to an A-type personality is ludicrous and insulting”

        I didnt say anything like that

        Aside if you tend to have anxiety coffeine can make anxiety worse and if you mix with cannabis when not use to it of course you can trigger a panic attack… Not that it boost sativa effect but if your alredy prone to panic attack and its a new experience it can trigger and coffeeine can make some anxious responce too on top of that

        Iam a person who suffer from anxiety and PTSD
        i know what iam talking about

        I know cannabis effet are nothing compare than what is movies or games

        Using technique of relaxation found in different therapy can be really helpful to pass the anxiety feel because usually your just scare to loose control and just have to accept the sensation

        After that it can be a more pleasent experience

        When a strain smell myrcene i know i have to take less for me
        And i avoid cholotate and stimulant in general cause iam sensitive to it no matter cannabis

      • Samuel Rivard

        Coffee can trigger anxiety and if your sensitive to it with cannabis it can make anxiety worse (i have a friend if he drink just a cup of coffee he cant sleep for 3 days and he then get parranoia (not psychosis like in movies) (and that is without weed… Just the effect of caffeine

        Mix with weed it can make some side effect but it really depends de person
        I tolerate coffee well but i dont overdrink and chocolate with weed is very good but i get more anxiety if i take too much stimulant (like sugar and cafeine) overall

        I know about myrcene and iam careful about it… But there is also the same therpene find in coffee and chocolate… Often on sativa and they have more of a boosting effect but i tend to say iam a natural sativa person (lol) so i need something calming not too boosting

  • Stella

    Hmmm, every comment is awaiting moderation? I guess someone is otherwise engaged. Enjoy.

  • darkcycle

    Cannabis hyper emesis…three. 3, “documented” cases since legalization in Colorado. All diagnosed in two hospitals, BY THE SAME ER PHYSICIAN. None that I am aware of in any other state. That gets filed under the heading of “Things that make you go Hmmmm…” But okay… Can we talk about alcohol induced cyclical vomiting?
    Highly potent cannabis is not new, and poses no special risks (unless you happen to be a tube of cookie dough). Hashish and hash oil were the primary product consumed prior to prohibition. Cannabis is nothing new…as humans we have used it for at LEAST 4000 years, and there good evidence we used it long before. Now, mind you, in all that 4000 year history, you cannot find one fatal overdose. Not. A. Single. One. Can we get over this BS yet?

    • Donna Moorhouse

      There have been cases, and it MAY be attributed in some cases to cannabis that hasn’t been properly flushed before harvest, or the use of certain pesticides, especially Neem Oil products.

  • LL

    i have severe cannabinoid hypermesis Syndrome..and it’s completely frustrating because having CRPS and failed back syndrome from a botched fusion..I waited 81/2 yrs for legalization in Florida..I started MMJ very slow, increased in tiny amounts nowhere near my recommend at first..by week 3 I believe, still only up to one actual dose I started vomiting uncontrollably..craved hit baths and submerged in water was the only thing that slowed the vomiting..the sick feeling lasted a day the vomiting hours..
    I didn’t think there was a connection so after a week rest I tried a different strain and the same thing happened..same hot bath cravings,,no anti nausea med like zofran or phenergan helped and almost went to the ER thinking food poisoning first but the hit water thing made me search THC and vomiting and saw the cannabinoid hypermesis Syndrome…and listed the relief and cravings of hot water soaked up to your neck..one Dr mentioned even iv forms of anti nausea meds were failing in the ER to stop the vomiting Syndrome and several patients obviously were at risk of dehydration, but a one girl started kidney failure because it would not stop..another Dr knew about a psychological drug that also had an anti nausea side effect and tried it on the woman, and thankfully it stopped her vomiting when nothing else would..
    I thought no way, could I have this because all the literature is about heavier users and longer term users…I was only on week 2-3 and small amounts..so I thought maybe a hybrid and a different method…but it happened a 3rd time so I gave up..knowing it was CHS as did the Dr , but without cases being reported for new MMJ users, it wasn’t making sense to anyone..
    I can use high CBD from cannabis that has negligible THC of 0.1-4% without vomiting, but to try to get any of the potential pain relief and inflammation relief I’d be spending over $450 a month and I cannot afford to do that.. so I use what little I can and hope it’s helping something..very frustrating and even more so because I’ve only been able to find through the area dispensaries that a couple people had a little nausea

    • Samuel Rivard

      Thank for your experience its important to be aware these condition exists and there effect

  • Alison Draisin

    I am surprised that you have not included the work of Dr. Ethan Russo who addressed using Terpenes such as limonene and pinene to ameliorate the effects of Delta 9-THC (British Journal of Pharmacology 2012). Drinking orange juice or lemonade is all you need to reduce anxiety and paranoia from too much THC. I actually teach this to many ER teams in WA and CO. This has minimized the need for benzodiazepines and expensive medical treatments. #themoreyouknow

    • Samuel Rivard

      Orange juice do wonder for me also calm the cottonmouth effect

  • NekoMimi81

    It’s really messed up how dismissive so many are. You’re very lucky that you’ve not experienced an OD. You can’t die from toxcity but you can feel like you’re going to die all the way to wishing for death just to make this horrible situation stop!

    I challenge everyone that blows this off as nonsense to pop a couple extra edibles next time you consume and put your denial and ignorance to the test.

    If you REALLY believe this is propaganda or exageraexagg, do it yourself… Or do you not want to admit just how wrong you are?