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Study Finds Top 5 Causes of Cannabis-Related Emergency Visits

September 29, 2017
(MJFelt/iStock)
A new review published in the American Journal of Health-System Pharmacy determined the most common causes of cannabis-related emergency department (ED) visits, giving policy makers and industry leaders a compass for improvement. This analysis specifically looked at data from Colorado.

Cannabis legalization helps solves many problems: it eases the toll of the opioid epidemic; it creates jobs; it generates tax revenue; and it keeps cannabis out of the hands of minors. But for all the good cannabis does, we can’t lose sight of public health concerns that must be solved in order to successfully implant legalization across the U.S. and beyond.

This review provides us with five concerns to prioritize: accidental pediatric ingestion, acute intoxication, cannabinoid hyperemesis syndrome, synthetic cannabinoids, and injuries related to production of butane hash oil (BHO).

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Pediatric Ingestion

As previously stated, legalization has not led to higher rates of underage use, but this review found an increase in accidental pediatric intoxication. “Children are at particular risk of cannabis toxicity because cannabis-containing food products, known as edibles, look extremely similar to regular candy,” the authors wrote. “Also, we have found that the severity of symptoms from marijuana exposure has worsened due to the high THC concentration in edibles.”

States have taken several measures to reduce accidental consumption by children. Some policies mandate that:

  • Packaging is childproof
  • Packaging does not contain cartoons or other imagery attractive to children
  • Edibles do not come in candies or other forms enticing to children

Guidelines like these may help to reduce accidental ingestion by children, but full responsibility falls in the hands of adults and parents. It may seem like an excessive measure, but lock your products away until you intend to take them. Kids can be incredible hack artists.

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Acute Intoxication

Acute intoxication refers to those who simply consumed too much cannabis. “The number of marijuana-related ED visits has nearly doubled since the drug’s use was legalized in Colorado,” authors wrote, “and the rate is higher for non-Colorado residents who are visiting the state.”

They also mention that acute intoxication has historically gone unreported, which helps to account for the notable increase. Naturally, people are more inclined to seek help for intoxication by a legal drug than one that is illicit.

Furthermore, with the uptick in cannabis tourism, this statistic is unsurprising: a tourist inexperienced in cannabis may lack the experience to know how much is too much. The review outlines a particular instance in which one man consumed three edibles before a flight “when he realized he could not take the brownies on the plane.”

Many Colorado dispensaries go above and beyond to educate their customers on the effects of cannabis, especially edibles. Continuing to get that message through, especially to out-of-town visitors, should remain a top priority of businesses in legal markets.

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Cannabinoid Hyperemesis Syndrome

Cannabinoid Hyperemesis Syndrome (CHS) is a condition that is coming to light in the medical field – though its characterization has been somewhat controversial and divisive among professionals.

It’s primarily characterized by regular vomiting episodes, which is why it’s often assumed to be cyclical vomiting syndrome (CVS). The cause of CHS, researchers speculate, has to do with heavy, regular cannabis consumption in some individuals – a speculation that is supported by the fact that symptoms tend to resolve after cannabis cessation.

This review describes an instance of CHS recorded in Denver:

“A 32-year-old man came to the Denver Health Medical Center ED with a 12-hour history of intractable vomiting and epigastric pain. Throughout the interview the patient was retching uncontrollably. The patient reported several similar episodes over the past 2 months requiring medical care. Laboratory tests were conducted but unremarkable other than a THC-positive urine drug screen.”

While more cannabis specialized doctors are coming to acknowledge this condition’s existence, there’s overwhelming agreement that more research needs to be conducted on CHS.

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Synthetic Cannabinoids

Synthetic cannabinoids – also called SCs, Spice, K2, Scooby Snax, etc. – are not cannabis (and by that right shouldn’t even be on this list). They are chemical analogues intended to mimic the effects of natural cannabis, but because of their clandestine production and high affinity for receptor sites, synthetic cannabinoids can cause a laundry list of severe symptoms and, in worst cases, death. This report describes a 24-year-old man (who was of legal age to buy natural cannabis) who was admitted to the ED and suffered a seizure after consuming SCs purchased at a head shop.

The fact that synthetic cannabinoids had to be included in this report is disappointing. With legal cannabis widely available to adults over the age of 21, there’s no reason for anyone to turn to an unregulated, dangerous alternative. That being said, it’s clear that there’s much work yet to be done on the education front.

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Home Extraction Injuries

Once again, when there’s a legal, safe alternative, it’s disheartening to read about the injuries sustained by individuals attempting to produce butane extracts themselves. Professional extractors use state-approved equipment and processes to greatly reduce the risks associated with BHO production, but some individuals will take it upon themselves to make their own, “blasting” BHO in their homes often with butane cans and glass extraction tubes. Improper airflow can lead to explosions, injuring the person performing the extraction as well as others in the vicinity.

“In July 2015, a law was passed that explicitly made manufacturing hash oil using flammable solvents illegal,” the authors wrote. “Anecdotally, the effect of this legislation has had minimal effect on the number of burn patients admitted to our institution.”

If you’re interested in extracting cannabis at home, choose a safe method that doesn’t use dangerous solvents. Rosin, for example, is a solventless extract that simply uses heat and pressure to extract cannabinoids. It can be produced safely and affordably with a pair of strong hands and a hair straightener.

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The report ends with a single conclusory sentence: “Marijuana legalization in Colorado has been associated with an increase in marijuana-related ED visits.” In a young industry that attracts inexperienced consumers with novelty and newly gained legality, this report is not shocking.

But it’s important not to conflate this conclusion with “Legalization in Colorado caused an increase in public health issues.” Legalization may correlate with these increasing statistics, but it did not necessarily cause them. Cannabis legalization empowers people to report their emergencies. It’s also impossible to say that legalization is to blame for increases in synthetic cannabinoid use. It’s true that legalization invites more citizens to partake, but it’s up to us to assume responsibility and evolve cannabis – through education and research – in a direction that betters the lives of consumers and non-consumers alike.

Bailey Rahn's Bio Image

Bailey Rahn

Bailey is a senior content manager at Leafly, specializing in strains and health. She's spent 7+ years researching cannabis products, spreading patients’ stories, and exploring healthy ways of integrating cannabis into daily life.

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  • familyguy

    Let’s not make exaggerations, like the project SAM folks, no one been killed or seriously injured and all issues could have been resolved with a little common sense and a bag of Cheetos.

    • Man’s Ruin

      No one has ever died from a cannabis overdose, period. Stop engaging in cowardly equivocation.

  • Another problem with educating the public about “spice” is credibility. Warnings about synthetics are similar to warnings from officialdom about actual cannabis for the past several decades. When people tried marijuana, it was obvious that those dire warnings were nonsense. Unfortunately, that nonsense is still entrenched in DOJ thinking and in Federal law.

    • James

      Except synthetics actually are dangerous and can and will make you sick and can kill you whereas cannabis can only make you sick if you use too much. Not sick like you are going to die sick, sick like you throw up and then sleep for 12 hours. Spice will make you sick like health problems sick. As much fun as spice was back in the day I will never go back to that.

    • lovingc

      They need to stop calling this crap synthetic marijuana. It is not cannabis at all. It is a designer drug with no safety.

  • Harold Hutchinson

    First off i feel that adults or parents of young children should be putting all chemicals “cleaning supplies” and drugs out of the reach of children. If this kind of thing happens they need to be ordered to take parenting classes. Period. As for getting sick after smoking or ingesting that i personally
    think, Now this is just me thinking here. your allergic to pollinated products, if you get overly intoxicated well shame on you. its a no brainier that if you never tried something new than start out small. for example if you don’t like bananas and never had mud-pie you don’t grab a bowl full you try a spoonful instead, and that synthetic crap people are trying that because they want to have a high put not lose there jobs because marijuana or THC stays in our system for a longer period of time where the syn only a couple of days. lets keep it clean and green.

    • klw

      Either way something will have to be done sooner or later, if it’s legal in your state end of story. It’s ridiculous that I can drive and work under many prescriptions that even warn you about operating vehicle’s or machinery ya duhhhhh. But if I smoke pot at home or on the weekends and get a UA at work and fail tough sh*it, that’s bs. If they can come up with a VERY accurate test then OK otherwise get over it people. We have made it for many decades without all the unnecessary scrutiny why does it matter now??

  • klw

    Is it really possible to smoke to much resulting in a visit to the ER??? I smoke to much and I fall asleep. I have smoked for 45 yrs now and never heard of any of this happening except maybe eating to many edibles. I don’t eat it, never have liked it, smoking the flower is the best way. Easily dosed and fast results. And that fake crap, should be eliminated. Why would you smoke fake crap when you could get the real thing?? People are stupid. We have been smoking for many decades with zero problems, now it matters?? It seems like some people have way to much time on their hands.

    • boB

      They did specifically cite someone that ate too many edibles too quickly.

  • Man’s Ruin

    The writer of this article needs to do a bit more research, particularly around the issue of so-called “CHS”. The reports of this have been ENTIRELY ANECDOTAL, AND CANNABIS USE IS CORRELATIVE, NOT CAUSATIVE. There have been a handful cases of this CLAIMED in CO and Australia (it was originally reported in Australia in 2004), and while marijuana use may be a factor in those extremely rare manifestations, there is absolutely zero proof that it is the direct cause. Reading, particularly critical reading of available research, is fundamental.

    Additionally, there are several further problems with so-called “CHS”:

    1. Have you noticed that NONE of these reports discuss the numbers of manifestations of this “illness”? That’s because there are only one or two. It all started with the a claim by one dude, Luke Crowder, who claimed that his two year stomach problem ended when he stopped smoking weed: that was when the term “CHS” was invented out of the blue, without any concern for medical proof.

    2. Since these symptoms have never before in recorded history been connected with cannabis use at any level, any reasonable thinker would look for another factor connected to marijuana use that might be at play….and low, and behold — Azadirachtin, AKA “Neem Oil”, a strong insecticide used commonly by cannabis growers across the globe beginning around (wait for it….) 2004! And guess what? Azadirachtin toxicity can create precisely those effects claimed as CHS!

    3. The cannabis in question in all of these cases was self-reported; it was never tested for purity.

    4. There are cases of CHS occurring in people who have consumed no cannabis.

    So let’s review, science-minded stoners: 1. Despite more than 2000 years of recorded, heavy cannabis use by humans, CHS was never seen until 2004, which was the time cannabis legalization movements began to take hold in the US and win major victories; 2. The sample size of these anecdotal observations and the rate of recurrence of this “syndrome” are unknown and intentionally left ambiguous; 3. There are cases of occurence in people who don’t puff da ganja; and 3. The symptoms are much, much more effectively explained by the consumption of plant material contaminated with high levels of insecticides like Azadirachtin.

    Reefer madness is real, and can be spread through ignorance and misinformation, even here at leafly. Educate yourself, always critique sample sizes and research methodologies, and never, ever trust a Prohibitionist.

    • Jessica Shmessica

      Go onto google scholar and search cannabis hyperemesis… There are many reported cases and have been linked to heavy cannabis use in many countries including Australia and the US. Please cite your sources for peer-reviewed studies concluding that CHS can occur in those not consuming cannabis, I have never heard of that.

    • Jessica Shmessica

      I’m just confused, are you saying that everyone who reports signs of CHS have ingested cannabis with neem oil?

      And of course these symptoms would never be reported before because Cannabis was not legal before…. people wouldn’t admit the factors that may have been causing their issues for fear of legal repercussions. Though humans have been using cannabis for thousands of years, the way that it is being used now is much different than it has been.

  • Jan Scott

    It is very easy to take too much THC via edibles. There needs to clear instructions and dosage. I took too much once and was convinced I’d had a stroke and would be an imbecile for life.

    • Jessica Shmessica

      I’m pretty positive that in every state there are recreational edibles, there are dosage instructions… Medically, not so much, because everyone’s medical issues are different.