Update: US marijuana trade linked to emergency room visits

As we have previously noted, marijuana is the USA's fastest growing industry and it shows no sign of slowing. However, besides the strain it puts on electricity, another downside has emerged, as people visiting Colorado, one of the four US states where marijuana is legal, are filling emergency rooms having smoked or consumed too much weed. According to new research, twice as many out-of-state visitors have ended up in the emergency room with marijuana-related symptoms compared to two years earlier. Side effects of cannabis can include hallucinations, anxiety, high blood pressure, heart palpitations and vomiting. Researchers predict that other states where marijuana is legal are experiencing similar spikes in emergency room visits. 

Tourists are harshing the mellow in Colorado.

The number of cannabis-related emergency room visits by non-Colorado residents has increased compared with those by in-state residents since recreational marijuana was legalized in 2012, according to a report released Wednesday by Northwestern University, the University of Colorado and the Colorado Department of Public Health and Environment. Out-of-town patient visits to an urban academic hospital in Aurora, Colo., for health issues that arose after consuming cannabis nearly doubled from 85 per 10,000 visits in 2013 to 168 per 10,000 visits in 2014, even though similar visits from Colorado residents didn't change significantly in that time period, according to the report. The statewide rate of out-of-state visits increased from 78 per 10,000 visits in 2012 to 163 per 10,000 visits in 2014, compared with an increase from 61 to 70 per 10,000 visits to 86 to 101 per 10,000 visits over the same period among Colorado residents, the report stated.

One of the primary ways consumers ingest too much cannabis is by eating edibles, says Dr. Andrew Monte, assistant professor of emergency medicine at the University of Colorado School of Medicine. The effects of marijuana are delayed when eaten, leading people to continue eating past the amount they can tolerate. Overdosing on cannabis can cause anxiety, an altered mental state, high blood pressure, abdominal pain and vomiting, according to the report. Patients are typically discharged shortly after they’ve checked in if there are no other underlying conditions or symptoms that need treatment. Some are given a sedative for their heart rate or fluids if they are dehydrated, Monte says.

Along with marijuana intoxication, Monte says marijuana-related cases include patients with underlying chronic conditions that have been exacerbated after consuming cannabis and those who have complications after using cannabis, like getting into a car accident.

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While part of the rise of these emergency room visits can be attributed to increased openness in patients disclosing marijuana use to health professionals because of its legal status in the state, Monte says the researchers were surprised at how drastically the number of visits from out-of-town patients increased relative to other patients.

One reason for the discrepancy could be the higher potency of industrially-cultivated marijuana and unfamiliarity with edible marijuana products for visitors from states where cannabis is outlawed. “The marijuana you buy in Colorado may be a lot different than the marijuana people are used to,” says Mike Van Dyke, branch chief for environmental epidemiology at the CDPHE and co-author of the report. “It is a lot more potent now than in the past, especially when you’re using edibles.”

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The report’s findings underscore the need to emphasize consumption education when customers visit dispensaries, Van Dyke says. “A lot of our efforts have been focused on the Colorado population,” he says. “People out of state aren’t going to see our mass-media campaigns, so the way to educate them is through point of sale.”

With the rise of hospital visits, the role of “budtenders” — the salespeople at dispensaries — becomes increasingly important, he adds. Like bartenders, budtenders are trained to explain the quality and properties of the strains they sell to assist dispensary customers. In conjunction with written materials, budtenders can help unfamiliar consumers navigate the new industry, Van Dyke says.

Along with state efforts, companies within the industry are working to reverse the pattern of overconsumption. Denver-based My 420 Tours is a cannabis tourism company that provides transportation and activities like dispensary tours and marijuana cooking classes to visitors interested in the industry. As part of its program, the company teaches its customers the basics of marijuana consumption, from the difference between indica and sativa strains to the recommended amount of edibles customers should consume. The variety of choices the legal recreational cannabis industry provides “is a lot for an out-of-towner to wrap their head around,” says Danny Schaefer, chief operating officer at My 420 Tours.

Even with information provided on product labels, customers coming from the black market may not understand the difference between 25% THC content and 75% THC content, Schaefer says. (THC is a psychoactive component of cannabis.) “We recommend they take it slow,” he says.

Since it was founded in 2013, My 420 Tours has only had three cases of overconsumption, Schaefer says. In one case, a man fell asleep on the tour bus; in another, an elderly woman was dehydrated, and the third involved New York Times columnist Maureen Dowd, who wrote about her experience.

Monte says the report should be studied by states that will be legalizing recreational marijuana in coming years. “It is really important for states considering a liberalization of policies to implement pre-emptive public health education,” he says. “There needs to be education on these effects so the same mistakes aren’t made.”