A Colorado hospital has revealed that cannabis edibles triggers more cardiovascular symptoms and acute psychiatric events amongst patients of emergency department in comparison to inhaled marijuana. Andrew Monte of the University of Colorado School of Medicine in Aurora reported that inhalable cannabis lead to more overall ED visits whereas edibles caused more ED visits than expectation.
Monte revealed to MedPage Today that the research is “the first study to systematically demonstrate that edible cannabis products are more dangerous than inhaled cannabis.” He further added that, “In this time of cannabis policy liberalization, this can help guide us in educating cannabis users and physicians. It can also help guide us in the development of public health policy to mitigate patient illness.”
Medical marijuana and recreational cannabis received the green signal of Colorado laws in 2009 and 2014 respectively. However, more cannabis is purchased in flower form for smoking in Colorado. Edible cannabis thus accounts for 0.3% of THC weight in cumulative cannabis product sales.
A survey conducted by the Colorado Behavioral Risk Factor Surveillance System revealed that 3.6% of users opt for edible products whereas 40.4% smoke cannabis and the remaining use a combination of both. Reports published by focus groups as well as Poison center suggest that consumption of edibles can lead to occurrence of adverse circumstances.
Monte and co-authors carried on a retrospective study wherein they studied 9,973 charts from 2012 to 2016 at the University of Colorado Health ED. They used ICD-9-CM or ICD-10-CM codes for measuring the degree of cannabis exposure. 2,567 ED visits out of the same were deemed to be partially attributable to cannabis.
This frequency underwent a constant increase from 2012 to 2016 wherein the total number increased by three times. Amongst the patients, 90% were residents of Colorado.The edibles in totality accounted for 9.3% of total visits. Both the edible cannabis patients as well as the ones who inhaled marijuana belonged to the age group of 30 and were mostly females living outside Colorado.
Gastrointestinal (GI) symptoms have been pointed out to be the biggest cause of ED visits. Cannabinoid hyperemesis syndrome is the most popular GI adverse event which also stands out as the biggest cause of hospital admissions. This can be seen occurring twice as much in patients smoking cannabis in comparison to the ones who consumed edibles.
Patients consuming edibles reported acute psychiatric symptoms, intoxication and cardiovascular symptoms in comparison to the patients who inhaled the same. However adverse cardiovascular events such as ventricular dysrhythmia and myocardial infarction could be seen in both the groups.
This data collated by researchers were compared with cannabis product sales in Colorado with the basic assumption that THC content was 20% per kilogram of flower sold for inhalable cannabis and 10 mg of THC for each unit of edible cannabis sold. According to these calculations, THC was sold by 309 times more in flower form in comparison to edible products between 2014 and 2016. About 1,819 University of Colorado Health ED visits were earmarked against inhaled exposure whereas 219 was matched to edible consumption.
The researchers noted that, “If inhalable and edible cannabis were equally toxic and resulted in the same number of ED visits, we would expect that 0.3% of cannabis-attributable visits would be due to use of edible products. The observed proportion of cannabis-attributable visits with edible exposure was about 33 times higher than expected (10.7% vs 0.32%) if both routes of exposure were equally toxic.”
Nora Volkow, the director of National Institute on Drug Abuse (NIDA) pointed out that this increasing number of adversities “is consistent with prior findings, including a 2017 poison control center report in which edible products accounted for 17% of cannabis-related visits to health care facilities among adults.”
According to Ruben Baler, “The slow rate of absorption of orally ingested THC (peak blood levels achieved in 3 hours) compared with inhalable THC (peak blood levels achieved within 30 minutes) makes it harder for users of edible cannabis to titrate the doses required to achieve the desired drug effects.” Volkow and Baler also revealed that, “Further, the slower clearance of oral (12 hours) versus inhalable (4 hours) THC can lead to drug accumulation if users take additional doses when they do not experience the desired effects as quickly as expected.”