Background: Little is known about the relative harms of edible and inhalable cannabis products. Objective: To describe and compare adult emergency department (ED) visits related to edible and inhaled cannabis exposure. Design: Chart review of ED visits between 1 January 2012 and 31 December 2016. Setting: A large urban academic hospital in Colorado. Participants: Adults with ED visits with a cannabis-related International Classification of Diseases, Ninth or 10th Revision, Clinical Modification (ICD-9-CM or ICD-10-CM), code. Measurements: Patient demographic characteristics, route of exposure, dose, symptoms, length of stay, disposition, discharge diagnoses, and attribution of visit to cannabis. Results: There were 9973 visits with an ICD-9-CM or ICD-10-CM code for cannabis use. Of these, 2567 (25.7%) visits were at least partially attributable to cannabis, and 238 of those (9.3%) were related to edible cannabis. Visits attributable to inhaled cannabis were more likely to be for cannabinoid hyperemesis syndrome (18.0% vs. 8.4%), and visits attributable to edible cannabis were more likely to be due to acute psychiatric symptoms (18.0% vs. 10.9%), intoxication (48% vs. 28%), and cardiovascular symptoms (8.0% vs. 3.1%). Edible products accounted for 10.7% of cannabis-attributable visits between 2014 and 2016 but represented only 0.32% of total cannabis sales in Colorado (in kilograms of tetrahydrocannabinol) during that period. Limitation: Retrospective study design, single academic center, self-reported exposure data, and limited availability of dose data. Conclusion: Visits attributable to inhaled cannabis are more frequent than those attributable to edible cannabis, although the latter is associated with more acute psychiatric visits and more ED visits than expected. Primary Funding Source: Colorado Department of Public Health and Environment.
Background: Cannabis (MJ) policy liberalization in a majority of US states has impacted emergency department (ED) visits. It is important to understand why people come to the ED after using MJ because the drug is now available to experienced and naïve people across the country. The objectives of this study were to (1) improve upon administrative dataset methodology by performing additional chart review to describe ED visits related to cannabis, (2) understand why patients come to the ED after using cannabis, and (3) begin to inform our understanding of cannabis-attributable ED visits to start to educate patients and providers about cannabis' safety. Methods: We performed a retrospective chart review of ED visits identified by cannabis ICD-9 and 10-CM codes between 2012 and 2016. Visits were reviewed and determined if the visit was partially attributable to cannabis based upon a pre-specified definition, then categorized into clinical complaint categories. Descriptive statistics, Chi-Square, and T-tests were used to elucidate the data. Results: About one-fourth (25.74%) of visits with cannabis ICD-CM codes were found to be at least partially attributable to cannabis. These patients are more often young, Caucasian males when compared to the overall ED population (p < .0001). Patients with a cannabis-attributable visit were more often admitted to the hospital (p < .0001). The most common complaints in cannabis-attributable visits were gastrointestinal and psychiatric complaints, as well as intoxication. The number of cannabis-attributable visits rose with time (p=.012).
The Emergency Medicine Specimen Bank (EMSB) was developed to facilitate precision medicine in acute care. The EMSB is a biorepository of clinical health data and biospecimens collected from all adult English-or Spanish-speaking individuals who are able and willing to provide consent and are treated at the UCHealth-University of Colorado Hospital Emergency Department. The EMSB is the first acute care biobank that seeks to enroll all patients, with all conditions who present to the ED. Acute care biobanking presents many challenges investigator-initiated research. AAM owns stock in Illumina, the company that makes the MEGA chip genotyping platform utilized at the University of Colorado. There were no financial inducements or services donated by Illumina for this work. Illumina had no role in designing this project, had no access to data, and had no involvement in the preparation of this manuscript. Author Contributions: JLS-protocol concept, design, and implementation; regulatory management and daily oversight; training personnel on protocol; and drafting of the manuscript. SKS-protocol concept and design, training personnel on protocol, and daily project management. AJHprotocol concept and design, training personnel on protocol, and daily project management. BJS-protocol concept and design, training personnel on protocol, and daily project management. EBM-protocol concept and design, training personnel on protocol, and daily project management; MWel and MWes-daily project implementation; RZ-protocol design and implementation and critical revision of the manuscript for important intellectual content. AAG-protocol concept, design, and implementation and critical revision of the manuscript for important intellectual content; KB-protocol design and implementation and critical revision of the manuscript for important intellectual content. JO-protocol design and implementation. MC-protocol design and implementation. MD-critical revision of the manuscript for important intellectual content. AL-protocol concept and design, regulatory oversight, and critical revision of the manuscript for important intellectual content. JH-protocol concept and design, regulatory oversight, and critical revision of the manuscript for important intellectual content. LBR-protocol design and implementation and critical revision of the manuscript for important intellectual content. ERR-daily project management. MT-protocol concept and design and critical revision of the manuscript for important intellectual content. MJA-critical revision of the manuscript for important intellectual content. KCprotocol concept and design and critical revision of the manuscript for important intellectual content. SJW-protocol concept and design and critical revision of the manuscript for important intellectual content. KCB-protocol concept and design, critical revision of the manuscript for important intellectual content, and acquisition of funding. AAM-protocol concept and design, critical revision of the manuscript for important intellectual content, and acquis...
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