Acute Illness Associated With Cannabis Use, by Route of Exposure

Abstract

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.

Adverse events following cannabis for medical use in Tuscany: An analysis of the Italian Phytovigilance database

“…This syndrome is labelled cannabinoid hyperemesis syndrome (CHS), and consists of nausea, vomiting and abdominal pain particularly associated with chronic use . A recent retrospective observational study shows that, among cannabis users, gastrointestinal symptoms, including CHS, are the most common cause of cannabis‐related emergency departments visits . Two main hypothesis involving THC try to explain this phenomenon.…”

Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

“…A recent observational study in a state with legalized marijuana reported that although edible cannabis products accounted for only 0.32% of sales between 2014 and 2016, they accounted for 10.7% of emergency department visits during that time period. 56 The adverse effects that prompted the emergency department visits also differed by route of exposure, with cannabinoid hyperemesis syndrome more common for inhaled cannabis and acute psychiatric symptoms, intoxication, and cardiovascular symptoms more common for edible cannabis. 56 The authors propose that the delayed onset of effect associated with the edible route may lead users to repeat the dose, potentially resulting in delayed higher plasma concentrations.…”

Substance Use among Older Adults: An Update on Prevalence, Etiology, Assessment, and Intervention

“…These negative effects may also be increasingly common as OA are exposed to the exponential rising potency of THC and ratio of THC to CBD [53]. While OA marijuana use (particularly edibles) is associated with increased injury, emergency department visits, and driving under the influence [54][55][56], OA perceive less risk from using marijuana compared to their younger counterparts, particularly among frequent users, medical marijuana users, and in states where marijuana has been legalized [57]. Gerontology 2020;66:249-258 DOI: 10.1159/000504363…”