With recreational as well as medical marijuana now legal in Michigan, hospitals in the western part of the state are seeing a small jump in patients – including seniors — seeking treatment for the infamously super-powered after-effects of eating too much cannabis in foods like brownies.
From November 2018-July 2020, the number of patients diagnosed with edible cannabis toxicity at several hospitals grew from around zero a month to more than 10. Nine of the patients were hospitalized according to the study, published last month in the American Journal of Emergency Medicine.
Lead author Brian Lewis, MD, an emergency medicine resident with Michigan State University, discussed it as well at the virtual American College of Emergency Medicine annual meeting.
“It would be speculative to say that people are using it frequently. But I don’t know how else we would get an increased number of visits in emergency department if there wasn’t some sort of change in use within the community,” Lewis told MedPage Today.
Michigan voters supported the legalization of recreational marijuana in 2018, and the state began to allow legal sales in December 2019.
For the study, Lewis and colleagues tracked diagnoses for cannabis toxicity at seven hospitals, including a children’s hospital. These facilities evaluated 909 patients for the condition, 17.1% of whom reported using so-called edibles.
By month, the number of cases involving edibles rose steadily from the end of 2018 – when recreational cannabis could not be sold legally – through July 2020, when it reached 12. The study also found that ER diagnoses for inhaled cannabis toxicity soared over the same period, from fewer than 20 a month in November 2018 to 70 in July 2020.
Marijuana users are often surprised by edibles’ potency, especially if they eat more because they don’t understand that it may take an hour for the psychotropic effects to kick in.
In 2014, New York Times columnist Maureen Dowd famously wrote about what happened when she ate a cannabis chocolate bar in Colorado, which had recently legalized recreational pot. She landed in a panting, paranoid “hallucinatory state” for 8 hours: “I strained to remember where I was or even what I was wearing, touching my green corduroy jeans and staring at the exposed-brick wall. As my paranoia deepened, I became convinced that I had died and no one was telling me.” (Dowd was mocked online for not knowing better.)
In the Michigan study, mean age for the 155 cases involving edibles was 30.5, ranging from 1 to 82; a total of 16 were 65 or older, while nine were younger than 12. At least 15 said they’d eaten cannabis accidentally. “There was a larger proportion of younger children and senior citizens that would come in after an edible exposure” versus those who had inhalation cannabis toxicity, Lewis said.
Researchers got information about the type of product ingested from 147 patients: baked goods including brownies and cookies (44.9%), candy/gum (27.9%) and beverages (11.6%). Nearly 8% ate raw marijuana such as buds and joints, and 2% consumed cannabis resin.
The symptoms of the nine patients who were hospitalized included pneumonia (two), delirium (two), status epilepticus (one) and “altered mental status” (four).
Generally, Lewis said, the treatment for edible cannabis toxicity is to provide supportive care and monitoring. “In more benign cases, it’s basically just watching the patient and making sure that they return back to their baseline mental status,” he said.
But some patients have had to be intubated, he said, and cannabis consumption can be dangerous in very young children. Their mental status can be more altered because of their weight, and they may experience respiratory depression, Lewis said, noting that he’d recently seen affected children need to be intubated.
Last year, a study examined 2,567 admissions at a Colorado hospital involving cannabis use from 2012-2016, with 9% connected to edibles. “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%),” researchers reported.
Richard Clark, MD, chief toxicologist at the University of California San Diego, told MedPage Today that it’s common to see tourists who head to the ED after eating too much edible cannabis. “People come into California, see we’ve got legal marijuana, and want to try it. For them, edibles are the perfect option.” Then it kicks in and they have “almost a panic reaction,” he said, “sometimes with high heart rates and nausea/vomiting.”
In extreme cases, physicians may give them IV fluids or a sedative, he said. Typically, the patients feel better in 2-3 hours, he said.
Toddlers who accidentally eat cannabis may have convulsions/seizures, he said, although this is rare. Whatever the case, “there’s no antidote.”