Colorado’s experience with medical effects of legalizing marijuana

February 5, 2015, 12:27 am

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The Implications of Marijuana Legalization in Colorado. Monte AA et al. JAMA 2015 Jan 20;313:241-2.

No abstract available

This brief article, from the Department of Emergency Medicine at the University of Colorado and the Rocky Mountain Poison and Drug Center, gives a concise summary of the medical consequences following Colorado’s legalization of marijuana.

Although Colorado changed its state constitution in 2000 to allow medical marijuana, such use did not really become common until October 2009, when a U.S. Department of Justice memorandum indicated that the DOJ would not prosecute medical marijuana users who were in compliance with state law.

In November 2012, an amendment to the state constitution legalizing recreational marijuana for adults 21 years of age and older. Accordingly, non-medical marijuana sales in Colorado began on January 1, 2014.

The authors note that since that time, one or two patients a week — both children and adults — present to the University Medical Center Emergency Department solely because of marijuana intoxication. Almost all of these cases are related to marijuana edibles, which are difficult to titrate because they have a delay to peak effect (approximately 3 hours) and prolonged duration (12 hours or more.) In addition, the medical center has seen significant increases in the number of cases of cyclic vomiting from cannabinoid hyperemesis syndrome and also cannabis related burn injuries, mostly from attempts to make “dab” by extracting THC from marijuana using butane as a solvent.

The authors argue that marijuana edibles are a major cause of medical adverse effects for several reasons. First, they are often designed and packaged to look like candy, cookies, or spreads that are attractive to children. Second, dosing requirements are not rational. For example, a single cookie can contain as much as 100 mg of THC, ten times the basic dose recommended for inexperienced users. Finally, because of poor quality control, the dose of THC may differ significantly from that listed on the product’s label. New rules to address some of these problems are scheduled to go into effect this month.

To read my Emergency Medicine News column on marijuana edibles, click here.

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