David Cohen has a PhD in clinical criminology and worked in forensic psychiatry for 28 years. He also suffers from chronic back pain.
As both a professional and a patient, I believe that marijuana is a safe, viable alternative to prescription pain killers and other conventional medication, and that used responsibly it won’t hurt you. So I was concerned when in one day I saw one blog entitled: “ER visits linked to marijuana rose at Colorado hospital after legalization, study finds” and another entitled: “Edible marijuana sends outsize number of people to hospital, Colorado study finds”. Both papers cited recent studies from the Annals of Internal Medicine, described below.
Cannabis Related E.R. Visits:
One paper, from March 2019, cited in the blogs mentioned above published straightforward conclusions: Of 2567 ER visits which were “at least partially attributable to cannabis”, 9.3% were related to edible cannabis, despite the fact that only about 1/3 of a percent of cannabis sales were for edibles during the study period. 18% of visits attributable to inhaled cannabis were for cannabinoid hyperemesis syndrome (described below). Almost half the ER visits attributable to edibles were for intoxication, 18% were for acute psychiatric symptoms, 8.4% for cannabinoid hyperemesis syndrome and 8% for cardiovascular syndromes.
A second paper, from January 2019, asserted that while Cannabinoid hyperemesis was virtually unknown in Colorado until 2009, the hospital in which the authors work now sees over 100 cases a year. The authors conclude: “as emergency medicine providers in a state with a high level of cannabis use, we have observed a substantial increase in acute medical conditions associated with this substance”. They recommend (And I was staggered to realize that this was a recommendation that needed to be made) that physicians prescribing medical cannabis explain to patients how to store the drug, council them on safe use and warn them of potential side-effects.
These articles are disturbing, not only because they were published by reputable experts in reputable journals, but because they go against conventional wisdom and published evidence that cannabis use, on the whole, is much safer and has fewer side effects than other psychoactive substances.
"Start Low Go Slow" and Stay Out of The E.R.
Some Suggestions on How to Stay Out of the ER: Cannabis is indicated for alleviation of symptoms in a wide variety of maladies. However, it contains chemicals which can seriously mess with your brain. Cannabis is a drug. It should be taken seriously and used responsibly.
Here are some things to remember, to keep you out of the ER when using cannabis:
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- Don’t drive under the influence. The THC in marijuana seriously impairs your ability to drive for at least a few hours after inhaling (no way to know how long it will hit after ingestion). Even in states like Colorado and Washington, where marijuana is totally legal, driving under the influence is totally illegal.
- Don’t mix alcohol and marijuana. Alcohol and marijuana have many similar effects (for example, they are both sedative and both impair motor control) and they enhance and prolong each other’s effects. Using alcohol with cannabis may have many adverse effects, including enhancing the anxiety producing effects of THC.
- “Start low go slow”. Start with a low dose of marijuana and a strain either relatively low in THC or high in CBD. Smoke (better yet, vape) a small amount and see how it affects you. If you’re a medical marijuana user, you want alleviation of your symptoms, not getting high or stoned. If you’re a casual user, smoke until you’re relaxed, not half dead.
There are literally thousands of strains of marijuana to choose from. Each strain has a slightly different effect. Some are good for people who work (they kill pain and help focus) and some are good for insomnia and will knock you flat. Consult with your local licensed dispensary regarding the best strain and dosage for your needs.
- Have someone to call. It’s always good to have a not-high person around when using marijuana. If everyone is using, or if you’re alone, have someone to call and talk to when you feel anxiety kicking in. Marijuana overdoses can be scary as hell, and having someone to remind you that it’s just a “bad trip”, that you’re safe and that everything will be OK soon can seriously calm the panic attacks. Also, marijuana should not be used by people prone to panic attacks or under emotional strain, unless prescribed by a doctor.
- Predisposition to psychosis. Don’t use marijuana of you have been diagnosed with, or if any close family members have been diagnosed with a severe mental disorder.
- Remember: edibles take time to kick in. Their effects are strong and prolonged. Be patient, and don’t overdo it. Also remember that dosing is tricky with edibles, so read the package carefully to see how much THC you’re ingesting. Novice users shouldn’t ingest more than about 2.5mg of THC at a time. Check out this edibles dosing chart to learn more.
- If you do go to the ER, make sure to report your cannabis use. It will help with quicker, more accurate diagnosis and treatment.
Use marijuana legally and responsibly. It is a relatively safe drug, but it is a drug. Used properly, IMHO, it will only do you good. If you misuse it, be ready to suffer the consequences.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2019 David A Cohen
Pamela Oglesby from Sunny Florida on March 29, 2019:
I think this is excellent information for anyone using medical or recreation cannabis. Medical cannabis is legal here in FL, and I think it will eventually be legal nation wide. Thank you for this excellent information.
Kaili Bisson from Canada on March 29, 2019:
Great article David. Recreational cannabis became legal in Canada last October, and it has been legal for medicinal use since 2001. There was a story in the paper recently about a 70-year-old man with a history of heart disease who suffered a heart attack after he took a friend's advice and tried a marijuana lollipop for his arthritis. He ate most of it, when just a few licks was probably all he needed.