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Marijuana-Induced Colorado Mountain High Sends Visitors to ED

CHICAGO – Colorado has legally allowed sales of marijuana in retail dispensaries since 2014, and trying out the local product apparently is one of the tourist attractions.

The problem is that visitors who use the drug are ending up in the emergency department at an increasing rate, according to a research letter recently published in the New England Journal of Medicine.

“Emergency room visits related to cannabis use have increased more dramatically among out-of-state visitors than among Colorado residents,” said lead investigator Howard Kim, MD, a postdoctoral fellow in emergency medicine at Northwestern University Feinberg School of Medicine who began the study as a resident at the University of Colorado School of Medicine.

According to study results, out-of-state visitors to the emergency room for marijuana-related symptoms accounted for 78 per 10,000 emergency room visits in 2012 compared to 163 per 10,000 visits in 2014 – an increase of 109%. Among Colorado residents, the number of marijuana-related visits was 70 per 10,000 in 2012 compared to 101 per 10,000 in 2014, a 44% increase.

Kim suggests the research might be a cautionary tale for other states in which recreational marijuana is legal, such as Alaska, Oregon, and Washington, or those considering a change in laws.

The report notes that adverse effects of marijuana use may include psychiatric symptoms such as anxiety, hallucinations, and altered mental status; cardiovascular symptoms such as a fast heart rate, high blood pressure, or palpitations; and gastrointestinal symptoms, including abdominal pain and vomiting.

Kim pointed out that edible products, often cookies or brownies, might vary in strength and have a delayed effect, which could lead to overdosing. "People eating marijuana products often don't feel any effect immediately, leading them to eat another edible," he said. "Then they've ingested multiple products, so when the effect finally kicks in, it is much stronger."

The study didn’t distinguish whether the marijuana use leading to the ED visit was by ingested or inhaled products.

"Anecdotally, we noticed that most out-of-towners were in Colorado for other reasons, such as visiting friends or on business," Kim added in a Northwestern press release. "They ended up in the ER because they decided to try some marijuana."

For most patients, supportive care was offered and they were discharged after a few hours, but some had to be admitted for observation.

Senior author Andrew Monte, MD, assistant professor of emergency medicine at the University of Colorado School of Medicine, pointed out that the Colorado Department of Public Health and Environment's "Good to Know" campaign has improved education of users across the state and that is reflected in lower rates of ED visits by Colorado residents.

“ED visits related to cannabis use appear to be increasing more rapidly among out-of-state residents than among Colorado residents,” according to the study authors. “The initial educational efforts through mass media have focused primarily on Colorado residents. These data underscore the importance of point-of-sale education for visitors regarding the safe and appropriate use of marijuana products."