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Cannabis In Colorado – A Cautionary Tale

August 7, 2019

Written by Clay Smith and Thomas Davis

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Cannabis has some medical benefit, but there are some adverse health consequences worth reviewing as additional states consider legalization in the U.S.

Why does this matter?
Eleven states have fully legalized cannabis despite cannabis still being illegal at the federal level.  Cannabis legalization has become the classic example of modern day federalism in the United States.  Policy change often produces unintended consequences. What are the downstream health impacts emergency physicians are seeing after legalization in Colorado?

Massive Cheeto Shortage Grips Colorado
Colorado has followed a path from limited medical allowance to full recreational cannabis use and retail sale. Today’s cannabis is much more potent than in the days of Cheech and Chong, 20% THC vs <2%. The author of the review admits an anti-cannabis bias and presents some information specific to Colorado but also a fairly extensive review of additional literature on the negative health effects of cannabis. We want to focus solely on the Colorado experience since legalization.

  • Prevalence of use over age 18 has increased as have total ED and hospital visits related to marijuana.

  • Despite adolescent use declining in Colorado, ED/urgent care (UC) visits with a marijuana-related ICD-10 or positive drug screen have increased as have adolescent marijuana-related ED/UC behavioral health visits.

  • It is speculated that higher concentrations of THC lead to higher levels of schizophrenia or acute psychosis, but there are no presented data specifically from Colorado on this issue.

  • More patients who committed suicide had cannabis on toxicology screen since legalization, from 7.1% to 12.6%.  Of course, this is association and not necessarily causative.

  • Admissions for cyclical vomiting have increased, possibly related to cannabis hyperemesis.

  • In Colorado, “traffic fatalities with blood or urine drug screens positive for cannabinoids have sharply risen.” However, a recent study found no statistically significant changes in MVC fatality rates in Washington and Colorado after legalization when compared to similar states without recreational cannabis legalization.

  • Inadvertent exposures in children, largely from edible cannabis, have increased.

  • There were 29 cases of butane hash-oil burns admitted to the Colorado Burn Center from 2008-2014.

  • In one study, 60% of recreational dispensaries in Colorado offered medical advice regarding use of cannabis during first-trimester pregnancies.

  • Although legalization should lead to regulation and improved safety, some studies have found product labels to be wildly inaccurate. The linked study is not specific to Colorado.

Legalized Cannabis in Colorado Emergency Departments: A Cautionary Review of Negative Health and Safety Effects. West J Emerg Med. 2019 Jul;20(4):557-572. doi: 10.5811/westjem.2019.4.39935. Epub 2019 Jun 3.

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