Edibles and ER Visits In Colorado
Leonard I. Frieling, Lafayette, Colorado 80026 ©
3/29/2019
Edibles and ER Visits. Is this a problem needing a solution, or a problem without solution, or not a problem at all?
Colorado ER visits have made the press over the last few days. Apparently ER visits associated with edibles are showing a disproportionate number of ER visits compared to previous data. This article addresses THC-containing edibles, and does not address the CBD issues and questions. Since CBD is not psychoactive in that it does not “get you high,” it is not part of this article.
I believe there are several factors contributing to this anomaly in the numbers, with an apparent significant increase in pot edible-related ER visits.
There is no question that edibles are difficult to self-titrate for dosage. It is very hard to tell when you have eaten enough candy for the desired effect, whether it is medical, recreational, or both. The time lag from ingestion to maximum perceived impact can be as little as a half hour to as much as three hours. Contrast that with vaporizing (vaping) or smoking marijuana. Self-titration is quite effective, and this perception has good science backing it up. One can take a toke, wait a minute or less, and have a pretty good idea if a second toke is called for. With our current marijuana, a single toke or two might well be all that is desired.
So edibles are inherently hard to control dosage, while smoking and vaping are quite easy to control dosing. This psycho-dynamic alone is likely responsible for some people eating too many medicated candy or other medicated edibles. When an experienced marijuana user imbibes too much THC, and gets “too high,” they already know that there is no danger, and that the unpleasant feelings they are experiencing will pass, without problem, in a few hours at most. Aside from feeling unpleasant, possibly paranoid, for a few hours, there is simply no documented medical danger. The reference to a “heart attack related to eating too many edibles” is simply without precedent, and virtually impossible. Death is not and has never been a potential side-effect from using marijuana regardless of dosage.
The particular unforeseen consequence of the current structure of the usage laws in Colorado is that tourists are inadvertently pushed towards trying edibles. While an adult tourist can easily purchase marijuana in many strengths and in many forms, completely state legal, finding a legal place to smoke a joint (or take a single toke from a joint or even a vape) is quite difficult if not nearly impossible. There are several pending routes to provide people places to smoke or vape, legally, including clubs in Denver. The area is quickly developing legally and practically.
In the meantime, the “cautious tourist” might well opt for candy, avoiding the entire “illegal smoking, illegal vaping” problem. Of course, as we now know, this easily leads to more people eating too much candy. Eating too much candy is never a good thing!
There is another factor contributing to inexperienced users electing to imbibe edibles, and ending up in the ER. Edibles are NEW!! In the past, even back to the 1960s and far before that, “Alice B. Toklas” pot-laced brownies have been a product of some people’s kitchens. Now, no muss, no fuss, no odor, just stop at the store and pick your flavor of soda, ice cream, candy, etc., and you have all you need to try Colorado’s famous edible forms of THC.
Some of the ER visits are the result of children getting into their parents’ THC. This is just as inappropriate as having aspirin (potentially deadly, kills 50,000 people yearly in the USA) or other medications or alcohol where children can access it. While a child who gets into Mom’s candy might not be happy about it, the ER visit is almost certainly the result of a worried parent and not of a medical emergency.
SO, can we fix the edible-ER conundrum? Sure. First, part of it simply does not exist. There is no “change” and no “increase” since there was nothing in the past to compare it to. It’s like saying “auto-deaths have increased since the invention of the automobile.” While true, what does it really say? In the case of THC edibles, it means in part education. The rules and the playing field have changed so drastically that the comparison of ER visits before and after legalization is meaningless. Then, when the edible variable is mixed in, meaningless becomes meaningless and confused.
Second, we must make it easy for tourist and other travelers in Colorado to easily, conveniently, and safely imbibe vape or smoke, easing the route to non-edible ingestion. Do we even need edibles? Yes we do. For example, for the person who wants help sleeping, a longer-acting method of ingestion is desirable. If a person medically or recreationally wants to choose edibles instead of smoking or vaping, for a variety of reasons, that should be available. Ironically, a seizure-baby requiring THC or CBD or a combination medication arguably is better off taking a pill or candy than smoking or vaporizing for many obvious reasons.
Scientifically, medically, much of this entire challenge is the result of the cannabinoids being lipid soluble. What does that mean? MDs generally prefer water-soluble medicine. It is easier to dose-control, easier to administer, and generally a more convenient and safer chemistry. Lipid-soluble means fat-soluble. We are literally talking about mixing oil and water. Additionally, whether it is done by a vaporizer, accomplished by burning/combustion, or otherwise accomplished, THCA, as found in the plant, must be heated to “decarboxilize” it. That means “heat it to 215 deg. F.” Combustion, or burning, such as with smoking a joint, occurs at about 451 deg. F. Additionally, combustion produces an additional 100 or so chemicals besides accomplishing the decarboxilization. These chemicals include a list of things one simply would not wisely inhale, given an option. Vaping gives that option, with the apparent exception of whatever particulates are in the vapor. That leaves edibles, with their inherent problems.
Conclusion: the ER visits we’re seeing are the result of many things, mostly controllable or simply solvable. It does not suggest that the substance is dangerous, life-threatening, or anything beyond one of the most benign substances of so many purposes.
Shared Knowledge is Power!
Lenny Frieling 1998