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The 'lows' of edible marijuana

A marijuana overdose can occur, especially in people who have not used the drug before or who are not regular users. For instance, there is a delayed high when using edible marijuana, which may cause someone to initially ingest too much.

In March 2014, a 19-year-old Colorado college student took his own life after consuming an edible marijuana cookie containing 65 milligrams (mg) of delta-9 tetrahydrocannabinol (THC), the primary chemical responsible for marijuana's psychoactive effects.

The teen had no history of marijuana, alcohol, or illegal drug use, and no history of mental illness, according to the police report. Initially, he ate only a single piece of the cookie (one 10 mg "dose"). About 30-60 minutes later, not feeling any effects, he ate the rest of the cookie (five and a half more "doses"). During the next two hours, he developed erratic speech and hostile behavior. About three and a half hours after his first bite, he died after jumping from a fourth floor balcony.

Marijuana intoxication was the chief contributing factor to his death, according to the autopsy. His THC blood level was 7.2 ng/mL which is 2.2 ng/mL over the legal blood limit for driving in Colorado. The Centers for Disease Control and Prevention said that this case of marijuana overdose highlights "a potential danger" with edible marijuana.

Marijuana overdose: A marijuana overdose can occur, especially in people who have not used the drug before or who are not regular users. Symptoms may be:

  1. Psychological including paranoia, fear, anxiety, mania, disorientation and hallucinations

  2. Physical including shortness of breath, fast heart rate, nausea, vomiting, shaking, cold intolerance and hangover

Delayed "high" with edible marijuana products can lead to overdose: The drug actions of THC vary depending on how it is consumed. Inhaled marijuana results in psychological effects within 10 minutes, peak blood concentrations in 30-90 minutes, and complete clearance in two to three hours. Ingested marijuana takes anywhere from 30-90 minutes to produce an effect, peaks in about 3 hours, and clears in approximately 4-12 hours. Some of this variability in ingested marijuana is due to individual differences in gastrointestinal absorption rates.  The delayed effects may make people think they need more of the product to get their desired "high." This is likely the reason that edible products are responsible for the majority of health care visits due to marijuana intoxication for all ages.

Non-standardized doses can lead to overdose: Manufacturing practices for edible products are not standardized, which may lead to variable doses. Colorado considers 10 mg to be a "dose." Retail products are capped at 100 mg per unit regardless of whether the edible is a single slice of cheesecake or a package of gummy bears. Inconsistent THC concentrations add to the dosing problems. According to a report in the Denver Post, products described as containing 100 mg of THC actually contained from 0-146 mg of THC.

Children have overdosed after unintentionally ingesting edible marijuana: Edible marijuana is often in the form of cookies, cakes and candies, making it very appealing to children and leading to unintentional ingestion. Even if a product is sold in a childproof container, once the package is opened, it is readily accessible to children. In addition, children may react differently from adults. In a study at a children's hospital in Colorado that looked back at Emergency Department  cases between 2005 and 2011, the ED had evaluated 14 children younger than 12 years for unintentional marijuana ingestion: nine had lethargy, one had ataxia (motor incoordination) and one had respiratory failure. Eight of the 14 cases involved medical marijuana and seven involved edible marijuana. Eight needed to be hospitalized, of whom two required the intensive care unit.

More problems with edible marijuana products: Experimentation with new ways to use and produce THC products has resulted in other unexpected complications:

  1. Marijuana-related burns: They are usually flash burns that occur during THC extraction from marijuana plants using butane as a solvent.

  2. Cyclic vomiting syndrome: The frequent use of high-THC-concentration products can lead to a cycle of severe abdominal pain, vomiting and excessive sweating.

My advice: Teens and children should "keep out" of edible marijuana, and adults, if they choose to ingest these products, should definitely "beware." If a parent or caregiver suspects that a child has ingested products containing marijuana, the child should be taken to the ED of the nearest hospital.

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