Legalized Cannabis in Colorado Emergency Departments: A Cautionary Review of Negative Health and Safety Effects

Abstract

Cannabis legalization has led to significant health consequences, particularly to patients in emergency departments and hospitals in Colorado. The most concerning include psychosis, suicide, and other substance abuse. Deleterious effects on the brain include decrements in complex decision-making, which may not be reversible with abstinence. Increases in fatal motor vehicle collisions, adverse effects on cardiovascular and pulmonary systems, inadvertent pediatric exposures, cannabis contaminants exposing users to infectious agents, heavy metals, and pesticides, and hash-oil burn injuries in preparation of drug concentrates have been documented. Cannabis dispensary workers ("budtenders") without medical training are giving medical advice that may be harmful to patients. Cannabis research may offer novel treatment of seizures, spasticity from multiple sclerosis, nausea and vomiting from chemotherapy, chronic pain, improvements in cardiovascular outcomes, and sleep disorders. Progress has been slow due to absent standards for chemical composition of cannabis products and limitations on research imposed by federal classification of cannabis as illegal. Given these factors and the Colorado experience, other states should carefully evaluate whether and how to decriminalize or legalize non-medical cannabis use.

Cannabis Legalization and Acute Harm From High Potency Cannabis Products: A Narrative Review and Recommendations for Public Health

“…Colorado state in particular has a long history of liberalization of cannabis attitudes and legislation, which, along with wider availability of cannabis, has led to greater longitudinal availability of data to describe patterns in cannabis use and related harms ( 59 ). After legalization of non-medical cannabis use in 2012 and opening of retail sales in early 2014, Colorado saw significant evidence of increasing acute harms, including increases in cannabis-related ED visits and accidental poisonings in young children, as well as a handful of deaths related to consumption of cannabis edibles ( 32 , 59 , 60 ).…”

“…Other ED data have similarly found increases in cannabis-attributable visits from pre- to post-legalization, especially relating to mental health ( 63 , 64 ), and have specifically seen an increase in adolescent cannabis-related ED visits ( 65 ). There was a significant increase in the proportion of suicide victims who tested positive for cannabis, from 7.1% in 2004–2009 to 12.6% in 2010–2015 ( 32 ). An analysis of hospital admissions in Colorado between 2010 and 2014 found a significant increase in hospitalizations related to cyclical vomiting ( 66 ), suggesting an increase in CHS.…”

“…In addition, the psychological consequences of acute cannabis intoxication (e.g. psychosis, suicidality, impairment-related injuries) can lead to emergency department (ED) visits and hospitalizations ( 32 ). ED visits have been linked to so-called “unexpected highs” that can occur when individuals consume more cannabis than intended ( 33 ).…”

The Association Between Cannabis Use and Schizophrenia: Causative or Curative? A Systematic Review

“…Researchers are conducting studies about its pharmaceutical use as well as its relation with schizophrenia and psychosis. Marijuana is legal for medical use in 31 states, and the District of Columbia in the United States [11] and nine states have legalized it for recreational use [12]. That is why it is imperative to understand how cannabis can affect our mental health.…”

Another Perspective on Cannabis and Emergency Medicine in Colorado

“…Dr. Roberts has delivered an excellent review of many medical aspects of cannabis use and the effect of cannabis legalization on emergency medicine in Colorado 1. As emergency physician researchers in Colorado, we echo many of his concerns.…”