Edible Complex

Are cannabis-related hospitalizations on the rise?

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SENIOR TRIP Officials says the elderly appear to be those suffering the most from edible cannabis health impacts.

Five years after Colorado legalized recreational cannabis—and five years after New York Times columnist Maureen Dowd had her scary fetal-position encounter with a Rocky Mountain state edible in a hotel room (she ate too much of a candy bar)—that state has raised an alarm over an emerging problem with ingesting edibles in unhealthy amounts, and winding up in the hospital with severe anxiety or other symptoms.

How is this problem playing out in California, which legalized marijuana in 2017 and is now offering recreational cannabis consumers a range of edible products that range from chocolate bars to gummy bearsto THC-infused soda?

In some measure, it’s a bit early to tell, say health officials and other experts. The state has only just embarked on legalization and the data is just starting to roll in to Sacramento officials charged with ensuring a safe rollout of California‘s ambitious legalization regime for recreational cannabis.

The Pacific Sun contacted some 50 healthcare providers in the North Bay, from the big regional hospitals to the small-town health clinics. We contacted paramedics and county health officials. What came back indicates that, if anything, this is an emerging story with scant detail from the state about the frequency of emergency-services calls and hospital visits related to cannabis use.

The survey of local healthcare providers, county health officials and emergency service revealed they don’t track the information. For example, Dean Fryer, a representative of Sutter Health in Sonoma County, says that the company does not monitor hospital admissions by cannabis-related admissions, and couldn’t therefore say whether they’ve seen a spike in edibles-related health issues since 2017.

“We have no way of really quantifying or knowing if this is an issue [or] if there’s a rise in admissions,” Fryer says. “It’s not tracked in that way.

Edibles-related calls for service do not appear to be tracked at the ground level, either. A representative of REDCOM Dispatch, the centralized agency which directs calls to fire and emergency service responders within Sonoma County, said the organization does not track emergency calls related to cannabis use.

Veteran emergency service officials in West Marin say that they have not seen any uptick in edibles-related calls since legalization took hold in California. For them, alcohol-related calls for service are predominant. Those officials amplify what others interviewed for this story have noted: Those who overdose on THC-infused edibles are often older persons who have not experimented with cannabis for some time—and are unaware that the cannabis they are ingesting has gotten far stronger since their youth. If anything, notes one high-ranking emergency services official in West Marin, young people are keenly aware that eating cannabis can be a far more potent experience than smoking it. And, say those officials, the handful of edibles-related calls they’ve gotten over the past couple of decades have not been for pre-packaged edibles on the legal market, but rather for an overly potent homegrown brownie or other food infused with cannabis.

Those edibles don’t come with the same degree of product information as is required under California law, including information about the potency of the product. But the state has struggled to square up its own regulations concerning THC potency in edibles, with conflicting regulations coming from two key state agencies—the Bureau of Cannabis Control and the California Department of Public Health.

Meanwhile, the production and manufacturing of edibles is overseen by one of the three legs of the California cannabis regulatory regime, the Manufactured Cannabis Safety Branch (MCSB).

But, says CDPH spokesman Matt Conens, the MCSB’s role is not to assess whether edible health-related problems are on the rise—but to make sure the products it approves are safe and properly manufactured and packaged.

In February, as California’s interim cannabis regulations became permanent—and as first reported by the Marijuana Business Daily—state regulators moved to update regulations in the edibles industry. Officials moved in when it was discovered that the CDPH and the Bureau of Cannabis Control had differing regulations concerning the amount of THC that an edible could contain.

The agencies in charge of regulating California‘s legalization rollout, noted the MBD, “issued seemingly conflicting rules detailing THC limits, testing and packaging for infused products. That caused some testing labs to unexpectedly fail products based on different interpretations of the rules.

The snafu caused great upset in an edibles industry worried that, among other things, the discrepancies could expose edibles-producers to lawsuits from consumers, reported MBD, claiming they were harmed because the THC limits printed on the packaging didn‘t reflect the exact THC contained in the product.

What this means is that localities are now sending their cannabis-health data to a state cannabis bureaucracy that itself may be in need of fine-tuning when it comes to allowable potencies in the products it is regulating. And, while the Office of Statewide Health Planning and Development is in charge of collecting patient data reported by hospitals (including ER visits and visits for cannabis poisoning) it’s yet to undertake an analysis of the data, says spokesman Andrew Diluccia, “and would not be able to provide any information/context as to why there might be rises or falls in cannabis poisonings. OSHPD does not have subject matter experts to address this issue. Also, the poisoning data does not contain how the cannabis entered the body (i.e., inhalation, ingestion), so there would be no data specific to edibles.

While Sonoma County “supplies all kinds of data to the state,it‘s also just getting up to speed on any edibles-related health impacts that may be afoot in the county, says Roshish Lal, the spokesperson for the Sonoma County Department of Health.

He notes that when the county eventually sends its cannabis-related data to the state Department of Health, “I don‘t know whether it will be broken down specifically—there are so many products.

The main barrier to tracking the problem is that California has not formally defined the symptoms of a cannabis overdose and has not created a system to record cases, says Matt Willis, Marin County’s Public Health Officer. Although medical providers are likely able to identify a cannabis-related incident when an individual comes into their care, they are currently unable to record it since the state has not defined the criteria.

The lack of state leadership has left county and city governments to attempt to track the problem on their own, he says. Many do not, but some are trying.

Six months ago, Marin Health and Human Services partnered with the county coroner to begin recording the level of THC during toxicology screenings in cases of accidental deaths.

“We are unlikely to have the same quality of data as Colorado does until we build a system to collect it,” says Willis, who adds that his department is also discussing ways of tracking cases in Marin County’s three emergency rooms.

If there has been an increase in the number of overdoses, Willis expects that it is due to the potency of cannabis since legalization. Legislators may be operating under outdated assumptions about the strength of the product; edibles are particularly dangerous because those experimenting with them may take a second or third dose while waiting for the drug to take effect.

While cannabis products are unlikely to be fatal on their own in the same way opioids and other drugs can be, Willis says he is concerned that the rate of DUIs because of cannabis use could increase.

Cannabis-related health issues are showing up in the South Bay since legalization, says Dr. Greg Whitley, chief medical officer at Dominican Hospital in Santa Cruz. The symptoms that users most often come in with, Whitley explains, include severe anxiety, vomiting, an exacerbation of asthma or emphysema—and severe intoxication. “Those people can come in with symptoms of just basically feeling really, really stoned—off-balance, difficulty walking, dizziness,” he says, and often it‘s as a result of over-consumption of edibles. “Sometimes people are lethargic,adds Whitley, who’s worked at Dominican since 2001 and served as the emergency room‘s medical director until taking his new position April 1. Sometimes people look like they’re having a stroke because they’ve had basically an overdose of THC.”

Whitley also noted, anecdotally, that over the past couple of years, the number of people coming to the Dominican emergency room with acute cannabis-related symptoms has skewed older. A decent-sized chunk of the patients, he reports, have included fathers and grandfathers who‘ve gotten into a family member’s pot brownies without realizing there might be any special ingredients.

And Whitley echoes the West Marin emergency services officials when he notes that lots of times, its older people who are surprised at the enhanced potency of the cannabis they are ingesting.

Additional reporting: Jacob Pierce

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