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 bears” to 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, it’s older people who are surprised at the enhanced potency of the cannabis they are ingesting.

Additional reporting: Jacob Pierce

The old joke about the California lieutenant governor’s office has been that its occupant’s main duty is to wake up in the morning, see whether the governor is still alive and, if so, go back to bed.

But that was before Gov. Gavin Newsom made Eleni Kounalakis his point woman on President Donald Trump’s trade wars.

Now, California’s lieutenant governor is among the busier officeholders in Sacramento—hustling to meet with members of Congress, federal agencies and trade organizations and deploying whatever influence she can to protect California’s place in the world market.

She has her work cut out for her. It has been a year since Trump sent a collective shudder through California’s economy, imposing taxes on imported steel and aluminum that in turn prompted China to impose new tariffs on agricultural products.

India and other countries soon followed suit, setting tariffs as high as 100 percent on some of California’s high-value crops. Since then, the Trump administration has engaged in trade brinkmanship on many fronts—including on-again, off-again threats to close the Mexican border. Meanwhile, a bevy of signature California products—almonds, pistachios, walnuts, wine grapes, oranges, dairy—have teetered on the verge of becoming collateral damage.

So far, the worst-case scenario has not come to pass, and some products, such as pistachios, have survived relatively unscathed, at least for now. But the damage has not been insignificant, either.

In a report last August, Daniel A. Sumner, an economist with UC Davis’ Agricultural Issues Center and Department of Agricultural and Resource Economics, projected that higher tariffs could cost major U.S. fruit and nut industries $2.64 billion per year in exports to countries imposing the higher levies; the economic blow could rise to as much as $3.34 billion because of lower prices in alternative markets.

And some fears have been entirely realized. Sales of California oranges to China are off by more than half, broader problems in the state dairy industry have been exacerbated by trade tussles, and the almond and wine industries have struggled to cope with price pressures and punishing tariffs.

“Whenever you have an atmosphere of uncertainty, it creates a chilling effect,” Kounalakis said in an interview. “Customers in Asia will look for alternatives elsewhere.”

And, she added, if customers find suppliers in other countries—say, Turkey for pistachios or New Zealand for wine—it could be hard for California to win them back.

As he had vowed on the campaign trail, Trump since taking office has hewed to an “America first” protectionist stance, pushing back against Republicans’ traditional embrace of open markets. He pulled out of the 12-country Trans-Pacific Partnership and pushed for a reboot of the North American Free Trade Agreement. The resulting United States-Mexico-Canada Agreement (USMCA)—what some describe as NAFTA 2.0—faces an uphill battle for ratification in the now Democratic-controlled House.

To ease the burden on hard-hit farmers throughout the country, the U.S. Department of Agriculture has paid out billions of dollars in aid, mostly to producers of soybean, corn and other commodities. Most California growers did not qualify for direct payments, but some sold products to the federal food-purchase program, which feeds needy U.S. residents; some grower groups received funds to help market their products overseas.

When it comes to trade with China, a huge and growing market, billions of dollars and tens of thousands of jobs are at stake in California. According to the UC Davis Agricultural Issues Center, the state’s top five agricultural exports in 2017 just to China and Hong Kong amounted to more than $1.6 billion. Last September, China added a 10 percent tariff on U.S. wine imports, atop a previous 15 percent tariff increase implemented in April 2018.

California has 6,800 almond growers, most of them small to medium-size, family-run enterprises. A study by the Almond Board of California found that the crop generated more than 100,000 jobs, mostly in the Central Valley. The industry contributes about $11 billion annually to the state’s economy.

For wine grape growers, tariffs have been a double whammy. U.S.-imposed levies have raised significantly the cost of steel products—wire, stakes, metal posts—needed to establish vineyards.

Under the Trump administration, “things have gotten a lot more bumpy,” said John Aguirre, president of the California Assn. of Winegrape Growers in Sacramento. “We see a much softer market for wine grapes.”

The industry is concerned about continued access to China, which had been a growing market. Last September, China added a 10 percent tariff on U.S. wine imports, atop a previous 15 percent tariff increase implemented in April 2018.

Since trade policy is mostly determined at the federal level, California officials such as Kounalakis have only a limited ability to make a difference. Still, the lieutenant governor—a former ambassador to Hungary during the Obama administration—notes that the state’s size and stake in the market make it critical that California strive to be heard.

“For anyone who thinks that this international portfolio is, you know, having tea and going on trips,” Kounalakis recently joked during a panel discussion in Sacramento, “that’s not what this is about.”

CalMatters is a nonpartisan, nonprofit journalism venture committed to explaining how California’s state capitol works and why it matters.