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The Disproportionate Rate of Acute Clinical Illness Associated with Cannabis Edible Use

31 Pages Posted: 27 Sep 2018

See all articles by Andrew Monte

Andrew Monte

University of Colorado at Denver - Department of Emergency Medicine; Denver Health - Rocky Mountain Poison & Drug Center

Shelby K. Shelton

University of Colorado at Denver - Department of Emergency Medicine; Denver Health - Rocky Mountain Poison & Drug Center

Eleanor Mills

University of Colorado at Denver - Department of Emergency Medicine; Denver Health - Rocky Mountain Poison & Drug Center

Jessica Saben

University of Colorado at Denver - Department of Emergency Medicine; Denver Health - Rocky Mountain Poison & Drug Center

Andrew Hopkinson

University of Colorado at Denver - Department of Emergency Medicine; Denver Health - Rocky Mountain Poison & Drug Center

Brandon Sonn

University of Colorado at Denver - Department of Emergency Medicine; Denver Health - Rocky Mountain Poison & Drug Center

Michael Devivo

University of Colorado at Denver - Department of Emergency Medicine; Denver Health - Rocky Mountain Poison & Drug Center

Tae Chang

University of Colorado at Denver - Department of Emergency Medicine; Denver Health - Rocky Mountain Poison & Drug Center

Jacob Fox

University of Colorado at Denver - Department of Emergency Medicine; Denver Health - Rocky Mountain Poison & Drug Center

Cody Brevik

University of Colorado at Denver - Department of Emergency Medicine; Denver Health - Rocky Mountain Poison & Drug Center

Kayla Williamson

University of Colorado at Denver - Department of Emergency Medicine; Denver Health - Rocky Mountain Poison & Drug Center

Diana Abbott

University of Colorado at Denver - Department of Emergency Medicine; Denver Health - Rocky Mountain Poison & Drug Center

More...

Abstract

Background: Cannabis-associated emergency department (ED) visits have risen due to increased availability of the drug in Colorado. Edible cannabis products have been associated with pediatric ED visits and emergency providers report a high incidence of edible related visits in adults. We sought to determine if edible cannabis products result in more ED visits than inhaled products when standardized for product availability.    

Methods: This was a retrospective chart review study at a large academic hospital. Cases were identified by cannabis ICD-9 and ICD-10 codes. All ED visits with a cannabis ICD-9/10 code between January 1, 2012 and December 31, 2016 were reviewed. Rates of inhaled cannabis-attributed visits and edible-attributed visits were standardized by inhaled and edible product sales provided by the Colorado Department of Revenue over the study period.    

Findings: There were 9,973 visits with an ICD-9 or ICD-10 code for cannabis use. 2,567 (25·7%) visits were deemed to be at least partially cannabis-attributable; 238 of those (9·3%) were related to edibles ingestion. When standardized for product sales, edibles had a cannabis-attributable ED visit rate 269 times the rate of inhaled cannabis. Inhaled cannabis-attributed visits were more likely to be for cannabinoid hyperemesis syndrome (p<0·0001) and patients with edible-attributed visits were more likely to be due to acute psychiatric symptoms (p<0·0001).

Interpretation: Inhaled cannabis-attributable visits are more frequent than edible cannabis-attributable visits though when standardized for sales data, edible cannabis products are associated with a higher rate of emergency department visits than inhaled products.    

Funding Statement: NIH K23 GM110516, NIH CTSI UL1 TR001082, and CDPHE 17 FHHA 96950.

Declaration of Interests:  Andrew A. Monte received support from NIH K23 GM110516, NIH CTSI UL1 TR001082, and CDPHE 17 FHHA 96950. The contents of this work are the sole responsibility of the authors and do not necessarily represents the views of the National Institutes of Health (NIH) or the Colorado Department of Public Health and Environment (CDPHE).  

Ethics Approval Statement: This study protocol was approved by the Colorado Multiple Institution Review Board.

Suggested Citation

Monte, Andrew and Shelton, Shelby K. and Mills, Eleanor and Saben, Jessica and Hopkinson, Andrew and Sonn, Brandon and Devivo, Michael and Chang, Tae and Fox, Jacob and Brevik, Cody and Williamson, Kayla and Abbott, Diana, The Disproportionate Rate of Acute Clinical Illness Associated with Cannabis Edible Use (July 9, 2018). Available at SSRN: https://ssrn.com/abstract=3247884

Andrew Monte (Contact Author)

University of Colorado at Denver - Department of Emergency Medicine ( email )

Aurora, CO
United States

Denver Health - Rocky Mountain Poison & Drug Center

1391 Speer Boulevard, Suite 600
Denver, CO 80204
United States

Shelby K. Shelton

University of Colorado at Denver - Department of Emergency Medicine

Aurora, CO
United States

Denver Health - Rocky Mountain Poison & Drug Center

1391 Speer Boulevard, Suite 600
Denver, CO 80204
United States

Eleanor Mills

University of Colorado at Denver - Department of Emergency Medicine

Aurora, CO
United States

Denver Health - Rocky Mountain Poison & Drug Center

1391 Speer Boulevard, Suite 600
Denver, CO 80204
United States

Jessica Saben

University of Colorado at Denver - Department of Emergency Medicine

Aurora, CO
United States

Denver Health - Rocky Mountain Poison & Drug Center

1391 Speer Boulevard, Suite 600
Denver, CO 80204
United States

Andrew Hopkinson

University of Colorado at Denver - Department of Emergency Medicine

Aurora, CO
United States

Denver Health - Rocky Mountain Poison & Drug Center

1391 Speer Boulevard, Suite 600
Denver, CO 80204
United States

Brandon Sonn

University of Colorado at Denver - Department of Emergency Medicine

Aurora, CO
United States

Denver Health - Rocky Mountain Poison & Drug Center

1391 Speer Boulevard, Suite 600
Denver, CO 80204
United States

Michael Devivo

University of Colorado at Denver - Department of Emergency Medicine

Aurora, CO
United States

Denver Health - Rocky Mountain Poison & Drug Center

1391 Speer Boulevard, Suite 600
Denver, CO 80204
United States

Tae Chang

University of Colorado at Denver - Department of Emergency Medicine

Aurora, CO
United States

Denver Health - Rocky Mountain Poison & Drug Center

1391 Speer Boulevard, Suite 600
Denver, CO 80204
United States

Jacob Fox

University of Colorado at Denver - Department of Emergency Medicine

Aurora, CO
United States

Denver Health - Rocky Mountain Poison & Drug Center

1391 Speer Boulevard, Suite 600
Denver, CO 80204
United States

Cody Brevik

University of Colorado at Denver - Department of Emergency Medicine

Aurora, CO
United States

Denver Health - Rocky Mountain Poison & Drug Center

1391 Speer Boulevard, Suite 600
Denver, CO 80204
United States

Kayla Williamson

University of Colorado at Denver - Department of Emergency Medicine

Aurora, CO
United States

Denver Health - Rocky Mountain Poison & Drug Center

1391 Speer Boulevard, Suite 600
Denver, CO 80204
United States

Diana Abbott

University of Colorado at Denver - Department of Emergency Medicine

Aurora, CO
United States

Denver Health - Rocky Mountain Poison & Drug Center

1391 Speer Boulevard, Suite 600
Denver, CO 80204
United States

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