Original Research
26 March 2019

Acute Illness Associated With Cannabis Use, by Route of Exposure: An Observational Study

Publication: Annals of Internal Medicine
Volume 170, Number 8

Abstract

Background:

Little is known about the relative harms of edible and inhalable cannabis products.

Objective:

To describe and compare adult emergency department (ED) visits related to edible and inhaled cannabis exposure.

Design:

Chart review of ED visits between 1 January 2012 and 31 December 2016.

Setting:

A large urban academic hospital in Colorado.

Participants:

Adults with ED visits with a cannabis-related International Classification of Diseases, Ninth or 10th Revision, Clinical Modification (ICD-9-CM or ICD-10-CM), code.

Measurements:

Patient demographic characteristics, route of exposure, dose, symptoms, length of stay, disposition, discharge diagnoses, and attribution of visit to cannabis.

Results:

There were 9973 visits with an ICD-9-CM or ICD-10-CM code for cannabis use. Of these, 2567 (25.7%) visits were at least partially attributable to cannabis, and 238 of those (9.3%) were related to edible cannabis. Visits attributable to inhaled cannabis were more likely to be for cannabinoid hyperemesis syndrome (18.0% vs. 8.4%), and visits attributable to edible cannabis were more likely to be due to acute psychiatric symptoms (18.0% vs. 10.9%), intoxication (48% vs. 28%), and cardiovascular symptoms (8.0% vs. 3.1%). Edible products accounted for 10.7% of cannabis-attributable visits between 2014 and 2016 but represented only 0.32% of total cannabis sales in Colorado (in kilograms of tetrahydrocannabinol) during that period.

Limitation:

Retrospective study design, single academic center, self-reported exposure data, and limited availability of dose data.

Conclusion:

Visits attributable to inhaled cannabis are more frequent than those attributable to edible cannabis, although the latter is associated with more acute psychiatric visits and more ED visits than expected.

Primary Funding Source:

Colorado Department of Public Health and Environment.

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Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 170Number 816 April 2019
Pages: 531 - 537

History

Published online: 26 March 2019
Published in issue: 16 April 2019

Keywords

Authors

Affiliations

Andrew A. Monte, MD, PhD
University of Colorado School of Medicine, Aurora, Colorado, and Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, Colorado (A.A.M.)
Shelby K. Shelton, MPH
University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
Eleanor Mills, BS
University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
Jessica Saben, PhD
University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
Andrew Hopkinson, BS
University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
Brandon Sonn, MS
University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
Michael Devivo, BA
University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
Tae Chang, MD
University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
Jacob Fox, BA
University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
Cody Brevik, MD
University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
Kayla Williamson, MS
University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
Diana Abbott, PhD
University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
Disclaimer: The contents of this work are the sole responsibility of the authors and do not necessarily represent the views of the National Institutes of Health (NIH) or the CDPHE.
Grant Support: By a grant entitled “The Adverse Health Effects of Edible Cannabis Products” from the CDPHE. Dr. Monte received support from NIH K23 GM110516, NIH CTSI UL1 TR001082, and CDPHE 17 FHHA 96950.
Disclosures: Dr. Monte reports grants from the Colorado Department of Public Health and Environment during the conduct of the study and also sits on the Colorado Retail Marijuana Public Health Advisory Committee, a group of clinicians and scientists tasked with reviewing the scientific literature related to the public health effects of cannabis use and exposure. Dr. Saben reports grants from the Colorado Department of Public Health and Environment during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2809.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement: Study protocol, statistical code, and data set: Available from Dr. Monte (e-mail, [email protected]).
Corresponding Author: Andrew A. Monte, MD, PhD, Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, Aurora, CO 80045; e-mail, [email protected].
Current Author Addresses: Drs. Monte, Chang, Brevik, and Abbott; Ms. Mills; Mr. Hopkinson; Mr. Devivo; and Mr. Fox: Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, Aurora, CO 80045.
Ms. Shelton, Dr. Saben, and Mr. Sonn: University of Colorado, 12469 East 17th Place, Aurora, CO 80045.
Ms. Williamson: Colorado School of Public Health, University of Colorado, 13001 East 17th Place, Aurora, CO 80045.
Author Contributions: Conception and design: A.A. Monte.
Analysis and interpretation of the data: A.A. Monte, S.K. Shelton, E. Mills, J. Saben, K. Williamson, D. Abbott.
Drafting of the article: A.A. Monte, S.K. Shelton, J. Saben.
Critical revision of the article for important intellectual content: A.A. Monte, S.K. Shelton, J. Saben, D. Abbott.
Final approval of the article: A.A. Monte, S.K. Shelton, E. Mills, J. Saben, A. Hopkinson, B. Sonn, M. Devivo, T. Chang, J. Fox, C. Brevik, K. Williamson, D. Abbott.
Statistical expertise: A.A. Monte, K. Williamson, D. Abbott.
Obtaining of funding: A.A. Monte.
Administrative, technical, or logistic support: A.A. Monte, E. Mills, J. Saben, A. Hopkinson, B. Sonn.
Collection and assembly of data: A.A. Monte, S.K. Shelton, E. Mills, M. Devivo, T. Chang, J. Fox, C. Brevik.
This article was published at Annals.org on 26 March 2019.

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Andrew A. Monte, Shelby K. Shelton, Eleanor Mills, et al. Acute Illness Associated With Cannabis Use, by Route of Exposure: An Observational Study. Ann Intern Med.2019;170:531-537. [Epub 26 March 2019]. doi:10.7326/M18-2809

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