Edibles have long been the health conscious cannabis fan's delivery method of choice. But it turns out that ingesting marijuana comes with its own set of risks, at least according to a new study published April 16, 2019 in the journal Annals of Internal Medicine.
Visits to emergency rooms 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 ER visits than expected.
People who get high through inhalation are more likely to seek emergency room medical treatment for related health concerns, the research team found. But those who come looking for medical help after ingesting their weed complain of more severe problems like psychosis and cardiovascular issues.
Mitch Earleywine, a psychology professor at the University at Albany, says it likely has something to do with the way that marijuana moves through the body when ingested. It can take hours for the stomach to pass Tetrahydrocannabinol (THC), the chemical that gives weed its psychoactive properties, through the liver. The body also converts THC to 11-hydroxy-THC during that time, giving it a stronger impact.
"The process literally takes hours longer than the smoking approach, but the impact is invariably more dramatic and enduring," Earleywine, who focuses on addiction and marijuana policy, says. "11-hydroxy-THC crosses the blood brain barrier more readily than THC, leading to subjective effects that dwarf the impact created by smoking the same amount of THC."
The Colorado study comes as cities and states around the country are moving to relax restrictions on marijuana use. Colorado is among 10 states that has put a legal stamp of approval on the recreational use of cannabis, treating it much like alcohol. Another 23 states have legalized pot for certain medical purposes.
Studying ER Visits
The Colorado researchers found a mixed bag when they looked into emergency room records for marijuana users.
Andrew Monte, a doctor at the University of Colorado Medical School, and his team reviewed the medical charts for people who visited a large emergency room in Colorado over a four-year period ending in 2016. Nearly 10,000 marijuana users came to the ER complaining of issues during that time, and more than a quarter were deemed to be experiencing issues at least partially related to cannabis. Less than 10 percent of that group — or about 240 people — had ingested marijuana in an edible form.
Inhalers most commonly sought treatment for cannabinoid hyperemesis syndrome (CHS), a rare condition that usually effects people who use marijuana heavily and on a daily basis. Doctors still aren't entirely sure how substance abuse causes CHS, which leads to severe cases of nausea and vomiting.
Marijuana eaters were most likely to complain of acute psychiatric symptoms, intoxication and cardiovascular issues, the researchers found.
Don't Smoke 'Em if You Have 'Em
Anyone who's ever tried baking a plate of pot brownies in their kitchen knows it can be tough to predict just how much THC made it into each individual portion. If it takes a while to feel the effects, some users may overdose by jumping the gun and going back for more.
"As many headlines emphasize, inexperienced users occasionally misjudge the dosage or fail to wait an appropriate amount of time for effects to begin, leading them to re-dose at ill-advised levels," Earleywine says. "First-timers should find a labeled product, ingest a mere 5 milligrams worth, wait at least 150 minutes (two-and-a-half hours), relish the experience, and consider taking more next time."
Smoking, of course, brings its own separate set of possible long term health issues that can come with filling your lungs with burned air. Canada's Center for Addiction and Mental Health in 2014 tried to navigate the various health concerns for each method of marijuana enjoyment by rolling out a set of guidelines for "lower-risk cannabis use."
"Smoking cannabis (for example, smoking a joint) is the most harmful way of using cannabis because it directly affects your lungs," the CAMH says in the guidelines. "There are safer, non-smoking options like vaping or taking edibles that are better for your lungs."
The method of delivery isn't the only factor when it comes to the possible health impact of enjoying marijuana. The Canadian experts also urged users to opt for "low potency" pot.