As more states are on the way to legalizing medical marijuana, a different pot conversation has heated up: The potential health risks of consuming marijuana-infused edibles. The New York Times’ Maureen Dowd even documented her own experience with edible pot in the form of a candy bar, which left her “curled up in a hallucinatory state for the next eight hours.” There have certainly been reports of ER doctors in Colorado seeing more patients with intoxication from pot-infused edibles, as well as some startling incidents of psychotic behavior and deaths from the products. But is edible pot really any worse than the inhaled version? Or are have people just discovered a new plaything that they just don’t know how to work?
The answer is a little bit of both.
One of the issues lies in how the two forms of the drug are metabolized, and how quickly the high comes on. “The major difference is in the absorption of the [edible] product into the blood stream,” says Kari Franson, PharmD, PhD, the Associate Dean for Professional Education, Department of Clinical Pharmacy, at University of Colorado at Denver. “Once it is in the blood, it quickly goes to and has an effect on the brain. With smoking, the peak blood levels happen within 3-10 minutes, and with eating, it’s 1-3 hours. Note that both are about a three-fold difference, but most users are willing to wait 10 minutes, not 3 hours before re-using.
In other words, it’s easier to self-monitor when smoking a joint, since one feels the effects so quickly. But with edible pot, because there can be an hours-long lag before experiencing the high, you might inadvertently consume an overdose amount while waiting.
And what you already have in your system matters more with edible marijuana – whether you’ve eaten recently or not, or have other meds in your body can also affect how the active ingredient, THC, is metabolized. These variables can change “the amount in the blood five-fold,” says Franson. “The THC will compete for metabolism in the liver with other drugs. Things that are inhaled can go directly to the brain and not have these interactions. So even confident users can get surprised with an edible.”
Another, trickier issue is that it’s very difficult to know what you’re getting when you eat a pot-infused candy bar or other edible. Though there have been recent attempts to regulate it, Franson says she’s still skeptical about the standardization of the product. Laboratory tests have shown that the actual amount of THC can vary widely in either direction, with some products containing more and some less than the amount indicated on the packaging’s “nutritional information.” A new law requires more rigorous testing of edible products in an effort to standardize the amount of THC, and remove from the shelves that ones that exceed the maximum 100 mg of the active ingredient. But time will tell how, if at all, this will reduce the risk.
The symptoms of an overdose from edible marijuana are similar to that from inhaled version, but apparently have the potential to be more severe, for some of the reasons mentioned above. Like smoked pot, the symptoms can be both physical and psychological in nature.
“The most common presenting symptom to the ER are anxiety and panic attacks, and acute psychotic episodes – confusion, disorientation, delusions, hallucinations, depersonalization [feeling as if you’re observing yourself from the outside],” says Franson. “Physically, people have tachycardia, impaired motor ability, ataxia. The time of onset can be 30 minutes to 3 hours and last from 3 to 10 hours.”
In her editorial, Dowd writes that her symptoms lasted for eight hours. “I barely made it from the desk to the bed,” she writes, “where I lay curled up in a hallucinatory state for the next eight hours. I was thirsty but couldn’t move to get water. Or even turn off the lights. I was panting and paranoid, sure that when the room-service waiter knocked and I didn’t answer, he’d call the police and have me arrested for being unable to handle my candy.
So how will the edible pot problem play out? Tighter regulations on edibles may help somewhat, but it’s partly a matter of raising awareness of the risks – and waiting for the learning curve to level out, says Sam Kamin, PhD, JD, professor of law and director of the Constitutional Rights & Remedies Program at the University of Denver. “I think edibles pose a real challenge,” he says. “They allow a person to get very high, sometimes without meaning to. Labeling and dosing will help with this, but there will still be a learning curve.”
Unfortunately, more lives may be lost while the country is still finding its way in this new territory. But there are still riskier substances out there, says Kamin, and comparatively speaking, the risk of pot-infused edibles is still fairly low. “One doesn’t need to be an apologist for the industry, though, to note that incidents related to misuse or overuse of marijuana still pale compared to similar incidents related to alcohol.”
People will continue experimenting, of course, and pot-infused edibles won’t be the last new product to raise concern: Pot-infused coffee may soon be introduced in Washington. And this and other new products will, no doubt, pose a set of issues and debates of their own.