As a practising emergency physician, I am quite concerned about the number of people I have seen lately who are overdosing on cannabis. The common element in many of these patient presentations is that they have consumed cannabis in an edible form—like a cookie, brownie or gummy—and ended up taking way too much. The result is that they end up in the emergency department vomiting, feeling like their heart is racing, agitated, panicky and often a bit paranoid. Sometimes it is not clear that cannabis is the culprit and we become concerned that they are having a stroke, heart attack or worse and they end up getting a lot of unnecessary medical interventions before the cause is found.
Why is this happening so much?
A lot of it comes down to a lack of awareness of the delayed onset of action of cannabis edibles. Anyone who consumes an edible needs to be aware that when you ingest cannabis in this form, it sometimes does not reach its peak effect until as long as three to four hours after you have taken it. That’s a big delay.
When you smoke or vape cannabis it reaches its peak effect in 15 to 30 minutes. So you feel it pretty quickly. That will usually trigger you not to inhale anymore because you are feeling the effects and don’t want to feel anything stronger.
However, you can sometimes not feel anything at all for up to two hours after you consume an edible. In that period many people take more and more in an attempt to start the effects and the next thing you know, they have taken way too much. We call that an overdose, because you have taken “over the dose” appropriate for you.
Now, thankfully, there are no cases of death resulting directly from an overdose of cannabis (a fatal overdose), but that doesn’t mean you shouldn’t be careful. If you have underlying health problems like heart disease, the high demand state of being intoxicated by cannabis could trigger a heart attack. Also, if you become paranoid or confused you could injure yourself by making inappropriate decisions like walking into traffic or falling from a height.
So, the rule of thumb with edibles is that if you consume, wait at least three to four hours after you ingest one portion before you take any more. That way you reduce the risk of taking too much. You should also remember that if you take too much, you may continue to feel the effects for up to 12 hours or more. Edibles last much longer in your system than inhaled forms of cannabis. So it’s best to avoid that possibility altogether: start low and go slow.
A lack of information
Another problem with cannabis edibles is that they are not currently being labelled clearly. This is because there are no plans for cannabis edibles to become legal in Canada until June 2019. Therefore, cannabis edibles for recreational use are still illegal and thus are not subject to labelling and packaging regulations. No one is ensuring that a cannabis edible product contains what it says it does even if it does have a label on it. It’s important to know what constitutes a serving size and how many servings are in a single product, such as a cannabis chocolate bar. It’s also important to know how much THC and CBD are in each serving so that you know how much you can take.
THC is the chemical found in cannabis that makes you feel “high.” First-time users should not take more than 5 mg of THC at a time before knowing how they will react to that amount.
Keeping edibles out of the reach of children
It is really important to remember the dangers of edibles with respect to accidental ingestions involving children. Children are obviously much smaller than adults and have a different physiology. If they consume a large amount of cannabis they can actually present with lethargy and sleepiness instead of extreme agitation like we see in adults. There are reports of children who have ingested large amounts of cannabis resulting in such lethargy that they needed to be admitted to a hospital’s ICU (intensive care unit) and be placed on a ventilator to assist with their breathing. These types of situations could have caused death if doctors hadn’t intervened in a timely manner. We must keep edibles, which are often in appealing forms such as gummies, brightly coloured drinks or cookies, away from children who are obviously drawn to such products.
When edibles become fully legal there will hopefully be more strict packaging requirements and also a more robust public health campaign so that the general public is more aware of how to use cannabis edibles in a safer manner. This will go a long way towards minimizing the cases of overdosage that we are currently seeing on the front lines of the emergency room.
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