Take Home Points
- Store all cannabis products as you would any other prescription medication: clearly labeled and out of reach of children
- Modern cannabis products are potent: start with a low dose and increase slowly
- Edible cannabis products can be appealing in taste and appearance. Keep them away from children and from unsuspecting adults
- Call the Utah Poison Control Center at 1-800-222-1222 if someone accidentally consumed cannabis or is having side effects from cannabis
Access to cannabis has increased across the country. Legal medical or recreational cannabis is now available in 37 states. Along with increased access to any drug comes an increase in side effects and accidental overdoses.
In Utah, cannabis exposures reported to the Utah Poison Control Center have more than doubled since 2017 (Utah Poison Control Center internal data).
We use the term cannabis to refer to all forms of the plant Cannabis sativa containing the psychoactive compound tetra-hydrocannabinol (THC) such as edibles, flower (weed, marijuana), vapes, extracts, and concentrates.
Everyone is at risk for either potential side effects from cannabis or accidentally consuming cannabis including:
- Patients using cannabis products who take too much
- Patients using cannabis in combination with certain other medications
- Other people in the household, especially children, taking an edible product by mistake
Below are issues around each of these scenarios.
Adverse Effects in Patients Using Cannabis
While medical cannabis may replace other, more dangerous medications such as opioids or benzodiazepines, medical cannabis may still cause side effects and must be used safely.
Modern cannabis products are now very potent compared to the illegal marijuana available years ago. For instance, cannabis flower (weed) used to contain 1% to 5% THC while products now available in Utah contain around 20% THC.
A standard dose of THC in an edible cannabis product is 5 to 10 mg. Some products available in Utah contain up to 25 mg of THC per dose. An entire package may contain 5, 10, or even more total doses. Additionally, edible THC may take up to 2-4 hours to produce its peak effect.
Patients should be cautious when using edible cannabis products and should not take more than a single dose at a time. A common scenario for overdose is a patient who eats a single gummy or candy, doesn’t feel any effect 15-30 minutes later, and then keeps taking additional doses until they begin to feel ill when all the THC is absorbed a few hours later.
This high amount of THC often makes patients feel very anxious, paranoid, dizzy, and causes the heart to beat rapidly. Many patients are evaluated in the emergency department due to the severe anxiety. Rarely, serious effects may occur such as stroke or heart attack.
Cannabis & Medication Interactions
Cannabis can interact with other prescription and over-the-counter medications. Patients should be especially cautious combining cannabis with other sedating medications such as opioids, sleeping medications, allergy medications (e.g. Benadryl® or diphenhydramine), or alcoholic beverages. Using the medications together could cause excessive sedation, dizziness, or falls.
Patients should not use cannabis and drive or operate machinery for at least 4 to 6 hours after a dose.
Cannabis may also cause problems with other prescription medications. For instance, patients taking the blood-thinner warfarin may be at increased risk for bleeding when using THC.
Any patient recommended to use cannabis should review potential drug interactions with their healthcare provider and pharmacist.
Accidental Ingestion of Cannabis Products
Cannabis products should be treated and stored like other medication: kept in the original, labeled container and kept out of reach and sight of children.
Edible products are particularly prone to being accidentally eaten by other members of the household including adults and children. Though Utah law requires medical cannabis edibles to be sold as “gelatinous cubes,” they may still have attractive labeling, colors, and flavors that could be mistaken for regular candy. Cannabis products obtained from other states may have fewer regulations and be deliberately made to look like common candy bars with slightly different cannabis-themed names.
Children are particularly susceptible to accidental ingestion of edibles. Their small body size makes even a single adult dose potentially serious. In contrast to adults, the effect of THC on children often results in sleepiness, incoordination, difficulty walking, and in rare cases, trouble breathing. This may lead to expensive, unnecessary emergency room visits or hospitalization looking for things like head trauma, meningitis, or other illness as the child is often unable to report eating an edible cannabis product.
Conclusion
As the availability of cannabis products has increased in and around Utah, so have calls to the poison center and visits to the emergency room for problems related to cannabis.
All cannabis products should be kept up and away from children in their original, labeled containers. Patients should exercise caution with the dose of cannabis products as they are quite potent. Additionally, the effects of edibles can be delayed leading to a patient taking multiple doses.
While unlikely to be fatal, accidental consumption of cannabis products by adults or children can lead to significant side effects and costly emergency room visits or hospitalization.
Anyone concerned about side effects from cannabis or accidental exposure to cannabis should call the Utah Poison Control Center anytime 24/7 for free, expert advice at 1-800-222-1222.
Author: Michael Moss, MD, Medical Director, Utah Poison Control Center
Photo Credit: THC Photos CC BY-ND 4.0
THC-Infused Candies and Cookies https://www.flickr.com/photos/thcproductphotos/49756719093/
Sour Orange and Mixed Fruit THC Gummies https://www.flickr.com/photos/thcproductphotos/51537214915/