Pubdate: Mon, 07 Apr 2014
Source: Los Angeles Times (CA)
Copyright: 2014 Los Angeles Times
Author: Jenny Deam


In Colorado, Some Worry That the State Is Overlooking the Risks of 
Edible Marijuana.

DENVER - It was spring break, and Levy Thamba, a 19-year-old college 
student from Africa, had checked into a fourth-f loor hotel room with 
three of his buddies. They had come from their small college in 
Wyoming looking for an adventure.

No one is sure how much Thamba ate of the marijuana cookie purchased 
by one of his friends at a local pot shop. But soon the engineering 
student, who had never tried marijuana before, began acting strangely 
hostile, tearing around the room and pulling pictures from the wall.

Sometime in the early hours of March 11, Thamba leaped over the 
balcony to his death.

Thamba died from injuries suffered in the fall, the coroner's office 
ruled last week, but the report made an unusual notation: The death, 
involving a victim with no history of mental problems or suicidal 
tendencies, was linked to "marijuana intoxication."

Authorities are calling the incident the state's first 
marijuana-related death since Colorado legalized sales of 
recreational marijuana at the beginning of the year to those over 21.

The case has become a grim exhibit in a growing case file as Colorado 
health officials wonder whether, in the rapid rollout of legalized 
marijuana, adequate attention was paid to potential health risks of 
its use, especially in the little-scrutinized area of edible marijuana.

"We do know that marijuana is not without harm," said Tim Byers, an 
associate dean at the Colorado School of Public Health, as he listed 
potential consequences including cancer, lower IQs and a possible 
trigger for latent psychosis associated with heavy or long-term use. 
There is also emerging research that fetal, infant and childhood 
development can be damaged if a woman uses marijuana while pregnant 
or breast feeding.

Doctors have also documented shorter-term medical complaints 
associated with marijuana use, especially in its edible forms, 
including anxiety, nausea, vomiting, shortness of breath and 
hallucinations. Doctors at the Telluride Medical Center in the 
Colorado ski resort town report patients with symptoms resembling a 
severe anxiety attack. Some think they are having a heart attack.

"The marijuana of 2014 is not the marijuana of 1969," warned Byers, 
who said he was concerned by the lack of research surrounding the 
higher potency of the drug's current forms.

Last month, 350 public health experts, doctors, researchers, 
educators, law enforcement officials and advocates on both sides of 
the legalization debate gathered for a symposium here to discuss what 
the current scientific research says about marijuana use - and what 
is still missing.

At the standing-room-only event, held in a meeting hall called Mile 
High Station, Byers made clear he was not interested in debating the 
merits of the 2012 initiative that made recreational use of marijuana 
legal in Colorado. "That decision has already been made," he said.

The problem, public health officials say, is that nearly all of the 
regulations associated with the new law focus on growth, sales and 
public use of the product. Health aspects are addressed primarily in 
limits for operating an automobile: drivers face penalties if caught 
with a blood level greater than 5 nanograms per milliliter of THC, 
the active ingredient in pot.

More attention needs to be focused on edible forms of the drug, which 
are especially popular with first-time users, health officials say. 
The treats, candies and elixirs are among the hottest new products 
since pot became legal, making up 40% of all sales so far. And while 
edible products are packaged with warning labels and potency levels, 
officials worry those cautions may not go far enough.

By law, such products can contain no more than 10 milligrams of THC 
per serving, but often consumers don't pay attention to serving 
sizes. One large brownie can contain up to 10 servings, or 100 
milligrams, of THC.

Dr. Paula Riggs, a psychology professor and director of the division 
of substance dependence at the University of Colorado Denver, says 
smoking marijuana hits the central nervous system quickly. But edible 
marijuana has a delayed reaction so people often keep eating, looking 
for a buzz. "A half-hour later they are on their back," she said.

Health officials also are concerned that edible marijuana could be 
become an on-ramp for pre-teens and teenagers to regular marijuana use.

Frequent marijuana use by adolescents at a time when their brains are 
still developing has been linked in some research to the loss of 6 to 
8 IQ points in adulthood - a result not dissimilar from lead 
poisoning, Riggs said.

There already are incidences of young children ingesting edible 
marijuana. Even before passage of the legalization initiative, at 
least 14 children who had ingested marijuana went to the emergency 
room at Children's Hospital Colorado between 2009 and 2011, according 
to a study reported in the Journal of the American Medical Assn.

All were under 12; one was 8 months old. Two of the children ended up 
in the intensive care unit. Symptoms ranged from sleepiness to coma.

In the four years prior, before medical marijuana use in the state 
skyrocketed, there were no such cases.

"Any drug, including alcohol, tobacco, caffeine, prescription 
medication - and marijuana - are going to have health risks," said 
Rachel Gillette, Colorado executive director of the National 
Organization for the Reform of Marijuana Laws, a lobbying and 
research organization that backs marijuana legalization.

Gillette said legalization advocates welcomed more research: "It 
benefits everybody." At the same time, she said, such research should 
include potential health benefits of marijuana use, including its 
possible use in treating epilepsy, seizures in children and 
post-traumatic stress disorder.

In the case of Thamba, the young student from Democratic Republic of 
Congo who died, toxicology reports showed no other drugs or alcohol 
in his blood, but his THC level was 7.2 nanograms per milliliter - 
above the legal driving limit. Police are continuing the 
investigation to determine who bought the cookie and whether charges 
will be filed.

Though the severity of symptoms and frequency of patients are still 
less than those associated with alcohol overdose, Dr. Scott Bentz, 
medical director of emergency services at Presbyterian/St. Luke's 
Medical Center in Denver, said he found himself facing a new and 
troubling health issue.

"All of the old studies and textbooks and toxicology are based on the 
effects of inhaled marijuana," he said. "The edibles are uncharted 
territory for those of us in emergency medicine."
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