Pubdate: Thu, 25 Feb 2016 Source: Chicago Tribune (IL) Copyright: 2016 Chicago Tribune Company Contact: http://www.chicagotribune.com/ Details: http://www.mapinc.org/media/82 Author: Leonor Vivanco STUDY: COLO. POT-RELATED ER VISITS UP NU Doctor Leads Research; Hospitals See More Tourists Marijuana-related emergency room visits in Colorado have increased at a higher rate for out-of-state guests than for residents since cannabis was legalized, according to a new study. The study, from Northwestern Medicine and the University of Colorado School of Medicine, looked at ER visits at more than 100 hospitals in Colorado in which there was a diagnosis of patients having used cannabis. Researchers compared the records from 2012, when the Colorado ballot measure passed to legalize marijuana, with 2014, when it was legally sold for recreational use. It found marijuana-related ER visits by out-of-state visitors grew by 109 percent, from 78 per 10,000 emergency room visits in 2012 to 163 per 10,000 visits in 2014. Over the same time, marijuana-related ER visits by Colorado residents saw a 44 percent increase, from 70 per 10,000 in 2012 to 101 per 10,000 in 2014. "The interpretation is that emergency room visits possibly related to cannabis use are increasing in both Colorado and out-of-state residents, but the rate is increasing more dramatically among out-of-state visitors," said lead investigator Dr. Howard Kim, a postdoctoral fellow in emergency medicine at Northwestern University's Feinberg School of Medicine and an emergency medicine physician at Northwestern Medicine. Kim said the lower rate of in-state ER visits may be attributed to Colorado's marijuana education campaign. "Our hypothesis is that out-of-state visitors weren't as aware of the potential side effects of marijuana use," he said. The study will be published Thursday in the New England Journal of Medicine. The statewide data provided for the study did not state the purpose of all the ER visits, Kim said. However, the most common reasons for a subset of patients - out-of-state residents visiting the University of Colorado Hospital in Aurora - were psychiatric, cardiopulmonary and gastrointestinal complaints, Kim said. About 57 percent of the out-of-state patients were discharged while the other 43 percent were admitted, he said. Kim began the study when he was working on his residency in Colorado, before taking the job at Northwestern. "We were observing more and more out-of-state visitors coming to the emergency room for marijuana-related symptoms," he said. Typical adverse side effects of marijuana use can include anxiety, agitation, fast heart rate, high blood pressure and vomiting, Kim said. Marijuana advocates find the statistics problematic because they don't measure whether cannabis was the reason for the ER visits. "Obviously, if there was a 50 percent increase in alcohol poisoning, that would be very different than if there was a 50 percent increase in people showing up who mentioned they had a beer," said Mason Tvert, communications director for the Marijuana Policy Project, which seeks to legalize marijuana. He said he had no doubt people who consumed marijuana have felt uncomfortable and were compelled to visit the ER. But he questioned whether some symptoms reported by patients, such as nausea, could be attributed to altitude sickness or alcohol consumption. "It's great there is research being done into this type of stuff. It's really important that we nail it down and make sure we understand what the results mean," Tvert said. More honest reporting from patients could also factor into the increase, said Ali Nagib, assistant director of the Illinois chapter of the National Organization for the Reform of Marijuana Laws. "In the past, when it was illegal, they might not tell (the doctors about marijuana use), and now that it's legal, they might be more willing to be honest," he said. The study did not look at whether ER patients smoked marijuana or ingested edible marijuana products. Based on his clinical observations, Kim said inexperienced users are unaware of the delayed effect of edibles. "Frequently, inexperienced users will eat a pot brownie, not feel any effects and think it isn't working and so they eat another pot brownie. So when the effect finally kicks in two or three hours later, they now have had multiple marijuana products," Kim said. Patients who overconsume marijuana can be treated with anti-anxiety medication if they are experiencing anxiety or agitation, with intravenous fluids if they are having heart palpitations and a fast heart rate, and with anti-nausea medication if they are vomiting or nauseous, Kim said. He suggested future efforts should focus on educating visitors on safe and appropriate marijuana usage. The Marijuana Policy Project has a campaign aimed at responsible consumption and wanted to put up ads at Denver and Seattle airports a year ago to target tourists but did not get approval for it, Tvert said. "There's no doubt education is effective at preventing overconsumption. If the state's efforts and those by organizations and businesses are resulting in more informed consumers locally, the state should look into ways of getting that information to tourists," he said. Businesses must do their part in educating users, and users need to take personal responsibility as well, said Kayvan Khalatbari, co-founder of Denver Relief dispensary and co-founder of Denver Relief Consulting, which is a partner with Cresco Labs, a cultivator in Illinois. "We're pretty transparent and honest and communicate what these infused products contain and entail and how they should be used appropriately," he said. For example, his employees will advise a buyer of a 100 milligram chocolate bar, which splits into 10 pieces, to try one dose at 10 milligrams and wait 45 minutes to an hour before taking another for the desired effect. - --- MAP posted-by: Jay Bergstrom