Common marijuana-related cases encountered in the emergency department

In 2000, Colorado voters decriminalized marijuana for medical use; however, because marijuana use remained illegal under federal law, the number of users was low.1 In 2009, President Obama instructed federal officials not to enforce marijuana laws that were in conflict with state laws, and the number of registered medical marijuana users in Colorado increased to 60,000 in 2008 compared with 2,000 in the prior 8 years.1 In 2012, Colorado legalized recreational marijuana use.1 As the number of people using marijuana has increased, there has been a parallel increase in marijuana-related emergency department (ED) visits2 and poison center calls (Figure 1). We expect that as other states liberalize marijuana laws, they will also experience an increase in marijuana-related ED visits. This article reviews several common marijuana-related ED cases that we have encountered in our practice. Pediatric ingestion. Children are at particular risk of cannabis toxicity because cannabis-containing food products, known as edibles, look extremely similar to regular candy, and these edibles have a high concentration of tetrahydrocannabinol (THC). According to the National Poison Data System, from 2005 through 2011, 985 unintentional pediatric exposures were reported in children age 9 years or younger in the United States.3 The number of pediatric exposures is increasing as marijuana is becoming more commercially available. Also, we have found that the severity of symptoms from marijuana exposure has worsened due to the high THC concentration in edibles.