Although inhaled cannabis contributes to more emergency department visits than edible cannabis, the edible cannabis has been linked to more severe psychiatric visits and a higher-than-expected rate of emergency department visits, according to a study published in the Annals of Internal Medicine.

This observational, retrospective study included 9973 adult cannabis-related visits to a Colorado emergency department between January 2012 and December 2016. Among the patient characteristics studied were a cannabis-related cause of visit, diagnosis at discharge, disposition, length of hospitalization, symptoms, dosage, route of exposure, and demographic information. Categorical variables were characterized using descriptive statistics among the general and subpopulations. A chi-squared test was used to examine intergroup differences.

Among the recorded visits, 25.7% were partially or wholly due to cannabis use, with 9.3% attributable to edible cannabis. Inhaled cannabis was likelier than edible cannabis to be associated with cannabinoid hyperemesis syndrome (18.0% vs 8.4%; mean difference, 9.6%; 95% CI, 0.057-0.135]; P <.001), whereas edible cannabis was likelier to be associated with cardiovascular symptoms (8% vs 3.1%), intoxication (48.3% vs 27.8%), and severe psychiatric symptoms (18% vs 10.9%). Edible cannabis was disproportionately responsible for cannabis-related emergency department visits, as it comprised just 0.32% of total cannabis sales in 2016 but was responsible for 10.7% of all visits, making its proportion of emergency department visits approximately 33 times higher than expected.

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Limitations to this study include a retrospective design, the use of a single academic center, exposure data gathered by self-reporting, and the limited availability of data on dosage.

The study researchers concluded that “inhalable cannabis results in a higher frequency of cannabis-attributable [emergency department] visits, although acute psychiatric events and cardiovascular symptoms are more common with edible exposure. Future studies that examine cannabis-attributable [emergency department] visits should be stratified by route of exposure and should account for population exposure to inhalable and edible products.”

Disclosures: This study received funding from the Colorado Department of Public Health and Environment, with which several authors report financial associations. For a full list of author disclosures, please see the reference.


Monte AA, Shelton SK, Mills E, et al. Acute illness associated with cannabis use, by route of exposure: an observational study [published online March 26, 2019]. Ann Intern Med. doi: 10.7326/M18-2809