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Marijuana EREarly this year, Colorado became the first state in the United States to legalize the commercial sale of marijuana. The legalization went ahead even after the strong protest of the Mayor. Now, it seems that the genie is out of the bottle. Several leading hospitals in Colorado indicate more marijuana related emergency room (ER) visits after the legalization of its sales in Colorado. They indicate that this surge is associated with the use of high dosage edible marijuana products including marijuana cookies, brownies, candies, pastries, and gummy bears available in the market.

In the opinion of an ER physician at the Telluride Medical Center, the number of patients visiting the emergency department for marijuana-related complications from using edibles increased dramatically in Colorado after the recreational use of marijuana was legalized. The head of Emergency Medicine at the University of Colorado Hospital says the hospital is admitting at least one person each day for marijuana-related problems and most of those cases are linked to the use of edibles. ER physicians in the metro area hospitals such as Denver Health Medical Center also report more patients reacting to edibles are being admitted.

Edibles typically have high doses of tetrahydrocannabinol (THC) which is the main active ingredient in marijuana. The user gets a dose of roughly 5mg while smoking marijuana even though it depends upon the concentration of THC in the marijuana and the way in which it is smoked. However, Colorado law restricts the THC content in an edible to 100g and eating one 100mg edible is equal to smoking 20 hits of marijuana. Though a heavy user may find this dosage tolerable, it is quite enough to create problems such as severe nausea and vomiting, elevated heart, anxiety, respiratory and blood pressure rates in most people thus sending them to emergency rooms. The sale of marijuana edibles in the form of soda, candy and cookies can be luring to the children. New York Times reports nine children have been admitted in the Children’s Hospital Colorado so far in 2014 after consuming marijuana while the number of such cases was only eight in 2013. It also says about the death of a 19-year-old African exchange student in Denver, who behaved wildly after consuming marijuana-infused cookies and leapt from a hotel balcony.

The increasing number of emergency cases related to marijuana is challenging for ER physicians not only in the sense of providing quality care but also in ensuring accurate medical billing for ER services. A recent poll conducted by the American College of Emergency Physicians in 2014 reveals around 51% of ER physicians believe the payment for emergency visits will be reduced after the implementation of Affordable Care Act (ACA). Most of the ER physicians (42%) think that if their emergency department is not able to collect payment from patients beyond their health insurance, the department would become financially unstable. Rise in marijuana ER visits will make the job of ER physicians more hectic leaving them little if no time to handle the billing tasks.

Finding an immediate solution to minimize the adverse effects of marijuana edible products and thereby reducing the number of ER visits is becoming important for both consumers and physicians. Most of the healthcare experts suggest educating consumers to what an appropriate dose is safe for them. They also urge that a minor’s marijuana use should be strictly under the recommendation of a pediatrician and a psychiatrist. The New York Times report highlights the fact that groggy and nauseated children visiting emergency departments has forced the state to make the labeling and packaging rules for edible marijuana stricter, which is really a good step.