A few years ago, Morgan Rowe eagerly anticipated her first marijuana experience. Washington had just legalized adult-use sales, and Rowe, who lived in Seattle, had never gotten high.
After ingesting some carefully measured homemade brownies, âI was suddenly overcome with giggles,â recalled Rowe, who now lives in Maine. âAnd I was very conscious of how much I wanted to experience that particular phenomenon, being stoned like that. And that was super exciting.â
Morgan Rowe, first-time edible eater
But not long afterward, she remembered, âI felt like something was terribly, terribly wrong. To me it was very physical. I felt like there was a very hot lava cube traveling through my nervous system.â
The person with her, an experienced cannabis consumer, reassured her. She was OK. But Roweâs symptoms became worse.
âAt the point where I felt the sensation get to my heart,â she told Leafly, âI really thought I was going to have a heart attack. And I think thatâs when we called the paramedics.â
Emergency medical personnel came to Roweâs residence and examined her. After determining she would be fine once the effects of the cannabis wore off, the EMTs left.
(Roweâs account of her experiences, part of the Leafly series Tales of Terrifying Highness, can be read here.)
Her story is an illustration of the growing number of people who have found themselves in physical and/or mental distress after consuming too much cannabis.
Over the past several weeks, as Canada prepares for the legalization of adult-use, recreational cannabis in October, Canadian media has been filled with cautionary articles about the risk of cannabis overconsumption.
CBC News reports that emergency room visits in Canada, for what some are calling cannabis âgreen-out,â have risen dramatically over the past several years. In Ontario, Canadaâs most populated province, federal health officials say that ER visits due to so-cannabis overdoses have nearly tripled over the past five years.
Cannabis overdosing has been a big issue in the United States for several years now, as more states legalize recreational use.
And we should note that we are not talking about the growing crisis surrounding so-called synthetic marijuana, a manufactured drug often found in states where marijuana remains illegal. There have been terrifying reports about people overdosing on synthetic marijuana with life-threatening and sometimes lethal results.
In Colorado, which legalized recreational cannabis more than four years ago, doctors say theyâve seen a spike in the number of overconsumption cases among adults.
âWe see a few a week,â said Dr. Eric Lavonas, an emergency physician and medical toxicologist at Denver Health Medical Center. He also works with the Rocky Mountain Poison and Drug Center, the poison control emergency contact for Colorado and five other states. âWe donât really keep numbers on it, but my best guess would be three or four a week.â
Lavonas told Leafly that the arrival of high-potency cannabis strains and high-concentration THC edibles over the past several years has been a game-changer.
âItâs just a different marijuana than what was easily available ten years ago,â he said. âAnd when you have a stronger drug, you have stronger drug effects.â
According to Lavonas, most of the cannabis overconsumption cases that doctors are seeing involve edibles. A common scenario: A first-time consumer eats an infused candy or cupcake but doesnât feel any immediate effects. Out of frustration, they then consume more edibles, not realizing the first dosage is already working its way through their system and that the delayed effect of all that cannabis will hit them shortly.
âWhen people smoke pot, they get peak effect of the drug within a few seconds,â Lavonas noted, âwhich allows the user to self-regulate, to sort of get where you want to be.â With edibles, on the other hand, âwhen that train leaves the station, you donât know where itâs going to go for 30 minutes to two hours.â
In metro Denver, the majority of patients coming into ERs due to cannabis overconsumption are tourists, often first-time consumers who took too many edibles. There are locals coming in as well, said Lavonas, but theyâre mostly dealing with cannbinoid hyperemesis, the vomiting and abdominal pain syndrome sometimes associated with heavy, long-term cannabis use.
In the field, emergency medical service personnel treat cases of cannabis overconsumption based on the symptoms shown by the patients.
âIf a patient were severely agitated, paramedics could administer a medication for sedation. For example, a benzodiazepine like midazolam,â Kristi Koenig, EMS medical director for Californiaâs San Diego County, told Leafly via email.
âIf the patient was experiencing nausea and vomiting, paramedics could give intravenous fluids for hydration and anti-nausea medications such as ondansetron,â Koenig added.
The paramedics also closely watch a patientâs vital signs, both at the scene and during transport to the hospital. But many of those suffering from too much cannabis, said Lavonas, are brought into emergency rooms by their family and friends, where patients are examined and treated by doctors.
Some of the more common symptoms for cannabis overconsumption, he said, are anxiety and paranoia.
âUsually, in the milder cases, people are very aware that theyâre anxious and paranoidâand come in saying, âI feel terrible,ââ Lavonas added.
Paranoia and anxiety are the most common symptoms of overconsumption.
Less common but still an issue, Lavonas said, are the cases where someone has gone âway over the topâ with edibles and are truly psychotic. At that point, he said, a patient is typically unable to understand that âwhatâs going on is a chemical reaction in the body. Theyâre unable to control that behavior. But thatâs uncommon compared to people who just simply feel terrible and need a little help in getting over it.â
While few adults end up being admitted to hospital for cannabis overdose, the story can be quite different for children and teens.
Researchers at Childrenâs Hospital Colorado noted in a recent study that the number of teens diagnosed annually with cannabis overconsumption or testing positive for cannabis during drug screenings at the facility rose more than fourfold between 2005 and 2014, the year recreational cannabis became legal in Colorado.
And according to the studyâs lead researcher, Dr. George Sam Wang, an emergency medicine physician and assistant professor of pediatrics at the University of Colorado Anschutz Medical Campus, the rate of ER and urgent-care visits by stoned teenagers more than doubled between 2009 and 2015.
Wang told Leafly that most pediatric cases of cannabis overdose can be attributed to cannabis edibles.
Symptoms with young children, Wang said in an email, can vary in their severity âfrom mild sleepiness to the extreme rare case of children requiring a ventilator or mechanical breathing assistance.â
Most of the children in these cases, he said, are brought in by their parents. And with legalization, it appears that many parents are also more forthcoming about how their kids got hold of the cannabis that made them ill.
Wangâs advice to parents who consume cannabis is to âtreat marijuana products just like alcohol, cigarettes, prescription and OTC drugs, or dangerous household chemicals,â he said.Â âKeep them out of sight, reach, and locked away, and in child-resistant packaging.â
Stricter regulations in cannabis-legal states, with education campaigns and child-resistant packaging, have reportedly helped reduce cases of cannabis overconsumption.
âItâs certainly something we talk about nationally and have tried to address,â said Dr. Kennon Heard, professor of emergency medicine at the University of Colorado School of Medicine. âColorado is early on in the field, one of the first places youâd see this. We take our experiences and share, especially regarding pediatric cases.â
And according to Dr. Lavonas, experience has taught emergency medical personnel that time is the best antidote for most cannabis overconsumption cases. âOffhand I canât think of an adult that Iâve had to admit (into the hospital) for this,â he said.
As with all such cases, he said, doctors need to make sure there arenât other ailments that might complicate their treatments. âJust because you smoke marijuana doesnât mean you canât get pneumonia, so weâve got to make sure there arenât two problems.â
And then, he added, thereâs the importance of âletting people know that theyâre in good hands, that time is on their side and theyâll be OK. And then, if the reassurance alone isnât getting them where they need to be, then a little bit of medicine to help them relax, something for anxiety, a little bit of fluids and justâŚ time.â
One classic recent case at Denver Health, according to Lavonas, involved a man in a fast-food restaurant whoâd been smoking marijuana.
The man felt himself choking, recalled Lavonas, âso he calls 911 and arrives in the ER still with his bag of (burgers) and his âŚ soda. My adept senior resident meets the man âŚ sizes up the situation, and figures out that he has really bad cottonmouth and some anxiety. And he has him drink his soda and eat his burger, reassures him, and sends him out.â
âIn the end what weâre about is happy endings,â said Lavonas. âWe donât judge. We just take care of them, get them feeling better, and get them home safely.â