SPRINGFIELD – It’s a question that bore examining. What might happen when the recreational use of marijuana for adults over the age of 21 suddenly became legal on July 1? Would hospitals see an uptick in emergency room visits, as people could freely smoke and ingest what was previously considered an illegal substance for most users?

Dr. Gerald Beltran, chief or pre-hospital and disaster medical division for Baystate Medical Center told Reminder Publications he didn’t expect any big jump in emergency room visits right off the bat.

“We already saw the uptick when [marijuana use] became a civil penalty, not a criminal one,” Beltran said, adding he didn’t anticipate another noticeable bump until more cities and towns finalized their bylaws regarding cultivation and sale of marijuana.

But the slow acceptance of cannabis as a legitimate business doesn’t mean Betran and Dr. Louis Durkin MD FACEP, chief of Emergency Medicine at Mercy Medical Center, don’t have their concerns. From accidental pediatric exposure to potency issues to impaired driving, both men acknowledged there would be issues as marijuana became more widely accessible to the public.

“We do expect to see an overall increase of accidental and intentional overexposure and overdose, but it’s likely to increase on an individual basis, not 20 patients all at once,” Durkin said. “All the things that we’ve seen even though it was not legal, we’re going to see more frequently now that it is legal.”

Impaired driving and accidents
    Beltran noted that a survey from one of the states where recreational marijuana use has been legal for some time found users felt comfortable driving an hour after smoking a joint.

“Studies show [marijuana’s effect] is still in the system three hours after smoking. People don’t realize they are impaired,” he said. “ Nobody wants to admit it, but studies have [also] been done on the number of accidents and fatalities, and there is an uptick in the number of deaths from operating under the influence [of marijuana.]

Durkin said driving accidents weren’t the only injury concerns with marijuana impairment.

“There’s going to be more slips and falls – [injuries] related to intoxication, similar to alcohol use, but it will be harder to measure” because there is currently no definitive test for marijuana intoxication, he said.
    
Pediatric exposure
    Beltran noted that nationally, as marijuana legalization has spread from state to state, there’s been a steady, sometimes dramatic, increase in emergency room visits for children unintentionally exposed to marijuana.

For example, at a June 6 marijuana forum in Springfield addressing youth exposure concerns,  Captain Brian Keenan, Springfield Police Department Narcotics Division,  noted “pediatric exposure to marijuana is up 30 percent in Colorado.”

Durkin said this uptick is especially true when it comes to marijuana edibles. Though Jennifer Flanagan, a member of the Massachusetts Cannabis Control Commission who spoke at the Springfield event emphasized the Commission has gone to great lengths to discourage  any markings that would appeal to kids and tweens, and to and clearly label marijuana edibles as not for children, both doctors acknowledged accidents would happen.

“Like with Tide Pods, the same thing can happen with edible marijuana,” Beltran said. “I think it’s going to be very difficult to control as [they] become more available.”

Edible toxicity
    Durkin said individuals unfamiliar with how marijuana works in an edible form are likely to run into trouble with the substance.

“The peak onset of effect is two to four hours after ingestion,” Durkin said. “You can get into the trap where you’re not feeling anything and you eat another brownie, and another brownie, and at four hours, you’re toxic.”

He said some individuals may feel some effects before the two hour mark, but the full intoxication doesn’t hit until the four hour mark and because “edibles take longer than inhalation to take effect, it takes longer [for the effects] to go away.”

Polysubstance problems
Both Beltran and Durkin said their biggest concern going forward would be polysubstance admissions involving marijuana, as it’s often used in conjunction with other substances.

“Marijuana and alcohol, marijuana and cocaine, marijuana and alcohol and cocaine, there are a lot of iterations” that might land an individual in the emergency room, Durkin noted.

Beltran agreed, noting marijuana is frequently a polysubstance drug.

“There are no tests for [marijuana]. If someone comes in completely altered – and we have seen people with marijuana and pcp – was it trauma from an accident or was it pcp or was it marijuana  –  it creates an interesting differentiation,” Beltran said.

Potency concerns
“Over the last 20 or 30 years, the level of THC [the psychedelic compound in marijuana] is much higher. People who smoke it now who have been away from it will [find] a more interesting effect that goes along with it,” Beltran noted.

At the June 6 seminar in Springfield, Lena Marceno, prevention specialist, Springfield Dept. of Health and Human Services, noted that the concentration of THC in street-level marijuana had increased from 3.7 percent in 1990 to 13.2 percent today.

Durkin said this potency inccrease is especially concerning when it comes to older former users.

“As all medications goes, it does depend on the sensitivity equation. If you’ve got a more susceptible older patient using a higher concentration [of THC], there’s a higher possibility of toxicity being achieved,” he said.

Seeking help
Durkin noted the following symptoms as indicating overexposure or toxicity when it comes to marijuana use:

"The most concerning symptom is  [that] you are unable to wake the person up. Seizure activity is another concern. And then there is intractable vomiting,” he said.

Beltran noted intractable vomiting is mostly associated with daily marijuana use, and the only cure is to stop using.