• Andrew A Monte, Shelby K Shelton, Eleanor Mills, Jessica Saben, Andrew Hopkinson, Brandon Sonn, Michael Devivo, Tae Chang, Jacob Fox, Cody Brevik, Kayla Williamson, and Diana Abbott.
• University of Colorado School of Medicine, Aurora, Colorado, and Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, Colorado (A.A.M.).
• Ann. Intern. Med. 2019 Apr 16; 170 (8): 531537531-537.

BackgroundLittle is known about the relative harms of edible and inhalable cannabis products.ObjectiveTo describe and compare adult emergency department (ED) visits related to edible and inhaled cannabis exposure.DesignChart review of ED visits between 1 January 2012 and 31 December 2016.SettingA large urban academic hospital in Colorado.ParticipantsAdults with ED visits with a cannabis-related International Classification of Diseases, Ninth or 10th Revision, Clinical Modification (ICD-9-CM or ICD-10-CM), code.MeasurementsPatient demographic characteristics, route of exposure, dose, symptoms, length of stay, disposition, discharge diagnoses, and attribution of visit to cannabis.ResultsThere were 9973 visits with an ICD-9-CM or ICD-10-CM code for cannabis use. Of these, 2567 (25.7%) visits were at least partially attributable to cannabis, and 238 of those (9.3%) were related to edible cannabis. Visits attributable to inhaled cannabis were more likely to be for cannabinoid hyperemesis syndrome (18.0% vs. 8.4%), and visits attributable to edible cannabis were more likely to be due to acute psychiatric symptoms (18.0% vs. 10.9%), intoxication (48% vs. 28%), and cardiovascular symptoms (8.0% vs. 3.1%). Edible products accounted for 10.7% of cannabis-attributable visits between 2014 and 2016 but represented only 0.32% of total cannabis sales in Colorado (in kilograms of tetrahydrocannabinol) during that period.LimitationRetrospective study design, single academic center, self-reported exposure data, and limited availability of dose data.ConclusionVisits attributable to inhaled cannabis are more frequent than those attributable to edible cannabis, although the latter is associated with more acute psychiatric visits and more ED visits than expected.Primary Funding SourceColorado Department of Public Health and Environment.

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