I recently finished my residency in emergency medicine and began to practice in Pueblo, Colorado. I grew up there, and I was excited to return home. However, when I returned home, the Pueblo I once knew had drastically changed. Where there were once hardware stores, animal feed shops, and homes along dotted farms, I now found marijuana shops—and lots of them. As of January 2016, there were 424 retail marijuana stores in Colorado compared with 202 McDonald’s restaurants.1
Explore This IssueACEP Now: Vol 36 – No 05 – May 2017
These stores are not selling the marijuana I had seen in high school. Multiple different types of patients are coming into the emergency department with a variety of unexpected problems such as marijuana-induced psychosis, dependence, burn injuries, increased abuse of other drugs, increased homelessness and its associated problems, and self-medication with marijuana to treat their medical problems instead of seeking appropriate medical care.
I watched one of my colleagues and several security guards restrain a psychotic teenage girl who was reportedly “dabbing” (heating highly concentrated, solidified THC, which is inhaled). A short time later, a young adult male came in, having reportedly tried to hang himself three times. He stated that he had been smoking marijuana “all day, every day.” He was “seeing ghosts” that told him to kill himself. Not long after, a man presented in tears, saying that he had lost his job, was on the verge of losing his family, and needed help stopping the use of marijuana and didn’t know where go for help. Another colleague saw two young adult patients from a hash oil explosion that left them with very severe burns. I have certainly seen more cases of infective endocarditis from injection drug use than I expected in this once-quaint town.
I had expected to see more patients with cannabinoid hyperemesis syndrome (and I have), but they were the least of my concern. Our local homeless shelter reported seeing 5,486 (unique) people between January and July 2016, while for the entire year of 2013 (before recreational marijuana) that number had been 2,444 people.2 Most disturbing, we weren’t seeing just homeless adults but entire families. It is a relatively common occurrence to have patients who just moved here for the marijuana show up to the emergency department with multiple medical problems, without any of their medications, often with poor or nonexistent housing, and with no plan for medical care other than to use marijuana. They have often left established medical care and support to move here for marijuana and show up to the emergency department, often with suitcase in hand.
Increasingly Potent & Dangerous Drug
This new commercialized marijuana is near 20 percent tetrahydrocannabinol (THC, the psychoactive component of cannabis), while the marijuana of the 1980s was less than 2 percent THC. This tenfold increase in potency doesn’t include other formulations such as oils, “shatter” (highly concentrated solidified THC), or “dabbing” (heated shatter that is inhaled to get an even more potent form) that have up to 80 or 90 percent THC.3