Telluride Clinic Sees Jump in Pot-Related ER Visits
by Samuel Adams
Feb 13, 2014 | 3753 views | 2 2 comments | 42 42 recommendations | email to a friend | print

TELLURIDEMarijuana-related emergency room visits are on the rise in Telluride, according to Telluride Medical Center emergency room physician Daniel Hehir, MD. The spike in patients visiting the medical center due to over-consuming marijuana coincides with the recent opening of retail marijuana shops in Telluride, allowing anyone over 21 to purchase and consume the formerly illegal drug.

Virtually every patient he’s treated for an adverse reaction to the drug had consumed edible marijuana products, Hehir said.

An emergency room doctor with 15 years experience, Hehir said that he didn’t see a single case of a patients experiencing adverse effects from consuming too much marijuana until the state began relaxing its marijuana enforcement laws in the early 2000s.

At that time, “There was a soft rise in marijuana-related problems related to medical marijuana,” Hehir said. But the real shift came with the legalization of recreational weed. “We saw a sharp increase as of January 1 this year,” he said. “It’s a noticeable, palpable trend. We wonder what it will be like during the summer festivals, when 12,000 people show up for Bluegrass.”

Hehir said that roughly ten patients have visited the Medical Center reporting overdosing on marijuana since January 1; beyond that, Emergency Medical Services crews have responded to multiple 911 calls, and clinic staff have reassured distressed edible marijuana consumers over the phone.

“But for every one that we see in the clinic or help over the phone or with our EMS crews, there are probably many more that we don’t see,” Hehir said, so the total number, to date, of overdose concerns is “impossible to quantify.”

He perceives the patients as being a mix of visitors and local residents, and across a wide spectrum of ages. That said, “We’ve seen a lot of people in their 60s.

“Most of the people I’m seeing are relatively THC-immune – they are not big pot smokers,” he said, of marijuana consumers who have sought medical help. “But I have seen people that claim to smoke pot every day,” and come in reporting over-consumption.

The patients’ reaction, he said, “has to do with the dosage” of THC, or tetrahydrocannabinol, the psychoactive ingredient in marijuana, in edibles, and “nearly every patient” checking in, he said, “was there was for eating too many edibles.”

Edible marijuana products, often candies and baked goods, are infused with THC, and the effects of THC-infused edibles generally take longer to manifest the effects from smoking THC. The result, Hehir said, is that consumers can ingest too much THC, and experience effects disproportionate with their intentions.

People’s reactions to what is, in effect, a THC overdose, Hehir said, can be mixed.

“We’ll get people who throw up multiple times, people who will sometimes vomit violently for 30 to 60 minutes at a time, so we treat that by giving them an anti-nausea medication,” he said. Nausea, he explained, is a common side effect of eating too many pot products.

“But the other major symptom is anxiety, so we give them medication to help them calm down.”

Many of the patients he has treated for over-consumption of edibles in the ER are older, and thus in the at-risk group for heart disease; some believe they’re having a heart attack. For them, “We sometimes will perform an EKG and determine that this is not happening,” said Hehir.

Hehir said none of his THC over-consuming patients have experienced anything more serious than nausea and anxiety.

TMC emergency room physician Simon Kotylar, MD, has treated six THC “overdosers” at the clinic since January, and treated a few more over the telephone.

He said that many appeared to be in a hyperadrenergic state, “similar to what someone feels when someone puts a gun to their head,” with symptoms including “serious anxiety, a pending sense of doom, elevated blood pressure, high heart rate and dilated pupils.”

But while the number of patients treated for marijuana over-consumption at the medical center has increased, Kotylar downplays the significance of those numbers.

“I don’t see it as a different phenomenon from that of, say, over-consuming alcohol,” he said. “We see a fair number of people who make errors in judgment, or young people who may not be familiar with alcohol who get in trouble because of their relative lack of experience with the substance.”

The vast majority of patients he has treated for eating too many edibles have been visitors to Telluride who have no prior experience with consuming marijuana in edible form.

The result? “People end up consuming more than they intended to.”

‘Err on the Side of Caution’

Hehir believes that emergency room visits to treat these symptoms can easily be avoided.

“If you’re going to do it, educate yourself on the dosages involved, and be particularly wary of the edible products,” he said. “Err on the side of caution.”

But with the change in Colorado laws that made marijuana legal for recreational use, Kotylar said he is not so certain about appropriate dosages.

Users need to educate themselves “on proper milligram dosage,” he said. “People in general have a limited understanding of how many milligrams they should eat.”

For Hehir, keeping edible products out of reach of children is paramount.

“Candies, gummies and brownies are very appealing to children, so your edible products should be protected as if they were as dangerous as, say, grandma’s high blood pressure medication.”

Taylor West, deputy director of the National Cannabis Industry Association in Washington, D.C., said that while the industry emphasizes educating consumers, consumers need to be responsible, as well, particularly when consuming edibles.

West recently took over for Betty Aldworth, a leader in the campaign for Amendment 64, which legalized recreational marijuana use in Colorado.

The industry anticipated that customers in this new market would over-consume, West said. “It’s not totally unexpected.”

Because the marijuana industry in Colorado largely follows the state’s liquor policies, consumers should treat purchasing and consuming edible forms of the drug as if it were alcohol.

“Most people who consume alcohol understand that you don’t drink whiskey the same way you drink wine or beer,” she said. “The industry has been aware of, and has tried to be proactive, in educating customers. But at a certain point, it’s a point of individual responsibility. It’s their responsibility to property and safely consume marijuana.”

West also downplayed the medical harm that could be caused by over-ingesting marijuana.

“It’s not a fun experience when you eat too many edibles,” she said. “But unlike alcohol, taking a larger than expected dose of marijuana does not have lasting medical effects. The good news is that you’re not seeing serious medical problems; you’re seeing isolated episodes, which we want to prevent.”

West points to an informational PDF created by the marijuana industry that aims to educate consumers on responsible marijuana use. More companies, she said, are coming forward with educational materials to better inform consumers of safe marijuana consumption.

“That’s been a big commitment in the industry; as more people become more educated, we’ll see fewer incidences,” she said.

Will Evans, director of marketing and business development at Telluride’s Alpine Wellness  pot shop, said his store is in the process of drafting information and literature for customers.

“The majority of edibles we provide consist of 25 milligrams of THC, with some products that contain 50 milligrams of THC (which is the highest we offer),” he said in an email. “‘Less is more’ and ‘start slow’ are general rules of thumb we encourage our customers to follow. Above all, we take a proactive approach to consumer education, responsibility and safety.”

Kotylar said that medical center staff and local marijuana dispensary proprietors are in contact.

“We have plans to go visit the proprietors, but more for mutual educational purposes.”

Law Enforcement Not Involved

Unlike other drug overdoses or alcohol poisoning, no patient treated for over-consuming marijuana at the Medical Center has been turned over to authorities, who often transport overly intoxicated people to the San Miguel County Detoxification Center, in the county jail in the Illium industrial park.

In 2013, more than thirty people were placed in the jail for detoxification; countless more were placed into the custody of a relative, friend or roommate by local authorities, according to San Miguel County Sheriff Bill Masters.

Not one, he stated was transported because they consumed too much marijuana.

“This is not a detox situation. We do not need to incarcerate them like we do with people who drank too much alcohol or did too much of other drugs,” he said.

“They’re given a drug to counteract whatever they’re feeling, and they’re released,” Masters said. “The impact on the patient is nothing like it is with alcohol poisoning. We’ve detoxified people overdosing on methamphetamine, cocaine and who drank too much alcohol. Sometimes the people we need to detoxify are physically violent, they sometimes vomit all over the holding cell…. We haven’t had anyone that has had the kind of reaction to marijuana.”

While Masters knows there is an increase in patients seeking emergency medical care in Telluride, he doesn’t hear about it.

“I don’t see any increase,” he said, but “I know it’s happening,” he said. “The public consumption of marijuana has been happening here for a long time.”

Editor's Note: This story has been updated to correct an interview attribution error. 

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February 14, 2014
gcraig: not sure it would be a proper metric alcohol related visits to the medical center, since some who've overindulged in alcohol will invariably wind up dealing with law enforcement for one reason or another.
February 13, 2014
How many alcohol related patients have they seen in same period?