Marijuana edibles can be dangerous

Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Marijuana edibles are legal in New York state for adults 21 and older, but that doesn't mean they're safe to use. For help understanding what to watch out for. I'm speaking with Dr. Willie Eggleston. He's a clinical assistant professor of emergency medicine specializing in toxicology, and he's part of the Upstate New York Poison Center. Welcome back to The Informed Patient, Dr. Eggleston.

Willie Eggleston, PharmD: Thanks, Amber. I'm happy to be here.

Host Amber Smith: To begin, I'd like to ask you to explain what cannabis does to the body. How does it work?

Willie Eggleston, PharmD: Well, that's a big question. In general, when we think about cannabis or marijuana, it's important to remember we're talking about the plant or things derived from the plant. And so there's a lot of different chemicals and compounds in there that can have a lot of different effects on the body. In general, marijuana can cause some sleepiness, some sense of euphoria, and generally that's the reason that people are seeking out its use.

Host Amber Smith: So the big ones that we hear about, the big initials we hear about are CBD and T H C. Are both of these things in marijuana?

Willie Eggleston, PharmD: They are. And depending on how you grow the plant, that can be there in different concentrations, and they have very different effects on the body. So THC is the one that people are typically experiencing the sensations that they're familiar with when they use marijuana. It's the psychoactive component of marijuana. It's the part that causes the euphoria. It's the part that causes the high that people are seeking out when they're using marijuana. CBD is a little bit different. It actually blocks the effects of THC at the main receptor, and it can cause a whole host of different effects that are still being researched for medicinal reasons today in the United States.

Host Amber Smith: So it is my understanding, you can find products that have both CBD and THC, and you can find products that are CBD only. Can you also find products that are THC only?

Willie Eggleston, PharmD: So, any product that you're using that is marijuana or derived from marijuana is going to have both in there. Now, people can manipulate the plant in ways that increase one or decrease the other. And so it's important to look at the dosing on the product you're using, if it's available. You can find CBD only products currently available in New York and across the United States. These are derived from hemp. Hemp is a special strain of marijuana that contains no THC, and so you're able to get CBD from that plant. It's harder to get products that are just THC with no CBD, but certainly there are recreational products available that have very, very high concentrations of THC and very, very low concentrations of CBD. So you can find things all across the spectrum.

Host Amber Smith: So it sounds like the products are going to differ quite a bit. What symptoms may indicate that someone is having a bad reaction to the product they've used?

Willie Eggleston, PharmD: So some of the more common adverse effects that are reported to us include things like what's called a dysphoric reaction. You might think of that as like a bad trip. So that can depend on that individual, that individual's experience with marijuana, the setting that they're using the product in. But in general, what that can mean is a fast heart rate, anxiety, being worried about everything going on around you, heightened awareness. And so certainly that can lead to someone having a, what we would consider a bad reaction to the product. Outside of that, certainly because it does cause the individual to become more sleepy, and it delays their reaction time, there can be difficulty with completing tasks that are normally easy to do. So we encourage people not to use this if they're going to have to do any tasks that involve a thought process or quick reaction time. It's just not a good combination.

And then lastly, there's some ongoing research to suss out how risky is this for individuals with other chronic diseases, for example, psychiatric diagnoses or heart conditions that may lead it to be more dangerous with longer-term use.

Host Amber Smith: I wonder, is there a difference in the way it's ingested -- smoking or vaping versus if you swallow it in an edible. Are the effects going to be different?

Willie Eggleston, PharmD: They are very, very different. And that's one of the important messages we want people to be aware of as recreational products become available in New York. We know that adult use of marijuana is coming. We know that dispensaries will be open soon. And so it's important for folks to understand if you've smoked a product in the past, and now you're using an edible, although the chemicals in there are the same, the way that they take root in your body is very, very different. When you smoke generally, you know the effects from that dose within three to five minutes. It's very, very rapid acting. And it goes away fairly quickly too. The effects are gone within a couple of hours. Whereas edibles, it takes about two to three hours to even start to feel the effects, and up to six hours to know how strong those effects are going to be. And once they start, they last for many, many hours. So in general, when you think about smoking versus edibles, smoking works fast, lasts for a short amount of time. Edibles take a long time to start, and once they start, they last for a very long time. So if it's your first time using an edible product, you want to start with a very low dose. You. Want to take that dose, and you don't want to take any more. Even if it's been an hour and nothing's happening, it doesn't mean nothing's going to happen two hours from now. So you really want to, start low, see how that affects you, and then gradually you can increase with subsequent uses.

Host Amber Smith: You mentioned that research is ongoing into chronic conditions that people may have and how that may or may not be influenced. Is there any way a person can, sort of, predict what their reaction is likely to be?

Willie Eggleston, PharmD: There's really not. You know, we certainly know in individuals who use marijuana more frequently, they kinda know how their body reacts to the product. But in someone who just uses occasionally, we really don't have any good information to figure out who's going to have a bad reaction. In general, how much does it take, or how frequently does someone need to use it to develop something like a use disorder? Those are things that we're still trying to answer.

What we do know is that chronic use or regular use of marijuana can lead to something called cannabinoid hyperemesis syndrome. And that's a fancy medical way of saying the patient starts to vomit and they vomit a lot. They feel nauseous, they feel cruddy. And the typical medicines that we use to treat the nausea and vomiting don't work very well for cannabinoid hyperemesis syndrome. So it's certainly a problem, and it's one that public health officials and medical folks are trying to get a better response to, get a better handle on. But it's still an emerging issue that we're learning about.

Host Amber Smith: Why do people report getting the munchies when they, at least when they smoke marijuana? And I wonder, does that happen with edibles as well?

Willie Eggleston, PharmD: That's a great question. Yeah. Marijuana in the body is really a very fascinating thing, and it's something we don't know a whole lot about still, despite it being around for thousands and thousands of years. The receptors that marijuana binds to in the brain, we have more of those receptors than any other receptor in the brain. And they affect so many different organ systems, including our hunger. A couple of different changes happened when marijuana enters the body, one of which is it upregulates a hormone that tells us, "Hey, it's time to eat. I'm hungry." It's one of the reasons we can use a marijuana-like product to treat diseases in which patients have very low weights and we need to increase their appetite. So it does do that. It does a whole host of other things. And it does that if you smoke it, if you vape it, or if you ingest it.

Host Amber Smith: You're listening to Upstate's The Informed Patient podcast. I'm your host, Amber Smith talking with Dr. Willie Eggleston from the Upstate New York Poison Center. Dr. Eggleston is a clinical assistant professor of emergency medicine, and he specializes in toxicology.

Is marijuana addictive?

Willie Eggleston, PharmD: That's a little bit of a loaded question, but the short answer is yes. We have a spectrum of how addictive something can be. And we have things like opioids that we think of as a classic example of things that can cause a substance use disorder. And marijuana is on that spectrum. We just don't know where it is on that spectrum. It seems to be at the lower risk end, but in individuals who do use the product regularly, frequently, we know it can interfere with their job, with their life, with their family and relationships, with legal problems. And it does have a withdrawal when you take the drug away. And so it does cause a use disorder. We just don't know how frequently and how severe that use disorder is. And we're still learning about how to best treat that.

Host Amber Smith: You mentioned how it stays in the body longer if you consume it as an edible and that it could stay with you and feeling the effects of it for hours. So if someone's a recreational user on the weekend, how can they be sure that they'll be fresh to go to work Monday morning or school Monday morning?

Willie Eggleston, PharmD: It does stay for hours, but generally, the next day, it's out of your system from the psychoactive component. What I mean by that is that the compound that's in marijuana that causes the altered mental status, the delayed reaction time, the euphoria, that, even with edibles, that is generally at a low enough concentration the next day that it's not going to have any impact on you. When I talk about duration, meaning like instead of two or three hours with smoking, we're talking more like eight to 12 hours of duration with edibles.

Host Amber Smith: Are there any medications or supplements that are dangerous to use while using marijuana?

Willie Eggleston, PharmD: Sure. In general, we recommend not mixing marijuana with anything if possible. The effects of marijuana can be changed dramatically if they're taken with, particularly products that are sedating, so alcohol, benzodiazepines, medications used for sleep. They can really increase the effects of it on your reaction time and your sleepiness. And then when taken with stimulants, it can really increase potentially that risk for reactions that are not pleasant, dysphoric reactions. And so in general, mixing marijuana with other products is not a great idea. And as I said earlier, one of the populations where we're still learning about a risk of combining marijuana with other disease states: certainly older adults with cardiac conditions. We know that to be a potential risk for bad outcomes when mixed with marijuana.

Host Amber Smith: I'm assuming it's unsafe to drive under the influence of marijuana because you have slowed reaction and impaired judgment...

Willie Eggleston, PharmD: You are assuming correctly. Yes, it is absolutely dangerous to drive under the influence of marijuana. And we certainly recommend strongly against it.

Host Amber Smith: What about CBD-only products?

Willie Eggleston, PharmD: That's. A tough question to answer. CBD-only products can cause you to be a little sleepy or drowsy when you use them. And so we do encourage the first time that someone's using a CBD product, they want to avoid things like driving or other activities that require coordination. But once someone is using a product and they know how they react to it, from there, they can kind of make decisions as to what's safe for them to do. In general, there's not a whole lot of research on CBD and its effects on driving or other activities that require reaction time. But marijuana, for sure, we have substantial research to demonstrate that it significantly delays reaction time, and it's not a good combination with someone driving a car.

Host Amber Smith: What about marijuana use during pregnancy, or during breastfeeding?

Willie Eggleston, PharmD: So marijuana use during pregnancy has been fairly extensively researched. It's not like alcohol or other substances that impair the development of the unborn child. But the child, when they are born, sometimes they have a lower birth weight, so their weight is lower than that of a typical baby born to a mother not smoking marijuana. And sometimes that can lead to admissions, to a neonatal intensive care unit, an ICU for babies. And we know that the incidence of babies going to the ICU is higher in mothers who smoke marijuana than those who don't. Aside from that, there's not a whole lot of other data to show that it's risky, versus not risky. There's no real compelling evidence to show that it has long-term effects on development once the baby's born. And as far as babies who are breastfed by mothers who smoke marijuana versus mothers who do not, again, we know that marijuana gets into the breast milk. We know that it gets into the baby's bloodstream, to some degree. But we really don't have any evidence to show that that has a detrimental effect on the baby.

Host Amber Smith: Interesting. Well, I'd like to ask you about storage of edibles. Do marijuana products have a shelf life, or does their potency fade over time?

Willie Eggleston, PharmD: In general, most edibles will have a similar shelf life to the product that they are made in as long as they're prepared correctly. So for example, an edible gummy will have a shelf life that is much longer than an edible cookie or an edible drink or an edible condiment. But when thinking about these products, as far as how to store them, I encourage people that even though a lot of the edibles are in food products, not to think about these as food products, to think about these as medications. When we worry about risk and exposure the concerns that we have are magnified tenfold, a hundred fold when you think about kids getting into these products. An adult getting a little bit sleepy, no big deal. A kid getting the same dose of marijuana gets far more sleepy, can have difficulty with their breathing, may require admission to an intensive care unit. And so we encourage folks who have these in their home to store them up away out of sight, ideally in a locked container to avoid those unintentional exposures in little kids.

Host Amber Smith: I wanted to ask you, if a child or even a pet at home ingests an edible, you know, accidentally, and someone calls the poison center for help, what are you likely to ask the person? What are you looking for?

Willie Eggleston, PharmD: So we'd be looking for signs and symptoms of the ingestion, which initially would include things like sleepiness. And most of the time, kids who get into these products, because they are so unpredictable, because they're not designed to be used in two- and three- and four-year-olds, they generally will require observation in an emergency department for their symptoms because they can get severe.

Host Amber Smith: What is the treatment for an overdose? A person could take way too much, eating too many edibles. I can see where that would happen. If the effects don't happen and they think, oh, I need more. Someone could really ingest quite a bit of this before they get into trouble. What is a treatment for an overdose?

Willie Eggleston, PharmD: We don't have an antidote. There's not something we can give someone to reverse the effects of marijuana in the body. It's mostly just using the medications we have to treat the symptoms that are present until the marijuana has left the body. So for example, if someone is very anxious and nervous and they're having a bad trip, we can give them medications to calm and relax them. But it's mostly just supporting the patient until the marijuana is out of their system, they're back to their normal baseline and they can safely go home.

Host Amber Smith: Well, this has been very informative. I really appreciate you taking time to explain this to us.

Willie Eggleston, PharmD: Oh, sure. Absolutely.

Host Amber Smith: My guest, from the Upstate New York Poison Center, has been Dr. Willie Eggleston. He's a clinical assistant professor of emergency medicine specializing in toxicology at Upstate. The Informed Patient is a podcast covering health, science and medicine brought to you by Upstate Medical University in Syracuse, New York. Find our archive of previous episodes at upstate.edu/informed. I'm your host, Amber Smith, thanking you for listening.