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Edible cannabis

Jonathan S. Zipursky, Orly D. Bogler and Nathan M. Stall
CMAJ February 18, 2020 192 (7) E162; DOI: https://doi.org/10.1503/cmaj.191305
Jonathan S. Zipursky
Department of Medicine, and Institute of Health Policy, Management and Evaluation (Zipursky, Stall), University of Toronto; Faculty of Medicine, University of Toronto (Bogler); Sunny-brook Health Sciences Centre (Zipursky); Sinai Health System (Zipursky, Stall); Women’s College Hospital (Stall), Toronto, Ont.
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Orly D. Bogler
Department of Medicine, and Institute of Health Policy, Management and Evaluation (Zipursky, Stall), University of Toronto; Faculty of Medicine, University of Toronto (Bogler); Sunny-brook Health Sciences Centre (Zipursky); Sinai Health System (Zipursky, Stall); Women’s College Hospital (Stall), Toronto, Ont.
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Nathan M. Stall
Department of Medicine, and Institute of Health Policy, Management and Evaluation (Zipursky, Stall), University of Toronto; Faculty of Medicine, University of Toronto (Bogler); Sunny-brook Health Sciences Centre (Zipursky); Sinai Health System (Zipursky, Stall); Women’s College Hospital (Stall), Toronto, Ont.
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More than 40% of North American nonmedical cannabis users consume edibles

Edibles are increasingly popular forms of nonmedical cannabis and include baked goods, candies and beverages.1,2 Legal edibles are available in several US states and became commercially available in Canada in late 2019.3

Edibles have a long latency period and duration of action

Compared to inhaled cannabis, edibles have delayed peak effects of about 3 hours, and these effects may last up to 12 hours after ingestion.4 People accustomed to an instantaneous effect from inhaled cannabis may ingest excessive doses of edibles before peak effects have occurred (i.e., “dose stacking”).4

Unfamiliarity with edible dosing and difficulties in dividing edibles can result in unintentional overdose

In Canada, regulated edibles must be sold in individual packaging containing no more than 10 mg of tetrahydrocannabinol (THC),3 although unregulated edibles can contain larger amounts of THC.4 A typical intoxicating dose of edibles contains 10–30 mg of THC.4 The impracticalities of dividing edibles into smaller portions (e.g., one-tenth of a 100-mg THC cookie) is a common reason for overdose.4

Psychiatric and cardiovascular complications are more likely with edibles

A study of 9973 emergency department visits related to cannabis use reported that visits attributed to edible cannabis were less frequent than those for inhaled cannabis (9% v. 91%). However, the reasons for the visits were different, with edible users being more likely to have visits for acute psychiatric conditions (18% v. 10.9%) such as psychosis and anxiety, cardiovascular symptoms (8% v. 3.1%) and intoxication (48% v. 28%).5

Unintentional exposure to edibles is particularly dangerous for children

Ingestion of edibles accounts for three-quarters of all cannabis-related exposures in children.4 Similarities in taste and packaging between unregulated edibles and noncannabis foods and candies is a common reason for unintentional exposure. Regulated edibles in Canada must be sold in child-resistant packaging with a standardized cannabis symbol and dose, and should be stored in locked locations in households with children.3

CMAJ invites submissions to “Five things to know about …” Submit manuscripts online at http://mc.manuscriptcentral.com/cmaj

Acknowledgement

The authors thank Donald A. Redelmeier for helpful comments on earlier versions of this manuscript.

Footnotes

  • CMAJ Podcasts: author interview at https://soundcloud.com/cmajpodcasts/191305-five

  • Competing interests: None declared.

  • This article has been peer reviewed.

  • Disclaimer: Nathan Stall is an associate editor with CMAJ and was not involved in the editorial decision-making for this article.

References

  1. ↵
    1. Steigerwald S,
    2. Wong PO,
    3. Cohen BE,
    4. et al
    . Smoking, vaping, and use of edibles and other forms of marijuana among US adults. Ann Intern Med 2018;169:890–2.
    OpenUrl
  2. ↵
    Canadian Cannabis Survey 2018 summary. Ottawa: Government of Canada; updated 2018 Nov. 19. Available: www.canada.ca/en/services/health/publications/drugs-health-products/canadian-cannabis-survey-2018-summary.html (accessed 2019 Sept. 13).
  3. ↵
    Final regulations: edible cannabis, cannabis extracts, cannabis topicals. Ottawa: Government of Canada; modified 2019 Oct. 29. Available: www.canada.ca/en/health-canada/services/drugs-medication/cannabis/resources/regulations-edible-cannabis-extracts-topicals.html (accessed 2019 Sept. 13).
  4. ↵
    1. Monte AA,
    2. Zane RD,
    3. Heard KJ
    . The implications of marijuana legalization in Colorado. JAMA 2015;313:241–2.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Monte AA,
    2. Shelton SK,
    3. Mills E,
    4. et al
    . Acute illness associated with cannabis use, by route of exposure: an observational study. Ann Intern Med 2019;170:531–7.
    OpenUrlCrossRefPubMed
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Canadian Medical Association Journal: 192 (7)
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Vol. 192, Issue 7
18 Feb 2020
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Edible cannabis
Jonathan S. Zipursky, Orly D. Bogler, Nathan M. Stall
CMAJ Feb 2020, 192 (7) E162; DOI: 10.1503/cmaj.191305

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Jonathan S. Zipursky, Orly D. Bogler, Nathan M. Stall
CMAJ Feb 2020, 192 (7) E162; DOI: 10.1503/cmaj.191305
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    • More than 40% of North American nonmedical cannabis users consume edibles
    • Edibles have a long latency period and duration of action
    • Unfamiliarity with edible dosing and difficulties in dividing edibles can result in unintentional overdose
    • Psychiatric and cardiovascular complications are more likely with edibles
    • Unintentional exposure to edibles is particularly dangerous for children
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