It was like watching the news footage of shoppers trampling each other to get through the doors of a Filene’s Basement sale or witnessing people standing outside all night for the new iPhone even though it isn’t a sale and it will be made in mass production for months or years to come.  I am talking about seeing people line up in the dark of pre-dawn to get their fingers on some of that new-fangled recreational marijuana.  Similar to the iPhone craze, recreational marijuana is not a sales bargain and it is not going away anytime real soon, so these people waiting in long lines really are being a bit over zealous.

But it not the spectacle of the event that I actually want to talk about, it is the potential fallout of such marijuana fervor, specifically where it come to potential medical complications.  I had written about the potential for unrelenting vomiting due to heavy cannabis usage before, but there are other potential problems too.

Let me just start out by saying that I personally am not against mild to moderate recreational marijuana use. I am concerned that there might be some unintended consequences of legalization without providing an appropriate public education campaign surrounding the “safe” use of marijuana.

I have some qualms with three areas of potential problems with widespread availability of marijuana and it’s products.  My concerns focus around the following:

1. Lack of understanding by the general population regarding the dosing and timing of effect of various tetrahydrocannabinol (THC) products.
2. The potential danger to children due to the colorful and tasty looking edibles that may be found in a drawer, purse, etc.
3. The unknown effect that an increase in number of driver’s under the influence of THC will have on the accident and death rate in motor vehicle accidents, plus the questionable methods of determining THC  intoxication.

Let’s address each concern in order.

Lack of understanding regarding the dosing and timing of effect of various THC products

Marijuana strains have been aggressively cultivated over the past few decades to the point where the THC content of current strains is much greater than in the past.  The THC content of marijuana has increased from an average of 3% 30 years ago to around 13% from some of today’s strains.  The Marijuana Potency Monitoring Project at the University of Mississippi has found concentrations in the mid to high 20% range with one sample getting all the way up to 37%.

For those who may be just breaking into the use of marijuana because it is now legal in Colorado or those who may return to marijuana use after not partaking for awhile due to legality issues and ease of access, they may be in for a surprise of the effect.

At least with smoking marijuana, the user will generally know fairly shortly that they are stoned and can decide at that time to partake no more.  However, they may have already received more THC than they may have intended and might suffer some of the potential negative effects too as a consequence.

Edible products are a whole different animal.  The wide variety of products containing a wide variety of THC concentrations with a wide variety of absorption and effect profiles makes judging the correct usage of these products more difficult.  The size of the product also has no correlation in general to the drug concentration.  For example, a small chocolate bar the size of a miniature (1″ x 2″) may contain more than 60mg of THC but a gummy which does not appear much smaller than 1/3rd the size of the chocolate bar contains only 10mg of THC.  A mini chocolate bar is a common snack size for normal chocolate.  One would normally eat the whole thing.  Doing so with the marijuana edibles would result in a significant ingestion of THC.  Unless you read the very tiny print on the wrapper that states that 1 dose is 1/6th of a bar, then you are likely in for a bit so a surprise when that bar takes full effect.

Onset of effect is another hurdle that newbies especially could run into problems with.  The variety of edibles not only vary significantly in concentration of THC but also absorption rate.  Some may not be absorbed for up to an hour leading to a delayed onset effect.  This delay may give the user the impression that what they ingested is not working and therefore take added amounts only to have taken too much when the effect does start to happen.

The potential danger to children

Having seen many of the edibles, I am concerned about a potential for a significant number a underage individuals consuming THC containing products due to the nature of them being produced as palatable and appealing looking products.  Candy, cookies, brownies … they all look so yummy.  Who wouldn’t want to try one?

I know there is an initial packaging and labeling requirement with the new laws but children and even adults either can’t or simply don’t bother to read the packaging.  Once the package leaves the shop, all rules are out and there could easily be free floating products in multiple easily accessible areas.  A nice sweet looking bunch of gummy bear looking candies would appeal to most children and many adults who may not know what the product actually is.  Possibly bad for an adult, possibly really bad if a child gets into some of them.

Drivers under the influence of THC

There is this general belief among marijuana users that smoking and driving is not nearly as bad as drinking and driving.  Unfortunately this belief may end up leading to an increase in accident and fatality rates on our roads.

Marijuana use is associated with slower reaction times, easy distractibility, paranoia, short-term memory loss, and distortion of perception of space and time.  Up until now, it has been known among law enforcement that driving under the influence includes marijuana intoxication.  The new law in Colorado states that a driver suspected of driving under the influence must submit to a blood test for THC set at a relatively low level of 50ng/dL.  Failure to do so results in license suspension.

While the law attempts to incorporate stricter measurements for identification of impaired drivers, it is the simple math of there likely being more impaired drivers on the road with the legalization of recreational marijuana that will potentially lead to a significant uptick in motor vehicle accidents.  The “catching” of impaired drivers is only an after the fact safety mechanism that is only implemented after someone has already taken to the streets.  This method is also quite limited in effectiveness with a rather dismal “capture” rate of all of the potential dangerous drivers roaming the roadways.

Hopefully none of the above has a major negative impact on society, but only time will tell.  The social experiment has begun.

Jonathon Savage is an emergency physician who blogs at Medical Mojo.