How marijuana legalization impacts trauma

NEW ORLEANS — As marijuana use has increased, the visits to Colorado emergency departments has increased. The types and incidences of injuries secondary to marijuana intoxication were described by Howard Kim, MD at the EMS World Expo.

Kim briefly described the pathophysiology of marijuana toxicity and presented data from Colorado after the legalization of marijuana for recreational use. The presentation specifically explored the impact of legalized marijuana on trauma from motor vehicle collisions, butane hash oil burns and acute psychosis violence.

Currently, 25 states allow for medical use of marijuana and four states — Washington, Oregon, Colorado and Alaska — allow for recreational marijuana use. Four additional states will vote on legalization in November and many other states are considering marijuana legalization. Because of the increasing legalization and usage, EMS providers everywhere are likely to encounter patients with trauma secondary to marijuana intoxication.

Memorable quotes on trauma from marijuana legalization
Here are memorable quotes from Kim's presentation on the impact of legalized marijuana in Colorado.

"A drug doesn't need to be legal for patients to use. As legalization has increased so has usage across the United States. More adults are using marijuana and using it more days in a year and more adults are likely to use it."

"THC content of marijuana has tripled in last decade."

"Ingested marijuana is delayed two to three hours which has led to lots of problems."

Key takeaways on trauma secondary to marijuana toxicity
Here are the key takeaways from Kim's presentation on trauma secondary to marijuana toxicity.

Supportive care for intoxication
Treat marijuana intoxication based on the patient's symptoms. Most care for intoxication is supportive. For example, agitation and psychosis is treated with sedation.

Toxicity related trauma
Marijuana toxicity puts patients at risk of traumatic injury. The most common trauma is motor vehicle collisions from alterations in perception and motor dysfunction. Researchers have showed the risk of a fatal motor-vehicle collision doubles with marijuana use. The decision to apply spinal motion restrictions is complicated when the patient's mental status is compromised from marijuana toxicity.

Burns from butane hash oil happen during production of the oil. Colorado experienced a sharp increase in butane hash oil injuries after marijuana legalization. Victims were predominately male and had significant burn injuries. Burn care for butane hash oil burns is similar to other types of burn injuries.

Case reports, the lowest quality evidence, give limited insight into marijuana toxicity caused psychosis. Acute psychosis is not an uncommon patient presentation, but it doesn't prove marijuana leads to violent death. Kim discussed a Denver Health protocol and case series to administer ketamine to patients experiencing excited delirium.

Pediatric accidental ingestion
Colorado has experienced an increased incidence of pediatric marijuana exposures through accidental ingestion of a marijuana edible. The pediatric presentation is more likely to be CNS depression, rather than ingestion. During the assessment of a somnolent child, make sure to consider marijuana ingestion and ask parents and caregivers if there are drugs in the house.

Learn more:

• Child ER visits for marijuana on the rise following legalization
• Pot tourism overwhelms Colo. emergency rooms
• Remember 2 Things: Patient complications from high-dose and high-potency marijuana
• Remember 2 Things: Legal marijuana use still has consequences
• Prehospital use of ketamine
• When overdoses go wild: Protecting the EMS provider

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