How & why to discuss cannabis edibles with your patients

Cannabis edibles are gaining ground for both recreational and medical uses. How should you talk to your patients about overconsumption? Learn more here.

How to talk to your patients about overconsuming cannabis edibles

Edibles pose potential health risks that your patients may not know

As of August 2023, 23 states have fully legalized cannabis edibles including recreational as well as medical use.

Often, people don’t think about edibles as being harmful. But they can cause intoxication and other unwanted effects. In fact, the CDC cautions that cannabis edibles pose a greater risk of poisoning than smoked marijuana.

What are the potential harms? Who is most susceptible? And how can you talk with your patients about their risks? Here’s what you should know.

What are edibles?

Edibles are foods or beverages that contain marijuana or marijuana oils. They come in different forms, such as gummies, brownies, chocolates and sodas. Depending on the product, an edible may include one or both of the following:

Tetrahydrocannabinol (THC) — This psychoactive substance in marijuana causes a high. Along with desired pleasurable effects, THC can also have adverse consequences. For example, it may impair thinking and disrupt balance, reaction time and coordination.
Cannabidiol (CBD) — This compound found in the cannabis plant is FDA-approved for treating certain seizures. However, people may also use CBD to relieve pain, anxiety and depression.

How are edibles different from smoked marijuana?

Cannabis edibles may be safer for the lungs than inhaled marijuana. Still, they present different concerns based on how they work in the body. Several key differentiators include:

Edibles take longer to take effect. It may take up to four hours to feel the peak effects of cannabis edibles, compared to only 30 minutes with inhaling cannabis. So, some people may overconsume edibles and not realize the impact until they’ve had too much.
Edibles have longer-lasting effects. The effects of eating or drinking edibles can last up to 12 hours after use, compared to only six hours for smoking or vaping cannabis.
Edibles have potentially more intense effects. The THC in inhaled marijuana goes from the lungs straight to the bloodstream. But the THC in edibles must first go through the liver, which converts it into a more potent form, causing a more intense high.

What are the possible complications of overconsuming edibles?

Complications may vary between edibles and inhaled marijuana. A Colorado study found people who smoke marijuana visit the ED primarily for symptoms like nausea and vomiting. On the other hand, people who consume edibles are more likely to seek care for:

acute psychiatric symptoms (e.g., acute anxiety, panic attacks, hallucinations)
cardiovascular symptoms (e.g., very high heart rates)

Eating and drinking too many edibles make these symptoms worse and more frequent. As it turns out, the study also found ER visits tied to marijuana edibles were 33 times higher than expected.

Groups at risk for edibles overconsumption

Edibles pose risks for all different people and groups. However, some populations are at higher risk. According to a January 2020 Canadian Medical Association Journal (CMAJ) article, those most at risk include:

Children – Children may mistake cannabis edibles for candy or other foods. From 2013 to 2017, Colorado’s poison control center fielded a 70% increase in calls for accidental cannabis exposure in children.
Older adults – Older adults may consume edibles to manage symptoms of chronic health conditions. However, the CMAJ links this group to greater cognitive impairment and a heightened risk of falls, arrhythmia and drug interactions. These preexisting conditions can compound the effects of edibles.

How can you support your patients?

Help your patients by talking with them about their cannabis use – and the possible risks. If they use cannabis, for instance, you might ask if they consume edibles, how they use them and why.

In 2020, physicians Jonathan Zipursky and Nathan Stall discussed how best to talk to patients in a podcast and CMAJ article on edible cannabis. They both stressed the value of communication and the importance of guiding patients to:

Keep edibles out of the reach of children
Use only products regulated by the government (with regulated dosing and labeling)
Follow safe drug prescribing principles (e.g., start low and go slow)
Acknowledge the delayed effect of edibles
Recognize the psychiatric and cardiovascular complications
Consider their underlying health conditions

Open discussion about the overconsumption of edibles can protect your patients from harm. Dr. Zipursky says it may also impact your care decisions and the therapies you prescribe.