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How marijuana legalization impacts trauma

Types and frequency of traumatic injury secondary to marijuana intoxication described at EMS World Expo World Trauma Symposium


Marijuana toxicity puts patients at risk of traumatic injury.

Photo by Greg Friese

This article, originally published 10/4/2016, has been updated with current information

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.

In 2016 25 states allow for medical use of marijuana and four states — Washington, Oregon, Colorado and Alaska — allowed for recreational marijuana use. Four additional states were to vote on legalization in November, 2016 and many other states were considering marijuana legalization.

By March 2019 recreational marijuana was legalized in 10 states and medical marijuana is legal in 33 states. 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.

1. 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.

2. 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 shown 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.

3. Burn injuries

Burns from butane hash oil happen during the 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.

4. Acute psychosis

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 a violent death. Kim discussed a Denver Health protocol and case series to administer ketamine to patients experiencing excited delirium.

5. 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 about marijuana and traumatic injury:

Greg Friese, MS, NRP, is the Lexipol Editorial Director, leading the efforts of the editorial team on Police1, FireRescue1, Corrections1 and EMS1. Greg served as the EMS1 editor-in-chief for five years. He has a bachelor’s degree from the University of Wisconsin-Madison and a master’s degree from the University of Idaho. He is an educator, author, national registry paramedic since 2005, and a long-distance runner. Greg was a 2010 recipient of the EMS 10 Award for innovation. He is also a three-time Jesse H. Neal award winner, the most prestigious award in specialized journalism, and the 2018 and 2020 Eddie Award winner for best Column/Blog. Connect with Greg on LinkedIn.