Sunday, January 3, 2016

Half-Baked — The Retail Promotion of Marijuana Edibles — New England Journal of Medicine

Voters have moved to legalize marijuana because it is popular and it seems to be no more problematic than alcohol.  But marijuana is a drug which should not be legalized without a regulatory structure, argue two Stanford researchers. - gwc 
Half-Baked — The Retail Promotion of Marijuana Edibles — NEJM
by Robert J. MacCoun, M.D. and Michelle Mello, J.D., Ph.D.

A striking feature of the rollout of the state-legalized retail sales of marijuana has been the tremendous popularity of edible marijuana products. Marijuana brownies have long been a staple of cannabis coffee shops in the Netherlands, but the new products are quite different. They are skillfully produced and packaged to closely mimic popular candies and other sweets (see photoEarly Examples of Prepackaged Marijuana Edibles.). These products can now be purchased legally in four states; retail stores are operating in Colorado and Washington State, and voters recently approved retail sales in Alaska and Oregon.
The new edibles raise public health concerns, including a risk of consumption by children. Although the states that have legalized recreational use of marijuana have only partially addressed these risks, many others — including Arizona, California, Maine, Massachusetts, Missouri, Nevada, and Vermont — are likely to move legalization proposals forward, developments that may amplify the problem.
Marijuana is associated with a long history of public misinformation and anxiety, and many observers will therefore view concerns about edibles with skepticism. Still, edibles that resemble sugary snacks pose several clear risks. One is overintoxication. Whereas consumers commonly assume that a candy bar constitutes a single serving, some of these products contain four or more times the level of tetrahydrocannabinol (THC) that is considered to be a safe dose. (Colorado, for instance, set a standard size for an edible serving at no more than 10 mg of THC.) At high doses, THC can produce serious anxiety attacks and psychotic-like symptoms. This problem is augmented by differences in the pharmacokinetic and metabolic effects of marijuana when it is ingested rather than smoked.1 In addition, case reports document respiratory insufficiency in young children who have ingested marijuana.2......

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