More than 40% of North American nonmedical cannabis users consume edibles
Edibles are increasingly popular forms of nonmedical cannabis and include baked goods, candies and beverages.1,2 Legal edibles are available in several US states and became commercially available in Canada in late 2019.3
Edibles have a long latency period and duration of action
Compared to inhaled cannabis, edibles have delayed peak effects of about 3 hours, and these effects may last up to 12 hours after ingestion.4 People accustomed to an instantaneous effect from inhaled cannabis may ingest excessive doses of edibles before peak effects have occurred (i.e., “dose stacking”).4
Unfamiliarity with edible dosing and difficulties in dividing edibles can result in unintentional overdose
In Canada, regulated edibles must be sold in individual packaging containing no more than 10 mg of tetrahydrocannabinol (THC),3 although unregulated edibles can contain larger amounts of THC.4 A typical intoxicating dose of edibles contains 10–30 mg of THC.4 The impracticalities of dividing edibles into smaller portions (e.g., one-tenth of a 100-mg THC cookie) is a common reason for overdose.4
Psychiatric and cardiovascular complications are more likely with edibles
A study of 9973 emergency department visits related to cannabis use reported that visits attributed to edible cannabis were less frequent than those for inhaled cannabis (9% v. 91%). However, the reasons for the visits were different, with edible users being more likely to have visits for acute psychiatric conditions (18% v. 10.9%) such as psychosis and anxiety, cardiovascular symptoms (8% v. 3.1%) and intoxication (48% v. 28%).5
Unintentional exposure to edibles is particularly dangerous for children
Ingestion of edibles accounts for three-quarters of all cannabis-related exposures in children.4 Similarities in taste and packaging between unregulated edibles and noncannabis foods and candies is a common reason for unintentional exposure. Regulated edibles in Canada must be sold in child-resistant packaging with a standardized cannabis symbol and dose, and should be stored in locked locations in households with children.3
Acknowledgement
The authors thank Donald A. Redelmeier for helpful comments on earlier versions of this manuscript.
Footnotes
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CMAJ Podcasts: author interview at https://soundcloud.com/cmajpodcasts/191305-five
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Competing interests: None declared.
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This article has been peer reviewed.
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Disclaimer: Nathan Stall is an associate editor with CMAJ and was not involved in the editorial decision-making for this article.