Emergency Care For You

Legalization of Marijuana in Michigan – What you need to know

Keenan Bora, MD FACEP, is an emergency physician and expert in toxicology practicing in Ann Arbor and Detroit, Michigan.

The passage of recreational marijuana in Michigan likely will result in more people needing emergency care. Colorado legalized the drug in 2014, where it has been tied to increases in traffic accidents, accidental ingestions by children and in some cases, mental health issues, including psychosis and delusions.

Consumers are growing their own plants and growing conditions have a huge impact on plant THC (tetrahydrocannabinol). Increased availability of edible products containing THC makes accidental exposures more likely among children and the elderly.  

For example, two weeks ago, I took care of a patient in his 70s who was at a family reunion and unknowingly ingested an edible with a very high THC content that was brought by his son for his son to eat.

Effects of Consumption

The patient, not being used to that dose, had an extremely prolonged drug effect and did not return to anything near normal mental status during my time with him. No history was available other than altered mental status. There was significant testing that happened before the patient’s son arrived with the complete story.

At higher levels, THC tends to produce more agitation and can lead to hallucinations and seizures. This is seen across the country and in Michigan when chemicals are mixed with plant material and sold as “legal pot,” or “synthetic marijuana.”

These compounds are branded as K2, Spice, and others. They may contain ingredients that can be much stronger than THC, sometimes hundreds of times over, making these drugs much more dangerous. Reported effects include kidney failure and heart attacks.  Abuse of these substances also can lead to severe and lasting heart conditions. 

The different methods of consumption will also lead to different times to onset and potentially duration. Smoking marijuana is faster acting because it leads to very rapid blood intake through the lungs. Consuming pills, oils, edibles or applying dermal patches will lead to a slower absorption.

There has been some research about the effects of marijuana on driving that shows impairment down to very low levels, but there is no accepted legal driving THC level in most states with Colorado, Washington, and Nevada having statutorily defined blood levels for impaired driving.

Enforcement

Marijuana is still considered a Schedule 1 drug by the Drug Enforcement Agency. This means that the federal government does not recognize any medicinal value and that it is still illegal to possess in any amount.

Recently, an exception has been made for cannabidiol (CBD) treatment for a specific type of seizure disorder.

Consumers of legal marijuana can know what they are using because of the testing and labeling requirements but there are still black markets for the products in California and Colorado.

Detection

Many companies are working on developing devices to detect marijuana in breath or mouth fluids. However, they are likely to suffer from accuracy problems, similar to portable breath alcohol testing devices.

Employers will also face challenges in crafting policies. As THC is still a Schedule I drug, employers may decide to adopt a zero-tolerance policy. If they choose to adopt an abstinence time prior to a shift at work, then they will have to face many challenges related to impairment.

Under Michigan law, presence of any level of a cannabinoid compound found in the person is per se evidence of impairment. In other words, if you are pulled over for erratic driving in Michigan and are found to have marijuana in your system, you may end up with legal troubles that could make getting your license renewed more difficult.

Unlike alcohol, levels of THC in the blood are not as easy to correlate with impairment. And, its important to remember that intoxication can take a variety of guises.

A urine test is not proof of impairment. Accidental ingestions by children will become more common and levels of THC may be present in patients being brought in for routine procedures, such as blood draws.

The bottom line remains the same: If you or someone you know is having a medical emergency, always seek emergency care.