Legalized Cannabis in Colorado Emergency Departments: A Cautionary Review of Negative Health and Safety Effects

West J Emerg Med. 2019 Jul;20(4):557-572. doi: 10.5811/westjem.2019.4.39935. Epub 2019 Jun 3.


Cannabis legalization has led to significant health consequences, particularly to patients in emergency departments and hospitals in Colorado. The most concerning include psychosis, suicide, and other substance abuse. Deleterious effects on the brain include decrements in complex decision-making, which may not be reversible with abstinence. Increases in fatal motor vehicle collisions, adverse effects on cardiovascular and pulmonary systems, inadvertent pediatric exposures, cannabis contaminants exposing users to infectious agents, heavy metals, and pesticides, and hash-oil burn injuries in preparation of drug concentrates have been documented. Cannabis dispensary workers ("budtenders") without medical training are giving medical advice that may be harmful to patients. Cannabis research may offer novel treatment of seizures, spasticity from multiple sclerosis, nausea and vomiting from chemotherapy, chronic pain, improvements in cardiovascular outcomes, and sleep disorders. Progress has been slow due to absent standards for chemical composition of cannabis products and limitations on research imposed by federal classification of cannabis as illegal. Given these factors and the Colorado experience, other states should carefully evaluate whether and how to decriminalize or legalize non-medical cannabis use.

Publication types

  • Review

MeSH terms

  • Accidents, Traffic / trends
  • Behavioral Symptoms / chemically induced
  • Cannabis / chemistry
  • Colorado / epidemiology
  • Driving Under the Influence / trends
  • Drug Contamination
  • Drug Overdose / epidemiology
  • Emergency Service, Hospital / statistics & numerical data*
  • Hospitalization / trends
  • Humans
  • Legislation, Drug
  • Marijuana Use / adverse effects*
  • Marijuana Use / trends*
  • Mental Disorders / chemically induced
  • Mental Health Services / trends
  • Poisoning / epidemiology
  • Vomiting / epidemiology