If Marijuana Effects Aren’t Deadly, Why So Many ER Visits?

Close Up Marijuana Bong
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Since states started legalizing marijuana, they have seen an increase in E.R. visits for marijuana effects. This affects the broader public perception of harm to be sure, but is it the full picture? Are there larger human behaviors at play? And what about political posturing? Today we will explore the relationship between legalizing recreational marijuana and the experiences or behaviors leading to the reported increase of cannabis-related emergency room visits.

The fight leading to marijuana legalization has not only expanded research and education platforms on cannabis, but has helped further the need to understand (rather than reactionarily prohibit) the effect of cannabis on the human mind and body.

While research on the plant yields an understanding of how marijuana has effects on the brain and nervous system, triggering a behavior or emotion is ultimately up to the individual, their perception, and the situation. Marijuana may not cause behaviors or emotions, but it may influence situations leading to them. And at a point, this becomes statistically significant.

The Bias of Legal Marijuana


Ambulance ER Visits Marijuana Overdose
Photo by: Bennian/Shutterstock
Critics of reforming marijuana laws may position the idea that marijuana use increases as legality changes. The thing is, in the context of consumer behavior, such a statement only makes sense to a point.


The epidemic of marijuana-related emergency room visits in legal markets presents a particularly sound example of one of the key lessons of behavioral economics.

Allow me to explain:

You and 49 other people all sign up for a book club. Everyone is given the same book with membership; however, of those 50 members, a total of 10 are randomly sent a T-shirt with the club name on it. If you ask those 10 members how much they would pay for the shirt, the endowment effect would suggest they would place a higher value on the shirt than would someone who had to buy it to receive it.

In other words, the value of an object increases to a consumer when they already own it. The value of the T-shirt is distorted under the positive association of being given (i.e. endowed with) the object.

If we apply this behavioral principal to why legalizing marijuana affects E.R. visits within several adult-use states, the situation suggests a surprising consumer bias.

Overvaluing Legality, Overestimating Effects

There are three main reasons why users end up in the hospital emergency room after consuming cannabis, none of which deal with toxicity or overdose.

Anxiety Caused by Marijuana Intoxication

One of the most pervasive causes of weed-related visits to the emergency room in Colorado and Washington, it turns out, is consumption-related anxiety. Users report feeling like they can’t breathe or they’re paranoid that they’re experiencing further medical complications. Overconsumption of marijuana edibles or concentrates is often pointed to as the cause.

Acute Marijuana Intoxication

Acute marijuana intoxication occurs when simply put, someone falls into a deep, deep sleep after consuming marijuana. To the point it is difficult to get them to respond, this can unsettle family members and friends. The growing diversity of marijuana products and the growing availability of them has made it difficult to ensure each consumer is educated on this startling but completely harmless phenomenon.

Pediatric Marijuana Intoxication

Of course, children remain a flashpoint. As stated by the Deputy Director of the National Organization for the Reform of Marijuana Laws (NORML), Paul Armentano, in a phone interview published by the Cannabist, “The numbers bear out that [cannabis-related pediatric E.R. visits are] not a significant problem.” He noted that “far more children are hospitalized for the inadvertent ingestion of those laundry detergent pods than for cannabis ingestion.”

How We View Marijuana Matters

On the surface, this could suggest an undereducated marijuana consumer, yet it could also point to how quickly the marijuana industry is evolving. The incentives are aligned with increasing revenues, driving both innovation and efficiency for the business owner. Public excitement may be exaggerated and accelerated by marijuana legalization in some way as well.

Under these conditions, the endowment effect would suggest that those who are able to buy weed legally are likely overvaluing the opportunity to do so, allowing the experience to seem more valuable than it objectively is.

Largely, the consensus remains that legalization is more positive than negative. The scarcity of legal states, currently represented by less than 1/5th of the US, provides a decision architecture. It has a built-in mechanism of inclusiveness, endowing both resident and visiting marijuana users with a context where they feel privileged.

Many of us feel connected to the changing marijuana laws. Our votes were voices helping to change the legal status of cannabis in our communities fundamentally.

Cause & Effect: How Legal Marijuana Correlates with E.R. Visits

The endowment effect may position cannabis use within the realm of personal satisfaction, unrelated to the actual eating of edibles, taking of dabs, or other weed consumption methods. We just may value the experience more because we are able to have it. This has the potential to allow our brains to choose marijuana more openly, given the option. Still, physical withdrawal from marijuana affects no one.

It has been reported by the Cannabist, among others, how marijuana affects users and leads to increased E.R. visits. While the easy assumption is that increased access means increased exposure, there is more going on.

First, people are more likely to seek help if they perceive no legal risk. Risk-averse behavior (cautiousness) may limit exposure to risk, but under particular circumstances (like when one knowingly ingested an illegal drug), avoiding risk may actually lead to worse outcomes. Yes, risk-averse people still take drugs.

Second, the products at dispensaries are much stronger. The legal marijuana industry has stepped up their game. Smoked a joint or two in your day? Maybe ease into those weed edibles.

For many, the point of reference for marijuana effects come from smoking. Usually within 10 minutes of smoking weed, you are experiencing the cannabinoids. However, edibles are a different story, sometimes taking hours to kick in. Used to puffing on a blunt with friends? Slow your roll with cannabis concentrates, which are often 3x more potent than cannabis flower.

Third, the format is confusing. Legal weed may be measured in grams and ounces, yet the potency of the products is in percentages. Buying fresh flower and concentrates by weight (grams) while using milligrams (10 mg) to define edible strength further adds noise to the true effect those marijuana products will have.

The Problem?

Consumer excitement is valued over consumer education, with all the incentives piled towards scaling the industry larger.

As you may be able to tell, the way legalizing marijuana affects E.R. visits has multiple forces behind it. As the industry continues to rapidly progress, monitoring and evaluating the effects will become both interesting and cumbersome. The role of the budtender will likely continue to grow into an important position that involves shaping consumer perception and understanding.