Article

Cooking with cannabis: The rapid spread of (mis)information on YouTube

Correspondence

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American Journal of Emergency Medicine

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Cooking with cannabis: The rapid spread of (mis)information on YouTube

According to the 2015 National Survey on Drug Use and Health, mar- ijuana is the most commonly used illicit drug in the United States [1]. Can- nabis is traditionally consumed by smoke inhalation, however as marijuana legalization becomes more prominent, oral consumption of products containing cannabis (edibles) has become more prevalent. When consumed in edible form the effects of the primary psychoactive ingredient, delta-9-tetrahydrocannabinol (THC), differ notably from smoking cannabis. Psychoactive effects have a substantially delayed onset (30-60 min vs. 7-8 min), are described as being more intense, and may last over 6 h [2]. Because cooking methods and strengths of can- nabis can vary, there is often great variation in potency of edibles from one batch to the next. These factors contribute to a risk of accidental over- dose, especially by inexperienced users. Both accurate and inaccurate in- formation regarding edibles and cooking with cannabis is freely available to any person with internet access. Video-sharing websites are a popular method of broadcasting that can be viewed by individuals on many plat- forms. This study aimed to characterize the content and popularity of dangerous trends involved in edible marijuana consumption by teens and young adults on the video-sharing Web site YouTube.

This is a retrospective content analysis study. Data was collected by

searching for videos on YouTube’s search engine using twelve terms re- lating to marijuana/cannabis edibles. Videos were identified and viewed in October and November 2016. Standardized forms were used for data abstraction. Any videos without sound, with duplicate content, or those that are news reports or public service announcements were excluded. Key quantitative and qualitative descriptive variables included the number of views, participants, and the cooking technique used or de- scribed. Viewers’ comments from the videos on YouTube were exam- ined as an index of viewer response. The scientific claims made by the videos were classified as substantiated or unsubstantiated using opin- ions of two board-certified toxicologists. Descriptive statistics and fre- quency tables were used to describe research findings.

During the 2-month study period, 120 YouTube videos relating to

edible marijuana cooking and consumption were identified. The most common product described was cannabutter, a butter-based solution which has been infused with cannabinoids (39%). This was followed by cooking techniques for brownies/cake (10%), cookies (8%), cupcakes (8%), drinks (8%) and candy (7%). These videos were collectively viewed 15,559,614 times; the mean number of views per video was 129,663. Participants featured in the videos were typically male (55%), Caucasian (88%), and often between the ages of 31 to 40 years (37%). A total of 25 videos (20.8%) had warnings associated with cooking using cannabis (e.g., potency of THC, danger to children, and risk of accidental over- dose). Although few contained inaccurate or dangerous information (e.g., “you cannot overdose on cannabis”); the majority of videos did not describe the amount or potency of the cannabis ingredient used in cooking.

Edibles have become more accessible in recent years as the dynamic marijuana market evolves and matures. With key differences in dose, onset, duration and metabolism, oral cannabis presents a considerable risk of accidental overdoses, especially in inexperienced or novice users [3]. Use of edibles has been associated with unexpected highs when controlling for age, gender, education, Mental health status, cur- rent marijuana or hashish use, and mean amount of marijuana or hash- ish consumed in the previous month [4]. It has also been shown that permitting home cultivation and more lax cannabis laws are related to higher likelihood of younger age of experimentation with edibles [5]. Video-sharing Web sites (e.g., YouTube) and other social media sites (e.g., Twitter) promoting cooking with cannabis and ingesting edibles are increasing in popularity among youth as well as older generations. However, there is little information regarding the basic effects of edi- bles, and about users’ knowledge and habits of ingestion of edibles. The majority of posts do not have warnings or precautions associated with using cannabis edibles, and negative experiences have been docu- mented by users. Websites such as YouTube and Twitter may be useful tools for epidemiological monitoring of emerging or suspected drug use trends [6]. Knowledge about what people are viewing may also help health care practitioners better understand their patients’ own informa- tional databank, stay informed about the latest trends in drug abuse, and position themselves as more credible resources to their patients.

Lindsey Ouellette1

Michigan State University, College of Human Medicine, Department of

Emergency Medicine, United States

Mary Cearley2 Bryan Judge2 Brad Riley2

Spectrum Health – Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States

Jeffrey Jones

Michigan State University, College of Human Medicine, Department of

Emergency Medicine, United States Spectrum Health – Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States Corresponding author at: 15 Michigan St NE Suite 701, Grand Rapids, MI

49503, United States.

E-mail address: [email protected].

17 October 2017

https://doi.org/10.1016/j.ajem.2017.10.060

1 15 Michigan St NE 736, Grand Rapids, MI 49503.

2 15 Michigan St NE, Suite 701, MC 038, Grand Rapids, MI 49503.

0735-6757/(C) 2017

References

Results from the 2015 national survey on drug use and health: detailed tables, SAMHSA, CBHSQ. http://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs- 2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.htm.
  • Lemberger L, Weiss JL, Watanabe AM. Delta-9-tetrahydrocannabinol: temporal corre- lation of the psychologic effects and blood levels after various routes of administra- tion. NEJM 1972;286(13):685-8.
  • Erowid E, Erowid F. The L.E.S.S. method: a measured approach to oral cannabis. Erowid Extracts 2011;21:6-9.
  • Allen JA, Davis KC, Duke JC, et al. New product trial, used of edibles, and unexpected highs among marijuana and hashish users in Colorado. Drug Alcohol Depend 2017; 176:44-7.
  • Borodovsky JT, Lee DC, Crosier BS, et al. US cannabis legalization and use of vaping and edible products among youth. Drug Alcohol Depend 2017;177:299-306.
  • Lamy FR, Daniulaityte R, Sheth A, et al. “Those edibles hit hard”: exploration of Twitter data on cannabis edibles in the US. Drug Alcohol Depend 2016;164:64-70.
  • In dental office, supine abdominal thrust is recommended as an effective relief for asphyxia due to aspiration

    In dental office, sudden cardiac arrest and asphyxia due to aspiration of dental material into the trachea are two major life-threatening emer- gencies. Especially, asphyxia is leading cause of death. During dental surgery patients are usually in the dental chair, which is usually not sta- ble for external chest compression. We previously reported the useful- ness to stabilized the dental chair by using a stool for effective chest compression, and this procedure is recommended in the ERC guideline 2015 [1]. In the case of asphyxia, however, no actual procedure has not been suggested.

    During dental surgery patients are usually in supine or semi-recum- bent position in the dental chair. These positioning may be a greater risk of falling something in the oropharynx [2-4]. Every small dental materi- al, including orthoprosthesis or evulsion tooth, might be fallen into the oropharynx, and might cause accidental ingestion or airway obstruction due to aspiration into the trachea. Dentists, therefore, should be ex- tremely attentive in handling of small instruments and or material, as airway obstruction could be happened during any intervention related to the oral cavity. Airway obstruction is a serious situation and requires emergency response. In the case of asphyxia, a lot of references recom- mended that removal of the material with back blows and/or abdominal thrust (Heimlich maneuver) should initially be attempted [5,6].

    Heimlich maneuver is the most common life-saving technique for dislodging foreign body out from the respiratory tract. However, this technique is usually applied in the standing position, as asphyxia is often caused in restaurants or dining room by foodstuff, which obstructs in the pharynx. During dental surgery, in contrast, airway obstruction mainly occurs in the trachea ascribed to aspiration of dental material, and patients are usually in reclined position. Raising the patient in the sitting position may let the material slip into the deeper space in the tra- chea or the bronchus. On the contrary, it let the material in the pharynx be aspirated into the trachea.

    Abdominal thrust, therefore, should not be performed in the stand- ing position or sitting position to avoid secondary falling of the materials in the dental office. In addition, it should be noted that abdominal thrust is useful in the case of severe airway obstruction. Abdominal thrust is in- valid if airway is open even a little and has leakage. We, therefore, con- firm it before performing abdominal thrust as it may give serious damage to visceral organs as same as chest compression.

    Abdominal thrust is feasible also in supine position. Sanuki exam- ined the peak airway pressure in the manikin when supine abdominal thrust [7]. His group demonstrated that abdominal thrust in supine po- sition showed higher peak pressure and was easier to perform than that in the standing position; peak airway pressure in standing was 11.5 +-

    2.6 cmH2O, while that in supine was 22.6 +- 2.8 cmH2O (pb 0.001).

    If asphyxia cannot be relieved and the patient loses consciousness, cardiopulmonary resuscitation should be started as soon as possible. Dental chairs are not always stable for external chest compression The patient, however, should not be moved from the dental chair for exter- nal chest compression as recommended in the guideline 2015 [1]. The dental chair should be stabilized by putting a stool under the head side of the backboard [8].

    Considering the situation during dental surgery, dentists should try to avoid accidental ingestion and aspiration into the trachea, when they drop some dental material into the oral cavity. First, the face of the patient should be turned aside without letting the mouth closed, as ingestion is prevented when the mouth remained open. Breathing should be slowly through the nose to avoid aspiration into the trachea. Second, dentists should check the breath. In case of asphyxia due to se- vere airway obstruction, patients can neither speak anything nor coughing, and usually shows choking sign putting the both hands on the throat. When the patient can cough even a little, abdominal thrust may be invalid, as it means that the airway is open. Third, when the pa- tient is in a state of asphyxia due to a dental material, supine abdominal thrust should be performed immediately until it is relieved. During ab- dominal thrust the dental chair should be stabilized, as chest compres- sion should be started when abdominal thrust was performed in vain and the patient became unconscious.

    In conclusion, we will offer to perform supine abdominal thrust when asphyxia due to aspiration of a dental material occurs.

    Conflict of interest statement

    There are no conflicts of interest.

    Takashi Hitosugi* Masahiro Tsukamoto

    Jun Hirokawa Takeshi Yokoyama

    Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan

    *Corresponding author.

    E-mail address: [email protected] (T. Hitosugi).

    23 October 2017

    https://doi.org/10.1016/j.ajem.2017.10.061

    References

    1. Truhlar A, Deakin CD, Soar J, Khalifa GEA, Alfonzo A, Bierens JJLM, et al. Cardiac arrest in special circumstances section collaborators. European resuscitation council guide- lines for resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resus- citation 2015;95:148-201.
    2. Rakesh KY, Hemant KY, Anil C, Simith Y, Promila V, Vijay KS. Accidental aspiration/in-

      gestion of foreign bodies in dentistry: a clinical and legal perspective. Nat J Maxillofac Surg 2015;6:144-51.

      Cameron SM, Whitlock WL, Tabor MS. foreign body aspiration in dentistry: a review. J

      Am Dent Assoc 1996;127:1224-9.

      Milton TM, Hearing SD, Ireland AJ. Ingested foreign bodies associated with orthodon- tic treatment: report of three cases and review of ingestion/ aspiration incident man- agement. Br Dent J 2001;190:592-6.

    3. Heimlich HJA. Life-saving maneuver to prevent food-choking. JAMA 1975;27: 398-401.
    4. Du Toit DF. Heimlich manoeuvre: adjunctive emergency procedure to relieve choking

      and asphyxia. SADJ 2004;59:18-21.

      Sanuki T, Sugioka S, Son H, Kishimoto N, Kotani J. Comparison of two methods for ab- dominal thrust: a manikin study. Resuscitation 2009;80:499-500.

    5. Fujino H, Yokoyama T, Yoshida K, Suwa K. Using a stool for stabilization of a dental chair when CPR is required. Resuscitation 2010;81:502.

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