Throughout Dr. Scott Bentz's career in emergency medicine, marijuana wasn't something he much worried about.
Perhaps a person a month would come in feeling panicky after smoking pot. A sedative and a quiet room usually did the trick.
"It's the easiest emergency medicine case you're going to see," said Bentz, the medical director of emergency services at Presbyterian/St. Luke's Medical Center in Denver.
And then came the day a man arrived in the emergency room so sedated and breathing so slowly after eating a marijuana-infused edible that he was nearly comatose.
For the past few months, Bentz said, he's seen more and more patients at the hospital who have consumed marijuana-infused products. And, while the cases don't come close in number or severity to alcohol-related cases, Bentz said they show the kind of problems that can go along with edible marijuana — especially for those trying pot for the first time and who see edibles as a more appealing access point.
Potency amounts vary. It's far easier to overconsume than it is with smoking. And the products can affect everyone differently, from intense anxiety to excessive sedation.
"The edibles are just a whole different ball of wax," Bentz said. "You just don't know what you're going to get."
The potential risks of edibles are receiving new attention after the death of a Wyoming college student last month. Levy Thamba, 19, became agitated after eating marijuana-infused cookies and then leapt to his death from a hotel balcony, according to a coroner's report released this week. His death was classified as an accident.
Denver police are still investigating, and state law could allow for criminal charges against whoever gave the underage Thamba the cookies, though police spokesman Sonny Jackson wouldn't comment on the possibility of charges in the case.
"I'm not going to speculate one way or another," Jackson said Thursday.
Lawmakers this week are expected to introduce a bill that would further restrict the potency level of edibles. Current state law limits individual edible products to 100 milligrams of THC, the psychoactive chemical in marijuana. That amount, though, is equivalent to 10 servings — meaning most infused products are meant to be nibbled over time, not consumed all at once.
Bentz said most of the patients coming into the emergency room are naive users who consumed too much, too fast.
Edibles can take over an hour to kick in, leading many first-time users to eat more after not immediately feeling the effects. And the potency levels of edibles — which are not yet subject to mandatory testing — can differ even from what's listed on the label.
It remains unclear how much Thamba ate or how long elapsed before his death.
In 2011, 3,871 people in Denver who went to the emergency room mentioned recent marijuana use, according to federal data. Bentz, though, said he has never seen a case of extreme agitation caused by a marijuana edible. Patients most commonly arrive at the hospital over-sedated, he said.
"It's very, very rare that somebody is going to be at risk for serious harm," Bentz said.
Marijuana use, however, can spur psychotic episodes in people who are predisposed to mental health problems, said Dr. Paula Riggs, a professor of psychiatry at the University of Colorado School of Medicine. Most of the research has focused on how frequent marijuana use impacts the onset of psychosis. But Riggs said it is also possible that first-time use can lead to problems.
"We don't know as much about it as we need to know," Riggs said, "but it's unequivocal that it increases risk."