This Viewpoint describes the legalization of marijuana in Colorado and the unexpected and adverse health effects reflected in hospital data collected so far.

Little is known about acute illness due to use of cannabis products. This study compares symptoms, diagnoses, and outcomes in adults who had emergency department visits related to edible or inhaled... Background: Little is known about the relative harms of edible and inhalable cannabis products. Objective: To describe and compare adult emergency department (ED) visits related to edible and inhal...

Background: Cannabis legalization in Colorado resulted in increased cannabis‐associated health care utilization. Our objective was to examine cooccurrence of cannabis and mental health diagnostic coding in Colorado emergency department (ED) discharges and replicate the study in a subpopulation of ED visits where cannabis involvement and psychiatric diagnosis were confirmed through medical review.Methods: We collected statewide ED International Classification of Diseases, 9th Revision, Clinical Modification diagnoses from the Colorado Hospital Association and a subpopulation of ED visits from a large, academic hospital from 2012 to 2014. Diagnosis codes identified visits associated with mental health and cannabis. Codes for mental health conditions and cannabis were confirmed by manual records review in the academic hospital subpopulation. Prevalence ratios (PRs) of mental health ED discharges were calculated to compare cannabis‐associated visits to those without cannabis. Rates of mental health and cannabis‐associated ED discharges were examined over time.Results: Statewide data demonstrated a fivefold higher prevalence of mental health diagnoses in cannabis‐associated ED visits (PR = 5.35, 95% confidence interval [CI], 5.27–5.43) compared to visits without cannabis. The hospital subpopulation supported this finding with a fourfold higher prevalence of psychiatric complaints in cannabis attributable ED visits (PR = 4.87, 95% CI = 4.36–5.44) compared to visits not attributable to cannabis. Statewide rates of ED visits associated with both cannabis and mental health significantly increased from 2012 to 2014 from 224.5 to 268.4 per 100,000 (p < 0.0001).Conclusions: In Colorado, the prevalence of mental health conditions in ED visits with cannabis‐associated diagnostic codes is higher than in those without cannabis. There is a need for further research determining if these findings are truly attributed to cannabis or merely coincident with concurrent increased use and availability.

Young men in Colorado presented with altered mental status and seizures after ingestion of a synthetic cannabinoid known as “black mamba.” Medical toxicologists and public health and law enforcement officials identified 263 cases of exposure to this novel substance.

The liberalization of marijuana policy in Colorado was a stepwise process; voters approved the legalization of medical marijuana in 2000, medical licensure and use increased in 2009, voters approved the legalization of retail marijuana in 2012, and retail sales began in 2014. Given the reports of marijuana tourism (i.e., visits to the state with the purpose of marijuana product consumption),¹ we sought to determine whether the rates of emergency department (ED) visits possibly related to cannabis use have increased disproportionately among out-of-state residents, as compared with Colorado residents.

Background: Although biological males and females are equally likely to become infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), evidence has mounted that males experience higher severity and fatality compared to females. Main: The objective of this review is to examine the existing literature on biological mechanisms underlying sex-based differences that could contribute to SARS-CoV-2 infection clinical outcomes. Sex-based differences in immunologic response and hormonal expression help explain the differences in coronavirus disease 2019 (COVID-19) outcomes observed in biological males and females. X inactivation facilitates a robust immune response to COVID-19 in females, who demonstrate a more profound antibody response and faster recovery when compared to males. Low testosterone levels also help explain the dysregulated inflammatory response and poor outcomes observed in some males with COVID-19. Gender differences in health expression and behaviors further compound these observed differences. Conclusion: Understanding the biology of sex-based differences in COVID-19 severity and mortality could help inform preventative measures, treatment decisions, and development of personalized, sex-specific therapies.