Edible cannabis exposure and toxicity increase among young children

Edible cannabis exposure in young children has consistently increased in the past 5 years, leading to an increased potential for significant toxicity, according to a recent study.

The legalization of cannabis in more states has made cannabis products more readily available. Medical use of cannabis was allowed in 39 states and Washington DC by the end of May 2022, while 18 states and Washington DC allowed recreational cannabis use. In the past 5 years, there has been a 95% increase in people with access to recreational cannabis.

Following legalization, an increase in unintentional cannabis exposure has been observed, with regional poison centers in states where cannabis has been legalized receiving more calls. In visits to pediatric care centers have increased as well.

The starting dose for an adult taking cannabis is 2.5 to 10 mg. There are often multiple doses in these products, and edible preparations appear similar to treats which appeal to children. Given children would not know when to stop ingesting the product, and their smaller weight, they are at an increased risk of toxicity.

To evaluate the unintentional ingestion of edible cannabis products in children aged up to 5 years, investigators conducted a retrospective study using data from the National Poison Data System, which spanned 55 regional poison control centers.

Data was gathered on edible cannabis cases involving children aged under 6 years from 2017 to 2021. Aggregate data was gathered on sex, age, clinical symptoms, medical outcomes, caller site, management site, and exposure site. 

During the study period, 7043 cases involving edibles in this age group were recorded. After excluding cases because of an unknown outcome, 4827 cases remained.

Medical outcomes included no effect, minor effect, moderate effect, and major effect. Levels of health care included admitted to critical care, admitted to noncritical care, treatedand released, patient lost to follow-up or left against medical advice, and patient refused referral.

From 2017 to 2021, the number of pediatric edible exposure cases rose from 207 to 3054. Pediatric edible cases made up 0.02% of all pediatric exposures in 2017, rising to 0.36% in 2021. The largest number of cases were from patients aged 2 years, followed by those aged 3 years. The median age for patients throughout the entire study period was 3 years.

The site of exposure was a residential study in 97.1% of cases, with 90.7% occurring in the child’s own residence. Of the cases, 13.8% were managed onsite and were not referred to a health care facility. Almost half of calls originated from a residential setting.

Major effects were recorded in 2.2% of cases, and moderate effects in 21.9%. The severity of toxicity saw a major increase in 2020 and 2021 compared to 2017 to 2019, with major effect cases increasing from 1.6% to 2.4% and moderate effect cases from 15.9% to 23.8% between these time periods.

Critical care admission occurred in 8.1% of patients, while 14.6% were admitted to noncritical care units. Patients treated and released from the emergency department made up 36.2% of patients, while those lost to follow-up made up 25.6%, and other situations made up 15.4%. 

Central nervous system depression was the most common clinical effect. Other common clinical effects included tachycardia, vomiting, mydriasis and respiratory depression.

These results showed increases in edible cannabis exposures and toxicity severity among children aged 5 years and less. Investigators urged providers to be aware of these increases in their practice.

Reference

Tweet MS, Nemanich A, Wahl M. Pediatric edible cannabis exposures and acute toxicity: 2017–2021. Pediatrics. 2023;151(2). doi:10.1542/peds.2022-057761