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Matthay EC, Mousli LM, Sun C, Lewis J, Jacobs LM, Heard S, Ho R, Schmidt LA, Apollonio DE. Associations of Local Cannabis Control Policies With Harmful Cannabis Exposures Reported to the California Poison Control System. Epidemiology 2024; 35:447-457. [PMID: 38912711 PMCID: PMC11191557 DOI: 10.1097/ede.0000000000001737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/18/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Cannabis exposures reported to the California Poison Control System increased following the initiation of recreational cannabis sales on 1 January 2018 (i.e., "commercialization"). We evaluated whether local cannabis control policies adopted by 2021 were associated with shifts in harmful cannabis exposures. METHODS Using cannabis control policies collected for all 539 California cities and counties in 2020-2021, we applied a differences-in-differences design with negative binomial regression to test the association of policies with harmful cannabis exposures reported to California Poison Control System (2011-2020), before and after commercialization. We considered three policy categories: bans on storefront recreational retail cannabis businesses, overall restrictiveness, and specific recommended provisions (restricting product types or potency, packaging and labeling restrictions, and server training requirements). RESULTS Localities that ultimately banned storefront recreational retail cannabis businesses had fewer harmful cannabis exposures for children aged <13 years (rate ratio = 0.82; 95% confidence interval = 0.65, 1.02), but not for people aged >13 years (rate ratio = 0.97; 95% confidence interval = 0.85, 1.11). Of 167 localities ultimately permitting recreational cannabis sales, overall restrictiveness was not associated with harmful cannabis exposures among children aged <13 years, but for people aged >13 years, a 1-standard deviation increase in ultimate restrictiveness was associated with fewer harmful cannabis exposures (rate ratio = 0.93; 95% confidence interval = 0.86, 1.01). For recommended provisions, estimates were generally too imprecise to detect associations with harmful cannabis exposures. CONCLUSION Bans on storefront retail and other restrictive approaches to regulating recreational cannabis may be associated with fewer harmful cannabis exposures for some age groups following statewide commercialization.
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Affiliation(s)
- Ellicott C. Matthay
- From the Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Leyla M. Mousli
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Chloe Sun
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Justin Lewis
- California Poison Control System, School of Pharmacy, University of California, San Francisco, San Francisco, CA
| | - Laurie M. Jacobs
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Stuart Heard
- California Poison Control System, School of Pharmacy, University of California, San Francisco, San Francisco, CA
| | - Raymond Ho
- California Poison Control System, School of Pharmacy, University of California, San Francisco, San Francisco, CA
| | - Laura A. Schmidt
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, San Francisco, CA
- Department of Humanities and Social Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Dorie E. Apollonio
- School of Pharmacy, University of California, San Francisco, San Francisco, CA
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Moussa MK, Hall MAK, Akwe J. Cannabis-Induced Acute Encephalopathy in a 94-Year-Old Woman Due to Family Administration of Cannabidiol (CBD) Products: A Case Report. Cureus 2023; 15:e37927. [PMID: 37223146 PMCID: PMC10202677 DOI: 10.7759/cureus.37927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
In the United States, cannabis use is rising, including among older adults, as is unintentional ingestion. We describe the case of a 94-year-old woman admitted with altered mental status, diarrhea, and hallucinations. She lived with her family, who had noticed recent confusion with weakness, poor oral intake, and loose bowel movements. In the emergency room, her vital signs revealed mild tachycardia and hypotension. She was lethargic, disoriented, confused, and anxious but could answer simple questions. The attending hospitalist administered the Mini-Cog dementia screening and found that the patient was oriented to herself only and was unable to perform word recall tests or complete a clock drawing. The rest of her physical exam was within normal limits for her age. Despite a workup including urine culture, chest X-ray, and computed tomography scan of her head, no organic source for her mental change was found. After five days of admission, a close relative confessed that they had given the patient cannabis oil (marketed as "pure CBD," i.e., cannabidiol, a nonpsychoactive cannabis derivative widely touted as a remedy for pain, anxiety, and anorexia) in the form of edible brownies to help her with her persistent back pain and poor appetite. We performed a urine drug screen for tetrahydrocannabinol (THC), the psychoactive component of cannabis, which verified cannabis use, as well as exposure to THC. The patient recovered to baseline with supportive care. Currently, there is no governing body or framework for the regulation of cannabis products in the United States. Nonprescription CBD products are not regulated by the US Food and Drug Administration, and these products are not tested for safety, efficacy, or quality. Some producers voluntarily conduct such testing, but there is no regulatory oversight, and consumers may be unaware of the need for testing and/or which testing bodies are credible. Given the rapidly increasing proportion of older adults who are cannabis users, physicians should inquire about outpatient use of cannabis in general and CBD in particular during discussions with patients, even the most elderly.
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Affiliation(s)
- Mohamad K Moussa
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, USA
- Hospital Medicine, Emory Johns Creek Hospital, Johns Creek, USA
| | | | - Joyce Akwe
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, USA
- Hospital Medicine, Atlanta Veterans Affairs Medical Center, Atlanta, USA
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Fong K, Hsueh A, Kendric K, Kunihira K, Siddiqi N, Phan TH, Reibling E, Wolk BJ. Unwitting adult marijuana poisoning: a case series. Clin Toxicol (Phila) 2021; 59:913-917. [PMID: 33688774 DOI: 10.1080/15563650.2021.1891241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
STUDY PURPOSE With increasing state legalization, marijuana use has become commonplace throughout much of the United States. Existing literature on unintentional exposure focuses primarily on children.We report on a cluster of adults with unwitting marijuana exposure. METHODS A cluster of cases were referred to the Medical Toxicology Service after ingesting marijuana-contaminated food at a family event. We conducted a retrospective analysis of twelve subject charts and a qualitative analysis with six of these subjects who willingly consented to be interviewed about their experiences. The study was approved by the Institutional Review Board. RESULTS Three of the subjects (25%) required prolonged observation due to persistent symptoms. Eleven (92%) were urine immunoassay positive for tetrahydrocannabinol (THC). Two subjects (17%) tested positive for ethanol in their blood. Common symptoms experienced by the subjects included confusion (50%), difficulty speaking (67%), nausea (25%), tremors (17%), and feelings of unreality (33%). All interviewed subjects reported sleepiness and three (50%) reported a negative impact on work. Subjects also reported multiple emotions, including anger, confusion, disbelief, and helplessness. None of the cases resulted in admission for critical care or death. CONCLUSIONS Our series illuminates effects of unwitting and/or unintentional marijuana exposure in adults. Unintentional marijuana poisonings have increased, but legal and regulatory barriers have limited the study of marijuana outside highly controlled conditions. While the marijuana exposure in this study did not result in admission for critical care or death, it did result in psychological distress and adversely affected work in some cases.
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Affiliation(s)
- Kelly Fong
- Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Andy Hsueh
- Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kayla Kendric
- Department of Emergency Medicine, Loma Linda University, CA, USA
| | - Karissa Kunihira
- Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Nadia Siddiqi
- Department of Emergency Medicine, Nova Southwestern University College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Tammy H Phan
- Department of Emergency Medicine, Loma Linda University, CA, USA
| | - Ellen Reibling
- Department of Emergency Medicine, Loma Linda University, CA, USA
| | - Brian J Wolk
- Department of Emergency Medicine, Loma Linda University, CA, USA
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White AE, Van Tubbergen C, Raymes B, Contreras AE, Scallan Walter EJ. Cannabis-Infused Edible Products in Colorado: Food Safety and Public Health Implications. Am J Public Health 2020; 110:790-795. [PMID: 32298168 PMCID: PMC7204451 DOI: 10.2105/ajph.2020.305601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 11/04/2022]
Abstract
Cannabis-infused "edibles" are a popular means of cannabis use, and the variety of edible food products available to consumers continues to grow. Although there has been much discussion on dose standardization, childproof packaging, and the prevention of overconsumption, the important topic of food safety has received less attention.We discuss potential food safety hazards associated with cannabis-infused edible food products, drawing on examples from Colorado, and describe edible-associated foodborne illness outbreaks and other contamination events.It is important for public health agencies, particularly environmental health and enteric disease programs, to be familiar with the cannabis industry, including regulatory partners, signs and symptoms of cannabis ingestion, the scope of edible products sold and consumed, and the food safety risks unique to cannabis products.
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Affiliation(s)
- Alice E White
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| | - Christine Van Tubbergen
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| | - Brianna Raymes
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| | - Alexandra Elyse Contreras
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| | - Elaine J Scallan Walter
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
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Retrospective study of addictive drug-induced acute toxicity of cases admitted to the Poison Control Centre of Ain Shams University Hospital (2015–2016). EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2019. [DOI: 10.1186/s41935-019-0118-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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