When the grass isn’t greener: a case series of young children with accidental marijuana ingestion

Sociodemographic profile and clinical presentation of young children unintentionally exposed to marijuana: A single site retrospective cohort

BACKGROUND AND OBJECTIVES

Legalization of medical marijuana has increased unintentional exposure to marijuana in young children. We aim to explore the sociodemographic disadvantage profile, prevalence, and clinical presentation of children diagnosed with unintentional exposure to marijuana.

METHODS

We conducted a retrospective chart abstraction of 121 children (aged 0-6) seen at the Emergency Department (ED) at a single tertiary hospital center in Dayton, Ohio between January 01, 2010 and January 09, 2022.

RESULTS

Majority were female (62.8%), white (50.4%), and with Medicaid as their primary insurance (84.3%). The median age at exposure was 1.8 years. There was a 14-fold increase in unintentional marijuana cases pre-2017 (7 cases) versus post-2017 (114 cases), the year of legalization of medical marijuana in the state of Ohio. Majority of the patients were using public assistance (66.4%). 26.7% of the cases had a prior social work consultation and 38.1% had a prior children services consultation. 51.3% of the children had a social disadvantage index score of 3 or greater (range 0-5) with higher scores indicating greater disadvantage.

DISCUSSION AND CONCLUSIONS

The number of patients presenting to the ED at the hospital has increased 14-fold since the legalization of medical marijuana in Ohio. Half of the children displayed a higher sociodemographic disadvantage index score.

SCIENTIFIC SIGNIFICANCE

Our study is the first study investigating the sociodemographic profile of children exposed to marijuana. The findings of this study may be utilized to inform policy for safely dispensing recreational and medicinal marijuana products and focus the efforts on families with sociodemographic disadvantage.

Unintentional cannabis exposures in children pre- and post-legalization: A retrospective review from a Canadian paediatric hospital

OBJECTIVES

Canada legalized recreational cannabis in October 2018. Cannabis is increasingly available in numerous forms-especially edibles-that make children vulnerable to unintentional intoxication. We sought to: determine the frequency of visits due to cannabis intoxication pre- and post-legalization; characterize the clinical features and circumstances of cannabis intoxication in the paediatric population; and create greater awareness among healthcare providers about this issue.

METHODS

We performed a retrospective chart review of Emergency Department visits at the Children's Hospital of Eastern Ontario (Ottawa, ON) between March 2013 and September 2020. Inclusion criteria were: age <18 years; unintentional cannabis ingestion, identified by ICD-10 codes T40.7 and X42. We assessed basic demographics, clinical signs and symptoms, exposure details, investigations, and patient disposition.

RESULTS

A total of 37 patients (22 male) met inclusion criteria, mean age 5.9±3.8 years. Most visits (32; 86%) occurred in the 2-year period after legalization. Altered levels of consciousness, lethargy/somnolence, tachycardia, and vomiting were the most common presenting signs and symptoms. The majority of exposures were to edibles (28; 76%) in the home setting (30; 81%). Poison control and child protective services were involved in 19 (51%) and 22 (59%) of cases, respectively. Twelve patients (32%) required admission to the hospital, the majority of whom stayed <24 h.

CONCLUSIONS

Our data confirm increased paediatric hospital visits related to unintentional cannabis exposures post-legalization. Consideration of this clinical presentation is critical for acute care providers. Advocacy for safe storage strategies and appropriate enforcement of marketing/packaging legislation are imperative for public health policymakers.

Setting the baseline: a description of cannabis poisonings at a Canadian pediatric hospital prior to the legalization of recreational cannabis

INTRODUCTION

This study describes the events and circumstances preceding children aged 16 years or younger being treated for cannabis poisoining in the emergency department (ED) of a Canadian pediatric hospital.

METHODS

We extracted cannabis poisoning treated in the ED at British Columbia Children's Hospital (BCCH) between 1 January, 2016 and 31 December, 2018, from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database. The poisonings were distinguished by the inadvertent or intentional ingestion of cannabis. We reviewed the hospital's electronic health information system and the patients' health records to obtain additional information on the context, including spatial and temporal characteristics.

RESULTS

Of the 911 poisonings treated at BCCH, 114 were related to intentional cannabis use (12.5%). Fewer than 10 poisonings resulted from inadvertent ingestions by children and the median age for these was 3 years. All inadvertent ingestion occurred at home and involved cannabis belonging to the patient's family. The vast majority of poisonings resulted from the intentional use of cannabis only (28.9%) or cannabis use with other psychoactive substances (co-ingestions; 71.1%). The median patient age was 15 years. Most patients reported consuming cannabis through inhalation with peers. Cannabis and co-ingestion poisonings were more often reported on weekdays than weekends. The consumption of cannabis leading to poisoning more often occurred in private residences. Patients with cannabis poisoning more often sought medical treatment themselves or were helped by their family.

CONCLUSION

The characteristics of cannabis poisonings among children are described for the three-year period prior to recreational cannabis legalization in Canada in order to set a baseline for future comparisons. Implications for improving injury prevention initiatives and policies are discussed.

Cannabis-related emergencies in children and teens

PURPOSE OF REVIEW

To examine the spectrum of emergency department presentations associated with cannabis use or misuse that are currently seen in the pediatric population.

RECENT FINDINGS

There is a growing concern that pediatric emergency department visits related to cannabis are on the rise, especially given rapidly changing legislation on cannabis and its broad availability in certain areas. These concerns are substantiated in the current literature, as the evidence mounts for an array of emergency department presentations of intentional or accidental cannabis use. The range of presentations documented in the recent literature spans gastrointestinal, psychiatric and cardiorespiratory effects, in addition to traumatic injuries and accidental ingestions by younger children. Complications of chronic cannabis use, such as 'cannabis hyperemesis syndrome', depression, psychosis or cognitive impairment, are now recognized outcomes and even more are likely to emerge.

SUMMARY

An array of cannabis-related symptoms is possible from acute use or exposure. Common presentations include acute intoxication, hyperemesis, depression and acute physical injuries from impaired psychomotor function. Uncommon presentations include cardiorespiratory effects, and a range of symptoms in young children that include hyperkinesis and coma. Clinical vigilance is needed to suspect and clinically diagnose cannabis exposure in the emergency department.

Acute Marijuana Intoxication in Children

As the number of states legalizing marijuana for medical and/or recreational use continues to grow, there are an increasing number of children exposed to marijuana-containing products in homes and communities. Increased exposure leads to a greater probability of accidental ingestion and toxicity. Because marijuana ingestion can cause a dangerous and potentially life-threatening toxicity for children, pediatric health care providers need an increased awareness of the danger. This article describes the growing problem and outlines clinical management as well as prevention. [Pediatr Ann. 2018;47(12):e474-e476.].

The lows of getting high: sentinel surveillance of injuries associated with cannabis and other substance use

OBJECTIVES

Cannabis is a widely used illicit substance that has been associated with acute injuries. This study seeks to provide near real-time injury estimates related to cannabis and other substance use from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database.

METHODS

Data from the eCHIRPP database, years 2011 to 2016, were analyzed via data mining, descriptive, logistic regression, and sensitivity analyses. Drug use trends over time for cannabis and/or other substances (alcohol, illicit drugs, and medications) were assessed. Descriptive statistics (intent, external cause, and nature of injury) and proportionate injury ratios (PIR) associated with cannabis use are presented.

RESULTS

Cannabis use was observed in 184 cases/100,000 eCHIRPP cases, and related injuries were mostly identified as unintentional (66.8%). Poisoning (68.5%) and intoxication (69.4%) were the external cause and nature of injury most associated with these events, and hospitalization was recorded for 14.3% of cases. Per 100,000 eCHIRPP cases, cannabis was used alone in 72.4 cases, and in combination with alcohol, illicit drugs, or medications in 74.6 cases, 11.3 cases, and 7.9 cases, respectively. Relative to non-use, the PIR of hospitalization was not significant for cannabis-only users of either sex (males: PIR 1.0, 95% CI 0.6-1.7, females: PIR 0.9, 95% CI: 0.5-1.7).

CONCLUSION

Cannabis use injuries are rare, but can occur when cannabis is used with or without other substances. As Canada considers legislative changes, our finding of cases related to unintentional injury, poisoning, and intoxication suggests areas that might benefit from health literacy efforts.

Unintentional Cannabis Ingestion in Children: A Systematic Review

OBJECTIVE

To analyze published reports of unintentional cannabis ingestions in children to determine presenting signs and symptoms, route of exposure, treatment, and outcome.

STUDY DESIGN

PubMed, OpenGrey, and Google Scholar were systematically searched. Articles were selected, reviewed, and graded using Oxford Center for Evidence-Based Medicine guidelines.

RESULTS

Of 3316 articles, 44 were included (3582 children age ≤12 years). We found no high quality (Oxford Center for Evidence-Based Medicine level I or II) studies and 10 level III studies documenting lethargy as the most common presenting sign and confirming increasing incidence of unintentional ingestion in states having decriminalized medical and recreational cannabis. We identified 16 level IV case series, and 28 level V case reports with 114 children, mean age 25.2 ± 18.7 months, range 8 months to 12 years, and 50 female children (44%). The most common ingestion (n = 43, 38%) was cannabis resin, followed by cookies and joints (both n = 15, 13%). Other exposures included passive smoke, medical cannabis, candies, beverages, and hemp oil. Lethargy was the most common presenting sign (n = 81, 71%) followed by ataxia (n = 16, 14%). Tachycardia, mydriasis, and hypotonia were also commonly observed. All cases were cared for in the emergency department or admitted, and mean length of stay was 27.1 ± 27.0 hours. Twenty (18%) were admitted to the pediatric intensive care unit, and 7 (6%) were intubated.

CONCLUSIONS

Unintentional cannabis ingestion by children is a serious public health concern and is well-documented in numerous studies and case reports. Clinicians should consider cannabis toxicity in any child with sudden onset of lethargy or ataxia.