Acute Marijuana Intoxication in Children

Cannabis Toxicity in Children and Adolescents

The legalization of recreational and medical cannabis has increased the availability and potency of cannabis products in homes and communities. Although state laws regarding legalization and commercial sale often encompass adult use only, pediatric toxicity from unintentional exposures to cannabis edibles and adolescent harm from chronic use are increasing in states and countries that have relaxed laws on use. Unintentional edible ingestions are shown to increase in regions that legalize and commercialize cannabis products at the retail level. Long-term effects on teenagers regarding psychiatric changes as well as acute gastrointestinal effects from hyperemesis syndrome are well documented in the medical literature. This article provides clinical information on the presentation, evaluation, and management of adverse effects from pediatric and adolescent teen exposures to cannabis seen in acute care and emergent settings. [Pediatr Ann. 2023;52(5):e181-e186.].

Pediatric Emergency Department Management in Acute Poisoning-A 2-Year Retrospective Study

(1) Background: Poisonings in children are common reasons for addressing ED and can potentially have serious complications. Our research aims to review risk factors leading to poisoning in children. (2) Methods: A retrospective review of all pediatric poisoning cases addressing the Children's emergency department of St Mary Hospital over a two-year period was performed. (3) Results: We collected data on 797 children admitted for acute poisoning. The highest incidence identified was in the 12-18 and 1-3-year-old age groups. The distribution of voluntary versus unintentional poisonings was relatively balanced: 50.19% versus 47.43% (for some cases the type of intoxication remained unknown). Exposure to the toxic substance by ingestion was significant compared to the other routes, with an incidence of 87.1%. Acute poisoning happened at home in 70.4% of cases. A known risk factor before reaching the ED was present in 13.04%. (4) Conclusions: Our study showed a greater risk for acute poisoning in children between 1-3 years of age, and adolescents over 12 years. Identifying and documenting epidemiological aspects and other variables is important for establishing preventive measures and for therapeutic conduct. Adequate risk stratification and preventive measures involving closer supervision of minors or cognitive-behavioral programs can prevent voluntary intoxication.

Government-mandated warnings on cannabis legally sold for recreational use

Background

Frequent cannabis use can pose risks to health and safety. Multiple governments have legalized the sale of cannabis for recreational use and mandated health and safety warnings for recreational cannabis packages or signs at sales locations. The purposes of this study were to identify common themes across warnings and to compare the actual warnings with those previously recommended by cannabis experts and cannabis users.

Methods

We searched Google and Google Scholar for online lists of governments that allow or will soon allow the sale of cannabis for recreational use. Using the online lists we found, we searched for laws mandating the warnings, using the search terms “mandated warnings for recreational use marijuana” in addition to the name of the jurisdiction under review. We evaluated the content of the warnings and compared them with warnings recommended by cannabis experts and by users of recreational cannabis.

Results

Each search led to millions of results. Within the top results of each of the searches there were website links to official legislative websites, databases and documents of the jurisdiction under review. We used these official documents. The search revealed that 11 U.S. states and two countries allow the recreational use of cannabis and that 10 U.S. states and Canada mandate warnings on legally sold recreational cannabis. The mandated warnings can be categorized as focusing on one of nine risks: (1) negative health effects on the user, (2) harm to children or fetuses, (3) risks related to driving or operating machinery, (4) risks of habit formation leading to over-use, (5) risks relating to over-use on a single occasion, especially with regard to edible cannabis, (6) developmental risks for young people, (7) harm caused by secondary smoke, (8) risks of effects lasting several hours, and (9) risks specific to using cannabis topicals. The warnings include no graphic images and no phone number to call for help quitting.

Conclusions

The warnings, as a group, parallel most warnings recommended by cannabis experts and a sample of recreational users of cannabis. The effects of the warnings are unknown, but prior research findings on warnings for cannabis and for other substances suggest potential for positive effects in raising awareness of risks and decreasing the risks. The warnings could be used in public health campaigns. Public health professionals may find it possible through research to help improve the warnings, either in presentation or in content. Cannabis researchers can use the list to identify additional risks suitable for inclusion in mandated warnings.

Acute Cannabis Toxicity

The change in legal status of cannabis (the botanical species Cannabis sativa, commonly known as marijuana) in the United States has had significant impact on pediatric drug exposures. In states with decriminalization of recreational and medicinal use of cannabis, emergency department visits and poison control center calls for unintentional pediatric cannabis intoxication are on the rise in the last few decades. Exploratory or unintentional ingestions of cannabis-containing products (as opposed to those derived from synthetic cannabinoids, which may mimic the structure and/or function of cannabis, but are not the focus of this article) can lead to significant pediatric toxicity, including encephalopathy, coma, and respiratory depression. With the increasing magnitude of the public health implications of widespread cannabis use, clinicians who care for pediatric patients routinely must be adept in the recognition, evaluation, management, and counseling of unintentional cannabis exposure.