Accidental Marijuana Ingestion Up: Are New Laws to Blame?

Jennifer Garcia

May 28, 2013

Incidence of unintentional marijuana ingestion by young children (<12 years of age) has increased after changes were made to marijuana possession policies in September 2009, according to a new study published online May 27 in JAMA Pediatrics.

The researchers, led by George Sam Wang, MD, from the Rocky Mountain Poison and Drug Center, Denver, Colorado, reviewed cases of marijuana ingestion in pediatric patients at a tertiary care children's hospital. Poisoning cases between January 1, 2005, and September 30, 2009, were compared with those between October 1, 2009, and December 31, 2011. The authors found that accidental marijuana ingestion visits increased from 0 (0%; 95% confidence interval [CI], 0% - 0.6%) of 790 total unintentional ingestions to 14 (2.4%; 95% CI, 1.4% - 4.0%) of 588 (P < 0.001).

The researchers note that after changes were made to federal drug enforcement laws in 2009, in which federal prosecutors would not seek arrest of medical marijuana users and suppliers as long as they were complying with state laws -- there was a dramatic increase in the number of patients with valid medical marijuana identification cards in Colorado.

Of the accidental marijuana ingestions identified, the researchers found that medical marijuana was involved in 8 of the 14 accidental ingestions cases, 7 of which involved exposure from food products.

The age of patients exposed to marijuana ranged from 8 months to 12 years. The primary symptoms involved central nervous system effects such as lethargy, somnolence, or respiratory insufficiency, and most (92.8%) patients were admitted to or observed in the emergency department.

"The increase in marijuana exposures in young children in Colorado is most likely due to the decriminalization of medical marijuana, which has resulted in an explosion of medical marijuana dispensaries and an increase in medical marijuana cards," Dr. Wang and colleagues write.

The authors note that this increase in marijuana exposure may also be related to increased palatability, as these products are often sold as edibles (ie, cookies, candy), making them more attractive to children. These products also contain higher concentrations of tetrahydrocannabinol, "resulting in symptomatic exposures despite small ingestions."

"This unintended outcome may suggest a role for public health interventions in this emerging industry, such as child-resistant containers and warning labels for medical marijuana," the study authors write.

The researchers acknowledge the limitations of the study, such as the retrospective design and record review at a single tertiary care facility. In addition, the author who reviewed the medical records was not masked to the study questions, which may have introduced bias.

In an accompanying editorial about the effects of marijuana policy on children and adolescents, Sharon Levy, MD, MPH, from Harvard Medical School and Boston Children's Hospital, Massachusetts, reports that the nationwide rates of adolescent marijuana use are climbing. "Likely driving these increases are declines in the perceived risk of harm that has been associated with the national conversation regarding legalization," Dr. Levy writes.

Because of the increasing potency of marijuana in the US, "[t]he risk of significant toxic reactions from exposures is more likely today than in the past," write William Hurley, MD, from the University of Washington and Washington Poison Center in Seattle, and Suzan Mazor, MD, from Seattle Children's Hospital, in a second editorial. Dr. Hurley and Dr. Mazor recommend additional training for emergency medicine and pediatric physicians to recognize and manage these toxic reactions.

The study authors and editorialists have disclosed no relevant financial relationships.

JAMA Pediatr. Published online May 27, 2013. Article abstract, Levy editorial extract, Hurley and Mazor editorial extract

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