Increase in Child Pot Exposures Linked to Decriminalization

Jennifer Garcia

February 11, 2014

The incidence of pediatric marijuana exposure has increased between 2005 and 2011 in states that have passed marijuana legislation, according to a study published online February 7 in the Annals of Emergency Medicine.

Researchers evaluated data from the American Association of Poison Control Centers National Poison Data System from between January 1, 2005, and December 31, 2011, and found that the call rate for unintentional marijuana exposure among children younger than 9 years increased by 30.3% (95% confidence interval [CI], 22.5% - 38.5%) in states where laws decriminalizing marijuana use had been passed. The rate was unchanged in states with no marijuana legislation and trended toward an increase of 11.5% per year (95% CI, −0.4% to 24.7%) in transitional states.

George S. Wang, MD, from the Rocky Mountain Poison and Drug Center, Denver, Colorado, and colleagues documented 985 unintentional marijuana exposures and found the median age range to be 1.5 to 2.0 years. "States were considered nonlegal if they had not passed legislation up through 2012 and decriminalized if they passed laws before 2005 (Alaska, California, Colorado, Hawaii, Maine, Nevada, Oregon, Vermont, and Washington). States that enacted legislation between 2005 and 2011 were analyzed as transitional states (Arizona, Michigan, Montana, New Mexico, and Rhode Island)." Among all exposures, 496 occurred in nonlegal states, 93 occurred in transitional states, and 396 occurred in decriminalized states.

The researchers found that accidental ingestion was the most common route of exposure (78%); however, it was not documented whether this was ingestion of a food product or of marijuana intended for smoking.

Symptoms of children exposed to marijuana varied but were primarily neurologic, with effects lasting less than 24 hours in the majority of cases. The study authors note that patients evaluated in decriminalized states were more likely to have major or moderate effects (odds ratio [OR], 2.1; 95% CI, 1.4 - 3.1) and a greater likelihood of being admitted to a critical care unit (OR, 3.4; 95% CI, 1.8 - 6.5) when compared with patients in nonlegal states.

The researchers hypothesize that because most exposures were the result of ingestion and were associated with greater clinical effects in decriminalized states, edible marijuana products likely played a significant role. The authors discuss a recently published case series of accidental marijuana ingestion that showed that the majority of exposures were a result of ingestion of medical marijuana packaged in the form of a food product. "These edible products are often indistinguishable from non–marijuana-containing food products, are highly attractive and palatable to children, and can contain very high amounts of tetrahydrocannabinol (100 to 500 mg)," the authors write.

Limitations to the study include the fact that not all cases are likely reported to the National Poison Data System and that caregivers in decriminalized states may be more likely to call poison centers or seek healthcare than those in nonlegal states. In addition, confirmatory testing was not performed on all exposures.

"Ongoing surveillance is crucial in assessing the marijuana industry's effect on children and evaluating preventive efforts as it continues to expand," Dr. Wang and colleagues write. "We believe state lawmakers should consider requirements, such as child-resistant packaging, warning labels, and public education, when drafting marijuana legislation to minimize the effect on children."

The authors have disclosed no relevant financial relationships.

Ann Emerg Med. Published online February 7, 2014. Full text

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