Cannabis poisoning in children rose dramatically after edibles legalized: study

 

Emergency rooms in Ontario saw a dramatic rise in the number of young children treated for cannabis poisoning in the year after edibles were legalized, a new Ottawa-led study shows.

It also found significantly more children (under the age of 10) suffered poisonings serious enough to require hospitalization once edible products became available.

The study was published Friday in the online medical journal, JAMA Network Open.

The study’s lead author, Ottawa’s Dr. Daniel Myran, said the findings suggest Canada’s approach to legalization, designed to prevent increases in child cannabis poisonings, is not working.

“These events weren’t supposed to happen: Canada prided itself on a public health, strict regulatory approach to legalization,” said Myran, a family physician and postdoctoral fellow at The Ottawa Hospital. “I find it very concerning it doesn’t seem to have worked.”

Almost 10 per cent of all Ontario emergency department visits for poisonings in young children can now be tied to cannabis, he said.

Federal regulations require cannabis edibles, such as gummies and chocolates, to be sold in plain, child-resistant packages and to contain no more than 10 mg of tetrahydrocannabinol (THC) per package.

As part of their study, Myran and his fellow researchers examined emergency department visits in Ontario between Jan. 1, 2016, and March 31, 2021, for children under the age of 10.

The research team identified cannabis poisonings in the data and divided them into three time periods: the 33 months before legalization (Jan. 2016-Sept. 2018); the 16 months during which only flower-based cannabis products were legalized (Oct. 2018-Jan. 2020); and the first 14 months after edible cannabis products became available in Ontario (Feb. 2020-March 2021).

In total, 522 children were brought to emergency departments with cannabis poisoning during the five-and-a-half-years encompassed by the study. None of them died.

Researchers found the number, rate and severity of cannabis poisonings escalated in each of the three time periods.

In the 33 months before legalization, 81 children under the age of 10 received emergency care for cannabis poisoning, a rate of 2.5 visits per months. One-quarter of the children had to be admitted.

During the 16 months immediately after cannabis was legalized, 124 children visited emergency departments for cannabis poisoning, a rate of 7.8 visits per month. That represented a three-fold increase over the pre-legalization period, but the hospitalization rate remained stable.

In the 14 months after edibles were legalized, 317 children were brought to emergency departments with cannabis poisoning, a rate of 22.6 visits per month. That represented a nine-fold increase over the pre-legalization period.

Many more children (39 per cent) also had poisoning cases severe enough to require a hospital admission after edibles went on the market.

The researchers concluded: “These findings suggest that the introduction of legal commercial edible cannabis products was a key factor associated with emergency department visit frequency and severity.”

Curiously, Myran noted, poisonings among children for other reasons – medications, cleaning products, hand sanitizer, etc. – decreased in the year after commercial edibles became available.

In the study, the average age of those children going to hospital with cannabis poisoning was three years, nine months.

The study does not explore what kind of cannabis products the children ingested, or how they gained access to them.

Since children are smaller than adults, the effects of THC are amplified in their bodies.  Cannabis poisoning in a child can cause vomiting, confusion, lethargy, muscle weakness and depressed breathing that sometimes requires ICU treatment. In rare cases, children can end up in a coma.

Myran, a public health and preventative medicine specialist, said edible cannabis products should have better safety designs and be made less appealing to children.

“My view is that there is no need for cannabis products to look and taste like candy, baked goods or snacks,” he said.

Myran also urged parents to keep cannabis products locked up and out of a child’s reach. “These products should be treated like a poison,” he said, “because that’s what it is if a young child ingests it.”

Quebec does not allow the sale of edible cannabis products in the form of candies, desserts or chocolate.

Myran wants to compare pediatric poisoning numbers in Quebec to those in Ontario. It’s one of many studies needed to better understand the impact of cannabis legalization in Canada, he said, adding: “It’s absolutely astounding that we are three years post-legalization and we have so little information about what has happened.”

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