Unintentional marijuana ingestions by young children apparently increased after modification of drug enforcement laws for possession of marijuana in Colorado, according to a report.
Several states and Washington, D.C. have enacted laws to decriminalize medical marijuana, and Colorado and Washington have passed amendments to legalize the recreational use of marijuana, according to background information in the study, which was published May 27 on the website of JAMA Pediatrics. In late 2009, the Justice Department instructed federal prosecutors not to seek arrest of medical marijuana users and suppliers if they were complying with state laws.
Tetrahydrocannabinol, the active chemical in marijuana, is incorporated into medical marijuana products in higher concentrations. “In addition, medical marijuana is sold in baked goods, soft drinks and candies,” the authors noted.
George Sam Wang, MD, from the Rocky Mountain Poison and Drug Center in Denver, and colleagues compared the proportion of marijuana ingestions by young children who sought care in a childrens hospital ED before and after the modification of drug enforcement laws in October 2009 regarding medical marijuana possession. A total of 1,378 patients younger than 12 were evaluated for unintentional ingestions: 790 patients before Sept. 30, 2009, and 588 after Oct. 1 of that year.
Among patients younger than 12 who went to a hospital, the proportion related to marijuana exposure increased from 0 of 790 before Oct. 1 to 14 of 588 afterward, the authors wrote. Eight of the 14 cases involved medical marijuana, and seven exposures came from food products. Nine patients had lethargy, one had ataxia and one had respiratory insufficiency. Eight patients were admitted, including two the ICU.
“Because of a perceived stigma associated with medical marijuana, families may be reluctant to report its use to healthcare providers,” the authors wrote. “Similar to many accidental medicinal pediatric exposures, the source of the marijuana in most cases was the grandparents who may not have been available during data collection.
“Physicians, especially in states that have decriminalized medical marijuana, need to be cognizant of the potential for marijuana exposures and be familiar with the symptoms of marijuana ingestion. 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.”
In an accompanying editorial, Sharon Levy, MD, MPH, from Harvard Medical School and Boston Children’s Hospital, wrote that “the findings reignite the debate over whether and how legalized marijuana impacts children and adolescents.”
Levy noted nationwide rates of adolescent marijuana use are climbing rapidly: “The skyrocketing rates of adolescent marijuana use indicate that we are losing an important public health battle and we have a lot of work to do if we want to reverse these trends. Physicians have a key role to play in educating our young patients and their families about the health consequences of marijuana use regardless of its legal status.”
In another editorial, William Hurley, MD, of the University of Washington and Washington Poison Center, and Suzan Mazor, MD, of Seattle Children’s Hospital, wrote that the “legalization of recreational marijuana, especially the solid and liquid-infused forms permitted in Washington, will provide children greater access to cookies, candies, brownies and beverages that contain marijuana.
“Ingestion of marijuana results in the absorption of delta-9-tetrahydrocannibinol (THC) and stimulation of cannabinoid receptors in the central nervous system. This produces stimulation with hallucinations and illusions followed by sedation.”
The authors recommend additional training for emergency medicine, pediatric emergency medicine and primary care pediatric clinicians to recognize and manage these toxic reactions.
Read the study abstract: http://archpedi.jamanetwork.com/article.aspx?articleid=1691416.