Kids’ Unintentional Exposures to Edible Cannabis on the Rise

Pediatric exposures to edible cannabis products increased more than 10-fold in recent years, according to a retrospective analysis of the National Poison Data System.

From 2017 to 2021, unintentional ingestions of cannabis edibles among U.S. children younger than 6 years rose from 207 to 3,054 cases, with almost all exposures (97.7%) occurring in a residential setting, reported Marit Tweet, MD, of Southern Illinois University School of Medicine in Springfield, and colleagues in Pediatrics.

“Unintentional exposure to cannabis edibles in children has become a significant public health issue, and there is a large number of children at risk given how common these products have become,” co-author Antonia Nemanich, MD, of Rush University Medical Center in Chicago, told MedPage Today.

The group found that over half of all cannabis exposures occurred in 2- and 3-year-olds (27.7% and 24.6%, respectively).

“The natural curiosity and climbing ability of toddlers means that they can often get into edibles stored on a high shelf or in a plain-looking closed container,” Nemanich said.

Of all 7,043 reported cases during the 5-year study period, 4,827 had a known outcome: 70% were reported to have central nervous system (CNS) depression, followed by tachycardia (11.4%), vomiting (9.5%), mydriasis (5.9%), and respiratory depression (3.1%).

No deaths were reported. Overall, 22.7% were admitted to hospital, including 573 to the intensive care unit (ICU), Tweet and colleagues noted.

While the findings add to reports of increasing pediatric cannabis exposures associated with widespread legalization (which in some states coincided with pandemic lockdowns), the rise in both ICU and non-ICU admissions was particularly notable during the pandemic years, when cases increased by 296% from prepandemic years. Tweet and co-authors suggested this may have been related to COVID-related quarantines and school/daycare closures, thus increasing the opportunities for exposure at home, as well as possibly higher levels of cannabis use due to increased stress or more leisure time.

The proportion of critical care admissions remained unchanged, accounting for around 9% of all cases in 2017 and in 2021, the investigators noted. Noncritical care admissions increased from 9.7% to 16.3%, respectively.

However, a comparison of prepandemic to pandemic rates showed that admissions for critical care increased by 30%, from 6.6% in 2017-2019 to 8.6% in 2020-2021 (P<0.05). The number of patients treated and released at the emergency department (ED) declined from approximately 41% in the prepandemic years to 35% during the COVID years (P<0.05).

Major effect cases (n=155 over the study period) increased from 1.6% of all cases during the prepandemic years to 2.4% during the pandemic years, while moderate effect cases (n=1,539 in total) increased from 15.9% to 23.8%, respectively (P<0.05).

The authors noted an increase in acute toxicity, “as indicated by increasing critical care admissions, more patients admitted to noncritical care beds, and fewer patients being treated and released from the ED.” These unexplained changes may be related to providers’ increased experience and comfort with managing these cases, bed availability during the pandemic, or other factors, the researchers noted.

Cannabis intoxication can present with a wide range of potential symptoms that differ from patient to patient, Nemanich explained. “One of our roles as consulting medical toxicologists is to help ED doctors appropriately gauge their degree of concern in these exposures and prevent unnecessary ICU admissions and transfers.”

The most common therapies provided were intravenous fluids (20.7%), dilution/irrigation/washing (10.9%), and food/snack (10.3%), with oxygen therapy used in 4% of cases, showing that “life-threatening sequelae can develop and may necessitate invasive supportive care measures,” the researchers said.

Despite growing awareness of pediatric cannabis exposures, and the 2019 release of prevention recommendations by the American College of Medical Toxicology, “our study shows a continued increase in pediatric cannabis exposures after these guidelines came out and highlights how important it is to increase efforts to educate the public about prevention strategies,” Tweet and co-authors wrote.

Nemanich recommended that pediatricians and family practice doctors should screen for cannabis use — and specifically edible use — so they can educate caregivers, emphasizing locked storage, using edibles only when children are not watching, and putting edibles away immediately after use. “A non-judgmental approach is vital, since caregivers are unlikely to be forthcoming if they worry about being judged or having child protective services involved if they admit to drug use,” she emphasized.

“As well, patients with a cannabis exposure that is not known to providers may get a very extensive work-up for life-threatening problems such as stroke, sepsis, or meningitis, in addition to toxicologic causes,” Nemanich added. “The more forthcoming parents are about what items are in the home, the more likely this can be avoided.”

Study limitations, the researchers said, included underestimation of the actual number of cannabis exposures in this age group, and missing data for patients lost to follow-up.