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Legalization of recreational marijuana yields increase in unintentional exposure to children
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Researchers from the University of Colorado observed an association between the increase in unintentional pediatric exposures to marijuana and the legalization of recreational use in Colorado.
“In 2015, the American Academy of Pediatrics published a policy statement reaffirming its opposition to legalizing marijuana, citing the potential harm to children and adolescents,” George Sam Wang, MD, assistant professor in the department of pediatrics at University of Colorado Anschutz Medical Campus, and colleagues wrote. “States that decriminalized medical marijuana have shown an increase in emergency department (ED) visits and regional poison center (RPC) cases for unintentional pediatric marijuana exposures.”
To determine the association between legalization of recreational marijuana in Colorado and unintentional marijuana exposure to children, the researchers conducted a retrospective cohort study assessing pediatric marijuana exposures evaluated in the ED, urgent care centers and RPC at Children’s Hospital in Aurora, Colorado prior to and after legalization. Between 2009 and 2015, clinicians evaluated 81 patients at the children’s hospital and at the RPC there were 163 marijuana exposure cases, all in children aged younger than 10 years.
Analysis showed the RPC experienced a mean increase of 34% (P < .001) per year during the 6-year period compared with the national remainder’s increase of 19% (P < .001). The median patient age was 2 years in both Children’s Hospital Colorado and Colorado RPC visits. More boys visited the ED (60%), however, more girls visited the RCP (52%). Average marijuana-related children’s hospital visits increased from 1.2 per 100,000 population 2 years before recreational use was legal to 2.3 per 100,000 population 2 years after legalization (P = .02). Exposure due to edibles occurred in 48% of cases monitored in Colorado.
In addition to unintentional pediatric exposures, the researchers recommend policy makers address the concerns and risks involved with marijuana use around children including secondhand marijuana smoke, prenatal and breastfeeding exposures, medicinal uses and the effects on adolescent mental health.
“Continued surveillance is critical in evaluating the effect marijuana legislation has on the pediatric population,” Wang and colleagues wrote. “Edible marijuana products continue to be a significant source of pediatric exposures given their attractiveness and palatability to children. Identifying successful preventive strategies requires further investigation. As more states pass laws legalizing recreational marijuana, legislators and health care professionals will need to consider strategies to decrease its effect on the pediatric population.” – by Kate Sherrer
Disclosure: Wang and Bajaj report grant funding from the Colorado Department of Public Health and Environment; Wang reports royalties from UPTODATE.
Perspective
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Henry A. Spiller, MS, DABAT
Our primary concern with pediatric exposure to recreational marijuana is the edibles, and we believe a good deal of this exposure is coming from this age group because, honestly, children do not read. Instead, they see these packages that are intended to resemble other edible products such as gummi candies, Pop-Tarts or cookies — common snacks in a child’s life that do not carry risk.
Pediatricians discussing possible exposure prevention will have to understand that parents who already have edibles in their homes accept this as part of their life, and often do not consider edibles a risk within the home. The problem is that the dose of the edible is enormously different for a 150- to a 200-pound adult compared with a 20- to 35-pound child. Moreover, while the parents are knowledgeable about the dosing of these edibles and may limit their intake to one cookie or five gummies, the child might eat several because they are snacks and unintentionally overdose as a result.
When pediatricians are working with these families, they need to let them know this is really a medication, that the dose can really be excessive in these small children. Despite the parents’ belief that it is a recreational substance, not medication, pediatricians must encourage parents to take care to keep edibles out of reach of children and treat edibles as if they were medication.
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