Editor’s note: This commentary is by Amy Wenger, RN, who is the practice administrator for Appleseed Pediatrics in Morrisville.
[O]n July 1, cannabis (aka marijuana) was legalized for recreational use for people over the age of 21 here in Vermont. An unintentional consequence of legalization, as seen in other states that have legalized cannabis for medicinal and recreational purposes, are higher instances of accidental ingestion of cannabis in young children. The Northern New England Poison Control Center reports that the rates of pediatric exposure to marijuana calls in legalized states increased to 30 percent when compared to those states who had not legalized. In Lamoille County, this trend in accidental cannabis exposures is occurring.
Tetrahydrocannabinol (THC)is the psychoactive ingredient in cannabis and hash. Marijuana and hash are most commonly smoked or ingested through various edibles. Edibles are different types of food products where THC has been infused into it so that it can be eaten instead of smoked. Edible marijuana products are most commonly found in the form of baked goods such as brownies and cookies and candy such as gummies, lollipops, chocolate bars, caramels and other common treats. They are also packaged and sold in the cannabis dispensaries as sweetened drinks. The treats are produced to taste good, and therefore, a young child would not know if they were eating something they should not be.
The cannabis dispensaries in Vermont have guidelines surrounding the dosing, safe packaging, and selling of edible products; however, many edibles used by adults are homemade. Homemade edibles have an unknown amount and potency of the cannabis infused in the edible. The packaging is usually a common household item. Any THC infused edible can easily be confused as a regular food or treat; children are at risk for ingesting several times the recommended dose of THC for an adult which can result in THC poisoning.
After legalization in Colorado for recreational sale and use in 2014 there was a two-year study that focused on the unintentional pediatric exposures to marijuana. The following are points the public should know based on the findings from the Colorado study.
Edible marijuana products account for a significant amount of the accidental exposures in young children
Safe packaging was found to not be enough to keep children from accessing the edibles. Many edibles, such as cookies or brownies, are meant to have multiple serving sizes in one item.
The age of children that had the most reported calls to poison control was less than 5 years of age with the average age being 2.5 years.
Infants and toddlers under the age of 3 years are at the highest risk for the most serious effects that required a hospital admission for THC poisoning.
Ingesting edible cannabis takes longer to have an effect than inhaled cannabis. It can take 30-60 minutes to be digested and absorbed; peak effects are 3-4 hours after eating.
Common signs and symptoms in children are low energy, confusion, panic, agitation or altered consciousness, loss of control of bodily movements, muscle weakness, rapid heart rate, pupil dilation, and red eyes. This could also be a very scary and confusing experience for a child.
More serious symptoms that required intensive care and a breathing tube were due to a decrease in brain function that results in serious breathing issues, seizure or coma. These were seen mostly in children under 3 years of age. There have been no deaths to date due to ingestion of edibles, but long-term effects on children are unknown.
How to keep children safe (based on recommendations from the American Academy of Pediatrics)
If there are edibles in the home, they should be stored out of sight and out of reach. Keep them in a locked area in child-resistant containers and in original packaging. Clearly label them and they should not be placed in common areas. Children are naturally curious; many see a treat and may not ask an adult before eating it.
Do not consume edibles in front of children even if it is prescribed medically. This can create temptation and children will seek out treats if they know they are around. Adults should always place edibles back in their original packaging and return to the safe area directly after eating them. Always keep inventory of edibles so any missing will be noted quickly.
Talk to your friends and family. Although the evidence shows that the highest rates of accidental exposure come from edibles in a child’s own home, conversations with grandparents, family members, friends, and babysitters should be had to make sure that if edibles are around that they are stored safely and in a place a child will not be able to access.
Know what to do in case of emergency. If your child accidentally consumes any form of marijuana, especially edibles; call Poison Control at 1-800-222-1222 or your child’s practitioner at their office as soon as possible. If symptoms seem or become severe call 911 or go to the closest emergency room for treatment. There is no reversal medication for cannabis intoxication. Supportive symptomatic therapy and observation is common.
It is important to note that Lamoille County medical practitioners and community partners are using this forum to educate on this growing issue. It is about keeping children safe. Everyone understands that accidents occur even with the best prevention. Cannabis is used medically as a carefully regimented treatment for severe neurologic issues in children. Cannabis is not to be used by children under the age of 21 years recreationally and is still a federally controlled substance. Cannabis should not be smoked in the presence of adolescents or younger children; secondhand cannabis smoke is harmful. Cannabis use in adolescence has been shown to have negative effects on the intellectual and cognitive functions of the developing brain. It is important for families to have healthy conversations with their adolescents about the potential harm and risks of smoking or ingesting it prior to the legal age; as well as what potential consequences it could have. Ask open-ended questions regarding their thoughts, attitudes, and what they see in their school and social environments. For more information please reference the links below. Talk to your child’s health care provider, school counselor, or local coalition for further guidance.
Referred studies and links:
Claudet, I., Mouvier, S., Labadie, M., Manin, C., Pascale, A., Lenoir, M., (2017). Unintentional Cannabis Intoxication in Toddlers. Pediatrics. 140 (3). http://pediatrics.aappublications.org/content/140/3/e20170017
Wang, G, S., LeLait, Marie-Claire., Deakyne, S., Bronstien, A., Bajaj, L., Roosevelt, G.,(2016). Unintentional Pediatric Exposures to Marijuana in Colorado, 2009-2015. JAMA Pediatrics. 170(9).
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2534480
Ryan, S., Ammerman,S, D., COMMITTEE ON SUBSTANCE ABUSE AND PRENVENTION. (2017). Counseling Parents and Teens About Marijuana in an Era of Legalization of Marijuana. Pediatrics. 2017;139 (3) http://pediatrics.aappublications.org/content/139/3/e20164069
Schaeffer, T. (2014). Pediatric Marijuana Exposures. Northern Exposures, September 2014. Northern New England Poison Control Center.
https://www.nnepc.org/clinical-resources/pediatric-marijuana-exposures
Committee for Substance Abuse and Prevention. (2017) Edible Marijuana Dangers: How Parents can prevent Pot Poisoning. 2017. American Academy of Pediatrics. https://www.healthychildren.org/English/ages-stages/teen/substance-abuse/Pages/Edible-Marijuana-Dangers.aspx
Vermont state resources:
http://www.healthvermont.gov/alcohol-drug-abuse/alcohol-drugs/marijuana
https://legislature.vermont.gov/assets/Documents/2018/Docs/ACTS/ACT086/ACT086%20As%20Enacted.pdf
