Incidence of edible cannabis exposures and severity of acute toxicity symptoms in young children increased significantly between pre-pandemic and post-pandemic years, according study findings published in the journal Pediatrics.
Researchers at 3 Illinois universities conducted a retrospective analysis of information obtained from the National Poison Data System between 2017 and 2021 regarding 7043 potential edible cannabis exposures in children younger than 6 years old. Only 1.1% of these cases were confirmed as nonexposures.
They analyzed incidence trends, changes in acute toxicity, clinical presentation, medical outcomes, and utilization of health care services, specifically comparing the pre-COVID years (2017-2019) with the COVID years (2020-2021).
The researchers calculated a 1375% increase in pediatric exposures to edible cannabis from 2017 (n=207) to 2021 (n=3054), 97.1% of which occurred in household settings with 90.7% being the child’s own home.
Clinical presentation in affected children included neurologic, cardiovascular, gastrointestinal, ocular, and respiratory effects. Neurologic effects consisted of central nervous system (CNS) depression, ataxia, confusion, tremor, seizures, agitation, and confusion. Some children who exhibited neurologic toxicity progressed to more severe CNS depression or coma.
Cardiovascular effects included tachycardia more frequently than bradycardia and hypotension more frequently than hypertension. Gastrointestinal symptoms consisted of vomiting, nausea, and abdominal pain. Ocular manifestations of acute toxicity involved mydriasis more than miosis, conjunctivitis, and nystagmus. Respiratory symptoms included respiratory depression and hyperventilation/tachypnea.
Symptom severity was rated as mild (75.9%), moderate (21.9%), or major (2.2%). Although no children died during the 5-year study period, trends in incidence of major severity of acute toxicity rose from 1.6% of cases during the pre-pandemic years (2017-2019) to 2.4% of cases during the pandemic (2020-2021). Moderate severity cases increased from 15.9% of pre-pandemic cases to 23.8% of cases during the pandemic. In contrast, mild severity cases or cases where the exposure had no effect on the child decreased between the pre-pandemic and post-pandemic years.
Approximately 573 (8.1%) of these 7043 children were admitted to critical care units, 1027 (14.6%) were admitted to noncritical care units, and 15.4% of cases received treatment outside of a health care facility. Around 25.6% of all cases either were lost to follow-up, left the facility against medical advice, or never presented to any facility for treatment.
Medical treatments administered included intravenous fluids, dilution/irrigation/washing, feeding, and oxygen therapy including intubation. Medications administered included naloxone, flumazenil, and charcoal.
Unintentional cannabis exposures in young children are increasing rapidly, the researchers acknowledged. “These exposures can cause significant toxicity and are responsible for an increasing number of hospitalizations,” they said.
They concluded that “Prioritizing prevention strategies such as changing product packaging and labeling, regulating the maximum allowable dose in a package, and increasing public education on mitigation of household risks are key in reducing these exposures.”
Results were limited to only pediatric cannabis exposures that were reported, suggestive of an underestimation of exposures in this age group. Additionally, results depended on accurate coding in the electronic medical records documented by the poison center staff. Other study limitations included lack of follow-up, incomplete data, and lack of assessment of variables such as decreased stigma associated with cannabis use that may have contributed to rise in rate of pediatric exposures.
Tweet MS, Nemanich A, Wahl M. Pediatric edible cannabis exposures and acute toxicity: 2017-2021. Pediatrics. Published online January 3, 2023. doi:10.1542/peds.2022-057761