Increase in unintentional marijuana ingestion among children following new drug laws in Colorado

Following modification of drug enforcement laws for possession of marijuana in Colorado, there was an apparent increase in unintentional marijuana ingestions by young children, according to a report and accompanying editorials published Online First by JAMA Pediatrics, a JAMA Network publication.

Several states and Washington, D.C. have enacted laws to decriminalize medical marijuana and two states, Colorado and Washington, have passed amendments to legalize the recreational use of marijuana. In late 2009, the Justice Department issued a policy instructing federal prosecutors not to seek arrest of medical marijuana users and suppliers, if they were complying by state laws. According to background information in the study, 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 note.

George Sam Wang, M.D, from the Rocky Mountain Poison and Drug Center, Denver, and colleagues compared the proportion of marijuana ingestions by young children who sought care in a children's hospital emergency department 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 years of age were evaluated for unintentional ingestions: 790 patients before September 30, 2009 and 588 patients after October 1, 2009.

"The proportion of ingestion visits in patients younger than 12 years (age range 8 months to 12 years) that were related to marijuana exposure increased after September 30, 2009, from 0 of 790 to 14 of 588," the authors report. "Eight of the 14 cases involved medical marijuana, and 7 of these exposures came from food products." The authors note most of the children were male and were admitted to or observed in the emergency department. "Because of a perceived stigma associated with medical marijuana, families may be reluctant to report its use to health care providers. 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," the authors conclude. (JAMA Pediatr. Published online May 27, 2013. doi:10.1001/jamapediatrics.2013.140. Available pre-embargo to the media at http://media.jamanetwork.com.)

In an accompanying editorial, Sharon Levy, M.D., M.P.H., from Harvard Medical School and Boston Children's Hospital, writes that "the finding reignites the debate over whether and how legalized marijuana impacts children and adolescents."

Dr. Levy reports that 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."

(JAMA Pediatr. Published online May 27, 2013. doi:10.100/jamapediatrics.2013.2270. Available pre-embargo to the media at http://media.jamanetwork.com).

"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," write William Hurley, M.D., from the University of Washington and Washington Poison Center and Suzan Mazor, M.D., from Seattle Children's Hospital.

"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 state. The authors recommend additional training for emergency medicine, pediatric emergency medicine and primary care pediatric physicians to recognize and manage these toxic reactions.

"Methods to prevent accidental exposures to marijuana need to be studied for efficacy and progressively developed. Parents and providers should be encouraged to call the Poison Center for data collection, information, education, and management advice," the authors conclude.

(JAMA Pediatr. Published online May 27, 2013. doi: 10.1001/jamapediatrics.2013.2273. Available to the media pre-embargo at http://media.jamanetwork.com.)

Editor's Note: Please see articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.