Laws legalizing marijuana throughout the United States have made the drug more accessible for adults for recreational and medicinal purposes. But that means marijuana-infused edibles are also more likely to fall into the hands of young children.
Two recent cases highlight the prevalence of these products: Seven students at a junior high school in Prince George’s County, Virginia, got sick last month after eating candies infused with THC, the main compound in marijuana. Also last month, a D.C. middle school student brought an edible to school and shared it with several classmates. At least one was sent to the hospital.
Such cases have spiked at the same time as the number of states that allow adult recreational cannabis use has more than doubled, with the potential for rare but serious health consequences. As a result, experts say safe storage of cannabis products and limits on packaging that uses bright colors and cartoon characters are critical to making them less enticing to young children.
“Legal for adults doesn’t mean legal or safe for children. And if you are going to have cannabis products in the home, it’s imperative that it gets stored safely,” said Caleb Ward, a pediatrician who sees patients in the Children’s National Hospital emergency departments in Northwest Washington and at Cedar Hill Regional Medical Center GW Health.
Most exposures occur at home. Experts recommend products be kept locked in a location secret from children — outside the kitchen and away from other food items to reduce the chance that children mistake them for food.
There are no federal packaging laws for edibles as there are for tobacco and alcohol. But several states, including Maryland, require plain packaging, child-resistant seals or warning labels, according to an industry tracker.
Sean G. Morgan, acting medical director at D.C. Fire and EMS, said the department in recent years has seen an increase in 911 calls after young children and teens have ingested the products, although data specific to cannabis was not available.
“People don’t feel that it’s an illicit drug, like cocaine or heroin,” he said in an interview. “These in overdose generally aren’t lethal as comparison to other illicit drugs.”
But he cautioned parents to treat edibles as they would any drug, especially as products become more widely accessible.
“Before, these products were being made in the home,” Morgan said. “Now there’s dispensaries where you can buy things, and so there are more products ultimately available, and that’s probably why we’re seeing an uptick as well.”
Local cases anecdotally are in line with national trends. Reported exposures nationwide spiked from 207 in 2017 to 3,054 cases in 2021, a 15-fold increase in just four years, according to a 2023 study in the journal Pediatrics, which analyzed National Poison Data System data for children age 5 and younger.
During roughly the same time frame, the number of states allowing adult recreational use more than doubled from eight to 18, and the number allowing medical cannabis increased from 30 to 39, the study shows. The numbers include D.C.
Researchers have not determined whether decreased stigma surrounding cannabis use could have contributed to the increase in exposures.
But anecdotally, Ward said he has observed a marked increase in cases during his decade at Children’s National. He typically sees two types: teenagers who use edibles deliberately and young children who have mistaken edibles for harmless treats.
In general, these children may look sleepier than usual, have slurred speech or difficulty walking. In severe cases they can develop more significant neurological complications such as seizures, or paranoia or psychosis, although those symptoms are difficult to identify in very young children, he said.
Breathing can be slow or irregular, and in the most severe cases children could stop breathing and require intubation or a breathing tube, he said.
When there’s seemingly no explanation for symptoms, providers have to do some investigating to consider whether the child ingested a drug. The most common drug of concern is cannabis, Ward said.
The presence of cannabis can be confirmed by a urine drug test, but providers say they need to know up front about potential exposures to treat children safely and effectively. Families may not know a child had access to weed-infused edibles. If they know a child was at risk for exposure, they may be reticent to share it because they worry about legal liability.
Studies show people of color are more likely to be flagged for child protective services after a positive drug exposure in the emergency department, and clinicians are mandated reporters if they worry a child is being mistreated.
But Ward said clinicians take into consideration the severity of the case — if the patient was intubated or admitted to intensive care, for example — and whether there was repeated exposure.
“It’s certainly not my clinical practice that every single case of this is being referred to child protective services, and I do try to be mindful of the systemic inequities in the system,” he said.
In addition, not every child exposed to cannabis products must be taken to the emergency room. Parents’ first call should be to their child’s pediatrician or the local poison control center. A visit to the emergency department would be necessary if the child is very hard to wake up, unable to eat or drink, or has shallow or irregular breathing, Ward said.
In the Pediatrics study, fewer than one-quarter of patients, or 23 percent, were admitted to the hospital.
Unlike new forms of synthetic drugs such as opioids, cannabis is not new. But providers may not have been accustomed to seeing cases in young children until now.
“What’s new here is the prevalence of it and how common it might be,” Ward said. “It’s higher up my list of things I’d think about as a possible diagnosis than it was 10 years ago.”
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