More children are ending up at hospital emergency departments after unintentionally ingesting marijuana following the modification of drug enforcement laws for marijuana possession in Colorado, says a new report published in JAMA Pediatrics.
Several U.S. states and Washington D.C. have passed laws decriminalizing medical marijuana. In Washington and Colorado laws have been amended to legalize the recreational use of marijuana. In 2009, federal prosecutors were told by the Justice Department not to arrest medical marijuana users and suppliers who were complying to state legislation.
As background information, the authors, from the Rocky Mountain Poison and Drug Center, Denver, explained that medical marijuana has higher levels of tetrahydrocannabinol (THC) than when used recreationally. They added that medical marijuana is sold in candies, soft drinks and baked goods.
George Sam Wang, M.D, and team set out to determine whether the number of children who sought care in a children’s hospital emergency department had changed since the drug enforcement laws regarding medical marijuana came into force in October 2009.
In that hospital’s emergency department, 1,378 children younger than 12 had been evaluated for unintentional ingestions – 790 before the new law came into force and 588 afterwards.
The authors wrote:
“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. Eight of the 14 cases involved medical marijuana, and 7 of these exposures came from food products.”
The majority of the children were boys, and were admitted or observed in the emergency department.
There is concern that parents/grandparents may not disclose their use of medical marijuana because of the perceived stigma associated with the drug. The authors wrote “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.”
Dr. Wang concluded:
“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 number of children suffering from medical marijuana poisoning is far lower than those poisoned by accidentally consuming adult prescription drugs. Hospital emergency rooms receive more childhood poisoning cases after ingesting adult prescription medications than car accident victims.
The findings revealed in this report reignite the controversy over whether/how legalized medical marijuana affects children and teenagers, Sharon Levy, M.D., M.P.H., from Harvard Medical School and Boston Children’s Hospital, wrote in an Accompanying Editorial.
Marijuana usage has been rising rapidly among American adolescents.
Dr. Levy wrote:
“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.”
William Hurley, M.D., from the University of Washington and Washington Poison Center and Suzan Mazor, M.D., from Seattle Children’s Hospital, wrote that legalizing recreational marijuana, particularly the solid and liquid-infused forms which are allowed in Washington, will provide kids with much greater access to drinks, brownies, candies, and cookies that contain marijuana.
Drs. Hurley and Mazor wrote “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.”
Healthcare professional need additional training in order to detect and manage these toxic reactions, especially doctors who work in:
- pediatric emergency medicine
- pediatric primary care
They concluded “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.”
Researchers at the University of Colorado School of Medicine reported in Child and Adolescent Psychiatry (August 2012 issue) that adolescents in substance abuse treatment commonly use “diverted” medical marijuana – marijuana that was recommended for somebody else.
Marijuana is a useful source of pain relief for patients with chronic conditions. A study published in CMAJ (May 2012 issue) reported that patients with multiple sclerosis experienced less pain and muscle tightness after taking marijuana. Prescription drugs are available for muscle tightness (spasticity), but they have side effects and do not always work.
Written by Christian Nordqvist