January 24, 2022
2 min read
In Canada, pediatric ED visits due to cannabis exposure significantly increased after recreational cannabis was legalized, according to recent data.
The website for the government of Canada states that the country legalized sales of fresh cannabis, dried cannabis, cannabis oil, cannabis seeds and cannabis plants in 2018. One year later, the sale of edible cannabis products, cannabis extracts and cannabis topicals was also legalized.
Reference: Myran DT, et al. JAMA Netw Open. 2022;doi: 10.1001/jamanetworkopen.2021.42521.
Daniel T. Myran, MD, MPH, a family physician and health services researcher within the clinical epidemiology program at the Ottawa Hospital Research Institute, and colleagues analyzed 81 cannabis exposure-related ED visits and hospitalizations prior to legalization (January 2016 to September 2018). They compared the prevalence of the visits with 124 cannabis exposure visits after the legalization of cannabis flower products (October 2018 to January 2020) and 317 visits after the legalization of commercial edibles, which also overlapped with the first year of the COVID-19 pandemic (February 2020 to March 2021). The patients either presented to the ED or were hospitalized in Ontario, Canada. Their mean age was 3.8 years, and 53.8% were boys.
The researchers reported in JAMA Network Open that, compared with the pre-legalization period, the incidence rate ratio [IRR] of cannabis exposure-related ED visits and hospitalizations was 3.13 (95% CI, 2.37-4.16) in October 2018 to January 2020 and 9.12 (95% CI, 7.15-11.65) in February 2020 to March 2021. After adjusting for an increasing time trend in ED visits caused by cannabis exposures throughout the study period, the increase in visits remained significantly higher in February 2020 to March 2021 (IRR = 2.23; 95% CI, 1.17-4.27).
Throughout the study period, 3.6% of the cannabis exposure-related ED visits and hospitalizations required an ICU admission; no deaths were recorded. The researchers also reported that their findings were sevenfold higher than rates reported in Colorado, where recreational cannabis sales were legalized in 2012 and began in 2014.
Daniel T. Myran
“Our study was limited by lack of data on the source and type of cannabis ingested, and it is possible that cannabis from illicit sources and nonedible products contributed to the increase in visits,” Myran and colleagues wrote. “Further regulatory measures, such as limiting formulations and appearance of commercial edibles, combined with education for parents and caregivers, may be required to decrease pediatric cannabis exposures.”
References
Collecting the history of marijuana legalization in Colorado. https://www.historycolorado.org/story/stuff-history/2019/04/19/collecting-history-marijuana-legalization-colorado. Accessed Jan. 20, 2022.
Myran DT, et al. JAMA Netw Open. 2022;doi: 10.1001/jamanetworkopen.2021.42521.
Regulations under the Cannabis Act. https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/laws-regulations/regulations-support-cannabis-act.html. Accessed Jan. 20, 2022.
The Cannabis Act: The Facts. https://www.canada.ca/en/health canada/news/2018/06/backgrounder-the-cannabis-act-the-facts.html. Accessed Jan. 20, 2022.
Perspective
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Christian Thurstone, MD
The clinical implications of this study are that physicians must have conversations with families and parents about keeping all chemicals and medicines locked up; we need to have a similar conversation around marijuana. For parents of toddler-aged children, that means keeping it out of reach. For parents of adolescents, that means not keeping it in the house or making sure it is secured, because just as you do not want your own children accessing marijuana, you do not want their friends accessing it ether. The paper also notes that there were some children who were admitted to ICU for marijuana ingestion. So, the bottom line is that marijuana ingestion, especially by toddlers, is very serious and something not to be taken lightly.
Most of the data that the authors cite from Colorado came from one children’s hospital in one metro area as opposed to a whole health system, as was the case in the study by Myran and colleagues. Colorado also has marijuana products that appeal to young people. For example, we have candy, candy bars and gummy squares that are infused with cannabis. I was pushing for everything to be in child-resistant packaging, but that was thought to be a little onerous and too expensive. I was also pushing for plain brown packaging that would not have cartoons and bright colors on it that might appeal to young people and grab their attention. However, that was something Colorado did not opt to do.
Christian Thurstone, MD
Director of behavioral health, Denver Health
Associate professor of psychiatry, University of Colorado, Denver
Disclosures: Thurstone reports no relevant financial disclosures.
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