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Cannabis Abuse and Misuse Is On the Rise, Study Suggests

By Alexander Beadle

Published: Dec 12, 2022   
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Cases of intentional cannabis misuse and abuse among school-aged children and adolescents have grown by nearly 250% since the year 2000, a new study of US poison control data has found.

Published in Clinical Toxicology, the study identified more than 338,000 instances of intentional abuse or misuse of substances among children aged 6 to 18. The researchers from the Oregon Health and Science University (OHSU) found that cannabis has overtaken alcohol in recent years as the substance with the highest number of annual misuse/abuse cases.

Of particular concern are edible cannabis products, they say, which may be marketed in ways that make them more attractive to youth.

Study finds upward trend in cannabis exposures

To learn more about substance misuse and abuse behavior among school-aged children and adolescents, the researchers examined cases involving youth that were reported to the US National Poison Data System between the years 2000 and 2020.

Here, intentional misuse was defined as exposure resulting from the incorrect use of a substance for reasons other than intoxication. Intentional abuse cases were exposures in which a substance was improperly or incorrectly used while the individual was likely attempting to gain a “high” or similar from using the substance recreationally.

The researchers observed that overall reports of substance misuse/abuse fluctuated across the two decades, reaching a peak in 2011. However, cases of cannabis exposure rose consistently across the study period. By 2018, cannabis was the substance involved in the most abuse/misuse cases reported to poison control, beating out both alcohol and the active ingredient in cough syrup, dextromethorphan (DXM).

A total of 510 cannabis exposure cases were recorded in 2000, compared to 1,761 in 2020 – a 245% increase over those 20 years. Cannabis exposures also had the highest monthly increase in cases overall, followed by CBD, diphenhydramine (antihistamines), nicotine e-cigarettes, and benzodiazepines.

Edibles are of particular concern

Looking at the method of exposure recorded for each cannabis case, the researchers found that cannabis edibles had the highest average monthly increase in call rates over the study period, compared to other forms of cannabis.

Collectively, edible-related cannabis poisoning reports increased by 11.7 cases per month from 2000 to 2020. In the age 10-12 demographic, dried plant cannabis had the second-highest monthly average increase; cannabis concentrates had the second-highest increase among the age 13-15 and 16-18 age groups.

“Our study describes an upward trend in marijuana abuse exposures among youth, especially those involving edible products,” lead author Adrienne Hughes, assistant professor of emergency medicine in the OHSU School of Medicine, said in a statement.

“This information is important because it will allow researchers to better understand the trends and make recommendations to improve clinical care and interventions aimed at reducing substance misuse among youth.”

“These edible and vaping products are often marketed in ways that are attractive to young people, and they are considered more discrete and convenient,” Hughes continued. “These findings highlight an ongoing concern about the impact of rapidly evolving cannabis legalization on this vulnerable population.”

Interestingly, the upward trend in cannabis cases – regardless of consumption method – contrasts rather starkly with a continued decline in ethanol (alcohol) cases. According to the study, reports of cannabis abuse/misuse first overtook alcohol-related cases in 2014 and, ever since then, the number of cannabis exposure cases has exceeded the number of alcohol-related ones by a larger margin every year.

Cannabis poisonings are on the rise post-legalization

This is not the first study to suggest that accidental cannabis-related “poisonings” and intentional misuse/abuse cases are on the rise.

Another recent study of calls to US poison centers between 2017 and 2019 also found that cannabis exposure cases were increasing year-on-year, with the cannabis flower being the most commonly cited cause for impairment. This was followed by edibles, concentrates, and vape liquids, in that order. Interestingly, the study found that most of the incidents involving cannabis flower also involved a second substance, such as alcohol.

In Canada, emergency department visits from children relating to unintentional cannabis exposure increased ninefold in Ontario following the nationwide legalization of edible cannabis products. This increase occurred despite the strict regulations on edibles set out by Health Canada, which states that products must be packaged in child-resistant containers. The guidance on product packaging also prohibits the use of fluorescent colors that might attract young people, and requires that prominent warning labels be displayed on exterior packaging.

And it’s not just humans who need to be protected from this apparently heightened risk of unintentional ingestion after cannabis legalization. A recent survey of more than 200 veterinarians from the US and Canada found that the number of cannabis-related poisoning events in pets has also increased since 2018. While these cannabis toxicosis cases were largely minor and could be treated as outpatient cases, the study did highlight a need for better diagnostic equipment to detect accidental cannabis exposure in pets.


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