Cannabis “Poisonings” in Children Increased Ninefold After Edibles Were Legalized in Canada, Study Finds
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The rates of children visiting emergency department (ED) due to an unintentional cannabis exposure increased by nine times in Ontario following the legalization of cannabis edibles, new analysis from the Ottawa Hospital Research Institute has found.
The research, published in JAMA Network Open, also noted that while ED visits for pediatric poisonings of any kind decreased following the advent of the coronavirus pandemic, visits for cannabis-related exposures continued to increase. After commercial edibles became legally available in 2019, cannabis-related exposures were seen to be responsible for nearly 10 percent of all ED visits for poisonings in Ontario.
The researchers suggest that more education programs targeted at parents and caregivers could help to curb this rise in cannabis “poisoning” incidents in children. Introducing even stricter limits on edible packaging and appearance should also be considered, even if Canada’s existing edibles regulations “largely exceed US regulations”, according to the researchers.
Emergency department visits rise after legalization of flower and edible products
For this analysis, the researchers looked at all ED visits recorded in Ontario between January 1, 2016, and March 31, 2021. These data were further broken down into three key time periods: pre-legalization, after the legalization of flower and cannabis oil products in October 2018, and in January 2020, after the legalization of cannabis edible products.
Across this time period there were a total of 522 ED visits related to cannabis poisoning for children under 10 years old. The average age of the children visiting the ED was three years and nine months. No deaths were reported due to unintentional cannabis exposure, though 171 cases (32.7 percent) would require hospitalization and 19 visits (3.6 percent) resulted in admission to an intensive care unit.
Significant jumps in the average number of monthly ED visits related to cannabis exposure in young children were observed following each legalization event. After the legalization of flower and oil products, the average grew from 2.5 visits per month pre-legalization to 7.8 visits per month, a three-fold increase.
Following the legalization of edibles in Canada, the average monthly ED visits related to cannabis exposure jumped to 22.6 visits per month, approximately nine times greater than the levels seen pre-legalization. It was also noted that a higher percentage of visits ended in hospitalization during the post-edibles legalization period, as compared to the two other timeframes.
“We saw more frequent and severe ED visits due to cannabis poisoning in children under 10 following the legalization of cannabis, and the legalization of edible cannabis products appears to be a key factor,” lead author Dr Daniel Myran, and a postdoctoral fellow at the Ottawa Hospital and the University of Ottawa Department of Family Medicine, said in a statement.
This study is the first of its kind to look at changes in unintentional pediatric cannabis exposures across an entire region; previous research in the field was limited to observing individual hospitals. In the research letter, the authors of the most recent study write that “these population-level findings suggest that prior work from single centers may have underestimated the burden associated with pediatric cannabis exposures.”
Increases observed despite strict rules on child proofing
Canada’s decision to stagger its legalization of cannabis products was a unique one. By waiting a year from the legalization of smokables and oil products to legalize edibles, the Canadian government was able to launch public consultations and develop a new set of regulations that could be made to suit the edibles market while the wider cannabis industry was already beginning to develop in the country.
Speaking to Analytical Cannabis in 2019, Steve Rolles, a senior policy analyst at Transform Drugs Policy Foundation, praised this staggered approach. “I worked as an advisor for the federal task force [charged with implementing legalization] and we actually suggested the two-phase rollout,” he said, “because edibles and concentrates involve a different set of regulatory challenges.”
“I think that was wise. Regulating foods that contain drugs is not something that the Canadian government or any government has a great deal of experience with. It’s quite a novel concept.”
The result of this approach was a suite of regulations that explicitly sought to child-proof the edibles market. Child-resistant packaging would be required for all products, with the added requirement that the appearance of these products must not be “appealing to youth,” in packaging or in the physical appearance of the product. The government also imposed an upper limit on the amount of THC a single serving of an edible product could contain, a decision that would appear more relevant following the publication of research in 2020 highlighting the increased risks of cannabis overconsumption presented by edible products.
“Canada’s approach to legalization was intended to prevent increases in child cannabis poisonings through policies limiting the strength of cannabis edibles, requiring child resistant packaging and education for parents and caregivers,” said Dr Myran. “Unfortunately, the rates we saw in our study suggest the approach has not met that goal.”
Due to the nature of the source data in this study, the researchers were not able to determine the source, legality, or the type of the cannabis products ingested in these unintentional exposure incidents. The legal cannabis market in Ontario itself has also expanded rapidly since the legalization of edible products, and so this may have had an effect on the figures recorded in the study.
“As more places around the world consider legalizing recreational cannabis, we need to learn how to better protect children from cannabis poisoning,” Dr Myran said. “More education is a start, but we may need to consider other measures to reduce cannabis edibles’ appeal to young children, such as much stricter limits on what edibles can look and taste like after they are removed from their packaging.”
In the event of a child accidentally consuming cannabis, the Ontario Poison Control Centre can be contacted at 1-800-268-9017.