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Emergency department visits for child poisoning increased ninefold after cannabis legalization

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Ontario saw nine times more emergency department (ED) visits per month for cannabis poisoning in young children under the age of 10 after Canada legalized recreational cannabis, according to a study published in JAMA Network is open. While individual hospitals have reported cases of cannabis poisoning of children before, this is the first study looking at an entire region.

“We have seen more frequent and severe visits to ED due to cannabis poisoning in children under the age of 10 following the legalization of cannabis, and the legalization of edible cannabis products appears to be the main factor,” said lead author Dr. Daniel Miran, MD, a family physician. Specialist in Public Health and Preventive Medicine, and Postdoctoral Fellow at The Hospital of Ottawa and the Department of Family Medicine at the University of Ottawa.

The research team considered all emergency department visits in Ontario during three periods; Pre-certification, following the legalization of cannabis flower products and oils in October 2018, and following the legalization of commercial cannabis (such as gum and chocolate) and other products and becoming available for sale in late January 2020.

During the entire study period (January 2016 to March 2021), there were 522 ED visits to cannabis poisoning for children under the age of 10. The average age of these children was three years and nine months.

While there were no deaths, 171 (32.7%) visit required hospitalization and 19 visits (3.6%) required admission to the intensive care unit (ICU). ED visits to cannabis intoxication increased more after legalizing commercial foods, and more of these visits required hospitalization than the other two periods (39% vs. 25%).

Results:

Pre-certification (January 2016 – September 2018)

  • Total emergency department visits: 81
  • Average monthly emergency department visits: 2.5
  • Percentage of emergency department visits admitted to hospital: 25%

Legalization of hemp flower, seed and oil (October 2018 – January 2020)

  • Total emergency department visits: 124
  • Average monthly emergency department visits: 7.8
  • Average monthly emergency department visits increased compared to pre-certification: 3 times
  • Percentage of emergency department visits admitted to hospital: 24%

Legalization of foodstuffs and other products (February 2020 – March 2021)

  • Total emergency department visits: 317
  • Average monthly emergency department visits: 22.6
  • Average monthly emergency department visits increased compared to prior approval: 9 times
  • Percentage of emergency department visits admitted to hospital: 39%

Researchers note that cannabis legalization in Canada is interfering with the COVID-19 pandemic. They found that while emergency department visits for child poisoning cases of any kind decreased in Ontario during the epidemic, visits for cannabis poisoning cases increased during this time. After commercial foods became available, nearly 10% of all pediatric poisoning ED visits in Ontario were related to cannabis.

Canada’s approach to legislation was intended to prevent an increase in cases of cannabis poisoning in children through policies that limit the power of cannabis eaters, and require child-resistant packaging and education for parents and caregivers. Unfortunately, the rates we saw in our study indicate that the approach did not achieve this goal.”

Dr.. Daniel Miran, lead author

“As more places around the world are considering legalizing recreational cannabis use, we need to learn how to better protect children from cannabis poisoning,” said Dr. Miran. “More education is a start, but we may need to consider other measures to reduce the appeal of edible cannabis to young children, such as stricter restrictions on what food can look and taste after it has been removed from its packaging.”

If your child accidentally ingests cannabis, call the Ontario Poison Control Center at 1-800-268-9017. Cannabis poisoning in infants, children, and young adults is a medical emergency. Call 9-1-1 if your child is sick and/or has trouble breathing. Caregivers can prevent poisonings by keeping cannabis products in a closed container away from other foods and beverages, and out of the reach of children. Learn more about the dangers of cannabis and how to prevent accidental poisoning.

Researchers at ICES, the Bruyère Research Institute, the Canadian Center on Drug Abuse and Addiction and the Hospital for Sick Children (SickKids) also contributed to the study.

Source:

Miran, D.T., et al. (2022) Cases of unintentional exposure to cannabis in children after legalization of recreational cannabis in Canada. JAMA Network is open. doi.org/10.1001/jamanetworkopen.2021.42521.

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