Poison Center Reports of Cannabis Exposures among Children in Washington State, 2016

Abstract

Washington State began legal cannabis retail sales in 2014. Legalization of adult use cannabis and retail sales may result in more cannabis products in homes and opportunities for accidental exposures among young children. Consumption of cannabis by young children can result in significant adverse health effects. This study examined details of cannabis exposure events involving children under age 12 that were reported to the Washington State Poison Center (WAPC) during January – December 2016. Redacted charts were obtained from the WAPC “Toxicall” database. 50 eligible events were identified. Structured data were used to describe child age and gender and to obtain information about the involved products, route of administration, exposure setting, and clinical effects. Additional information about the exposure event was available in case notes; qualitative methods were used to develop themes and categorize the cases. Most exposure events (62%) were for children ages 0-2, and 26% were for ages 3-5. None of the exposures were reported as intentional. Of those where the source of the product could be determined (N=29) either a parent (n=20, 69%) or grandparent (n=6, 21%) was the most common source. Nearly all (94%) exposures occurred at the patient’s home and involved a single substance (90%). Of those that noted the type (N=13), 85% indicated that the cannabis was obtained for medical purposes. Most exposures were by ingestion (86%), and edibles were the most often reported form (52% of 41 cases with product specified). Nearly all edibles were brownies, cookies, and candies (96%). Baked goods were reported to be both homemade and purchased. Three cases were exposures to cannabidiol (CBD) among children being treated for seizures by their parents: one was the result of a therapeutic error, one an adverse reaction, and one an unintentional exposure. A single child was reported as exposed through breastmilk. Of those with known medical outcomes (N=33), nearly all caused no or minor clinical effects (78%), and nearly all had symptoms for less than 24 hours, most commonly lethargy and drowsiness (50%), but five children were hospitalized for non-critical care and one child with a history of seizures, who was given CBD oil containing THC, required intensive care and intubation. Risk for accidental exposures to cannabis among young children may be increasing as legal cannabis markets become more common. Although most exposures do not cause long-lasting harms, some children can experience significant harm requiring medical intervention. Caregivers of young children are advised to safely store cannabis products in the home so that they are out of reach of children, and to use caution and consult with a healthcare provider about use of cannabis products for medical treatment of a child or adult use while breastfeeding. Clinicians may play a role by screening for household cannabis use among parents and other caregivers, and advising about safe home practices. Continued regulatory approaches to limit exposure, such as limits on THC potency and single-serving packaging designs, may also be useful.