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Original Investigation |

Pediatric Marijuana Exposures in a Medical Marijuana State

George Sam Wang, MD1; Genie Roosevelt, MD, MPH2; Kennon Heard, MD1
[+] Author Affiliations
1Rocky Mountain Poison and Drug Center, Denver Health, Denver, Colorado
2Department of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine, Aurora
JAMA Pediatr. 2013;167(7):630-633. doi:10.1001/jamapediatrics.2013.140.
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Importance  An increasing number of states are decriminalizing the use of medical marijuana, and the effect on the pediatric population has not been evaluated.

Objective  To compare the proportion of marijuana ingestions by young children who sought care at a children’s hospital in Colorado before and after modification of drug enforcement laws in October 2009 regarding medical marijuana possession.

Design  Retrospective cohort study from January 1, 2005, through December 31, 2011.

Setting  Tertiary-care children’s hospital emergency department in Colorado.

Participants  A total of 1378 patients younger than 12 years evaluated for unintentional ingestions: 790 patients before September 30, 2009, and 588 patients after October 1, 2009.

Main Exposure  Marijuana ingestion.

Main Outcomes and Measures  Marijuana exposure visits, marijuana source, symptoms, and patient disposition.

Results  The proportion of ingestion visits in patients younger than 12 years (age range, 8 months to 12 years)that were related to marijuana exposure increased after September 30, 2009, from 0 of 790 (0%; 95% CI, 0%-0.6%) to 14 of 588 (2.4%; 95% CI, 1.4%-4.0%) (P < .001). Nine patients had lethargy, 1 had ataxia, and 1 had respiratory insufficiency. Eight patients were admitted, 2 to the intensive care unit. Eight of the 14 cases involved medical marijuana, and 7 of these exposures were from food products.

Conclusions and Relevance  We found a new appearance of unintentional marijuana ingestions by young children after modification of drug enforcement laws for marijuana possession in Colorado. The consequences of unintentional marijuana exposure in children should be part of the ongoing debate on legalizing marijuana.

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Figure.
Colorado Department of Public Health and Environment’s Marijuana Registry

New patient applications for medical marijuana cards and patients who possessed valid registry cards in Colorado, from January 1, 2009, through December 31, 2011.

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De-criminalization of Cannabis - Potential Risks for Children
Posted on June 18, 2013
Israel Amirav, Anthony Luder
Pediatric Department, Ziv Medical Center, Bar Ilan University, Safed, Israel
Conflict of Interest: None Declared
We would like to draw the reader's attention to our cautionary report in 2010 regarding the "risks of childhood exposure in the light of the legalization of cannabis for medical purposes and its greater availability" (Amirav et al). Following a case of infantile coma due to cannabis ingestion, we specifically cautioned about the consequences of legalization. We have concluded our report and suggested that "Legalization of cannabis use may lead to increasing childhood exposure, but reporting may be reduced because of de-criminalization. Large-scale prospective studies may provide insight into the potential risks associated with the current trend regarding access to cannabis."The current study published in JAMA Pediatrics confirms our concern (Wang et al). As childhood cannabis exposure may also occur when caretakers are careless because of their own acute intoxication, or withdrawal from drugs or alcohol (Duncan et al), we believe that it will be important to build on published data with a view toward examining possible implications for child abuse. References:Wang GS, Roosevelt G, Heard K. Pediatric marijuana exposures in a medical marijuana state [published online May 27, 2013]. JAMA PediatrAmirav I, Viner Y, Luder AS, Finkel M. De-criminalization of Cannabis - Potential Risks for Children? Acta Pediatrica doi: 10.1111/j.1651-2227.2010.02081.x. Epub 2010 Dec. Duncan AE, Sartor CE, Scherrer JF, Grant JD, Heath AC, Nelson EC, et al. The association between cannabis abuse and dependence and childhood physical and sexual abuse: evidence from an offspring of twins design. Addiction 2008;103: 990–7.
risks of childhood exposure in the light of the legalization of cannabis
Posted on July 29, 2013
Israel Amirav, Anthony Luder
Faculty of Medicine, Bar Ilan University, Safed, Israel
Conflict of Interest: None Declared
We would like to draw the reader's attention to our cautionary report in 2010 regarding the "risks of childhood exposure in the light of the legalization of cannabis for medical purposes and its greater availability" (Amirav et al). Following a case of infantile coma due to cannabis ingestion, we specifically cautioned about the consequences of legalization. We have concluded our report and suggested that "Legalization of cannabis use may lead to increasing childhood exposure, but reporting may be reduced because of de-criminalization. Large-scale prospective studies may provide insight into the potential risks associated with the current trend regarding access to cannabis."The current study published in JAMA Pediatrics confirms our concern (Wang et al.). As childhood cannabis exposure may also occur when caretakers are careless because of their own acute intoxication, or withdrawal from drugs or alcohol (Duncan et al.), we believe that it will be important to build on published data with a view toward examining possible implications for child abuse. References:Wang GS, Roosevelt G, Heard K. Pediatric marijuana exposures in a medical marijuana state [published online May 27, 2013]. JAMA PediatrAmirav I, Viner Y, Luder AS, Finkel M. De-criminalization of Cannabis - Potential Risks for Children? Acta Pediatrica doi: 10.1111/j.1651-2227.2010.02081.x. Epub 2010 Dec. Duncan AE, Sartor CE, Scherrer JF, Grant JD, Heath AC, Nelson EC, et al. The association between cannabis abuse and dependence and childhood physical and sexual abuse: evidence from an offspring of twins design. Addiction 2008;103: 990–7.
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