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Characterization of edible marijuana product exposures reported to United States poison centers.
Clin Toxicol (Phila). 2016 Nov; 54(9):840-846.CT

Abstract

CONTEXT

Edible marijuana products are sold as brownies, cookies, and candies, which may be indistinguishable from counterparts without marijuana and are palatable to children and adults. The consumption of an entire product containing multiple dose-units may result in overdose.

OBJECTIVE

To characterize edible marijuana exposures reported to US poison centers with subgroup analysis by age.

METHODS

We analyzed single substance, human exposure calls coded to marijuana brownies, candies, cookies, beverages, or other foods reported to the National Poison Data System from January 2013 to December 2015. Calls were analyzed by state, age, gender, exposure route, clinical effect, therapies, and level of healthcare facility utilization.

RESULTS

Four-hundred and thirty calls were reported: Colorado (N = 166, 1.05/100,000 population/year) and Washington (96, 0.46) yielded the highest number of exposures. Three hundred and eighty-one (91%) calls occurred in states with decriminalized medical/recreational marijuana. The number of calls increased every year of the study. The most common age groups were: ≤5 years (N = 109, 0.15/100,000 population/year) and 13-19 (78, 0.09). The most frequent clinical effects were drowsiness/lethargy (N = 118, percentage = 43%), tachycardia (84, 31%), agitated/irritable (37, 14%), and confusion (37, 14%). Children ≤5 years have more drowsiness/lethargy, ataxia, and red eye/conjunctivitis. No deaths were reported. The most common therapies administered were intravenous fluids (85, 20%), dilute/irrigate/wash (48, 11 %), and benzodiazepines (47, 11%). Three patients (ages 4, 10, and 57 years) received intubation. 97 (23%), 217 (50%), and 12 (3%) calls were managed at home, treated/released, admitted to a critical care unit, respectively.

DISCUSSION

Although most clinical effects are minor, ventilatory support may be necessary for children and adults. We speculate the increasing exposures may be related to a combination of delayed absorption kinetics of Δ9-tetrahydrocannablnol, lagging packaging regulations, increased accessibility in decriminalized states, and increased familiarity of poison center specialists with edible product codes.

CONCLUSIONS

Edible marijuana exposures are increasing and may lead to severe respiratory depression.

Authors+Show Affiliations

Cao D
a Department of Emergency Medicine , University of Texas Southwestern Medical Center , Dallas , TX , USA.
Srisuma S
b Ramathibodi Poison Center, Division of Clinical Pharmacology and Toxicology, Department of Medicine , Ramathibodi Hospital, Mahidol University , Bangkok , Thailand.
Bronstein AC
c Hawaii Department of Health, Emergency Medical Services Injury Prevention System Branch , Honolulu , HI , USA. d Denver Health and Hospital Authority, Rocky Mountain Poison and Drug Center , Denver , CO , USA. e Department of Emergency Medicine , University of Colorado School of Medicine at Anschutz Medical Center , Aurora , CO , USA.
Hoyte CO
d Denver Health and Hospital Authority, Rocky Mountain Poison and Drug Center , Denver , CO , USA. e Department of Emergency Medicine , University of Colorado School of Medicine at Anschutz Medical Center , Aurora , CO , USA.

MeSH

AdolescentAdultAge DistributionCannabisChildChild, PreschoolDronabinolDrug OverdoseFemaleFoodHumansMalePoison Control CentersRetrospective StudiesUnited StatesYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27418198

Citation

Cao, Dazhe, et al. "Characterization of Edible Marijuana Product Exposures Reported to United States Poison Centers." Clinical Toxicology (Philadelphia, Pa.), vol. 54, no. 9, 2016, pp. 840-846.
Cao D, Srisuma S, Bronstein AC, et al. Characterization of edible marijuana product exposures reported to United States poison centers. Clin Toxicol (Phila). 2016;54(9):840-846.
Cao, D., Srisuma, S., Bronstein, A. C., & Hoyte, C. O. (2016). Characterization of edible marijuana product exposures reported to United States poison centers. Clinical Toxicology (Philadelphia, Pa.), 54(9), 840-846.
Cao D, et al. Characterization of Edible Marijuana Product Exposures Reported to United States Poison Centers. Clin Toxicol (Phila). 2016;54(9):840-846. PubMed PMID: 27418198.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characterization of edible marijuana product exposures reported to United States poison centers. AU - Cao,Dazhe, AU - Srisuma,Sahaphume, AU - Bronstein,Alvin C, AU - Hoyte,Christopher O, Y1 - 2016/07/15/ PY - 2016/7/16/pubmed PY - 2017/3/1/medline PY - 2016/7/16/entrez KW - Epidemiology KW - poison center KW - toxicity SP - 840 EP - 846 JF - Clinical toxicology (Philadelphia, Pa.) JO - Clin Toxicol (Phila) VL - 54 IS - 9 N2 - CONTEXT: Edible marijuana products are sold as brownies, cookies, and candies, which may be indistinguishable from counterparts without marijuana and are palatable to children and adults. The consumption of an entire product containing multiple dose-units may result in overdose. OBJECTIVE: To characterize edible marijuana exposures reported to US poison centers with subgroup analysis by age. METHODS: We analyzed single substance, human exposure calls coded to marijuana brownies, candies, cookies, beverages, or other foods reported to the National Poison Data System from January 2013 to December 2015. Calls were analyzed by state, age, gender, exposure route, clinical effect, therapies, and level of healthcare facility utilization. RESULTS: Four-hundred and thirty calls were reported: Colorado (N = 166, 1.05/100,000 population/year) and Washington (96, 0.46) yielded the highest number of exposures. Three hundred and eighty-one (91%) calls occurred in states with decriminalized medical/recreational marijuana. The number of calls increased every year of the study. The most common age groups were: ≤5 years (N = 109, 0.15/100,000 population/year) and 13-19 (78, 0.09). The most frequent clinical effects were drowsiness/lethargy (N = 118, percentage = 43%), tachycardia (84, 31%), agitated/irritable (37, 14%), and confusion (37, 14%). Children ≤5 years have more drowsiness/lethargy, ataxia, and red eye/conjunctivitis. No deaths were reported. The most common therapies administered were intravenous fluids (85, 20%), dilute/irrigate/wash (48, 11 %), and benzodiazepines (47, 11%). Three patients (ages 4, 10, and 57 years) received intubation. 97 (23%), 217 (50%), and 12 (3%) calls were managed at home, treated/released, admitted to a critical care unit, respectively. DISCUSSION: Although most clinical effects are minor, ventilatory support may be necessary for children and adults. We speculate the increasing exposures may be related to a combination of delayed absorption kinetics of Δ9-tetrahydrocannablnol, lagging packaging regulations, increased accessibility in decriminalized states, and increased familiarity of poison center specialists with edible product codes. CONCLUSIONS: Edible marijuana exposures are increasing and may lead to severe respiratory depression. SN - 1556-9519 UR - https://www.unboundmedicine.com/medline/citation/27418198/Characterization_of_edible_marijuana_product_exposures_reported_to_United_States_poison_centers_ DB - PRIME DP - Unbound Medicine ER -