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Pediatric exposure to cannabis is a growing public health concern. With increasing legalization and decriminalization of recreational and medicinal marijuana across states, there is a growing number of unintentional pediatric exposures to cannabis as well as intentional use and abuse of cannabis by adolescents and young adults.1 Cannabis is the most commonly used recreational drug in the United States and adolescents age 12 to 17 years are the third highest percentage of consumers.2 Pediatricians should be prepared to treat and prevent unintentional ingestion in small children as well as chronic effects of prolonged adolescent use.3
With improved agricultural techniques and increased sophistication of strain development, cannabis has increased in potency4 and, at the same time, there is a decreased perception of risk.5 Delta-9-tetrahydrocannabinol (THC), the psychoactive ingredient in the cannabis plant, is the usual measure of potency. According to the Drug Enforcement Administration's seizure data, in 2021, cannabis averaged more than 15% THC content compared with only 3% in 1995.6 In addition to the increased potency of the smoked and inhaled flower portion of the plant, other forms, such as vaping, THC concentrates or extracts, topical preparations, and edibles, have also increased and are available in dispensaries and in community markets.
Individuals who use cannabis may use any of the above forms through inhalation and ingestion or transcutaneous, rectal, or vaginal routes. Contrary to popular belief, the use of marijuana can be highly addictive, and smoking marijuana has the highest addictive potential because of the rapid and effective delivery of the lipophilic compound, THC, to the brain.7
The most common cause of poison center cases and emergency department visits for unintentional pediatric exposures is due to edible ingestion.7–9 There are also increasing numbers of teenagers seen in the emergency department with severe psychiatric changes or abdominal pain and refractory vomiting from cannabis hyperemesis syndrome (CHS).
Cannabis Edible Toxicity
Unintentional Ingestions in Children
Young children are at high risk for accidental ingestion of edible marijuana.3 Often these products are in attractive packaging and sold as gummies, candy, baked goods, chips, or other treats. THC edible products are often available in packaging that is similar to well-known commercial food products, which increases the risk of accidental ingestion...