More Pot-Linked Poisoning Cases as Edibles' Popularity Booms
Newfangled marijuana products -- edibles, concentrates, vapes -- are driving an overall increase in pot-related calls to U.S. poison control centers, a new study shows.
There were more than 11,100 calls related to marijuana use in 2019, up from about 8,200 in 2017, researchers said.
More and more of those calls are related to manufactured products that contain distilled amounts of THC, CBD and other chemicals found in cannabis.
"We saw this generalized increase in calls nationally," said lead researcher Julia Dilley, an epidemiologist with the Oregon Public Health Division in Portland.
"But when we dug into it, that increase is being driven by these manufactured products," Dilley continued. "Flower cannabis exposure calls are actually declining."
Pot plant exposures made up the bulk of calls to centers in 2017, with 7,146 pertaining to marijuana plants and just 1,094 related to manufactured products. But by 2019, calls related to manufactured products totaled 5,503 while pot plant exposure prompted 5,606 calls.
The findings were published May 24 in the journal JAMA Network Open.
Manufactured products tend to contain large amounts of THC, the chemical in pot plants that causes intoxication, and these numbers show that they pose a greater risk for causing a bad reaction.
More than 81% of calls related to manufactured products came from people using those products on their own, not in combination with alcohol or some other substance, Dilley noted.
"It only took the cannabis product exposure to be serious enough that there was some sort of help needed," Dilley said.
Poisoning hazards rise
On the other hand, only 38% of pot plant use calls came from using marijuana alone. "They were more often using it with alcohol or some other substance in the mix," Dilley said.
Edibles make up the greatest share of poison control calls related to manufactured products, accounting for just over half of the exposures.
And "edible product exposures are more likely to be [involving] children than other types of products, so that's certainly a concern," Dilley said.
Over three years of poison control center calls, there were 2,505 cases involving manufactured products and kids younger than 10, versus 1,490 reported plant-based exposures in that age group, researchers said.
However, Dilley emphasized that more than 60% of the time, these exposures caused minor medical problems. Most of the time, people call in because they just aren't feeling right.
"Some people might be experiencing something that scares them," Dilley said. "Maybe they're feeling dizzy and they don't know if that's OK or not, and so they call but they don't really need medical treatment."
The poison control call rate was higher in states where recreational use of marijuana has been legalized, researchers found.
For example, the rate of manufactured product calls was 2.5 per 100,000 people in 2019 in legalization states, versus 1.3 per 100,000 in states where recreational pot is still outlawed.
"This tells us that states that have legalized marijuana are not doing enough to protect children from its harms," said Linda Richter, vice president of prevention research and analysis for the Partnership to End Addiction.
"Edibles can too easily be mistaken for popular types of candy and other sweets and are often designed and packaged in a way that explicitly appeals to young people [e.g., gummy bears, mini chocolate bars with names and branding that mimic popular brands]," Richter continued. "Vaped marijuana is odorless and extremely discreet and, therefore, carries all the same risks to children that we saw emerge from the recent nicotine vaping epidemic."
Child-resistant packaging cuts risk
State regulators could play a strong role in protecting children from inadvertent exposures to marijuana, Dilley said.
"We can design packages that are tough for kids to get into," Dilley noted. "I know Washington state requires that each serving of an edible is separately wrapped, so if a child finds an edible product they have to open each individual dose separately. That makes it a little tougher for kids to get into it and be accidentally exposed."
NORML Deputy Director Paul Armentano pointed out another reason why call rates might be higher in states with legal recreational use -- folks in those places might feel more comfortable calling a poison control center, because they face no potential criminal charges.
But he agreed that there is a role for state regulators to play in these new recreational markets.
"These products ought to be uniquely and distinctly labeled in a manner that makes it readily clear that they contain cannabis and sold in child-resistant packaging, so as to better discourage inadvertent consumption," Armentano said.
Increased public education about the differences between manufactured products and marijuana plant use also would help, he added.
"With non-traditional cannabis-infused products becoming more prevalent in the retail market, parallel efforts ought to be made to increase public awareness with respect to the dramatic differences in herbal versus orally consumed products," Armentano said. "At a minimum, potential consumers should be informed that cannabis-infused oral products possess delayed onset, greater variability, and prolonged duration of effect compared to inhaled marijuana.
"The imposition of sensible regulations on the cannabis industry, coupled with better public safety information and greater consumer responsibility and accountability, are the best strategies to address cannabis-specific health concerns due to the inadvertent ingestion or over-ingestion of these products," Armentano concluded.
Parents should also be encouraged not to leave pot products lying casually around, in easy access of children, Richter said.
"As is true of any addictive substance, if these products are in the home, adults should be sure to safeguard children from them by ensuring that they remain out of sight and out of reach of young people," Richter said. "If adults do use them in the presence of children, they should be very careful to explain that they are dangerous for children to touch or ingest and should refrain from conveying in any way that the products are harmless or fun or needed to relax and enjoy oneself."
The U.S. National Institute on Drug Abuse has more about marijuana.
SOURCES: Julia Dilley, PhD, epidemiologist, Oregon Public Health Division, Portland; Linda Richter, PhD, vice president, prevention research and analysis, Partnership to End Addiction; Paul Armentano, deputy director, NORML; JAMA Network Open, May 24, 2021