32 Accidental ingestions of cannabis in children pre- and post-legalization: Perspectives from a Canadian paediatric hospital

Abstract

Abstract Primary Subject area Public Health and Preventive Medicine Background Cannabis is one of the most prevalent recreational substances worldwide. In 2018, Canada legalized the use of recreational cannabis. Cannabis is available in numerous forms, including a wide range of ingestible forms (baked goods, candies, gummies, etc.). This increasing availability and palatability of cannabis – coupled with a rise in the concentration of tetrahydrocannabinol (THC; the psychoactive component of cannabis) in many products – has made children particularly vulnerable. Research has demonstrated rising cases of pediatric accidental cannabis exposures, primarily in U.S. states, but there is a paucity of Canadian data. Objectives We sought to: i) Characterize the frequency and clinical features of children presenting with accidental cannabis ingestions to a Canadian tertiary pediatric hospital; and ii) Compare the rates and presentations in the pre- and post-legalization periods. Design/Methods A retrospective chart review of Emergency Department visits at the Children’s Hospital of Eastern Ontario (Ottawa, ON) between March 2013 and September 2020 was undertaken, with institutional ethics approval sought. Inclusion criteria were: (i) Age < 13 years; and (ii) Accidental cannabis ingestion, as identified by specific ICD-10 diagnostic codes (T40.7, X42). Data collected from each chart included basic demographics; type and quantity of cannabis ingested; timing and location of ingestion; vital signs and Glasgow Coma Scale (GCS) rating at triage; presenting symptoms; investigations and procedures performed; as well as length of stay in hospital. Data were analyzed using descriptive statistical methods. Results A total of 39 patients met inclusion criteria (23 male; 59%). The mean age of presentation was 5.2 years (± 3.3; range 1 month–12 years). The vast majority of visits (32/39; 82%) occurred in the last two years of data collection (i.e., after legalization of recreational cannabis in Canada in October 2018). A total of 15 patients (38%) required admission to hospital, with a mean length of stay of 1.3 (± 1.0) days. Details about each patient’s presenting symptoms, investigations, and disposition were analyzed. Conclusion Our data from a Canadian tertiary pediatric centre confirms an increased rate of unintentional cannabis ingestions among young children, particularly post-legalization. This is of significant public health concern. An understanding of the clinical presentation of cannabis intoxication, as well as advocacy for safe storage strategies is prudent for parents, pediatric providers, and public health policymakers.