What are manifestations of inadvertent pediatric marijuana intoxication?
June 4, 2013, 1:53 pm
Pediatric Marijuana Exposures in a Medical Marijuana State. Wang GS et al. JAMA Pediatr 2013 May 27 [Epub ahead of print]
In October 2009, the US. Justice Department decided not to prosecute medical marijuana users and suppliers who were conforming to state laws. As a result, in Colorado the use of medical marijuana skyrocketed. The effects of this change — especially on children — are not yet completely understood.
The goal of this paper, from the Rocky Mountain Poison Center and the University of Colorado School of Medicine, was to compare the number of children seen in a tertiary-care pediatric emergency department for exposure to marijuana in the years before and after October 2009.
The authors did a retrospective study covering January 2005 through December 2011 to identify children < 12 years old who had specific ICD-9 codes and a urine toxicology screen positive for marijuana. They found identified no such patients before October 1 2009, but 14 patients after that date. They conclude that after the Justice Department’s policy change, there was a “new appearance of unintentional marijuana ingestions by young children”.
I’m sure they’re correct, but the explanation for the increased number of cases may partially involved heightened awareness on the part of clinicians, and a lower threshold for ordering toxicology screen on children with suggestive but nonspecific signs and symptoms. The main value of this paper, however, is in the brief descriptions of their 14 cases. Some key points:
- Seven patients had a history of exposure to marijuana cookies, cakes, or candy.
- Ten patients were described as lethargic or somnolent.
- One patient was admitted to the pediatric intensive care unit because of respiratory insufficiency.
- One patient was ataxic; another complained of dizziness.
As the 60 Minutes piece at the top of this page suggests, in some states THC is becoming available in palatable form such as brownies, cookies, soft drinks etc. As both medical and recreational use of marijuana become legal and more widespread, inadvertent pediatric exposure will definitely go up. The diagnosis should be considered in children who present with unexplained lethargy, ataxia or dizziness, and parents questioned about possible sources at home. In 4 of these cases, the source was a grandparent’s medical marijuana.
In an accompanying editorial, Hurley and Mazor point out that signs and symptoms of marijuana intoxication may include:
- panic attacks
- chest pain
- CNS depression
- respiratory depression
Note: Although Wang’s abstract and paper states that the study population included children less than 12 years of age, one of the fourteen patients was 12.