Poison center: More children are getting sick from cannabis edibles
Jan. 14—Admitted to the pediatric intensive care unit, the child was screaming, hallucinating, confused and demanding food. The nurses were afraid to give him anything to eat for fear he could vomit and choke.
The youngster had gotten into an adult's cannabis edibles. After hours of screaming, he finally fell asleep.
As more states legalize recreational use of marijuana, public health experts are warning about the danger that cannabis edibles can pose for little kids.
Last year, the Northern New England Poison Center handled 62 cases of New Hampshire residents sickened after exposure to cannabis.
Nineteen involved children under 6, and most of them had consumed cannabis edibles.
Karen Simone, director of the Northern New England Poison Center, said the number of accidental ingestion cases among little kids has gone up as the cannabis industry has moved from illegal to medicinal to recreational use. The center handles calls 24/7 for New Hampshire, Maine and Vermont.
"Typically a parent, grandparent or other relative is calling about a small child who has gotten into some kind of marijuana product," Simone said.
"In our ideal world, they call us right after it happens," she said. But "sometimes they don't call us until things start looking a little scary."
NNEPC reported 24 cases of accidental ingestion of cannabis in New Hampshire among children 5 and under in 2020 and 22 in 2021. For children 6 to 12, there were nine cases of cannabis exposure reported to the center in 2020, 13 in 2021 and 10 in 2022.
Simone said she believes many cases go unreported by adults who fear getting in trouble.
Temptation for children
It's easy to see the temptation for little kids. Legal products sold at licensed cannabis dispensaries can look like gummies, chocolate bars and cookies.
Even more dangerous are cannabis-infused products sold online whose form and packaging imitate popular snack foods and candies, experts say.
The most common symptoms of cannabis poisoning include vomiting, drowsiness and unsteadiness, but in rare cases, children have difficulty breathing or experience seizures, Simone said.
"It's a miracle that we haven't had deaths yet," she said.
The dosing for edibles can be dangerous for little ones, who may eat an entire chocolate bar or brownie meant to be consumed in small pieces by adults, NNEPC's Simone said. And edibles can take a while to take effect.
"There's a little bit of a delay until you get sick," Simone said. "If a little kid is a little unsteady on their feet or they're wobbly, sometimes people think it's cute."
It's not, she said.
"Some get admitted to hospitals or critical care," she said. "Some of them even require ventilation on a ventilator for eating too much marijuana, and that's not funny at all. It's very scary."
She urges adults to store cannabis edibles away from food, ideally in a locked compartment, and to never consume cannabis in front of children.
A study published in the journal Pediatrics found the number of pediatric exposures to edible cannabis products in children under 6 jumped from 207 in 2017 to 3,054 in 2021.
The overwhelming majority (97%) occurred in residential settings, and most children (nearly 91%) were in their own homes. Nearly 23% of the children were admitted to the hospital, and a third of those were admitted to critical care units.
Two-year-olds accounted for nearly 28% of cases, and 3-year-olds 25%.
The study correlates the increasing number of cases with access to legalized cannabis. In 2017, 68.9 million Americans had such access; by 2021, that nearly doubled to 134.4 million.
Deceptive packaging
Recreational use of cannabis is illegal in New Hampshire, though possession of small amounts has been decriminalized.
New Hampshire remains an island, surrounded by states in which recreational use of marijuana is now legal. Dispensaries are as close as Tyngsborough, Mass., right over the border from Nashua, and Kittery, Maine, just over the bridge from Portsmouth.
The state does have a therapeutic cannabis program, with seven licensed "alternative treatment centers" that sell cannabis products to registered patients with qualifying medical conditions and their caregivers.
The Department of Health and Human Services requires all products sold at those treatment centers to be "packaged in plain, opaque tamper-proof, and child-resistant containers" — unless the patient or caregiver has affirmed in writing that there are no young children living in the household and the person would have difficulty opening a child-resistant container.
The rules also state that cannabis products "shall be packaged in a manner that is not attractive to children," that no depictions of cartoons, product images or images other than the center's logo are allowed, and that packaging of edible products "shall not bear a reasonable resemblance to any commercially available product."
The federal Food and Drug Administration issued an alert last June, warning about accidental ingestion of products containing THC by young children.
"Some manufacturers are packaging and labeling edible products containing THC to look like popular brands of commonly consumed foods, such as breakfast cereal, candy and cookies," the alert said. "These products appeal to children and may be easily mistaken for popular, well-recognized foods."
A spokesperson for the agency said the FDA "is actively working with federal and state partners to further address the concerns related to these products, and monitoring the market for adverse events, product complaints, and other emerging cannabis-derived products of potential concern."
Public health experts issued a similar warning here.
"We urge residents using therapeutic cannabis purchased from a licensed dispensary to follow the same precautions as other prescription drugs, such as storing medicine safely away from children and securing safety caps," said Dr. Jonathan Ballard, child medical officer at the state Department of Health and Human Services, in a statement.
Parental precautions
The warnings come as debate over legalizing recreational use of cannabis is about to be revived in New Hampshire, with several bills pending in the Legislature.
Proponents of legalization say it's the best way to eliminate the illicit drug trade and to protect minors from those look-alike products.
Opponents worry that legalization would only increase the availability of cannabis edibles — and the danger they pose to small children.
Daryl Eames, founder of the NH Cannabis Association, said his organization advocates for a "responsible, adult-use market."
"None of us would suggest that more minors consuming cannabis is a good thing anybody wants," he said.
He noted that state law already makes it a misdemeanor for anyone to negligently store marijuana-infused products. "What I think it comes down to is adults need to be smart about how they store anything that might harm a child, period," he said.
But Eames said two markets currently serve New Hampshire residents: the licensed dispensaries in other states that you can't even enter if you're under 21, and the illicit market where anything goes. He contends the best way to prevent harm to children is to regulate the cannabis industry here, driving out bad actors.
"A properly taxed and regulated market will also help to shrink the illicit market, allowing law enforcement to better concentrate efforts on the illicit dealers that do sell cannabis to minors," Eames said.
Eames supports the bipartisan House Bill 639, which would legalize, regulate and tax cannabis, and license businesses that sell cannabis products for adults 21 and older.
The bill proposes restrictions on marketing and packaging of cannabis products, including a prohibition on "mass-market campaigns that have a high likelihood of reaching minors," and a ban on "products that are named, packaged, marketed, or designed in a way that mimics or is likely to cause confusion with commercially available, trademarked non-cannabis products..."
A teen's worry
Kaylee McGlynn, 16, a senior at Raymond High School, said edibles are popular among students at her high school "because it's super discreet." She said teenagers get them from their parents, peers and online, and eat them at school.
McGlynn, who is active in the Raymond Coalition for Youth, a substance abuse prevention organization, has testified in Concord against previous bills to legalize cannabis for recreational use, and plans to do so again in the new session. "I will be continuing to battle for what we've got in our cannabis island," she said.
McGlynn, who calls herself a "science-driven person" and an animal lover, said she worries about young children and pets accidentally ingesting edibles.
"It just hurts me to see that," she said. "It's super dangerous, and I just don't feel comfortable with the adults in this society that we have right now to handle this situation appropriately."
The Pediatrics study noted that no nationwide laws regulate how cannabis products are packaged. "Products continue to be offered in brightly colored, enticing packaging that is identical in style to how candy and snack products are marketed," the authors wrote.
HB639 in New Hampshire would mandate packaging that is "not designed to appeal to or be attractive to minors including providing that they cannot be in the shape of cartoons, toys, animals, or people..."
Trademark infringement
Copycat products sold online pose the greatest danger to young children, those on both sides of the debate here agree.
Some companies are fighting back, filing lawsuits against companies that sell such edibles.
A judge in Canada last summer ruled in favor of Mars Wrigley in its trademark infringement case against entities selling cannabis edibles online in packaging identical to that of Skittles candies.
In awarding punitive damages to Mars Wrigley, the judge wrote, "I also find that advertising and offering for sale of a potentially dangerous product using appropriated trademarks that are evidently and obviously attractive to children represents a marked departure from ordinary standards of decent behaviour that deserves to be denounced and deterred."
Lawsuits are still pending in this country, a spokesperson for Mars Wrigley said in a statement.
"At Mars Wrigley we take great pride in making fun treats that parents can trust giving to their children and children can enjoy safely," the company said. "We are deeply disturbed to see our trademarked brands being used illegally to sell THC-infused products, and even more so to hear of children ingesting these products and becoming ill."
Trent Woloveck, chief strategy director for Jushi, the parent company of Nature's Remedy dispensaries, said there's a big difference between his company's tested, regulated products and those sold by online companies or "CBD" shops where "anyone can walk in there and pick away."
Unregulated products pose "a huge public safety risk," Woloveck said, noting a 6-year-old in Virginia died after eating his mother's "CBD" gummies, and the mother was charged with murder.
"Having access to safe, standardized, tested products in a regulated market that is tested and age-controlled is the answer to that," he said.
At Nature's Remedy locations, including the one in Tyngsborough, customer IDs are checked multiple times, numerous cameras monitor what's going on, and all products are sold in child-resistant packaging, Woloveck said. Employees also stress the importance of safe storage of products to customers, he said: "Please act as if this is a bottle of alcohol or a firearm."
In case of emergency
If a child does get into cannabis edibles, NNEPC's Simone urges adults to call the poison center number right away at 1-800-222-1212. They'll immediately be connected with a specially trained nurse or pharmacist who will do an assessment and explain how to monitor the child for signs of poisoning.
"The idea is we start at home and if things start not looking good, we send them into the hospital," she said.
All adults need to recognize the risk "and take measures in your own life to get this out of the mouths of children," Simone said.
"I'm not here to tell people don't get high," she said. "I would like for children not to be hurt."