Poison control centers across the country say they have seen a spike in the number of children who have ingested THC after eating their parents' edibles, rising from just 19 cases in 2010, before recreational pot was legalized in any state, to 554 cases last year. About 400 of those cases were children under age 5.
Poison control officials attribute the rise in large part to a growing number of states having legalized marijuana. There are now 36 that allow marijuana for medical use — and 18 of them now allow adult recreational use or have recently approved laws to do so— with a number of others moving in that direction.
According to the American Association of Poison Control Centers, when a state begins allowing the sale of marijuana for recreational purposes, an uptick occurs in pediatric ER visits by children who have ingested THC-laden edibles.
Kids at the ER
For instance, when Massachusetts legalized marijuana in late 2018, there were just 52 cases. By 2020, that figure was 257, according to Massachusetts’ Poison Control Center. New Jersey legalized marijuana last November, and ERs have seen 85 children suffering the effects of ingesting pot already, 55 of whom were under 5, according to the N.J. Poison Control Center.
In Colorado, which in 2012 along with Washington state became the first to legalize recreational marijuana, 121 “marijuana exposures” involving edible marijuana products were reported to the Colorado Poison Center in 2019, 81 of which involved children up to age 18. Edible exposures in children ages 0 to 5 increased from 26 cases in 2016 to 56 in 2019, according to the poison center data.
“Any time a state goes to some form of enhanced cannabis access, whether they make medical marijuana legal or they legalize it for recreational use, those states experience an increase in edible exposures in kids,” says Diane Calello, executive and medical director of the N.J. Poison Control Center. “And that’s from the poison control centers in Colorado, in Washington, in Oregon. Every state that’s made it legal has seen this increase.”
She says that the increase is higher for states that legalized recreational marijuana use. Those allowing only medical use have fewer pediatric exposures, she says.
“It is difficult for anyone, especially children, to distinguish an edible marijuana product from food when the packaging is almost identical to common everyday products,” says Calello, questioning why edible products need to look like children’s favorite candies. “That’s just an accident waiting to happen.”
High levels of THC can lead to dangerous side effects in children, such as trouble breathing, loss of coordination, drowsiness and seizures. In severe cases, children have landed in an intensive care unit and had to be put on a ventilator, Calello says.
Some states have attempted to address the issue.
Colorado passed in 2017 a law that banned edibles in the shape of a human, an animal or a fruit. It also prohibited the use of the word “candy” or “candies” on marijuana products and required them to carry labels indicating their potency in boldface, a very large font size, and enclosed in a shape, such as a circle or square, or highlighted with a bright color. When lawmakers were discussing the legislation, they discovered they couldn’t tell the difference between the regular gummies and those that contained marijuana.
Other states have either passed language requiring childproof packaging and strict labeling requirements or banning edibles outright. For example:
●California restricts the sale of edibles shaped like people, animals, insects or fruit.
●Pennsylvania allows only pills, oils, gels, creams, tinctures, liquids and products that can be nebulized and used in a vaporizer.
●Utah allows a gelatinous cube or gummy as an edible, but prohibits cookies, brownies, candy and anything that has the appearance of appealing to children.
●North Dakota prohibited from the outset all edibles.
●Connecticut, having legalized only medicinal marijuana, allows for baked goods but prohibits marijuana to be put into a beverage or confectionary or any form that would “customarily be associated with persons under the age of eighteen.” (Connecticut has not yet legalized recreational marijuana, although supporters of legalization say it may this year.)
Debra Borchardt, editor in chief of the Green Market Report, a cannabis financial news website, said edibles most commonly use the gummy form — as well as chocolate — because cannabinoids bind better with those elements.
“At the beginning of legal recreational sales, there were numerous candy copycats whose names played on existing candies. Stoner humor if you will. With few safeguards, the edibles could easily pass as a normal [not THC] product back then,” she says.
There were Stoner Patch Dummies instead of Sour Patch Gummies, or Mr. Dankbar instead of Mr. Goodbar, and Reefers Cup instead of Reese’s Cup. But many states passed regulations to combat this practice and trademark battles caused many of these copycat companies to stop, Borchardt says.
Most packaging for marijuana edibles today is childproof and the containers are clearly labeled, Borchardt says. Some states require that the product is stamped with a cannabis leaf or THC symbol. There are also limits on how much THC can be put into edible products so consumers cannot accidentally take too much, she says, and the amount in each candy is clearly stated.
But why would adults choose candies that clearly appeal to children?
“Adults like candy, too,” Borchardt says.
Popularity of edibles
Edibles, which are considered food products infused with cannabis extract, are one of the fastest growing segments of the cannabis market. They now comprise about 10 percent of the $18.5 billion cannabis market, with sales growing from $1.34 billion in 2019 to $1.81 billion in 2020, according to Headset, which provides data and analytics on the cannabis industry. (“Flower” — meaning the leafy stuff and buds — holds the largest share of the market at about 47 percent, while vaping pens are in second place at just over 19 percent, according to Headset).
Marijuana edibles have moved so fast into the mainstream that they were named a food trend of the year for 2018, by the Specialty Food Association, a trade association for specialty food products.
Cannabis industry officials are quick to point out that while the number of children winding up in the ER after ingesting THC may be growing, it is still far less than the number who have inadvertently ingested other items in the house — such as cleaning products, which comprise more than 11 percent of all pediatric poison exposures, according to the American Association of Poison Control Centers.
“We agree preventative measures such as childproof packaging are important, but to look at marijuana as if it’s the only thing that adults need to be careful to keep away from kids creates a distorted picture,” said Violet Cavendish, communications manager at the Marijuana Policy Project, which advocates for state and federal cannabis legalization.
Therese Canares, an assistant professor of pediatric emergency medicine at Johns Hopkins School of Medicine, says it’s true that edibles aren’t the biggest problem she sees in the pediatric ER. But they are a recurring one, she adds, and a phenomenon that 10 years ago didn’t exist.
And it’s a problem that can be avoided, she says, if parents were just more careful. She recalls a case from November 2019 in which a 20-month-old toddler got into a parent’s backpack that was left on the floor and found a bag of marijuana gummies in a pocket and began eating them. A parent caught her and pulled candy remnants from her mouth, but it was unclear how many she had already consumed.
In that case, the child was fine, and it was easy to diagnose because the parents had witnessed the ingestion, Canares says.
But in other cases, the parents will show up at the ER with a child who is acting odd, perhaps falling asleep and won’t wake up, and the doctors have to determine whether it’s a seizure, a brain injury, a fall or something else.
“It’s generally not going to be life-threatening to ingest marijuana, and it could be life threatening to ingest certain cleaning products, but they’re both problematic,” Canares says. “Any time a child gets into a substance that can hurt them, that’s never okay, no matter what the source is.”
David Porcella, a retired police detective from Fresno, Calif., can attest to that.
In January 2020, he got a call from his 10-year-old daughter. She was at a friend’s house and said she didn’t feel well. She and the friend had found some gummy worms in the bedroom of an adult living in the house and had eaten several of them without realizing they were laced with THC. The friend was now throwing up and his daughter felt sick. He took her to the ER, where he said she was hallucinating and feeling paranoid and saying things you don’t want to hear a 10-year-old say.
Laced with THC
“She told me she didn’t know if she was alive or if she was dead,” Porcella said. “No one ever wants to see their child intoxicated, let alone having a bad trip on marijuana. But she’s telling me, ‘Daddy, am I dying? I can’t tell if I’m alive or dead. Everything seems real, but it seems fake at the same time.’ ”
The ER doctors told him there was nothing they could do except monitor her, so he took her home, where she eventually fell asleep and woke up feeling better. But he’s angry, not at the parents of his daughter’s friend but at the companies promoting this product in a way that he says is irresponsible and reckless.
“They’re not making any attempt to keep it from being opened by kids or being identified by kids as something they shouldn’t eat,” he said. “They’re doing the opposite. They’re tricking kids into eating it.”