Cannabis-related emergencies in children and teens

Abstract

Purpose of review To examine the spectrum of emergency department presentations associated with cannabis use or misuse that are currently seen in the pediatric population. Recent findings There is a growing concern that pediatric emergency department visits related to cannabis are on the rise, especially given rapidly changing legislation on cannabis and its broad availability in certain areas. These concerns are substantiated in the current literature, as the evidence mounts for an array of emergency department presentations of intentional or accidental cannabis use. The range of presentations documented in the recent literature spans gastrointestinal, psychiatric and cardiorespiratory effects, in addition to traumatic injuries and accidental ingestions by younger children. Complications of chronic cannabis use, such as ‘cannabis hyperemesis syndrome’, depression, psychosis or cognitive impairment, are now recognized outcomes and even more are likely to emerge. Summary An array of cannabis-related symptoms is possible from acute use or exposure. Common presentations include acute intoxication, hyperemesis, depression and acute physical injuries from impaired psychomotor function. Uncommon presentations include cardiorespiratory effects, and a range of symptoms in young children that include hyperkinesis and coma. Clinical vigilance is needed to suspect and clinically diagnose cannabis exposure in the emergency department.

Emergency Department Pediatric Visits in Alberta for Cannabis After Legalization

“…In addition, because cannabinoid hyperemesis syndrome is typically seen in individuals who are long-term cannabis users, this finding is inconsistent with decreasing intentional cannabis ingestion rates and warrants further investigation. 9 Although we are reassured by lack of previously reported lifethreatening sequalae (cardiorespiratory, neurologic encephalopathy, and seizures) related to cannabis exposure in our data set, potentially deadly effects underscore the need for cannabis legislation to consider pediatric exposure risks. [8][9][10][11][12][13][14][15] Community pediatricians should be aware of individuals storing cannabis in close proximity to children and should remind caregivers of hazards associated with improper and unlabeled storage, particularly for young children.…”

Cannabinoid Acute Intoxication, Diagnosis, and Management

“…In the pediatric population, cannabis use has a significant impact, especially following legalization in the United States, especially in the last five years [10,11]. The decriminalization of medical and recreational cannabis use in the United States resulted in increased emergency department visits from unintentional pediatric cannabis intoxication [10].…”

“…Emergency department visits secondary to cannabis toxicity have enhanced in adolescents and adults, with doubled rates in those aged 12 to 17 years between 2004 and 2011, and also in the pediatric population after producing new cannabis edibles, such as hemp oil, candy, popcorn, and beverages [10,12]. Also, parents' outbreak of cannabis usage with their children at home has risen from 4.9% to 6.8% from 2002 to 2015 and increased in the call volume to poison control centers for unintentional pediatric cannabis exposure [11,13]. This rise in pediatric unintentional cannabis intoxication is likely multifactorial: it is mostly associated with diverse modes of delivery, increased availability, and improved palatability of cannabis [10].…”

Setting the baseline: a description of cannabis poisonings at a Canadian pediatric hospital prior to the legalization of recreational cannabis

“…12 Common signs of cannabis poisoning includevomiting,dizziness,slurredspeech andadecreasedlevelofconsciousness. [13][14][15] Oftentimes, these symptoms can be resolved in the emergency department (ED) and pose little or no long-term harm. 13 According to the Canadian Institute for Health Information, approximately 40% of the 23580 Canadians aged 10 to 24 years who were hospitalized in 2017-2018 for harms caused by substance use have been admitted due to cannabis use.…”