UMEM Educational Pearls

Title: Pediatric cannabis exposure before and after legalization in Canada

Keywords: cannabis intoxication, trend, Canada, ICU admission, legalization (PubMed Search)

Posted: 7/8/2021 by Hong Kim, MD
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Canada legalized recreational cannabis use in 2017. A retrospective study of children (0-18 years) who presented to pediatric ED with cannabis intoxication/exposure was performed between Jan 1, 2008 to Dec 21, 2019 to assess the trend/severity of intoxication.

Methods

Single center study: Hospital for Sick Children, Toronto
Case identification by ICD 10 code for cannabis intoxication and positive urine drug screening test
Pre-legalization period was defined as 1/1/2008 to 4/12/2017
Peri-post legalization period was defined as 4/13/2017 to 12/31/2019

Result

A total of 298 patients were identified

Pre-legalization period: 232 (77.8%)
Peri-post legalization period: 66 (22.1%)
Male: 150 (50.3%)
Median age: 15.9 years (IQR: 15.0-16.8)

	Pre-legalization	Peri-post legalization	P value
Monthly ED visit	2.1 (IRQ: 1.9-2.5)	1.7 (IQR: 1.0-3.0)	0.69
ICU admission	4.7%	13.6%	0.02
Respiratory symptoms	50.9%	65.9%	0.05
Altered mental status	14.2%	28.8%	<0.01
Age < 12 years	3.0%	12.1%	0.04
Unintentional exposure	2.8%	14.4%	0.02
Edible ingestion	7.8%	19.7%	0.02

Respiratory symptoms: tachypnea/bradypnea, cyanosis, O2 sat < 92%, bronchospasm, oxygen requirement

Edible ingestion was a predictor of ICU admission (OR: 4.1; 95% CI: 1.2-13.7)

Conclusion

Legalization of recreational cannabis in Canada was associated with increased rates of severe intoxication in children.

References

Cohen N et al. Pediatric cannabis intoxication trends in the pre and post-legalization era. Clin Toxicol 2021. e-pub Jun 17, 2021.

https://doi.org/10.1080/15563650.2021.1939881