UMEM Educational Pearls

Bottom Line:  Edible marijuana products have high potential for overdose, particularly in children, as they are commonly mistaken for appealing food or candy, have had exponential growth in availability and ease of access in homes, can be present in very large doses due to lack standardization and quality control, and users often have confusion regarding dosing due to its long and erratic absorption and time to peak effect which may lead to redosing.

Additional Information

Edibles refers to food or drink products infused with cannabis extracts. Cannabis contains numerous biologically active substances most notably delta-9-tetrahydrocannabinol (THC) which mediate most of the psychoactive effects by CB1 receptor agonism. 

Edible products include candy (gummies, hard candies, lollipops), baked goods (cookies, brownies), infused beverages, cooking oils and butters, and lozenges. Edibles are often packaged in multiple dose containers and may contain large doses of THC (up to 500 mg).  A single unit typical dose is 5 mg with 1-5 mg considered microdoses and doses > 100 mg being considered very high dose for an adult.

Onset of peak effects are 30 mins- 2 hours (up to 8 hours) because of gastrointestinal aborption of orally consumed cannabis. This range of timing may lead to overdose as individuals ingest more edibles (redosing) assuming they are not being affected.

Children >6 year of age are at special risk for edible marijuana toxicity. Most pediatric exposures (97.7%) occur in a residential setting. Weight-based dose is a substantial predictor of severe toxicity and duration of symptoms: ranging from somnolence, lethargy, nausea, and vomiting to more severe effects of respiratory depression and failure, altered mental status, seizures, and unresponsiveness. Studies report a 70% incidence of central nervous system depression with 22.7%  admitted to the hospital. Symptoms typically presented 2- 4 hours after ingestion. Patients with severe toxicity experienced symptoms for 6 hours and greater.  A few deaths have been reported.

Unintentional marijuana ingestion should be considered in the differential diagnosis of patients < 6 years of age who present with acute onset of somnolence, altered mental status,or  lethargy.

References

Packaging of Cannabis Edibles, Health Warning Recall, and Perceptions Among Young Adults. Cooper M, Shi Y. JAMA Netw Open. 2025;8(4):e253117. doi:10.1001/jamanetworkopen.2025.3117

Tweet MS, Nemanich A, Wahl M. Pediatric Edible Cannabis Exposures and Acute Toxicity: 2017-2021. Pediatrics. 2023 Feb 1;151(2):e2022057761. doi: 10.1542/peds.2022-057761. PMID: 36594224.

Packaging Regulations Needed to Mitigate THC Ingestions in Children. Zwiebel H, Goldman RD, Greenky D. JAMA Health Forum. 2025;6(7):e252628. doi:10.1001/jamahealthforum.2025.2628

The evolving landscape of cannabis edibles,  Blake A,  Nahtigal I.  Current Opinion in Food Science, Volume 28, 2019, Pages 25-31, ISSN 2214-7993, https://doi.org/10.1016/j.cofs.2019.03.009.