PainRelief.com Interview with:
Daniel Myran, MD, MPH, CCFP, FRCPC
Family and Public Health and Preventive Medicine Physician
CIHR Fellow, Ottawa Hospital Research Institute
Department of Family Medicine Innovation Fellow
University of Ottawa
PainRelief.com: What is the background for this study?
Response: Canada legalized recreational, or non-medical, cannabis in October 2018. Canada took phased approach to legalization initially only allowing flower-based cannabis products and oils and after one year permitting the sale of commercial cannabis edibles (e.g. THC containing candies, baked goods, and drinks). In this study we took advantage of this phased roll out of legal cannabis to understand the impact of legalization on cannabis exposures or poisonings in children aged 0-9 years and the contribution of different types of cannabis products to these events.
PainRelief.com: What are the main findings?
Response: Recreational cannabis legalization was associated with a 9 times increase in the number of cannabis poisonings in children and 56% increase in the number of visits that required hospitalization.
Over the whole study period (January 2016 to March 2021), there were 522 ED visits for cannabis poisoning in children under 10. The average age of these children was 3 years, 9 months.
Pre-legalization there were on average 2.5 ED visits a month, 25% of which required hospitalization. During the first phase of legalization (flower products only) visits increased by 3 times (on average 7.8 visits a month) and 23% of children required hospitalization. During the second phase of legalization (commercial cannabis edibles) visits increased by 9 times (on average 22.6 visits a month) and 39% of children required hospitalizations.
PainRelief.com: What should readers take away from your report?
Response: Prior studies from US states also found increases in poisonings from cannabis among children following legalization. Hoping to learn from this experience Canada implemented regulations that largely exceeded US regulation including; plain packaging with warning symbols that is also child resistant, marketing restrictions, limits on THC content in edibles, and consumer education campaigns.
Despite these regulations we observed large increases in cannabis poisonings in children. These findings suggests that new policy approaches and interventions may be required to reduce child cannabis poisonings. This is particularly relevant as many countries and regions around the world are also currently considering legalization of recreational cannabis and regulatory frameworks to reduce potential health harms.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: Further research could focus on identifying regulatory measures that can reduce pediatric cannabis exposures and poisonings. This might include the effect of stricter limits on the appearance and tase of edible products or how to better warn consumers about risks of cannabis to young children
PainRelief.com: Is there anything else you would like to add?
Response: The cannabis market in Canada is continuing to rapidly expand. Our study ended in March 2021. Over the next 6 months legal cannabis sales in Ontario increased by 37% (edibles sales went up 43%) and the number of retail stores in Ontario doubled. Without changes in policy, it is possible that cannabis poisonings in children may increase even further.
Any disclosures? No disclosures
Myran DT, Cantor N, Finkelstein Y, et al. Unintentional Pediatric Cannabis Exposures After Legalization of Recreational Cannabis in Canada. JAMA Netw Open. 2022;5(1):e2142521. doi:10.1001/jamanetworkopen.2021.42521
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