Accidental cannabis intoxication among toddlers is rising at an alarming rate in France, and represents “a real public health issue,” the authors of a new study report.
Between 2004 and 2014, admissions to pediatric emergency departments (PEDs) across France for inadvertent cannabis intoxication rose by 133%, and calls to poison control centers related to pediatric cannabis intoxication increased by 312%. Similar calls to poison control centers in the United States increased by 147% between 2000 and 2013.
The proportion of severe cases also rose significantly, from three cases (7%) during 2004 to 2009 to 37 cases (19%) during 2010 to 2014 (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.1 – 11.8; P = .03).
Isabelle Claudet, MD, from the Service d’Accueil des Urgences Pédiatriques, Hôpital des Enfants, Centre Hospitalier Universitaire de Toulouse, France, and colleagues report their findings in an article published online August 14 in Pediatrics.
The researchers conducted a national, retrospective, multicenter, observational study of children younger than 6 years with confirmed cannabis intoxication admitted to PEDs in France between 2004 and 2014. The final cohort consisted of 235 children admitted to 24 PEDs, representing 80% of national PEDs across the country and 84% of the cannabis-related calls for symptomatic children.
The patients had a mean age of 1.5 years (standard deviation, 0.6). Seventy-one percent were aged 18 months or younger. Hashish was the cause of intoxication in 169 cases (72%), of which 33 cases (69%) occurred from 2004 to 2009, and 136 (73%) from 2010 to 2014 (P = .82).
Clinicians assessed intoxication severity using the Poisoning Severity Score (PSS), which ranges from 0 (no poisoning) to 4 (fatal poisoning). Most cases (n = 170; 72%) were mild (PSS 1), 25 (11%) were moderate (PSS 2), and 40 (17%) were severe (PSS 3). There were no fatal cases.
After excluding cases of intoxication with more than one substance, the authors also compared symptom severity between the two periods. During 2004 to 2009, 4.3% of cases had a PSS of 3 compared with 18.5% during 2010 to 2014 (OR, 5.0; 95% CI, 1.2 – 21.7; P = .02).
Similarly, the incidence of coma increased from two of 46 cases (4.35%) during 2004 to 2009 to 31 of 183 cases (16.9%) during 2010 to 2014 (OR, 4.9; 95% CI, 1.03 – 19.5; P = .03). In fact, as pediatric cannabis intoxication has become so prevalent, “this diagnosis should be considered when an afebrile comatose child is admitted to a French emergency unit,” the authors warn.
Highly Concentrated Hashish Resin Largely Responsible
The authors attribute the increase in severe cases to the rising concentration of tetrahydrocannabinol (THC), the compound that gives cannabis its euphoric properties, during the study period. Between 2004 and 2014, the THC concentration in the cannabis available in France went from 9.3% to 20.7%. Further, the most popular form of cannabis in France is hashish, the highly concentrated resin derived from the cannabis plant, as opposed to “herbal” cannabis or marijuana, which has a lower concentration of THC.
Cannabis decriminalization also seems to correlate with greater poisoning severity among children, the authors write. In the United States, severe cases “are significantly more represented in states where cannabis has been decriminalized.” There, as in France, where the drug is still illegal, pediatric cannabis poisoning usually results from ingestion, either of food products containing cannabis or of the resin itself, although infants may also be poisoned by second-hand cannabis smoke.
Study limitations include the lack of some important information, such as parental cannabis use, as a result of the retrospective design, and possible underestimation of cointoxication as a result of an inability to screen all of the patients.
“Children are collateral victims of changing trends in cannabis use and a prevailing THC concentration,” the authors conclude. “Unintentional intoxication should be tightly monitored, and it should be mandatory to report such cases.” They also recommend mandatory intervention by social services agencies.
The authors have disclosed no relevant financial relationships.
Pediatrics. Published online August 14, 2017. Abstract