As states legalize cannabis, a growing number of children are inadvertently consuming marijuana-infused foods.
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Mouthwatering chocolate, soft and chewy cookies, lollipops and fruity gummies: Marijuana edibles often look just like regular foods. Some candies even mimic familiar brands like Skittles or Starburst.
And for a young child — or anyone, really — that’s incredibly tempting.
Foods and beverages laced with cannabis have exploded in popularity. To protect children from accidentally ingesting marijuana edibles, some states have passed laws governing how these foods can be packaged and presented. Colorado, for example, requires the cannabis edibles to be contained in child-resistant packaging and include the letters “THC” (the main mind-altering chemical in cannabis). In addition, the state has banned the sale of edibles that look like people, animals or fruit.
But despite these measures, unintentional marijuana exposures have continued to climb in Colorado and elsewhere, especially in states where recreational cannabis has been legalized. In Washington state, unintentional cannabis exposures among children under 6 nearly tripled in the five years after retail cannabis stores opened. Nationally, in 2016 there were 187 exposures to marijuana edibles among kids 12 and under in the United States, according to data from the American Association of Poison Control Centers. By 2020 that number had risen to more than 3,100 — a majority of the children were 5 years old and under.
“That’s just the tip of the iceberg,” said Dr. Sharon Levy, the director of the Adolescent Substance Use and Addiction Program at Boston Children’s Hospital. Not everyone will call Poison Control to report an exposure, she added.
Of those who did call Poison Control, edibles were responsible for nearly half of the 4,172 marijuana exposures among children 9 and under between 2017 and 2019, according to a study published in the journal Pediatrics in April. (The other exposures were from things like concentrated extracts or dried marijuana plants.) Exposures were more common among children ages 3 to 5 and were more frequent in states where cannabis use is legal. While there were no deaths, 15 percent of children who were exposed experienced moderate symptoms — for example, they might have been very difficult to wake up or had a seizure. A small proportion — about 1.4 percent — experienced major effects that would be considered life-threatening, such as multiple seizures, sedation to the point where they were no longer responsive or difficulty breathing.
It has been nearly a decade since Washington and Colorado became the first states to legalize the recreational use of cannabis. Eventually, 16 other states and Washington, D.C., followed suit.
“The trend will likely continue upward as more states legalize cannabis and markets expand,” Jennifer M. Whitehill, the lead author of the Pediatrics study, said in an email.
Elizabeth Perry, a mother in Maryland, spoke to WRC-TV, the NBC News station in Washington, D.C., last year about the cannabis overdose that landed her toddler, Oliver, in the emergency room. Initially, when Oliver started displaying signs of lethargy, she didn’t know what was wrong. Then he started crying, shaking and seizing. She rushed him to the hospital where doctors intubated him and ran toxicology tests that revealed Oliver had THC in his system.
“I told them that wasn’t possible, we don’t smoke, we don’t have drugs in the house,” Ms. Perry told NBC4 Washington. “And then, two minutes later, my jaw dropped.” She suddenly realized that he had most likely eaten the cannabis gummies she bought to help her sleep.
The doctors told NBC4 Washington that Oliver, who wasn’t yet 2 years old, had eaten about 15 gummies, or about 75 milligrams of THC. That’s more than seven times the typical adult dose. (The amount of THC in one serving varies. Oregon permits a maximum of 5 milligrams per serving size, for example, while Colorado allows no more than 10 milligrams of THC per serving.)
A similar phenomenon has been happening in Canada. A study published in JAMA Network Open examined all cannabis-related emergency department visits and hospitalizations in Ontario among children 9 and under between January 2016 and March 2021. The researchers found that after marijuana edibles became available in early 2020, a greater proportion of kids were hospitalized. Overall, 19 of the children, or 3.6 percent, were admitted to intensive care.
Many adults and teenagers alike generally assume that edible marijuana products are harmless, said Dr. Levy, who specializes in treating adolescents with substance use disorders.
But that’s not the case.
“THC is addictive, associated with mental health disorders and interferes with brain development during adolescence,” Dr. Levy said. “People who use edibles are also at risk of using too much and having a bad side effect because it takes longer to feel the effect of edibles than smoking or vaping.”
She added: “We are seeing a whole lot more psychosis and cannabinoid hyperemesis syndrome,” a condition that leads to severe vomiting and dehydration.
Dr. Sam Wang, an associate professor of pediatrics at Children’s Hospital Colorado, said young children who ingest a little cannabis typically become sleepy. They might walk unsteadily and “they look a little high,” he said. But children who consume a larger quantity of marijuana have persistent vomiting or show up in the emergency room comatose, with slowed breathing. In rare cases, they need a mechanical ventilator to help them breathe.
The children generally become better over the course of one to two days, he added — and aside from one debatable case involving an infant in 2017, there are no known cases of a child dying from cannabis exposure.
“The children I’ve cared for and heard about at our hospital all recovered,” said Dr. Lois Lee, an associate professor of pediatrics and emergency medicine at Harvard Medical School. “But some had to be hospitalized for treatment and monitoring. And others were in the emergency department for hours, while their parents waited for them to improve enough so they could be safely discharged home.”
If you believe that your child might have ingested cannabis, call Poison Control to speak with someone right away, Dr. Lee said.
Poison Control can also advise you as to when it is necessary to seek medical care.
If your child has more severe symptoms — for example, he or she is vomiting, seizing, having trouble breathing or not waking up — it is best to go straight to the emergency room, where the doctors can run toxicology tests and provide oxygen and other treatments if needed, Dr. Lee added.
“Many children don’t require any substantial treatment, just observation until they wake up,” she said.
First, don’t assume that child-resistant packaging alone will prevent a determined child from eating your edibles.
“Parents and caregivers should always store cannabis products, especially edibles, safely out of reach of children,” Dr. Whitehill said. “Kids are really clever and some kids just get into everything, so actually locking it away — the way one would do with certain medications — is a good idea.”
“Locked is best, if possible,” agreed Kaitlyn Brown, the clinical managing director of the American Association of Poison Control Centers. “Parents think they have something up on top of the fridge, completely out of reach, out of sight, and the next thing they know their 2-year-old is a climber and is scaling the counter.”
Finally, the Children’s Hospital Colorado website says that if your child will be spending time at a friend’s house, it is important to ask their parents whether they keep marijuana in their home and whether they are storing it safely. Likewise, if you have guests staying at your home who use marijuana edibles, make sure they understand the house rules about keeping cannabis out of sight and out of reach.
If you or someone you know may have ingested a dangerous substance, please contact Poison Control immediately at 1-800-222-1222 or go to poisonhelp.org for assistance.