Marijuana Legalization and Poisoned Children
After the Justice Department signaled a more tolerant approach to medical marijuana in an October 2009 memo, the number of Colorado patients holding the state-issued cards that are required to buy cannabis from dispensaries jumped from 2,000 to 60,000. According to a new study reported in JAMA Pediatrics, the increase in registered patients was accompanied by an increase in accidental ingestions of marijuana by children. Researchers led by toxicologist George Sam Wang of the Rocky Mountain Poison and Drug Center found that a Denver children's hospital saw 14 patients younger than 12 who had ingested marijuana in the 27-month period from October 1, 2009, through December 31, 2011, compared to zero in the 57-month period from January 1, 2005, through September 30, 2009. The most common symptom was lethargy, observed in nine of the patients; the most serious symptom was respiratory insufficiency, observed in a 5-year-old boy. U.S. News & World report describes the medical consequences:
As with many similar poisonings, treatment is limited to supportive care and waiting until the marijuana clears the system…
Children recover quickly in most cases, Wang said. "They don't need more than a day or two of hospitalization," he said. "There were no deaths or lasting side effects."
Wang and his co-authors conclude that "the consequences of unintentional marijuana exposure in children should be part of the ongoing debate on legalizing marijuana." Fair enough, although the hazard that marijuana poses to children pales next to the hazard posed by alcohol, over-the-counter drugs such as aspirin, and prescription drugs such as opioid painkillers. All of those can kill in high enough doses, while the number of fatal marijuana ingestions can be counted on one hand with no fingers.
Which makes the U.S. News headline a bit misleading: "Kids Poisoned by Medical Marijuana, Study Finds." Likewise this CBS News headline: "Laxer Marijuana Laws Linked to Increase in Kids' Accidental Poisonings." Not only does "poisoning" suggest a potentially deadly threat, but "laxer" implies that the government is failing to meet its regulatory responsibilities when it lets people use marijuana as a medicine. This Boston Globe headline is not as slanted but still leaves something to be desired: "Medical Marijuana Might Put Kids at Risk, Study Says." Well, yes, but so might just about any other medicine or recreational intoxicant. If anything, marijuana is less worrisome on this count than most other drugs.
"To prevent harm to children," says U.S. News, "Wang advises treating marijuana like any other drug and keeping it out of their reach, particularly if it's in a tempting form like cookies." Duh. The magazine adds that "some poison-control experts also are pushing for marijuana to come in tamper-proof packages as a way of keeping children away from it." Such a requirement is part of the marijuana legislation signed today by Colorado Gov. John Hickenlooper, which sets rules for the recreational pot shops that are supposed to open next year. The mandate imposes extra costs that will be passed on to consumers, and its effectiveness is questionable, especially if the problem is carelessness by adults who do not bother to keep cannabis out of children's reach. After all, those same adults have to open the tamper-resistant packages before they can consume the goodies inside, and then we are back to the same situation again.
Addendum: In the comments Steve Rolles notes the distinction between the "tamper-proof packages" to which U.S. News refers and "childproof" containers that can be resealed after some of the contents has been consumed so that they are still hard for little kids to open. H.B. 1317, one of the bills Hickenlooper signed today, calls upon the Colorado Department of Revenue's new Marijuana Enforcement Division (formerly the Medical Marijuana Enforcement Division) to create "requirements…similar to the federal Poison Prevention Packaging Act of 1970," which describes "special packaging" that is "designed or constructed to be significantly difficult for children under 5 years of age to open or obtain a toxic or harmful amount of the substance contained therein within a reasonable time and not difficult for normal adults to use properly." Something like the cap on bottle of pills or a can of paint thinner. How exactly that will work with, say, cannabis-infused candy bars or brownies remains unclear. When I asked Laura Harris, head of the Marijuana Enforcement Division, about this issue in January, she noted that legislators had contemplated a similar requirement for medical marijuana:
They said…you create a rule that describes a kind of packaging we want that will be child resistant, and that remains undone, because that's a thorny issue. What does that look like?
Retailers can be forced to sell cannabis candy and pastries in resealable hard plastic containers with child-resistant locks, but consumers cannot be forced to put half-eaten edibles back in those cases and relock them.
[Thanks to Max Minkoff for the tip.]