Newsletters

POSTED: December 3rd, 2024
POSTED IN: 2024 Quarter 4, EM Pulse - The Official Newsletter of MOCEP,

Vivian Pham, MD and David Liss, MD 

Since the legalization of recreational THC in November 2022, edible cannabis products have been available statewide from licensed dispensaries to adults 21-years of age and older.  Like other jurisdictions in our country, there has been an increase in accidental pediatric ingestions of edible cannabis products after recreational cannabis legalization.  Most of these pediatric ingestions are from cannabis-containing candies, gummies, cookies, and other attractive treats.   

As Missouri has adapted to this new landscape, pediatric emergency departments have witnessed a significant impact on young children. Data from St. Louis Children’s Hospital has shown a 10-fold increase in urine drug screens positive for tetrahydrocannabinol (THC), the primary psychoactive substance in cannabis, in the 1 month- to 9 year-old age group from before cannabis legalization in Missouri to after recreational legalization.  This surge in pediatric exposure rates is likely due to the newly increased accessibility of edible cannabis products now found in many households. 

Overdose of THC can pose significant harm to children given their smaller body size resulting in high THC concentrations following accidental ingestion. Signs and symptoms of pediatric overdose can vary from sedation to bradycardia, bradypnea, and unresponsiveness. Some children undergo extensive and invasive medical workups when the history is unclear.  Data from St. Louis Children’s Hospital indicates an increase in the severity of illness in children with confirmed THC exposure, with more patients requiring hospital admission, ICU care, and supplemental oxygen since the legalization of recreational cannabis in Missouri. No antidotal therapy for THC overdose exists and supportive care is the only treatment option.   

Complicating the issue is the deregulation of delta-8, delta-10 THC, and other THC derivatives.  Current Missouri law applies to the main psychoactive component of cannabis, delta-9 THC.  These other products (delta-8 and delta-10) fall outside of the state’s regulation of cannabis and have been sold with no state or federal requirements for age verification, purity determination, or strength verification.  Significantly less is known about these variants and their effects on humans, and especially on small children.  Additionally, these products have been sold in quantities 10s or 100s of times greater than the standard delta-9 THC obtained from regulated dispensaries.  St. Louis Children’s Hospital has observed pediatric exposures to delta-8 THC, with lab testing confirming an increasing number of cases detecting delta-8 THC.  

Emergency physicians need to be aware that these products are increasingly available and that children presenting to the emergency department with altered mental status may be intoxicated with a cannabis product.  Recreational cannabis products need to be stored in a similar manner to medications, ideally in a locked container or cabinet, away from curious children.