Abstract
Objective
Multiple states have passed legislation permitting marijuana use. The impact of legalization
on trends in hospital encounters for marijuana exposures in young children across
states remains unknown. We aimed to describe trends in marijuana-related hospital
encounters over time in children <6 years and assess the association of state-level
marijuana legislation with the rate of marijuana-related hospitalizations.
Methods
We identified inpatient, emergency department and observation encounters for children
<6 years with marijuana exposures (defined by International Classification of Diseases
diagnosis codes) unique on the patient-year level at 52 children's hospitals in the
Pediatric Health Information System database from 01/01/2004 to 12/31/2018. Trends
in encounters across the study period were evaluated using negative binomial regression
with outcome of marijuana-related hospital encounters and year as the predictor variable
accounting for clustering by hospital. We then estimated a negative binomial regression
difference-in-difference model to examine the association between the main outcome
and state recreational and medical marijuana legalization.
Results
Of the 1296 included unique patient-year encounters, 50% were female with mean age
2.1 years (standard deviation = 1.4). Fifty percent were inpatient (n = 645) and 15%
required intensive care with 4% requiring mechanical ventilation. There was a 13.3-fold
increase in exposures in 2018 compared to 2004 (P< .001). We did not find an effect of state legalization status for recreational (P = .24) or medical (P = .30) marijuana.
Conclusions
The observed dramatic increase in marijuana-related hospital encounters highlights
the need for prevention strategies aimed at reducing unintentional marijuana exposures
in young children, even in states without legislation permitting marijuana use.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic PediatricsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes—United States Surveillance Special Report. 2019. 2019
ProCon.org. Legal medical marijuana states and DC. 2020; Available at: https://medicalmarijuana.procon.org/view.resource.php?resourceID=000881. Accessed December 24, 2020.
ProCon.org. Legal recreational marijuana states and DC. 2020; Available at: https://marijuana.procon.org/view.resource.php?resourceID=006868. Accessed December 24, 2020.
- Unintentional cannabis ingestion in children: a systematic review.J Pediatr. 2017; 190: 142-152
Leubitz A, Spiller HA, Jolliff H, et al. Prevalence and clinical characteristics of unintentional ingestion of marijuana in children younger than 6 years in states with and without legalized marijuana laws. Pediatr Emerg Care. 2019 [e-pub ahead of print]. https://doi.org/10.1097/pec.0000000000001841.
- Marijuana exposure among children younger than six years in the United States.Clin Pediatr (Phila). 2016; 55: 428-436
- Acute cannabis toxicity.Pediatr Emerg Care. 2019; 35: 799-804
- Association of unintentional pediatric exposures with decriminalization of marijuana in the United States.Ann Emerg Med. 2014; 63: 684-689
- Pediatric marijuana exposures in a medical marijuana state.JAMA Pediatr. 2013; 167: 630-633
- Unintentional pediatric exposures to marijuana in Colorado, 2009-2015.JAMA Pediatr. 2016; 170e160971
Thomas AA, Dickerson-Young T, Mazor S. Unintentional pediatric marijuana exposures at a tertiary care children's hospital in Washington State: a retrospective review. Pediatr Emerg Care. 2018 [e-pub ahead of print]. https://doi.org/10.1097/PEC.0000000000001703.
- Achieving data quality. How data from a Pediatric Health Information System earns the trust of its users.J AHIMA. 2004; 75: 22-26
- Pediatric toxicology: specialized approach to the poisoned child.Emerg Med Clin North Am. 2014; 32: 29-52
- 2018 Annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 36th annual report.Clin Toxicol. 2019; 57: 1220-1413
- Cannabis intoxication case series: the dangers of edibles containing tetrahydrocannabinol.Ann Emerg Med. 2018; 71: 306-313
- Characterization of edible marijuana product exposures reported to United States poison centers.Clin Toxicol (Philadelphia, Pa). 2016; 54: 840-846
- Accidental pediatric ingestions of medical marijuana: a 4-year poison center experience.Am J Emerg Med. 2015; 33: 844-845
- Pediatric concerns due to expanded cannabis use: unintended consequences of legalization.J Med Toxicol. 2017; 13: 99-105
- Changes in cannabis potency over the last 2 decades (1995-2014): analysis of current data in the United States.Biol Psychiatry. 2016; 79: 613-619
- The impact of marijuana policies on youth: clinical, research, and legal update.Pediatrics. 2015; 135: 584-587
- The safety effects of child-resistant packaging for oral prescription drugs. Two decades of experience.JAMA. 1996; 275: 1661-1665
- Safety interventions and liquid laundry detergent packet exposures.Pediatrics. 2019; 144e20183117https://doi.org/10.1542/peds.2018-3117
National Conference of State Legislatures. State Medical Marijuana Laws. 2020; Available at: https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx. Accessed April 20, 2020.
Article Info
Publication History
Published online: July 25, 2021
Accepted:
July 20,
2021
Received:
February 19,
2021
Footnotes
The authors have no conflicts of interest relevant to this article to disclose.
Identification
Copyright
Copyright © 2021 by Academic Pediatric Association
