Pubdate: Tue, 26 Jul 2016
Source: New York Times (NY)
Copyright: 2016 The New York Times Company
Contact: http://www.nytimes.com/ref/membercenter/help/lettertoeditor.html
Website: http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Jan Hoffman

STUDY FINDS SHARP INCREASE IN MARIJUANA EXPOSURE AMONG CHILDREN IN COLORADO

To a child on the prowl for sweets, that brownie, cookie or 
bear-shaped candy left on the kitchen counter is just asking to be 
gobbled up. But in states that have legalized marijuana for 
recreational use, notably Colorado, that child may end up with more 
than a sugar high.

A study published on Monday in the journal JAMA Pediatrics says that 
in Colorado the rates of marijuana exposure in young children, many 
of them toddlers, have increased 150 percent since 2014, when 
recreational marijuana products, like sweets, went on the market legally.

When children get their hands on the goodies they can become 
lethargic or agitated, vomit and lose balance, triggering a hospital 
visit or a frightened call to a poison center. A handful of patients 
were admitted to intensive care units and intubated.

Rates had started climbing in 2009, when the federal government said 
it would not prosecute users and suppliers who conformed to 
Colorado's medical marijuana laws. Those patients often ingested 
their prescription marijuana through baked goods.

When voters decided in 2012 to legalize marijuana for recreational 
use, researchers anticipated that rates of accidental exposure in 
children would rise.

"But we were not prepared for the dramatic increase," said the senior 
author of the study, Dr. Genie E. Roosevelt, an associate professor 
of emergency medicine at the University of Colorado School of 
Medicine and Denver Health Medical Center.

The number of cases in the study, drawn from Colorado's poison 
control data and from one children's hospital, is modest. Between 
2009 and 2015, there were 163 cases documented by the poison control 
center and 81 patients evaluated at one hospital for pediatric 
marijuana exposure.

Even so, Dr. Roosevelt said, "While these ingestions are not common, 
the effects are significant and preventable." Some cases, she said, 
could result from secondhand smoke inhalation. The documentation of 
cause is still evolving.

During that period, marijuana-related child poison control cases in 
Colorado rose 34 percent each year, compared with a 19 percent annual 
increase in other states.

"The study is not an argument for or against legalization," said 
Robert J. MacCoun, a professor at Stanford Law School who writes 
about drug policy. "But it's an argument for smart regulation," he 
said, noting that many products are packaged not only in bright, 
alluring colors, but also in highly variable doses.

At least 23 states have passed legislation allowing marijuana for 
medical use. Colorado and Washington have also decriminalized 
marijuana for recreational use, allowing products to be sold to 
people 21 and older. Alaska, Oregon and Washington, D.C., have also 
passed recreational-use laws.

Colorado, which received close to $588 million in revenue from 
recreational marijuana in 2015 (plus about $408 million from medical 
marijuana sales, which also include edibles), is struggling to 
contain the unintended consequences of its booming new industry. Last 
week, the town of Hugo ordered residents to stop drinking tap water 
because the municipal supply had tested positive for THC, the 
psychoactive chemical in marijuana.

As of 2015, Colorado has required marijuana products to be sold in 
childproof packaging. This month, the so-called gummy bear law went 
into effect: Edible marijuana may not be rendered in the shape of 
humans, animals or fruits, which had made them so irresistible to children.

Consistency of dosing and portion size remains a problem. Dr. Kari L. 
Franson, an associate professor at the University of Colorado Skaggs 
School of Pharmacy, noted that edible marijuana, such as candy bars 
or brownies, typically contained several servings.

"But what kid doesn't eat an entire brownie?" she asked. "And you 
know the toddler doesn't read the label."

That is why unintended marijuana ingestion by children tends to be more toxic.

The statistics in this study and in a national study this month might 
understate the problem. The national study looked at edible marijuana 
exposures reported to poison centers around the country from 2013 to 
2015, and included adults as well as children. While Colorado's 
exposures far outnumbered those from other states, the study said 
overall calls had risen each year.

Dr. Dazhe Cao, a medical toxicologist at the University of Texas 
Southwestern Medical Center and the lead author of the national 
study, published in Clinical Toxicology, said the 430 calls did not 
give a full portrait of "the total epidemiology of exposure" because 
many cases, handled by primary care providers, were not reported to 
poison centers.

Dr. Roosevelt of the Colorado study noted that decriminalization 
might be one reason that reports of accidental ingestions were on the 
rise in that state. Adults who take children to hospitals may be more 
willing now to disclose the source of the illness.

"In 2009, we didn't know what was wrong with these kids, and we did 
all kinds of work-ups," she said. "A brain bleed? Meningitis? Now, 
after legalization, more people are saying, 'Oops, I left my brownie 
out, and my child ate it.' That's not great, but it's helping us to 
manage these patients."
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MAP posted-by: Jay Bergstrom