Legal Cannabis Tied to Less Resource Use in Children With Cannabis Poisoning

State-level legalization of recreational cannabis is found to result in a significant decrease of resource use among children with cannabis poisoning, according to study results published in Pediatrics journal.

There has been a rise in unintentional cannabis ingestions among children in the US, with high rates of invasive diagnostic testing being performed in the emergency department (ED) for this population.

Researchers of a cross-sectional study determined the effect of cannabis legalization on resource use in children with cannabis poisoning.

Eligible participants were enrolled in the Pediatric Health Information Health (PHIS), had ED visits for cannabis poisoning or related disorders between 2016 and 2023, and were aged 6 years and younger.

Primary study exposure was legal status of recreational cannabis in the state in which the hospital with the ED encounter was located.

Primary study outcome was advanced diagnostic testing, such as neuroimaging or lumbar puncture; secondary outcomes were other types of diagnostic testing and severe illness, which included admission to the intensive care unit (ICU) or need for mechanical ventilation.

A total of 3649 ED visits (1838 girls and 1805 boys; mean age, 2) for cannabis poisoning were included in the analysis. The majority of patients (n=2267; 62%) were transferred to inpatient care. With regard to resource use, 1151 (32%) received advanced neuroimaging and 116 (3.2%) received lumbar puncture. Fewer than 10% of the cohort required ICU admission or mechanical ventilation, and the majority (89%) received laboratory testing.

Of 47 hospitals in the study, 4 were in states with legalized recreational cannabis and 16 were in states that changed their status during the study. A total of 71% of ED encounters occurred in states with an illegal status of recreational cannabis.

Trends showed that ED visits for cannabis intoxication among children aged less than 6 years increased from 2016 to 2023 in both cannabis-legal and -illegal states (2016: 1.0 to 7.1 and 2023: 0.5 to 9.4 cannabis encounters per 10,000 overall ED encounters, respectively).

Results of the multivariable analysis indicated that resource use was significantly less likely in ED encounters in cannabis-legal vs -illegal locations for advanced neuroimaging (adjusted odds ratio [aOR], 0.62; 95% CI; 0.53-0.74) and lumbar puncture (aOR, 0.42; 95% CI, 0.24-0.69), as well as for ICU admission (aOR, 0.72; 95% CI, 0.55-0.92) and mechanical ventilation (aOR, 0.31; 95% CI, 0.14-0.59). However, patients with ED encounters in cannabis-legal vs -illegal locations were more likely to receive urine testing (aOR, 1.94; 95% CI, 1.66-2.27).

One of the main limitations of the study was the inability to accurately determine the total number of cannabis-related encounters because of dependence on the International Statistical Classification of Diseases, Tenth Revision (ICD-10) codes for identification and low sensitivity of diagnoses for drug overdoses.

“Our findings suggest the need for education on the early recognition and management of cannabis intoxication in young children and a focus on policies and procedures to minimize invasive and potentially harmful testing,” the researchers concluded.