ER visits on the rise for cannabis-related conditions among children

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More and more young patients are turning up in emergency rooms across New Jersey with marijuana-related health issues, echoing a trend that’s been playing out across the country over the past few years.

According to newly released findings from the U.S. Centers for Disease Control and Prevention, between 2020 and 2022, hospitals nationwide saw a surge in the number of kids who consumed toxic levels of cannabis or smoked enough marijuana to require medical care.

Published July 14, the CDC’s report found that most incidents involved patients 15 to 24 years old. Altogether, this age group represented 90% of overall cannabis-related ED visits, rising only about 8% from 2019 to 2022, the analysis said.

The most notable increases occurred just after stay-at-home orders were put into place during the spring of 2020, suggesting a link between cannabis and self-soothing during stressful times. By 2022, the number of visits for the age group returned to pre-pandemic levels, the study said.

However, the report found the largest spikes in ED visit rates from 2019 to 2022 were among adolescents between ages 11 and 14, as well as children aged 10 and younger. For the former, the highest number of admissions occurred during the school year and the latter tended to peak during summer break, data showed.

Altogether, preteens recorded a 24% average increase during the period in ED visits by males, while females accounted for a 111% rise during the time frame, underscoring the findings in a separate CDC study from February that found young teenage girls are experiencing record levels of hopelessness and sadness, which may be leading them to use cannabis more.

Among the 10-and-under cohort, there was a 214% increase, with the average number of weekly cannabis-related ER visits ranging from 20.9 per 10,000 visits in 2019 to 65.6 per 10,000 visits in 2022.

These exposures are likely the result of accidental poisoning associated with edibles sold in colorful, cartoonish packaging that appeals to kids, the study’s authors wrote.

Dr. Lewis Nelson, chair of emergency medicine at University Hospital in Newark, said there has “undoubtedly” been an increase in cannabis-related ED visits by young people at the hospital.

“As with the CDC findings, the greatest percentage increase has been in young children aged 2-6 years, though they still account for a small minority of the overall visits,” he said.

“Since the number of young children presenting to the ED prior to the legalization of cannabis in the state could be counted on one hand, the fact that we now see several cases a month represents a substantial increase,” he said. “Because the baseline use in older teens and young adults is higher, the relative increase in visits has been fairly small but the numbers of visits are quite high.”

Nelson went on to say that many of the young patients admitted “are here for peripherally related issues, such as injury” but that the number of individuals “presenting directly for cannabis intoxication has been rising” both during and after the pandemic.

“Though the number of patients presenting directly for cannabis intoxication has been rising and increased during and post-pandemic. That said, it is hard to determine if this is pandemic stress-related, legalization related, or due the availability of more and stronger, more potent cannabis,” Nelson explained.

At Holy Name Medical Center in Teaneck, Dr. Tae Park, the emergency department’s medical director, said, “The increased use for self-medicating for mental health issues that developed during the pandemic likely led to increased utilization – legal or illegal.”

Even before the coronavirus outbreak, hospital admissions were starting to rise as more states in the U.S. legalized marijuana, with experts pointing to the proliferation of edibles, combined with a growing perception that these forms of cannabis are less risky than lighting up, as the biggest drivers.

Hospitals in New Jersey – where cannabis has been legal for recreational use for those 21 and up since 2022 and for medicinal purposes since 2010 – say they have seen an uptick in children visiting the emergency room for accidental ingestion of cannabis.

Park agreed that the availability via adult-use legalization plays a role, saying “the commercialization of cannabis allowed for an increased variety of delivery methods, from vaping, edibles, accidental ingestion of edibles, etc.”

Another factor, he said, is that the U.S. Drug Enforcement Agency still classifies marijuana as a Schedule I narcotic, which means there is “limited regulation of the manufacturing and labeling” nor is it required to have “child safe packaging.”

When it comes to the cause of cannabis exposures, Nelson noted that there “is a stark difference” between the age groups.

Younger children almost always develop cannabis intoxication due to edibles, lured by their form, color or taste, Nelson explained. “Parents and others need to be very careful about storage, especially because some of the products look identical to commercial non-cannabis-containing products.”

The patients who are a bit older “most often present because the plant variety [strain] or vape oil used was of a higher potency than previously available, meaning there is a higher concentration of active drug in the product making it harder to safely dose,” Nelson said.

Emergency rooms have also noted a “marked increase” among older children and young adults developing a “previously uncommon syndrome – cannabinoid hyperemesis syndrome,” according to Nelson.

“In these cases, extensive use of high potency cannabis leads to uncontrolled vomiting that is often abated by taking a hot shower, or by certain medications we can provide in the ED,” he said.

After a child is discharged, Park said it’s hard to know if the exposure will lead to any “long-term neurocognitive/development effects” due to U.S. Food and Drug Administration restrictions on conducting clinical research using THC, CBD and marijuana.

“There may be risk of injury from accidents due to the effects of the psychoactive components. Smoking the product still has carcinogenic effects. There have been some studies correlating THC and certain mental health illnesses. But those may be correlation results and not causation,” Park said.

In a written commentary accompanying the CDC study, lead author Douglas Roehler said there are a combination of strategies that “can help mitigate concerning rises in cannabis-involved ED visits among young persons.”

“It is important for adults who use cannabis to safely and securely store cannabis products in places inaccessible to children. Communities, schools, and coalitions (such as Drug-Free Community coalitions) can implement evidence-based youth substance use prevention interventions to address changing patterns of cannabis use during the pandemic. These local organizations are best suited to meet youths in their communities and tailor interventions to effectively decrease cannabis use. States can implement or strengthen packaging restrictions to decrease youth appeal (e.g., plain packaging, comprehensive labeling, and more prominent warning labels),” he wrote.