Poison Center urges precaution about marijuana edibles, with spike in number of kids affected

Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. The Upstate New York Poison Center is seeing an increase in calls about children and teens who've ingested marijuana edibles. Here to provide advice about edibles is Dr. Vince Calleo. He's the medical director of the poison center. Welcome back to "The Informed Patient," Dr. Calleo.

Vincent Calleo, MD: Thanks so much, Amber. It's great to be back.

Host Amber Smith: Now is this increase in calls about kids who intended or who accidentally ate cannabis- containing food products?

Vincent Calleo, MD: What we've seen overall in the course of the last few years is an increase in the overall number of cases of pediatric exposures to edible forms of marijuana products. Now, generally once we start to get into the teenage years, it's a lot more challenging to know if something was truly unintentional or accidental, or whether it was something a teenager was trying to do. But, what we have found is there's been a very large increase in the number of cases between the ages of 0 to 5, where those almost exclusively end up being accidental or unintentional exposures.

Host Amber Smith: Are these edibles the candy-looking edibles, the gummies or the chocolates?

Vincent Calleo, MD: So it's kind of a mix of a lot of different things. I always tell people that from the Poison center, sometimes it's a little bit more challenging to have the really granular details for what the product may have been, simply because we're getting calls coming into the center. But the majority of the time, what we've found is that these products tend to be some form of substance that resembles a candy or a baked good. And that tends to be the most frequent thing that we see for these accidental pediatric exposures.

Host Amber Smith: Now, how big of an increase in the numbers are you seeing?

Vincent Calleo, MD: So if we're looking at the numbers for, again, just looking in particular at that age range of 0 to 5, what we found is that in 2019, we had just under 10 calls for pediatric exposures in this age range. And from January of 2022 up through the end of July / very early beginning of August, we found that we had over 60 calls for that same age range. So, what we found is that based on what we have right now, we're already over six times where we were four years ago for that particular age range. And to be honest with you, we anticipate that number is still going to continue to go up because there's still many months left in this year. So we're on pace to see record numbers of unintentional pediatric exposures to edible products at our center. And so we're on the lookout for that going forward.

Host Amber Smith: Are you seeing similar increases in children over the age of five and teenagers?

Vincent Calleo, MD: We definitely did see an overall increase in the number of cases that were called into the center for all children, between the ages of 0 to 19. I don't have the exact numbers in front of me right now for what the numbers were, but the number increase was very substantial from 2019 up through 2022.

Host Amber Smith: Now, is the theory behind the sharp increase that because these products are now legal in New York, they're more available?

Vincent Calleo, MD: I always hesitate to say exactly what the cause of these things may be, but I think you hit the nail on the head in speaking to the availability of these products. Whether legalization directly impacted this or not, I don't know. But with that being said, we have found that many more people are reporting using edible forms of THC (delta-9-tetrahydrocannabinol, the main psychoactive ingredient in marijuana) now that it's legalized. And if we're looking at the numbers before the legalization, they were much lower. Now they are higher. Kind of like you said, Amber, I think that one of the main reasons why we saw such a large increase is because these products are more available. And because they look like forms of candy or baked goods, things that are very enticing for small children, they're a lot more likely to go ahead and try to eat these products if they see them sitting out, just because they look like normal sweets.

Host Amber Smith: Have you uh, seen this trend? Have you talked to other poison centers in the country about a trend like this once marijuana was legalized in their states?

Vincent Calleo, MD: It's very interesting that you mention that because there is some published literature out there that look at a couple of different states, and we have found that our trend is not dissimilar from them in that once legalization occurred the number of unintentional exposures did go up. And I think, again, it's just because as these products become more available, there's an increased chance that they may be accidentally left out or in a place where a child could get into them. And as a result, you see more children being exposed.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith, talking with Dr. Vince Calleo. He's the medical director of the Upstate New York Poison Center, at 1 800 222 1 2 2 2, and we're talking about how marijuana edibles can be dangerous, and how the poison center is seeing a huge increase in calls about them.

Let's talk about the meaningful differences between the effects of marijuana that is smoked and marijuana that is ingested. Is one more dangerous than the other?

Vincent Calleo, MD: Well, I always tell people that the amount of a substance that you use can really impact how much it affects your body. So if you use enough of anything, it could be dangerous and life threatening. But one of the reasons why we think that edible forms of THC can potentially pose a little bit more of a danger is because when people are using them recreationally, they may think that the amount of time it takes to have an effect from it is similar to if the product was smoked. And in reality, these edible forms of THC can take a lot longer to kick in. So it's not uncommon for us, particularly to see in the teenage or adult population, for patients to call the poison center or be seen in a hospital, saying, "I wasn't feeling an effect, so I took another one." and then all of a sudden they start to feel the effects very, very quickly. So because they'll take oneedible and they won't feel an effect, they'll take a second or a third, and it may be 60, 90, 120 minutes in some cases before they start to feel an effect. And as a result, they can have a very significant effect because they took in a lot more of the product than they normally would have, thinking that it takes the same amount of time as smoked marijuana to give you that same type of effect. So from that standpoint, it can pose more of a danger if it's not taken properly.

Host Amber Smith: So this can be an issue for adults. Is it a special concern when it's a young child?

Vincent Calleo, MD: It is. So there are a lot of differences that exist between young children, teenagers, and adults, and the way that the child's body may respond to something may be different than it will respond from an adult standpoint. And as a result, these children can have much more significant effects, especially because they're much less likely to take an appropriate -- I say appropriate dose, but when we're thinking about things from an adult standpoint, if they know to take one gummy, they may just take one gummy. As opposed to a child, if they see a package, they may take multiple gummies because they think it's like a normal pack of fruit snacks or a normal pack of gummies. So as a result, they can get a much larger dose, and children are much smaller, meaning the dose they take in terms of the amount per weight is relatively higher than it is for an adult. And because children are different from the way that their bodies kind of deal with these different medications or substances, they can have more serious and pronounced effects, in many cases, than we typically see with an adult.

Host Amber Smith: If a parent realizes that their child has ingested an edible, but the child seems fine, is there anything the parents need to do, just to be safe?

Vincent Calleo, MD: The first thing I would tell them is to stay calm because it's not uncommon when this occurs to see families get very, very nervous, much like they would, if a child got into any substance. But I always remind families that the time it takes for the body to start to see an effect from these edible forms of marijuana can be very delayed. So even if your child appears to be acting normally, it doesn't mean that they may not get sick. And so if you think your child had gotten into a product, please feel free to call us at the poison center so we can help provide guidance as to how to best take care of your child or loved one. Because like we talked about before, these products can be very, very dangerous. And our job here at the poison center is to help decrease the bad outcomes that could potentially result from these exposures.

Host Amber Smith: These products being legal, you know, a lot of people, a lot more people have them in their homes, and it sounds like you're advising them to treat them like other medications. Keep them up and away from kids?

Vincent Calleo, MD: That's exactly it, Amber. I always remind families to treat edible forms of THC exactly like you treat any dangerous medication. Keep these medications out of sight and out of reach of children. Remember, out of sight, out of mind goes a long way with a small child. And also, if you have available a medication lockbox, keep your edibles in there with it. Lock boxes aren't perfect, but it certainly provides another barrier to help decrease the likelihood, particularly of a young child accidentally getting into these forms of THC. So using a medication lockbox, keeping them out of sight and out of reach, and not taking the product in front of a child can really help decrease the chances that the child may be accidentally or unintentionally exposed.

Host Amber Smith: When a call comes into the poison center, I'm curious how the nurses and doctors and pharmacists at the poison center actually determine if a child needs to be brought to the hospital or see their physician after they've ingested an edible. What sorts of questions are you going to ask the parent?

Vincent Calleo, MD: It really depends on each scenario, but in general, what we like to do here is try to get an overall picture for how old the child is, how much the child weighs, how much of the product they may have been exposed to, when the exposure occurred, if the child's having any symptoms, and some additional information from there. Fortunately here at the poison center, we're very, very lucky to have a very highly trained staff of like you mentioned, Amber, of doctors and nurses and pharmacists who can answer your questions and help to provide the best guidance on how to safely care for your child. In all reality, there is a good chance that if a child was unintentionally exposed to a edible form of marijuana, they may need to be seen by a healthcare professional, either a pediatrician or in the emergency department, just to make sure they're safe. Because these products can take a while to start to see an effect, one thing we worry about is that we may not be able to accurately guess who's going to develop significant symptoms and who may have mild ones. So that's why it's always very important to try and seek healthcare evaluation, or at least the guidance from the poison center to help make that best decision in terms of how to safely, effectively care for your loved one.

Host Amber Smith: Once you've ingested the marijuana product, is there something else that can be done to negate the effects of the marijuana, or to neutralize what has been ingested?

Vincent Calleo, MD: A lot of that depends on how long after the child ingested it, that they can get to a healthcare facility. There is a medication that we use from the toxicology standpoint called activated charcoal. And what this is, is a solution that someone can drink, and it helps to bind to different types of medications or substances. And as a result, it may decrease how much can get into the bloodstream or the body by being absorbed. Now the longer it is from the exposure, the less likely it is that that charcoal is likely to be effective. But with that being said, if you can get it in the child very early and get them to drink it, it may help to decrease the chances that they'll get very, very sick from the THC product.

Now, once you've started to see an effect from the substance on the child, a lot of times it's challenging to think, okay, is there a quote, unquote "antidote" I can give someone? And the answer to that really is there's not. But more importantly than that, from our standpoint is helping to provide what we call very good supportive care. And essentially that's ensuring that the body's heart rate, blood pressure, oxygen, all those things we help to keep those at a normal range so that the body can do what it does best. And that's breakdown the substances in a safe way until the child can get back to normal. So while there may not be a specific antidote, early and timely intervention may be a good way to help get some activated charcoal in their system to decrease how much their body may absorb. But if it's already in their system, we can help to provide that good supportive measure that they need to really have a good outcome.

Host Amber Smith: Do you ever advise parents to induce vomiting?

Vincent Calleo, MD: So that's not something that we advise doing on a routine basis. In many years past, people used to use something like syrup of Epicac or different things to help make people vomit afterwards. And what we found is that that actually could potentially be dangerous because, in particular if they notice that a child has gotten into one of their products and their mental status or how they respond to the outside world, essentially, if that's changed and they vomit, there is a good chance that some of that vomit actually may go down the wrong pipe into the lungs and cause a lot of damage. So we don't routinely recommend inducing vomiting or anything like that.

Host Amber Smith: Well, I want to remind listeners your website at Upstate.edu/poison has a lot of information on there, including where to obtain free lock boxes. But I know you've also made a video recently aimed at families to help educate about this marijuana edible issue. So, I want to make sure people are aware that the Upstate New York Poison Center is also on Facebook, so they can find you there, and they can find the video there and lots of other information as well.

Vincent Calleo, MD: Yep. That's all correct. And we're really hoping that this can help to spread the message about some of the ways to help keep children safe.

Host Amber Smith: Well, I appreciate you making time for this interview, Dr. Calleo.

Vincent Calleo, MD: The pleasure was mine. So, thank you.

Host Amber Smith: My guest has been Dr. Vincent Calleo, the medical director of the Upstate New York Poison Center. And once again, that number is 1 800 222 1 2 2 2. "The Informed Patient" is a podcast covering health, science and medicine brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at Upstate.edu/i nformed. This is your host, Amber Smith, thanking you for listening.