Kids are mistaking marijuana edibles for candy, experts caution

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 number of children who accidentally ingest cannabis is a growing concern to medical professionals at the Upstate New York Poison Center. Here with me to talk about this troubling trend is Michele Caliva. She's a nurse and the administrative director of the center. Welcome back to "The Informed Patient," Ms. Caliva.

Michele Caliva, RN: Thank you. Glad to be here.

Host Amber Smith: The Upstate New York Poison Center has been getting more calls about cannabis exposure for a few years now, right?

Michele Caliva, RN: We have. Since it became legalized in 2021, we've started to see an upward trend in cannabis calls, particularly in children under the age of five.

Host Amber Smith: So is it mostly affecting children under age 18, or little kids?

Michele Caliva, RN: So we've been looking at all the numbers. Predominantly what we have been focusing on is children under the age of five. We don't anticipate children under the age of five being positive for cannabis, so that's the area that we have really focused on. But we have looked across all age cohorts, all age groups, and have seen an increased trend with other ages as well.

Host Amber Smith: I was going to ask what forms of cannabis you're getting the most calls about.

Michele Caliva, RN: It's mostly gummies. It's mostly edibles. They look so similar, indistinguishable from regular candy gummies or even children's gummies melatonin and vitamins. You know, they look like gummy bears, right? So the cannabis just looks like something they're used to.

Host Amber Smith: How do the effects differ between cannabis that is smoked and cannabis that is ingested?

Michele Caliva, RN: Regardless of the age, when you eat something, when you ingest something, it sits in your stomach a little bit longer than it would if you inhaled it. So if you inhale a cannabis product, you're going to get a effect very quickly. It goes into your lungs and then gets to your brain, and you feel those effects very, very fast.

With something that's ingested like a gummy, it's going to sit in the stomach a little bit. Absorption's going to be slower. So you're not going to feel the effect right away. It could be delayed 15, 20 minutes, maybe even longer. In children, we see delayed effects, or we see effects that last a long time -- different than we would in an older person.

Host Amber Smith: Well, now that it's legal, is the cannabis that people are buying at stores considered safer?

Michele Caliva, RN: That's a very good question. There are two types of dispensaries. There is the licensed dispensary, and that is licensed by New York State Office of Cannabis Management. People go through a rigorous application process. And then there are the unlicensed dispensaries that pop up.

When you're buying from a licensed dispensary, the ingredients are all supposed to be listed. They have to meet certain expectations, and you'll know what the serving size is. So what I mean by that is you might purchase a chocolate chip cookie, but the serving size is not the entire cookie. The serving size might be an eighth of that cookie. So in a licensed dispensary, all of that is supposed to be listed. All those ingredients are supposed to be listed. Serving size are listed.

In an unlicensed, there's no regulation. In an unlicensed dispensary, you might get a package that looks like an Oreo, or the same color packaging of an Oreo or a Sour Patch kid or a Sweetheart, or really anything. It looks exactly the same, same color, colors used, same marketing, same verbiage. The lettering may be the same, but on closer inspection, you realize that it's not the Sour Patch kids that you would normally buy for consumption, right, for kids. It's not candy. Those packages can be sold in an unlicensed dispensary because there's no regulation.

In a licensed dispensary you won't get packaging that looks similar to food products.

Host Amber Smith: Let's talk about the dangers of cannabis. What effects can it have on people?

Michele Caliva, RN: So in children we see a variety of things. Again, they're delayed. Children don't get silly. They can get very lethargic. They get really drowsy to the point of being lethargic, right? Really difficult to stay awake or to wake up. They can get very anxious, fearful, paranoid. They can have hallucinations. We had a case where a child talked to an IV pole because he thought it was a person, for hours. They can also have, in some cases, reported to us, we've seen cases where children may have their respiratory, their breathing rate, slowed down. So we're very concerned about the effects that it has in children under the age of five, so much so that if a parent called and said their child got into even a bite of a cannabis edible or gummy, we would send them in. We send all children into a health care facility when they've ingested these gummies because we really don't know how long their symptoms are going to last or what they are. There's a level of unpredictability that is concerning. So they all go in.

I would like to comment that sometimes parents say, "oh dear, you know, I'm concerned about bringing my child in." There's no reason to be concerned. Cannabis is legal. It's no different than if you called and said your child got into grandma's heart medicine, orgrandpa's diabetic medication. It's no different. And we really want to assure parents that if your child gets into one of these products, you need to bring them in. You need to call us. You need to bring them in. And it's OK. There's nothing to be concerned about. We'll talk about, I'm sure, as we go on, about some of the safety measures. But they need to get into a health care facility. Bottom line, they need to go to an emergency room.

Host Amber Smith: Is cannabis more dangerous for kids because of the size, where they're getting so much more of the cannabis...

Michele Caliva, RN: Yes.

Host Amber Smith: ... for a body that's so much smaller?

Michele Caliva, RN: Yes, absolutely. Size makes a difference. And then you had asked me, what else do you see in older adults, or the rest of the age groups? And I don't say this in jest: Who eats just one chocolate chip cookie or one brownie?

Host Amber Smith: Right.

Michele Caliva, RN: And we're finding that even adults sometimes don't take the time to read the serving size that's appropriate. So we'll get an adult that might say, "Gee, I ate this entire brownie, and I don't like the way I feel. It's not what I was expecting. I'm feeling very uncomfortable, and not feeling right." Because if they had gone back and read the ingredients, maybe they were supposed to take a half of that brown or a quarter of it. So that, that's one thing we're seeing.

The other thing we're seeing is, it might be somebody who said, "You know, back in the day, I smoked cannabis products, and I liked it, and I was fine. I'm going to fast forward and try it now, but this time I'm going to try it in an edible form." And they eat it, and they're not getting the effect that they expected. So they eat more. They take more in. So all of a sudden now they're really feeling it. And again, it's too much. It's not what they anticipated.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with administrative director Michele Caliva from the Upstate New York Poison Center, which covers 54 counties in New York State and can be reached around the clock at 1 800-222-1222. We've been talking about the growing concern about accidental ingestion of cannabis products, especially involving little kids.

So how long do the effects of the cannabis ingestion last in a child?

Michele Caliva, RN: We've seen cases where kids might have symptoms for a few hours, and then it goes away. But we've even seen children that have been admitted to the hospital overnight, maybe 24 hours. And we've even had a couple of cases where children have stayed in the hospital longer than that, a couple of days. So again, it's a bit unpredictable, which is why we're so cautious about sending them in.

Host Amber Smith: So once they're at the hospital, is there a way to reverse the effects of the cannabis?

Michele Caliva, RN: So mostly it's just close monitoring and supportive care and checking their vital signs and supporting them as they need to be, giving the fluids if they need it. There's no antidote, but there is good supportive care that helps them, particularly if you have a child that's very drowsy. You want to make sure that they're breathing well. If you have a child that is very anxious, is very scared, very paranoid, you want to make sure that they're in a safe space.

You mentioned before that parents sometimes are hesitant about bringing their child to the hospital and having to explain that they got into the edibles, even though they're legal. It's no different than having any product in the house. Again, you could have, you could inadvertently leave your PineSol on the counter, and your child takes a swallow of it, is coughing, and we say they need to go into the health care facility. It's the same thing. It's legal. It's OK to have cannabis.

We do really, really try to get the message out that you need to treat your cannabis products exactly the same way you would treat medication. So if you store medication up and away from children, you should store your cannabis up and away from children. And we're really pushing lock boxes. We would love to see cannabis in a lockbox so that a child couldn't get into it.

Host Amber Smith: So that, I guess, is the advice about preventing accidental ingestion?

Michele Caliva, RN: A hundred percent. I mean, there's several. One: look at the packaging, and make sure that the packaging isn't confusing to your child. Make sure that they're not going to see it and say -- whether it's in a package, or whether it's the product itself. I mean, you could take it out of its packaging and have what looks like a Rice Krispy treat sitting on your counter that either you bought or you made, and your child's not going to know the difference.

So making sure that when you have those products around, and they do contain cannabis, that you keep them out of their way. If it's a container, if it's a baggie of edibles or a package of edibles, you put it in a lockbox so they can't get to it.

Host Amber Smith: If I understand correctly, even as the concern over accidental ingestion of cannabis is on the rise, cannabis is not the top poisoning for all age groups. Can you tell us what is?

Michele Caliva, RN: We see a variety of exposures in little children. We see a lot of cosmetic products that they get into. A lot of that is hand sanitizers. We see analgesics. We see acetaminophen, for example, or ibuprofen. Parents may give the medication to the child and then they leave it on the counter for a second to go, maybe, get a Kleenex to wipe the child's nose or whatever, and the child says, "oh, I think I'll take some myself," and reach up and grab it.

Those products taste good. We kind of laugh in my home because sometimes I'll see a commercial for bubblegum acetaminophen, and I start yelling at the television. And my husband has to remind me that they can't hear me. Only he can. But it's because we want a child that has a fever to like the acetaminophen we're giving them, right? Because we want them to take it. But the reality is those products do taste good, and I think it's confusing sometimes. Kids think it's candy, so they help themselves through the rest of the bottle. They do that with vitamins too. Vitamins are gummies. So they're like, "oh, that's a treat" when it's not a treat. It's a medicine.

So yes, we see a variety of exposures, cleaning products and cosmetics and medications in this under five years of age. They get into little toy products. And again, there's a lot that we track in this age group.

This particular problem was concerning because we started to see that rise in exposures -- and again, we send them all to the hospital -- where some of the other products we're able to keep them at home.

Host Amber Smith: Well, I'd like to ask you what is happening with fentanyl. Can you first explain what fentanyl is and why it has been a problem?

Michele Caliva, RN: Fentanyl is an opioid. It's an analgesic. It's a legitimate drug that's used for pain management. It's a good drug if it's used appropriately and prescribed. What we found is that fentanyl was sometimes sold to people unknowingly as heroin or sometimes mixed with heroin or with other opioids.

And what happens is, when somebody takes an opioid like heroin, they have the effect, the drug effect. And if they lose their ability to breathe or they're a little bit drowsy or lethargic, they're given Narcan (naloxone.) They do great. And it reverses it.

With fentanyl, it kind of makes those symptoms last longer. So sometimes you need more than one dose. So they get a dose of Narcan, and everybody thinks they're OK, and in fact they go down again a little bit later because they needed more Narcan.

So again, it's out there. I'm always hesitant to say that something is gone away or that something is no longer a problem. We have seen heroin, fentanyl, and opioid misuse, abuse for years. Long before people were talking about it, we were talking about it. So we also see trends. We see things that seemingly are not longer being used and then suddenly come back again.

The good news is right now there's data out there that suggests, statistics out there that suggest that maybe there are less fentanyl related deaths. And we'd like to think that that may be because so many more people are now trained to give naloxone, to give Narcan. So many people are carrying it with them so that they're able to rescue somebody who has stopped breathing. But whether the misuse, abuse of it is gone, I'm always hesitant to make that kind of prediction or statement.

Host Amber Smith: So the fentanyl deaths do, at least right now, appear to be on the decline?

Michele Caliva, RN: Yes. I mean we've heard that anecdotally. And also I just really want to stress different communities will have different statistics, right? So you might hear from one county where there's a rise in whatever the drug is. And then from another county they'll say, "yeah, we're not seeing it." Our take home message is, it's still an issue. It's still a problem. Make sure that you learn how to appropriately give the antidote, which is Narcan, and carry it with you.

Well, Ms. Caliva, thank you so much for making time for this interview.

My pleasure. Thank you for the invitation.

Host Amber Smith: My guest has been Michele Caliva, the administrative director for the Upstate New York Poison Center. Reach the center at 1 800-222-1222. "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 with sound engineering by Bill Broeckel and graphic design by Dan Cameron. Find our archive of previous episodes at upstate.edu/informed. If you enjoyed this episode, please invite a friend to listen. You can also rate and review "The Informed Patient" podcast on Spotify, Apple podcasts, YouTube, or wherever you tune in. This is your host, Amber Smith, thanking you for listening.