Childhood exposure to cannabis sparks California public health advisory for safe storage

At the SPARC cannabis dispensary in Santa Rosa, a dizzying array of child-resistant packaging aims to keep edible cannabis products such as gummies, chocolates, mini cookies, infused root beer and savory chips from being accidentally consumed by very young kids or pets.

Some packages or dispensers are similar to those of prescription drugs, with push and twist caps, while others use multiple tabs or buttons that must be pressed at the same time to open. Another product requirement in California’s legal marijuana market involves “tamper-evident“ seals and the now familiar, triangular, cannabis warning logo.

Even so, accidental cannabis exposure among young children does occur, just as it does with alcohol and prescription drugs. Last week, state health officials issued a public health advisory warning people that such exposures among kids are on the rise.

In recent years, the total number of calls to California’s Poison Control Centers for cannabis exposure among children under 6 years old increased from 330 calls statewide in 2018 to 791 calls in 2021, a 140% increase. In contrast, poison control calls for cannabis exposure among youth 6-to-19 increased 27.5% during that period.

Of those 791 calls to poison control in 2021, the vast majority, about 63%, were for exposure to edibles.

Melissa Struzzo, section manager of Sonoma County’s substance use disorder services, said the increase in calls to poison control is deeply concerning, given the high levels of THC found in some cannabis products today.

“It’s something we want parents to understand,” she said. “These edible products can actually contain higher levels of THC and the effects last longer. With children, exposure poses a higher risk than with adults, because they’re so much smaller.”

Struzzo said child-resistant packaging does safeguard against accidental exposure, but parents should take further steps to assure that cannabis products are out of reach once the packaging is opened. That includes making sure to put such things as gummies back in their safety package and storing them in a safe place.

“When it comes out of the childproof packaging and is put on the counter, a child isn’t able to distinguish it from regular candy,” said Struzzo, adding that cannabis-infused products should not be stored with similar non-cannabis food products.

Tess Kofoid, vice president of marketing and sales for SPARC and a mother of a 14-year-old, agrees.

“It’s our responsibility as adults in the house to, first, keep it away from children, just as we do with alcohol and medications,” Kofoid said.

She said parents must also educate their children, depending on their age, about cannabis warning labels.

Public health officials and medical professionals say there’s a link between increase of poison control calls to the recent legalization of recreational cannabis and the proliferation of edibles.

Stuart Heard, executive director of the California Poison Control System, points to a paper published a year ago in the international journal Clinical Toxicology whose findings suggest cannabis legalization is linked to increased exposures among children under 13.

Changes in California cannabis exposures.pdf

The study, whose authors are members of the state’s poison control system, found that between 2010 and 2020 edible exposures reported to poison control increased from near zero to 79% of exposures in 2020.

Heard said in an email that although the state poison control system does not report comparative data by county, “I think you can assume that there is an upward trend in Sonoma County that would be similar to statewide data.”

Erich Pearson, CEO of SPARC, said one possible culprit in the increase in pediatric cannabis exposures is the growth of the illicit marijuana market, which has mirrored that of the legal market. He said the illegal cannabis market now makes many of the same edible products but without the child-resistant packaging and safety warnings.

“The illicit market never had edibles in it,” Pearson said. “I mean, there was the guy who used to make some brownies or whatever, but the illicit market has gotten very sophisticated.

“You can pretty much get everything, product wise, in the illicit market that you can get in the legal market, with the exception of the highly regulated packaging that we have to go through because our packaging is expensive,” he said.

But Pearson warned that safe packaging must be coupled with parent responsibility.

Dr. Omar Ferrari, medical director of the emergency medicine at Santa Rosa Memorial Hospital, said he’s noticed a definite increase in pediatric exposures coming into the emergency department. Ferrari said that while he has not analyzed hospital records, anecdotally he’s seeing a “dramatic increase in these sorts of exposures since legalization.”

Cannabis exposure for very young children is particularly worrisome, he said, because the effects can be more extreme given their body mass index compared to adults, as well as their inability to psychologically understand what’s happening to them.

Adults, he added, can self-soothe and rationalize the experience to avoid “totally losing it. But a 5-year-old can’t do that.” What’s more, Ferrari said edibles often yield a prolonged, intense effect that can last hours.

When a young child enters the emergency department for cannabis exposure, they are often isolated with their parents and kept apart from the chaotic environment often common in an emergency department. They are comforted as much as possible, he said.

“In extreme cases, we may use benzodiazepines that can help calm the child and induce sleep or a sleep-like state,” he said. “Those are complex medical decisions that are made by our team.”

Ferrari said he welcomed the state’s messaging campaign for safe cannabis storage.

“I’m awfully glad we’re acknowledging this and taking it seriously,” he said. “We have to be vigilant and thoughtful.”

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.