Hospital Visits Due to Accidental Ingestion of Marijuana after Recreational Legalization

Introduction
Legalization of Recreational Marijuana increases with each election season. This led to increasing availability of marijuana and a decrease in stigma. Many of these products are edible with appealing appearances, lending themselves to accidental pediatric exposure.1-3 Of concern, is that these children may require inpatient, or PICU care as a result of ingestion.
Objective
The objective of this study is to identify the volume of patients under age 12 with accidental ingestion of marijuana at a tertiary care center before and after recreational legalization in December 2018.
Methods
Retrospective chart review of children under age 12 treated in our system who had a urine drug screen test positive for THC five years prior to recreational marijuana legalization to one-year post. Data included patient demographics, urine drug screen results, admission unit, and diagnosis codes. Medical record reports generated lists of total number of admissions and ED visits. Rates of positive tests and admission where calculated and evaluated with Chi-squared analysis.
Results
Between January 2014 and January 2020 there were 0.02-0.04 patients per 1000 who tested positive for THC on a urine drug screen. In 2018 there was a statistically significant increase to 0.13 per 1000 and to 0.16 per 1000 total patients in 2019. The rate of patients with a positive drug screen for THC who required admission to the hospital was 0.1-0.2 patients per 1000 per year from 2015 – 2018, with an increase to 0.6 in 2019, which approaches statistical significance (p-value 0.06).
Conclusions
The number of children under age 12 testing positive for THC during an ED visit or hospital admission has increased significantly since 2017. This implies increased overall exposure for children in the community. More children are requiring admission to the hospital which may indicate increased severity. The largest increase in total exposure was from 2017-2018 when the resolution to legalize recreational marijuana passed. The largest increase in admissions was from 2018 - 2019, the first year of legalization. These findings suggest an increase in availability in THC containing products and decrease in stigma lead to an increase in accidental ingestions and healthcare utilization. This demonstrates the need for community education regarding marijuana safety practices.

References: 1. Thomas AA, Von Derau K, Bradford MC, Moser E, Garrard A, Mazor S. Unintentional Pediatric Marijuana Exposures Prior to and After Legalization and Commercial Availability of Recreational Marijuana in Washington State. The Journal of Emergency Medicine. 2019;56(4):398-404.
2. Wang GS, Le Lait M-C, Deakyne SJ, Bronstein AC, Bajaj L, Roosevelt G. Unintentional Pediatric Exposures to Marijuana in Colorado, 2009-2015. JAMA Pediatrics. 2016;170(9):e160971.
3. Wang GS, Roosevelt G, Le Lait M-C, et al. Association of Unintentional Pediatric Exposures With Decriminalization of Marijuana in the United States. Annals of Emergency Medicine. 2014;63(6):684-689.