New Study Reveals Link Between THC Dose and Toxicity in Children Who Ingest Edible Cannabis
A new study has found that the dose of tetrahydrocannabinol (THC) in edible cannabis products is directly related to the degree of toxicity experienced by children under the age of 6. The retrospective review, led by Dr. Lesley Pepin of Denver Health and Hospital Authority, included 80 children with a median age of 2.9 years. The researchers discovered that the weight-based THC dose was a significant predictor of severe and prolonged toxicity.
According to the study, THC ingestions of at least 1.7 mg/kg can predict severe toxicity with a sensitivity of 97.3%, and prolonged toxicity with a sensitivity of 75.4%. The authors recommend that exposures exceeding this threshold be managed in pediatric services with prolonged observation or admission capabilities. They also suggest that smaller ingestions may only require observation and could avoid transfer to tertiary facilities.
The most common route of cannabis exposure in young children is ingestion, particularly through edible cannabis products such as gummies, chocolate, candy, and baked goods. The authors note that these products can often be difficult to distinguish from non-cannabis items, posing a heightened risk for young children.
The study also revealed an increase in overall cannabis exposures in young children from 2017 to 2021, largely due to ingesting edible cannabis products. During this time, a higher proportion of children required hospital admission, indicating an increase in toxicity from these exposures.
Dr. Pepin expressed surprise at the lower threshold of THC dose that predicts more severe and prolonged effects from cannabis. In Colorado, where the study was conducted, the maximum THC content for a single recreational gummy edible is 10 mg. A 3-year-old child at the 50th percentile for weight could reach the 1.7 mg/kg threshold with just 2.5 edible gummies.
It is important to note that cannabis product regulations vary by state, with medicinal products potentially having higher THC content. Additionally, products purchased online or illegally may have unreliable labeled THC doses.
Among the 80 cases of edible cannabis ingestion, 43% of patients did not require medical interventions, with 76% of these patients ingesting 2 mg/kg of THC or less. However, severe toxicity was present in 46% of cases.
The study recommends using THC dose to risk stratify patients in this age group, with ingestions exceeding 1.7 mg/kg being more likely to develop severe and prolonged toxicity. This threshold should be considered in medical management decisions and the development of marijuana regulations.
The study had some limitations, including potential errors in reporting by parents or guardians, lack of confirmatory testing for cannabis exposure in all patients, and the retrospective study design.
In conclusion, this study highlights the importance of understanding the relationship between THC dose and toxicity in children who ingest edible cannabis products. Healthcare providers and policymakers can use these findings to guide medical management and develop regulations to prevent harm to young children.
Primary Source: Pediatrics
Reference: Pepin LC, et al “Toxic tetrahydrocannabinol (THC) dose in pediatric cannabis edible ingestions” Pediatrics 2023; DOI: 10.1542/peds.2023-061374.