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Cannabis is now legal in Canada, but there are still issues to be 
considered, especially with edible products

It’s a frightening scenario. Your toddler, who has been active all day, suddenly seems very drowsy—much more drowsy than usual. She seems dizzy, and to be having difficulty breathing. Has she fallen and hit her head? Gotten into something? You consult your local poison control centre, and then it comes to you. A friend brought you a few “space brownies” (brownies laced with cannabis). Your child may have gotten into them. Off to the emergency department you go.

Although cannabis became legal in Canada in October of this year, the sale of edibles is not allowed. However, people will still make their own using legally purchased cannabis, and all too often these products are very tempting to small children. Chocolate bars, cookies and squares, frosting on cakes and squares, beverages, and candies like gummy bears, fudge and caramels are popular choices for people who prefer to ingest cannabis via food products rather than by smoking and inhaling the drug.

Dr. Shannon MacPhee is the chief at the IWK Health Centre’s emergency department and also chief of pediatric emergency medicine. She says that— as is the situation in states such as Colorado where cannabis has been legal for several years—they are seeing more children at emergency who have been accidentally poisoned by cannabis, usually through ingesting edibles.

“The trend that we’ve seen has been primarily with really young children,” Dr. MacPhee says. “Toddlers, preschoolers, even a school-age child—and they’ve had similar incidents in that there was an edible product, which to a child is indistinguishable from treats. They get into those “treats” and come into Emergency poisoned because it was too much for their little bodies to take.”

Dr. Shannon MacPhee is the chief at the IWK Health Centre’s emergency department and also chief of pediatric emergency medicine.
Symptoms and treatment

Unlike smoking cannabis, which takes effect fairly quickly in terms of a person getting high, cannabis-laced edibles can take much longer to show any effect—as much as six hours after eating—which makes it even harder for a parent or guardian to unravel the mystery of what the child has gotten into. Dr. MacPhee says, “When these kids come in, it’s not immediately clear what is going on, and it’s a medical mystery for us to unravel. We have to think about infection, or bleeding into the head, or other head trauma, or prescription drug exposure.”

Registered nurse Laurie Mosher is the clinical leader at the IWK regional poison centre. She says that although the numbers of patients with accidental cannabis poisoning haven’t been huge, they are expecting an increase with legalization, “because there will be more exposure and availability to the public. As with other household products, if it’s accessible to a young child, risks are increased.” She also says that homemade edibles are apt to have inconsistent dosages of cannabis, so while one cookie might have a very small amount of active ingredient, another could have significantly more, and it’s difficult to know how much the child has ingested.

In the case of a child arriving at an emergency department with possible cannabis poisoning, the emergency physicians, nurses and paramedics will ensure that the child is awake enough and will protect her breathing. In some cases, intubation is required to ensure breathing continues. The medical professionals will monitor vital signs and ensure that the child is safe and not at risk of falling and getting injured. In some cases, signs of cannabis toxicity will include shaking and tremors, agitation and paranoia. Dr. MacPhee says often children have to be admitted and monitored until symptoms go away.

Preventing accidental poisonings

If you suspect your child may have ingested edible cannabis products, it is best to err on the side of caution, Laurie Mosher says. “Earlier treatment is better,” she says. “Go to the nearest emergency department or health care facility and if the physician or other health care professional treating the child feels they’re at risk and needs to be transported to the IWK, they make that decision and have a process for such situations.” She says that when parents or caregivers call the poison control centre, they will assess by asking a series of questions and determine whether a child is safe to go by car to an emergency department, or needs to go by ambulance, or is safe to stay home.

To avoid having to deal with such frightening situations, it’s important to be vigilant when using cannabis in any form. Dr. MacPhee says the first act is to be aware, “that this can be a real danger to very young children. Like all other medications we recommend they are stored up high, away from smaller children and in child-proof containers that they can’t get into.” She stresses that there’s no judgement from medical professionals when such a situation does occur. “Really great families have the best interest of their children at heart, but when they’re done using the cannabis product they may forget to put it away. So it’s important to be really vigilant about that.”

In addition, both Dr. MacPhee and Laurie Mosher have noticed a particular spike in cases during summer months or over other holidays, when family members or guests are visiting and may be carrying edible products in a purse or bag that is easily accessed by a curious child. “Make it clear to guests to be sure to store their cannabis products in a safe space—offer them the space if necessary,” Mosher says.

Although the IWK poison centre has had fewer cases of cannabis toxicity in children from second-hand smoke, Mosher says it does happen. “It depends on the circumstances like a small, enclosed room and a lot of smoke. People should not smoke anything around children—including vaping—due to risk of intoxication, and the dangers of irritation to the lungs.”

As your children get older, you will have to modify how you store cannabis products, adds Dr. MacPhee. “They’re going to be curious about the effects of cannabis and you don’t want them trying edibles at someone else’s house without adult permission.” A locked cabinet—similar to what those used for alcoholic beverages—is effective for deterring unmonitored experimenting.

It should also be noted that in some US states where cannabis is already legal, legislation has been passed banning cannabis edibles, especially in child-tempting shapes such as gummy bears. Such safeguards put in place in Canada should also help to prevent accidental poisonings in young children.

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