Child's cannabis edible incident sparks concern - improving edible safety
Key Takeaways
The THC edibles market is growing, with sales in the billions. For many buyers, edibles offer a less-toxic way to ingest marijuana.
THC has been shown to improve everything from pain and sleep to inflammation and anxiety. However, experts believe that certain patients should refrain from using THC, as it can impact physical and psychological health in serious ways.
Edibles may also cause delayed onset effects, which may lead to overconsumption and uncomfortable symptoms.
Recently, a child in California was sickened after getting a cannabis gummy as a treat during a school Halloween event, raising the question once again of how to keep children from unintentionally ingesting cannabis.[]
The cannabis edibles market is booming, with projected sales expected to reach over $8 billion in 2025. This isn’t surprising, given that marijuana—which derives from the cannabis plant and contains psychoactive tetrahydrocannabinol (THC)—is the single most commonly used, federally illegal drug in the United States.[][]
For people who seek cannabis’s benefits, THC-infused edibles (sold in states where marijuana is legal) come in handy, as they’re discreet and don’t require the inhalation of toxins.[]
Understanding edibles
The cannabis plant contains phytocannabinoids—compounds that engage the body’s cannabinoid receptors—securing its place in ceremony, recreation, and wellness. Studies have shown that THC (and its non-psychoactive cousin, cannabidiol, or CBD) can improve chronic pain, anxiety, sleep, and inflammation.[] [][]
Not every THC edible is created equal, though. Each state has its own set of laws around the manufacturing of edibles. According to the American Journal of Preventive Medicine, for example, Oregon and Washington place product weight and volume limits on edibles, while Colorado, Illinois, Massachusetts, and Nevada place limits on the total grams of THC sold through edibles. Some edibles could contain 2 mg THC, while others have more than 10 mg. Edibles could be problematic for patients who don’t know what this means.[]
According to Leafly, the “world’s most trusted destination to discover cannabis products and order them from legal, licensed retailers,” a microdose edible contains 1 to 2.5 mg of THC. The impact will be minimal. At 3 to 5 mg, a slight high may be felt. At 10 to 15 mg, new users may feel “overwhelmed.” Higher dosages are only recommended for experienced users.
According to the RTI Press Methods Report Series, there is a “prominent difference” in effect “between ingestion and inhalation of cannabis extracts”—and that’s the delayed onset. “Consumers often do not understand this aspect of edible use and may consume a greater than intended amount of drug before the drug has taken effect, often resulting in profoundly adverse effects,” the authors write.[]
How THC edibles could affect your patients
Despite THC’s clinically proven benefits, it isn’t always right or safe for everyone. According to Carl P. Kaplan, MD, Chief of the Division of Pediatric Emergency Medicine at Stony Brook Children's Hospital, THC edible use in the immediate term can pose certain health and psychiatric risks, ranging from the physical (increased heart rate, syncope, vomiting, poor reaction time) to the psychiatric (mood changes, paranoid, sedation, hallucinations, poor decisionmaking). In the long term, it can cause gastritis, reflux, appetite issues, eye health problems, mood changes, difficulty concentrating, impulsivity, forgetfulness, and psychological dependence.
The risk to children is clearly documented as well. Pediatrics found that in 2021, over 3,000 children accidentally ingested cannabis edibles, leading to ataxia, agitation, confusion, tremors, seizures, gastrointestinal problems, ocular issues, and more.[]
This issue seems to be growing. From December 30, 2018 to January 1, 2023, there were over 530,000 cannabis-related ER visits in the United States among people under the age of 25, according to the Centers for Disease Control and Prevention (CDC).[]
Patients who might be interested in trying edibles, whether medicinally or recreationally, should start with a low dose, Dr. Kaplan says. “Effects may not come for up to 2 hours depending on what you have eaten recently and your individual metabolism. Many people make the mistake of taking more and potentially having adverse effects because they didn’t feel anything more immediately.” More so, patients should be warned to eat edibles in a safe place, to stay hydrated, and to not drive after use.
Dr. Kaplan also notes that patients should be educated on how taking edibles could impact current conditions and any medications they are currently taking, “especially those for blood pressure, other heart problems, [and] neurologic or psychiatric problems,” he says.
You’ll want to be extra careful about educating patients with mental health concerns, echoes Ryan Sultan, MD, a researcher and teaching psychiatrist at Columbia University Vagelos College of Physicians and Surgeons. He notes that patients with a history of mental health conditions—including anxiety or psychosis—might experience a worsening in symptoms as a result of consuming edibles.
There’s no single way THC could affect your patients, though, Dr. Sultan says: “Cannabis can affect mental health differently for each person.”
Other general risks?: “Mixing cannabis edibles with alcohol or other substances can increase the risk of adverse effects and impairment. It's advisable to consume them separately,” Dr. Sultan adds.
Storing THC edibles at home
Dr. Kaplan says that people who keep edibles inside a home where children live must be vigilant about storage. “Ideally, [edibles should be] locked in an inaccessible [place] to those under 21, especially young children and pets. If they cannot be locked [away], then they should be out of sight and out of reach…in child-resistant containers.” Dr. Kaplan says never to store edibles with other food or snacks or in containers whose contents could be mistaken for food.
If a patient has a negative experience with an edible, they shouldn’t feel embarrassed to ask for help, Dr. Sultan stresses. “If patients experience severe discomfort or adverse effects after consuming cannabis edibles, they should seek medical attention immediately,” he adds. Patients should also be encouraged to speak openly and honestly about their THC use.