“We should not consider marijuana ‘innocent until proven guilty,’ given what we already know about the harms to adolescents,”1 Sharon Levy, MD, chair of the American Academy of Pediatrics Committee on Substance Abuse, said in an AAP press release, speaking of the legalization of marijuana in Washington and Colorado. The press release was issued in 2015 when the AAP updated its policy on the impact of marijuana policies on youth (Pediatrics. 2015. doi: 10.1542/peds.2014-4146 ), reaffirming its opposition to legalization of marijuana because it contended that limited studies had been done on “medical marijuana” in adults, and that there were no published studies either on the form of marijuana or other preparations that involved children.
Marijuana is a schedule I controlled substance, so the Food and Drug Administration does not regulate marijuana edibles, resulting in poor labeling and unregulated formulations.2
Newsweek published a story Jan. 21, 2018, about a middle schooler handing out gummies labeled “Incredibles” at school. Unbeknownst to her, these were her grandfather’s candies that were infused with the marijuana byproduct tetrahydrocannabinol (THC). Shortly after the ingesting three gummies, she complained of dizziness and trouble seeing. The other children who ate the candy also were sent to the nurse’s office to be checked for adverse effects.
Edibles are marijuana-infused foods. Extraction of the cannabinoid THC, the major psychoactive ingredient, from the cannabis plant involves heating the flowers from the female plant in an oil base liquid. As it is heated, the inactive tetrahydrocannabinoid acid (THCA) is converted to THC and dissolves into the oil base liquids, and it is this additive that is used in food products to create the edible. A safe “serving size,” was determined to be 10 mg of THC,3 but an edible may contain 100 mg of THC if consumed in its entirety.
Many prefer ingesting edibles ,compared with smoking, because there are no toxic effects from the inhalation of smoke, no odors, it’s more potent, and its duration of action is longer.3 The downside is the onset of action is slower, compared with smoking, so many will consume more before the “high” begins, and therefore there is a greater risk for intoxication. For example, a chocolate bar may contain 100 mg of THC, and despite the “serving size” stated as one square, a person might consume the entire bar before the onset of the high begins. Improved labeling and warning of intoxication now are required on packaging, but this does little to reduce the risk.3
Edibles also are made in way that is attractive to children. Commonly, they come in packaging and forms that resemble candy, such as gummies and chocolate bars. Although laws have been put in place to require them to be sold in childproof containers, unintentional ingestions of marijuana edibles have increased, which have led to increased ED visits and calls to poison control. 3,4 As feared, once cannabis oil is obtained legally, there is little control over what it is put in.
As for medicinal purposes, edibles have a great advantage for children when used for that purpose. Ease of administration, long duration of action, and a great taste are all positive attributes. As with all good things, there is a downside when used inappropriately.
Marijuana overdoses can result in cognitive and motor impairment, extreme sedation, agitation, anxiety, cardiac stress, and vomiting. High quantities of THC have been reported to cause transient psychotic symptoms such as hallucinations, delusions, and anxiety.3
The arguments for or against the legalization of marijuana still can be hotly debated. More work still needs to be done to standardize formulation, improve labeling, and require childproof containers to reduce unintentional exposures, but legalization does offer more opportunity for regulation.2 According to an AAP chart of state laws on marijuana , eight states (Alaska, California, Colorado, Maine, Massachusetts, Nevada, Oregon, Washington) and the District of Columbia have legalized recreational use of marijuana, 22 have decriminalized marijuana use, and 30 have legalized medical marijuana use. (See aap.org/marijuana .)
As pediatricians, it is essential to educate teens and their families on the harmful effects of marijuana and dispel the myth that is benign. They need to be informed of the negative impact of marijuana, which leads to impairment of memory and executive function, on the developing brain. Parents also need to be aware of the current trends of use and formulations, so they can be aware of potential exposures.5
Dr. Pearce is a pediatrician in Frankfort, Ill. She said she had no relevant financial disclosures. Email her at pdnews@MDedge.com .
References
1. “American Academy of Pediatrics Reaffirms Opposition to Legalizing Marijuana for Recreational or Medical Use,” AAP press release on Jan. 26, 2015.
2. N Engl J Med. 2015;372:989-91.
3. Methods Rep RTI Press. 2016 Nov. doi: 10.3768/rtipress.2016.op.0035.1611 .
