Young children and polysubstance use predicted severe outcomes from pediatric cannabis intoxication

Among 138 pediatric cannabis intoxication cases, 38% required ICU admission, with younger age and polysubstance exposure being the strongest predictors of severe outcomes.

Cohen, Neta et al.·Clinical toxicology (Philadelphia·2023·Moderate EvidenceProspective Cohort
RTHC-04466Prospective CohortModerate Evidence2023RETHINKTHC RESEARCH DATABASErethinkthc.com/research

Quick Facts

Study Type
Prospective Cohort
Evidence
Moderate Evidence
Sample
N=138

What This Study Found

Of 138 pediatric patients presenting with cannabis intoxication, 52 (38%) were admitted to ICU including one death. Polysubstance ingestion (aOR 16.3) and younger age (P=0.001) were strong independent predictors of severe outcome. All children 10 and younger ingested edibles. Among teens over 10, only polysubstance use predicted severe outcomes (aOR 37.1).

Key Numbers

138 patients; 54% male; median age 14.0 years; 38% ICU admission; 1 death; polysubstance aOR 16.3 (95% CI 4.6-58.3); all children <=10 exposed to edibles; teen polysubstance aOR 37.1 (95% CI 6.2-221.2)

How They Did This

Prospective cohort study from the Toxicology Investigators Consortium, collecting data on all pediatric patients (<18 years) presenting with cannabis intoxication from August 2017 to June 2020 across participating US emergency departments. Multivariable logistic regression identified predictors.

Why This Research Matters

As cannabis legalization expands and edible products proliferate, understanding which pediatric exposures lead to severe outcomes can inform product safety regulations and anticipatory guidance for parents.

The Bigger Picture

Severe pediatric cannabis outcomes fall into two distinct patterns: young children accidentally ingesting edibles, and teenagers combining cannabis with other substances. Prevention strategies need to address both scenarios differently.

What This Study Doesn't Tell Us

Participating toxicology sites may see more severe cases, overestimating overall severity. Cannot determine population-level incidence rates. Small sample limits subgroup analysis precision. Wide confidence intervals for some estimates.

Questions This Raises

  • ?Would child-resistant packaging reduce accidental edible ingestions in young children?
  • ?What specific substances combined with cannabis produce the worst teen outcomes?

Trust & Context

Key Stat:
38% ICU admission rate; polysubstance use increased severe outcome odds 16-fold
Evidence Grade:
Multi-center prospective study with standardized data collection, but relatively small sample produces wide confidence intervals for some estimates.
Study Age:
Published 2023 using 2017-2020 data
Original Title:
Severe outcomes following pediatric cannabis intoxication: a prospective cohort study of an international toxicology surveillance registry.
Published In:
Clinical toxicology (Philadelphia, Pa.), 61(8), 591-598 (2023)
Database ID:
RTHC-04466

Evidence Hierarchy

Meta-Analysis / Systematic Review
Randomized Controlled Trial
Cohort / Case-ControlFollows or compares groups over time
This study
Cross-Sectional / Observational
Case Report / Animal Study

Enrolls participants and follows them forward in time.

What do these levels mean? →

Frequently Asked Questions

How serious are pediatric cannabis intoxications?

In this study of 138 cases, 38% required ICU admission and one child died. Young children who ingested edibles and teenagers with polysubstance exposure were at highest risk.

What makes pediatric cannabis cases more dangerous?

Polysubstance use increased the odds of severe outcome 16-fold overall and 37-fold in teenagers. For young children (10 and under), all exposures involved edibles, and younger age itself was a strong predictor.

Read More on RethinkTHC

Cite This Study

RTHC-04466·https://rethinkthc.com/research/RTHC-04466

APA

Cohen, Neta; Mathew, Mathew; Brent, Jeffrey; Wax, Paul; Davis, Adrienne L; Obilom, Cherie; Burns, Michele M; Canning, Joshua; Baumgartner, Kevin; Koons, Andrew L; Wiegand, Timothy J; Judge, Bryan; Hoyte, Christopher; Chenoweth, James A; Froberg, Blake; Farrar, Henry; Carey, Jennifer L; Hendrickson, Robert G; Hodgman, Michael; Caravati, E Martin; Christian, Michael R; Wolk, Brian J; Seifert, Steven A; Bentur, Yedidia; Levine, Michael; Farrugia, Lynn A; Vearrier, David; Minns, Alicia B; Kennedy, Joseph M; Kirschner, Ron I; Aldy, Kim; Schuh, Suzanne; Campleman, Sharan; Li, Shao; Myran, Daniel T; Feng, Lisa; Freedman, Stephen B; Finkelstein, Yaron. (2023). Severe outcomes following pediatric cannabis intoxication: a prospective cohort study of an international toxicology surveillance registry.. Clinical toxicology (Philadelphia, Pa.), 61(8), 591-598. https://doi.org/10.1080/15563650.2023.2238121

MLA

Cohen, Neta, et al. "Severe outcomes following pediatric cannabis intoxication: a prospective cohort study of an international toxicology surveillance registry.." Clinical toxicology (Philadelphia, 2023. https://doi.org/10.1080/15563650.2023.2238121

RethinkTHC

RethinkTHC Research Database. "Severe outcomes following pediatric cannabis intoxication: a..." RTHC-04466. Retrieved from https://rethinkthc.com/research/cohen-2023-severe-outcomes-following-pediatric

Access the Original Study

Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.

This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.