Thailand Saw More Cannabis Poisonings and Child Exposures After Legalization | Research

The takeaway

A Thai poison center recorded 1,695 cannabis cases from 2018-2022, with hospitalization rates rising from 69% to 97% and child/adolescent exposures increasing after recreational legalization.

Policymakers evaluating legalization frameworks, public health officials, harm reduction advocates working in newly legal markets

Hospitalization rate rose from 69% to 97% across legalization stages

What the researchers found

Hospitalization rates increased significantly after each policy change: from 68.7% during the illegal period to 82% (medical), 91.5% (decriminalized), and 96.8% (recreational). The proportion of children and adolescents exposed to cannabis increased significantly during the recreational period. Cannabis oil (41.4%) and smoking products (26.7%) were the most common products involved.

Why it matters

Thailand's rapid progression from prohibition to full legalization provides a natural experiment in how policy changes affect cannabis-related poisonings. The data show that increased availability without adequate education led to more hospitalizations and more child exposures.

The numbers in context

1,695 cases. Median age 38 (IQR 24-53). 67.2% male. Products: cannabis oil 41.4%, smoking 26.7%, sweets 12.5%. Reasons: health belief 29.7%, recreational 29.6%, curiosity 22.5%. Hospitalization rates: illegal 68.7%, medical 82%, decriminalized 91.5%, recreational 96.8%. Lab confirmation in only 20% of cases.

How the study worked

Retrospective analysis of 1,695 cannabis cases reported to the Ramathibodi Poison Center in Thailand from January 2018 to December 2022, compared across four regulatory periods: illegal, medical, decriminalized, and recreational.

What this study cannot tell us

Retrospective study from a single poison center. Lab confirmation available in only about 20% of cases. Cannot separate whether increased reporting reflects more actual cases or greater awareness and willingness to report. No denominator data to calculate population rates.

How to read the evidence

Moderate evidence from a poison center database spanning multiple policy periods, though limited by single-center design and low lab confirmation rates.

When this study was published

2025 study covering Thailand's 2018-2022 legalization transition.

The bigger picture

Thailand's experience adds to the growing international evidence on legalization outcomes. The rise in child exposures and hospitalizations mirrors patterns seen in U.S. states and Canada after legalization, suggesting these are predictable consequences that policy can address through packaging requirements, education, and access controls.

Questions still open

What specific measures could reduce child exposure to cannabis products in newly legal markets? Did hospitalization rates increase because of more severe cases or because of increased healthcare-seeking behavior? How does Thailand's experience compare to other recently legalized markets?

Common questions

What products caused the most poisoning cases?

Cannabis oil was involved in 41.4% of cases, followed by smoking products (26.7%) and cannabis-infused sweets (12.5%). The sweets are particularly concerning for accidental child exposures.

Why did hospitalizations increase?

The study attributes the increase to greater availability and accessibility of cannabis products combined with inadequate public knowledge about effects and safe use. Curiosity alone motivated 22.5% of cases.

Read the original research

Cannabis product exposures reported to Ramathibodi Poison Center, Thailand, during 2018-2022.

Clinical toxicology (Philadelphia, Pa.), 63(10), 760-769

View on PubMed ↗Publisher’s paper ↗

Citation

Paisarnrodjanarat, Bootsakorn; Srisuma, Sahaphume; Promrungsri, Puangpak; Tangsuwanaruk, Theerapon; Tongpoo, Achara; Rittilert, Panee; Mayurapong, Manutsanun. (2025). Cannabis product exposures reported to Ramathibodi Poison Center, Thailand, during 2018-2022.. Clinical toxicology (Philadelphia, Pa.), 63(10), 760-769. https://doi.org/10.1080/15563650.2025.2536771