After Canadian cannabis legalization, unintentional cannabis ingestions increased 77% in children and 36% in older teens, even though overall pediatric cannabis-related ER volume did not change when accounting for pre-existing trends.
Pediatric emergency physicians, poison control specialists, cannabis regulators, and parents.
77% increase in unintentional cannabis ingestions among children aged 0-11
What the researchers found
Pediatric cannabis-related ED visit volume did not change post-legalization when accounting for pre-existing trends. However, unintentional ingestions increased significantly in children aged 0-11 (IRR 1.77) and older adolescents aged 15-17 (IRR 1.36). Hyperemesis cases increased among older adolescents (RR 1.64), while co-ingestant use decreased (RR 0.77).
Why it matters
While total pediatric cannabis ER visits did not spike after legalization, the shift toward accidental ingestions in young children highlights the importance of child-resistant packaging and safe storage of cannabis edibles.
The numbers in context
Study period: Oct 2013-Feb 2020. Unintentional ingestion IRR children: 1.77 (95% CI 1.42-2.20). Older teen ingestion IRR: 1.36 (95% CI 1.07-1.71). Older teen hyperemesis RR: 1.64 (95% CI 1.13-2.37). Co-ingestant use decrease RR: 0.77.
How the study worked
Retrospective analysis of National Ambulatory Care Reporting System data for urban Alberta cannabis-related pediatric ED visits from October 2013 to February 2020. Used interrupted time series, incident rate ratios, and relative risk ratios across three age groups.
What this study cannot tell us
Limited to urban Alberta EDs. Cannot distinguish between pre-legalization medical cannabis access and post-legalization recreational access. ICD coding may miss some cannabis cases.
How to read the evidence
Population-level administrative data with interrupted time series design, a strong quasi-experimental approach.
When this study was published
Published in 2021 covering October 2013 to February 2020.
The bigger picture
The increase in accidental ingestions suggests edible cannabis products are reaching children despite regulations, while the decrease in co-ingestant use among teens may reflect a shift toward cannabis-only consumption after legalization.
Questions still open
- Are current child-resistant packaging requirements sufficient? Has the edible cannabis market specifically driven the increase in pediatric accidental ingestions?
Common questions
Did pediatric ER visits for cannabis increase after legalization?
What changed about how teens presented to the ER?
Read the original research
Emergency Department Pediatric Visits in Alberta for Cannabis After Legalization.
Pediatrics, 148(4)
Citation
Yeung, Matthew E M; Weaver, Colin G; Hartmann, Riley; Haines-Saah, Rebecca; Lang, Eddy. (2021). Emergency Department Pediatric Visits in Alberta for Cannabis After Legalization.. Pediatrics, 148(4). https://doi.org/10.1542/peds.2020-045922
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