Children, THC Edibles and the Emergency Room

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By News Team on October 25, 2021

In recent weeks, Carilion Clinic’s Emergency Department has seen several children whose appearance and behavior suggested that THC edibles were involved in their condition. THC is the psychoactive compound in marijuana that affects perception, behavior—and children’s developing brains.
 
Paul Stromberg, M.D., views it as the beginning of a trend. Board-certified in both Emergency Medicine and Medical Toxicology, Dr. Stromberg has a unique perspective on the matter.
 
“I think we will be seeing more pediatric and unintentional THC exposures via edibles as we get closer to dispensaries opening,” he said.
 
Regulators, law enforcement agencies and drug-prevention organizations such as the Prevention Council of Roanoke all look to two factors driving that trend:

  1. The inconsistent and confusing legal and regulatory status of marijuana and related products.
  2. The marketing and packaging of “delta-8” THC products to look and taste like familiar snacks and candies, such as those in the images below.

Dr. Stromberg’s observation in Carilion’s ED reflects reports from the Blue Ridge Poison Control Center, which fielded dozens of calls related to the synthetic “delta-8” THC in early 2021, after receiving zero in the same period in 2020.

What Is Delta-8 THC?

To understand what delta-8 is and how it works, let’s start by becoming familiar with the terms and compounds we’ll be hearing more about as dispensaries are established and marketing takes off.

THC-infused edibles packaged to resemble familiar foods
Delta-8 THC products are packaged to look like familiar candies and childhood breakfast cereals, making them difficult to distinguish from the grocery-store originals.

Cannabis: a plant of the Cannabaceae family that contains 80+ cannabinoids, or biologically active chemical compounds, including THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol). (U.S. Food and Drug Administration). Under Virginia state law (but not federal law!), cannabis is legal for individuals to grow in small amounts for personal use; it remains illegal to farm, distribute or sell in any form.

Marijuana: the parts of the cannabis plant that contain the highest concentrations of THC; it may be found in its natural form—as a bud directly harvested from the plant—or processed into concentrated forms like oils and edibles. Commercial versions of these products will eventually be available in regulated dispensaries in the Commonwealth, but they are not sold legally at this time.

CBD: a non-psychoactive cannabinoid extracted from the cannabis plant for personal and commercial use. CBD has not been extensively studied to determine its benefits and risks, and has been approved by the FDA only to treat certain types of seizures (FDA). While many people claim to benefit from the oils, salves and other wellness products made with CBD, it cannot legally be marketed in foods or labeled as a dietary supplement.
 
THC: the compound in the cannabis plant that produces the “high” associated with marijuana use; while legal for personal use according to state (not federal) law, THC (delta-9-tetrahydrocannabinol) is not legal for sale in Virginia in any form.

Delta-8: delta-8 is a synthetic product designed to mimic the delta-9 tetrahydrocannabinol known as THC. While delta-9 THC remains illegal to sell under state law (and fully illegal under federal law), delta-8 THC is less immediately potent and therefore legal; it can be found at the register next to energy drinks, cigarettes and lottery tickets at gas stations and convenience stores throughout the Commonwealth. Most concerning for children’s health and well-being, it is easily infused into existing foods and packaged to look like familiar products.

Hemp: an industrial agricultural product that is legal to grow and process for use in a wide range of consumer and commercial products, from clothing to biofuels; industrial hemp is a variety of cannabis that contains only trace, non-psychoactive amounts of THC. (Virginia Cooperative Extension

Legal Status

As noted above, marijuana laws vary widely across the country, and recent changes in Virginia’s marijuana laws are a confusing patchwork unfolding on a drawn-out schedule. This makes it challenging to know what compounds and products are legal and—perhaps more importantly for health and safety—whether and how they are regulated.
 
For parents and caregivers, two clear points can bypass the confusion and offer clear guidance:

  1. Marijuana remains illegal at the federal level in all forms and amounts—whether growing, possessing, using or selling it.
  2. The short- and long-term effects of THC on children's developing brains

According to Dr. Stromberg, those effects are twofold. "There are the immediate effects and possible delayed or chronic effects (seen with continued and heavier use)," he said.

THC and Children 

As Dr. Stromberg explains, the immediate effects, or acute presentation, can result in:

  • Nausea and vomiting
  • Significant altered mental status: delusions, anxiety and even psychotic behavior
  • Potential comatose presentation that requires admission to the ICU and possible placement on a ventilator

He points out that these effects can appear in adolescents and adults as well. "Someone either gets too high an edible dose accidentally—or takes some, doesn't get high, takes more, and eventually gets overdosed."

This doesn't include the trauma implications and risk-taking behavior that may occur while under the influence.

According to Christopher Pierce, M.D., chief of general pediatrics at Carilion Clinic, risk-taking behavior is part and parcel of being an adolescent. 

"Teenagers have lower inhibitions," he said, "and it's a developmental phase where the brain is developing and building synapses" that ingesting psychotropic drugs can interfere with.

"The old story was that alcohol 'killed' synapses, but you're modifying how they function while they're changing, developing, maturing," he said

For both providers, the risks of longer term or heavy use are equally significant. In addition to well-documented effects of lethargy and lack of motivation among marijuana users, self-medicating with any substance can mask and exacerbate other health issues.

"Kids that are using it have higher incidence of other mental health issues," said Dr. Pierce, "and once you get Into the habit of doing it, they’re often using it to self medicate, which could lead to other drugs."
 
Added Dr. Stromberg, "You may also see decrease in executive function, recall memory and IQ with sustained and chronic long-term use. Cyclical vomiting and bouts of severe vomiting with heavy marijuana was also recently described and we are certainly seeing an uptick of this in the emergency departments locally."

He describes the typical patient as a heavy THC user in their early to mid-20s who has used for at least 1 year.

"I would expect this is something we will see more of in the coming years," he said. "There is speculation as to why this occurs, but really only speculation and no clear mechanism has been described."
 
The good news: Most authors feel that these changes largely resolve with cessation of the marijuana use.
 
While naturally occurring THC continues to be studied, the health effects of synthetic delta-8 THC are not yet well-understood. However, as the CDC explains, “delta-8 THC is psychoactive and may have similar risks of impairment as delta-9 THC…. Delta-8 THC products may also have the potential to be confused with hemp or CBD products that are not intoxicating. Consumers who use these products may therefore experience unexpected or increased THC intoxication.”
 
The FDA goes further, noting that the psychoactive impact of delta-8 is compounded by inconsistent manufacturing methods and potentially contaminated, unsanitary manufacturing environments. Essentially, even though the packaging looks the same, there is no regulatory oversight that ensures the safety or consistency of what’s inside. From the FDA:

  • Manufacturers are packaging and labeling these products in ways that may appeal to children (gummies, chocolates, cookies, candies, etc.).
  • These products may be purchased online, as well as at a variety of retailers, including convenience stores and gas stations, where there may not be age limits on who can purchase these products.
  • There have been numerous poison control center alerts involving pediatric patients who were exposed to delta-8 THC-containing products.
  • Additionally, animal poison control centers have indicated a sharp overall increase in accidental exposure of pets to these products.

What Can Parents Do?

In spite of clickbait headlines about it, trick-or-treaters are unlikely to be given the much more expensive adulterated “snacks” than the originals this Halloween.

The less dramatic but much more likely scenario is that, like every generation before them, adolescents and teens are exposed to and find access to all kinds of influences and substances that their parents and caregivers don’t know about.
 
So how can you protect your children?

  • Talk to them about the risks involved and what to watch for
  • Listen to them about the pressures and temptations they face
  • Take a closer look at what you find in their backpacks and bedrooms
  • Secure your own marijuana products, if you use them, just as you would secure your guns and store prescriptions out of reach
  • Stay informed as the cannabis marketplace evolves; the CDC is currently monitoring the emergence of additional cannabis-derived products, such as those containing delta-10 THC and THC-O acetate

Candy and gum corporations are pushing back in court against the use of their brands on CBD and THC products—and courts are ruling in their favor.

But from a children’s health perspective, there may be a simpler solution: skip the sugar-drenched, highly processed cereals and candies altogether.

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