FILE - Cannabis is displayed for customers at a store on Friday, April 19, 2024, in Portland, Ore.
Jenny Kane / AP
The number of cannabis-related reports to poison control centers across the U.S. has risen greatly since 2009, according to new reporting from The New York Times. The paper also found a rise in cases in which cannabis poisoning led to breathing problems and even life-threatening effects, especially among teens and adults. Rob Hendrickson is the medical director of the Oregon Poison Center at Oregon Health & Science University. He joins us to share what he’s seen in the emergency room in recent years.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. A new analysis by The New York Times found that reports of cannabis poisonings nationwide jumped from under 1,000 in 2009 to more than 22,000 last year. That includes Oregon emergency rooms. Doctors here and around the country are seeing increasing numbers of patients, many of them toddlers, who’ve accidentally eaten so much THC that they are showing up with breathing problems, delusions and sometimes serious enough issues that they have to be intubated.
Rob Hendrickson is one of those ER docs. He’s the medical director of the Oregon Poison Center at OHSU and he joins us now. It’s good to have you back on the show.
Rob Hendrickson: Hey, thanks for having me on.
Miller: I want to start with that alarming statistic, a more than 22-fold increase in the number of cannabis-related incidents reported to poison control centers nationwide since 2009. What does it take for a cannabis-related incident to be reported to this national center?
Hendrickson: Sure, so the national Poison Data System is a collection of all of the poison centers across the country. So for that data to be collected, someone has to contact a poison center. Poison centers get contacted by the community, sometimes, maybe a parent in their house who realizes that their child just ate a gummy that contains THC. And we also get cases from emergency departments or ICUs from physicians who are seeking our expertise in taking care of those patients.
Miller: So just to be clear, if somebody intentionally takes cannabis, but they take more than they wanted, they have a bad experience, that’s not in this official … that’s not a poisoning? That’s just a bad decision that someone’s making?
Hendrickson: Right, it would require them to call the poison center and say, this is what I’m feeling, and we do get those cases occasionally. They’re a small percentage, but I don’t feel well. I feel confused. I’m having these hallucinations or something like that. They might call the poison center, but those are pretty unusual. I think the ones that we’re talking about, the cases that we’re reporting and the ones that we’re concerned about are the toddlers. They typically are 1 to 3 years old. They’re typically exposed in their home or a relative’s home, and they can get very severe toxicity.
Miller: We’re talking about toddlers 1 to 3. What’s the average age you would say of the patients that we’re talking about here?
Hendrickson: Yeah, it’s about 18 months old, usually 1 to 2 years old, is the ones that typically have these what we call exploratory exposures. So they didn’t mean to take cannabis. They found a bag of gummies, and they ate them. So that’s, as most people know, that age group, 1 to 2 years old, they tend to explore things, they tend to put things in their mouth. And certainly, some of the concerning products, most of the concerning products that are out there are things that look like candy or food – gummies, cookies, chocolate bars, things like that.
Miller: So it’s normally parents, guardians or some older person who left their own edibles in places where their very little kids can find them?
Hendrickson: Yeah, that’s the typical scenario for these little kids.
Miller: Can you give us an example of a story that you’ve heard?
Hendrickson: Sure. I’ve had hundreds and hundreds of these cases. Lots of them include things like someone took out what was their edible, maybe it was in a cookie or is in gummies, they put it on the counter, they turned around to get something and then turn around again, and there’s their toddler, chewing on or finishing the cookies or eating those gummies.
But a lot of the scenarios are also people who are not thinking that cannabis can be dangerous to a small child and leaving them out. And you can imagine a toddler walking into the kitchen and seeing a bag of gummy bears, gummies, a cookie or chocolate. I think most toddlers are going to go and eat that. So, a lot of those scenarios are like that as well.
Miller: And then parents call in pretty scared about what’s happened?
Hendrickson: Oh yeah, absolutely. These aren’t intentional, these are accidents and poison centers deal with these types of scenarios for all sorts of different things, including cannabis.
Miller: One of the things that we’ve heard a lot over the years, for all kinds of different substances, is the amount can make the difference between if something’s considered a poisoning or not. I bring that up because for years, I had heard that cannabis or THC, if you take a lot, you could feel really bad, you can be paranoid, you can have a terrible experience, but I don’t remember, a decade ago, hearing the word poisonings when it came to THC. So what do you think the public doesn’t understand about the severity of this?
Hendrickson: Yeah, I agree with you, and I think that’s how most people feel, that it’s pretty safe, certainly in those sort of therapeutic or recreational situations.
Miller: As opposed to say fentanyl, which we’ve talked about in the past …
Hendrickson: Correct. Exactly.
Miller: Where it’s literally, with tiny quantities, a life-or-death issue?
Hendrickson: Right. And I think the way to think about this is, adults who take maybe double the dose won’t feel well, but they’re not going to be so sick that they need to be hospitalized, for example.
But when you’re talking about a dose that’s supposed to be given to a 200-pound person that’s being eaten by a 20-pound person, that’s 10 times the dose. And so now imagine, if you used cannabis and you use 10, 20 or 40 times the dose, that’s the type of scenario we’re talking about. So it’s hard for adults to ingest that much. It’s happened. We’ve had adults also, become unconscious and get severe cannabis toxicity. It’s just not easy to do with edibles and common packages.
Miller: So can you give us a sense for what happens to these young people, say, a 1- or 2-year-old … What might you see in the more severe cases?
Hendrickson: Yeah. In the lighter cases, the ones that are sort of one gummy, that type of thing, they get confused, they can get off balance, they can fall down, things like that. But when the dose gets increased, we start to see a lot of sleepiness, they can become unconscious. And in very high doses, they can have seizures, their heart rate can slow down, their blood pressure can drop. All of those scenarios have and can happen.
Miller: So what kinds of medical interventions are available?
Hendrickson: Well, there’s nothing specific. There’s no antidote, but if someone stops breathing, we put them on a ventilator. If someone’s heart rate slows down, we have medications that will increase their heart rate and if their blood pressure goes down, we have medications. So those usually require, certainly a visit to an emergency department and usually to an ICU.
Miller: How long might it last in someone’s system?
Hendrickson: Most of the time, the severe symptoms resolve in 12 to 24 hours. So usually by the next day, the person is better.
Miller: What do you hear from parents or guardians if they’re the ones who, let’s say that inadvertently …. I mean, this is always inadvertent. In both the examples you gave where they had some of a cookie and then they left it there, or they didn’t realize that their kid could reach it. And then they’re, I imagine, terrified and also, I imagine feeling pretty guilty about what happened if their kid is then really dealing with serious health issues. What do you hear from parents?
Hendrickson: Yeah, I think you kind of hit it on the head. One of the responses I hear a lot is, “I just never realized that could hurt a child.” And I think that’s a message we have to get out is, doses like these, things that are really attractive to children, these can be harmful to kids. So one of the things that I’m trying to get across is, if you are an adult who uses cannabis and you ever have an exposure to a kid, to a toddler, make sure you treat that cannabis edible like it could harm a child. Store it up high, away from children, preferably in a locked box or a bag, some way that a kid just can’t come by it and eat it.
Miller: When recreational cannabis was first legalized, products had to be limited to 50 mg of THC within a container, meaning if there were 10 gummies, they could each only be up to 5 mg, or if it was a whole piece of something, that thing collectively could only have 50 mg. And then four years ago, the Oregon Legislature doubled that. What did you think of that change?
Hendrickson: Well, I was concerned about it, and we have seen an increase in cases of severe pediatric cannabis toxicity
Miller: Since then?
Hendrickson: Since then.
Miller: That you think is directly attributable to that packaging change?
Hendrickson: A lot of a lot of things happened at the same time, so it’s difficult to say 100%, but it does seem like that’s the case. When we look at cases, children who ingest more than 50 mg, which is the old packaging rule, about three-fourths of them will become unconscious to the point where they don’t even wake up if you touch them and move them. So that’s pretty severe. Kids that ingest less than 50 mg do much, much better. They can have lots of symptoms, but they’re unlikely to have the ones I was talking about before: seizures, low heart rate, low blood pressure.
They’re probably not gonna get on a ventilator, be intubated and on a ventilator. So, the way I look at this is, limiting to 50 mg is common sense, to not put so much in one package that a child would end up in an ICU. And it’s not a significant inconvenience to the average person who’s going to be purchasing that product, right? If you really want 100 mg of gummies, you can get two packages.
Miller: And keep one sealed?
Hendrickson: Right. Exactly. So, that to me seems common sense. It seems reasonable and it doesn’t seem particularly difficult for people who want to purchase cannabis.
Miller: OK, you say this as a public health person and as a medical professional, but politically, how hard do you think it would be to get lawmakers to reverse that decision and to go back to 50 mg within a package?
Hendrickson: Well, I think, I urge them to try. As I said before, I think this is just a very reasonable change and I think the important part is that this isn’t really a huge hurdle for people who want to purchase edible cannabis products. The people of Oregon voted for retail cannabis, for adults to be able to use retail cannabis. And this change would not be a significant burden to anyone who was trying to purchase retail cannabis. You just buy two packages instead of having one. I don’t think it’s particularly burdensome. So I’m hoping that the legislature understands that, sees that and maybe will reverse course.
Miller: While you’re here, I’m curious what else you want Oregonians to keep in mind, just as a public service announcement, for poison control or poisoning prevention more broadly?
Hendrickson: Yeah, thank you so much. I think that every adult can kind of look around, if you have exposure to children … And I’m being careful. I’m not saying parents necessarily because it’s not always parents, grandparents can have the kids, the grandkids over for a couple of hours a week and they don’t always think about childproofing their house or poison prevention. So if you have exposure to toddlers, think about what’s …
Miller: When you put it that way, it does make it seem like toddlers themselves are a poison. Exposure to toddlers, sometimes they feel that way. [Laughter]
Hendrickson: Yeah, if you have toddlers in your house at any time, it’s really important to just think about what you have in your house, what can be harmful to them. And that’s not just, there are cleaners that are under the sink, of course, but also medications. I think I would include things like over-the-counter medications and cannabis products in that, and store those up very high away from kids so they can’t see them. I think one of the issues with cannabis is that it’s packaged in things that are edible.
Miller: And they’re brightly colored, they’re in the shape or exact style of literal kid snacks.
Hendrickson: Correct.
Miller: Unlike Raid ant killer, which I imagine that could be terribly bad for kids, but it’s an ugly can that’s not a standard food.
Hendrickson: It’s not tempting the children. I can’t imagine there’s a 1- to 2-year-old out there that would walk along to the kitchen table and there’s a cookie on the table, who wouldn’t think about eating that or would just immediately eat it? When that cookie contains a large amount of THC, that can be really, really dangerous.
So I think the biggest message out there is if you have kids in your house ever, small children, just think about this and try to store things up and away. The Oregon Poison Center website has great information on poison prevention. If you have any questions, just go to the website, click on poison prevention. It’s got lots of information about how to keep kids safe in your house.
Miller: You talked about the desire that lawmakers would change the dosage allowance for packages. Do you also have hopes that they would change the actual products themselves to make them seem less attractive to kids?
Hendrickson: Yeah, there are some simple steps that we could take. I don’t think most consumers care if their gummies are green, red and blue. We could make them pale and not particularly attractive visually. We could limit the serving size, we can limit the package size. So I think that there are these bags that you can have, that have a little lock on them. They’re super simple, but a toddler won’t be able to get into those, and I think storing cannabis products and other potentially dangerous products in those would be really helpful.
Miller: Rob, thanks very much.
Hendrickson: Thank you.
Miller: Rob Hendrickson is an emergency room doctor and the medical director of the Oregon Poison Center at OHSU.
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