With legal cannabis use now in reach for more Virginians, doctors are addressing its effects on community members and their children. Following the Virginia General Assembly’s decriminalization of cannabis for personal use 2021, local health systems are seeing a rise in pediatric hospitalizations related to cannabis consumption.
Cannabis is a mind-altering psychoactive drug with a compound called delta-9-tetrahydrocannabinol, or THC, as its main active ingredient. THC affects the regulation of neural circuits which mature during adolescence to control attention, executive functioning and memory. This causes impairment in neurocognitive functioning beyond adolescence and into adulthood.
While experts agree that cannabis can relieve anxiety and reduce pain, some say there is not enough evidence to suggest how these benefits balance with adverse effects in adolescents and adults.
In Virginia, cannabis is not yet fully recreationally available, but it is available with a medicinal registration card. The number of people with these cards has increased from 1,377 cards in 2019 to 33,340 in 2021.
Only six licenses were originally awarded in Virginia — one for each of the six health districts in the state. As the cannabis industry grows to scale for recreational adult use, there is much debate over how this market should be set up.
Per Paul Seaborn, assistant professor of Commerce and section editor for the Journal of Cannabis Research, it can be very difficult to strike a balance between economic, public health and social justice interests.
“If you frame it more narrowly around the economic point of view, I think the case for legalization becomes much stronger,” Seaborn said. “Without legalization, what we've seen in the U.S. and many countries, is there's still a cannabis industry, it's just completely illegal. Like any illegal industry, it is not regulated. It's not part of the tax-paying system, so you're not generating any sort of taxes from it.”
As we move toward increasingly available legal cannabis, more children are likely to be exposed to its risks. U.Va. Health and Blue Ridge Poison Control are currently seeing a rise in the number of children accidentally consuming edibles. Colorado, the first state to legalize cannabis for recreational use, saw a near doubling of pediatric exposures in their poison centers in the years following legalization. Of these hospitalizations, almost half involved exposures due to edibles.
Edibles are foods that have been infused or baked with cannabis. While smoking is still the main form of cannabis consumption, edibles are becoming increasingly popular. Children, who are also prone to more intense symptoms due to their age, are particularly vulnerable to poisoning by edibles because of their attractive packaging and palatability.
Dr. Christopher Holstege, professor of emergency medicine and pediatrics and director of the Blue Ridge Poison Center, has seen first-hand the increase in cannabis poisonings among children.
“Children, due to their smaller size, appear to have more complications when eating edibles that are produced for adults,” Holstege said in an email statement to The Cavalier Daily. “Children are drawn to consuming these products because many are in the form of gummies, cookies or brownies. Because many edible cannabis products have high amounts of cannabis chemicals such as delta-9-tetrahydrocannabinol, the clinical impact is often more severe on a small child. Many young children who consume these edibles require hospital admission due to the severity of their symptoms.”
Edibles are often repackaged to look like popular candies such as Skittles. This has resulted in tragic mishaps such as when a food bank in Roy, Utah unintentionally gave out THC-infused candy to 72 families in April 2020. The debacle led to the hospitalization of two children who inadvertently ate the candy which contained over ten times the recommended adult dosage — a situation which, according to Seaborn, could have been avoided with legal regulation.
“You get the benefit of rules around packaging, where things are sold, childproof, seals and individual servings,” Seaborn said. “And every time that someone is buying from a legal source, they're going through the proper process, and they're not going to some unknown source where they may be making it appealing to children or using an attractive shape.”
Countries like Canada have tried to address this issue by requiring products to be packaged plainly to avoid confusion and limit youth appeal. Major companies like Kellogg and General Mills have also renewed calls to Congress to prevent the spread of cannabis products that mimic their brands.
“These products must be kept out of the reach of children,” Holstege said. “Cannabis — ‘marijuana’ — contains [numerous] potentially harmful chemicals that can adversely impact children. There should be close surveillance for the impacts on the public when these products are sold to consumers and these products should be regulated.”
In addition to locking up cannabis products, other protective measures such as positive scholastic attitudes, parental monitoring and disapproval of peer’s substance abuse appear to be protective in preventing adolescents from developing substance use disorder.
As Virginia moves forward with recreational cannabis legalization, policymakers are trying to strike a difficult balance between individual freedoms and public health. Importantly, experts believe that Virginia must try its best to mitigate predictable costs, such as the rise in pediatric poisonings and increased DUIs, so as to avoid any unnecessary suffering.
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