Cannabis-related emergency room visits rose among children and teens during the pandemic, study finds

The rate of weekly emergency room visits for cannabis tripled among children 10 and younger and increased by 50 percent among children 11 to 14.

The rate of weekly emergency room visits for cannabis tripled among children ages 10 and younger and increased by 50 percent among children ages 11 to 14.David L. Ryan/Globe Staff

Emergency departments around the country saw a notable increase in cannabis-related visits from children, teens, and young adults from 2020 through 2022, according to a study published Thursday by the Centers for Disease Control and Prevention.

The rate of weekly visits by children 10 and younger tripled after the pandemic started, and visits among children 11 to 14 grew by 50 percent, according to the article in the Morbidity and Mortality Weekly Report. But these occurrences were few in number and accounted for less than 10 percent of cannabis-related emergency visits.

The main share of such cases were people 15 to 24, whose ER visits for cannabis spiked in 2020 but returned to pre-pandemic levels by 2022.

Behind the increases are the greater potency of the cannabis consumed today and its growing availability. Now legal in many states, including Massachusetts, it comes in many forms, including candies, baked goods, and vape pens. As a result, young people are more likely to encounter the drug and can easily consume more than intended. And young children sometimes find cannabis gummies or other edibles and eat them like candy.

“The findings from the study show that we have an increasing issue on our hands in terms of rising cannabis-involved emergency room visits,” said Douglas R. Roehler, the study’s lead author. “ER staff needs to be aware so they can provide appropriate treatment. Secondly, it’s important for youth to have access to appropriate preventive care in their communities.” Additionally, he added, adults who use cannabis in households with children must keep their products locked away.

Cannabis-involved emergency department visits started increasing well before the pandemic, said Roehler, who is an epidemiologist for the Cannabis Strategy Unit in the Division of Overdose Prevention at CDC’s National Center for Injury Prevention and Control. But the pandemic clearly worsened the trend. The study drew from the National Syndromic Surveillance Program, which collects data from 75 percent of emergency departments but may not be representative of the whole country.

The study found that starting in the first half of the 2020-2021 school year, females were more likely than males to seek emergency room care for cannabis, suggesting that girls might be more likely to turn to the drug as a coping mechanism.

“With potency rising and cannabis stores proliferating, it’s not surprising to see an increase in cannabis-related emergency room visits,” said Dr. Kevin P. Hill, director of the Division of Addiction Psychiatry at Beth Israel Deaconess Medical Center. “Many users still don’t know a lot of the basic facts about cannabis that could make it safer.”

Hill faulted state governments for giving more attention to licensing issues than to safety and education.

Inexperienced cannabis users, including teens, often start with an edible, not realizing that it takes 30 minutes for the drug to take effect, Hill said. So when nothing happens, they take another bite, and then another, and soon have taken too much. The results can be jitteriness, paranoia, palpitations, and sometimes vomiting.

“That’s how a lot of people end up in the ER,” Hill said. “No one’s going to die, but it’s very scary and you’re also taxing an already stressed medical system. The ERs are packed.”

Dr. Matthew B. Mostofi, associate chief of emergency medicine at Tufts Medical Center, said he sees such cases every week or two. “They tell you, ‘I ate an edible. I don’t feel good. I think I’m going to die,’” he said. “It’s not a life-threatening event.”

Because common blood tests cannot detect cannabis, and urine tests take time to process, emergency doctors diagnose cannabis intoxication by eliminating other possible causes. Doctors will treat the symptoms, perhaps with a calming medication, until the intoxication clears, usually within a few hours. But mostly they make sure nothing else is wrong and provide reassurance, Mostofi said.

More serious are the patients, typically habitual users, who develop cannabis hyperemesis syndrome, which causes relentless vomiting. “This lasts hours and hours,” Mostofi said. The drugs typically used to treat vomiting aren’t effective for this condition, and doctors often resort to antipsychotics that reduce nausea. But a few hours later, the vomiting resumes. Sometimes patients become so dehydrated they need to be admitted.

Dr. Ari Cohen, chief of pediatric emergency medicine at Massachusetts General Hospital, said he sees a cannabis hyperemesis case almost every shift he works.

“We’re seeing a lot more than we ever saw before — adolescents with chronic nausea and vomiting,” he said. “This is notoriously difficult to treat. It’s not just a one-time occurrence. It can really linger,” even for days after the patient stops using marijuana.

Also troubling, although far less common, are the cases of young children who ingest a marijuana edible that someone has left around the house and start acting strangely or becoming lethargic. The big challenge is the uncertainty, Mostofi said. “A 4-year-old with altered mental status may be unresponsive, and we don’t know why. Often parents don’t know why,” he said. Many possibilities loom, including infections, toxins, or head injury, and they must be ruled out with multiple tests and scans.

“For your kid, it’s not a benign process to get a CAT scan of your head. It’s not fun for them. They’re in there for hours and hours, and sometimes need to get admitted,” Cohen said. Parents should treat all forms of cannabis as they would any dangerous substance, he advised. “Lock up your edibles,” Cohen said. “They really are toxic for kids.”

Asked why there was a striking increase in emergency visits among children under 14, Roehler said, “That’s the question of the day. We don’t know.” He noted that other data show no increase in cannabis use among high schoolers, even though emergency visits are increasing. The youngsters may be consuming more potent forms of cannabis, or unintentional ingestions may be increasing, he speculated.

Nearly one in five Americans ages 12 and older used cannabis in 2021, according to the National Survey on Drug Use and Health, and other studies have shown that people now perceive the drug as less risky than they once did.

“It’s viewed as a drug that has few consequences,” Cohen said. But that’s not true for everyone. “Everything has side effects. You have to understand them and make a decision based on them.”