Amid a proliferation of new pot shops in Massachusetts, health care officials are seeing an ominous trend: a sharp increase in calls to the state’s poison control center about toddlers getting into marijuana products — usually brownies, chocolate bars, or gummies — and ending up in the emergency room.
The number of calls about children 5 and younger ingesting marijuana nearly tripled in the first seven months after recreational pot shops opened last November, compared to the same period a year earlier, according to the Regional Center for Poison Control and Prevention.
“We can’t believe all these children who are going to the hospital and have to be admitted to the intensive care unit because they are so lethargic their parents are unable to wake them up, or they’re reporting seizure-like activity,” said Adina Sheroff, a registered nurse and poison specialist who answers calls at the center.
Sheroff said young children are especially vulnerable to overdose because the concentration of THC, the psychoactive substance in marijuana, in edibles is intended for adult use and easily overwhelms a tiny body. The long-term health effects of an incidence of early childhood exposure are not well known.
While the center’s data represent a fraction of marijuana-related poisonings — families are just as likely to call 911 or head to their local hospital if they discover a child has accidentally ingested pot — the numbers are a clear barometer of a jump in child exposures, officials say.
“Any increase in the numbers of children accessing marijuana is an alarming trend,” said Jennifer Flanagan, a member of the state’s Cannabis Control Commission.
“It goes to show the importance of locking the substance up,” Flanagan said. “Just because we legalized marijuana doesn’t mean it can be stored wherever you want it to be.”
Dr. Sharon Levy, a pediatrician and director of the Adolescent Substance Use and Addiction Program at Boston Children’s Hospital, said the increase indicates a critical lapse in the way parents are thinking about these products.
“They are putting these cookies and chocolates in the refrigerator, and we would never do that with other drugs,” Levy said. “Parents lock up things they think are dangerous, but they are thinking marijuana is safe.”
The numbers jumped from 13 calls about children 5 and younger ingesting marijuana from December 2017 to June 2018 to 37 calls from December 2018 through June, which is more than one call a week.
Overall, calls about these very young children accounted for more than 25 percent of all the marijuana-related calls the center recorded in those seven months, compared with just 14 percent during the same period in 2018. The total number of marijuana calls to the poison control center rose by more than 58 percent.
Sheroff, the poison control nurse, said some of the calls are from physicians who are not used to encountering such young, marijuana-exposed patients and are asking for guidance. While each case is different, Sheroff said in many instances she advises physicians to admit these youngsters to the intensive care unit with a cardiac monitor, because they are so lethargic.
Sheroff said the center has not recorded a death from these young exposures.
The spike in calls about such young children mirrors a trend witnessed in other states after recreational marijuana was legalized. The state of Washington’s poison center has recorded a near tripling of calls about children 5 and younger since July 2014, when the state’s first recreational shops opened.
While Massachusetts legalized the use of medical marijuana in 2012, the first medical marijuana dispensary didn’t open until June 2015. That’s when the poison control center started to see three or four cases a year involving toddlers. But it wasn’t until recreational shops opened late last year that the numbers started to shoot up.
Marijuana shops are already required to use child-resistent packages, and they are prohibited from wrapping products in bright colors, or using cartoons or other designs that would appeal to kids. They’re also required to stamp a “KEEP OUT OF REACH OF CHILDREN” statement on products.
But the increase in child exposures has prompted Cannabis Control Commissioner Shaleen Title to propose beefing up marijuana packaging regulations to require that products appealing to children, such as brownies and chocolate bars, not be easily opened with scissors or knives.
“The proposed policy change came from consumer concerns that were sent to me about possible accidental access to items like infused chocolates by children, and from my personal experience as the mother of a young child who can easily open resealable zipper bags with scissors,” she said.
The commission recently completed a $1.9 million public awareness campaign that included messages about locking up marijuana to keep it out of children’s hands. It recorded roughly 237,000 “clicks” on its social media messages and more than 3.6 million views of its videos.
Still, the number of young children ingesting marijuana is climbing. And that has prompted a discussion about whether these cases should be reported to the state’s child protective agency, the Department of Children and Families, which investigates suspected cases of abuse or neglect.
Health care providers are required under state law to report to DCF if they have “reasonable cause to believe a child is suffering” because of neglect or abuse.
Dr. Heather Forkey, director of the child protection program at UMass Memorial Children’s Medical Center, said they, too, are seeking a jump in young cases and have been reporting all to DCF.
“We do consider having edibles available to a child similar to putting alcohol in a baby bottle,” Forkey said. “It’s concerning to us. It’s not safe for kids. They become quite impaired and dangerously so when they overdose.”
Forkey said her hospital has always reported cases that involved children exposed to drugs that are commonly abused, including marijuana. She said doctors are not drawing conclusions about whether the young overdoses are just a “crazy accident” or an indication of a wider problem in a home. That’s for DCF to decide, she said. But Forkey said some cases have turned out to be a “sentinel incident” that alerted officials to other household problems.
At Boston Children’s Hospital, Levy said, physicians are also seeing more young children in the ER from marijuana poisonings, and that’s prompted calls to the hospital’s child protection team about whether to report the cases to DCF.
“They are being called to figure out if this is negligence — was this toddlers being toddlers, or parents’ negligence?” she said. “They are really having a tough time.”
A DCF spokeswoman said it “relies on mandated reporters to alert us to children whose safety may be at risk.” But she said it does not separately track the substance involved in each case referred to the department and was unable to say whether it has registered an increase in marijuana-related calls.