title: Characterization of edible marijuana product exposures reported to United States poison centers.
abstract: BACKGROUND
  Edible marijuana products are sold as brownies, cookies, and candies, which may be indistinguishable from counterparts without marijuana and are palatable to children and adults. The consumption of an entire product containing multiple dose-units may result in overdose.
  
  
  OBJECTIVE
  To characterize edible marijuana exposures reported to US poison centers with subgroup analysis by age.
  
  
  METHODS
  We analyzed single substance, human exposure calls coded to marijuana brownies, candies, cookies, beverages, or other foods reported to the National Poison Data System from January 2013 to December 2015. Calls were analyzed by state, age, gender, exposure route, clinical effect, therapies, and level of healthcare facility utilization.
  
  
  RESULTS
  Four-hundred and thirty calls were reported: Colorado (N = 166, 1.05/100,000 population/year) and Washington (96, 0.46) yielded the highest number of exposures. Three hundred and eighty-one (91%) calls occurred in states with decriminalized medical/recreational marijuana. The number of calls increased every year of the study. The most common age groups were: ≤5 years (N = 109, 0.15/100,000 population/year) and 13-19 (78, 0.09). The most frequent clinical effects were drowsiness/lethargy (N = 118, percentage = 43%), tachycardia (84, 31%), agitated/irritable (37, 14%), and confusion (37, 14%). Children ≤5 years have more drowsiness/lethargy, ataxia, and red eye/conjunctivitis. No deaths were reported. The most common therapies administered were intravenous fluids (85, 20%), dilute/irrigate/wash (48, 11 %), and benzodiazepines (47, 11%). Three patients (ages 4, 10, and 57 years) received intubation. 97 (23%), 217 (50%), and 12 (3%) calls were managed at home, treated/released, admitted to a critical care unit, respectively.
  
  
  CONCLUSIONS
  Although most clinical effects are minor, ventilatory support may be necessary for children and adults. We speculate the increasing exposures may be related to a combination of delayed absorption kinetics of Δ9-tetrahydrocannablnol, lagging packaging regulations, increased accessibility in decriminalized states, and increased familiarity of poison center specialists with edible product codes.
  
  
  CONCLUSIONS
  Edible marijuana exposures are increasing and may lead to severe respiratory depression.
authors.affiliation: a Department of Emergency Medicine , University of Texas Southwestern Medical Center , Dallas , TX , USA.
authors.forename: Dazhe
authors.initials: D
authors.lastname: Cao
authors.affiliation: b Ramathibodi Poison Center, Division of Clinical Pharmacology and Toxicology, Department of Medicine , Ramathibodi Hospital, Mahidol University , Bangkok , Thailand.
authors.forename: Sahaphume
authors.initials: S
authors.lastname: Srisuma
authors.affiliation: c Hawaii Department of Health, Emergency Medical Services Injury Prevention System Branch , Honolulu , HI , USA.|d Denver Health and Hospital Authority, Rocky Mountain Poison and Drug Center , Denver , CO , USA.|e Department of Emergency Medicine , University of Colorado School of Medicine at Anschutz Medical Center , Aurora , CO , USA.
authors.forename: Alvin C
authors.initials: AC
authors.lastname: Bronstein
authors.affiliation: d Denver Health and Hospital Authority, Rocky Mountain Poison and Drug Center , Denver , CO , USA.|e Department of Emergency Medicine , University of Colorado School of Medicine at Anschutz Medical Center , Aurora , CO , USA.
authors.forename: Christopher O
authors.initials: CO
authors.lastname: Hoyte
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002188:Cannabis / Q000506:poisoning*; D002648:Child; D002675:Child, Preschool; D013759:Dronabinol / Q000493:pharmacokinetics / Q000506:poisoning*; D062787:Drug Overdose / Q000453:epidemiology*; D005260:Female; D005502:Food / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011039:Poison Control Centers; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D013759:Dronabinol
keywords: Epidemiology; poison center; toxicity