U.S. poison-control centers are receiving a growing number of calls about adverse effects of manufactured cannabis products, including edibles and concentrates. Findings from the study, published in JAMA Network Open, also show an increasing number of children are being exposed to these products. "As more states are legalizing adult use of cannabis, there has been increasing cannabis retail sales over time, including sales (of) manufactured products," lead author Dr. Julia A. Dilley of the Oregon Health Authority, in Portland, told Reuters Health by email. "These manufactured products are of specific concern because they tend to have higher concentrations of THC and may have more health risks than use of lower THC flower." She and her colleagues examined data from the National Poison Data System on cannabis exposures reported to poison centers between 2017 and 2019. They compared exposures to manufactured products - including concentrates, edibles, and vaporized liquids - with exposure to the unprocessed cannabis plant. Two-thirds of the 28,630 exposures reported involved plant materials, whereas the remaining ones were related to edibles, concentrates, vaporized liquids, and other manufactured products. Exposure to manufactured cannabis products more often involved children under 10 compared with plant-based exposure (27.0% vs. 8.4%), with edibles taking the lead. More than half of all the calls came from a healthcare facility, and calls about manufactured products were twice as likely to come from a residence than were calls about plant exposure (40% vs. 20%; P<0.001). While the majority of plant-based reports involved additional agents like drugs and alcohol (62%), most manufactured cannabis reports were for the product alone (82%). Exposure to vaporized liquid formulations were most often linked to serious clinical outcomes (42%) than was exposure to plant-based products (39%) and manufactured products overall (36%). Dr. Dilley suggests regulatory agencies can play a fundamental role in driving down rates of adverse effects related to manufactured cannabis products "by requiring safe packaging, labeling, and testing to assure that THC concentrations on labels are accurate." In some states, she added, agencies have looked at ways to require child-resistant packaging on cannabis products to prevent accidental child exposures. There have also been moves to ensure edibles don't look appealing to kids and aren't packaged in ways that are appealing to children. "Public-health agencies in some states are doing public-education campaigns about reducing risks of cannabis use including to 'start low, go slow' with use of edibles or products that have higher THC concentrations," Dr. Dilley said. At the healthcare level, Dr. Dilley believes clinicians can help curb this trend by becoming more informed about the cannabis products available on legal markets. Ideally, clinicians should also discuss with their patients the steps they can take to reduce risks associated with manufactured cannabis, she said. "Pediatricians especially may want to encourage parents to make sure that cannabis edibles are stored where kids can't get to them and that family members or other caregivers for their children do the same," she noted. Dr. Ziva D Cooper, director of the UCLA Cannabis Research Initiative, in Los Angeles, told Reuters Health by email that a multi-pronged approach is needed to address the rising cases of adverse effects associated with manufactured cannabis. "First, we need to educate and inform the community about what is known and not known about these products, and then we need to more fully identify which types of products are associated with these events and how were they being used," said Dr. Cooper, who was not involved in the study. "There is also a need to improve physicians' recognition of cannabis-associated adverse events and develop strategies to efficiently and effectively address these events." Dr. Cooper said she and her colleagues are currently "working towards distinguishing adverse effects that occur due to non-medical use and those that occur with medical use" to further identify patterns in these cases and identify "strategies to mitigate adverse effects that arise when used both medically and non-medically." Dr. Dilley said it will be important to examine the variations in reported exposures among states and see if states using different regulatory approaches have better or worse poisoning rates. "Regulating cannabis markets is all new, and states are doing their best to create regulations that limit accidental exposures and overconsumption, especially when higher THC concentration in products makes using 'too much' easier to do," she said. "But there isn't a playbook yet for what is most effective. Looking at the data over time will help us get there." —Brandon May Source
