Marijuana and Kids Don't Mix. An Interview with Dr. Roneet Lev

It is not the least bit surprising that with the legalization of marijuana, more people are using it. Nor is it shocking that given the availability of THC gummies, children are getting their hands on what looks and tastes like candy and paying a price. Marijuana poisoning in children in the US has risen 14-fold between 2017 and 2021, and that number will surely be higher once 2022 is counted. A similar (but less drastic) trend has been seen in Canada.

For a look at how this is playing out "on the ground," I reached out to Dr. Roneet Lev, the former head of the Scripps Mercy Hospital emergency department. I interviewed Dr. Lev on the dangers of marijuana in 2022. She graciously agreed once again to answer some questions.

JB: Dr. Lev, thanks once again for taking the time to help ACSH readers understand the impact of the increased use of legal cannabis, especially in children. I suspect your emergency department is now quite busy, possibly even more so than when I interviewed you in June 2022.  Are you able to continue the podcast series on your High Truths website?

RL: Thank you, Josh; always a pleasure to chat with you. The emergency department is always busy, but the extra burden of marijuana poisoning makes it even more so. I have continued to do podcasts. I find them to be educational and also inspiring. I learn so much from my guests. By the way, for your fan club, your High Truths podcast on opioids can be found on Episode # 82.

JB: Great!  Now both members of my fan club can find it!  On a more serious note, what has life in the ED been like lately?

RL: Working in the Emergency Department is incredibly busy, stressful, and often very sad. I have the front-line view of what is happening in society – from trauma, mental health, lack of access to medical care, and, increasingly, marijuana poisoning.

JB: We're seeing an increasing number of news reports in the New York area about children being admitted to emergency departments because they have eaten THC gummies. Recently, in Minnesota, a child died from eating a high-potency gummy.  Are you seeing this in your ED?

RL:   My ED is not a pediatric receiving center, so I don't see children that frequently. It is my colleagues at our local Children's Rady Children's Hospital in San Diego who see most of the children, and they report that marijuana and its products are the number one cause of poisoning in kids aged 5 or younger. No children have died; this is still rare. But over the holidays, we treated a 4-year-old who took a gummy from mom's purse and ended up in a coma with his eyes shaking in his head. The child was admitted to the ICU and had to wait until he was detoxified a couple of days later. The mother was both concerned and embarrassed. 

Similarly, in December 2022, four kids at a California middle school ingested an unknown substance. Three of them were rushed to the hospital for a possible overdose of what doctors feared was fentanyl. While they were relieved it was not fentanyl, just marijuana-infused gummies, these kids did overdose. From THC. They were poisoned while at school and suffered serious reactions.

Nationally, cannabis exposure in children under 5 increased 13.3-fold from 2004 to 2018. Some of those children were critically ill; 15% needed treatment in intensive care, and 4% required a ventilator. And a United States Poison Centers report showed a steady increase in cannabis-related exposures. Plant material was the most common route of exposure, followed by edibles, concentrates, and vaped products.

JB: Aside from (by definition) getting a higher dose per body weight than adults, is there anything about children that make them more susceptible to cannabis poisoning?

RL: Dosing in children is a major concern. One gummy of 10 mg THC for an adult can cause psychosis. For a child, it can cause altered mental status or delirium. Perhaps more disturbing is that children are susceptible to exposure based on their cognitive development. My 10-month-old granddaughter puts everything in her mouth indiscriminately. Children are naturally attracted to candy and pretty packaging. Unlike adults, they don't understand the psychotropic potential of what they are ingesting. So it is not surprising that young children are more likely to get poisoned by edibles than smoked products; they do not have the developmental ability to smoke or vape.

Another problem with edibles is that they deliver a dose much more slowly than smoking. It takes longer for edibles to take effect, 30 - 60 minutes, because THC, just like most oral drugs, must pass through the stomach and liver and get into the blood before reaching the brain. This delay can cause people, adults, and children, to consume more gummies before they realize they have a problem. It also takes longer to metabolize edible products, 12- 24 hours, compared to six hours for alcohol.

On the positive side, kids tend to be healthy and have well-functioning livers, the organ primarily responsible for cannabis metabolism. Therefore, kids can sometimes have an easier time than adults who have certain medical conditions. I had to admit an 84-year-old to the hospital for two days after his grandson gave him a pot brownie. He suffered encephalopathy from the brownie, and his compromised liver could not metabolize the THC quickly.

JB: What are the symptoms of a child who has ingested too much THC? How are they different from those of adults who have smoked too much?

RL: Acute cannabis poisoning in children most often presents as altered mental status. The children do not behave normally. Depending on their age, they may have trouble talking, walking, standing, or eating.  They have trouble with coordination may result in falls, and the inability to eat or drink can result in dehydration.

JB: How do you treat children who have been poisoned?

RL: There is no antidote for cannabis poisoning. Therefore, I can just treat symptoms. I can give medications for nausea, agitation, and for seizures. I can treat blood pressure that is too high or too low. If a child's breathing is obstructed, I can place them on a ventilator.  After that, it is a matter of waiting for the cannabis to exit the body which can take a few days.

JB: What is the most serious case you've handled?

RL: That is a tough question. Placing a child on a ventilator, especially for a preventable condition, is tragic. Of course, they did not willingly take the drug to get “high.” Their exposure is a result of accidental exposure because of careless teens and adults, such a violation.

Right now, I have a pregnant woman in the emergency department waiting for mental health admission for psychosis. Her psychosis is exacerbated by marijuana, but I wonder what it is doing to her unborn child. A longitudinal study of Adolescent Brain Cognitive Development (ABCD) showed an increased mental health burden with prenatal cannabis exposure that persists from childhood to early adolescence.

However, I think the most serious case is related to violence. People mistakenly think that getting high on pot is "mellow" or "chill." However, high-potency THC can cause severe agitation and violence. The worst case is when an agitated patient on drugs assaults our staff. As a physician in charge of the emergency department, I am responsible for our staff's safety. One of our nurses suffered a head injury from an assault by a patient agitated on marijuana. This is a constant worry of mine.

JB:  The responsibility for children being poisoned falls on the parent, of course, but how about the marijuana industry? There cannot be a better way to have children overdose on drugs than to put them in candy form.

RL: I agree with you, Josh. The more adults buy cannabis products, especially edibles, the more kids get poisoned. We need consumer protection for children. I believe the marijuana industry is attracting children just like Big Tobacco was. Getting kids hooked young creates lifelong consumers. It is good for business. We learned from tobacco that if kids start young, they are more likely to continue using as adults. We also know that the human brain continues to grow until age 25. During those developing years addiction is up to 7 times more likely than in an adult brain.

JB: In light of this inevitable increase in children's poisonings, do you think gummies should be banned entirely?

RL: Why does the world need candy pot? Wheetos that look like Cheetos, Stoney Patch that looks like Sour Patch, THC Snickers, Stoneo that look like Oreos, pot tarts that look like pop tarts? If adults want to use recreational drugs that's one thing. However, as a society, we need to protect our children, and having “candy” lying around is a guaranteed recipe for trouble,

To protect children, I recommend:

1. Child-proof packaging, not just child-resistant, but child-proof. Childproofing medication was initiated because of pediatric poisoning, just like what is happening now with cannabis products.

2. Limiting THC potency. The THC products of today are no longer the 3% content of the 1980s; they can be over 90% in potency. At such concentrations, cannabis behaves like methamphetamine poisoning. Unless you believe in legal meth, you shouldn't want high-concentration THC to be so readily available.

3. Banning cannabis candies. If adults want to use cannabis, they can do so without jeopardizing children. They don't need lollipops. There are plenty of other ways for adults to get their THC.

JB: Any final words?

RL: I strongly believe that an informed public can make informed decisions. Americans should know the risks and side effects of cannabis and not just listen to promotion by the industry. I also believe that a society is judged by how it protects children. Today we are failing our children in this area.