Pubdate: Mon, 01 Apr 2013
Source: Denver Post (CO)
Copyright: 2013 The Denver Post Corp
Author: Michael Booth


 From early 2005 to late 2009, Children's Hospital Colorado had
exactly zero emergency-room visits by kids who had ingested marijuana.
In the following two years, when medical marijuana became legal in
Colorado and federal officials backed off prosecution, it had 14.

Pioneering studies of ER charts by Colorado doctors show looser pot
laws leading to childhood poisonings, often from mistakenly eating
tantalizing "edibles" like gummy worms or brownies.

Those doctors are now helping lead the charge for mandatory safety
packaging as Colorado gears up for even broader legal sales of pot
with recreational-marijuana stores.

"We've seen a dramatic increase in pediatric exposure," said Dr.
George Wang, a Children's ER doctor who also works with Denver
Health's Rocky Mountain Poison and Drug Center.

Calls about potential marijuana exposure at all ages have doubled
since 2009 at the poison center.

Safety packaging, as in other medicines, "is a supplement to careful
parenting that has been shown to work," said Wang's colleague, Dr.
Michael Kosnett. "There are solutions available right now." And the
marijuana industry agrees, up to a point. Many industry members favor
sending goods out the store door under tamper-proof seal. But they
would rather not break each individual joint or candy into a high
tech, lockable bag whose cost-up to $7, even in bulk-might approach
the price of the brownie inside.

"They'll have to buy so much tamperproof packaging that people will
just make it themselves at home," said Robin Hackett, co-owner of
Botana Care, a medical-marijuana store in Northglenn. "The challenge
is with a pound of butter and some cannabis, anybody can make edibles."

Hackett and other members of the Medical Marijuana Industry Group say
lockboxes and larger locking bags that buyers can use to transport
larger purchases home should solve most of the safety problems.

Breaking everything down into smaller tamper-proof bags is a landfill
problem and unnecessary expense, Hackett said. BotanaCare counsels
patients with children about safety, and keeps track of who has kids
as a reminder.

"Unfortunately, we can't write laws around 'dumb,' " she

None of the accidentally poisoned children has died, Wang and Kosnett

There are serious medical consequences for small children, though,
even while marijuana advocates say an adult "overdose" of pot is
nearly impossible.

Prescribed dosages of THC, the active ingredient in marijuana products
used to control nausea from chemotherapy, is between 4 and 12
milligrams for children ages 2 to 4, based on body surface area. Some
"edibles" have 300 milligrams of THC, Kosnett said.

The researchers say individual safety packs would be best, but the
current recommendation of all items leaving the store in one secure
package is "better than nothing."

Because there is no clear reporting category for marijuana poisonings,
doctors have to cull through files to count cases. Presbyterian/St.
Luke's, which operates Rocky Mountain Hospital for Children, said it
does not track similar cases.

The cases studied at Children's included decreased levels of
consciousness and breathing trouble. Children can also vomit from
ingesting too much of a strong substance and aspirate the vomit.

The median age in the 14 patients was 3 years, and the range was 8
months to 12 years, according to an abstract of the research published
in the journal Clinical Toxicology.

Child-ingested pot is also dangerous because ER doctors aren't looking
for it as a cause of any symptoms they see, Wang said. That can lead
to invasive and expensive diagnostic efforts, such as a spinal tap or
CT scan, if parents are embarrassed or scared to mention the true cause.

"When children get admitted to the ICU, that's serious," Kosnett said.
Symptoms may appear similar to meningitis, for example.

Safety packaging and parental prevention should be noncontroversial,
said Dr. Robert Brockmann, president of the Colorado Academy of Family
Physicians, especially as newly legal recreational use will greatly
expand the supply.

"None of that information is being disseminated when it's dispensed,"
Brockmann said. "It's like liquor or prescription medications, or
anything else you don't want your kids to get into."

Kosnett likens the social moment to that of the 1970 U.S. Poison
Prevention Packaging Act, which launched many of the safety containers
now ubiquitous in medical and chemical markets. One standard for
packages, Kosnett said, is that no more than 20 percent of 5-year-olds
be able to open a container within 10 minutes.

Such measures have cut pediatric poisonings in various categories by
40 to 90 percent over the decades, he said. 
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