Last summer, 20-month-old Jasmine was nearly comatose when she was brought to Harbor-UCLA Medical Center in Torrance. Her breathing was shallow and she didn’t respond to her name.
Jasmine, whose name has been changed, was admitted to the pediatric intensive care unit, or PICU. Doctors evaluating her did a screening for drugs, and her test was positive for cannabis.
It turned out the toddler had eaten cannabis candies that looked like Tootsie Rolls at her grandparents’ house.
“Her grandmother had a prescription for medical marijuana and wasn’t aware of any risks [for Jasmine],” said Bonnie Rachman, the PICU doctor who treated the toddler.
Rachman and I are colleagues. When I was talking to her about this case, it made me think about how I, as a pediatrician in South Los Angeles, counsel my patients about marijuana. Like Jasmine’s grandparents, many of the patients and families I see at my clinic—especially the teens—don’t perceive marijuana as risky. I’ve learned that discussing health threats isn’t usually effective for teenagers, who often have a sense of invincibility, a normal part of being an adolescent.
I recall one talkative 15 year old who I saw in the foster care clinic. He was a lean, muscular boy who recently became the wide receiver on his high school football team. He used marijuana daily and frequently snorted cocaine. He asked me what could he do to “bulk up” for football. I replied that, for starters, he could stop using cocaine.
Before I could finish my response, he said, “Oh yeah, I should just use marijuana—it gives me the munchies.” Clearly, this was not the health lesson I was planning to make. But, to illustrate my point above, he felt that smoking pot was no different than telling me he took a daily vitamin.
A doctor’s counsel
Although I discuss the health risks of any substance use with my patients, adolescents are generally more concerned about immediate consequences. So, I tell them that marijuana is illegal for anyone younger than 21 and they could get a criminal record—or not be able to be on a sports team or do whatever I learn is important to them. I also discuss the “tangible” effects, such as impairment of judgment, which may place them in harm’s way.
When I talk to parents, my conversations are often more direct: about the dangers of marijuana exposure, smoke or edibles, for young children, for example.
However, with California’s new legislation, it also may be time for me to up my prevention-counseling game.
On January 1, recreational use of marijuana became legal for adults 21 and older in California. The state was the first in the U.S. to legalize marijuana for medical use, in 1996. Currently, medicinal or recreational use of marijuana by adults is legal in 29 states and the District of Columbia. Medical use for minors, with parental permission, is legal in a few of those states.
However, marijuana remains illegal under federal law. Cannabis is classified as Schedule I drug, meaning it has no accepted medical use and a high potential for abuse.
Effects on children
Pediatricians and other child advocates are concerned that legalization may increase exposures for children and teens, either intentional or accidental, as in Jasmine’s case. In 2015, the American Academy of Pediatrics updated its policy statement, which opposes legalization of marijuana.
Between 2006 and 2013, the rate of children who were unintentionally exposed to marijuana and required a hospital visit increased 148 percent nationwide and 610 percent in states with legalized medical use, according to a recent report from researchers at UC Davis. The ingested products often looked like familiar treats, such as candies, brownies and cookies. The intoxicated children commonly had fast heart rates, lethargy and difficulty walking. Nearly 18 percent required admission to the PICU.
Researchers have shown that cannabis may be harmful for fetuses, children and adolescents. Marijuana alters brain development, causing detrimental effects on both brain structure and function.
However, not all of the effects are fully understood.
We do know that marijuana use during pregnancy increases the risk of complications for the mother and infant. Babies exposed to cannabis in the womb may suffer poor growth.
For teens, cannabis causes adverse effects on learning, memory and attention. There are also concerns about the negative impacts on the still-developing adolescent brain. For example, the pre-frontal cortex, the areas of the brain that control executive functions including judgment and decision-making, is not fully developed until the mid-20s.
Driving under the influence of marijuana impairs judgment and slows muscle response time—this may be exaggerated in less-experienced teen drivers. Cannabis is the most commonly drug detected in drivers and victims killed in a car crash, according to the National Highway Traffic Safety Administration.
Marketing to youths
Rates of adolescent use of marijuana in states before and after legalization for medical purposes have varied. In California, adolescent use rose from 24 to 26 percent. An increase was also seen in Delaware and Maine, but a decrease was observed in Alaska and Montana. In Colorado, adolescent use stayed about 21 percent after recreational use was legalized.
Opponents of legalization are also concerned about marketing of marijuana that could target youths, as previously seen with the alcohol and tobacco industries.
With the 2018 legalization, California has new laws that restrict advertising, packaging, product appearance and the amount of active cannabinoid permitted in an edible product. For example, products that look like gummy bears are prohibited and cartoons can’t be on labels. These measures are attempts to minimize attractiveness to children.
Hopefully these restrictions will help keep marijuana out of the hands of young children like Jasmine. Fortunately, the toddler recovered and, within 48 hours, she was back to her usual self.
“Most people don’t realize marijuana isn’t benign,” Rachman said. “I’m worried will see more [intoxications].”
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