220 - Oklahoma is not OK: Increasing Accidental Cannabis Exposures after Medical Marijuana Legalization

Poster Number: 220
Publication Number: 220.1240

Background: Pediatric cannabis exposure rates have been shown to increase following the legalization of cannabis in several states. In June 2018, Oklahoma passed State Question 788, which legalized medical cannabis and went into effect on September 1, 2018.

Objective: The purpose of this study is to describe pediatric emergency department visits and hospitalizations for accidental cannabis ingestions in the OU Health system before and after medical cannabis legalization in Oklahoma.

Design/Methods: In a retrospective chart review, accidental ingestions of cannabis products were compared pre and post legalization of medical marijuana in Oklahoma. Data was examined for children ages 0-17 years old with visits to the OU Health emergency departments, inpatient services and pediatric intensive care units having ICD codes related to accidental cannabis ingestion. Demographics, visit dates, ingestion type and location, and clinical information related to severity of presentation were collected. Unclear charts were manually reviewed for completeness; patients were excluded if ingestion was intentional. Analysis was performed using Chi Squared tests.

Results: 188 patients were identified from January 2016 to March 2023 meeting inclusion criteria. Five patients were identified in the pre-legalization study period; after legalization, 183 patients were included. Exposure numbers increased each year, with 9 in 2019, 36 in 2020, 47 in 2021, and 78 in 2022. Almost 50% of identified ingestions occurred in the last 15 months of the study period. Post legalization, accidental ingestions tended to occur in children < 5 years of age who identify as white; ingestions usually occurred at home and were in gummy form. 75% of patients required floor admission, and 7% of patients required ICU admission. The mean length of stay was one day.

Conclusion(s): Pediatric patients seeking medical evaluation for accidental cannabis ingestions have increased dramatically in Oklahoma in the years since the medical cannabis law went into effect in 2018. Exposures tend to occur in younger patients from cannabis gummies, which are often mistaken as candy and occur in a developmental age when oral exploration of the environment is common. Most patients required hospital admission and a significant number of patients required intensive care support, adding strain to the healthcare system in a state with finite pediatric resources. As Oklahoma evaluates a recreational cannabis law and as medical and recreational cannabis becomes more readily available in other states, further efforts into exposure prevention are critical to protect our pediatric patients.