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Journal of Medical Toxicology

, Volume 13, Issue 1, pp 99–105 | Cite as

Pediatric Concerns Due to Expanded Cannabis Use: Unintended Consequences of Legalization

  • George Sam WangEmail author
Proceedings

Abstract

An “unintended consequence” of marijuana legalization is the impact on the pediatric population. From prenatal exposure to unintentional childhood exposures, through concerns of adolescence abuse and marijuana use for medicinal indications in children, marijuana exposure can affect pediatric patients at every stage in childhood. Regardless of the stage or reason of exposure, concerns exist about short-term and long-term consequences in a child’s physical and mental health. The use of cannabidiol (CBD) may have some benefit for the treatment of epilepsy, but emphasis needs to be on rigorous clinical trials to evaluate efficacy and safety. As more states allow both medical and recreational marijuana, availability and prevalence of use will likely increase and more surveillance and research is needed to evaluate the consequences on the pediatric population.

Keywords

Marijuana Cannabis Cannabidiol Pediatrics Adolescents Breastfeeding Pregnancy 

Notes

Acknowledgements

I have a Colorado Department of Public Health and Environment grant, evaluating the Pharmacokinetics of cannabidiol (CBD) in pediatric epilepsy. I also receive royalties from UpToDate for authorship contributions.

Compliance with Ethical Standards

Conflicts of Interest

None

Sources of Funding

None

References

  1. 1.
  2. 2.
  3. 3.
    Results from the 2013 National Survey on Drug Use and Health: summary of national findings. http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf. Last accessed 2/22/2016.
  4. 4.
    Marijuana use among WIC clients: a survey following legalization of recreational marijuana in Colorado. Presented during Breakout Session 108: Unhealthy Living on Tuesday, June 16, 2015 at 2:00 p.m. at the Council of State and Territorial Epidemiologists (CSTE) conference in Boston, MA. Abstract 4428.Google Scholar
  5. 5.
    Lee CC, Chiang CN. NIDA Res Monograph. 1985;60:110.Google Scholar
  6. 6.
    Bailey JR, Cunny HC, Paule M, Slikker Jr W. Toxicol Appl Pharmacol. 1987;90:315.CrossRefPubMedGoogle Scholar
  7. 7.
    Martin BR, Dewey WL, Harris LS, Beckner JS. Res Commun Chem Pathol Pharmacol. 1977;17:457.PubMedGoogle Scholar
  8. 8.
    Blackard C, Tennes K. New Engl J Med. 1984;311:797.PubMedGoogle Scholar
  9. 9.
    Atkinson HC, Begg EJ, Darrlow BA. Clin Pharmacokinet. 1988;14:217.CrossRefPubMedGoogle Scholar
  10. 10.
    Perez-Reyes M, Wall ME. N Engl J Med. 1982;307:819.CrossRefPubMedGoogle Scholar
  11. 11.
    Day NL, Richardson GA, Goldschmidt L, Robles N, Taylor PM, et al. Effect of prenatal marijuana exposure on the cognitive development of offspring at age three. Neurotoxicol Teratol. 1994;16(2):169–75.CrossRefPubMedGoogle Scholar
  12. 12.
    Goldschmidt L, Day NL, Richardson GA. Effects of prenatal marijuana exposure on child behavior problems at age 10. Neurotoxicol Teratol. 2000;22(3):325–36.CrossRefPubMedGoogle Scholar
  13. 13.
    WIllford JA, Chandler LS, Goldschmidt L, Day NL. Effects of prenatal tobacco, alcohol and marijuana exposure on processing speed, visual-motor coordination, and interhemispheric transfer. Neurotoxicol Teratol. 2010;32(6):580–8.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Fried PA, Watkinson B, Gray R. Differential effects on cognitive functioning in 13 to 16 year olds prenatally exposures to cigarettes and marihuana. Neurotoxicol Teratol. 2003;25(4):427–36.CrossRefPubMedGoogle Scholar
  15. 15.
    Cornelius MD, Goldschmidt L, Day NL, Larkby C. Alcohol, tobacco, and marijuana use among pregnant teenagers: 6-year follow up of offspring growth effects. Neurotoxicol Teratol. 2002;24(6):703–10.CrossRefPubMedGoogle Scholar
  16. 16.
    Fried PA, James DS, Watskinson B. Growth and pubertal milestones during adolescence in offspring prenatally exposed to cigarettes and marihuana. Neurotoxicol Teratol. 2001;23(5):431–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Porath AJ, Fried PA. Effects of prenatal cigarette and marijuana exposure on drug use among offspring. Neurotoxicol Teratol. 2005;27(2):267–77.CrossRefPubMedGoogle Scholar
  18. 18.
    Gray KA et al. Prenatal marijuana exposure: effect on child depressive symptoms at ten years of age. Neurotoxicol Teratol. 2005;27(3):439–48.CrossRefPubMedGoogle Scholar
  19. 19.
    Day NL, Leech SL, Goldschmidt L. The effects of prenatal marijuana exposure on delinquent behaviors are mediated by measures of neurocognitive functioning. Neurotoxicol Teratol. 2011;33(1):129–36.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Klonoff-Cohen H, Lam-Kruglick P. Maternal and paternal recreational drug use and sudden infant death syndrome. Arch Pediatr Adolesc Med. 2001;155(7):765–70.CrossRefPubMedGoogle Scholar
  21. 21.
    Varner MW et al. Association between stillbirth and illicit drug use and smoking during pregnancy. Obstet Gynecol. 2014;123(1):113–25.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Linn S et al. The association of marijuana use with outcome of pregnancy. Am J Public Health. 1983;73(10):1161–4.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Day N et al. Prenatal marijuana use and neonatal outcome. Neurotoxicol Teratol. 1991;13(3):329–34.CrossRefPubMedGoogle Scholar
  24. 24.
    Forrester MB, Merz RD. Risk of selected birth defects with prenatal illicit drug use, Hawaii, 1986-2002. J Toxicol Environ Health A. 2007;70(1):7–18.CrossRefPubMedGoogle Scholar
  25. 25.
    Williams LJ, Correa A, Rasmussen S. Maternal lifestyle factors and risk for ventricular septal defects. Birth Defects Res A Clin Mol Teratol. 2004;70(2):59–64.CrossRefPubMedGoogle Scholar
  26. 26.
    Fergusson DM et al. Maternal use of cannabis and pregnancy outcome. BJOG. 2002;109(1):21–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Dekker GA et al. Risk factors for preterm birth in an international prospective cohort of nulliparous women. PLoS One. 2012;7(7):e39154.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Bada HS et al. Low birth weight and preterm births: etiologic fraction attributable to prenatal drug exposure. J Perinatol. 2005;25(10):631–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Shiono PH et al. The impact of cocaine and marijuana use on low birth weight and preterm birth: a multicenter study. Am J Obstet Gynecol. 1995;172(1 Pt 1):19–27.CrossRefPubMedGoogle Scholar
  30. 30.
    Saurel-Cubizolles, M.J., C. Prunet, and B. Blondel, Cannabis use during pregnancy in France in 2010. BJOG. 20.Google Scholar
  31. 31.
    El Marroun H et al. Intrauterine cannabis exposure affects fetal growth trajectories: the Generation R Study. J Am Acad Child Adolesc Psychiatry. 2009;48(12):1173–81.CrossRefPubMedGoogle Scholar
  32. 32.
    Fried PA, O’Connell CM. A comparison of the effects of prenatal exposure to tobacco, alcohol, cannabis and caffeine on birth size and subsequent growth. Neurotoxicol Teratol. 1987;9(2):79–85.CrossRefPubMedGoogle Scholar
  33. 33.
    English DR et al. Maternal cannabis use and birth weight: a meta-analysis. Addiction. 1997;92(11):1553–60.CrossRefPubMedGoogle Scholar
  34. 34.
    Hingson R et al. Effects of maternal drinking and marijuana use on fetal growth and development. Pediatrics. 1982;70(4):539–46.PubMedGoogle Scholar
  35. 35.
    Gray TR et al. Identifying prenatal cannabis exposure and effects of concurrent tobacco exposure on neonatal growth. Clin Chem. 2010;56(9):1442–50.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Janisse JJ et al. Alcohol, tobacco, cocaine, and marijuana use: relative contributions to preterm delivery and fetal growth restriction. Subst Abus. 2014;35(1):60–7.CrossRefPubMedGoogle Scholar
  37. 37.
  38. 38.
    Wang GS, Roosevelt G, Heard K. Pediatric marijuana exposures in a medical marijuana state. JAMA Pediatr. 2013;167(7):630–3.CrossRefPubMedGoogle Scholar
  39. 39.
    Wang GS, Roosevelt G, Le Lait MC, Martinez EM, Bucher-Bartelson B, Bronstein AC, et al. Association of unintentional pediatric exposures with decriminalization of marijuana in the United States. Ann Emerg Med. 2014;63(6):684–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Onders B, Casavant MJ, Spiller HA, Chounthirath T, Smith GA. Marijuana exposures among children younger than six years in the United States. Clin Pediatr (Phila). 2015;[epub ahead of print].Google Scholar
  41. 41.
    Breault HJ. Five years with 5 million child-resistant containers. Clin Toxicol. 1974;7(1):91–5.CrossRefPubMedGoogle Scholar
  42. 42.
    Clarke A, Walton WW. Effect of safety packaging on aspirin ingestion by children. Pediatrics. 1979;63(5):687–93.PubMedGoogle Scholar
  43. 43.
    Rodgers GB. The effectiveness of child-resistant packaging for aspirin. Arch Pediatr Adolesc Med. 2002;156(9):929–33.CrossRefPubMedGoogle Scholar
  44. 44.
  45. 45.
  46. 46.
  47. 47.
  48. 48.
    Lee ML, Novotny M, Bartle KD. Gas chromatography/mass spectrometric and nuclear magnetic resonance spectrometric studies of carcinogenic polynuclear aromatic hydrocarbons in tobacco and marijuana smoke condensates. Anal Chem. 1976;48(2):405–16.CrossRefPubMedGoogle Scholar
  49. 49.
    Moir D et al. A comparison of mainstream and sidestream marijuana and tobacco cigarette smoke produced under two machine smoking conditions. Chem Res Toxicol. 2008;21(2):494–502.CrossRefPubMedGoogle Scholar
  50. 50.
    Sparacino, C.M., P.A. Hyldburg, and T.J. Hughes, Chemical and biological analysis of marijuana smoke condensate, U.S.D.o.H.a.H. Services, Editor. 1990.Google Scholar
  51. 51.
    U.S. Department of Health and Human Services. Let’s make the next generation tobacco-free: your guide to the 50th anniversary surgeon general’s report on smoking and health. [PDF–795 KB] Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2014 Mar 5]. Last accessed Feb 26, 2016.Google Scholar
  52. 52.
    U.S. Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the surgeon general. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006. Last accessed Feb 26, 2016.Google Scholar
  53. 53.
    U.S. Department of Health and Human Services. A report of the surgeon general: how tobacco smoke causes disease: what it means to you. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010.Last accessed Feb 26, 2016.Google Scholar
  54. 54.
    U.S. Department of Health and Human Services. The Health consequences of smoking—50 years of progress: a report of the surgeon general. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Last accessed Feb 26 2016.Google Scholar
  55. 55.
  56. 56.
  57. 57.
  58. 58.
    Morean ME, Kong G, Camenga DR, Cavalla DA, Krishnan-Sarin S. High school students’ use of electronic cigarettes to vaporize cannabis. Pediatrics. 2015;136(4):611–6.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Pope HG, Gruber AJ, Hudson JI, Cohane G, Huestis MA, et al. Early-onset cannabis use and cognitive deficits: what is the nature of the association? Drug Alcohol Depend. 2003;69(3):303–10.CrossRefPubMedGoogle Scholar
  60. 60.
    Bolla KI, Brown K, Eldreth D, Tate K, Cadet JL. Dose-related neurocognitive effects of marijuana use. Neurology. 2002;59(9):1337–43.CrossRefPubMedGoogle Scholar
  61. 61.
    Medina KL, Hanson KL, Schweinsburg AD, Cohen-Zion M, Nagel BJ, Taper SF. Neuropsychological functioning in adolescent marijuana users: subtle deficits detectable after a month of abstinence. J Int Neuropsychol Soc. 2007;13(5):807–20.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Hooper SR, Woolley D, De Bellis MD. Intellectual, neurocognitive, and academic achievement in abstinent adolescents with cannabis use disorder. Psychopharmacology (Berl). 2014;231(8):1467–77.CrossRefGoogle Scholar
  63. 63.
    Fergusson DM, Horwood LJ, Beautrais AL. Cannabis and educational achievement. Addiction. 2003;98(12):1681–92.CrossRefPubMedGoogle Scholar
  64. 64.
    Sillins E, Fergusson DM, Patton GC, Horwood LJ, Olsson CA. Adolescent substance use and educational attainment: an integrative data analysis comparing cannabis and alcohol from three Australasian cohorts. Drug Alcohol Depend. 2015;156:90–6.CrossRefGoogle Scholar
  65. 65.
    Brook JS, Balka EB, Whiteman M. The risks for late adolescence of early adolescent marijuana use. Am J Public Health. 1999;89(10):1549–54.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Lynne-Landsman SD, Bradshaw CP, Ialongo NS. Testing a developmental cascade model of adolescent substance use trajectories and young adult adjustment. Dev Psychopathol. 2010;22(4):933–48.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Swift W et al. Cannabis and progression to other substance use in young adults: findings from a 13-year prospective population-based study. J Epidemiol Community Health. 2012;66(7):e26.CrossRefPubMedGoogle Scholar
  68. 68.
    Fergusson DM, Boden JM, Horwood LJ. Cannabis use and other illicit drug use: testing the cannabis gateway hypothesis. Addiction. 2006;101(4):556–69.CrossRefPubMedGoogle Scholar
  69. 69.
    Schepis TS, Krishnan-Sarin S. Characterizing adolescent prescription misusers: a population-based study. J Am Acad Child Adolesc Psychiatry. 2008;47(7):745–54.PubMedPubMedCentralGoogle Scholar
  70. 70.
    Fiellin LE et al. Previous use of alcohol, cigarettes, and marijuana and subsequent abuse of prescription opioids in young adults. J Adolesc Health. 2013;52(2):158–63.CrossRefPubMedGoogle Scholar
  71. 71.
    Fergusson DM, Horwood LJ, Ridder EM. Tests of causal linkages between cannabis use and psychotic symptoms. Addiction. 2005;100(3):354–66.CrossRefPubMedGoogle Scholar
  72. 72.
    Zammit S et al. Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. BMJ. 2002;325(7374):1199.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    van Os J et al. Cannabis use and psychosis: a longitudinal population-based study. Am J Epidemiol. 2002;156(4):319–27.CrossRefPubMedGoogle Scholar
  74. 74.
    Kuepper R et al. Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. BMJ. 2011;342:d738.CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Henquet C et al. Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. BMJ. 2005;330(7481):11.CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Borgelt LM, Franson KL, Nussbaum AM, Wang GS. Pharmacotherapy. 2013;33(2):195–209.CrossRefPubMedGoogle Scholar
  77. 77.
    https://www.colorado.gov/pacific/cdphe/data. Last accessed January 5, 2016.
  78. 78.
    Consroe P, Wolkin A. Cannabidiol-antiepileptic drug comparisons and interactions in experimentally induced seizures in rats. J Pharmacol Exp Thr. 1977;201(1):26–32.Google Scholar
  79. 79.
    Turkanis SA, Smiley KA, Borys HK, Olsen DM, Karler R. An electrophysiological analysis of the anticonvulsant action of cannabidiol on limbic seizures in conscious rats. Epilepsia. 1979;20(4):351–63.CrossRefPubMedGoogle Scholar
  80. 80.
    Karler R, Turkanis SA. Subacute cannabinoid treatment: anticonvulsant activity and withdrawal excitability in mice. Br J PHarmacol. 1980;68(3):479–84.CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    Leite JR, Carlini EA, Lander N, MEchoulam R. Anticonvulsant effects of the (−) and (+) isomers of cannabidiol and their dimethylheptyl homologs. Pharmacology. 1982;24(3):141–6.CrossRefPubMedGoogle Scholar
  82. 82.
    Colansanti BK, Linamood 3rd C, Craig CR. Effects of marihuana cannabinoids on seizures activity in cobalt-epileptic rats. PHarmacol Biochem Behav. 1982;16(4):573–8.CrossRefGoogle Scholar
  83. 83.
    Wallace MJ, Wiley JL, Marin BR, Delorenzo RJ. Assessment of the role of CB1 receptors in cannabinoid anticonvulsant effects. Eur J Pharmacol. 2001;428(1):51–7.CrossRefPubMedGoogle Scholar
  84. 84.
    Jones NA, Hill AJ, Smith I, Bevan SA, Williams CM, Whalley BJ, et al. Cannabidiol displays antiepileptiform and antiseizure properties in vitro and in vivo. J Pharmacol Exp Ther. 2010;332(2):569–77.CrossRefPubMedPubMedCentralGoogle Scholar
  85. 85.
    Jones NA, Glyn SE, Akiyama S, Hill TD, Hill AJ, et al. Cannabidiol exerts anti-convulsant effects in animal models of temporal lobe and partial seizures. Seizure. 2012;21(5):344–52.CrossRefPubMedGoogle Scholar
  86. 86.
    Hill TD, Cascio MG, Romano B, Duncan M, Pertwee RG, et al. Cannabidivarin-rich cannabis extracts are anticonvulsant in mouse and rat via a CB1 receptor-independent mechanism. Br J Pharmacol. 2013;170(3):679–92.CrossRefPubMedPubMedCentralGoogle Scholar
  87. 87.
    Porter BE, Jacobson C. Report of parent survey of cannabidiol-enriched cannabis use in pediatric treatment-resistant epilepsy. Epilepsy Behav. 2013;29(3):574–7.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Gedde M, Maa E. Whole cannabis extract of high concentration cannabidiol may calm seizures in highly refractory pediatric epilepsies. Abstract. American Epilepsy Society, 67th Annual Meeting. December 6-10, 2013.Google Scholar
  89. 89.
    Gloss D, Vickrey B. Cannabiniods for epilepsy. Cochrane Database Syst Rev. 2014;3:CD009270.Google Scholar
  90. 90.
  91. 91.
  92. 92.
  93. 93.
  94. 94.
    Geffrey AL, Pollack SF, Bruno PL, Thiele EA. Drug-drug interaction between clobazam and cannabidiol in children with refractory epilepsy. Epilepsia. 2015;56(8):1246–51.CrossRefPubMedGoogle Scholar

Copyright information

© American College of Medical Toxicology 2016

Authors and Affiliations

  1. 1.Department of PediatricsUniversity of Colorado Anschutz Medical CampusAuroraUSA

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