Association of Unintentional Pediatric Exposures With Decriminalization of Marijuana in the United States

      Study objective

      We compare state trends in unintentional pediatric marijuana exposures, as measured by call volume to US poison centers, by state marijuana legislation status.


      A retrospective review of the American Association of Poison Control Centers National Poison Data System was performed from January 1, 2005, to December 31, 2011. States were classified as nonlegal if they have not passed legislation, transitional if they enacted legislation between 2005 and 2011, and decriminalized if laws passed before 2005. Our hypotheses were that decriminalized and transitional states would experience a significant increase in call volume, with more symptomatic exposures and more health care admissions than nonlegal states.


      There were 985 unintentional marijuana exposures reported from 2005 through 2011 in children aged 9 years and younger: 496 in nonlegal states, 93 in transitional states, and 396 in decriminalized states. There was a slight male predominance, and the median age ranged from 1.5 to 2.0 years. Clinical effects varied, with neurologic effects the most frequent. More exposures in decriminalized states required health care evaluation and had moderate to major clinical effects and critical care admissions compared with exposures from nonlegal states. The call rate in nonlegal states to poison centers did not change from 2005 to 2011. The call rate in decriminalized states increased by 30.3% calls per year, and transitional states had a trend toward an increase of 11.5% per year.


      Although the number of pediatric exposures to marijuana reported to the National Poison Data System was low, the rate of exposure increased from 2005 to 2011 in states that had passed marijuana legislation.
      To read this article in full you will need to make a payment
      ACEP Member Login
      ACEP Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features.

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Medical Marijuana: Will Colorado's “green rush” last? October 21, 2012. Available at:;contentBody. Accessed May 2 2013.

      2. 18 Legal Medical Marijuana States and DC. Available at: Accessed June 30, 2013.

        • Joffe A.
        • Yancy W.S.
        Legalization of marijuana: potential impact on youth.
        Pediatrics. 2004; 133: e632-e638
        • Thurstone C.
        • Lieberman S.A.
        • Schmiege S.J.
        Medical marijuana diversion and associated problems in adolescent substance treatment.
        Drug Alcohol Depend. 2011; 118: 489-492
        • Salomonsen-Sautel S.
        • Saki J.T.
        • Thurstone C.
        • et al.
        Medical marijuana use among adolescents in substance abuse treatment.
        J Am Acad Child Adolesc Psychiatry. 2012; 51: 694-702
        • Appelboam A.
        • Oades P.J.
        Coma due to cannabis toxicity in an infant.
        Eur J Emerg Med. 2006; 13: 177-179
        • Blackstone M.
        • Callahan J.
        An unsteady walk in the park.
        Pediatr Emerg Care. 2008; 24: 193-195
        • Bonkowsky J.L.
        • Sarco D.
        • Pomeroy S.L.
        Ataxia and shaking in a 2-year-old girl: acute marijuana intoxication presenting as seizure.
        Pediatr Emerg Care. 2005; 21: 527-528
        • Carstairs S.D.
        • Fujinaka M.K.
        • Keeney G.E.
        • et al.
        Prolonged coma in a child due to hashish ingestion with quantitation of THC metabolites in urine.
        J Emerg Med. 2011; 41: e69-e71
        • Macnab A.
        • Anderson E.
        • Susak L.
        Ingestion of cannabis: a cause of coma in children.
        Pediatr Emerg Care. 1989; 5: 238-239
        • Weinberg D.
        • Lande A.
        • Hilton N.
        • et al.
        Intoxication from accidental marijuana ingestion.
        Pediatrics. 1983; 71: 848-850
        • Wang G.S.
        • Roosevelt G.
        • Heard K.
        Pediatric marijuana exposures in a medical marijuana state.
        JAMA Pediatrics. 2013; 167: 630-633
        • Bronstein A.C.
        • Spyker D.A.
        • Cantilena L.R.
        • et al.
        2011 Annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 29th annual report.
        Clin Toxicol (Phila). 2012; 50: 911-1164
      3. SAMSHA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012). Available at: Accessed June 26, 2013.

        • Wall M.M.
        • Poh E.
        • Cerda M.
        • et al.
        Adolescent marijuana use from 2002 to 2008: higher in states with medical marijuana laws, cause still unclear.
        Ann Epidemiol. 2011; 21: 714-716
        • Harper S.
        • Strumpf E.C.
        • Kaufman J.S.
        Do medical marijuana laws increase marijuana use? replication study and extension.
        Ann Epidemiol. 2012; 22: 207-212
        • Cerda M.
        • Wall M.
        • Keyes K.M.
        • et al.
        Medical marijuana laws in 50 dates: investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence.
        Drug Alcohol Depend. 2012; 120: 22-27
      4. Mullaney T. Medical marijuana industry growing billion dollar business. USA Today. Available at: Accessed May 2, 2013.

      5. Pisani J. CNBC. Edible pot hits the spot for some, spurring an industry. Available at: Accessed May 2, 2013.

        • Scherz R.G.
        Prevention of childhood aspirin poisoning. Clinical trials with three child-resistant containers.
        N Engl J Med. 1971; 285: 1361-1362
        • Breault H.J.
        Five years with 5 million child-resistant containers.
        Clin Toxicol. 1974; 71: 91-95
        • Walton W.W.
        An evaluation of the Poison Prevention Packaging Act.
        Pediatrics. 1982; 69: 363-370