Research In Action

Children’s Hospital of Philadelphia, and the entirety of the U.S., has been experiencing an epidemic of child injuries due to marijuana and THC (Δ-9-tetrahydrocannabinol). In the aftermath of social, political, commercial, and scientific progression of thought related to marijuana, and in response to different interpretations of the U.S. Agriculture Improvement Act of 2018 (aka “The Farm Bill”), many new marijuana-like chemicals are being sold in gas stations, corner stores, and smoke shops around Pennsylvania and Delaware. These minor cannabinoid chemicals also pose risk to children (we previously told the frightening story of a young girl unwittingly poisoned by “delta-8”) and warrant careful policy considerations.

Key Definitions

Hemp: The plant Cannabis sativa with a delta-9-THC content of 0.3% or less.

Marijuana: The plant Cannabis sativa (or indica) with a delta-9-THC content greater than 0.3%.

Delta-9-THC: An intoxicating chemical in, or derived from, marijuana. Often just called “THC.”

Minor Cannabinoids: Marijuana and hemp contain small amounts of many chemicals which can potentially affect the brain.These include delta-8-THC, delta-10-THC, THCP, THCV, and others.

Synthesized Cannabinoids: Due to vaguely written and variable legislation, minor cannabinoids are often sold in concentrated form as purported “legal highs.” They cannot be economically extracted from the plant, so they are synthetically manufactured (i.e., “Delta-8” sold in smoke shops is a synthesized cannabinoid).

Synthetic Cannabinoids: Purely synthetic chemicals, designed in a laboratory, which act at some of the same sites in the brain as delta-9-THC. Widely known initial street “brands” of synthetic cannabinoids were “K2” and “spice.”

CBD: CBD, or cannabidiol, is the best known, and most widely sold, non-intoxicating cannabinoid. Its injury epidemiology has been previously detailed.

Recent Data

The U.S. CDC released a health advisory about delta-8-THC and adverse events in 2021. The National Institute on Drug Abuse has recently reported, from the 2023 Monitoring the Future survey, that 11% of 12th-grade students admitted using delta-8-THC in the previous year.

Poison control centers have been receiving calls of adverse events related to minor cannabinoids, further raising concerns for safety around these products. Before looking at cases involving these chemicals reported to poison control centers we must acknowledge some clear limitations in these reports. Poison center data regarding minor cannabinoids present a very small part of the picture of minor cannabinoid use and toxicity.

• Most hospital laboratories can’t test for minor cannabinoids.
• Most healthcare providers are not knowledgeable about minor cannabinoids.
• Much of the public doesn’t understand the differences between the sale of minor cannabinoids and marijuana.
• Product labeling may be absent or wrong.
• Reports to poison centers are voluntary and healthcare workers are more likely to call a poison center the first time they encounter a new drug than they are subsequent times.

5,022 cases involving the minor cannabinoids delta-8-THC, delta-10-THC, and THC-O-acetate, were reported to America’s Poison Centers National Poison Data System in 2021 and 2022.

Below are more recent data from eastern PA, as well as DE, as reported to the Poison Control Center at Children’s Hospital of Philadelphia. Thirty percent of minor cannabinoid cases involved children 5-years of age or younger.

Injury Prevention Implications for Minor Cannabinoids (not including CBD)

The “Farm Bill” is typically renewed every five years and is currently extended pending reauthorization. Policy considerations should include clarifying the murky regulations on purifying, concentrating, or synthesizing psychoactive cannabinoids derived from hemp. The commercial status of minor cannabinoids should be examined in the context of marijuana and delta-9-THC ordinance. Public health and legal enforcement systems need to be developed.

Decades of poisoning prevention experience inform us that children can be protected from injury due to minor cannabinoids. Clinicians play a key role in advising families on effective safety strategies. Recommendations include:

• Avoid appealing edible forms. Avoid selling or buying minor cannabinoid products in candies or desserts that are especially attractive to children.
• Use child-resistant packaging. Use child-resistant packaging conforming to the Poison Prevention Packaging Act. Unit-dose packaging is especially effective.
• Establish and follow product standards. Advocate for the development of standards for product purity, drug concentration, dosage, and clear labeling.
• Secure storage in all settings. In stores, and in homes, minor cannabinoids should be out of sight, out of reach, and out of the minds of children.

If you suspect that a child has eaten a THC or other cannabinoid edible, please call the Children’s Hospital of Philadelphia (or your own regional) Poison Help Hotline at 1-800-222-1222 to be connected to a specialist. If the child is having trouble breathing or loss of consciousness, call 911.