Doing The Right Thing for Texas - Part Five
Failures of State regulations, inept and ineffective policies, lack of oversight, and negligence to corruption have all put people's lives in danger. We'll look at a few ways that are almost never discussed with the public.
Bypassing FDA Regulations for Purity and Safety
"Medical marijuana" as allowed in State programs, as well as the CBD under Texas' Compassionate Use program, are not like prescription medications that have been approved and are regulated by the FDA. That means, they've also bypassed FDA regulations for manufacturing purity and safety, and contain unpredictable and unlabeled amounts of psychoactive ingredients and other unlabeled ingredients.
Researchers testing the cannabis concentrates, such as dabs, being sold to the public through California's "medical marijuana" program, for example, found the THC levels varied from 23.7% to 75%, with THC content higher than was being reported by the dispensaries in their laboratory submissions to the State. Reporting in the Journal of Toxicological Sciences, they revealed that the CBD products in the "medical cannabis" market most often gave patients extracts with psychoactive properties. In other words, the THC content was considerably higher than disclosed to the State, doctors or potential patients.
Solvents and Pesticides. Also disturbing, over 80% of "medical marijuana" products contained solvent residues, including isopentane, butane, heptane, propane, and other solvents. Over a third contained pesticides, the most common was paclobutrazol, which is not registered with the EPA for use on food crops. Inhaling these products, rather than oral ingestion, bypasses the body's first metabolism in the gut, meaning higher toxic levels are absorbed when inhaled.
The lack of quality control in the cultivation, processing and preparation of "medical cannabis" products also expose patients to toxic levels of pesticides, which has concerned medical professionals for years. Marijuana plants are extremely vulnerable to fungus diseases and other diseases, and require heavy use of pesticides, rodenticides and fertilizers. Toxic levels of pesticides in commercial cannabis products are well documented, according to toxicology researchers in the Journal of Toxicology.
"To date, there are no approved pesticides or application limits established for use on cannabis crops by the US Environmental Protection Agency, therefore, all pesticide use on this crop is currently illegal," the researchers said. Yet, the use of pesticides and plant growth regulators in "medicinal cannabis" cultivation has been shown in laboratory testing to be quite prevalent. They tested "medical cannabis" products available at dispensaries in Los Angeles and found samples with bifenthrin levels as much as 1600 times higher than the legal digestible amount. Heating these products for smoking creates additional toxic materials.
A review of State "medical marijuana" policies, found six States are completely silent on pesticides and the rest have adopted a hodgepodge of regulations that may or may not address pesticide use, growing practices, testing for pesticide residues, and labeling of pesticides used in production or laboratory test results. "While much of the focus is on residues in inhaled, ingested, or absorbed cannabis, the environmental impacts associated with growing practices are mostly not addressed" at all, the review concluded. Without policies even in place, serious doubts are raised about any State enforcement efforts.
Tobacco cigarettes have been shown to have pesticide residues ranging from 2% to 16%. In contrast, toxicologists working with a Los Angeles testing lab found pesticides in 60%-70% of the cannabis smoked in glass pipes and 42%-60% in water pipes. This pesticide exposure poses serious risks to immunocompromised patients or those with other health conditions, such as liver disease, which can intensify the toxicological effects, they cautioned.
Bacteria, fungus and other pathogens. After two relatively young cancer patients, in winnable cancer battles, died from a relatively rare but lethal fungal infection after using "medical marijuana," UC-Davis researchers launched a study. Gathering twenty samples of "medical marijuana" being sold across California, they analyzed the samples for dangerous bacteria and fungi, with DNA analysis. They found numerous Gram-negative bacilli and fungal pathogens contaminating "medical marijuana," which posed a grave risk to their patients, especially those who are immunosuppressed. Previous studies, they reported, have cultured multiple fungi and bacteria, with growing organisms found in cannabis being sold on the market and even from the smoke.
Highly immunocompromised patients are routinely advised to avoid soil, plants, cut flowers, raw produce and fresh condiments because of the danger of molds, bacteria, funguses and other serious pathogens. But healthcare professionals commonly fail to educate patients about the infectious risks of "medical marijuana," they wrote. Patients also may confuse marijuana dispensaries with pharmacies, giving them a false sense of security they've come to have with FDA-regulated medicines. Regardless of how well-intentioned practitioners may be in trying to relieve suffering, by supporting "medical marijuana," they are ignoring that these products are unregulated and are placing patients at risk for severe infections.
Vaping and E-cigarettes – Licensed and Marketed Before Safety Known
Vaping and e-cigarettes are a poignant illustration that marketing and popular sentiments override government regulations that may be in the best interests of the public. Vaping turned deadly for young people in 2019. This story is important for Texans as it exposes how regulatory weaknesses can jeopardize public health and safety.
What is vaping?
Both vaping and e-cigarettes involve heating a liquid (called E-liquid or vape juice) in a tank or cartridge to create a vapor that is inhaled. While the vapor may look like water vapor, it's actually a vaporized base (called the carrier liquid) that's usually a mixture of vegetable glycerin and propylene glycol, solvents used to dissolve nicotine or marijuana. Small amounts of sweeteners and flavoring chemicals including diacetyl, cinnamaldehyde, acetoin, maltol, pentanedione, and others. The specific ingredients in E-liquids vary among brands and manufacturers.
Marketing to young people. E-cigarettes have been around since 2007 and has become the most popular tobacco product among young people since 2014, with teens 4 1/2 times more likely to use e-cigarettes than adults. As of August 8, 2016, it has been illegal to sell nicotine e-cigarettes and other vaping products to young people under 18 years of age in the U.S.. But since then, more than 8,000 retailers have been cited by the FDA for selling vaping products to minors, with more than 1,100 warning letters and 131 civil penalty complaints also issued in September 2018.
Companies look to hook young customers early, and make vaping seem fun and cool. The marketing tactics targeting young people have been called out for years: using social media, offering scholarships, sponsoring music festivals, and offering kid-friendly flavors such as cotton candy and gummi bear. Since 2016, companies continued to market vaping and e-cigarette products to children, with products specifically designed to appeal to kids and look just like juice boxes, candy, cookies and kid-friendly cereals, said the FDA. These vaping products have nearly identical names to popular children's products, cartoon characters and marketing promotions. Vaping products come in candy-like fruit flavors that are most popular with youngsters. The marketing to children prompted the FDA to issue more than 40 warning letters to companies in 2018.
Vaping among young people, especially teens, has skyrocketed, according to the FDA, despite federal laws against selling to minors. In 2020, 19.6% of the nation's high school students used e-cigarettes, according to the CDC and FDA analysis of the 2020 National Youth Tobacco Survey. Fruit flavored e-cigarettes are most popular with young people.
Smoking health experts with the CDC are concerned with the intensity of vaping and e-cigarette marketing to young people because vaping leads to smoking tobacco and other substances. Why else would the industry be doing it? As had been reported nearly a decade earlier from national surveys done in 2011-2013, young people who use E-cigarettes are twice as likely to have intentions of smoking cigarettes, compared to those who've not vaped. About 44% of vapers said they planned to smoke cigarettes within the year.
Vaping is increasing among Texas youngsters. In 2016, 15% of Texas high school seniors said they'd vaped in the last month and 14.5% of 10th graders. Nearly half of Texas kids reported it was very easy or easy to get tobacco products. Two years later, the 2018 Texas Youth Tobacco Survey reported the numbers were continuing to rise: 24.% of Texas high school seniors said they had vaped in the last month, and 16.4% of 10th graders.
But what are kids really vaping?
Hiding illicit drugs in vaping. Vaping and e-cigarettes quickly became a popular way for young people to use illicit drugs in public, undetected, said Dr. Michelle Peace, a forensic toxicology researcher at Virginia Commonwealth University. These products also became available under State sanctioned "medical marijuana" programs across the country. Legalized E-liquids advertise as 100% natural CBD extracts (yet are commonly found to contain THC) or 75% to 80% pure THC, she said.
A wide range of illicit substances have been detected in E-liquids being sold to the pubic, her lab has reported, including THC, CBD, methamphetamines, dextromethorphan and, more disturbingly, extremely dangerous synthetic cannabinoids ("fake" cannabis) or cathinones.
These research findings are a call to action to physicians "prescribing" CBD products and anyone involved in public health or public safety needs to be aware of what's potentially in these products, she said. There are no regulations or oversight protecting the public with these products and opportunities for abuse are wide open.
Sheriffs in Kentucky warned of marijuana vaping products available online that were clearly being marketed to children. They are regularly seizing vaping devices on school grounds that contain over 90% THC, many times higher than the marijuana plant. Vaping's popularity has made it harder for adults to monitor teen drug use, as the vape pens are easily concealed as pens, flashlights or lipsticks (or USB flash drives, as in the product called Juul), and the smoke doesn't have the identifiable smell.
Vaping marijuana among our country's teens has skyrocketed, according to the University of Michigan's Monitoring the Future study. In 2019, more than a fifth of high school students in the U.S. admitted vaping marijuana in the past year. The Survey is already seeing the highest levels of daily marijuana use among 8th graders ever tracked.
Colorado has reported a huge increase in the percentage of high school students vaping marijuana – soaring to 35% of high school sophomores and 37% of seniors in 2019, according to Colorado Department of Public Health and Environment data. Young people in Colorado are vaping marijuana at nearly twice the national average. Is this what we want for our children in Texas, too?
Vaping was permitted before the science was in. States granted licenses to manufacture and sell e-products − before they had any safety research and without any oversight of what is going into the E-liquids or any product labeling, Dr. Peace said.
Vaping is still a relatively new technology that isn't fully understood, said Dr. Peace. Scientists don't know how the particle sizes of the aerosol affects how far it reaches into the lung, nor the health affects of heating and inhaling the carrier products used in e-liquids. These are sticky oily substances, usually propylene glycol (which has specific warnings against inhaling the hot vapors) and vegetable glycerin, or the newer "more natural" carrier, vitamin E acetate).
Dr. Peace's lab has been studying E-liquids for years. She's found that they frequently contain unlisted ingredients such as ethanol, which was found in 95% of the commercial vaping liquids they tested, with one in five samples over 10% ethanol. The health affects of breathing such high concentrations of ethanol are also unknown, she said.
She has not been alone in raising concerns about possible health effects of vaping and urging more research. E-liquid constituents and their potential adverse effects are not well-understood, wrote University of Rochester researchers in Frontiers in Physiology. The flavoring chemicals are known to cause inflammatory and oxidative stress responses in lung cells, and there is much scientific uncertainty about yet unrecognized respiratory health hazards of inhaling these vapors, they said.
While many of the ingredients and flavorings in E-liquids may be generally recognized as safe when used in food, researchers have voiced a number of concerns about inhaling these heated chemicals and possible damage to lung tissues. International researchers reported in the journal Thorax in 2016, they found benzaldehyde in cherry-flavored E-cigarette vapors, with the long-term health effects unknown. Harvard researchers reported in Environmental Health in 2016 and in 2017 finding low but measurable amounts of toxic chemicals and carcinogens in the vapors, including acetaldehyde, diacetyl, toluene, benzene and other chemicals, especially from flavored E-liquids.
"Based on the current body of evidence, e‐cigarettes are not emission free (as some believe) and, in fact, they emit various potentially harmful and toxic chemicals," wrote researchers at the University of Texas-El Paso, who've been researching the cardiovascular effects of vaping. "It is clear that there are many unanswered questions regarding the overall safety, efficacy of harm reduction, and the long-term health impact of these devices," they said.
Deadly lung disease: EVALI. In June 2019, doctors across the country began reporting clusters of a very serious lipid pneumonia associated with vaping and e-cigarettes showing up in previously healthy young people, mostly in their 20s. Nearly all (95%) of these young people had to be hospitalized. At the peak of the outbreak in September, the University of Utah reported new cases arriving weekly. By December, Texas had seen 210 cases, with more than a dozen teens in Dallas County alone needing to be put on ventilators.
By the following March, 319 Texans were believed to had the lung damage and 25% of the confirmed cases were kids under 18 years of age. The CDC recorded 2,807 hospitalized cases and 68 deaths nationwide by February 2020.
Initially, researchers believed the lung damage might be linked to the chemical additive in E-liquids, propylene glycol, when it's heated, aerosolized and inhaled. Dr. Stanton Glantz at UC-San Francisco noted that the lung damage appeared similar to that demonstrated in mice studies. Research by Houston researchers replicated the lung inflammation and tissue damage in mice exposed to non-nicotine E-liquid vapor containing the solvents, propylene glycol and vegetable glycerin.
THC was illicitly in most of the vaping liquids used by victims of this lung disease tested by the FDA. The CDC believes EVALI may be linked to the vitamin E acetate used in some THC-infused E-liquids, reporting studies showing correlations. Later in the outbreak, it concluded that additives other than vitamin E acetate might cause the injury and "evidence is not sufficient to rule out the contribution of other chemicals of concern, including chemicals in either THC- or non-THC–containing products."
As of February 2020, the CDC reported 82% of the cases had used THC-containing vaping products, 14% used only nicotine vaping products and 69% were purchased commercially, and 16% had only purchased the marijuana-based from State licensed dispensaries. CDC reported that EVALI symptoms appeared within 90 days of vaping, and toxicologists at the California Department of Public Health later reported that symptoms appeared a median of three days from last vaping.
Utah experienced among the highest rates of EVALI cases in the country and doctors at the University of Utah Medical Center in Salt Lake City intensely studied 31 patients hospitalized at their center. As critical care doctors in Denver noted, they still don't know if lipids as in vitamin E plays a role in the lung damage, as not all EVALI cases have been associated with THC-infused products, and nicotine or flavored e-cigarettes have only been experimentally shown to cause the lung damage. There is a lot of knowns with this condition yet.
It could also be due to a combination of anything in vaping products.
At the Society of Toxicology Meeting last March, California Department of Public Health experts analyzed the vaping products associated with the EVALI lung damage. Their research revealed that none of the popular theories being linked to the lung disease were found consistently in the cases – the E-liquids the young people had used didn't all contain nicotine, THC or vitamin E; the vaping products didn't all come from unlicensed sources; nor did the patients all show an accumulation of lipids in their lung injuries. While flavorings, heavy metal contaminants, other oils, infectious germs and pesticides were all found in some of the E-liquids, they didn't explain the EVALI cases. These toxicologists believe toxic ketenes may have a role, which are formed when acetone vapors are heated near certain metals and ceramics. Acetone is a well known solvent used in THC extraction and is found in other chemicals used in E-liquids, including some flavorings, carrier liquids and other solvents. Vaping devices use a variety of metals and ceramics which been identified in E-liquids and vapors.
Officials scrambled to protect young people. In the midst of all of these unknowns, regulators made efforts to protect young people from the risks of vaping. In September 2019, Texas made it illegal to sell vaping and e-cigarette nicotine products to minors under age 21. Texas A&M banned vaping and e-cigarettes from campus completely in October 2019. The FDA's ban on nicotine e-cigarette flavorings that appeal to kids, including fruit and mint, was issued in January 2020.
But most of the EVALI cases were young adults in their 20s and of legal age. No place in the country had effective safety regulations for testing and labeling vaping products. Colorado enacted its first such regulations in November 2020, but those were an effort to help restore the vaping industry, which had taken a hit from the EVALI crisis.
EVALI's Lesson For Texans
Marijuana interests and the legalization lobby showed their real intentions with Evali. At the peak of the outbreak, efforts by Texas DSHS to enforce restrictions on vaping or vaping products that contain cannabis were blocked by marijuana interests.
Texans saw first hand the goals of marijuana marketing. The EVALI outbreak is an important example for Texans of not just what marijuana legalization is really up to, but how far marijuana interests will go.
Texas Hemp legislation only allows cannabidiol products to be manufactured in Texas for ingestion and Texas' Compassionate Use program only allows CBD products for ingestion to be used for specific qualifying conditions. Both pieces of legislation specifically forbid smoked CBS products – which would also prohibit vaping (heating CBD oils for inhalation) and help protect young people from this lung damage. But when attempting to enforce this legislation, DSHS ran afoul with the marijuana lobby concerned it will slow their efforts to "move legalization forward" and cost them potential revenue. Texas for Responsible Marijuana Policy organized activists who submitted hundreds of comments to the DSHS against enforcing the legislation and a few CBD companies even got a temporary restraining order last fall, with their lawyers saying the DSHS rule doesn't specifically prohibit in-State retail sales of smoked and vaped products.
Texas DSHS and politicians have publicly focused on e-cigarettes as being about nicotine. DSHS is concentrating its anti-vaping efforts on tobacco prevention. But now you have a glimpse of the rest of the story. As other States have experienced, Texas legislators have a opened the door to a regulatory-legal mess, as marijuana activists will fight every inch and every effort to regulate cannabis for years to come. The only best way to mitigate it at this point is probably to repeal the legislation all together.
Caution: Not all studies are the same. Some become marketing tools. A study was published in an open access issue of JAMA last April, purporting to find that legalization of recreational marijuana had the lowest rates of EVALI. The authors concluded that only access to recreational marijuana was protective. This paper was used across the country to market for legalization.
But how many in the public looked closely or critically at the paper? Not only did the number of EVALI cases per capita in prohibition States like Alabama or Texas, not differ significantly from recreational States like California or Nevada, there was no association with e-cigarette use at all. Their results also defied the known evidence about EVALI.
Remember, researchers have found no consistency in the cases – not all had used THC or nicotine-infused products, had gotten the vaping products from informal (illegal) sources, or used E-liquids containing vitamin E, etc. And, as has been well-documented, legalization increases black market marijuana products, negating a protective role of legalized recreational marijuana. Certainly, the CDC is not claiming that legalization of recreational marijuana is protective, either.
The methods used by the authors may offer an insight on how their computer may have come up with unsupported findings. Their analysis used an earlier interim CDC report from September 2019 of only 805 patients − only 28.7% of the EVALI cases; along with a dated 2017 SEERs database to get State populations numbers to compute the rate of cases. Using all 2,807 EVALI cases reported by the CDC in its latest February 18, 2020 report, and U.S. census data for each State from July 2019 when the outbreak began, finds very different results. The rate of EVALI cases in California and Washington, for example, were higher than in prohibition States like Georgia and Idaho, or Utah, which had the highest number of cases in the country. Basically, it's a stretch to find a meaningful correlation to credibly attribute it to legalization.
Children are Paying the Highest Price for Legalization
"Horrible things are happening to kids," said Colorado addiction psychiatrist Libby Stuyt, MD. Many people who've voted for legalization thought they were talking about the marijuana of the 1960s to 1980s when the THC content was under 2%, she said. Not understanding the reality of pot today is risking the lives and futures of our young people. She summarized the devastating consequences for young people in the journal Missouri Medicine, concluding that if States continue to commercialize marijuana as has been done in Colorado, we are destined to see many more people needing treatment for addiction, depression, anxiety, suicide ideation and psychosis.
For professionals following what's been happening to young people, the numbers keep getting increasingly more alarming. Behind each of these numbers is a young person, whose life and future is being forever changed.
No State has been able to regulate marijuana and keep it from children or teens, or out of schools.
Not one.
Poisonings and Unintentional Exposures
Legalization has made marijuana more available to minors. Legalization of marijuana in any form has put young people at hugely greater risks not just of using cannabis products, but of poisoning and unintentional exposures. Marijuana exposures and poisonings reported to the National Poison Data System significantly increased following legalization, rising 67-77% in States right after legalization. This danger has repeatedly been documented across the country since the legalization movement began. Yet, the situation continues to get worse.
· Researchers with Central Ohio Poison Center and the Center for Injury and Policy at Nationwide Children's Hospital investigated marijuana "exposures" and poisonings among children under six. From 2000 through 2013, rates of marijuana poisonings among young children were three times higher in States that had legalized "medical marijuana." Exposures among young children are continuing to rise.
· The average age of young children in the U.S. being poisoned and accidently exposed to marijuana was 1 ½ years, and most (75%) had eaten marijuana edibles. Almost half (47.6%) of children exposed to marijuana required medical treatment, 11.6% were hospitalized and another 6.9% required critical care. Lawmakers need to be aware of the risks to young children associated with legalizing the medical or recreational use of marijuana, the national poison control researchers urged.
· Latest research of the National Poison Data System data, published in Clinical Toxicology, reported that between 2000 and 2017, marijuana was the most common substance involved in calls to poison control centers for exposures to natural psychoactives – 35% were among teens 13-19 years of age. Marijuana accounted for nearly half of those poison control calls, and rates of marijuana poisoning calls increased 150%, while exposures of most other natural psychoactives decreased during that 18 year period.
· Nationwide, over 70% of marijuana ingestions among children under six occurred in States with legalized marijuana, according to the 2019 Rocky Mountain High Intensity Drug Trafficking Area report. With commercialization and legalization of marijuana in Colorado, marijuana exposures and accidental overdoses and poisonings among all ages has skyrocketed. Between 2013 and 2019, marijuana only exposures among Colorado's children quadrupled.
· Nationwide, according to data from the American Association of Poison Control Centers, of the 7,300 marijuana poison cases in 2017, 624 were due to edibles, including 202 in children under the age of five.
· Cannabidiol (CBD) related poisonings and accidental exposures is the newest emerging hazard, according to the American Association of Poison Control Centers. In its CBD Alert, it reports 2,218 cases related to CBD were managed by poison control centers in 2020 alone.
Unintentional marijuana exposures among children, emergency room visits and hospitalizations all increased after legalization, Colorado doctors reported in Clinical Pediatrics. Rising concerns over such problems being seen across the country led to multiple States enacting various regulations attempting to address the problems – including banning certain edibles, packaging and labeling rules, and limiting THC levels. These doctors set out to investigate whether the protective regulations enacted in Colorado had been effective.
They found that visits to the children's hospital doubled from 2015 to 2017; poison control calls increased 50-67% percent and the average age for children admitted to the hospital for marijuana poisoning was still just three years of age. More than half of the hospitalized pediatric patients had ingested marijuana-laced edibles, with some testing positive for toxic levels of cocaine and meth. The doctors concluded, despite multiple preventative regulatory measures, none were effective and children were being increasingly exposed to cannabis even four years later. States considering legalizing marijuana need to recognize that they are risking children and that regulatory efforts don't work, they said.
Dr. Karen Randall, an emergency room physician specializing in cannabis medicine sounded the alarm in September 2019 about Colorado's "experiment with marijuana legalization," saying it's been an epic disaster and the public is being misled about the effects of recreational marijuana. "I think the public needs to know that we are not okay," she said. "The grand experiment is not going so well…My fellow physicians don't understand the potency that we're dealing with at this point" and the marked increase in medical problems.
Edibles – Big Money For Companies, Most Costly for Young People
Edibles fuel marijuana sales today, with sales tripling in a single quarter in Colorado after legalization, and accounting for an estimated 20% of "medical marijuana" sold in Florida. According to marketing research, edibles are 12% of the current cannabis market and offer pot companies the highest profit margin at 92%. The industry can charge more for edibles and entice customers to buy more.
Edibles also fuel "medical marijuana" sales. "Medical marijuana" users spend nearly three times more on cannabis-based products than recreational users. There is no regulatory oversight of edible marijuana products – marketing is the Wild Wild West and no one knows what's actually in these edible products.
Edibles are packaged and marketed just like candy, cookies, cereals, sodas and other sweets. While marijuana is illegal to sell to minors, edibles clearly appear to be targeting children. They look like child-friendly products with colorful packaging, cartoon characters and fun names that appeal to minors. DEA agents are reporting a growing trend of edibles that are going to great lengths to package cannabis edibles to look like candy, snacks and cereals that kids love. They seized 2,300 pounds in Akron, Ohio the first week of September last year alone. This would never be permitted in prescription medications or any legitimate medication sold the consumers, which are specifically packed to avoid accidental ingestion by minors.
Among students in Colorado, by 2019 a shocking 39% of 9th graders and 35% of high school seniors reported using marijuana edibles within the past month.
So not surprisingly, edibles are a leading source of marijuana exposures and unintentional poisonings among children.
With legalization, States have seen escalating accidental exposures and poisonings among children. Marijuana-infused edibles are indistinguishable from regular treats and look especially appealing to a child who would not think twice about eating several cookies or brownies in a sitting, said poison control specialists Blair Thornley, PharmD at Children's Hospital of Philadelphia. Each gummy or cookie often contains several times the recommended dose of THC for an adult to get high and is enough to get a child in serious danger of toxicity.
Regulations, for labeling requirements and prohibiting sales to minors, under marijuana legalizations are notoriously nonexistent, weak, poorly enforced and ineffective. State and federal regulations of cannabis have completely failed to protect children.
After legalization in Colorado, Colorado medical professionals reported in JAMA that emergency room visits to children's hospital in Denver nearly doubled between 2009 and 2015; and statewide poison control calls increased 34% a year the first two years after legalization– nearly twice the rates in the rest of the country. Half were due to edibles.
The problem of children unknowingly eating everyday candy that's been laced with marijuana became so serious in Denver that the police department issued a public service video warning parents during Halloween in 2014. Since 2015, accidental marijuana-related exposures among children in Colorado had increased another 50% by 2019, the greatest increase has been in the youngest children under 12 − 56% of those exposures were from edibles.
Children and teens across the country are being rushed to the hospital from THC overdoses after eating gummy bears and other candies and edibles. Eleven teens in Indiana had each eaten half a gummy bear and were found hallucinating, suffering blurred vision and heart rates of 200 beats a minute, with extremely high levels of THC in their systems. In March 2015, police in Colorado reported the third death that year among young adults from suicides and homicide resulting from marijuana edibles.
Even adults don't know what they're getting in edibles. Many edibles contain over ten times more THC than a single joint and over 20-times the amount needed for intoxication. There's no standardized portion sizes, and one "dose" may only be a piece of a cookie or candy – not a whole cookie, piece of candy or a small package as many might believe. These accidental overdoses explain the large number of poison control calls and hospitalizations among all ages.
About 16%-25% of "medical marijuana" users consume edible cannabis products, according to research funded by John Hopkins, published in JAMA. But consumers have no assurances of what they are taking. Analyzing 75 edible "medical marijuana" products and 47 different brands, from three major metropolitan areas across the country, they found only 17% contained the THC or CBD on the labels, with levels varying wildly. All of the "medical cannabis" products failed to meet basic label accuracy standards for medications; and the most notable inaccuracy was that most CBD products had higher THC content than labeled. Their study highlighted the dangers of using nonprescription, unregulated products.
Under Arizona's "medical marijuana" program, more than 7,000 ounces of marijuana were sold as edibles in a single month, as in January, 2020, for example. These edibles readily find their way into schools, easily hidden in lunch packs and nearly indistinguishable to teachers or parents from actual candies. The nation's annual school survey found forty percent of young people in "medical marijuana" States had used marijuana edibles, nearly twice the rate in other States.
Edibles were to top selling marijuana product in Washington State, with over 731,000 edible products sold in 2015, according to the Washington State Marijuana Impact Report from the NW High Intensity Drug Trafficking Area. Ninety percent of retail license violations concerned sales to minors. Even years after legalization in Washington State, "there are no regulations on the packaging, labeling or advertising of medical marijuana businesses or products," the report found. Side by side examples of marijuana candies found vastly different amounts of THC on the labels, serving sizes and no guidance or information on the labels.
Schools and educators are being increasingly impacted by marijuana, especially in States with some form of legalization. During the first year of legalization in Washington, Seattle Public schools had 131 marijuana violations of kids with high THC-infused edibles and drinks. Schools in Washington, like other legalized States, are reporting more discipline problems, more truancy problems, higher drop out rates, lower grades, more school violence and delinquent behavior, more expulsions and suspensions for drug use and poorer educational attainment, with kids using marijuana a third less likely to complete high school or go on to college. After State legalization, drug-related school suspensions and expulsions increased, accounting for about half of all expulsions in Colorado and Washington State. Nearly all (98%) student drug violations in Seattle schools, for example, involved marijuana.
While bills in State legislatures mostly aim to expand the marijuana industry and legalize pot, doctors are increasingly calling it a public health experiment that supports the pot industry's interests while ignoring the implication for young people. There is a growing fear we may lose an entire generation before we realize we need to protect our children, said Leslie Walker-Harding, chair of Pediatrics at Seattle Children's Hospital. “It seems like everyone is looking the other way, and meanwhile kids are ending up in hospitals,” said one parent whose college-age son had been admitted for treatment.
In Part Six, we'll look at the costs of legalization: how the safety of local communities is endangered and the reality of financial costs and tax revenues.
By Sandy Szwarc, BSN
