Emergency department doctors are gearing up for the possibility of a spike in cannabis toxicity cases, particularly those involving children, ahead of legalization next week.
“We’ve been communicating with the IWK (Health Centre) physicians about this and certainly they’ve already seen cases,” said Dr. Nancy Murphy, director of the IWK Regional Poison Centre and a medical toxicologist who also works as an emergency department doctor.
“And again for them, it’s on their radar but if a child comes in who’s in a coma, that’s not the first thing on their mind. They have to look at other causes and make sure they rule out anything medical. But they certainly are thinking about it because they’ve already seen severe cases (of cannabis toxicity).”
The poison centre is developing an information sheet that will be used to recognize cannabis toxicity and to manage the symptoms when talking to callers to the poison centre line (1-800-565-8161).
“And that’ll be for everybody but I think it’s going to more impact the pediatric (side),” Murphy said. “Any emergency department across the province that sees pediatric patients, they should be on the lookout for this.”
Cannabis poisoning among children usually involves edible forms of the drug. Just last week, a child was hospitalized on Vancouver Island after eating gummy bears infused with cannabis.
Edible products won’t be on the shelves in Canada until some time next year. Health Canada is now working on rules governing their sale.
As of Oct. 17, Nova Scotia Liquor Commission will sell dried and fresh cannabis, cannabis oil and cannabis accessories. Those 19 and older will be able to buy 30 grams of cannabis in products with varying levels of the main psychoactive ingredient tetrahydrocannabinol (THC). Buyers are advised to store their cannabis away from children and pets.
While legalization could increase the number of toxicity cases, Murphy noted that government control of the drug has its benefits, particularly for older people trying cannabis for the first time.
“With more regulatory control over the THC percentage in the products, there’s a little less concern around unexpectedly high concentrations causing you to faint or have heart arrhythmia or something like that,” she said. “It’s helpful in reducing the risk of unexpected effects.”
But older people on multiple medications, particularly pain relievers, should aways be careful about using cannabis, Murphy said.
“Cannabis can have negative effects on the cardiovascular system as well so people need to be aware of their personal risk when they’re trying cannabis either for the first time or an on ongoing basis.”
The health risks are higher for heavy users of cannabis, especially in combination with alcohol and street drugs such as cocaine.
For example, there have been suspected cases in Nova Scotia of a debilitating stomach ailment called cannabinoid hyperemesis syndrome (CHS). Murphy said she sees one or two people a month at the emergency room who show symptoms of CHS, which are severe belly pain and cyclical vomiting. But she emphasizes that it’s usually difficult to definitely pinpoint cannabis as a cause.
“It’s not something that just appears after using it a couple of times,” Murphy said. “We’re talking years of heavy daily or nearly daily use. … As emergency physicians we see these patients coming back over and over again over time and obviously it’s not the first thing we think about if we see a patient for the first time. We have to make sure there’s nothing else going on. …
“But I certainly do bring it up as a possibility if I’ve done a bunch of tests and nothing is showing and they have been using heavily for years.”
A strong association between heavy cannabis use and psychosis in youth has been documented, according to the Canadian Pediatric Association, which also points to links between cannabis and the disruption of healthy neurological development.
The association recommended last year that Ottawa restrict cannabis use to people aged 21 and older.
But the federal government allowed each province and territory to decide on regulations and most chose 19 and over. Quebec and Alberta set a minimum age of 18, although the new Quebec government has said it will raise that age to 21.