51ºÚÁÏ

ST. LOUIS — For the first time in her 10-year career, Dr. Lindsay Clukies is admitting toddlers into the hospital and even the intensive care unit for accidentally eating products infused with cannabis.

“We are asking right off the bat in a neutral and supportive way: ‘Do you have THC-containing products in your home?’ Because it’s so common, it’s at the top of our differential (diagnosis) if we see a child who isn’t acting right,â€� said , a Washington University pediatric emergency physician at 51ºÚÁÏ Children’s Hospital.

Health officials are raising the alarm over increasing numbers of children ingesting THC — the intoxicating chemical in cannabis — since Missouri legalized the licensed use of recreational cannabis at the end of 2022.

Legal products include THC-laced chocolates, candy, cookies and potato chips that can be enticing to kids.

In addition, food products containing unregulated forms of THC are popping up in stores, able to skirt safety restrictions faced by state-licensed dispensaries.

At 51ºÚÁÏ Children’s Hospital, researchers pulled data from the first six months of 2023 and found 43 patients younger than 12 tested positive for THC. With dispensaries not opening until February of that year, Clukies suspects that the number is even higher now.

Symptoms of patients include extreme fatigue, difficulty walking, confusion, dizziness, hallucinations and vomiting, she said. Some experience long pauses in breathing or seizures, which land them in intensive care.

Physicians must sometimes rule out other conditions such as meningitis or head trauma, which requires performing invasive or costly tests such as spinal taps or CT scans.

Children are particularly at risk because they are ingesting adult-size doses, and often several at a time, Clukies said: “If they find some type of product that looks like a Sour Patch Kid, they are not going to eat just one.�

Another emergency room physician at Children’s who specializes in toxicology, , joined other Washington University researchers in looking at the hospital’s drug screenings in children ages 1 month to 9 years over the course of five years.

The team found that between November 2018 and May 2023, the number of screenings coming back positive for THC jumped from 1.7 out of every 1,000 tests, to 13.7, Liss said. The data confirmed what he saw as he made his rounds.

“We had more of these very small, sometimes 1 or 2 or 3 years old, admitted to the hospital and sometimes the ICU,� he said. “Sometimes these children take two or three days to wake up.�

The dangerous trend after legalizing marijuana for medical and recreational use.

The began seeing big increases in calls about ingestions and overdoses after cannabis was first approved for medical use in the state in 2018, said Julie Weber, director of the center.

In 2023, the center handled 168 cases of accidental ingestions of cannabis products among children ages 5 and younger, Weber said. In just the first nine months of this year, the center has already nearly matched that number.

“This is just what is reported to us, and not every case is reported to us,� Weber said. “How many cases are really out there, and how big is this problem?�

‘Nerds Rope Bites’

Adding to the dangers, doctors say, are unregulated forms of THC that are sold in places like gas stations, vape shops and liquor stores and packaged to look nearly identical to popular brands of candy and snacks.

In March, six third graders in the Riverview Gardens School District were sent home from school after eating these unregulated products, which they thought were candy, 51ºÚÁÏ County police reported.

A mother of a 9-year-old girl who ate two of the edibles told KTVI (Channel 2) that the girl had trouble walking and thought she was being kidnapped when her mother came to get her.

The children had eaten delta-8 THC-infused Nerds Rope Bites and Mad Monkey Sour Strawberry Premium Gummies, police said.

Delta-8 THC is derived from hemp, but it has similar psychoactive properties to the delta-9 THC found in marijuana. Both are cannabis plants.

In 2018, a national farm bill removed hemp and its byproducts from the list of controlled substances because of the plant’s low THC levels. Companies, however, have used this loophole to sell delta-8 products, usually with no age restrictions and with little oversight.

A month after the elementary school students were sickened, the Missouri Department of Health and Senior Services about the products.

“It is highly concerning how accessible these products are to the public, especially our youth,� said Paula Nickelson, director of DHSS. “There is no way for consumers to know exactly what is in the product they are consuming and just how intoxicating it may be.�

The products may be labeled as containing delta-8 THC, delta-10 THC, THC-P, or host of other letter combinations, the advisory warned.

Of the 43 young patients testing positive for THC in just six months last year at 51ºÚÁÏ Children’s Hospital, 16 were confirmed to be from delta-8, Clukies said.

Since 2021, t receiving nearly 9,700 calls related to exposure to delta-8 THC.

, including neighboring Kansas and Iowa, have moved to regulate products with delta-8 THC. The Missouri Legislature is expected to take up the issue when it returns to action next year.

Missouri Gov. Mike Parson, however, is refusing to wait.

On Aug. 1, Parson issued an emergency rule banning all intoxicating hemp food and drinks from being sold. Missouri Secretary of State Jay Ashcroft, however, refused to sign off on the effort, arguing it lacks legal justification.

The rule also became the subject of a lawsuit filed by the Missouri Hemp Trade Association, which has characterized the governor’s effort as an overreach and move to strengthen the licensed cannabis industry’s grip on the market.

On Sept. 10, Parson and Missouri Attorney General Andrew Bailey instead : The state’s Division of Alcohol and Tobacco Control will investigate whether its licensees are “misbranding� its psychoactive cannabis products.

The cases will be referred to Bailey’s office for enforcement under the Missouri Merchandising Practices Act, which prohibits “any deception, fraud, false pretense, false promise, misrepresentation� in the sale or advertisement of merchandise.

Before this new investigation effort, the state health department had already identified nearly 11,500 of the unregulated products, placing warning tags on the shelves of products in 73 facilities.

Those cases will be referred to Bailey’s office, according to DHSS spokeswoman Lisa Cox, and the tags removed after 30 days.

The state also to report retailers selling unregulated THC products.

According to the DHSS, an estimated 40,000 food establishments and smoke shops and 1,800 food manufacturers could be affected by the enforcement actions.

“All of this is hopefully leading to broader action,� Cox said. “The data was showing that something had to happen soon, but we are hoping the Legislature in the coming session will commit to looking at this at a deeper level.�

Lockboxes

Liss said some hemp-derived products list as much as 1,000 mg of delta-8 THC in one edible, while regulated cannabis edibles tend to have about 5 to 20 mg of delta-9 THC.

While delta-8 is less potent, it’s hard to know what a safe amount is, Liss said. With no regulations on how delta-8 is made, .

“It makes me worried because if a child can get into an entire bag of a dozen or more delta-8 gummies, and if each of those is 500 to 1,000 mg, that’s tens of thousands of milligrams of delta-8 THC,� he said.

Liss urged adults to store their cannabis products out of reach of children just like they would any other medication.

“I know this is a recreational thing and you are not thinking of it as your blood pressure pills, but I would treat it the same,� he said. “Keep it away.�

Tiffany Taylor, a nurse in charge of trauma prevention at SSM Health Cardinal Glennon Children’s Hospital, said parents are often unaware that their children had ingested edibles while visiting or hosting friends and family.

Symptoms sometimes don’t show as long as two hours after ingestion, Taylor said, and it can be hard to determine what happened.

“It’s just really important to have that awareness of what is accessible and what is being brought into your home, or where your kids are going and asking those questions to make sure they don’t have access,� she said.

51ºÚÁÏ Children’s Hospital is providing 1,000 free lockboxes over the next year to patients at risk. The lockboxes are big enough to store several medicine containers. Only those with a key to its padlock can open it.

Patti and Ellis Fitzwalter provide locking medication bags through their local nonprofit (Heroin Education and Awareness League), which they founded after their son, Michael, died from a heroin overdose at the age of 22. His addiction was fueled by finding unlocked medications.

Ellis Fitzwalter said, “It’s been our mission to share our story in order to educate and spread awareness about the dangers of opiates and other harmful drugs, both legal and illegal.�