But these days, there's no end to the different ways of ingesting cannabis. It comes in vape pens, nasal sprays, dissolvable sublingual tablets, rectal or vaginal suppositories, skin creams and much more. Cannabis oils and tinctures can be concentrated into edibles, like candy, chocolate or carbonated drinks. The range of edible cannabis products is as extensive as any convenience store's selection: there are chocolate bars of all shapes and sizes, hard candies, sodas, cookies, pastries, and more.
Cannabis-infused candy is an especially popular means of getting stoned. But the existence of so many cannabis-infused candies has translated into a sharp rise in kids accidentally eating these foods. A stoned toddler can be a scary experience, sometimes requiring a trip to the ER, though fortunately such overdoses are rarely, if ever, fatal.
A study published in early January in the journal Pediatrics found an alarming rise in children eating cannabis candy. A trio of physicians at the department of emergency medicine at Rush University Medical Center in Chicago looked at data from the National Poison Data System regarding children under age six that were exposed to edible cannabis products between 2017 and 2021.
There were a little over 7,000 exposures during that period, but only about 200 in 2017 and more than 3,000 in 2021 — representing an increase of 1,375 percent. More than 90 percent of cases occurred at home and about 14 percent (973 cases) were resolved without needing a healthcare facility. And while only 2.2 percent (155 cases) qualified as "major effect" cases, for the most severe instances it could involve rapid heart rate, vomiting, seizures, even coma in a few cases. No deaths were reported.
These cases are likely an underestimate, the study authors reason, because it only includes incidents recorded by the National Poison Data System. Nonetheless, "This study demonstrates that unintentional cannabis exposures in young children are increasing rapidly," the authors write. "These exposures can cause significant toxicity and are responsible for an increasing number of hospitalizations."
"Prioritizing prevention strategies such as changing product packaging and labeling, regulating the maximum allowable dose in a package, and increasing public education on mitigation of household risks are key in reducing these exposures," they added.
A similar trend has been noted in Canada, according to data published in JAMA Health Forum in January. Between 2015 and 2021, there were 581 pediatric hospitalizations for cannabis overdoses, making it a "leading cause" of such hospitalizations in Canada. The authors recommend "restricting or prohibiting" the sale of "visually attractive and palatable commercial cannabis edibles."
This is why some experts think that putting marijuana into delicious, sugary treats like gummies or chocolates is a step too far. Dr. Peter Grinspoon, a primary care physician at Harvard Medical School who specializes in medical marijuana, describes having cannabis candies around kids or pets is like having a "loaded gun" around that just exposes opportunities for an accidental marijuana overdose.
"It's like you're leaving these little landmines around with these chocolate bars. And I think it's dangerous," Grinspoon told Salon. "You don't have to make it taste bad, but it shouldn't be appealing to kids and pets."
Grinspoon, who is the son of the famed cannabis advocate Lester Grinspoon, is not against legalizing weed. Far from it, in fact.
"Obviously, cannabis should be legal and accessible to medical patients and to adult users without criminalization," Grinspoon said. "But we wouldn't make other medicines into tasty gummies where you eat the whole package. No one's gonna die, but it's really awful for a kid or pet to consume a whole bag of gummies."
It can be hard to generalize about cannabis candy, because every state that has legalized cannabis has different regulations. More than 20 states have enacted adult-use cannabis laws, while nearly 40 have medical marijuana, meaning you need a doctor's note to medicate with cannabis. But at the federal level, cannabis is still completely illegal, so oversight related to packaging or the form it can come in varies from state to state.
"If you make a big bag of strong cannabis edibles look like Skittles, maybe a discerning adult can read the small 'THC' label and could see that 'Skittles' is written or spelled a little bit differently," Grinspoon said. "But a four year old is going to be like, 'Skittles, yum!'"
Part of the problem can be designing cannabis candy to look exactly like non-marijuana products. Some companies blatantly mimic existing candy and junk food brands, including Nerds, Sour Patch Kids, Rice Krispies Bars and more. A study published last spring in the journal Drug and Alcohol Dependence noted that many of these products lack few distinguishing characteristics, making it easy for a kid — or even an unsavvy adult — to unwittingly mistake them for a more familiar treat.
And if a four-year-old encounters a bag of gummies, they might not just take one or two — a standard dose of THC, the intoxicating drug in marijuana. They might eat the entire bag. Spotting a tiny bit of text in the corner that says THC 10mg isn't always clear.
"If you make a big bag of strong cannabis edibles look like Skittles, maybe a discerning adult can read the small 'THC' label and could see that 'Skittles' is written or spelled a little bit differently," Grinspoon said. "But a four year old is going to be like, 'Skittles, yum!'"
To be fair, many of the more unabashed copyright-infringing products exist in underground markets, so they aren't legal anyway. States like California have implemented laws requiring child-proof packaging and banning such marketing, but even the legal versions may be hard for someone to tell there is a medication or drug in that candy.
"Most state programs prohibit that sort of copycat packaging already," Justin Brandt, a business attorney based in Phoenix, Arizona who serves clients in the cannabis industry, told Salon. "I really don't think that cannabis in candy form is the issue. I think the issue stems on branding, packaging and labeling. You're going to be hard pressed to find anybody in this industry, who's going to say, 'Yeah, we should allow products and cannabis and THC edibles to be marketed towards children.'"
Brandt's wife owns numerous dispensaries across several states and they have three children together. He says whether cannabis comes in candy is a matter of parental responsibility and that talking to your kids can help avoid an accidental THC overdose.
"We secure our products in a safe, knowing that they can't access it, but kids are still curious," Brandt said. "But having that conversation with them. I think if parents feel it's appropriate, they should do that. That's what my wife and I do with our kids. This is something that you are not allowed to have. This is not for children. This is for mom and dad. If you have questions about it, we can talk through that. But having that transparency, I think is a good thing with children, especially if you're going to be having these types of products in your household on a regular basis."
Another aspect of this sharp upward trend in pediatric hospitalizations from cannabis is that, as laws against weed unravel in more areas, more parents may feel comfortable going to an emergency room. In the years before cannabis was legal, such a visit could easily be met with police or child protective services taking away one's kids. As more laws relax, parents may also feel more comfortable seeking emergency medical care.
The Pediatrics study was not designed to answer questions like that, nor could it based on the data available. "It is unknown whether other factors such as increased reporting to poison centers or decreased stigma surrounding cannabis use over the course of the study period may have contributed to the observed increase in exposure rates," the authors noted.
"Criminalization makes everything more dangerous, if parents can't even tell the doctors what their kids accidentally ingested," Grinspoon said. "Literally 20 years ago, if you went to the ER and said, 'My kid overdosed on cannabis,' there would be a very good chance that someone would call the police. So why on earth would you tell them it was because of the cannabis?"
But Grinspoon said this can't fully explain such a sharp rise in hospital visits. The increased availability of these products is clearly the driving force behind this increase in hospital visits. But cannabis is far from alone in this equation.
Melatonin, an over-the-counter drug that occurs naturally in the body, has also been the source of numerous child overdoses lately. Poison control calls related to kids overdosing on melatonin have risen six-fold between 2012 and 2021, according to a report issued last summer from the Centers for Disease Control and Prevention. Part of the issue stemming from the fact that the medication often comes in gummy form. But THC can be a lot more uncomfortable and life-threatening than melatonin, Grinspoon argued. Nonetheless, his position is not exactly a popular one.
"I get so much crap from the super pro-cannabis people," Grinspoon said, referring to a controversial blog he wrote arguing that cannabis should come in pills, not candy form. "It makes me feel like I'm doing a good job if I'm getting potshots about equally from people on both sides of the issue."
Brandt argued for more common sense from parents. "If you're gonna choose to have cannabis-infused edibles in your home, and it's somewhat similar to non-cannabis food, don't store it in your pantry," he said. "Don't store it in your fridge. Keep it separate and do what you have to do to avoid those scenarios where children have opportunities to ingest that."
