Unintentional Pediatric Cannabis Exposures After Legalization of Recreational Cannabis in Canada

approach to legalizing recreational cannabis.Initially, the sale of cannabis flower, seeds, and oils was permitted, and after 1 year, this expanded to a wider variety of products, including cannabis edibles.4 We evaluated changes in pediatric emergency department (ED) visits and hospitalizations due to cannabis exposures associated with these changes. MethodsThis repeated cross-sectional study was authorized under section 45 of Ontario's Personal Health Information Protection Act and approved by the privacy and legal office of ICES (formerly the Institute for Clinical Evaluative Sciences).Section 45 allows ICES to collect personal health information without consent for the purpose of health system evaluation and improvement.We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cross-sectional studies.We identified all ED visits and related hospitalizations due to cannabis exposures among 2.35 million children aged 0 to 9 years in Ontario, Canada, between January 1, 2016, and March 31, 2021.We compared trends and characteristics of ED visits over 3 periods: prelegalization (January 2016-September 2018); the period after legalization of flower products, or period 1 (October 2018-January 2020); and the period after commercial edibles became available, or period 2 (February 2020-March 2021).Poisson models were used to calculate incidence rate ratios (IRRs) for change in monthly rates of visits.Health administrative data sets were linked using encoded identifiers and analyzed at ICES (eMethods in the Supplement).All tests of significance were 2-sided, and P values < .05were considered statistically significant.Data analysis was conducted from June through August 2021 using Stata statistical software version 17.0 (StataCorp). ResultsThere were 522 ED visits due to cannabis exposures among children (mean [SD] age, 3.8 [2.6] years; 281 visits [53.8%] among boys) including 81 visits during prelegalization, 124 visits during period 1, and 317 visits during period 2. The proportion of cannabis-related ED visits with hospitalization increased significantly after the introduction of edibles (122 visits [38.5%] during period 2 vs 29 visits [23.4%] during period 1 and 20 visits [24.7%] during the prelegalization period; P = .002).There were 19 ED visits (3.6%) with intensive care unit admission; no deaths were recorded (Table ).Rates of ED visits associated with cannabis exposures increased from January 2016 to March 2021 (Figure).Period 1 (IRR, 3.13; 95% CI, 2.37-4.16;P < .001)and period 2 (IRR, 9.12; 95% CI, 7.15-11.65;P < .001)were associated with increases in visits compared with the prelegalization period, + Supplemental content