O3247: Temporal Association Between Cannabis Legalization and Intoxications in Ohio: A Statewide Poison Control Database Retrospective Cross-Sectional Analysis.

Background: Ohio legalized recreational cannabis in November 2023. Ohio regulates packaging for medical, but not recreational, cannabis. Currently proposed legislation aims to 1) prohibit adult-use cannabis that is attractive to children and 2) reduce the amount of cannabis within a single package. Poison Control Centers (OPCC) data may inform legislative decision-making. Our goal is to determine any association between cannabis legalization in Ohio and calls to OPCC.

Methods: Retrospective cross-sectional analysis of the OPCC database including all cannabis exposures between 1/1/2018-12/31/2024. There were no exclusion criteria. Exposures were described using summary statistics. Temporal trends were assessed using linear regression. The effect of legalization in November 2023 was examined using interrupted time series analysis (ITSA)

Results: Cannabis exposures increased 4.5-fold from 313 in 2018 to 1,417 in 2024 (p < 0.001). 69.9% (3,749/5,365) exposures occurred in children ≤ 19 years old. Children < 6 years old represented 35.5% (1,904/5,365). Exposures in children < 6 years old increased 13-fold from 47 in 2018 to 612 in 2024 (p < 0.001). 51.5% of total exposures (2,478/4,811) were unintentional, but 99.2% (1,809/1,824) in children < 6 years old. 91.5% (4,579/5,002) occurred in a private residence. 89.1% (4,637/5,203) of exposures were ingestions. Ingestions were more common among children < 6 years old than adults > 19 years old (95.0% [1,747/1,838] versus 88.5 [1,387/1,567], p < 0.001). The most common symptoms were central nervous system (CNS) depression (57.3% [2,640/4,606]), vomiting (17.5% [807/4,606]), and agitation (15.5% [714/4,606]). CNS depression was more common among children < 6 years old than adults > 19 years old (86.5% [1,263/1,460] versus 33.8% [500/1,480], p < 0.001). 44.6% (1,656/3,716) required medical hospitalization. Hospitalization was more common among children < 6 years old than adults > 19 years old (61.2% [762/1,246] versus 36.0% [370/1,027], p < 0.001). In ITSA, recreational cannabis legalization was associated with an increase of 36.5 [95% CI 18.9, 52.2] exposures per month, with 18.7 [95% CI 8.2, 29.2] in children < 6 years old.

Conclusion: Cannabis legalization was associated with increased exposures, most markedly in children < 6 years. These data highlight the risk to Ohio’s children related to access and ingestion of cannabis and suggest urgency in addressing safe packaging and storage.