P2.173: Pre and Post Legalization Trends of Pediatric Acute Cannabinoid Toxicity in Urban Emergency Departments in New York

Background: Unintentional cannabis exposures are on the rise among the pediatric population in the United States. In 2022, 22% of cannabis users in the United States were ages 12 and older. Cannabis was decriminalized in New York State in August 2019 and subsequently legalized on March 21, 2021. Our study aims to determine if there was a change in the percentage of children less than 13 years of age who presented to the emergency department (ED) for acute cannabis toxicity pre and post legalization of cannabis as evident by a positive urine drug screen for tetrahydrocannabinol.

Methods: We conducted a retrospective chart review of electronic medical records of children less than 13 years of age, presenting to all EDs in a large tertiary care hospital system in New York. The study period spanned 66 months (September 2017 to March 2023) and was divided into three time cohorts: September 1st, 2017, to August 31st, 2019 (pre-decriminalization), September 1st, 2019, to March 21st, 2021 (post decriminalization), March 22nd, 2021, to March 31st, 2023 (post legalization). Medical records of eligible patients were reviewed and parameters including age, sex, race/ethnicity, primary household zip codes, presenting complaints, emergency severity index level, initial vital signs, route of ingestion, dosage, ED length of stay, discharge diagnoses, and disposition were collected. Data on zip codes-based childhood opportunity index (COI), were collected from the COI 3.0 database.

Results: We identified a total number of 249,742 ED visits during the study period of which 35 presented with accidental cannabis ingestion. There was a statistically significant difference (p = .0006) in the proportion of children presenting with accidental cannabis ingestion between the three time periods with an increase post-legalization compared to pre-decriminalization; (4/97716 (0.004%) pre-decriminalization, 7/55069 (0.013%) post-decriminalization and 24/96957 (0.025%) post-legalization. The median age of patients was 8 years, 5 years, and 5 years in the pre-decriminalization, post- decriminalization, and post legalization cohorts, respectively with a p= 0.6. The overall cohort had a female predominance (54%) and ethnically identified as Spanish/Hispanic/Latino (51%). There was no difference in the COI quintile distribution in the study period (p= 0.1) with overall distribution of very low (71%), low (26%) and moderate (3%). There were no patients who resided in high and very high COI quintile neighborhoods.

Conclusion: There was a significant increase in the number of patients presenting to the ED post legalization of cannabis, the majority of whom lived in a neighborhood with very low COI. The COI may be a tool that aids risk stratification for children to help prevent accidental cannabis ingestions by implementing stricter regulations around the sale of cannabis.