Changes in Cannabis-Related Pediatric Emergency Visits following Recreational Marijuana Legalization in a New York City Hospital: A Retrospective Study

Background Legalization of recreational cannabis may increase access among adolescents and decrease perception of harm from the drug. Some states report increased use while others report no significant difference after legalization. We examined the relationship of legalization of recreational cannabis to cannabis exposure among children in our hospital. Methods Retrospective chart review of pediatric emergency department visits at a New York City hospital from April 2019to March 2023 (2 years before and after legalization) was carried out. Children and adolescents 0-18 years with tetrahydrocannabinol (THC) positive urine were included in the study. Descriptive statistics was used to summarize the demographic characteristics of the patients. Chi-square test and Mann-Whitney U test were used to determine difference between pre and post legalization groups. Results A total of 332 children had THC-positive urine. Sixty percent (60%) were females. Majority were African American (54%) or Hispanic (39%), reflecting the population catered by the hospital. Multiple patients had comorbid psychiatric (48%) and developmental (24%) conditions. Twenty-six percent (26%) also used other substances, with alcohol (19%) being the most common. THC positivity rate of urine drug screen increased from 26% (145 out of 553 tests done) to 32% (187 out of 590 tests done) (p=0.042) before and after legalization of recreational cannabis. Median age decreased from 16 to 15 years old (p<0.001). Cannabis-related diagnosis markedly increased from 14% to 36% (p<0.001). Intoxication with cannabis edibles also increased from 5% to 21% (p<0.001). Although most cases were mild and were discharged (74%), children 5 years old and below, were 10 times more likely to be admitted (p<0.001). Conclusion There is an increase in cannabis exposure and cannabis edibles intoxication among the pediatric population after legalization of recreational marijuana. Moreover, there was a decrease in median age of children exposed to cannabis and a rise in adverse outcomes in younger children. These findings suggest that policy changes surrounding adult cannabis use can affect access and use among children and adolescents.