Re: Presentation of pediatric cannabis ingestion in the emergency department

Issue: BCMJ, vol. 68, No. 2, March 2026, Pages 54-55 Letters
By: Hannah Zwiebel, MD, MPH Ran D. Goldman, MD, FRCPC David Greenky, MD

We read with interest the recently published article “Presentation of pediatric cannabis ingestion in the emergency department” by Sage and colleagues[1] and commend the authors for this important work. It highlights important information on the increasing prevalence of emergency department (ED) visits due to exploratory ingestions of and pediatric exposure to edible cannabis products in Canada. It also discusses the importance of prevention as a primary strategy for reducing the availability of these products to young children, including implementing strict package warnings, labeling standards, and promotional limitations, thereby reducing pediatric cannabis exposures.[1]

Tackling the packaging of edibles as a preventive strategy to reduce cannabis exposure in young children is an important aspect of this public issue in North America. Many labels used for cannabis products include bright, colorful figures and are highly attractive to young children exploring their environments. Moreover, much of the packaging is made to resemble popular non-cannabis-containing candy and snacks, further increasing children’s risk for consumption. Reducing the recognizability of packages using labeling standards and plain materials and design are critical tools that could reduce children’s exposure to cannabis ingestion.

Another important area for prevention of harm is regulating the amount of cannabis contained in one packaged edible. Sage and colleagues report that there is no exact dose–response relationship for cannabis, but oral bioavailability of tetrahydrocannabinol (THC) is higher in children than in adults.[1] This difference in the clinical pharmacological properties of THC among children has been reported with the increase in severe toxicity cases, resulting in more ED visits and pediatric ICU admissions following the legalization of marijuana.[2] Many edibles are packaged with multiple “doses” in each package, and children who accidentally ingest the edible are at risk of consuming the entire product, when the intent is for the product to be rationed into distinct “doses.” As an example, a single square of chocolate or a single gummy may contain one “dose,” but a package can contain an entire chocolate bar or several handfuls of gummies. Some packages of edibles contain up to 500 mg of THC, a highly toxic dose for children, since 100 mg of THC is considered a very high dose for an adult.[3]

We agree that pediatricians have an important role in counseling families about safe storage of edibles at home, but without increased public health attention and legislative drive, preventable ingestions will continue. Packaging that is not visually appealing to children and childproofing are two critical methods of reducing pediatric exposure to marijuana and visits to the ED for symptoms of toxicity.
—Hannah Zwiebel, MD, MPH
Atlanta, Georgia
—Ran D. Goldman, MD, FRCPC
Vancouver, BC
—David Greenky, MD
Atlanta, Georgia

This letter was submitted in response to “Presentation of pediatric cannabis ingestion in the emergency department.”

hidden

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

1.    Sage AP, Alahmadi M, Sabhaney V, et al. Presentation of pediatric cannabis ingestion in the emergency department. BCMJ 2025;67:318-323.

2.    Tweet MS, Nemanich A, Wahl M. Pediatric edible cannabis exposures and acute toxicity: 2017–2021. Pediatrics 2023;151:e2022057761. https://doi.org/10.1542/peds.2022-057761.

3.    Smart Approaches to Marijuana Minnesota. Edibles dosage. Accessed 21 December 2025. www.house.mn.gov/comm/docs/Xwf3qfOrtkSk7L4QdZVdUA.pdf.

Hannah Zwiebel, MD, MPH, Ran D. Goldman, MD, FRCPC, David Greenky, MD. Re: Presentation of pediatric cannabis ingestion in the emergency department. BCMJ, Vol. 68, No. 2, March, 2026, Page(s) 54-55 - Letters.


Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply