Ms. Johnson-Norris on Huff Post Live
Ricky: You're watching HuffPost Live. I'm Ricky Camilleri and as you've probably seen, we've talked a lot about marijuana legalization's effect on driving and on the economy. We've discussed it in pill and plant form, but what about the kids, guys?
A new study in Colorado shows that there's been a surge in medical marijuana use following a 2009 federal policy change and since then, 14 children have been treated for accidental consumption of the drug. In 2008, though, the hospital had received no such cases.
Here to discuss this, Dr. Ken Heard, one of the authors of the study and an Associate Professor of Emergency Medicine at the University of Colorado School of Medicine; Dr. Paul Chabot, a former drug czar and advisor to Presidents Bush and Clinton; Dr. Alan Shackelford, a Harvard-trained physician and researcher with experience in the use of cannabis as a medical treatment; Leah Maurer of Marijuana Legalization Advocate and mother; and Ms. Johnson-Norris, an attorney for medical marijuana users.
Welcome, Dr. Heard. I want to start with you. Tell us about your findings.
Dr. Heard: Well, good morning and thank you for having us on. Essentially, our study was that we looked at about two years' worth of data, well, over two years' worth of data that occurred after the US government stopped rigorously enforcing the marijuana regulations and what we found was that we were seeing small children who got into marijuana products and were coming into the hospital and then, actually, were pretty sick.
And we sort of noticed this initially in the late process and as we went back and looked at it in a more systematic way, we found that prior to the deregulation, we really had not seen any cases of this in the several years leading up to that. And so, our conclusion was that when the regulation was decreased, the number of cases where we saw kids getting into these products and getting sick increased.
Ricky: You said that they were pretty sick. Can you detail in what ways that they were pretty sick?
Dr. Heard: Well, several of them had-- They were all sleepy. There were a couple that just got into it and the parents brought them into, you know, were checked out, but the majority of them had symptoms such as sleepiness. A few of them had some effects—lowered respirations, difficulty walking. A couple of them actually required admission to the intensive care unit.
Ricky: I mean, because the other three to me, aside with the respiratory problems, you know, the other ones just seem like they were high. So, what are the intensive care unit problems that happened?
Dr. Heard: Well, again, we had one child who had decreased respirations. Probably, the more important thing is not so much the symptoms that they have, but in the vast majority of these cases, it wasn't clear to the treating physicians what was going on, so many of these children had extensive testing, including lumbar puncture, MRI, those kinds of things, to try to figure out exactly what was going on and why these kids were so, you know, not just sleepy, I mean, these kids weren't just a little out of it. These were kids that were significantly seen as the price.
Ricky: So are those kind of the differences between adult and child consumption?
Dr. Heard: Well, yeah, I think so. What you're seeing is a product that's developed for adults so it's got a lot more active ingredient in it and, in many cases, these products are developed for patients who are using them regularly so they have a relatively high tolerance.
In general, children are going to be much smaller, so they're getting a much bigger dose per unit of body weight and they're not tolerant to it. They haven't been exposed to it and using it and built up some tolerance.
Ricky: So drawing this out on a larger scale because right now, we're talking about medical marijuana and we're also seeing marijuana, in general, being legalized in Colorado. Can we see even more repercussions there?
Dr. Heard: Well, I think, you know, our study was really focused on these pediatric exposures and I think that a general rule in poisonings is if you have more of the product available, you're going to see more children exposed to it, I mean, that's just sort of the nature of kids. They get into whatever is around and with the increased availability, there's going to be more exposures.
And then, on top of it, the other big change that's happened in Colorado is when I was in high school and you wanted to get some marijuana, it's going to be in plant form. You're going to smoke it and it really didn't taste good. The products that are being developed now, they have very high potency, they're packaged in very appealing ways to children and in many cases, they're actually, my understanding is that they actually taste really good and so kids are likely to eat all of what they find.
Ricky: We're going to roll this later but let's actually roll the slideshow right now of these tasty marijuana products that Dr. Heard is talking about. You can see some starfish there, some Hashey's instead of Hershey's, medicinal marijuana chocolate bars; another chocolate bar called Mary Jane. These actually do look pretty tasty. I think you're kind of right, Dr. Heard. I don't even smoke marijuana but I would eat those.
So, opening this up a little bit more, how much more do you see, you know, what are the differences of people with children coming in with alcohol poisoning, children who have come in and accidentally drink alcohol or accidentally taken pills, prescription pills of some kind? What are the differences there? It seems, in my opinion, in my guesstimation, I'm not a doctor, but those things seem more lethal and dangerous than someone who is a little woozy, tired, maybe with slight respiratory problems because of eating a pop, a Mary Jane chocolate candy bar with pot in it.
Dr. Heard: Sure, well, I can speak specifically to alcohol. We actually looked at that as well because we do hear that point brought up and, actually, over the same time period where we had the 14 marijuana exposures that, again, resulted in children being seen in the hospital and several admissions, there are actually two kids over that same period seen for alcohol poisoning and one of them was an 11-year-old who raided the parents' liquor cabinet and so, a little bit different situation. The other was a small child who the parents observed getting into an alcohol product, brought in the child for observation. The child actually never developed symptoms.
Now, in terms of other medications, you're really talking about a huge spectrum. Certainly, a child getting into some of the very strong prescription opioid pain killers is going to be at much greater risk and the vast majority of pediatric deaths we've seen in this country occur from children getting access to these medications.
On the other hand, the vast majority of medications do not result in children, you know, the children come in to the Emergency Department, the chance of them being admitted to the hospital for this is very low. The majority of products that are out there are safe. They're well-tolerated and, in fact what we found...
Ricky: But there are, also, outside of prescription pills, there are cleaning products that a toddler could get into and drink. There are a number of products across a standard household that could be potentially lethal for a child.
Dr. Heard: Again, the vast majority of products are packaged in a specific way to prevent children from getting into them. They're not palatable and when you look at the actual data on calls to poison centers, very few children develop symptoms and very few children get admitted to the hospital for exposure to these other products.
Ricky: Let's look at a tweet right now from NewOaxacan, "Duh, wider MJ use leads to more accidental consumption in kids, but it take note, no one has died unlike #alcohol."
Paul, do you think it's absurd to make the comparison between marijuana being accidentally consumed in a house by a child than alcohol being accidentally consumed in the house?
Dr. Paul Chabot: You know I'm floored. I hear the marijuana people consistently saying, hey, how about bleach, how about cocaine, how about heroin? How about, "Hey, two wrongs don't make a right."
You heard the doctor out there in Denver talk clearly about the statistics. Let's just be honest about it. We have a problem in this country with youth drug use and I encourage your viewers to look at the Samhsa.gov study there. Look, if you'll look from 2004 to 2010, we got a 64% increase in emergency room visits from marijuana.
Now, the number one drug that we're seeing emergency admissions for is heroin. Number two is marijuana, and below that, you got the prescription drugs MDMA, GHP, methamphetamine. So, clearly, we have a problem in this country with 461,000 people admitted in 2010 to an ER. That's number two of all the illicit drugs and marijuana is number one amongst the youth.
Ricky: So you're saying that people get admitted to the hospital all the time because of marijuana?
Dr. Paul Chabot: I'm just telling you what the statistics say from the Drug Abuse Warning Network, almost a half million people in 2010 from marijuana.
Ricky: Okay, so the idea is that, I mean, but no one has ever died from marijuana like they have from alcohol. That's that point that everyone proves is that people don't die from marijuana.
Dr. Paul Chabot: And I think that's a really stupid point, I mean, does somebody have to die for it to be a concern? How about somebody just getting sick? How about somebody behind the wheel driving? How about being a danger to themself or others? Why is it that we say nobody has died from ingesting marijuana?
Why can't we just look at the negative health implications that we already know are associated with marijuana use and say that's a problem? Why do we always go to the extreme and talk about death, every single time trying to legitimize marijuana use? I'm sick of that.
Ricky: Leah, I want you to respond to this.
Leah: Yeah, okay, so I'm a mother of three. My oldest child is actually about to turn eight, so they are all young and I am of the opinion that, you know, first of all, if you're a responsible parent, anything that can harm your children, you have to lock up, whether it's bleach, prescription drugs, alcohol, marijuana, any of those things.
And I'm also of the opinion that, say, a strawberry death isn't any more or less appealing than some sort of chocolate cannabis edible. And that all being said, I think, that what we need to do is focus on, we need to make responsible regulations here, I mean, marijuana cookies or whatever should not be packaged in what is considered appealing to children. They should be clearly labeled and parents should be educated about this. And the only way to give us a chance to do this is to completely legalize it and bring it above ground and allow state officials to take this issue head on.
Ricky: I want to read a comment right now from one of our commenters, Nicon. He says, "None of these items are sold in stores children can enter. They can't even go in them."
So they may be marketed in/or packaged in sort of a child-like way, which I think is more for the purposes of irony for the user. But, you can't actually go into a Duane Reade or a drug store and purchase a marijuana chocolate bar off of the shelf.
Paul, is that something that you fear is down the road?
Dr. Paul Chabot: That's already happening. I work with kids across the schools here in California and I challenge anybody to talk to high school kids today. You know, first off, we got thousands of pot stores on our streets so people are going in there buying the marijuana, reselling it in the community. You got high school kids walking around with pot ID cards. They know all about these lollipops, these candy bars.
Look, for us, this has been a problem for a very long time, so we're not surprised to see the negative implications coming out of the Denver study. We've known about this for over a decade now with the national statistics that are being put out amongst the emergency room admissions.
Look, let me just tell you, in 2010, out of every 100,000 people, 144 young people were in the ER for either mental or physical problems resulting from marijuana use. Alcohol only sent 140 out of 100,000; prescription pain relievers, 36 young people per 100,000.
So we clearly have a problem with marijuana and we need to be honest about that and address the problem and not talk about Drano and all these other nonsense. We got to address the issue of our kids. It's a big problem.
Ricky: Lauren, do you think it's an issue that we have to address in sort of an extreme measure that I think Paul is reaching for or do you think there is responsible regulations that we can have that go along with these legalization measures?
Ms. Johnson-Norris: Well I think your previous guest really conflatea the idea that there are legal drugs and illegal drugs. And talking about medical marijuana, we are talking about medicine that where I practice law, in the State of California, it's permissible for adults to get a recommendation to use medical marijuana.
So, when we talk about accidental ingestion, I think it's wise to look and make policy around how should we treat illegal drugs versus how should we treat legal drugs that's different than alcohol, which is not used for medication. So conflating all of these together kind of confuses the topic and conjures medical marijuana in a way that makes it just as bad as every illegal drug out there.
Medical marijuana is used as medicine not only in California but in other states and, of course, parents have an obligation to make sure that their medical marijuana is outside of the reach of children, is contained in a way that children can't access it. I mean, we all care to make sure that children are safe, are not accidentally ingesting it, but there are measures parents should be taking and there are warnings that can be given. We should work toward a policy about it in increasing the need for warnings and better packaging, things like that.
Ricky: Dr. Shackelford, is this being blown out of proportion? Is there other information that we should be responding to?
Dr. Shackelford: I think there is other information that's important and since we're talking about statistics, I'd like to quote a study from the annals of emergency medicine from September of 2008 and in this particular study, they show that between January of 2003 and June of 2006, 9,179 children under the age of six were involved in an incident in which the child ingested a prescription opioid.
Now, eight of those children died, 43 suffered life-threatening injuries or serious disabilities, and 214 required prolonged medical attention. Dr. Richard Dart, who's now the Head of Rocky Mountain Poison Center, said that that study probably underestimated the extent of the problem and he felt that conservatively, the number was at least twice as high as and probably higher than that.
Additionally, the CDC recorded that nearly 40,000 people died in the United States in 2009 from unintentional opioid overdoses. More people die from drug interactions and unintentional overdoses in this country than from traffic accidents, so I think if we're looking at the full picture here, what really has to come to the fore is, first, equating medical treatments that are potentially life-threatening if abused or misused with those medical treatments and marijuana, I think, is one of those treatment options.
Ricky: Dr. Shackelford, not to interrupt you-- I am going to, sorry, I have a question.
Dr. Shackelford: That's alright.
Ricky: Before I forget, do you think that the legalization or the medicinal use of marijuana could potentially cut down on the prevalence of opiate prescriptions, I mean, they work the same way in terms of pain relief?
Dr. Shackelford: There is evidence that marijuana use decreases the need for opiate medications to control pain and it's quite successful in doing so in some instances as a primary treatment and in other instances, as an adjunct. So I think if it became more widespread and more people were actually using cannabis as a pain treatment option, we would see a decrease in opioid use, but it's really a drop in the bucket at this point.
The United States consumes 98% plus of the world's production of Hydrocodone, which is the primary active component in Vicodin and that's a stunning statistic. We clearly have a problem with drug abuse, in general, in this country, which absolutely must be addressed.
And I think that the study which Dr. Heard co-authored here is an important one in that it points out a couple of things. First, that parental responsibility is really, really important in preventing accidental exposure to potentially life-threatening pharmaceuticals or any other treatment like marijuana.
Additionally, it points out that tamper-proof or child-proof packaging really must be mandated and we tried to do that in the medical marijuana advisory work we have here in Colorado of which I was and still am a part. It is difficult, of course, to mandate precisely how one with package an attractive treat-like treatment such as a piece of candy or a brownie, but I would suggest this also implies that we need much more medical treatment options that is things that are not necessarily packaged or presented as a candy or a cookie or some other food stuff, but, rather, an actual medical-type treatment or delivery system.
Ricky: Paul, when we're talking about accidental consumption, I mean, how do you know when it's endangerment or accidental? How do you measure these things? Who's responsible?
Dr. Paul Chabot: Well, first off, we can't only talk about responsible parents today, I mean, we know the problem with our kids obviously is how they're raised and that many of them are raised in households who got a single parent or a parent who's not home that often, so if we're going to put the onus on parents.
Look, I'm a dad. I got four kids. I talk to parents quite often and many of them don't understand the drug issues today. And look, if you talk to kids about their bad grades or a teacher goes to talk to their parents and your kid's in trouble, how many times are we hearing about parents in denial about their kids with academic issues? They're already in denial with many of the illicit drug issues until it comes to an ER situation.
So, to talk about parent responsibility as a silver bullet, hey, in a perfect world, that will be wonderful. But, unfortunately, we don't live in that world today. May parents are quite irresponsible, especially those that are using marijuana.
Ricky: Dr. Heard, when we get to an ER situation, what does law enforcement look for to decide whether it was endangerment or accidental?
Dr. Heard: It really depends on the circumstances, I mean, for example, in a setting where you're talking about an illegal drug, for example, a child comes in, he has some symptoms and we detect methamphetamine in their system, that's a situation where, obviously, law enforcement is going to be contacted.
On the other hand, if we have a situation where a parent brings in a child and says, "I had some of my pain medication out. I think the child may have gotten into it." The child maybe have some symptoms. That would be a situation where I think it would be unusual to contact authorities. The onus on them, on the position and on the care team is if there's a suspicion that there is child endangerment, that needs to be reported and then, it's investigated by the appropriate child welfare agency.
Ricky: Lauren, I heard you sort of chuckling a little bit at what Paul had said. I'm wondering what you were responding to there.
Ms. Johnson-Norris: Well I think, you know, blaming our culture or single parents is really kind of beside the point here. Paul is also talking about older kids abusing drugs. This conversation is really about accidental ingestion. And so, when we talk about accidental ingestion, usually, we're talking about younger kids. We're talking about toddlers or kids who are able to take any edibles and eat them because they're attractive, right? That's what I think this conversation is about and how we can make sure that kids aren't getting into those substances.
But I can really speak to some of the child welfare issues because I represent parents in these cases and the courts in California have already looked at cases in which children have or are at risk of accidentally ingesting or abusing illegal drugs, so it's a little different when we talk about illegal versus legal, but a court might look at what is the home environment like. That's true, but, also, what kind of access does the child have to whatever medication or illegal drug is lying around, how old is this child?
And so, I just think that if you want to look at it from a legal perspective, whether or not child welfare is going to get involved, sure, they're going to look at the social aspect and we're also going to look, factually, at the facts of the case.
Ricky: Lauren, we have to wrap up, but I just want to, before we end, I just want to ask real fast, is it safe to say that the accidental ingestion of marijuana is generally far safer than the accidental ingestion of the majority of prescription medications that could be in a cabinet?
Ricky: Leah says yes. Lauren?
Ms. Johnson-Norris: You know, I don't know. I'm not a doctor. I don't know.
Ricky: Oh, let's ask the doctors. Dr. Shackelford?
Dr. Shackelford: Well, from just a purely perspective of potential for death, clearly, marijuana is much, much safer than most of the prescription or many of the prescription drugs that a child could accidentally ingest.
Ricky: Dr. Heard?
Dr. Heard: Well, I think, when you're talking about medications in general, that's the spectrum from antibiotics, which, essentially, you can't take enough to make yourself at all, all the way to something like....
Ricky: I mean, I think medicinal marijuana as for pain relief, so pain relief medications of some kind.
Dr. Heard: Well, and then, I think, if you're more precise with your question, then I think, certainly, marijuana is safer than ingestion of the opioids.
Ricky: And Paul, I'm pretty sure I know where you stand on this, so.
Dr. Paul Chabot: I'm just going to repeat the national statistics from Samhsa which is pain relievers, 36 out of every 100,000 and marijuana, 144 out of 100,000. So, clearly, it's 45 times that for prescription drugs that are entering the ER according to national statistics from ERs collected around the country.
Ricky: Thank you. No, I'm glad that you said that, Paul. Thank you so much. It seemed to me that maybe I was pushing a little too far there. Thanks for jumping in there.
Guys, thank you so much for having this conversation Dr. Shackelford, Dr. Heard, Lauren, Leah, and of course, our famous Paul Chabot who joins us all the time for these conversations. Thanks so much, guys. You've been a pleasure to talk to.
This is HuffPost Live. I am Ricky Camilleri.