Pediatric cannabis intoxication in France and Belgium: A 3-year retrospective study - 26/05/23

Doi : 10.1016/j.toxac.2023.05.003

Nadia Arbouche ^a,^{^{1
These authors contributed equally to this written work.}}, Laurie Gheddar ^a,^{^{1
These authors contributed equally to this written work.},}⁎ , Joris Guyon ^b,^{^{1
These authors contributed equally to this written work.}}, Alice Matheux ^c,^{^{1
These authors contributed equally to this written work.}}, Jenny Becam ^d, Lidvine Boland ^e, Clément Bruno ^f, Juliette Descoeur ^g, Nele van Den Eede ^h, Jeremy Lelong ⁱ, Marie Bellouard ^j, Touria Mernissi ^k, Romain Pelletier ^l, Pauline Thiebot ^m,ⁿ, Théo Willeman ^o, Alice Ameline ^a, Nicolas Fabresse ^d
^a Laboratory of Toxicology, Institute of Legal Medicine, 67000 Strasbourg, France
^b Service de pharmacologie médicale, CHU de Bordeaux, 33000 Bordeaux, France
^c Toxicology Department, Dijon University Hospital, 21000 Dijon, France
^d Laboratoire de biologie médicale, service de pharmacocinetique et de toxicologie, CHU de Timone, 13385 Marseille, France
^e Department of Clinical Chemistry, cliniques universitaires Saint-Luc, Brussels, Belgium
^f CHRU de Tours, service de pharmacologie médicale, 37000 Tours, France
^g Équipe médicale “toxicologie et suivi thérapeutique pharmacologique”, CHU de Lapeyronie, 34295 Montpellier, France
^h Universitair Ziekenhuis Leuven, UZ Leuven, Department of Laboratory medicine, Leuven, Belgium
ⁱ Service de toxicologie et pharmacocinétique, CHU de Poitiers, 86000 Poitiers, France
^j Laboratory of Pharmacology-Toxicology, Raymond-Poincaré Hospital, 92380 Garches, France
^k MP3CV Laboratory, EA7517, Jules-Verne University of Picardie, 80000 Amiens, France
^l Centre hospitalier universitaire de Rennes, laboratoire de toxicologie biologique et medico-légale, CHU de Pontchaillou, 35000 Rennes, France
^m Laboratoire de toxicologie biologique, fédération dE Toxicologie, hôpital Lariboisière, AP–HP, 10, rue Ambroise-Paré, 75010 Paris, France
ⁿ Inserm UMRS-1144, université Paris Cité, 4, avenue de l’Observatoire, 75006 Paris, France
^o Laboratoire de pharmacologie, pharmacogénétique et toxicologie, CHU de Grenoble Alpes, 38000 Grenoble, France

^⁎Corresponding author.

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Summary

Cannabis is the most widely used drug in the world with a prevalence of 2.5%. France and Belgium are no exception. Moreover, pediatric cannabis intoxications are increasing due to the growing use of cannabis in the adult population. In this study, we seek to investigate whether there is a correlation between symptoms and biological data in order to facilitate the diagnosis of pediatric cannabis intoxication. Data were retrospectively collected from 11 French laboratories and 2 Belgian laboratories over 3-year period (2019–2021). This study involved 123 children aged 2 months to 4 years. There was a geographical gradient with an increase in intoxication cases from northern to southern regions. THC, 11-OH-THC and THC-COOH levels were respectively 24.4ng/mL (range=0.4–109ng/mL; median=17.3ng/mL), 26.3ng/mL (range=0.6–263ng/mL; median=18ng/mL) and 217ng/mL (range=0.6–921ng/mL; median=163ng/mL). The most frequently observed symptom was drowsiness in 60.2% of cases. Coma (13.8%, n = 17), convulsions (4.1%, n=5) and bradypnea (8.1%, n=10) were the most severe symptoms. The increase of THC content in cannabis products could explain the increase in poisoning severity. However, according to the data collected, it does not seem that the clinical symptoms observed are correlated with plasma or blood THC concentrations. Indeed, cases of coma with Glasgow Coma Scale at 3 have been observed with plasma THC concentrations between 7 and 29ng/mL.