Unintentional pediatric poisonings before and during the COVID-19 pandemic: A population-based study

Acute cannabis intoxication among the paediatric population

This narrative review synthesizes the toxicological, clinical and medico-legal aspects of paediatric cannabis intoxication. By providing a comprehensive overview, it aims to inform future research, guide policymaking, and enhance clinical and toxicological practice in addressing this growing public health concern. The pharmacokinetics of cannabinoid ingestion in children are significantly influenced by the immaturity of their gastrointestinal tract and metabolic enzyme systems, resulting in altered oral bioavailability. Clinical data indicate that Δ9-tetrahydrocannabinol (THC)-related effects in paediatricpaediatric patients typically emerge within 2 hours of ingestion, with more severe symptoms developing within 4 hours. The endocannabinoid system (ECS) undergoes significant developmental changes, with marked differences in cannabinoid receptor expression and distribution across fetal, neonatal, and adult brains. During neurodevelopment, CB1 receptors exhibit unique expression patterns, including transient localization in brainstem regions critical for neurovegetative functions. These developmental dynamics likely explain children's heightened sensitivity to THC's neurological and neurovegetative effects, often resulting in more severe outcomes compared to adults. The reliable detection of cannabinoids involves integrating screening methods with confirmatory analytical techniques. Urine immunoassay testing is widely considered an helpful toolto assess a previous exposure, becoming positive within 3-4 h of ingestion. However, this method is prone to false positives. Plasma THC concentration, when measured close to the event, offers valuable insights into the quantity ingested and the correlation between exposure and clinical outcomes in the impairment window. Hair analysis, while useful for distinguishing between acute and chronic use, is susceptible to various biases. The rising incidence of acute cannabis intoxication in children underscores the urgent need for targeted public health interventions and stricter regulatory frameworks. Preventive measures such as child-resistant packaging, public education campaigns, and cannabis use screening during pregnancy are essential to mitigate risks. Clinicians should consider THC exposure in the differential diagnosis of children presenting with unexplained neurological, immune, or metabolic symptoms.

The trend of poisonings before and after the COVID-19 pandemic

The COVID-19 pandemic has substantially affected people and healthcare systems. One of the main challenges was the reduction and change in the pattern of non-COVID-19 diseases and conditions. Moreover, due to the mental burden of the pandemic, the trend of poisonings and abuses changed. In this study, we aimed to assess the trends of poisonings from different agents before and during the COVID-19 pandemic using the interrupted time series method. This study was conducted at one of the main Tehran referral centers for poisoning, Baharloo Hospital. Pre-COVID-19 period was defined as April 2018 to January 2020 while the COVID-19 time was from February 2020 to March 2022. The total number of monthly poisoning cases in addition to eight categories of drugs/substances/agents were identified, including drugs (such as psychiatric drugs, cardiovascular drugs, and analgesics), opioids, stimulants, methanol, ethanol, cannabis, pesticides, and carbon monoxide. Interrupted time series analysis was performed to compare the pre-pandemic trend of total monthly cases from each category in addition to the proportion (%) of each one. In total, 13,020 cases were poisoned during the study period, among which 6088 belonged to the pre-pandemic period and 6932 were admitted during the COVID-19 era. There was no significant difference in terms of demographic characteristics of patients before and during the pandemic (p-value > 0.05). At the beginning of the pandemic, there was a sudden fall in the number of poisoning patients (- 77.2 cases/month, p-value = 0.003), however, there was a significant increasing trend during the COVID time (3.9 cases/month, p-value = 0.006). Most of the categories had a sharp decrease at the beginning of the pandemic except for methanol and ethanol which had increases, although not significant. Cannabis also had a significant change in slope (- 0.6 cases/month, p-value = 0.016), in addition to the sudden decrease at the beginning of the pandemic (- 10 cases/month, p-value = 0.007). Regarding the proportion of each category from total monthly poisoning cases, methanol, and ethanol had immediate rises of 4.2% per month and 10.1% per month, respectively (both significant). The pandemic had significant effects on the pattern of poisonings from different agents in Iran, the most important of which were alcohol (ethanol and methanol). These differences had policy implications that can be helpful for policymakers and healthcare systems in combating similar situations in the future.