Cannabis product exposures reported to Ramathibodi Poison Center, Thailand, during 2018–2022

Abstract

Introduction: Cannabis was a category 5 narcotic in Thailand before legalization for medical use in February 2019. In June 2022, it was removed from the narcotics list. Objectives: To characterize cannabis cases reported to a poison center in Thailand and to analyze the impact of medical and recreational legalization. Methods: This retrospective cohort study analyzed data from January 2018 to December 2022. The time periods were classified into four timeframes according to regulations: (1) Illegal cannabis law (before February 19, 2019); (2) Medical cannabis law (February 19, 2019–December 14, 2020); (3) Decriminalized cannabis law (December 15, 2020–June 8, 2022); and (4) Recreational cannabis law (since June 9, 2022). Results: There were 1,695 cases with median [IQR] age of 38 years [24–53 years], and 67.2% were males. The proportion of children and adolescents (<20 years old) was higher during the recreational cannabis law period than the illegal cannabis law period (26.1% versus 14.1%, P = 0.013). Common products were cannabis oil (701, 41.4%), smoking products (452, 26.7%), and sweets (211, 12.5%). Common circumstances for cannabis use included: health benefit belief (504, 29.7%), recreational use (502, 29.6%), and curiosity (382, 22.5%). The medical, decriminalized, and recreational cannabis law periods exhibited higher hospitalization rates (82.0%, 91.5% and 96.8%, respectively) than the illegal cannabis law period (68.7%; P = 0.003, P < 0.001, and P < 0.001, respectively). Discussion: Increased availability and accessibility of cannabis products, in combination with lack of knowledge and awareness of its effects may lead to cannabis toxicity and hospitalization. Limitations include the retrospective nature of the study and laboratory confirmation of only one fifth of cases. Conclusions: More children and adolescents were exposed to cannabis during the recreational cannabis law period. In addition, the hospitalization rate increased after cannabis legalization for medical and recreational use.