Delta-9 THC detection in the young pediatric postmortem population: 2018-2024

In recent years, cannabis exposure to the young, pediatric population has increased as demonstrated in calls to poison control centers and emergency room visits.

The objective of this study was to assess the frequency of delta-9 tetrahydrocannabinol (THC) and metabolites in the pediatric (<10 years old), postmortem population.

Data from a large reference laboratory was collected from 2018 to 2024 to assess positivity rates.

From 2018 to 2024, 17,512 postmortem blood cases from medical examiner and coroner's offices throughout the United States were screened for cannabinoids via enzyme-linked immunosorbent assay (ELISA) or directly tested for THC and/or metabolites via liquid chromatography/tandem mass spectrometry (LC-MS/MS). In total, 518 (2.9 %) cases underwent LC-MS/MS testing based on the screening results and/or direct testing orders, and results were evaluated based both on the limit of detection (LOD) and the limit of quantitation (LOQ) of the assay.

Frequency rates for THC and/or metabolites ranged from 1.6 % to 2.8 % (p = 0.0075) and 0.43 % to 1.1 % (p = 0.0057) based on the LOD and LOQ, respectively. Based on the LOD, 342 (86 %) of cases were in children two years or younger, 284 (71 %) less than one year, 259 (65 %) six months or younger, and 125 cases (31 %) less than 1 month old or victims of intrauterine demise. Also, cannabis was the only drug indicated in most cases (N = 194, 49 %) with caffeine (N = 105, 26 %) being to most common co-finding.

Overall, this research shows an increase in young children being exposed to cannabis.