Legalized marijuana is a relatively new phenomenon, and little guidance exists for physicians who prescribe medical marijuana to parents of minor chilDr.en or for physicians who treat chilDr.en whose parents use marijuana. Colorado legalized recreational marijuana in 2012, and experts like Gregory Tung, PhD, an assistant professor at the Colorado School of Health and a member of the Pediatric Injury Prevention, Education and Research (PIPER) program, are developing health impact assessments to help the state’s lawmakers and the Colorado Department of Human Services develop science-based policies for considering the relationship between marijuana use and child welfare.

 “In most states, clinicians are legally mandated to report child abuse. Because the laws [on what must be reported] vary from state to state, clinicians need to be aware of the reporting laws where they practice,” Dr. Tung said.

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The decision whether to report or not may be more difficult when the parent is using marijuana legally. Dr. Tung’s group is evaluating whether child welfare policies should treat parents who use marijuana recreationally differently than parents who use marijuana medically, as well as what hospitals should do if a screened newborn tests positive for tetrahydrocannabinol.

“You can talk about all these different risk factors, like marijuana use, but the ultimate determinant of whether there is child abuse taking place—and it sounds obvious—is whether the child is being abused. There is no substitute for a very thorough assessment,” said Dr. Tung.

Parents who use medical marijuana should be advised to “take the same measures as parents who take any medication that might impact their ability to react,” Dr. Remain said. “Parents on any medication, whether it is cannabis or Xanax, should know how it affects them before tending to their chilDr.en,” she added.

Keeping marijuana away from chilDr.en is another important concern. Dr. Freisthler noted that her study only looked at neglect and abuse associated with parental marijuana use and not at “actual harm to chilDr.en, such as poisonings or other unintentional injuries.” Since Colorado legalized marijuana, the number of cases of accidental marijuana ingestion among chilDr.en has increased Dr.amatically. PIPER, in collaboration with the ChilDr.en’s Health Advocacy Institute at ChilDr.en’s Hospital Colorado, developed a health impact assessment in 2013 that set forth recommendations for packaging marijuana safely to reduce child ingestions. The literature also includes a handful of cases of cannabis toxicity in young chilDr.en passively exposed to marijuana smoke.7

Both Dr. Freisthler and Dr. Tung said more research is needed to determine the effects of parents’ marijuana use on their chilDr.en. “In general, very few have studied how marijuana use is related to abusive and neglectful parenting,” said Dr. Freisthler. “Our study is just a first attempt at starting to examine this…and has several limitations.” She said follow-up studies are needed to determine whether a parent’s marijuana use places a child at risk for abuse, neglect, or inadequate supervision that leads to harm.

References

1. Office of National Dr.ug Control Policy. Marijuana resource center: state laws related to marijuana. https://www.whitehouse.gov/ondcp/state-laws-related-to-marijuana. Accessed November 18, 2015.

2. Jones JJ. In US, 58% back legal marijuana use. http://www.gallup.com/poll/186260/back-legal-marijuana.aspx. Published October 21, 2015. Accessed November 18, 2015.

3. Pew Research Center. In debate over legalizing marijuana, disagreement over Dr.ug’s dangers. http://www.people-press.org/2015/04/14/in-debate-over-legalizing-marijuana-disagreement-over-Dr.ugs-dangers. Published April 14, 2015. Accessed November 18, 2015.  

4. Freisthler B, Gruenewald PJ, Wolf JP. Examining the relationship between marijuana use, medical marijuana dispensaries, and abusive and neglectful parenting. Child Abuse Negl. 2015;48:170-178.

5. Secret M. No cause for marijuana case, but enough for child neglect. New York Times. http://www.nytimes.com/2011/08/18/nyregion/parents-minor-marijuana-arrests-lead-to-child-neglect-cases.html?_r=0. Published August 17, 2011. Accessed November 19, 2015.

6. Wyatt K. Changing pot laws prompt child-endangerment review. Associated Press. http://www.denverpost.com/marijuana/ci_25967484/changing-pot-laws-prompt-child-endangerment-review. Published June 16, 2014. Accessed November 15, 2015.

7. Appelboam A, Oades PJ. Coma due to cannabis toxicity in an infant. Eur J Emerg Med. 2006;13(3):177-179.