Why Does Cannabis Require Child-Resistant Packaging, but Alcohol Doesn't?

Btap49 Asked

Why should cannabis require child-resistant packaging when alcohol doesn't?

Answer

Alcohol and cannabis are both substances that can be hazardous when consumed by children. There have been various regulations put in place over the years to try and protect children as best we can, but it can be difficult to understand where these regulations came from. Let's take a deeper look into the history behind child-resistant packaging and then we'll discuss why child-resistant packaging is required for cannabis products, but not for alcoholic beverages. 

Where did child-resistant packaging regulations come from?

As a poison control specialist, I have seen firsthand the devastating effects of accidental ingestion of drugs and chemicals in children. The Poison Prevention Packaging Act (PPPA), established in 1970 by Richard Nixon, was a significant step forward in preventing such incidents, requiring child-resistant packaging for various chemicals, prescription, and over-the-counter medications.

The primary goal of this act was to ensure child safety by preventing accidental ingestion of drugs and chemicals. Up to this point, there were a large number of exposures to various medications and chemicals reported to Poison Control Centers and a majority of them were in children. The creation of the PPPA helped tremendously by forcing many classes of chemicals, prescription medications, and over-the-counter medications to utilize child-resistant packaging. Details of the PPPA can be found in the Code of Federal Regulations.

Why aren’t alcohol or cannabis products mentioned anywhere in the PPPA?

You will notice if you look through the list of substances requiring child-resistant packaging that alcohol and cannabis are nowhere to be found. At the time of its creation, the PPPA did not need to include cannabis products since they were not legally available, medically or recreationally. They were regarded, and still are, as Federally illicit Schedule I drugs. The PPPA specifically regulates food, drugs, and cosmetics as well as “hazardous” substances. It is likely that alcohol was never addressed as it was not considered to have fallen in any of those categories by lawmakers.

Keep in mind it was pediatric exposure to medications that were the specific driving force for the creation of these laws. While alcohol can be dangerous it is generally not as dangerous as the other medications and chemicals regulated under the PPPA. 

This is still the case today.  According to the Centers for Disease Control and Prevention (CDC), from 2010 to 2018, there were an average of 4,277 alcohol-related visits to emergency departments each year among children aged 0 to 14 years old in the United States. While any such incident is concerning, it is important to note that the majority of these cases involved mild to moderate symptoms, with only a small fraction requiring critical care. In contrast, a study published in the same journal found that between 2001 and 2008, there were over 500,000 reported cases of children under the age of six being exposed to medications, with over 70% of these exposures being unintentional.

Clearly, childhood exposure to chemicals and medications has far outpaced exposure to alcohol and the danger of alcohol exposure in children was not near that of medications, so that is why it was likely not considered by lawmakers when the PPPA was originally drafted.

How did these regulations come to include cannabis products?

As medical marijuana legalization started to spread across the U.S. so did the need for legislation on how to treat these products. In states where medical marijuana is legal, it is treated as just that, a medicine. Many states have their own governing bodies that manage cannabis regulations. New York, for instance, has the Office of Cannabis Management which is responsible for implementing quality assurance regulations as well as governing the manufacturing, packaging, labeling, advertising, and testing of cannabis products. Since medical marijuana is treated as a drug, the laws governing its packaging generally point back to the PPPA and thus medical cannabis products must utilize the packaging outlined in the act.

While there is limited data on the subject due to the federal prohibition of marijuana, studies have shown that the number of accidental exposures to cannabis products in children has been on the rise since medical marijuana legalization began in various states. According to a study published in the Journal of Pediatrics, the number of children under the age of six exposed to marijuana in Colorado increased by 150% between 2014 and 2019. Similarly, a study published in JAMA Pediatrics found that the number of children under the age of six exposed to marijuana in Washington state increased by 1.5 times between 2013 and 2017.

The reason for this increase in accidental exposures is simple: as more states legalize medical and recreational marijuana, the products become more readily available and easier for children to get their hands on. Childhood exposures to cannabis can occur in a number of ways, but most commonly occur by ingesting edibles or other infused products that resemble candy or other sweets. Ingestion of cannabis edibles is concerning because the effects can take hours to manifest and can be more intense than if the drug were inhaled. This can lead to severe symptoms such as confusion, seizures, and even coma.

One may argue that the responsibility lies with parents to keep cannabis products out of reach of children, and while this is certainly true, it is not always enough. Children are curious by nature and can be surprisingly resourceful when it comes to getting into things they shouldn't. Moreover, parents may not always be aware that a particular product contains cannabis, especially if it is not clearly labeled as such. This problem is on full display in NY's grey market where we have cannabis edibles using copycat packaging that closely resembles non-infused alternatives. 

This is where child-resistant packaging comes in. By requiring cannabis products to be sold in child-resistant packaging, we can significantly reduce the number of accidental exposures in children. Studies have shown that child-resistant packaging can be effective in preventing such incidents. A study published in the Journal of Pediatrics found that between 2006 and 2013, child-resistant packaging for medications reduced the number of emergency department visits for unintentional ingestions by 45%.

In conclusion

Some may argue that child-resistant packaging is unnecessary or burdensome for the cannabis industry, but this is simply not the case. Child-resistant packaging is already required for many other chemicals and products, and the technology for such packaging is well-established. Many cannabis companies already use child-resistant packaging voluntarily in order to protect children from accidental exposures.