HARRISBURG (TNS) — As the legalization of recreational cannabis continues to face roadblocks in Pennsylvania, there’s much to learn from the dozens of states that have had legal weed for years.

The issue has been front and center in recent weeks, when House Bill 1200 to legalize the drug passed in the Pennsylvania House 102 — 101 in May. The bill was co-sponsored by Dan Frankel, D-Allegheny, who called the passage “a victory for common sense and public health.”

But it quickly died in the Senate due to a clause that would establish state-run dispensaries, similar to the Pennsylvania Liquor Control Board’s oversight of Fine Wine & Good Spirits stores, as opposed to privately owned dispensaries that could generate revenue for Pennsylvanians.

As legislators work to rewrite the bill and try again for passage, Ohio is nearing its first full year of recreational cannabis, revealing preliminary trends that are concerning to some experts.

One trend mirrors what’s already been observed in Pittsburgh and across the country: Children accidentally ingesting the drug in their homes and sometimes even at school. Ohio Poison Control Centers have similarly reported an increase in childhood overdoses of cannabis products since dispensaries in the state began selling them for recreational use in August.

Between January and December 2024, more than 800 children under 12 were exposed to cannabis products, the poison center said in an email statement, representing a nearly 52% increase among this age group compared to the year prior. More than 90% of the 2024 exposures were attributed to edible products such as troches, or lozenges, which come in an array of fruity flavors.

“Legalization opens the door for a lot of these edible products,” said Ryan Marino, a medical toxicologist, emergency medicine physician and addiction medicine specialist at University Hospitals in Ohio. “They look very appealing to children and often contain pretty large doses of THC,” or tetrahydrocannabinol, the main intoxicating compound in cannabis. “That is one area of concern.”

Similar trends have played out in Colorado and Oregon, which legalized adult-use cannabis in 2012 and 2014, respectively.

The first state to legalize recreational marijuana, Colorado saw a spike in emergency room visits related to the drug between 2012 and 2016, according to a 2019 study published in the Annals of Internal Medicine. While adults made up more of these visits, data showed visits for edibles were more likely to be linked to childhood exposures.

Colorado Poison Centers responded by establishing a cannabis exposure dashboard in 2015 to track who was being exposed to pot products. The dashboard shows a 260% increase in marijuana exposures in children under 5 from 2016 to 2021. Of the products available, edibles were the most likely to be involved in overdoses, where ingestion of plant material, or cannabis flower, is second-most likely.

Public health researchers found that changes in packaging are one way states have combatted pediatric cannabis overdoses, according to a paper published in the American Journal of Public Health last year.

In 2017, the Washington Poison Center and the Washington Liquor Control Board developed a warning symbol and the “Not for Kids” slogan that were placed on all cannabis edibles in response to a rise in pediatric overdoses. These products are required to have the Washington Poison Center’s phone number, and the state, which legalized adult-use marijuana roughly a month after Colorado, also implemented single-use packaging for cannabis edibles as a deterrent to childhood exposure.

“This suggests that single-unit packaging may be an effective way to reduce child exposures,” said the authors of the 2024 article.

Kids have a higher risk for complications related to cannabis exposures. While pot is rarely — if ever — lethal in adults, cannabis overdose can lead to respiratory depression in children, said Dr. Marino.

“Once a month or so I get called to see a kid in the ICU who may need a ventilator,” he said.

Oregon established a dashboard for cannabis product recall notices to alert the public about products tainted by pesticides, hidden allergens like milk and incorrect potency data. Other states, like Colorado and California, have similar product recall dashboards, and the New York Cannabis Control Board has unveiled a public health campaign to educate parents about leaving cannabis products out for kids to access.

It hasn’t all been positive. In April 2022, Oregon increased the allowable THC limit in edible products from 50 to 100 milligrams and subsequently saw a spike in pediatric overdoses reported to poison centers.

Dr. Marino said he’s also seen an increase in cannabis-related vomiting, a trend that is becoming more common and more understood by physicians as a symptom of long-term, heavy cannabis use.

“There are ways to be thoughtful about legalization,” he said. “All states that are doing this should have something planned in advance so it doesn’t become an issue like we’ve seen already.”

Dr. Marino specified that he supports legalization with the right level of oversight from public health entities.

Emergency room and poison center data from states including California, Washington, Oregon and Ohio act as a model for the obstacles Pennsylvania may face in its push to recreationally legalize cannabis, and how the state will choose to structure its regulatory policies and agencies.

State Sen. Daniel Laughlin, R-Erie, who has authored other cannabis legislation, said in a May 13 news release about House Bill 1200 that regulation, testing and age verification are already lacking for “legal” THC products sold in smoke shops and gas stations in Pennsylvania — that is, cannabis under the allowable 0.3% THC limit as dictated in the 2018 Farm Bill.

Many have said that 0.3% limit has simply created loopholes for other legal compounds like Delta 8-THC, which is just as psychoactive as its chemical cousin, Delta-9 THC, the intoxicating compound in cannabis.

Mr. Laughlin said he supports the creation of a Pennsylvania Cannabis Control Board adjacent to recreational legalization to oversee these regulatory problems.

“With legalization, we are going to have these growing pains,” said Dr. Marino. “Without having cannabis products legalized, there’s no way to address these issues that were happening already.

“It isn’t that this is all bad,” he went on. “These are things that we can work on and even plan for in advance, especially in the case of Pennsylvania.”