Cannabis-related emergency department visits by youths and their outcomes in Ontario: a trend analysis (original) (raw)
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Cureus
Introduction: Cannabis use has been associated with adverse outcomes among adults and adolescents. As more states legalize or consider legalization, it is imperative to understand cannabis-related hospitalizations among the US population. This study is aimed at understanding the prevalence of cannabisrelated hospitalizations using a nationally representative sample. Methods: Using the National Inpatient Sample (NIS) available through the Healthcare Cost and Utilization Project (HCUP), we included all hospitalizations that met the inclusion criteria of documented history of cannabis use and those with any cannabis diagnosis as the reason for hospitalization between 2012 and 2014, and 2016 and 2018 using listwise deletion methods. Cannabis use was identified based on International Classification of Disease (ICD 9 & 10) codes (304.3X, 305.2X) (F12.XXX) for 2012-2014 and 2016-2018, respectively. We included both primary and secondary diagnoses among hospitalized patients. We further analyzed the relationship between cannabis-related diagnoses, race and ethnicity cases, household income, region, age group, rural-urban demographics, and sex. Results: A weighted total of 2,099,665 and 1,023,325 patients with a history of cannabis use were identified for the period of 2012-2014 and 2016-2018, respectively. The primary reason for presentation among a majority of patients was related to mental health, alcohol, HIV, trauma, burns, and toxic effects of drugs for all included years. The rate of the presentation was highest among individuals 12-24-years-old (351, 846
Approach to cannabis use disorder in primary care: focus on youth and other high-risk users
Canadian family physician Médecin de famille canadien, 2014
To review the clinical features and complications of at-risk cannabis use and cannabis use disorder, and to outline an office-based protocol for screening, identifying, and managing this disorder. PubMed was searched for controlled trials, observational studies, and reviews on cannabis use among adolescents and young adults; cannabis-related medical and psychiatric harms; cannabis use disorder and its treatment; and lower-risk cannabis use guidelines. Physicians should ask all patients about cannabis use. They should ask adolescents and young adults and those at highest risk of cannabis-related harms (those with concurrent psychiatric or substance use disorders) more frequently. Physicians should also ask about cannabis use in patients who have problems that could be caused by cannabis, such as mood disorders, psychosis, and respiratory symptoms. In patients who report cannabis use, physicians should inquire about frequency and amount, tolerance and withdrawal symptoms, attempts to ...
PLOS ONE, 2022
Legalization of recreational cannabis in Ontario included the legalization of flower and herbs (Phase 1, October 2018), and was followed by the deregulation of cannabis retailers and sales of edibles (Phase 2, February 2020). Research on the impact of cannabis legalization on acute care utilization is nascet; no research has investigated potential age, gender, and geographically vulnerable subgroup effects. Residents living in Northern Ontario not only have higher levels of substance use problems, but also have inadequate access to primary healthcare. Our study investigated the impact of Ontario's recreational cannabis policy (including Phase 1 and 2) on cannabis-attributable emergency department (ED) visits, and estimated the impact separately for different age and gender groups, with additional analyses focused on Northern Ontarians. We created a cohort of adults (18 and over) eligible for provincial universal health insurance with continuous coverage from 2015-2021 (n = 14,900,820). An interrupted time series was used to examine the immediate impact and month-to-month changes in cannabis-related ED visits associated with Phase 1 & 2 for each subgroup. While Northern Ontario has higher rates of cannabis-related ED visits, both Northern and Southern Ontario show similar patterns of changes. Phase 1 was associated with significant increases in adults 25-64, with the strongest increases seen in women 45-64. Month-to-month trends were flattened in most groups compared to pre-legalization. Phase 2 was associated with significant immediate increases for adults aged 18-44 in both genders, but the increases were larger in women than men. No significant month-to-month changes were detected in this period. While current preventive efforts are largely focused on reducing cannabis-related harms in youths and younger adults, our results show that adults 25-64, particularly women, have been significantly impacted by cannabis policies.
Screening for cannabis use disorders in an adolescent emergency department sample
Drug and Alcohol Dependence, 2003
Cannabis, more often than alcohol, is the drug mentioned in substance-related reasons for treatment of an adolescent in an emergency department (ED). This study examined the prevalence of DSM-IV cannabis and alcohol diagnoses in an adolescent ED sample, evaluated the performance (i.e. sensitivity and specificity) of DSM-IV cannabis symptoms and other screening items as indicators of cannabis diagnosis status, and examined parent-adolescent agreement on the presence of cannabis and alcohol diagnoses. Adolescents (ages 13 Á/19, n 0/442) admitted to an ED for a non-substance-related injury were administered the diagnostic interview schedule for children (DISC). Parents (n 0/272) of adolescents younger than age 18 completed the DISC Á/parent version to report on their child's drug use. A minority met criteria for a current DSM-IV cannabis or alcohol diagnosis: 7.9% for both alcohol and cannabis, 7.5% for cannabis-only, and 9.0% for alcohol-only. Frequency of cannabis use had the best overall performance in discriminating those with and without a cannabis diagnosis compared with items on perceived risk of cannabis use, peer cannabis use, and alcohol and cigarette use. Parent reports generally underestimated the adolescent's substance use. Questions on level of substance use generally provide an efficient method of screening adolescents for substance-related problems in an ED setting. #
2020
Background The study of the use of cannabis for therapeutic purposes in the pediatric population is increasing, yet data on efficacy and safety are limited. Characterization of pediatric cannabis use for therapeutic purposes will improve understanding of the circumstances under which it occurs and the associated outcomes. Objective To describe the use of cannabis for therapeutic purposes, regardless of authorization, in a pediatric tertiary teaching hospital. Methods A retrospective chart review was completed for patients 18 years of age or younger who used cannabis for therapeutic purposes, regardless of authorization, between May 1, 2014, and May 1, 2017. Patients whose cannabis use was documented as recreational were excluded. Results In total, 300 patients were identified, of whom 37 met the inclusion criteria. Of these, 30 patients had documentation of medically supervised cannabis use. Most were using cannabis for seizures (n = 28), and many of these (n = 23) were patients wit...
Prevalence and correlates of cannabis poisoning diagnosis in a national emergency department sample
Drug and Alcohol Dependence, 2019
Background: One of the primary cannabis-related reasons individuals seek emergency medical care is accidental cannabis poisoning. However, our understanding of the incidence and characteristics of those who receive emergency medical care due to cannabis poisoning remains limited. We address this gap by examining up-to-date information from a national study of emergency department (ED) data. Methods: The data source used for this study is the Nationwide Emergency Department Sample (NEDS). An International Classification of Diseases (ICD-10-CM) diagnostic code was used to identify accidental poisoning by cannabis (T40.7X1A) as specified by healthcare providers. Logistic regression was employed to examine the relationship between ED admission for cannabis poisoning, sociodemographic factors, and mental health disorders. Results: In 2016, an estimated 16,884 individuals were admitted into EDs in the United States due to cannabis poisoning, representing 0.014% of the total ED visits for individuals ages 12 and older. Individuals who sought care for cannabis poisoning were more likely to be young, male, uninsured, experience economic hardship, reside in urban central cities, and experience mental health disorders as compared to individuals admitted for other causes. Among cases that included
Canadian Institute For Knowledge Development(CIKD), 2022
The legalization of cannabis for recreational use remains a controversial topic today. There are multiple known benefits of cannabis which include pain relief and treatment of epilepsy syndromes. However, there are also many associated risks. Shorter-term health consequences include cannabinoid hyperemesis syndrome and cannabis-induced psychosis. These conditions directly impact the influx of patients presenting to emergency departments (ED). This study aims to examine the impact of cannabis legalization on ED presentations. We performed a descriptive study via a retrospective chart review of cannabis-related ED visits in St. John's, Newfoundland (NL), ranging from six months prior to the date of legalization of cannabis for recreational use, to six months after. We searched the hospital ED visit records using keywords to identify patients who have symptoms relating to cannabis use. We manually reviewed all visit records that included one or more of these terms to distinguish true positives from false-positive cases unrelated to cannabis use. The number of cannabis-related visits increased from 2.56 per 1000 ED visits prior to legalization to 3.56 per 1000 ED visits post legalization (p < 0.01). There was no difference in the age of users between the two groups. Additionally, the most common presenting complaint due to cannabis use was nausea/vomiting (47.7%), followed by anxiety (12.2%). Following the implementation of the Cannabis Act in Canada, the EDs in St. John's, NL had a significant increase in the number of ED visits related to cannabis use. It is important to determine such consequences to ensure hospitals and public health are prepared to treat the influx of visits and are better equipped to manage the associated symptoms.
2021
Objective: As medical cannabis use increases in North America, establishing the safety profile of cannabis is a priority. The objective of this study was to assess rates of emergency department (ED) visits and hospitalizations due to poisoning by cannabis and cannabis-related mental health disorders among medically authorized cannabis patients in Ontario, Canada, between 2014 and 2017.Methods: This is a retrospective longitudinal study conducted among a cohort of patients who received an authorization to use cannabis for treating various health conditions in Ontario, Canada. The cannabis cohort was selected using data collected in participating Canadian cannabis clinics. Outcomes included: ED visit/hospitalization with a main diagnosis code for cannabis/cannabinoid poisoning; and ED visit/hospitalization with a main diagnosis code for mental/behavioural disorders due to cannabis use. The Spearman correlation and univariate Cox proportional hazard regression was utilized.Results: Fro...
Journal of medical toxicology : official journal of the American College of Medical Toxicology, 2015
Cannabis is the most commonly used illicit drug in Europe, and is generally regarded as having low acute toxicity. We present the findings of the first 6 months of data collection from the Euro-DEN project on presentations related to cannabis use to further understand the acute toxicity related to the use of cannabis. Data was extracted on clinical features, treatment and outcome from the Euro-DEN minimum dataset for all cases of acute recreational drug toxicity reported 1st October 2013 to 31st March 2014 for all cannabis-related presentations. Of 2198 presentations reported by 14 of the 16 Euro-DEN centres, 356 (16.2 %) involved cannabis either alone or together with other drugs/alcohol. There were 36 that involved lone use of cannabis (1.6 % of all presentations). Of the 35 non-fatal lone cannabis presentations, the most commonly reported features were neuro-behavioural (agitation/aggression 8 (22.9 %), psychosis 7 (20.0 %), anxiety 7 (20.0 %)) and vomiting 6 (17.1 %). Most patie...
Cannabis-related hospitalizations: unexpected serious events identified through hospital databases
British Journal of Clinical Pharmacology, 2011
We included 200 patients, and identified a total of 619 adverse events (AEs), one of which was lethal. Psychiatric disorders involved 57.7% of patients and accounted for 18.2% of AEs. Most frequent outcomes were central and peripheral nervous system disorders (15.8% of AEs), acute intoxication (12.1%), respiratory system disorders (11.1%) and cardiovascular disorders (9.5%). We estimated that in 2007 the incidence of cannabis-related AEs in the Midi-Pyrenees region ranged from 1.2 per 1000 regular cannabis users (95% confidence interval (CI) 0.7, 1.6) to 3.2 (95% CI 2.5, 3.9).