Acute cannabis intoxication in the emergency department: the effect of legalization

Baraniecki, Robert; Panchal, Puru; Malhotra, Danya Deepsee; Aliferis, A; Zia, Zaka

doi:10.1186/s12873-021-00428-0

Cited by 24 publications

(39 citation statements)

References 14 publications

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“…edibles and commercialization), we found evidence of an immediate increase in cannabisrelated ED visits; however, no studies including ours have been able to isolate the Phase 2 effect from the COVID-19 effects that coincided with Phase 2. Only one study from Hamilton, Ontario contradicted our results: they found that there was no change in the rate of cannabis-related ED visits following legalization (20), but the authors only examined a single hospital, and did not measure level and trend changes.…”

Section: Discussioncontrasting

confidence: 82%

Associations between recreational cannabis legalization and cannabis-related emergency department visits by age, gender, and geographic status in Ontario, Canada: an interrupted time series study

Kim

Chum

Nielsen

et al. 2022

Preprint

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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-legalisation. 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. Further research on gender-specific cannabis dosage and targeted interventions for adult women should be investigated. Legalization did not appear to have a differential impact on Northern versus Southern Ontario, but higher rates of ED visits in the North should be addressed.

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Section: Discussioncontrasting

confidence: 82%

Associations between recreational cannabis legalization and cannabis-related emergency department visits by age, gender, and geographic status in Ontario, Canada: an interrupted time series study

Kim

Chum

Nielsen

et al. 2022

Preprint

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“…Studies and reports examining changes in cannabis use and harms in the immediate period following legalization have generally reported no or modest increases in self-reported cannabis use and cannabisattributable health-care visits [5][6][7][8][9]. However, most of these studies have conceptualized legalization as a binary and short-term event [5,[8][9][10] which fails to consider the substantial and continuing expansion of the legal cannabis market (in both cannabis stores and sales) over time in jurisdictions throughout Canada [11,12]. A large body of evidence from other legal commercialized substances (e.g.…”

Section: Introductionmentioning

confidence: 99%

The association between recreational cannabis legalization, commercialization and cannabis‐attributable emergency department visits in Ontario, Canada: an interrupted time–series analysis

et al. 2022

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Background and aims Recreational cannabis was legalized in Canada in October 2018. Initially, the Government of Ontario (Canada’s largest province) placed strict limits on the number of cannabis retail stores before later removing these limits. This study measured changes in cannabis‐attributable emergency department (ED) visits over time, corresponding to different regulatory periods. Design Interrupted time–series design using population‐level data. Two policy periods were considered; recreational cannabis legalization with strict store restrictions (RCL, 17 months) and legalization with no store restrictions [recreational cannabis commercialization (RCC), 15 months] which coincided with the COVID‐19 pandemic. Segmented Poisson regression models were used to examine immediate and gradual effects in each policy period. Setting Ontario, Canada. Participants All individuals aged 15–105 years (n = 13.8 million) between January 2016 and May 2021. Measurements Monthly counts of cannabis‐attributable ED visits per capita and per all‐cause ED visits in individuals aged 15+ (adults) and 15–24 (young adults) years. Findings We observed a significant trend of increasing cannabis‐attributable ED visits pre‐legalization. RCL was associated with a significant immediate increase of 12% [incident rate ratio (IRR) = 1.12, 95% confidence interval (CI) = 1.02–1.23] in rates of cannabis‐attributable ED visits followed by significant attenuation of the pre‐legalization slope (monthly slope change IRR = 0.98, 95% CI = 0.97–0.99). RCC and COVID‐19 were associated with immediate significant increases of 22% (IRR = 1.22, 95% CI = 1.09–1.37) and 17% (IRR = 1.17, 95% CI = 1.00–1.37) in rates of cannabis‐attributable visits and the proportion of all‐cause ED visits attributable to cannabis, respectively, with insignificant increases in monthly slopes. Similar patterns were observed in young adults. Conclusions In Ontario, Canada, cannabis‐attributable emergency department visits stopped increasing over time following recreational cannabis legalization with strict retail controls but then increased during a period coinciding with cannabis commercialization and the COVID‐19 pandemic.

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“…Though cannabis consists of various cannabinoid compositions, the primary psychoactive compound is Δ9-Tetrahydrocannabinol (THC) that influences the Peripheral Nervous system (PNS) and the Central Nervous System (CNS) through cannabinoid 1 (CB1) receptor agonist together with other body organs [3,7,8]. This receptor is part of the endogenous cannabinoid system, consisting of the metabolism of the endocannabinoids, reuptake, the biochemical machinery for synthesis, endogenous ligands, and CB2 receptors [3].…”

Section: Cannabis Endogenous Effect and Adverse Outcomesmentioning

confidence: 99%

“…Considering that the widespread distribution of CB1 receptors in the CNS, THC creates a wide range of dose-dependent, acute psychotropic impacts, such as feeling high "euphoria" and relaxation, which is thought to be the major reason for cannabis consumption [3]. Moreover, THC has been used recreationally through various forms: vaporized, smoked, orally ingested, or even topically applied [7]. Acute cannabis intoxication includes both physical (cognitive impairment, tachycardia, conjunctival injection, and shortterm memory tasks) and psychiatric effects (relaxation, euphoria, loss of inhibition, and time distortion) [7].…”

Section: Cannabis Endogenous Effect and Adverse Outcomesmentioning

confidence: 99%

“…Moreover, THC has been used recreationally through various forms: vaporized, smoked, orally ingested, or even topically applied [7]. Acute cannabis intoxication includes both physical (cognitive impairment, tachycardia, conjunctival injection, and shortterm memory tasks) and psychiatric effects (relaxation, euphoria, loss of inhibition, and time distortion) [7]. Besides, animal studies showed that the endocannabinoid system affects dopamine release regulation during silence attribution.…”

Section: Cannabis Endogenous Effect and Adverse Outcomesmentioning

confidence: 99%

See 1 more Smart Citation

Cannabinoid Acute Intoxication, Diagnosis, and Management

Alghamdi¹,

Samman²,

Bahader³

et al. 2021

Int j pharm res allied sci

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Cannabis use is a common behavior among adults and adolescents, particularly after legalization in certain countries. It also reported that pediatric exposure to cannabinoid-containing products has increased for the same reason. Acute cannabinoid intoxication affects almost every part of the body, especially cardiovascular, nervous, and gastrointestinal systems, in addition to its psychoactive effects. This article aims to review the background of cannabis and its impact on the human body and review the common adverse outcomes, including the fatal consequences. Also, in this article, we aim to address the therapeutic approach of cannabinoid intoxication in the emergency setting. We used the PubMed database looking for relevant articles on the topic, addressing the emergency setting specifically. We used the following Mesh words: Cannabis, delta-9-tetrahydrocannabinol, cannabinoid intoxication, emergency department. Cannabinoid provides various body effects, but gastrointestinal and psychiatric complaints were the most common symptoms requiring emergency visits. Luckily, most of those patients do not demand hospital admission and are successfully discharged after symptomatic management. However, severe but rare symptoms must be adequately addressed, especially in concomitant use of another illicit drug, leading to respiratory depression, severe cardiovascular outcomes, or even death.

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Acute cannabis intoxication in the emergency department: the effect of legalization

Cited by 24 publications

References 14 publications

Associations between recreational cannabis legalization and cannabis-related emergency department visits by age, gender, and geographic status in Ontario, Canada: an interrupted time series study

Associations between recreational cannabis legalization and cannabis-related emergency department visits by age, gender, and geographic status in Ontario, Canada: an interrupted time series study

The association between recreational cannabis legalization, commercialization and cannabis‐attributable emergency department visits in Ontario, Canada: an interrupted time–series analysis

Cannabinoid Acute Intoxication, Diagnosis, and Management

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