1
|
Nguyen A, Lee R, Zhao L, Qu L, Todd B. The impact of recreational cannabis legalization on ED visit rates for acute cannabis intoxication. Am J Emerg Med 2024; 84:124-129. [PMID: 39111101 DOI: 10.1016/j.ajem.2024.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND In December 2018 the Michigan Regulation and Taxation of Marihuana Act legalized the recreational use of cannabis in Michigan. There are now high potency forms of cannabis readily available in the state, which could result in increased emergency department (ED) visit rates due to intoxication in adults and children. Although cannabis related visits account for a small percentage of all adult and pediatric ED visits, they impose a significant burden on the health care system's resources. This study aimed to assess the impact of the legalization of recreational marijuana on the rate of ED visits for acute cannabis intoxication. METHODS AND DESIGN We utilized the legalization of marijuana in the state of Michigan to conduct a natural experiment utilizing a retrospective observational cohort design of ED visits for acute intoxication before and after legalization. The study was conducted at a health system composed of eight hospitals in southeast Michigan, including both academic and community hospitals serving a diverse patient population. We estimated monthly cannabis-related ED visits based on cannabis-related ICD-10 discharge codes and total ED visits using electronic health record data from 2016 to 2022. A negative-binomial (NB) regression model was used to estimate the immediate and cumulative changes in cannabis-related ED visit rate after legalization. RESULTS There were a total of 2177 ED visits from 2066 patients for cannabis intoxication in our study cohort. Of the 2177 visits, 671 were before and 1506 were after legalization. In the univariate analysis, recreational cannabis legalization was associated with an increase in the average cannabis-related ED visit rate (Rate Ratio [RR]:1.70, 95% CI: (1.49, 1.94), p-value <0.001). In the multivariate analysis adjusting for age, results remain significant (RR 1.47, 95% CI (1.29, 1.70), p-value <0.001). The increased visit rate occurred in the first month after legalization; however, the slope of the increasing rate of ED visits were similar before and after cannabis legalization (RR, 1.28, 95% CI (1.07, 1.54), p-value <0.001). CONCLUSIONS The legalization of recreational cannabis in Michigan was associated with an immediate increase in ED visit rates for acute cannabis intoxications across all ages, especially among middle-aged adults, in the context of an stably increasing ED visit rate.
Collapse
Affiliation(s)
- An Nguyen
- Department of Emergency Medicine, William Beaumont University Hospital, Royal Oak, MI, USA.
| | - Ray Lee
- Department of Biostatics and Health Informatics, Corewell Health Research Institute, Royal Oak, MI, USA
| | - Lili Zhao
- Department of Biostatics and Health Informatics, Corewell Health Research Institute, Royal Oak, MI, USA
| | - Lihua Qu
- Department of Outcomes Research, Corewell Health Research Institute, Royal Oak, MI, USA
| | - Brett Todd
- Department of Emergency Medicine, William Beaumont University Hospital, Royal Oak, MI, USA
| |
Collapse
|
2
|
Costales B, Lu Y, Young-Wolff KC, Cotton DM, Campbell CI, Iturralde E, Sterling SA. Prevalence and trends of suspected cannabinoid hyperemesis syndrome over an 11-year period in Northern California: An electronic health record study. Drug Alcohol Depend 2024; 263:112418. [PMID: 39216202 PMCID: PMC11404979 DOI: 10.1016/j.drugalcdep.2024.112418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 07/26/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND As access to cannabis has increased, there has been a rise in a condition called cannabinoid hyperemesis syndrome (CHS). This study estimates annual prevalence of suspected CHS at emergency department visits (ED) over an 11-year period in Northern California. METHODS This retrospective observational cohort study used electronic health records from Kaiser Permanente Northern California. Two CHS case definitions were used to construct two cohorts of adults (18+) with ≥1 CHS visits from 2009 to 2019. The primary definition used a narrow definition based on past studies (CHS group 1) and an exploratory definition allowed for a broader range of codes (CHS group 2); both definitions required a primary diagnosis of vomiting. Annual prevalence of CHS and annual rates of counts of CHS visits estimated using a log-link Poisson model are reported per group. FINDINGS There were 57,227 patients with ≥1 CHS visits included in CHS group 1 and 65,645 patients included in CHS group 2. Over eleven years, CHS increased across groups with the fastest rise in CHS group 1 (prevalence ratio = 2.75, 95 % confidence interval [CI] 2.65-2.85, p<.0001 from 2009 to 2019 vs. prevalence ratio = 2.34, 95 % CI 2.27-2.43). CHS group 1 also exhibited the largest increase in ED visits (rate ratio = 2.35, 95 % CI 2.27-2.43, p<.0001). CONCLUSION In a large California population, suspected CHS increased over time across definitions. Annual prevalence increased by 134-175 %, depending on CHS definition. CHS group 2's definition may have been too broad and changes in ICD-10-CM coding may have impacted estimates.
Collapse
Affiliation(s)
- Brianna Costales
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Dr, Pleasanton, CA 94588, USA.
| | - Yun Lu
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Dr, Pleasanton, CA 94588, USA.
| | - Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Dr, Pleasanton, CA 94588, USA.
| | - Dale M Cotton
- The Permanente Medical Group, 1950 Franklin St., Oakland, CA 94612, USA.
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Dr, Pleasanton, CA 94588, USA.
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Dr, Pleasanton, CA 94588, USA.
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Dr, Pleasanton, CA 94588, USA.
| |
Collapse
|
3
|
Jiang X, Guy GP, Schmit K, Hoots B, Roehler DR, Govoni TD, Mallory V, Green JL. Substance Use Patterns and Characteristics Using Real World Data from Adolescents Assessed for Substance Use and Treatment Planning-United States, 2017-2021. Subst Use Misuse 2024; 59:1839-1859. [PMID: 39072503 PMCID: PMC11444876 DOI: 10.1080/10826084.2024.2383609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
BACKGROUND Although substance use rates among adolescents have decreased, drug overdose deaths among adolescents have increased since 2020, driven largely by illegally made fentanyl (IMF). This study explores substance use patterns and characteristics of adolescents who were assessed for substance use disorder (SUD) treatment to inform prevention and response strategies. METHODS A convenience sample of adolescents aged 10-18 years assessed for SUD treatment from September 2017 to December 2021 was analyzed using the Comprehensive Health Assessment for Teens. The percentage of lifetime and past 30-day substance use was examined. Adolescent characteristics (e.g., demographics, history of overdoses or hospital visits due to drug/alcohol use) were analyzed by lifetime substances used. RESULTS Among 5,377 assessments, most were male (58.7%), aged 16-18 years (50.5%), non-Hispanic White (43.1%), enrolled in school (87.3%), and living with their parent(s) (72.4%). The most commonly reported lifetime substances used were marijuana (68.0%), alcohol (54.2%), and prescription opioid misuse (13.6%). The most common past 30-day substance use combination was alcohol and marijuana (35.6%). The percentage of assessments indicating past-year overdoses or hospital visits due to drug/alcohol use was greatest among those who reported lifetime use of IMF (24.0%), followed by heroin (21.4%) and cocaine (15.3%). Overall, 2.3% reported lifetime IMF use and 0.6% thought IMF was causing them the most problems. CONCLUSIONS Findings inform opportunities to address substance use and increased IMF-involved overdose among adolescents. Continued overdose prevention and response strategies such as evidence-based education campaigns, naloxone distribution and harm reduction efforts, and evidence-based SUD treatment expansion are needed.
Collapse
Affiliation(s)
- Xinyi Jiang
- Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA, USA
| | - Gery P Guy
- Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA, USA
| | - Kristine Schmit
- Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA, USA
| | - Brooke Hoots
- Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA, USA
| | - Douglas R Roehler
- Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA, USA
| | | | - Vanessa Mallory
- Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA, USA
| | - Jody L Green
- Inflexxion, a division of Uprise Health, Irvine, California, USA
| |
Collapse
|
4
|
Campbell DE, Bhattarai C, Son Y, Khlystov A. An Automated "Hands-Off" Method for Sampling Mainstream Smoke from Cannabis Cigarettes. TOXICS 2024; 12:313. [PMID: 38787092 PMCID: PMC11125762 DOI: 10.3390/toxics12050313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024]
Abstract
A simple-to-use, portable, and relatively inexpensive system for characterizing the chemical components of mainstream smoke from cannabis cigarettes was developed and tested by using commercial hemp cigarettes. The system is described, and its performance for reproducing actual user puff topographies is shown along with extensive chemical analysis data, including PAHs, carbonyls, and organic and elemental carbon, for a small set of initial samples. By using a solid-state flow meter and fast-response mass flow controller, the prototype can reproduce measured puff topography with excellent fidelity, which will allow users to accurately reproduce the actual inhalation patterns for various types of smoking products and consumers, and to collect samples of mainstream smoke without the need to bring test subjects or controlled substances into a laboratory.
Collapse
Affiliation(s)
| | | | | | - Andrey Khlystov
- Organic Analytical Laboratory, Division of Atmospheric Sciences, Desert Research Institute, Reno, NV 89512, USA; (D.E.C.); (C.B.); (Y.S.)
| |
Collapse
|
5
|
Rozanc J, Klumpers LE, Huestis MA, Tagen M. Tolerability of High-Dose Oral Δ 9-THC: Implications for Human Laboratory Study Design. Cannabis Cannabinoid Res 2024; 9:437-448. [PMID: 38377580 DOI: 10.1089/can.2023.0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Background: Δ9-tetrahydrocannabinol (THC), the primary intoxicating compound in cannabis, has been tested extensively in controlled administration human studies. Some studies require a high THC dose that may induce adverse events (AEs), such as those testing novel treatments for cannabinoid overdose. Although there are ethical concerns related to administering high THC doses, there is no systematic analysis on studies utilizing these doses. In this review, we examine studies that administered oral THC doses ≥30 mg ("high-dose THC"), focusing on reported tolerability, subjective effects, and pharmacokinetics (PK), with the objective to inform the design of future studies. Methods: A comprehensive PubMed search was performed to identify studies meeting pre-specified criteria. Results: Our search identified 27 publications from 17 high-dose oral THC laboratory studies, with single doses up to 90 mg and multiple doses up to 210 mg per day. The maximum plasma THC concentration (Cmax) appeared to increase in a dose-proportional manner over this dose range. All high-dose THC studies enrolled participants with previous cannabis experience, although current use ranged from nonusers to regular cannabis users. High-dose THC was generally well tolerated with transient mild to moderate AE, including nausea and vomiting, anxiety, paranoia, and sedation. There were occasional participant withdrawals due to AEs, but there were no serious AE. Participants with frequent cannabis use tolerated high-dose THC best. Conclusion: Although based on limited data, THC was generally adequately tolerated with single oral doses of at least 50 mg in a controlled laboratory setting in healthy participants with past cannabis experience.
Collapse
Affiliation(s)
- Jan Rozanc
- Verdient Science LLC, Denver, Colorado, USA
- Institute of Biomedical Sciences, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Linda E Klumpers
- Verdient Science LLC, Denver, Colorado, USA
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
6
|
Reisdorph N, Doenges K, Levens C, Manke J, Armstrong M, Smith H, Quinn K, Radcliffe R, Reisdorph R, Saba L, Kuhn KA. Oral Cannabis consumption and intraperitoneal THC:CBD dosing results in changes in brain and plasma neurochemicals and endocannabinoids in mice. J Cannabis Res 2024; 6:10. [PMID: 38429800 PMCID: PMC10908076 DOI: 10.1186/s42238-024-00219-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/06/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND While the use of orally consumed Cannabis, cannabidiol (CBD) and tetrahydrocannabinol (THC) containing products, i.e. "edibles", has expanded, the health consequences are still largely unknown. This study examines the effects of oral consumption of whole Cannabis and a complex Cannabis extract on neurochemicals, endocannabinoids (eCB), and physiological parameters (body temperature, heart rate) in mice. METHODS In this pilot study, C57BL/6 J mice were treated with one of the following every other day for 2 weeks: a complex Cannabis extract by gavage, whole Cannabis mixed with nutritional gel through free feeding, or purified THC/CBD by intraperitoneal (i.p.) injection. Treatments were conducted at 4 doses ranging from 0-100 mg/kg/day of CBD with THC levels of ≤ 1.2 mg/kg/day for free feeding and gavage and 10 mg/kg/day for i.p. Body temperature and heart rate were monitored using surgically implanted telemetry devices. Levels of neurochemicals, eCB, THC, CBD, and 11-OH-THC were measured using mass spectrometry 48 h after the final treatment. Statistical comparisons were conducted using ANOVA and t-tests. RESULTS Differences were found between neurochemicals in the brains and plasma of mice treated by i.p. (e.g. dopamine, p < 0.01), gavage (e.g., phenylalanine, p < 0.05) and in mice receiving whole Cannabis (e.g., 3,4-dihydroxyphenylacetic DOPAC p < 0.05). Tryptophan trended downward or was significantly decreased in the brain and/or plasma of all mice receiving Cannabis or purified CBD/THC, regardless of dose, compared to controls. Levels of the eCB, arachidonoyl glycerol (2-AG) were decreased in mice receiving lowest doses of a complex Cannabis extract by gavage, but were higher in mice receiving highest doses compared to controls (p < 0.05). Plasma and brain levels of THC and 11-OH-THC were higher in mice receiving 1:1 THC:CBD by i.p. compared to those receiving 1:5 or 1:10 THC:CBD. Nominal changes in body temperature and heart rate following acute and repeated exposures were seen to some degree in all treatments. CONCLUSIONS Changes to neurochemicals and eCBs were apparent at all doses regardless of treatment type. Levels of neurochemicals seemed to vary based on the presence of a complex Cannabis extract, suggesting a non-linear response between THC and neurochemicals following repeated oral dosing.
Collapse
Affiliation(s)
- Nichole Reisdorph
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - Katrina Doenges
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Cassandra Levens
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Jon Manke
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Michael Armstrong
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Harry Smith
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Kevin Quinn
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Richard Radcliffe
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Richard Reisdorph
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Laura Saba
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Kristine A Kuhn
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| |
Collapse
|
7
|
Smith BP, Hoots B, DePadilla L, Roehler DR, Holland KM, Bowen DA, Sumner SA. Using Transformer-Based Topic Modeling to Examine Discussions of Delta-8 Tetrahydrocannabinol: Content Analysis. J Med Internet Res 2023; 25:e49469. [PMID: 38127427 PMCID: PMC10767625 DOI: 10.2196/49469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/15/2023] [Accepted: 10/11/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Delta-8 tetrahydrocannabinol (THC) is a psychoactive cannabinoid found in small amounts naturally in the cannabis plant; it can also be synthetically produced in larger quantities from hemp-derived cannabidiol. Most states permit the sale of hemp and hemp-derived cannabidiol products; thus, hemp-derived delta-8 THC products have become widely available in many state hemp marketplaces, even where delta-9 THC, the most prominently occurring THC isomer in cannabis, is not currently legal. Health concerns related to the processing of delta-8 THC products and their psychoactive effects remain understudied. OBJECTIVE The goal of this study is to implement a novel topic modeling approach based on transformers, a state-of-the-art natural language processing architecture, to identify and describe emerging trends and topics of discussion about delta-8 THC from social media discourse, including potential symptoms and adverse health outcomes experienced by people using delta-8 THC products. METHODS Posts from January 2008 to December 2021 discussing delta-8 THC were isolated from cannabis-related drug forums on Reddit (Reddit Inc), a social media platform that hosts the largest web-based drug forums worldwide. Unsupervised topic modeling with state-of-the-art transformer-based models was used to cluster posts into topics and assign labels describing the kinds of issues being discussed with respect to delta-8 THC. Results were then validated by human subject matter experts. RESULTS There were 41,191 delta-8 THC posts identified and 81 topics isolated, the most prevalent being (1) discussion of specific brands or products, (2) comparison of delta-8 THC to other hemp-derived cannabinoids, and (3) safety warnings. About 5% (n=1220) of posts from the resulting topics included content discussing health-related symptoms such as anxiety, sleep disturbance, and breathing problems. Until 2020, Reddit posts contained fewer than 10 mentions of delta-8-THC for every 100,000 cannabis posts annually. However, in 2020, these rates increased by 13 times the 2019 rate (to 99.2 mentions per 100,000 cannabis posts) and continued to increase into 2021 (349.5 mentions per 100,000 cannabis posts). CONCLUSIONS Our study provides insights into emerging public health concerns around delta-8 THC, a novel substance about which little is known. Furthermore, we demonstrate the use of transformer-based unsupervised learning approaches to derive intelligible topics from highly unstructured discussions of delta-8 THC, which may help improve the timeliness of identification of emerging health concerns related to new substances.
Collapse
Affiliation(s)
- Brandi Patrice Smith
- Office of Strategy and Innovation, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Brooke Hoots
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
- US Public Health Service Commissioned Corps, Bethesda, MD, United States
| | - Lara DePadilla
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Douglas R Roehler
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kristin M Holland
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Daniel A Bowen
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Steven A Sumner
- Office of Strategy and Innovation, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| |
Collapse
|
8
|
Myran DT, Gaudreault A, Konikoff L, Talarico R, Liccardo Pacula R. Changes in Cannabis-Attributable Hospitalizations Following Nonmedical Cannabis Legalization in Canada. JAMA Netw Open 2023; 6:e2336113. [PMID: 37796504 PMCID: PMC10556968 DOI: 10.1001/jamanetworkopen.2023.36113] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/23/2023] [Indexed: 10/06/2023] Open
Abstract
Importance The impact of adult-use cannabis legalization and subsequent commercialization (ie, increasing store and product access) on hospitalizations in Canada is unclear. Objectives To examine changes in overall and subtypes of hospitalizations due to cannabis and associated factors following legalization in Canada and to compare changes between provinces. Design, Setting, and Participants This repeated cross-sectional analysis included all acute hospitalizations for individuals aged 15 to 105 years in Canada's 4 most populous provinces (Ontario, Quebec, Alberta and British Columbia, population 26.9 million individuals in 2018). Data were obtained from routinely collected health administrative databases. Immediate and gradual changes in the age- and sex-standardized rates of hospitalizations due to cannabis were compared using an interrupted time series design over 3 time periods: prelegalization (January 2015 to September 2018), legalization with product and store restrictions (October 2018 to February 2020), and commercialization, which overlapped with the COVID-19 pandemic (March 2020 to March 2021). Main Outcomes and Measures Rates of hospitalizations due to cannabis per 100 000 individuals and per 1000 all-cause hospital admissions. Results There were 105 203 hospitalizations due to cannabis over the 7-year study period, 69 192 of which (65.8%) were among male individuals, and 34 678 (33%) of which were among individuals aged 15 to 24 years. Overall, the age- and sex-standardized rate of hospitalizations increased 1.62 times between January 2015 (3.99 per 100 000 individuals) and March 2021 (6.46 per 100 000 individuals). The largest relative increase in hospitalizations was for cannabis-induced psychosis (rate ratio, 1.40; 95% CI, 1.34 to 1.47 during the commercialization period relative to the prelegalization period). Nationally, legalization with restrictions was associated with a gradual monthly decrease of -0.06 (95% CI -0.08 to -0.03) in hospitalizations due to cannabis per 100 000 individuals. Commercialization and the COVID-19 pandemic were associated with an immediate increase of 0.83 (95% CI, 0.30 to 1.30) hospitalizations due to cannabis per 100 000 individuals. There was provincial variation in changes, with provinces with less mature legal markets experiencing the greatest declines immediately following legalization. Conclusions and Relevance This cross-sectional study found that legalization with restrictions was not associated with an increase in hospitalizations due to cannabis but commercialization was. The findings suggest that commercialization of cannabis may be associated with increases in cannabis-related health harms, including cannabis-induced psychosis.
Collapse
Affiliation(s)
- Daniel T. Myran
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adrienne Gaudreault
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lauren Konikoff
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert Talarico
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rosalie Liccardo Pacula
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
- Institute for Addiction Science, University of Southern California, Los Angeles
| |
Collapse
|
9
|
Florimbio AR, Walton MA, Coughlin LN, Lin LA, Bonar EE. Perceived risk of harm for different methods of cannabis consumption: A brief report. Drug Alcohol Depend 2023; 251:110915. [PMID: 37597308 DOI: 10.1016/j.drugalcdep.2023.110915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/18/2023] [Accepted: 07/29/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Emerging adults' (EAs; ages 18-25) perceived risk of cannabis-related harms has decreased in recent decades, potentially contributing to their high prevalence of cannabis consumption. With the changing cannabis policy and product landscape, it is critical to understand perceived risk related to different consumption methods (e.g., smoking, dabbing). We examined differences in cannabis risk perceptions by method and consumption patterns. METHODS EAs recruited from an emergency department (N=359, 71.3% female, 53.5% Black) completed assessments on individual characteristics, cannabis/other substance use, and perceived risk of cannabis-related harm for four different methods (smoking, vaping, dabbing, ingestion) and two use frequencies (occasional, regular). Analyses examined associations between variables of interest and three mutually exclusive groups: no cannabis use, smoking-only, and multiple/other methods. RESULTS Forty-two percent of EAs reported no past 3-month cannabis use, 22.8% reported smoking only, and 35.1% reported consumption via multiple/other methods. Among all participants, the methods and frequency with the largest number of EAs endorsing any perceived risk from cannabis were dabbing and vaping cannabis regularly; smoking occasionally had the smallest number of EAs endorsing perceived risk. A greater proportion of EAs in the no use group viewed vaping cannabis regularly as having the most risk (63.6%), whereas the largest proportion of EAs in the smoking-only (64.6%) and multiple/other methods (47.2%) groups perceived dabbing regularly as having the most risk. CONCLUSIONS This work shows that EAs vary in perceptions of risk across methods of cannabis use and can inform potential directions for public health and policy efforts.
Collapse
Affiliation(s)
- Autumn Rae Florimbio
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Maureen A Walton
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Lewei Allison Lin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
10
|
Roehler DR, Smith H, Radhakrishnan L, Holland KM, Gates AL, Vivolo-Kantor AM, Hoots BE. Cannabis-Involved Emergency Department Visits Among Persons Aged <25 Years Before and During the COVID-19 Pandemic - United States, 2019-2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:758-765. [PMID: 37440436 DOI: 10.15585/mmwr.mm7228a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
To understand trends in U.S. cannabis-involved emergency department (ED) visits (i.e., those for which cannabis use was documented in the chief complaint or a discharge diagnosis) among young persons aged <25 years during the COVID-19 pandemic, CDC used National Syndromic Surveillance Program data to examine changes in ED visits during 2019-2022. Mean weekly cannabis-involved ED visits among all young persons were higher during the COVID-19 pandemic in 2020, 2021, and 2022, compared with corresponding periods in 2019. Large increases in cannabis-involved ED visits throughout the COVID-19 pandemic compared with prepandemic surveillance periods in 2019 were identified among persons aged ≤10 years. ED visit rates among children and adolescents aged 11-14 years did not differ by sex until the first half of the 2020-21 school year (2020, weeks 37-53), when ED visit rates among females surpassed those among males. Improving clinicians' awareness of rising cannabis-involved ED visits might aid in early diagnosis of cannabis intoxication among young persons. Further, increasing adults' knowledge regarding safe cannabis storage practices, strengthening youths' coping and problem-solving skills through evidence-based prevention programs, and modifying cannabis packaging to decrease appeal to youths might help prevent intentional and unintentional cannabis use.
Collapse
|
11
|
Dykstra RE, Beadnell B, Rosengren DB, Schumacher JA, Daugherty R. A Lifestyle Risk Reduction Model for Preventing High-Risk Substance Use Across the Lifespan. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:863-875. [PMID: 37269468 PMCID: PMC10409837 DOI: 10.1007/s11121-023-01549-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/05/2023]
Abstract
While effective models of alcohol and drug prevention exist, they often focus solely on youth or young adults. This article describes the Lifestyle Risk Reduction Model (LRRM), an approach applicable across the lifespan. The intent behind the LRRM is to guide the development of prevention and treatment programs provided to individuals and small groups. The LRRM authors' goals are to help individuals reduce risk for impairment, addiction, and substance use's negative consequences. The LRRM identifies six key principles that conceptualize the development of substance-related problems by drawing parallels with health conditions, such as heart disease and diabetes, which often result from combined effects of biological risk and behavioral choices. The model also proposes five conditions that describe important steps for individuals as they progress toward greater perception of risk and lower risk behavior. One LRRM-based indicated prevention program (Prime For Life) shows positive results in cognitive outcomes and in impaired driving recidivism for people across the lifespan. The model emphasizes common elements across the lifespan, responds to contexts and challenges that change across the life course, complements other models, and is usable for universal, selective, and indicated prevention programs.
Collapse
|
12
|
Crocker CE, Emsley J, Tibbo PG. Mental health adverse events with cannabis use diagnosed in the Emergency Department: what are we finding now and are our findings accurate? Front Psychiatry 2023; 14:1093081. [PMID: 37304435 PMCID: PMC10247977 DOI: 10.3389/fpsyt.2023.1093081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
We have previously reviewed the types and numbers of cannabis-associated adverse events that have mental health presentations that are encountered in the Emergency Department. A particular challenge in examining these events is disentangling cannabis use adverse events from adverse events associated with use of multiple recreational substances. Since that review was published, cannabis legalization for recreational use has greatly expanded world-wide and with these changes in the legal climate has come clearer information around the frequency of adverse events seen in the Emergency Department. However, as we examined the current state of the literature, we also examined some of research designs and the biases that may be impacting the validity of the data in this field. The biases both of clinicians and researchers as well as research approaches to studying these events may be impacting our ability to assess the interaction between cannabis and mental health. For example, many of the studies performed examining cannabis-related admissions to the Emergency Department were administrative studies that relied on front line clinicians to identify and attribute that cannabis use was associated with any particular admission. This narrative review provides an overview on what we currently know about mental health adverse events in the Emergency Department with a focus on the mental health impacts both for those with and without a history of mental illness. The evidence that cannabis use can adversely impact genders and sexes differently is also discussed. This review outlines what the most common adverse events related to mental health with cannabis use are; as well as noting the most concerning but much rarer events that have been reported. Additionally, this review suggests a framework for critical evaluation of this field of study going forward.
Collapse
Affiliation(s)
- Candice E. Crocker
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Jason Emsley
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
- IWK Children’s Health Centre, Halifax, NS, Canada
| | - Philip G. Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, Nova Scotia Health, Halifax, NS, Canada
| |
Collapse
|
13
|
Han BH, Brennan JJ, Orozco MA, Moore AA, Castillo EM. Trends in emergency department visits associated with cannabis use among older adults in California, 2005-2019. J Am Geriatr Soc 2023; 71:1267-1274. [PMID: 36622838 PMCID: PMC10089945 DOI: 10.1111/jgs.18180] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The use of cannabis among older adults is increasing in the United States. While cannabis use has been suggested to help alleviate chronic symptoms experienced by older adults, its potential adverse effects may lead to unintended consequences, including increased acute healthcare utilization related to its use. The objective of this study was to examine trends in cannabis-related emergency department (ED) visits in California. METHODS Using data from the Department of Healthcare Access and Information, we conducted a trend analysis of cannabis-related ED visits from all acute care hospitals in California from 2005 to 2019. For each calendar year, we determined the cannabis-related ED visit rate per 100,000 ED visits for adults aged ≥65 utilizing primary or secondary diagnosis codes. We estimated the absolute and relative changes in overall cannabis-related visit rates during the study period and by subgroup, including age (65-74, 75-84, ≥85), race/ethnicity, sex, payer/insurance, Charlson comorbidity index score, and cannabis-related diagnosis code. RESULTS The cannabis-related ED visit rate increased significantly for adults aged ≥65 and all subgroups (p < 0.001). The overall rate increased from 20.7 per 100,000 visits in 2005 to 395.0 per 100,000 ED visits in 2019, a 1804% relative increase. By race/ethnicity, older Black adults had the highest ED visit rate in 2019 and the largest absolute increase while older males had a higher ED visit rate in 2019 and a greater absolute increase than older women. Older adults with a higher Charlson score had a higher ED visit rate in 2019 and a larger absolute increase during the study period. CONCLUSION Cannabis-related ED visits are increasing among older adults in California and are an adverse effect of cannabis use. Asking about cannabis use and providing education about its use should be a part of routine medical care for older adults.
Collapse
Affiliation(s)
- Benjamin H. Han
- Division of Geriatrics, Gerontology, and Palliative Care, University of California San Diego School of Medicine
| | - Jesse J. Brennan
- Department of Emergency Medicine, University of California San Diego School of Medicine
| | - Mirella A. Orozco
- Division of Geriatrics, Gerontology, and Palliative Care, University of California San Diego School of Medicine
| | - Alison A. Moore
- Division of Geriatrics, Gerontology, and Palliative Care, University of California San Diego School of Medicine
| | - Edward M. Castillo
- Department of Emergency Medicine, University of California San Diego School of Medicine
| |
Collapse
|
14
|
Bradley EK, Hoots BE, Bradley ES, Roehler DR. Unintentional ingestion of putative delta-8 tetrahydrocannabinol by two youth requiring critical care: a case report. J Cannabis Res 2023; 5:9. [PMID: 36941718 PMCID: PMC10029299 DOI: 10.1186/s42238-023-00176-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/13/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Delta-8 tetrahydrocannabinol (THC) is a psychoactive cannabinoid from the cannabis plant that can be synthetically converted from cannabidiol (CBD). Most states permit the full or restricted sale of hemp and hemp-derived CBD products, and therefore, delta-8 THC products are on the rise. Delta-8 THC consumption can cause intoxication. Products are often sold in edible form and occasionally in packaging that appears similar to candy. Clinical presentations for delta-8 THC ingestions are understudied and may differ from those described for delta-9 THC ingestions. CASE PRESENTATION This case report describes unintentional ingestions of putative delta-8 THC by two pediatric patients that results in admission to the pediatric intensive care unit. The ingestions were of putative delta-8 THC infused product that resembled popular candies. Both patients developed periods of bradypnea with continued intermittent periods of agitation. Medical intervention included observation, noninvasive positive pressure ventilation via high flow nasal cannula, and intubation-but was not needed for both patients. Although family noted ongoing irritability for the patients, both were discharged approximately 45 h after ingestion. Delta-8 THC ingestion is reliant on self-report. CONCLUSIONS As the availability of delta-8 THC increases, along with associated pediatric exposures, it is imperative for health care providers to quickly recognize and provide adequate treatment. While there is no specific antidote for THC intoxication beyond supportive care, providers can play an important role in prevention by educating parents and guardians on safe cannabis storage and by documenting cases for adverse event monitoring.
Collapse
Affiliation(s)
- Erin K Bradley
- Department of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Brooke E Hoots
- Cannabis Strategy Unit, Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, USA
| | - Evan S Bradley
- Department of Emergency Medicine, Division of Medical Toxicology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Douglas R Roehler
- Cannabis Strategy Unit, Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, USA.
| |
Collapse
|
15
|
Hoch AM, Schoenberger SF, Boyle TP, Hadland SE, Gai MJ, Bagley SM. Attitudes and training related to substance use in pediatric emergency departments. Addict Sci Clin Pract 2022; 17:59. [PMID: 36274146 PMCID: PMC9590142 DOI: 10.1186/s13722-022-00339-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, pediatric emergency departments (PED) have seen an increase in presentations related to substance use among their adolescent patient population. We aimed to examine pediatric emergency medicine (PEM) physicians' knowledge, attitudes, and beliefs on caring for adolescents with substance use. METHODS We conducted a cross-sectional online survey of PEM physicians through the American Academy of Pediatrics Pediatric Emergency Medicine Collaborative Research Committee (PEM-CRC) listserv. The 41-item survey contained the following domains: demographics, current protocols and education for managing adolescent substance use, and attitudes about treatment of substance use. We calculated descriptive statistics for each variable within the domains. RESULTS Of 177 respondents (38.2% response rate), 55.4% were female, 45.2% aged ≥ 50 years, 78% worked in a children's hospital, and 50.8% had > 15 years clinical practice. Overall, 77.8% reported caring for adolescents with a chief complaint related to non-opioid substance use and 26.0% opioid use at least once a month. Most (80.9%) reported feeling comfortable treating major medical complications of substance use, while less than half were comfortable treating withdrawal symptoms. 73% said that they were not interested in prescribing buprenorphine. CONCLUSIONS Among this national sample of PEM physicians, 3 of 4 physicians managed substance-related visits monthly, but 52% lacked comfort in managing withdrawal symptoms and 73.1% were not interested in prescribing buprenorphine. Almost all PEM physician identified substance use-related education is important but lacked access to faculty expertise or educational content. Expanded access to education and training for PEM physicians related to substance use is needed.
Collapse
Affiliation(s)
- Ariel M Hoch
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, One Boston Medical Center Place, Boston, MA, 02118, USA.
| | - Samantha F Schoenberger
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Tehnaz P Boyle
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, One Boston Medical Center Place, Boston, MA, 02118, USA
| | - Scott E Hadland
- Division of Adolescent Medicine, Department of Pediatrics, MassGeneral Hospital, Harvard Medical School, Boston, MA, USA
| | - Mam Jarra Gai
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Sarah M Bagley
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Division of General Pediatrics, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
16
|
Hernandez M, Levin FR. Attention-Deficit Hyperactivity Disorder and Therapeutic Cannabis Use Motives. Psychiatr Clin North Am 2022; 45:503-514. [PMID: 36055735 PMCID: PMC11032069 DOI: 10.1016/j.psc.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Rates of cannabis use have been rising in the US due to the increasing legalization/decriminalization of cannabis products for medical and recreational use. Individuals with attention-deficit hyperactivity disorder (ADHD) may be at an increased risk of experiencing cannabis use problems due to deficits in self-regulation. This article explores motivations for cannabis use in ADHD populations. Research on the neural correlates and therapeutic potential of cannabis use are reviewed.
Collapse
Affiliation(s)
- Mariely Hernandez
- Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 43, New York, NY 10032, USA.
| | - Frances R Levin
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 66, New York, NY 10032, USA
| |
Collapse
|
17
|
Kim J, Reitsma J, Parsh B. CBD: Key information for nurses. Nursing 2022; 52:10-11. [PMID: 35866850 DOI: 10.1097/01.nurse.0000839812.29927.ad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Justin Kim
- At California State University, Sacramento, Justin Kim and Jenna Reitsma are nursing students, and Bridget Parsh is a professor. Dr. Parsh is also a member of the Nursing2022 editorial board
| | | | | |
Collapse
|