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Abstract
Little is understood about the unintended consequences of cannabis liberalization on children. Subsequently, this scoping review aimed to map and identify evidence related to acute cannabis intoxication in children. We searched three medical literature databases from inception until October 2019. We identified 4644 information sources and included 158 which were mapped by topic area relating to 1) public health implications and considerations; 2) clinical management; and 3) experiences and information needs of HCPs and families. Public health implications were addressed by 129 (82%) and often reported an increased incidence of acute pediatric cannabis intoxications. Clinical information was reported in 116 (73%) and included information on signs and symptoms (n = 106, 92%), clinical management processes (n = 60, 52%), and treatment recommendations (n = 42, 36%). Few sources addressed the experiences or information needs of either HCPs (n = 5, <1%) treating children for acute cannabis intoxication or families (n = 1, <1%) seeking care. Increasing incidence of acute cannabis intoxications concurrent with liberalization of cannabis legislation is clear, however, evidence around clinical management is limited. Additionally, further research exploring HCPs and families experiences and information needs around cannabis intoxication is warranted.
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Affiliation(s)
- Lindsay A Gaudet
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kaitlin Hogue
- Department of Pediatric Emergency Medicine, Max Rady College of Medicine, Winnipeg, University of Manitoba, MB, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sarah A Elliott
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Cochrane Child Health, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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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.
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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
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Kortas GT, Abrahão ABB, Malbergier A, Fidalgo TM, Moura H, de Andrade AG, Neto FL, Torales J, Ventriglio A, Castaldelli-Maia JM. Immigrants, refugees and cannabis use. Int Rev Psychiatry 2022; 34:59-77. [PMID: 35584015 DOI: 10.1080/09540261.2022.2039595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Immigration typically occurs from low- to high-income countries and regions. Unfortunately, these wealthier areas also have higher rates of cannabis use (e.g. European Union and the US). This systematic review aimed to summarize available studies on cannabis use among immigrants, refugees, and asylum seekers. In addition, evidence on the association between immigration and cannabis use was reviewed. The rates of cannabis use were lower among immigrants than natives. The risk and protective factors to cannabis use were quite similar to those of the native populations. The population at greatest risk for cannabis use were refugees, males, singles, non-religious, those with lower educational level, living in urban areas, with friends that use cannabis and/or other drugs. Cannabis use tend to increase over generations, and acculturation seems to play a pivotal role. First generation migrants report equal or lower consumption of cannabis when compared with the majority population with a subsequent increase in following generations, with a clear association with acculturation factors. A higher cannabis use was found among migrants with lower cultural congruity as well as a higher level of culture assimilation. This use seems to be unrelated to alcohol or illicit drugs consumption, but possibly associated with tobacco smoking.
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Affiliation(s)
| | | | - André Malbergier
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Thiago Marques Fidalgo
- Department of Psychiatry, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.,Young Leaders Program from the National Academy of Medicine, Rio de Janeiro, RJ, Brazil
| | - Helena Moura
- Faculty of Medicine, University of Brasília (UnB), Brasilia, Brazil
| | - Arthur Guerra de Andrade
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Department of Neuroscience, Medical School, FMABC University Center, Santo André, Brazil
| | | | - Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, Asunción, Paraguay
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - João Mauricio Castaldelli-Maia
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Department of Neuroscience, Medical School, FMABC University Center, Santo André, Brazil
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Bechard M, Cloutier P, Lima I, Salamatmanesh M, Zemek R, Bhatt M, Suntharalingam S, Kurdyak P, Baker M, Gardner W. Cannabis-related emergency department visits by youths and their outcomes in Ontario: a trend analysis. CMAJ Open 2022; 10:E100-E108. [PMID: 35135825 PMCID: PMC9259464 DOI: 10.9778/cmajo.20210142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cannabis-related emergency department visits can be an entry point for youths to mental health and substance use care systems. We aimed to examine trends in cannabis-related emergency department visits as a function of youths' age and sex. METHODS Using administrative data, we examined all visits to emergency departments in Ontario, Canada, from 2003 to 2017, by youth aged 10-24 years (grouped as 10-13, 14-18 and 19-24 yr) to determine trends in cannabis-related emergency department visits. Cannabis-related visits were identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes for cannabis poisoning and mental disorders due to cannabinoids. We categorized presentations as "less severe" versus "more severe" using scores assigned by nurses at triage. RESULTS We examined 14 697 778 emergency department visits. Cannabis-related visits increased from 3.8 per 10 000 youths (95% confidence interval [CI] 3.5-4.0) in 2003 to 17.9 (95% CI 17.4-18.4) in 2017, a 4.8-fold increase (95% CI 4.4-5.1). Rates increased for both sexes and each age group. Males were more likely to have a visit than females (rate ratios ≥ 1.5 in 2003 and 2017). The number of cannabis-related visits in 2017 was 25.0 per 10 000 (95% CI 24.0-25.9) among youth aged 19-24 years, 21.9 per 10 000 (95% CI 20.9-22.9) among those aged 14-18 years, and 0.8 per 10 000 (95% CI 0.5-1.0) among those aged 10-13 years. In 2017, 88.2% (95% CI 87.3%-89.0%) of cannabis-related visits and 58.1% (95% CI 58.0%-58.2%) of non-cannabis-related visits were triaged as "more severe," (rate ratio 1.52, 95% CI 1.50-1.53). Similarly, in 2017, 19.0% (95% CI 18.0%-20.1%) of cannabis-related visits and 5.8% (95% CI 5.7%-5.8%) of non-cannabis-related visits resulted in hospital admission (rate ratio 3.3, 95% CI 3.1-3.5). INTERPRETATION Rates of cannabis-related emergency department visit by youths aged 10-24 years increased almost fivefold from 2003 to 2017, with increases in visit severity and hospital admissions. These trends describe an emerging public health problem, and research is needed to identify the causes of this increase and the health and social consequences of cannabis-related visits for these youths.
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Affiliation(s)
- Melanie Bechard
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - Paula Cloutier
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - Isac Lima
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - Mina Salamatmanesh
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - Roger Zemek
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - Maala Bhatt
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - Sinthuja Suntharalingam
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - Paul Kurdyak
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - Melissa Baker
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - William Gardner
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont.
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Yeung MEM, Weaver CG, Hartmann R, Haines-Saah R, Lang E. Emergency Department Pediatric Visits in Alberta for Cannabis After Legalization. Pediatrics 2021; 148:peds.2020-045922. [PMID: 34544846 DOI: 10.1542/peds.2020-045922] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Canada legalized nonmedical cannabis possession and sale in October 2018. In the United States, state legalization has been tied to an increase in cannabis-related emergency department (ED) visits; however, little research exists on provincial changes in pediatric visits after nationwide legislation. We compared pre- and postlegalization trends in pediatric cannabis-related ED visits and presentation patterns in urban Alberta EDs. METHODS Retrospective National Ambulatory Care Reporting System data were queried for urban Alberta cannabis-related ED visits among patients aged <18 years from October 1, 2013, to February 29, 2020. Population subgroups included children (aged 0-11 years), younger adolescents (12 to 14 years), and older adolescents (15 to 17 years). We calculated interrupted time series, incident rate ratios (IRRs), and relative risk (RR) ratios to identify trend change. IRRs identified changes against growth-adjusted Alberta population, while RRs measured presentation pattern changes against prelegalization ED visits. RESULTS Pediatric visit volume did not change postlegalization when accounting for preexisting volume trends. Unintentional ingestions increased in children (IRR: 1.77, 95% confidence interval [CI]: 1.42 to 2.20 and RR: 1.24, 95% CI: 1.05 to 1.47, respectively) and older adolescents (IRR: 1.36, 95% CI: 1.07 to 1.71 and RR: 1.48, 95% CI: 1.21 to 1.81, respectively). Presentation patterns remained similar, although older adolescent co-ingestant use decreased (RR: 0.77, 95% CI: 0.67 to 0.88), whereas hyperemesis cases increased (RR: 1.64, 95% CI: 1.13 to 2.37). CONCLUSIONS Cannabis legalization has increased child and older adolescent unintentional cannabis ingestions, increasing child cannabis-related ED visits. Changes highlight need for public health interventions targeting pediatric exposures.
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Affiliation(s)
| | - Colin G Weaver
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Riley Hartmann
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Changes in Rates of Hospitalizations due to Cannabis Harms in Ontario, Canada Before the Legalization of Nonmedical Cannabis: Retrospective Population-level Study Between 2003 and 2017. J Addict Med 2021; 16:e177-e184. [PMID: 34387560 DOI: 10.1097/adm.0000000000000906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the burden of hospitalizations due to cannabis harms in Ontario, Canada before Canada's legalization of nonmedical cannabis. METHODS We conducted a retrospective population-level study that included all individuals living in Ontario between 2003 and 2017. We described patterns of hospitalizations due to cannabis harms in men and women by demographics, socioeconomic factors, and mental health comorbidities. We calculated annual crude rates of hospitalizations due to cannabis harms and assessed time trends using Poisson regression models. RESULTS There were 39,092 hospitalizations due to cannabis harms among 32,811 unique individuals. Annual hospitalizations due to a cannabis harm increased by 280% between 2003 and 2017 (1712 vs 4730), with increases noted for all age groups and sexes. Rates of hospitalizations due to cannabis harms were greater in young adults, low-income individuals, and those with mental health comorbidities. Overall, the rate of hospitalizations due to cannabis harms increased on average by 7.8% per year (95% CI 7.5-8.0). Women aged 15 to 24 experienced the largest average annual increase (12.2% per year, 95% CI 11.5 to 12.8). CONCLUSIONS There are distinct patterns of hospitalizations due to cannabis harms in different priority populations. Young women aged 15 to 24 are a key demographic that is disproportionately burdened with a rapid increase in hospitalizations due to cannabis harms. Jurisdictions considering new approaches to cannabis control policy and addiction services should consider the rising burden of harms faced by youth and young adults when planning interventions.
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Crocker CE, Carter AJE, Emsley JG, Magee K, Atkinson P, Tibbo PG. When Cannabis Use Goes Wrong: Mental Health Side Effects of Cannabis Use That Present to Emergency Services. Front Psychiatry 2021; 12:640222. [PMID: 33658953 PMCID: PMC7917124 DOI: 10.3389/fpsyt.2021.640222] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/19/2021] [Indexed: 12/25/2022] Open
Abstract
Cannabis use is a modifiable risk factor for the development and exacerbation of mental illness. The strongest evidence of risk is for the development of a psychotic disorder, associated with early and consistent use in youth and young adults. Cannabis-related mental health adverse events precipitating Emergency Department (ED) or Emergency Medical Services presentations can include anxiety, suicidal thoughts, psychotic or attenuated psychotic symptoms, and can account for 25-30% of cannabis-related ED visits. Up to 50% of patients with cannabis-related psychotic symptoms presenting to the ED requiring hospitalization will go on to develop schizophrenia. With the legalization of cannabis in various jurisdiction and the subsequent emerging focus of research in this area, our understanding of who (e.g., age groups and risk factors) are presenting with cannabis-related adverse mental health events in an emergency situation is starting to become clearer. However, for years we have heard in popular culture that cannabis use is less harmful or no more harmful than alcohol use; however, this does not appear to be the case for everyone. It is evident that these ED presentations should be considered another aspect of potentially harmful outcomes that need to be included in knowledge mobilization. In the absence of a clear understanding of the risk factors for mental health adverse events with cannabis use it can be instructive to examine what characteristics are seen with new presentations of mental illness both in emergency departments (ED) and early intervention services for mental illness. In this narrative review, we will discuss what is currently known about cannabis-related mental illness presentations to the ED, discussing risk variables and outcomes both prior to and after legalization, including our experiences following cannabis legalization in Canada. We will also discuss what is known about cannabis-related ED adverse events based on gender or biological sex. We also touch on the differences in magnitude between the impact of alcohol and cannabis on emergency mental health services to fairly present the differences in service demand with the understanding that these two recreational substances may impact different populations of individuals at risk for adverse events.
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Affiliation(s)
- Candice E Crocker
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Alix J E Carter
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.,Emergency Health Services, Halifax, NS, Canada
| | - Jason G Emsley
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kirk Magee
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Paul Atkinson
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.,Horizon Health Network, Saint John, NB, Canada
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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Is there an interest for hair analysis in non-intentional pediatric cannabis intoxication? Forensic Sci Int 2020; 313:110377. [DOI: 10.1016/j.forsciint.2020.110377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 11/22/2022]
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9
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Cannabis et cannabinoïdes de synthèse. À propos de leur détection biologique. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2020; 204:577-582. [PMID: 32300253 PMCID: PMC7161525 DOI: 10.1016/j.banm.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/07/2020] [Indexed: 11/21/2022]
Abstract
Parmi la soixantaine de cannabinoïdes présents dans le cannabis sativa indica on trouve essentiellement des terpénophénols, parmi lesquels figure le delta-9-trans tétrahydrocannabinol (Δ9-THC) qui constitue le principal produit psychoactif chez l’homme. Depuis une dizaine d’années, avec l’émergence du e-commerce et la recherche pharmaceutique sur des médicaments originaux, des dérivés synthétiques du Δ9-THC ont fait leur apparition. Ces molécules, sous le nom générique anglo-saxon de « spices », ont des structures chimiques très différentes, mais se lient toutes sur les mêmes récepteurs CB1 et CB2. Elles miment les effets du Δ9-THC, avec des effets pharmacologiques plus puissants, et donc des effets secondaires bien plus délétères et des durées d’action augmentées. L’usage de tous les cannabinoïdes est contrôlé, ce qui nécessite de disposer de méthodes analytiques performantes pour leur détection. L’objet de cette mini revue est de faire le point sur les possibilités actuelles de mise en évidence et de discuter, en fonction de la matrice biologique utilisée (sang, urine, salive, sueur, air expiré, cheveux) des avantages et des limitations de chaque approche.
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Gonçalves-Pinho M, Bragança M, Freitas A. Psychotic disorders hospitalizations associated with cannabis abuse or dependence: A nationwide big data analysis. Int J Methods Psychiatr Res 2020; 29:e1813. [PMID: 31808250 PMCID: PMC7051837 DOI: 10.1002/mpr.1813] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/25/2019] [Accepted: 10/23/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES We aimed to describe and correlate the hospital panorama of psychotic disorders (PD) with cannabis use (CU) trends in all Portuguese public hospitals. METHODS We conducted a retrospective observational study that analysed all hospitalizations that occurred in Portuguese public hospitals from 2000 to 2015. Hospitalizations with a primary diagnosis of PD or schizophrenia were selected based on Clinical Classification Software diagnostic single-level 659. Episodes associated with CU were identified by the International Classification of Diseases Version 9, Clinical Modification code 304.3/305.2 that correspond to cannabis dependence/cannabis abuse. RESULTS The number of hospitalizations with a primary diagnosis of PD and schizophrenia associated with CU rose 29.4 times during the study period, from 20 to 588 hospitalizations yearly (2000 and 2015, respectively) with a total of 3,233 hospitalizations and an average episode cost of €3,500. Male patients represented 89.8% of all episodes, and the mean/median age at discharge were 30.66/29.00 years, respectively. From all hospitalizations with a primary diagnosis of PD or schizophrenia, the ones with a secondary diagnosis of CU rose from 0.87% in 2000 to 10.60% in 2015. CONCLUSIONS The increase on secondary diagnosis coding and the change on cannabis patterns of consumption in Portuguese population with an increasing frequency of moderate/high dosage cannabis consumers may explain the rise on PD hospitalizations.
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Affiliation(s)
- Manuel Gonçalves-Pinho
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,2D4H - Secondary Data for Healthcare Research, Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Miguel Bragança
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alberto Freitas
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,2D4H - Secondary Data for Healthcare Research, Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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