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Soh J, Kim Y, Shen J, Kang M, Chaudhry S, Chung TH, Kim SH, Hwang Y, Lim D, Khattak A, Frimer L, Yoo JW. Trends of emergency department visits for cannabinoid hyperemesis syndrome in Nevada: An interrupted time series analysis. PLoS One 2024; 19:e0303205. [PMID: 38809874 PMCID: PMC11135771 DOI: 10.1371/journal.pone.0303205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/21/2024] [Indexed: 05/31/2024] Open
Abstract
Cannabis-related emergency department visits have increased after legalization of cannabis for medical and recreational use. Accordingly, the incidence of emergency department visits due to cannabinoid hyperemesis syndrome in patients with chronic cannabis use has also increased. The aim of this study was to examine trends of emergency department visit due to cannabinoid hyperemesis syndrome in Nevada and evaluate factors associated with the increased risk for emergency department visit. The State Emergency Department Databases of Nevada between 2013 and 2021 were used for investigating trends of emergency department visits for cannabinoid hyperemesis syndrome. We compared patients visiting the emergency department due to cannabinoid hyperemesis syndrome with those visiting the emergency department due to other causes except cannabinoid hyperemesis and estimated the impact of cannabis commercialization for recreational use. Emergency department visits due to cannabinoid hyperemesis syndrome have continuously increased during the study period. The number of emergency department visits per 100,000 was 1.07 before commercialization for recreational use. It increased to 2.22 per 100,000 (by approximately 1.1 per 100,000) after commercialization in the third quarter of 2017. Those with cannabinoid hyperemesis syndrome were younger with fewer male patients than those without cannabinoid hyperemesis syndrome. A substantial increase in emergency department visits due to cannabinoid hyperemesis syndrome occurred in Nevada, especially after the commercialization of recreational cannabis. Further study is needed to explore factors associated with emergency department visits.
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Affiliation(s)
- Jaeseung Soh
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, University of Hallym College of Medicine, Anyang, Korea
| | - Yonsu Kim
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, United States of America
| | - Jay Shen
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, United States of America
| | - Mingon Kang
- Department of Computer Science, Howard Hughes College of Engineering, University of Nevada, Las Vegas, NV, United States of America
| | - Stefan Chaudhry
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
| | - Tae Ha Chung
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
- Department of Family Medicine, Wonju Severance Hospital, Wonju, Gangwon Province, Korea
| | - Seo Hyun Kim
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
- Connection Sphere, Las Vegas, NV, United States of America
| | - Yena Hwang
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
| | - Daniel Lim
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
| | - Adam Khattak
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
| | - Leora Frimer
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
| | - Ji Won Yoo
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
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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.
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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
| | - 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
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Brown GW, DeGelorm A, Bellnier TJ. The safety of lookalikes: a new THC beverage enhancer and a non-THC counterpart. J Cannabis Res 2023; 5:14. [PMID: 37198705 DOI: 10.1186/s42238-023-00188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 05/08/2023] [Indexed: 05/19/2023] Open
Abstract
A new tetrahydrocannabinol (THC) beverage enhancer is available to medical and recreational cannabis consumers across the US. Beverage enhancers that do not contain THC, but instead contain flavored concentrates and/or other additives such as caffeine, are used by squirting the contents of a bottle into water, or other beverage of choice, ad libitum and can be used in a titratable manner according to the user's preference or taste. The THC beverage enhancer described herein has an important safety feature: a mechanism that allows users to measure out a 5-mg dose of THC before they add it to their beverage. This mechanism, however, can be easily bypassed if a user attempts to use the product exactly the same way that its non-THC counterparts are used, by turning the bottle upside down and squirting the contents of the bottle into a beverage ad libitum. The THC beverage enhancer described herein would benefit from additional safety features such as a mechanism that prevents the contents of the bottle from leaving the device when turned upside down and a THC warning label.
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Affiliation(s)
- Geoffrey W Brown
- GPI Clinical Research, 1597 W Ridge Rd # 302, Rochester, NY, 14615, USA.
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Nunez J, Corroon J, Vilke G, Castillo E, Alfaraj DN, Coyne CJ. Perceptions and Practices of Cannabis Use Among Emergency Department Patients. J Emerg Med 2023; 64:543-554. [PMID: 37032203 DOI: 10.1016/j.jemermed.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 02/06/2023] [Accepted: 02/17/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Nationally, in states where cannabis has been legalized, increases in cannabis-related hospitalizations and emergency department (ED) visits have also been observed. OBJECTIVES This study aims to: 1) Describe the sociodemographic characteristics of cannabis users presenting to two academic EDs in California; 2) Assess cannabis-related behaviors; 3) Assess perceptions of cannabis; 4) Identify and describe reasons for cannabis-related ED utilization. METHODS This is a cross-sectional study of patients visiting one of two academic EDs between February 16, 2018 and November 21, 2020. Eligible participants completed a novel questionnaire developed by the authors. Basic descriptive statistics, Pearson correlation coefficients, and logistic regression were used for statistical analysis of responses. RESULTS The questionnaire was completed by 2577 patients. A quarter were categorized as Current Users (n = 628, 24.4%). Current, Regular Users were evenly divided across gender, were relatively younger (18-34 years, 48.1%), and were largely non-Hispanic Caucasian. Over half of all respondents believed that the use of cannabis was less harmful than tobacco or alcohol use (n = 1537, 59.6%). One in five Current Users (n = 123, 19.8%) reported driving while using cannabis in the past month. A small proportion (n = 24, 3.9%) of Current Users reported ever visiting the ED for a cannabis-related chief complaint. CONCLUSIONS Overall, many ED patients are currently using cannabis; few report utilizing the ED due to cannabis-related problems. Current, Irregular Users may represent the ideal target group for ED-based educational efforts aimed at improving knowledge of safe cannabis use.
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Affiliation(s)
- Jason Nunez
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Jamie Corroon
- Department of Family Medicine, University of California San Diego, San Diego, California; Helfgott Research Institute, National University of Natural Medicine, Portland, Oregon
| | - Gary Vilke
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Edward Castillo
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Dunya N Alfaraj
- King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Al Khobar, Eastern, Saudi Arabia
| | - Christopher J Coyne
- Department of Emergency Medicine, University of California San Diego, San Diego, California
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Kim S, Weekes J, Young MM, Adams N, Kolla NJ. Trends of repeated emergency department visits among adolescents and young adults for substance use: A repeated cross-sectional study. PLoS One 2023; 18:e0282056. [PMID: 36812221 PMCID: PMC9946266 DOI: 10.1371/journal.pone.0282056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
Emergency Department (ED) visits for substance-related concerns among young people have been increasing in recent years. Understanding the factors related to repeated ED visits (two or more ED visits per year) for substance use concerns among young people is critical to developing a more efficient mental healthcare system that does not overburden ED and that provides efficient care for substance use patients. This study examined trends of substance use-related ED visits and factors related to repeated ED visits (two or more ED visits per year, in comparison to one ED visit per year) among adolescents and young adults (aged 13 to 25 years) in the province of Ontario, Canada. Binary logistic regression models were conducted to examine associations between hospital-related factors (hospital size, urbanicity, triage level, ED wait time) and visit status (2+ vs 1 ED visit/year), controlling for patient characteristics (age/sex). A population-based, repeated cross-sectional data over a 10-year period (2008, 2013, and 2018) was used. The proportion of substance use-related repeated ED visits significantly and consistently increased in the year 2013 and 2018 compared to 2008 (2008 = 12.52%, 2013 = 19.47%, 2018 = 20.19%). Young adult, male, medium-sized hospital, urban location, wait times longer than 6 hours, and symptom severity was associated with increased numbers of repeated ED visits. Furthermore, polysubstance use, opioid use, cocaine use, and stimulant use were strongly associated with repeated ED visits compared with the use of substances such as cannabis, alcohol and sedatives. Current findings suggest that repeated ED visits for substance use concerns could be reduced by policies that reinforce evenly distributed mental health and addiction treatment services across the provinces in rural areas and small hospitals. These services should put special efforts into developing specific (e.g., withdrawal/treatment) programming for substance-related repeated ED patients. The services should target young people using multiple psychoactive substances, stimulants and cocaine.
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Affiliation(s)
- Soyeon Kim
- Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
- * E-mail: (SK); (NJK)
| | - John Weekes
- Carleton University, Ottawa, Ontario, Canada
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Matthew M. Young
- Carleton University, Ottawa, Ontario, Canada
- Greo, Ottawa, Canada
| | - Nicole Adams
- Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Nathan J. Kolla
- Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- * E-mail: (SK); (NJK)
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Britch SC, Walsh SL, Vickers-Smith R, Babalonis S, Slavova S. Cannabinoid Poisoning-Related Emergency Department Visits and Inpatient Hospitalizations in Kentucky, 2017 to 2019. Subst Use Misuse 2022; 58:66-76. [PMID: 36453437 PMCID: PMC9890590 DOI: 10.1080/10826084.2022.2148478] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background and objectives: Cannabis is the most used federally illicit substance. Due to widespread medicinal use and state-level legalization, public perceptions of cannabis have shifted toward the assumption that cannabis is safe. However, cannabinoids can cause adverse medical complications that may lead people to seek treatment. This study characterized cannabinoid poisoning-related medical encounters, poisoning involving cannabinoids and other psychoactive substances, and cannabinoid poisoning-related cardiac complications. Methods: Administrative billing data for emergency department visits and inpatient hospitalizations in acute care facilities with a discharge date from January 1, 2017 to December 31, 2019 were used to characterize cannabinoid poisoning events in Kentucky, identified by ICD-10-CM diagnosis code T40.7X. Results: There were 1,490 encounters of cannabinoid poisoning; patients were primarily non-Hispanic White males, ages 15-44, who had Medicaid and lived in a metropolitan area. Of those, 31.21% involved poisoning with a second psychoactive substance, primarily stimulants and/or opioids, and 17.72% experienced a cardiac complication. Cannabinoid-polydrug poisoning was associated with inpatient treatment (χ2=199.18, p < 0.001) and cardiac complications (χ2=4.58, p < 0.001). Discussion and Conclusions: These results are consistent with other state-level data. Patients who were diagnosed with cannabis-polydrug poisoning, compared to cannabis alone poisoning, had greater odds of hospital admission and cardiac complications, and longer length of hospital stays. Scientific Significance: The health risks of cannabinoid use must be more broadly recognized, while timely and accurate data need to be shared to guide policies on cannabis access. Future research on cannabinoid poisoning should consider the involvement of other psychoactive drugs.
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Affiliation(s)
- Stevie C. Britch
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
| | - Sharon L. Walsh
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Department of Pharmacology, University of Kentucky, Lexington, KY, USA
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, KY, USA
- Department of Psychiatry, University of Kentucky, Lexington, KY, USA
| | - Rachel Vickers-Smith
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, KY, USA
| | - Shanna Babalonis
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
| | - Svetla Slavova
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
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Roehler DR, Hoots BE, Holland KM, Baldwin GT, Vivolo-Kantor AM. Trends and characteristics of cannabis-associated emergency department visits in the United States, 2006-2018. Drug Alcohol Depend 2022; 232:109288. [PMID: 35033959 PMCID: PMC9885359 DOI: 10.1016/j.drugalcdep.2022.109288] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/10/2021] [Accepted: 12/09/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cannabis policies are rapidly changing in the United States, yet little is known about how this has affected cannabis-associated emergency department (ED) visits. METHODS We studied trends in cannabis-associated ED visits and identified differences by visit characteristics. Cannabis-associated ED visits from 2006 to 2018 were identified from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project's (HCUP) Nationwide Emergency Department Sample (NEDS). JoinPoint analysis was used to identify trends from 2006 to 2014, prior to medical coding changes in 2015, and Z-tests were used to compare annual rate changes from 2016 to 2018. Changes in rates from 2017 to 2018 were examined by visit characteristics. RESULTS From 2006-2014, the rate of cannabis-associated ED visits increased, on average, 12.1% annually (p < 0.05), from 12.3 to 34.7 visits per 100,000 population. The rate increased 17.3% from 2016 to 2017 (p < 0.05) and 11.1% from 2017 to 2018 (p < 0.05). From 2017-2018, rates of visits increased for both males (8.7%; p < 0.05) and females (15.9%; p < 0.05). Patients 0-14 years and 25 years and older had significant rate increases from 2017 to 2018 as did the Midwest region (36.8%; p < 0.05), the Northeast (9.2%; p < 0.05), and the South (4.5%; p < 0.05). CONCLUSIONS Cannabis-associated ED visits are on the rise and subgroups are at increased risk. Some potential explanations for increases in cannabis-associated ED visits include increased availability of cannabis products, increased use, and diversity of products available in marketplaces. Strategies are needed to prevent youth initiation, limit potentially harmful use among adults, and ensure safe storage where cannabis use is legal.
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Affiliation(s)
- Douglas R. Roehler
- Correspondence to: Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, MS: S106-8, 4770 Buford Highway NE, Atlanta, GA 30341, United States., (D.R. Roehler)
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Chun SY, Yoo JW, Park H, Hwang J, Kim PC, Park S, Shen JJ. Trends and age-related characteristics of substance use in the hospitalized homeless population. Medicine (Baltimore) 2022; 101:e28917. [PMID: 35212298 PMCID: PMC8878700 DOI: 10.1097/md.0000000000028917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 11/29/2021] [Accepted: 01/24/2022] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT We aimed to examine trends and characteristics of substance use (opioid, cocaine, marijuana, and heroin) among hospitalized homeless patients in comparison with other hospitalized patients in 3 states.This was a cross-sectional study, based on the 2007 to 2015 State Inpatient Data of Arizona, Florida, and Washington (n = 32,162,939). Use of opioid, cocaine, marijuana, heroin, respectively, was identified by the International Classification of Diseases, 9th Revision. Multi-level multivariable regressions were performed to estimate relative risk (RR) and 95% confidence intervals (CI). Dependent variables were the use of substances (opioid, cocaine, marijuana, and heroin), respectively. The main independent variable was homeless status. The subgroup analysis by age group was also conducted.Homeless patients were associated with more use of opioid (RR [CI]), 1.23 [1.20-1.26], cocaine 2.55 [2.50-2.60], marijuana 1.43 [1.40-1.46], and heroin 1.57 [1.29-1.91] compared to other hospitalized patients. All hospitalized patients including those who were homeless increased substance use except the use of cocaine (RR [CI]), 0.57 [0.55-0.58] for other patients and 0.60 [0.50-0.74] for homeless patients. In all age subgroups, homeless patients 60 years old or older were more likely to be hospitalized with all 4 types of substance use, especially, cocaine (RR [CI]), 6.33 [5.81-6.90] and heroin 5.86 [2.08-16.52] in comparison with other hospitalized patients.Homeless status is associated with high risks of substance use among hospitalized patients. Homeless elderly are particularly vulnerable to use of hard drugs including cocaine and heroin during the opioid epidemics.
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Affiliation(s)
- Sung-youn Chun
- Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Ji W. Yoo
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV
| | - Hyeki Park
- Department of International Cooperation, Health Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Jinwook Hwang
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Pearl C. Kim
- Department of Healthcare Administration and Policy, University of Nevada Las Vegas School of Public Health, Las Vegas, NV
| | - Seong Park
- Department of Criminal Justice, University of Nevada Greenspun College of Urban Affairs, Las Vegas, NV
| | - Jay J. Shen
- Department of Criminal Justice, University of Nevada Greenspun College of Urban Affairs, Las Vegas, NV
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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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10
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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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11
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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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12
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Newcomb PA, Ton M, Malen RC, Heffner JL, Labadie J, Phipps AI, Burnett-Hartman AN. Cannabis use is associated with patient and clinical factors in a population-based sample of colorectal cancer survivors. Cancer Causes Control 2021; 32:1321-1327. [PMID: 34263391 DOI: 10.1007/s10552-021-01468-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 06/20/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE This study aimed to characterize patient and clinical factors associated with cannabis (marijuana) use among patients diagnosed with colorectal cancer (CRC). METHODS We identified CRC patients, diagnosed from 2016 to 2018, using the Seattle-Puget Sound Surveillance, Epidemiology, and End Results (SEER) cancer registry. CRC patients were recruited via mail and telephone, and participants completed a questionnaire eliciting information on medical history, demographics, and lifestyle factors, including cannabis use. Cancer stage was obtained from SEER registry data. RESULTS Of 1,433 survey respondents, 339 (24%) were current cannabis users. Current cannabis use was associated with younger age at diagnosis, lower BMI, and a higher prevalence of cigarette smoking and alcohol consumption (p-value < 0.05). Cannabis use was also associated with lower quality of life scores (FACT-C) and advanced-stage cancer (p-value < 0.05). CONCLUSION Cannabis use among CRC patients was common. Patients with more advanced disease were more likely to report cannabis use. Use also varied by some personal factors, consistent with patterns in the general population. Given the high prevalence of cannabis use among CRC patients, research is needed to determine the benefits and harms of cannabis use for symptom management in cancer patients.
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Affiliation(s)
- P A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA. .,Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - M Ton
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - R C Malen
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
| | - J L Heffner
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
| | - J Labadie
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
| | - A I Phipps
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - A N Burnett-Hartman
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA.,Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
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13
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Bourdon JL, Francis MW, Jia L, Liang C, Robinson HI, Grucza RA. The effect of cannabis policies on treatment outcomes for cannabis use among U.S. adults. J Subst Abuse Treat 2021; 131:108535. [PMID: 34154870 DOI: 10.1016/j.jsat.2021.108535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/12/2021] [Accepted: 06/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Research has explored the impact of various medical cannabis policies on substance use treatment admission in recent years, but we know little about factors related to participants' treatment engagement and outcome. To fill this gap in the existing literature, this study used national data to examine the influence of cannabis policies (decriminalized, medical, and recreational) and referral sources (criminal justice vs. voluntary) on treatment completion and length of stay. METHODS Data came from the Treatment Episode Data Set-Discharge (2006-2017) on adults 18+ whose primary drug at treatment admission was cannabis. Difference-in-difference analyses using logistic regression examined the effect of cannabis policies on outpatient treatment completion (yes/no; n = 2,192,807) and length of stay (more/fewer than 90 days; n = 1,863,585) in those with a criminal justice or voluntary referral source. RESULTS Cannabis policy was not associated with treatment completion in either those with a criminal justice or voluntary referral source. Compared to individuals in states where cannabis use was strictly illegal, those in states with a decriminalization policy were less likely to stay in treatment for 91+ days regardless of the referral source. CONCLUSIONS Cannabis policy appears to have a differential effect on treatment completion versus length of stay, with policy having no impact on successful treatment completion. Specifically, we found that decriminalization policies hinder treatment engagement past 90 days. In this sense, length of stay may be a more useful measure of treatment outcome for research than treatment completion moving forward. Furthermore, our study found that neither medical nor recreational policies affected length of stay or treatment completion, regardless of referral source.
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Affiliation(s)
| | - Meredith W Francis
- Brown School of Social Work, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA; Department of Psychiatry, Washington University in St. Louis, 4560 Clayton Avenue, Suite 1000, St. Louis, MO 63110, USA.
| | - Lena Jia
- Washington University School of Medicine, 660 S Euclid Avenue, St. Louis, MO 63110, USA.
| | - Chenxue Liang
- Department of Psychiatry, Washington University in St. Louis, 4560 Clayton Avenue, Suite 1000, St. Louis, MO 63110, USA; Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510.
| | - Helen I Robinson
- Brown School of Social Work, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA.
| | - Richard A Grucza
- Department of Psychiatry, St. Louis University, 660 S Euclid Avenue, St. Louis, MO 63110, USA.
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14
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Carlini BH, Garrett SB, Firth C, Harwick R. Cannabis Retail Staff ("Budtenders") Attitudes Towards Cannabis Effects on Health and Experiences Interacting with Consumers - Washington State, USA. J Psychoactive Drugs 2021; 54:34-42. [PMID: 33781175 DOI: 10.1080/02791072.2021.1900628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cannabis legalization in Washington State has increased the availability, consumption, and potency of cannabis products for adults. Public health education promoting safe use for adult consumers has lagged behind these trends. This study assesses the potential of cannabis retail workers (budtenders) to engage in responsible use education with adult consumers at point of sale. Focus groups explored how budtenders perceive their professional role, including educating consumers about cannabis over intoxication, storage, and risks of use before driving and during pregnancy. Transcripts were analyzed to develop a coding scheme, which was then applied with an iterative review by the research team. Budtenders identified three main professional roles: creating a good experience for customers; being compliant with the state law and regulations, and educating customers on products. Budtenders did not believe their job involved discussing use during pregnancy or while driving or safe storage. They prioritized customers' autonomy over education on these topics, and they did not necessarily consider these behaviors to be harmful. Budtenders are committed to keeping minors outside stores and educating consumers on how to avoid over intoxication and exposure to cannabis contaminants. Future research could build on this to develop point-of-sale education to reduce cannabis use risks.
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Affiliation(s)
- Beatriz H Carlini
- Addiction, Drug & Alcohol Institute, University of Washington, Seattle, WA, USA
| | - Sharon B Garrett
- Addiction, Drug & Alcohol Institute, University of Washington, Seattle, WA, USA
| | - Caislin Firth
- Addiction, Drug & Alcohol Institute, University of Washington, Seattle, WA, USA.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Robin Harwick
- Addiction, Drug & Alcohol Institute, University of Washington, Seattle, WA, USA
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15
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Fong K, Hsueh A, Kendric K, Kunihira K, Siddiqi N, Phan TH, Reibling E, Wolk BJ. Unwitting adult marijuana poisoning: a case series. Clin Toxicol (Phila) 2021; 59:913-917. [PMID: 33688774 DOI: 10.1080/15563650.2021.1891241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
STUDY PURPOSE With increasing state legalization, marijuana use has become commonplace throughout much of the United States. Existing literature on unintentional exposure focuses primarily on children.We report on a cluster of adults with unwitting marijuana exposure. METHODS A cluster of cases were referred to the Medical Toxicology Service after ingesting marijuana-contaminated food at a family event. We conducted a retrospective analysis of twelve subject charts and a qualitative analysis with six of these subjects who willingly consented to be interviewed about their experiences. The study was approved by the Institutional Review Board. RESULTS Three of the subjects (25%) required prolonged observation due to persistent symptoms. Eleven (92%) were urine immunoassay positive for tetrahydrocannabinol (THC). Two subjects (17%) tested positive for ethanol in their blood. Common symptoms experienced by the subjects included confusion (50%), difficulty speaking (67%), nausea (25%), tremors (17%), and feelings of unreality (33%). All interviewed subjects reported sleepiness and three (50%) reported a negative impact on work. Subjects also reported multiple emotions, including anger, confusion, disbelief, and helplessness. None of the cases resulted in admission for critical care or death. CONCLUSIONS Our series illuminates effects of unwitting and/or unintentional marijuana exposure in adults. Unintentional marijuana poisonings have increased, but legal and regulatory barriers have limited the study of marijuana outside highly controlled conditions. While the marijuana exposure in this study did not result in admission for critical care or death, it did result in psychological distress and adversely affected work in some cases.
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Affiliation(s)
- Kelly Fong
- Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Andy Hsueh
- Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kayla Kendric
- Department of Emergency Medicine, Loma Linda University, CA, USA
| | - Karissa Kunihira
- Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Nadia Siddiqi
- Department of Emergency Medicine, Nova Southwestern University College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Tammy H Phan
- Department of Emergency Medicine, Loma Linda University, CA, USA
| | - Ellen Reibling
- Department of Emergency Medicine, Loma Linda University, CA, USA
| | - Brian J Wolk
- Department of Emergency Medicine, Loma Linda University, CA, USA
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16
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Takakuwa KM, Schears RM. The emergency department care of the cannabis and synthetic cannabinoid patient: a narrative review. Int J Emerg Med 2021; 14:10. [PMID: 33568074 PMCID: PMC7874647 DOI: 10.1186/s12245-021-00330-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/05/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cannabis is the most prevalent illegal drug used and the second most common cause of ED drug-related complaints in the USA. Recently, newer more potent strains, concentrated THC products, and consumption methods have become available. OBJECTIVE Our first objective was to define cannabis use in the USA and provide a summary background on its current preparations, pharmacokinetics, vital sign and physical exam findings, adverse effects, and laboratory testing. Our second objective, using the aforementioned summary as relevant background information, was to present and summarize the care and treatment of the most commonly reported cannabis-related topics relevant to ED physicians. METHODS We first performed an extensive literature search of peer-reviewed publications using New PubMed and Cochrane Central Register of Controlled Trials to identify the most commonly reported cannabis-related topics in emergency care. Once the six topic areas were identified, we undertook an extensive narrative literature review for each section of this paper using New PubMed and Cochrane Central Register of Controlled Trials from the inception of the databases to September 30, 2020. RESULTS The six subject areas that were most frequently reported in the medical literature relevant to cannabis-related ED care were acute intoxication/overdose, pediatric exposure, cannabinoid hyperemesis syndrome, cannabis withdrawal, e-cigarette or vaping product use-associated lung injury (EVALI), and synthetic cannabinoids. CONCLUSION As cannabis becomes more widely available with the adoption of state medical cannabis laws, ED-related cannabis visits will likely rise. While cannabis has historically been considered a relatively safe drug, increased legal and illegal access to newer formulations of higher potency products and consumption methods have altered the management and approach to ED patient care and forced physicians to become more vigilant about recognizing and treating some new cannabis-related life-threatening conditions.
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Affiliation(s)
- Kevin M Takakuwa
- Society of Cannabis Clinicians, PO Box 27574, San Francisco, CA, 94127, USA.
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17
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Takakuwa KM, Shofer FS, Schears RM. Letter to the Editor: A National Survey of U.S. Emergency Medicine Physicians on Their Knowledge Regarding State and Federal Cannabis Laws. Cannabis Cannabinoid Res 2021; 5:337-339. [PMID: 33381647 DOI: 10.1089/can.2019.0073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Frances S Shofer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raquel M Schears
- Department of Emergency Medicine, University of Central Florida, Orlando, Florida, USA
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18
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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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19
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Shan G, Bayram E, Caldwell JZ, Miller JB, Shen JJ, Gerstenberger S. Partial correlation coefficient for a study with repeated measurements. Stat Biopharm Res 2020; 13:448-454. [PMID: 35003527 PMCID: PMC8735669 DOI: 10.1080/19466315.2020.1784780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 02/01/2023]
Abstract
Repeated data are increasingly collected in studies to investigate the trajectory of change in measurements over time. Determining a link between one repeated measurement with another that is considered as the biomarker for disease progression, may provide a new target for drug development. When a third variable is associated with one of the two measurements, partial correlation after eliminating the effect of that variable is able to provide reliable estimate for association as compared to the existing raw correlation for repeated data. We propose using linear regression models to compute residuals by modeling a relationship between each measurement and a third variable. The computed residuals are then used in a linear mixed model (implemented by SAS Proc Mixed) to compute partial correlation for repeated data. Alternatively, the partial correlation may be computed as the average of partial correlations at each visit. We provide two real examples to illustrate the application of the proposed partial correlation, and conduct extensive numerical studies to compare the proposed partial correlation coefficients.
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Affiliation(s)
- Guogen Shan
- School of Public Health, University of Nevada Las Vegas, Las Vegas, NV 89154
| | - Ece Bayram
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Avenue, Las Vegas, NV 89106
| | - Jessica Z.K. Caldwell
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Avenue, Las Vegas, NV 89106
| | - Justin B. Miller
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Avenue, Las Vegas, NV 89106
| | - Jay J. Shen
- School of Public Health, University of Nevada Las Vegas, Las Vegas, NV 89154
| | - Shawn Gerstenberger
- School of Public Health, University of Nevada Las Vegas, Las Vegas, NV 89154
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20
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Fischer B, Daldegan‐Bueno D, Boden JM. Facing the option for the legalisation of cannabis use and supply in New Zealand: An overview of relevant evidence, concepts and considerations. Drug Alcohol Rev 2020; 39:555-567. [PMID: 32436274 PMCID: PMC7383663 DOI: 10.1111/dar.13087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 12/18/2022]
Abstract
ISSUES Non-medical cannabis policies are changing, including towards legalisation-with-regulation frameworks. New Zealand will hold a public referendum on cannabis legalisation in 2020. We reviewed data on cannabis use and health/social harms; policy reform options; experiences with and outcomes of reforms elsewhere; and other relevant considerations towards informing policy choices in the upcoming referendum. APPROACH Relevant epidemiological, health, social, criminal justice and policy studies and data were identified and comprehensively reviewed. KEY FINDINGS Cannabis use is common (including in New Zealand) and associated with risks for health and social harms, mainly concentrated in young users; key harms are attributable to criminalisation. 'Decriminalisation' reforms have produced ambivalent results. Existing cannabis legalisation frameworks vary considerably in main parameters. Legalisation offers some distinct advantages, for example regulated use, products and user education, yet outcomes depend on essential regulation parameters, including commercialisation, and policy ecologies. While major changes in use are not observed, legalisation experiences are inconclusive to date, including mixed health and social outcomes, with select harms increasing and resilient illegal markets. It is unclear whether legalisation reduces cannabis exposure or social harms (e.g. from enforcement) for youth. IMPLICATIONS/CONCLUSIONS No conclusive overall evidence on the outcomes of legalisation elsewhere exists, nor is evidence easily transferable to other settings. Legalisation offers direct social justice benefits for adults, yet overall public health impacts are uncertain. Legalisation may not categorically improve health or social outcomes for youth. Legalisation remains a well-intended, while experimental policy option towards more measured and sensible cannabis control and overall greater policy coherence, requiring close monitoring and possible adjustments depending on setting-specific outcomes.
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Affiliation(s)
- Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
- Department of PsychiatryUniversity of TorontoTorontoCanada
- Centre for Applied Research in Mental Health and AddictionSimon Fraser UniversityVancouverCanada
- Department of PsychiatryFederal University of Sao PauloSao Paulo, Brazil
| | - Dimitri Daldegan‐Bueno
- Schools of Population Health and Pharmacy, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Joseph M. Boden
- Department of Psychological MedicineUniversity of OtagoChristchurchNew Zealand
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21
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Hwang J, Shen JJ, Kim SJ, Chun SY, Kim PC, Lee SW, Byun D, Yoo JW. Opioid use disorders and hospital palliative care among patients with gastrointestinal cancers: Ten-year trend and associated factors in the U.S. from 2005 to 2014. Medicine (Baltimore) 2020; 99:e20723. [PMID: 32569209 PMCID: PMC7310906 DOI: 10.1097/md.0000000000020723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to analyze the trends of opioid use disorders, cannabis use disorders, and palliative care among hospitalized patients with gastrointestinal cancer and to identify their associated factors.We analyzed the National Inpatient Sample data from 2005 to 2014 and included hospitalized patients with gastrointestinal cancers. The trends of hospital palliative care and opioid or cannabis use disorders were analyzed using the compound annual growth rates (CAGR) with Rao-Scott correction for χ tests. Multivariate logistic regression analyses were performed to identify the associated factors.From 2005 to 2014, among 4,364,416 hospitalizations of patients with gastrointestinal cancer, the average annual rates of opioid and cannabis use disorders were 0.4% (n = 19,520), and 0.3% (n = 13,009), respectively. The utilization rate of hospital palliative care was 6.2% (n = 268,742). They all sharply increased for 10 years (CAGR = 9.61%, 22.2%, and 21.51%, respectively). The patients with a cannabis use disorder were over 4 times more likely to have an opioid use disorder (Odds ratios, OR = 4.029; P < .001). Hospital palliative care was associated with higher opioid use disorder rates, higher in-hospital mortality, shorter length of hospital stay, and lower hospital charges. (OR = 1.527, 9.980, B = -0.054 and -0.386; each of P < .001)The temporal trends of opioid use disorders and hospital palliative care use among patients with gastrointestinal cancer increased from 2005 to 2014, which is mostly attributed to patients with a higher risk of in-hospital mortality. Cannabis use disorders were associated with opioid use disorders. Palliative care was associated with both reduced lengths of stay and hospital charge.
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Affiliation(s)
- Jinwook Hwang
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Jay J. Shen
- Department of Health Care Administration and Policy School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Sun Jung Kim
- Department of Health Administration and Management, Soonchunhyang University, Asan, South Korea
| | - Sung-Youn Chun
- Department of Health Care Administration and Policy School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Pearl C. Kim
- Department of Health Care Administration and Policy School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Se Won Lee
- Department of Physical Medicine and Rehabilitation, Mountain View Hospital, Las Vegas, Nevada
| | - David Byun
- Department of Internal Medicine, Southern Nevada Veterans Affairs Health System, North Las Vegas, Nevada
| | - Ji Won Yoo
- Department of Internal Medicine, University of Nevada Las Vegas, School of Medicine, Las Vegas, Nevada
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22
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Kam AJ. Grandma's brownies are not what they used to be: Acute intoxication from cannabis ingestion. Paediatr Child Health 2020; 25:S3-S4. [PMID: 33390751 PMCID: PMC7757769 DOI: 10.1093/pch/pxaa014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/21/2019] [Indexed: 06/29/2024] Open
Affiliation(s)
- April J Kam
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster Children’s Hospital, McMaster University, Hamilton, Ontario
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23
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Incidence and Correlates of Cannabinoid-Related Psychiatric Emergency Care: A Retrospective, Multiyear Cohort Study. CANADIAN JOURNAL OF ADDICTION 2020. [DOI: 10.1097/cxa.0000000000000075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Lee SW, Shen J, Kim SJ, Chun SY, Kim P, Riaz J, Yoo JW, Hwang J. US Trends of Opioid-use Disorders and Associated Factors Among Hospitalized Patients With Spinal Conditions and Treatment From 2005 to 2014. Spine (Phila Pa 1976) 2020; 45:124-133. [PMID: 31851144 PMCID: PMC6924939 DOI: 10.1097/brs.0000000000003183] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/06/2019] [Accepted: 06/17/2019] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Serial cross-sectional study utilizing the National Inpatient Sample (NIS) 2005 to 2014. OBJECTIVE The aim of this study was to examine the trends of opioid-use disorders among hospitalized patients with spinal conditions and treatment and to identify its contributing factors. SUMMARY OF BACKGROUND DATA The opioid is widely used in chronic spinal conditions, and misuse of prescriptions is the main culprit of the opioid crisis. Cannabis, the most commonly utilized illicit drug, has recently been substituted for opioid despite increasing cannabis-use emergency room visits. There is limited information on opioid-use disorders, the association with cannabis, and other contributing factors. METHODS We analyzed the 2005 to 2014 NIS data that identified opioid-use disorders among hospitalized patients with cervical and lumbar spinal conditions and treatment using the International Classification of Disease, Ninth Revision-Clinical Modification codes for opioid abuse, dependence, poisoning, and cervical and lumbar spinal diseases and procedures. The compound annual growth rate (CAGR) was used to quantify trends of opioid-use disorders among hospitalized patients. Multilevel and multivariable regression analyses were performed to determine their contributing factors. RESULTS The number of hospitalizations with spinal conditions and treatment increased from 2005 to 2011, then decreased between 2011 and 2014 with an overall decrease in length of stay, resulting in the CAGR of -1.60% (P < .001). Almost 3% (2.93%, n = 557,423) of hospitalized patients with spinal conditions and treatment were diagnosed as opioid-use disorders and its CAGR was 6.47% (P < .0001). Opioid-use disorders were associated with cannabis-use disorders (odds ratio 1.714), substance use, mental health condition, younger age, white race, male sex, higher household income, and public insurance or uninsured. CONCLUSION This study suggests that opioid-use disorders are increasing among hospitalized patients with spinal conditions and treatment and associated with several demographic, and socioeconomic factors, including cannabis-use disorders. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Se Won Lee
- Department of Physical Medicine and Rehabilitation, Mountain View Hospital, Las Vegas, NV
| | - Jay Shen
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
| | - Sun Jung Kim
- Department of Health Administration and Management, Soonchunhyang University, Asan, Chungcheongnam-do, Korea
| | - Sung-Youn Chun
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
| | - Pearl Kim
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
| | - Jahan Riaz
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV
| | - Ji Won Yoo
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV
| | - Jinwook Hwang
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
- Department of Cardiovascular and Thoracic Surgery, Korea University Medical Center, Ansan Hospital, Ansan, Gyeonggi-do, South Korea
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25
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Kim PC, Yoo JW, Cochran CR, Park SM, Chun S, Lee YJ, Shen JJ. Trends and associated factors of use of opioid, heroin, and cannabis among patients for emergency department visits in Nevada: 2009-2017. Medicine (Baltimore) 2019; 98:e17739. [PMID: 31764772 PMCID: PMC6882558 DOI: 10.1097/md.0000000000017739] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
To examine trends and contributing factors of opioid, heroin, and cannabis-associated emergency department (ED) visits in Nevada.The 2009 to 2017 Nevada State ED database (n = 7,950,554 ED visits) were used. Use of opioid, heroin, and cannabis, respectively, was identified by the International Classification of Diseases, 9th & 10th Revisions. Three multivariable models, one for each of the 3 dependent variables, were conducted. Independent variables included year, insurance status, race/ethnicity, use of other substance, and mental health conditions.The number of individuals with opioid, heroin, cannabis-associated ED visits increased 3%, 10%, and 23% annually from 2009 to 2015, particularly among 21 to 29 age group, females, and African Americans. Use of other substance (odds ratio [OR] = 3.91; 95% confidence interval [CI] = 3.84, 3.99; reference - no use of other substance), mental health conditions (OR = 2.48; 95% CI = 2.43, 2.53; reference - without mental health conditions), Medicaid (OR = 1.41; 95% CI = 1.38, 1.44; reference - non-Medicaid), Medicare (OR = 1.44; 95% CI = 1.39, 1.49; reference - non-Medicare) and uninsured patients (OR = 1.52; 95% CI = 1.49, 1.56; reference - insured) were predictors of all three substance-associated ED visits.With a steady increase in trends of opioid, heroin, and cannabis-associated ED visits in recent years, the main contributing factors include patient sociodemographic factors, mental health conditions, and use of other substances.
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Affiliation(s)
- Pearl C. Kim
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada, Las Vegas
| | - Ji Won Yoo
- Department of Internal Medicine, School of Medicine, University of Nevada, Las Vegas
| | - Chris R. Cochran
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada, Las Vegas
| | - Seong-Min Park
- Department of Criminal Justice, Greenspun College of Urban Affairs, University of Nevada, Las Vegas, NV
| | - Sungyoun Chun
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada, Las Vegas
| | - Yong-Jae Lee
- Department of Family Medicine, College of Medicine, Yonsei University, Seoul, South Korea
| | - Jay J. Shen
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada, Las Vegas
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Cannabis-Induced Third-Degree AV Block. Case Rep Emerg Med 2019; 2019:5037356. [PMID: 31637064 PMCID: PMC6766110 DOI: 10.1155/2019/5037356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/18/2019] [Accepted: 07/31/2019] [Indexed: 01/27/2023] Open
Abstract
Background Cannabis (marijuana) is the most widely consumed illicit drug in Europe. However, many are unaware of its potential cardiovascular side effects. Case Report A 19-year-old man presented to the emergency department with palpitations and presyncope after smoking cannabis. A third-degree atrioventricular block (complete heart block) was diagnosed. We believe cannabis exposure to have been the likely cause. Extensive work-up—including Borrelia and auto-immune serology, CT coronary angiography, magnetic resonance imaging, and electrophysiological study—was negative. The patient was initially treated with IV isoprenaline. Within one day, the bradycardia spontaneously resolved. The patient was advised to quit using cannabis. No further therapy was initiated. We discuss the clinical presentation, pathophysiology, and evidence from the literature linking cannabis exposure to bradycardia. Conclusion We describe a case of third-degree atrioventricular block after cannabis use. Emergency physicians should be aware of the potential cardiovascular side effects of this drug.
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Bahji A, Stephenson C. International Perspectives on the Implications of Cannabis Legalization: A Systematic Review & Thematic Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173095. [PMID: 31454942 PMCID: PMC6747067 DOI: 10.3390/ijerph16173095] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/15/2019] [Accepted: 08/23/2019] [Indexed: 12/16/2022]
Abstract
The legality, recreational and medical use of cannabis varies widely by country and region but remains largely prohibited internationally. In October 2018, Canada legalized the recreational use of cannabis—a move many viewed as controversial. Proponents of legalization have emphasized the potential to eradicate the marijuana black market, improve quality and safety control, increase tax revenues, improve the availability of medical cannabis, and lower gang-related drug violence. Conversely, opponents of legalization have stressed concerns about cannabis’ addictive potential, second-hand cannabis exposure, potential exacerbation of underlying and established mental illnesses, as well as alterations in perception that affect safety, particularly driving. This systematic review synthesizes recent international literature on the clinical and public health implications of cannabis legalization.
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Affiliation(s)
- Anees Bahji
- Department of Public Health Sciences, Queen's University, Kingston, ON K7L 3N6, Canada.
- Department of Psychiatry, Queen's University, Kingston, ON K7L 3N6, Canada.
| | - Callum Stephenson
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada
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Montgomery L, McClure EA, Tomko RL, Sonne SC, Winhusen T, Terry GE, Grossman JT, Gray KM. Blunts versus joints: Cannabis use characteristics and consequences among treatment-seeking adults. Drug Alcohol Depend 2019; 198:105-111. [PMID: 30901744 PMCID: PMC6467739 DOI: 10.1016/j.drugalcdep.2019.01.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/03/2019] [Accepted: 01/27/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite the high prevalence of blunt smoking among cannabis users, very few studies examine the clinical profile of blunt smokers relative to those using more common methods of cannabis use, such as joints. METHODS The current study uses baseline data from the ACCENT (Achieving Cannabis Cessation-Evaluating N-acetylcysteine Treatment) study, a multi-site randomized pharmacotherapy clinical trial within the National Drug Abuse Treatment Clinical Trials Network, to predict the association between blunt and joint use frequency and cannabis use characteristics (e.g., grams of cannabis used) and consequences (e.g., withdrawal) among past-month cannabis users (N = 377) who were screened for study participation. RESULTS After controlling for race, age, gender, other forms of cannabis use (including joint use) and nicotine dependence, multivariable linear regression models indicated that the number of days of blunt use in the past month was a significant predictor of the average amount of cannabis per using day (t = 3.04, p < .01), the estimated average cost of cannabis (t = 2.28, p < .05) and Cannabis Withdrawal Scale scores (t = 1.94, p < .05). Frequency of joint use did not significantly predict any of the cannabis use characteristics or consequences. CONCLUSIONS Blunt smokers may present to treatment with greater amounts of cannabis smoked and more intense withdrawal symptoms, which may adversely impact their likelihood of successful abstinence. Cannabis-dependent blunt smokers may be more likely to benefit from treatment that targets physiological and mood-related withdrawal symptoms.
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Affiliation(s)
- LaTrice Montgomery
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 104, Cincinnati, OH, 45229, USA.
| | - Erin A. McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA
| | - Rachel L. Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA
| | - Susan C. Sonne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA
| | - Theresa Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 104, Cincinnati, OH 45229, USA
| | - Garth E. Terry
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1660 S Columbian Way, Seattle, WA 98108, USA
| | - Jason T. Grossman
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles; Integrated Substance Abuse Programs, 11075 Santa Monica Blvd Ste 200, Los Angeles, CA 90025, USA
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA
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