1
|
Fortier A, Zouaoui I, Dumais A, Potvin S. Effects of Recreational Cannabis Legalization on Mental Health: Scoping Review. Psychiatr Serv 2024; 75:872-887. [PMID: 38650490 DOI: 10.1176/appi.ps.20230434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Recreational cannabis legalization (RCL) is expanding rapidly. RCL's effects on mental health issues are of particular concern because cannabis use is more frequent among people receiving psychiatric care and is associated with several psychiatric disorders. The authors conducted a scoping review to examine the evidence and discern gaps in the literature concerning the effects of RCL on mental health and to assess the factors responsible for an observed heterogeneity in research results. METHODS This scoping literature review followed PRISMA guidelines. Five databases-MEDLINE, CINAHL, Embase, APA PsycInfo, and Web of Science-were searched for English- or French-language reports published between January 1, 2012, and April 30, 2023. RESULTS Twenty-eight studies from the United States and Canada were found. The studies were classified by category of the study's data (patients receiving psychiatric care [k=1], death records [k=4], emergency department or hospital records [k=10], and the general population [k=13]) and by the diagnosis (schizophrenia or psychoses, mood disorders, anxiety disorders and symptoms, suicide or suicidal ideation, or other mental health issues) examined. The review findings revealed a paucity of research and indicated mixed and largely inconclusive results of the studies examined. Research gaps were found in the examination of potential changes in cannabis use patterns among people receiving psychiatric care and in the availability of longitudinal studies. CONCLUSIONS Clinicians, researchers, and policy makers need to collaborate to address the research gaps and to develop evidence-based policies that reflect a thorough understanding of the effects associated with RCL.
Collapse
Affiliation(s)
- Alexandra Fortier
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, and Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal
| | - Inès Zouaoui
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, and Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal
| | - Alexandre Dumais
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, and Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal
| | - Stéphane Potvin
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, and Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal
| |
Collapse
|
2
|
L’Heureux S, Huot-Lavoie M, Bergeron A, Bergeron C, Blouin BP, Roy MA. Effect of Cannabis Legalization in Canada on the Incidence of Psychosis Consultations in Quebec City's Psychiatric Emergency Services. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:630-632. [PMID: 38380880 PMCID: PMC11298097 DOI: 10.1177/07067437241232901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Sophie L’Heureux
- PPEP Capitale-Nationale, Centre Intégré Universitaire de Soins et Services Sociaux (CIUSSS) de la Capitale Nationale, Québec, QC, Canada
- Department of Psychiatry and Neurosciences, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Maxime Huot-Lavoie
- PPEP Capitale-Nationale, Centre Intégré Universitaire de Soins et Services Sociaux (CIUSSS) de la Capitale Nationale, Québec, QC, Canada
- Department of Psychiatry and Neurosciences, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Audrey Bergeron
- Centre Intégré de Santé et de Services Sociaux de Lanaudière, Joliette, Québec, Canada
| | - Christina Bergeron
- Department of Psychiatry and Neurosciences, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Bruno-Pier Blouin
- Department of Psychiatry and Neurosciences, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Marc-André Roy
- PPEP Capitale-Nationale, Centre Intégré Universitaire de Soins et Services Sociaux (CIUSSS) de la Capitale Nationale, Québec, QC, Canada
- Department of Psychiatry and Neurosciences, Faculty of Medicine, Laval University, Québec, QC, Canada
| |
Collapse
|
3
|
Schoeler T, Baldwin JR, Martin E, Barkhuizen W, Pingault JB. Assessing rates and predictors of cannabis-associated psychotic symptoms across observational, experimental and medical research. NATURE. MENTAL HEALTH 2024; 2:865-876. [PMID: 39005547 PMCID: PMC11236708 DOI: 10.1038/s44220-024-00261-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 04/26/2024] [Indexed: 07/16/2024]
Abstract
Cannabis, one of the most widely used psychoactive substances worldwide, can give rise to acute cannabis-associated psychotic symptoms (CAPS). While distinct study designs have been used to examine CAPS, an overarching synthesis of the existing findings has not yet been carried forward. To that end, we quantitatively pooled the evidence on rates and predictors of CAPS (k = 162 studies, n = 210,283 cannabis-exposed individuals) as studied in (1) observational research, (2) experimental tetrahydrocannabinol (THC) studies, and (3) medicinal cannabis research. We found that rates of CAPS varied substantially across the study designs, given the high rates reported by observational and experimental research (19% and 21%, respectively) but not medicinal cannabis studies (2%). CAPS was predicted by THC administration (for example, single dose, Cohen's d = 0.7), mental health liabilities (for example, bipolar disorder, d = 0.8), dopamine activity (d = 0.4), younger age (d = -0.2), and female gender (d = -0.09). Neither candidate genes (for example, COMT, AKT1) nor other demographic variables (for example, education) predicted CAPS in meta-analytical models. The results reinforce the need to more closely monitor adverse cannabis-related outcomes in vulnerable individuals as these individuals may benefit most from harm-reduction efforts.
Collapse
Affiliation(s)
- Tabea Schoeler
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
- Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Jessie R. Baldwin
- Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ellen Martin
- Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Wikus Barkhuizen
- Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Jean-Baptiste Pingault
- Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| |
Collapse
|
4
|
Di Ciano P, Wickens C, Paul EM, Mahmood R, Crépault JF, Rueda S, Boileau I. The Cannabis Act: implications for human participant research with cannabis. J Psychiatry Neurosci 2024; 49:E212-E217. [PMID: 38889952 PMCID: PMC11192575 DOI: 10.1503/jpn.240049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Affiliation(s)
- Patricia Di Ciano
- From the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont. (Di Ciano, Wickens, Paul, Rueda); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Boileau); the Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Crépault); the Campbell Family Mental Health Research Institute, Toronto, Ont. (Di Ciano, Wickens, Rueda, Boileau); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Rueda); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Wickens, Boileau); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Mahmood, Rueda, Boileau); the Addiction Imaging Research Group, Centre for Addiction and Mental Health, Toronto, Ont. (Mahmood, Boileau); the Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Boileau); Communications and Partnerships, Centre for Addiction and Mental Health, Toronto, Ont. (Crépault)
| | - Christine Wickens
- From the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont. (Di Ciano, Wickens, Paul, Rueda); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Boileau); the Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Crépault); the Campbell Family Mental Health Research Institute, Toronto, Ont. (Di Ciano, Wickens, Rueda, Boileau); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Rueda); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Wickens, Boileau); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Mahmood, Rueda, Boileau); the Addiction Imaging Research Group, Centre for Addiction and Mental Health, Toronto, Ont. (Mahmood, Boileau); the Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Boileau); Communications and Partnerships, Centre for Addiction and Mental Health, Toronto, Ont. (Crépault)
| | - Elvin M Paul
- From the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont. (Di Ciano, Wickens, Paul, Rueda); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Boileau); the Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Crépault); the Campbell Family Mental Health Research Institute, Toronto, Ont. (Di Ciano, Wickens, Rueda, Boileau); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Rueda); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Wickens, Boileau); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Mahmood, Rueda, Boileau); the Addiction Imaging Research Group, Centre for Addiction and Mental Health, Toronto, Ont. (Mahmood, Boileau); the Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Boileau); Communications and Partnerships, Centre for Addiction and Mental Health, Toronto, Ont. (Crépault)
| | - Raesham Mahmood
- From the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont. (Di Ciano, Wickens, Paul, Rueda); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Boileau); the Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Crépault); the Campbell Family Mental Health Research Institute, Toronto, Ont. (Di Ciano, Wickens, Rueda, Boileau); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Rueda); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Wickens, Boileau); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Mahmood, Rueda, Boileau); the Addiction Imaging Research Group, Centre for Addiction and Mental Health, Toronto, Ont. (Mahmood, Boileau); the Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Boileau); Communications and Partnerships, Centre for Addiction and Mental Health, Toronto, Ont. (Crépault)
| | - Jean-François Crépault
- From the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont. (Di Ciano, Wickens, Paul, Rueda); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Boileau); the Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Crépault); the Campbell Family Mental Health Research Institute, Toronto, Ont. (Di Ciano, Wickens, Rueda, Boileau); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Rueda); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Wickens, Boileau); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Mahmood, Rueda, Boileau); the Addiction Imaging Research Group, Centre for Addiction and Mental Health, Toronto, Ont. (Mahmood, Boileau); the Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Boileau); Communications and Partnerships, Centre for Addiction and Mental Health, Toronto, Ont. (Crépault)
| | - Sergio Rueda
- From the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont. (Di Ciano, Wickens, Paul, Rueda); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Boileau); the Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Crépault); the Campbell Family Mental Health Research Institute, Toronto, Ont. (Di Ciano, Wickens, Rueda, Boileau); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Rueda); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Wickens, Boileau); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Mahmood, Rueda, Boileau); the Addiction Imaging Research Group, Centre for Addiction and Mental Health, Toronto, Ont. (Mahmood, Boileau); the Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Boileau); Communications and Partnerships, Centre for Addiction and Mental Health, Toronto, Ont. (Crépault)
| | - Isabelle Boileau
- From the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont. (Di Ciano, Wickens, Paul, Rueda); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Boileau); the Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Di Ciano, Wickens, Crépault); the Campbell Family Mental Health Research Institute, Toronto, Ont. (Di Ciano, Wickens, Rueda, Boileau); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Rueda); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Wickens, Boileau); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Mahmood, Rueda, Boileau); the Addiction Imaging Research Group, Centre for Addiction and Mental Health, Toronto, Ont. (Mahmood, Boileau); the Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Boileau); Communications and Partnerships, Centre for Addiction and Mental Health, Toronto, Ont. (Crépault)
| |
Collapse
|
5
|
Cantor N, Silverman M, Gaudreault A, Hutton B, Brown C, Elton-Marshall T, Imtiaz S, Sikora L, Tanuseputro P, Myran DT. The association between physical availability of cannabis retail outlets and frequent cannabis use and related health harms: a systematic review. LANCET REGIONAL HEALTH. AMERICAS 2024; 32:100708. [PMID: 38486811 PMCID: PMC10937151 DOI: 10.1016/j.lana.2024.100708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/10/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024]
Abstract
An increasing number of regions have or are considering legalising the sale of cannabis for adult use. Experience from tobacco and alcohol regulation has found that greater access to physical retail stores is positively associated with increased substance use and harm. Whether this association exists for cannabis is unclear. We completed a systematic review examining the association between cannabis retail store access and adverse health outcomes. We identified articles up until July 20, 2023 by searching four databases. We included studies examining the association between measures of cannabis store access and adverse outcomes: frequent or problematic cannabis use, healthcare encounters due to cannabis use (e.g., cannabis-induced psychosis), and healthcare encounters potentially related to cannabis (e.g., self-harm episodes). Results were compared by study design type, retail access measure, and by subgroups including: children, adolescents, young adults, adults, and pregnant individuals. This review was registered with PROSPERO (CRD42021281788). The search generated 5750 citations of which we included 32 studies containing 44 unique primary analyses (unique retail measure and outcome pairs). Studies come from 4 countries (United States, Canada, Netherlands and Uruguay). Among the included analyses, there were consistent positive associations between greater cannabis retail access and 1) increased healthcare service use or poison control calls directly due to cannabis (10/12 analyses; 83%) (2) increased cannabis use and cannabis-related hospitalization during pregnancy (4/4; 100%) and 3) frequent cannabis use in adults and young adults (7/11; 64%). There was no consistent positive association between greater cannabis retail and increased frequent cannabis use in adolescents (1/4; 25%), healthcare service use potentially related to cannabis (2/6; 33%) or increased adverse neonatal birth outcomes (2/7; 26.8%). There is a positive association between greater cannabis store access and increases in cannabis harm. In countries with legal cannabis, retail restrictions may reduce use and harm. Funding Canadian Centre on Substance Use and Addiction (CCSA).
Collapse
Affiliation(s)
- Nathan Cantor
- Department of Medicine, McMaster University, 90 Main St W Hamilton, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, ON, Canada
| | - Max Silverman
- Department of Medicine, McMaster University, 90 Main St W Hamilton, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, ON, Canada
| | - Adrienne Gaudreault
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, ON, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, ON, Canada
| | - Catherine Brown
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, ON, Canada
| | - Tara Elton-Marshall
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON SN 1006, Canada
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, Canada
| | - Lindsey Sikora
- University of Ottawa, 75 Laurier Avenue East, ON, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, ON, Canada
- Bruyere Research Institute, 85 Primrose Ave, ON, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, 1053 Carling Avenue, ON, Canada
| | - Daniel T. Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, ON, Canada
- Bruyere Research Institute, 85 Primrose Ave, ON, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, 1053 Carling Avenue, ON, Canada
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent, ON, Canada
| |
Collapse
|
6
|
Leclerc L, Fakra E, Pignon B, Benyamina A, Gaillard R, Rolland B. Opinions of French psychiatrists on the regulatory status of cannabis: Results from the "PsyCan - Encéphale" national online survey. L'ENCEPHALE 2024:S0013-7006(23)00215-4. [PMID: 38311481 DOI: 10.1016/j.encep.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 09/30/2023] [Accepted: 11/02/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVE To explore the opinions of French psychiatrists toward the legalization of medical or recreational use of cannabis in France. METHODS Psycan was an anonymous Internet survey conducted between September 28, 2021 and March 29, 2022, among subscribers of the Encéphale Online community, i.e., approximately 4000 French psychiatrists. Participants were asked to complete a structured questionnaire, collecting their socio-demographic features, clinical experience, opinions toward cannabis legalization, and perceived impact of cannabis derivatives for psychiatric disorders. Logistic regression models were used to identify factors associated with being for or against cannabis legalization. RESULTS In total, 413 psychiatrists answered the survey, of whom 253 (61.3%) declared being in favour of recreational cannabis, and 349 (84.4%) of medical cannabis. Being in favour of legalization of recreational cannabis was negatively associated with being female (odd ratio [OR]=0.61; 95% confidence interval [CI]=0.41-0.93), and with the frequency of meeting patients with cannabis use disorder (OR=0.60; 95%CI=0.43-0.83). Most respondents were concerned about the development of psychotic disorders. The most frequent pro-legalization arguments were improved prevention, better control of product content, and better protection of youth, respectively. Arguments against legalization were increased societal damages, increased impact on health, including mental health. CONCLUSIONS A majority of French psychiatrists were in favour of the marketing of medical cannabis, and, to a lesser extent, the legalization of recreational cannabis. For recreational cannabis, the proportion of pro-legalization psychiatrists was slightly more elevated than that found in the French general population.
Collapse
Affiliation(s)
- Léa Leclerc
- Service universitaire d'addictologie de Lyon (SUAL), hospices civils de Lyon, pavillon K, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
| | - Eric Fakra
- Service de psychiatrie, CHU Saint-Étienne, université Jean-Monnet, Saint-Étienne, France; PSYR2, CRNL, CNRS UMR5292, Inserm U1028, UCBL1, université de Lyon, Bron, France
| | - Baptiste Pignon
- AP-HP, hôpitaux universitaires « H. Mondor », DMU IMPACT, Inserm, IMRB, Translational Neuropsychiatry, Fondation FondaMental, université Paris-Est-Créteil (UPEC), 94010 Créteil, France
| | - Amine Benyamina
- Centre d'enseignement, de recherche et de traitement des addictions, hôpital universitaire Paul-Brousse (AP-HP), université Paris- Saclay, France UR PSYCOMADD, Villejuif, France
| | - Raphaël Gaillard
- Inserm, UMR S894, Paris Cité University and Sorbonne University, Paris, France; Centre hospitalier Sainte-Anne, Paris, France; Centre de psychiatrie et neurosciences, Paris, France
| | - Benjamin Rolland
- Service universitaire d'addictologie de Lyon (SUAL), hospices civils de Lyon, pavillon K, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France; PSYR2, CRNL, CNRS UMR5292, Inserm U1028, UCBL1, université de Lyon, Bron, France
| |
Collapse
|
7
|
Chesney E, Lawn W, McGuire P. Assessing Cannabis Use in People with Psychosis. Cannabis Cannabinoid Res 2024; 9:49-58. [PMID: 37971872 PMCID: PMC10874830 DOI: 10.1089/can.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Introduction: Cannabis use is common in people with psychotic disorders and is associated with the exacerbation of symptoms, poor treatment adherence, and an increased risk of relapse. Accurate assessment of cannabis use is thus critical to the clinical management of psychosis. Discussion: Cannabis use is usually assessed with self-report questionnaires that were originally developed for healthy individuals or people with a cannabis use disorder. Compared to these groups, the pattern of cannabis use and the associated harms in patients with psychosis are quite different. Moreover, in people with psychosis, the accuracy of self-reported use may be impaired by psychotic symptoms, cognitive deficits, and a desire to conceal use when clinicians have advised against it. Although urinary screening for delta-9-tetrahydrocannabinol is sometimes used in the assessment of acute psychotic episodes, it is not used in routinely. Cannabis use could be assessed by measuring the concentration of cannabinoids in urine and blood, but this is rarely done in either clinical settings or research. Conclusion: Using quantitative biological measures could provide a more accurate guide to the effects of use on the disorder than asking patients or using questionnaires.
Collapse
Affiliation(s)
- Edward Chesney
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Will Lawn
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Philip McGuire
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, United Kingdom
- NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| |
Collapse
|
8
|
Marquette A, Iraniparast M, Hammond D. Adverse outcomes of cannabis use in Canada, before and after legalisation of non-medical cannabis: cross-sectional analysis of the International Cannabis Policy Study. BMJ Open 2024; 14:e077908. [PMID: 38171626 PMCID: PMC10773397 DOI: 10.1136/bmjopen-2023-077908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES To date, there is little evidence on the extent to which cannabis legalisation affects the prevalence of adverse events from cannabis at the population level. The current study examined trends in the prevalence of adverse events among people who consumed cannabis before and after Canada's legalisation of recreational cannabis. DESIGN Data come from the first four survey waves of the International Cannabis Policy Study, which were conducted online annually immediately prior to non-medical cannabis legalisation in Canada in October 2018, and in the three following years (2019-2021). PARTICIPANTS The current analysis included 18 285 Canadian respondents aged 16-65 who reported cannabis use in the past 12 months. OUTCOME MEASURES Primary outcomes included types of adverse events experienced from cannabis use, medical help-seeking and the types of products used. Weighted logistic regression models examined differences in help-seeking, emergency room usage and the experience of cannabinoid hyperemesis syndrome across survey years. RESULTS Approximately one-third of people who consume cannabis reported experiencing at least one adverse event within the past 12 months, including 5% of consumers who sought medical help for an adverse event, most commonly for panic attacks, feeling faint/dizzy/passing out, heart/blood pressure problems and nausea/vomiting. The prevalence of seeking help and the types of adverse events were similar before (2018) and after legalisation (2019-2021); however, the proportion of consumers seeking help from emergency rooms increased postlegalisation (F=2.77, p=0.041). Adverse events were associated with various product types, with dried flower and oral oils accounting for the largest proportion of events. Help-seeking associated with cannabis edibles significantly decreased after legalisation (p=0.001). CONCLUSIONS Substantial proportions of people who consume cannabis report adverse events, suggesting widespread difficulty in 'dosing'. Few changes were observed in the prevalence of adverse events reported by consumers since legalisation; however, the location of medical help-seeking and associated products used have changed postlegalisation.
Collapse
|
9
|
Anderson KK, Rodrigues R, Le B, Mamun M, Archie S, Edwards J, Elton-Marshall T, Gilliland J, Myran DT, Palaniyappan L, Perlman CM, Seabrook JA, Murray RM, Shariff SZ. Impact of non-medical cannabis legalization with market restrictions on health service use and incident cases of psychotic disorder in Ontario, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104285. [PMID: 38071933 DOI: 10.1016/j.drugpo.2023.104285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/01/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Cannabis is a risk factor in the onset and persistence of psychotic disorders. There is concern that non-medical cannabis legalization in Canada may have population-level impacts on psychotic disorders. We sought to examine changes in health service use and incident cases of psychotic disorder following cannabis legalization, during a period of tight restrictions on retail stores and product types. METHODS We conducted a cross-sectional interrupted time-series analysis using linked population-based health administrative data from Ontario (Canada) from January 2014 to March 2020. We identified psychosis-related outpatient visits, emergency department visits, hospitalizations, and inpatient length of stay, as well as incident cases of psychotic disorders, among people aged 14 to 60 years. RESULTS We did not find evidence of increases in health service use or incident cases of psychotic disorders over the short-term (17 month) period following cannabis legalization. However, we found clear increasing trends in health service use and incident cases of substance-induced psychotic disorders over the entire observation window (2014-2020). CONCLUSION Our findings suggest that the initial period of tight market restriction following legalization of non-medical cannabis was not associated with an increase in health service use or frequency of psychotic disorders. A longer post-legalization observation period, which includes expansion of the commercial cannabis market, is needed to fully understand the population-level impacts of non-medical cannabis legalization; thus, it would be premature to conclude that the legalization of non-medical cannabis did not lead to increases in health service use and incident cases of psychotic disorder.
Collapse
Affiliation(s)
- Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London ON Canada; ICES Western, London ON Canada; Lawson Health Research Institute, London Health Sciences Centre, London ON Canada.
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada
| | | | - Maliha Mamun
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada
| | - Suzanne Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton ON Canada
| | - Jordan Edwards
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton ON Canada
| | - Tara Elton-Marshall
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa ON Canada; Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON Canada; Dalla Lana School of Public Health, University of Toronto, Toronto ON Canada
| | - Jason Gilliland
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; Department of Geography and Environment, Western University, London ON Canada
| | - Daniel Thomas Myran
- Department of Family Medicine, University of Ottawa, Ottawa ON Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa ON Canada; ICES uOttawa, Ottawa Hospital Research Institute, Ottawa ON Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London ON Canada; Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal ON Canada
| | | | - Jamie A Seabrook
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; School of Food and Nutritional Sciences, Brescia University College, London ON Canada
| | - Robin M Murray
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, United Kingdom
| | - Salimah Z Shariff
- Arthur Labatt Family School of Nursing, Western University, London ON Canada; ICES Western, London ON Canada; Lawson Health Research Institute, London Health Sciences Centre, London ON Canada
| |
Collapse
|
10
|
Hall W, Stjepanović D, Dawson D, Leung J. The implementation and public health impacts of cannabis legalization in Canada: a systematic review. Addiction 2023; 118:2062-2072. [PMID: 37380613 PMCID: PMC10953418 DOI: 10.1111/add.16274] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/15/2023] [Indexed: 06/30/2023]
Abstract
AIMS We provide a narrative summary of research on changes in cannabis arrests, cannabis products and prices, cannabis use and cannabis-related harm since legalization. METHODS We systematically searched for research on the impacts of cannabis legalization in Canada in PubMed, Embase, Statistics Canada and government websites and Google Scholar, published between 2006 and 2021. RESULTS Cannabis legalization in Canada has been followed by substantial reductions in cannabis-related arrests and cannabis prices. It has also increased adults' access to a diverse range of cannabis products, including edibles and extracts. The prevalence of cannabis use among young adults has increased, but there have been no marked increases or decreases in use among high school students or changes in the prevalence of daily or near-daily use. Legalization has been associated with increased adult hospital attendances for psychiatric distress and vomiting, unintentional ingestion of edible cannabis products by children and hospitalizations for cannabis use disorders in adults. There is conflicting evidence on whether cannabis-impaired driving has increased since legalization. There is suggestive evidence that presentations to emergency departments with psychoses and cannabis use disorders may have increased since legalization. CONCLUSIONS Legalization of cannabis in Canada appears to have reduced cannabis arrests and increased access to a variety of more potent cannabis products at lower prices. Since 2019, recent cannabis use in Canada has modestly increased among adults but not among adolescents. There is evidence of increased acute adverse effects of cannabis among adults and children.
Collapse
Affiliation(s)
- Wayne Hall
- National Centre for Youth Substance Use ResearchThe University of QueenslandBrisbaneAustralia
| | - Daniel Stjepanović
- National Centre for Youth Substance Use ResearchThe University of QueenslandBrisbaneAustralia
| | - Danielle Dawson
- National Centre for Youth Substance Use ResearchThe University of QueenslandBrisbaneAustralia
| | - Janni Leung
- National Centre for Youth Substance Use ResearchThe University of QueenslandBrisbaneAustralia
| |
Collapse
|
11
|
Myran DT, Gaudreault A, Konikoff L, Talarico R, Liccardo Pacula R. Changes in Cannabis-Attributable Hospitalizations Following Nonmedical Cannabis Legalization in Canada. JAMA Netw Open 2023; 6:e2336113. [PMID: 37796504 PMCID: PMC10556968 DOI: 10.1001/jamanetworkopen.2023.36113] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/23/2023] [Indexed: 10/06/2023] Open
Abstract
Importance The impact of adult-use cannabis legalization and subsequent commercialization (ie, increasing store and product access) on hospitalizations in Canada is unclear. Objectives To examine changes in overall and subtypes of hospitalizations due to cannabis and associated factors following legalization in Canada and to compare changes between provinces. Design, Setting, and Participants This repeated cross-sectional analysis included all acute hospitalizations for individuals aged 15 to 105 years in Canada's 4 most populous provinces (Ontario, Quebec, Alberta and British Columbia, population 26.9 million individuals in 2018). Data were obtained from routinely collected health administrative databases. Immediate and gradual changes in the age- and sex-standardized rates of hospitalizations due to cannabis were compared using an interrupted time series design over 3 time periods: prelegalization (January 2015 to September 2018), legalization with product and store restrictions (October 2018 to February 2020), and commercialization, which overlapped with the COVID-19 pandemic (March 2020 to March 2021). Main Outcomes and Measures Rates of hospitalizations due to cannabis per 100 000 individuals and per 1000 all-cause hospital admissions. Results There were 105 203 hospitalizations due to cannabis over the 7-year study period, 69 192 of which (65.8%) were among male individuals, and 34 678 (33%) of which were among individuals aged 15 to 24 years. Overall, the age- and sex-standardized rate of hospitalizations increased 1.62 times between January 2015 (3.99 per 100 000 individuals) and March 2021 (6.46 per 100 000 individuals). The largest relative increase in hospitalizations was for cannabis-induced psychosis (rate ratio, 1.40; 95% CI, 1.34 to 1.47 during the commercialization period relative to the prelegalization period). Nationally, legalization with restrictions was associated with a gradual monthly decrease of -0.06 (95% CI -0.08 to -0.03) in hospitalizations due to cannabis per 100 000 individuals. Commercialization and the COVID-19 pandemic were associated with an immediate increase of 0.83 (95% CI, 0.30 to 1.30) hospitalizations due to cannabis per 100 000 individuals. There was provincial variation in changes, with provinces with less mature legal markets experiencing the greatest declines immediately following legalization. Conclusions and Relevance This cross-sectional study found that legalization with restrictions was not associated with an increase in hospitalizations due to cannabis but commercialization was. The findings suggest that commercialization of cannabis may be associated with increases in cannabis-related health harms, including cannabis-induced psychosis.
Collapse
Affiliation(s)
- Daniel T. Myran
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adrienne Gaudreault
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lauren Konikoff
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert Talarico
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rosalie Liccardo Pacula
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
- Institute for Addiction Science, University of Southern California, Los Angeles
| |
Collapse
|
12
|
Myran DT, Pugliese M, Roberts RL, Solmi M, Perlman CM, Fiedorowicz J, Tanuseputro P, Anderson KK. Association between non-medical cannabis legalization and emergency department visits for cannabis-induced psychosis. Mol Psychiatry 2023; 28:4251-4260. [PMID: 37500826 DOI: 10.1038/s41380-023-02185-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023]
Abstract
A major public health concern of cannabis legalization is that it may result in an increase in psychotic disorders. We examined changes in emergency department (ED) visits for cannabis-induced psychosis following the legalization and subsequent commercialization (removal of restrictions on retail stores and product types) of non-medical cannabis in Ontario, Canada (population of 14.3 million). We used health administrative data containing the cause of all ED visits to examine changes over three periods; 1) pre-legalization (January 2014-September 2018); 2) legalization with restrictions (October 2018 - February 2020); and 3) commercialization (March 2020 - September 2021). We considered subgroups stratified by age and sex and examined cocaine- and methamphetamine-induced psychosis ED visits as controls. During our study, there were 6300 ED visits for cannabis-induced psychosis. The restricted legalization period was not associated with changes in rates of ED visits for cannabis-induced psychosis relative to pre-legalization. The commercialization period was associated with an immediate increase in rates of ED visits for cannabis-induced psychosis (IRR 1.30, 95% CI 1.02-1.66) and no gradual monthly change; immediate increases were seen only for youth above (IRR 1.63, 1.27-2.08, ages 19-24) but not below (IRR 0.73 95%CI 0.42-1.28 ages, 15-18) the legal age of purchase, and similar for men and women. Commercialization was not associated with changes in rates of ED visits for cocaine- or methamphetamine-induced psychosis. This suggests that legalization with store and product restrictions does not increase ED visits for cannabis-induced psychosis. In contrast, cannabis commercialization may increase cannabis-induced psychosis presentations highlighting the importance of preventive measures in regions considering legalization.
Collapse
Affiliation(s)
- Daniel T Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Bruyère Research Institute, Ottawa, ON, Canada.
| | - Michael Pugliese
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Rhiannon L Roberts
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marco Solmi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | | | - Jess Fiedorowicz
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Neurosciences, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kelly K Anderson
- Departments of Epidemiology & Biostatistics and Psychiatry, Western University, London, ON, Canada
- ICES Western, London, ON, Canada
| |
Collapse
|
13
|
Thurstone C, Loh R, Foreman K, Thurstone CA, Wolf C. Program Evaluation to Aid Choice of Aripiprazole or Risperidone for Hospitalized Adolescents with Cannabis Use Disorder and Psychosis. J Child Adolesc Psychopharmacol 2023; 33:332-336. [PMID: 37861990 DOI: 10.1089/cap.2023.0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Introduction: Co-occurring cannabis use and psychosis is an increasing problem. No single behavioral or pharmacologic treatment has emerged as clearly superior. To address the gap, this nonrandomized, quality improvement project compares outcomes for adolescents with co-occurring cannabis use disorder and psychosis prescribed risperidone or aripiprazole. Materials and Methods: This project is a retrospective chart review of 110 adolescents (ages 13-21 years) hospitalized for psychosis and co-occurring cannabis use disorder. The primary outcomes are length of stay and length of stay index. Results: Adolescents prescribed risperidone compared with aripiprazole had a significantly greater length of stay (9.7 days vs. 5.8 days, p = 0.002) and length of stay index (1.4 vs. 0.79, p = 0.004). Conclusions: Adolescents hospitalized for co-occurring psychosis and cannabis use disorder had a significantly longer length of stay and length of stay index. These data are consistent with a more rapid reduction in acute psychotic symptoms for aripiprazole compared with risperidone in the context of co-occurring cannabis use disorder.
Collapse
Affiliation(s)
- Christian Thurstone
- Denver Health and Hospital Authority, Denver, Colorado, USA
- University of Colorado, Department of Psychiatry, Aurora, Colorado, USA
| | - Ryan Loh
- Denver Health and Hospital Authority, Denver, Colorado, USA
- University of Colorado, Department of Psychiatry, Aurora, Colorado, USA
| | | | | | - Chelsea Wolf
- Denver Health and Hospital Authority, Denver, Colorado, USA
- University of Colorado, Department of Psychiatry, Aurora, Colorado, USA
| |
Collapse
|
14
|
Walker M, Carpino M, Lightfoot D, Rossi E, Tang M, Mann R, Saarela O, Cusimano MD. The effect of recreational cannabis legalization and commercialization on substance use, mental health, and injury: a systematic review. Public Health 2023; 221:87-96. [PMID: 37429043 DOI: 10.1016/j.puhe.2023.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE To determine the effect of recreational cannabis legalization (RCL) and/or recreational cannabis commercialization (RCC) on emergency department (ED) visits, hospitalizations, and deaths due to substance use, injury, and mental health among those aged 11 years and older. METHODS A systematic review of six electronic databases up to February 1, 2023. Original, peer-reviewed articles with interrupted time series or before and after designs were included. Four independent reviewers screened articles and assessed risk of bias. Outcomes with 'critical' risk of bias were excluded. Protocol registered on PROSPERO (# CRD42021265183). RESULTS After screening and risk of bias assessment, 29 studies were included which examined ED visits or hospitalizations for cannabis use or alcohol (N = 10), opioid mortality (N = 3), motor vehicle fatalities or injury (N = 11), and intentional injury/mental health (N = 5). Rates or number of cannabis-related hospitalizations increased after RCL in Canada and the USA. Immediate increases in rates of cannabis-related ED visits were found after both RCL and RCC in Canada. Rates of traffic fatalities increased after RCL and RCC in certain jurisdictions in the USA. CONCLUSIONS RCL was associated with increased rates of cannabis-related hospitalizations. RCL and/or RCC was associated with increased rates of cannabis-related ED visits, consistently shown across sex and age groups. The effect on fatal motor vehicle incidents was mixed, with observed increases found after RCL and/or RCC. The effect of RCL or RCC on opioids, alcohol, intentional injury, and mental health is not clear. These results inform population health initiatives and international jurisdictions considering RCL implementation.
Collapse
Affiliation(s)
- M Walker
- Injury Prevention Research Office, Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - M Carpino
- Injury Prevention Research Office, Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - D Lightfoot
- Health Sciences Library, St. Michael's Hospital, Toronto, Ontario, Canada
| | - E Rossi
- Injury Prevention Research Office, Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - M Tang
- Injury Prevention Research Office, Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - R Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - O Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - M D Cusimano
- Injury Prevention Research Office, Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada.
| |
Collapse
|
15
|
Crocker CE, Emsley J, Tibbo PG. Mental health adverse events with cannabis use diagnosed in the Emergency Department: what are we finding now and are our findings accurate? Front Psychiatry 2023; 14:1093081. [PMID: 37304435 PMCID: PMC10247977 DOI: 10.3389/fpsyt.2023.1093081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
We have previously reviewed the types and numbers of cannabis-associated adverse events that have mental health presentations that are encountered in the Emergency Department. A particular challenge in examining these events is disentangling cannabis use adverse events from adverse events associated with use of multiple recreational substances. Since that review was published, cannabis legalization for recreational use has greatly expanded world-wide and with these changes in the legal climate has come clearer information around the frequency of adverse events seen in the Emergency Department. However, as we examined the current state of the literature, we also examined some of research designs and the biases that may be impacting the validity of the data in this field. The biases both of clinicians and researchers as well as research approaches to studying these events may be impacting our ability to assess the interaction between cannabis and mental health. For example, many of the studies performed examining cannabis-related admissions to the Emergency Department were administrative studies that relied on front line clinicians to identify and attribute that cannabis use was associated with any particular admission. This narrative review provides an overview on what we currently know about mental health adverse events in the Emergency Department with a focus on the mental health impacts both for those with and without a history of mental illness. The evidence that cannabis use can adversely impact genders and sexes differently is also discussed. This review outlines what the most common adverse events related to mental health with cannabis use are; as well as noting the most concerning but much rarer events that have been reported. Additionally, this review suggests a framework for critical evaluation of this field of study going forward.
Collapse
Affiliation(s)
- Candice E. Crocker
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Jason Emsley
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
- IWK Children’s Health Centre, Halifax, NS, Canada
| | - Philip G. Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, Nova Scotia Health, Halifax, NS, Canada
| |
Collapse
|
16
|
Farrelly KN, Wardell JD, Marsden E, Scarfe ML, Najdzionek P, Turna J, MacKillop J. The Impact of Recreational Cannabis Legalization on Cannabis Use and Associated Outcomes: A Systematic Review. Subst Abuse 2023; 17:11782218231172054. [PMID: 37187466 PMCID: PMC10176789 DOI: 10.1177/11782218231172054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
Background Recreational cannabis legalization has become more prevalent over the past decade, increasing the need to understand its impact on downstream health-related outcomes. Although prior reviews have broadly summarized research on cannabis liberalization policies (including decriminalization and medical legalization), directed efforts are needed to synthesize the more recent research that focuses on recreational cannabis legalization specifically. Thus, the current review summarizes existing studies using longitudinal designs to evaluate impacts of recreational cannabis legalization on cannabis use and related outcomes. Method A comprehensive bibliographic search strategy revealed 61 studies published from 2016 to 2022 that met criteria for inclusion. The studies were predominantly from the United States (66.2%) and primarily utilized self-report data (for cannabis use and attitudes) or administrative data (for health-related, driving, and crime outcomes). Results Five main categories of outcomes were identified through the review: cannabis and other substance use, attitudes toward cannabis, health-care utilization, driving-related outcomes, and crime-related outcomes. The extant literature revealed mixed findings, including some evidence of negative consequences of legalization (such as increased young adult use, cannabis-related healthcare visits, and impaired driving) and some evidence for minimal impacts (such as little change in adolescent cannabis use rates, substance use rates, and mixed evidence for changes in cannabis-related attitudes). Conclusions Overall, the existing literature reveals a number of negative consequences of legalization, although the findings are mixed and generally do not suggest large magnitude short-term impacts. The review highlights the need for more systematic investigation, particularly across a greater diversity of geographic regions.
Collapse
Affiliation(s)
- Kyra N Farrelly
- Department of Psychology, York
University, Toronto, ON, Canada
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
| | - Jeffrey D Wardell
- Department of Psychology, York
University, Toronto, ON, Canada
- Institute for Mental Health Policy
Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of
Toronto, Toronto, ON, Canada
| | - Emma Marsden
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
| | - Molly L Scarfe
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
| | - Peter Najdzionek
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
| | - Jasmine Turna
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
- Michael G. DeGroote Centre for
Medicinal Cannabis Research, McMaster University & St. Joseph’s Healthcare
Hamilton, Hamilton, ON, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
- Michael G. DeGroote Centre for
Medicinal Cannabis Research, McMaster University & St. Joseph’s Healthcare
Hamilton, Hamilton, ON, Canada
- Homewood Research Institute, Guelph,
ON, Canada
| |
Collapse
|
17
|
Callaghan RC, Sanches M, Vander Heiden J, Kish SJ. Impact of Canada's cannabis legalisation on youth emergency department visits for cannabis-related disorders and poisoning in Ontario and Alberta, 2015-2019. Drug Alcohol Rev 2023. [PMID: 36908258 DOI: 10.1111/dar.13637] [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: 08/18/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Although there is momentum towards legalising adult recreational cannabis use worldwide, the extent of youth cannabis-related harm associated with legalisation is still uncertain. The current study aimed to assess whether the initial implementation of Canada's cannabis legalisation (via the Cannabis Act) on 17 October 2018 might be associated with youth harm, as assessed by emergency department visits for cannabis-related disorders/poisoning. METHODS We used Ontario and Alberta, Canada emergency department data from 1 April 2015 to 31 December 2019. We identified all cannabis-related disorders/poisoning (ICD-10 CA: F12.X, T40.7) emergency department visits of youth (n = 13,615), defined as patients younger than the minimum legal cannabis sales age (18 years, Alberta; 19 years, Ontario). Seasonal Autoregressive Integrated Moving Average (SARIMA) models were employed to assess the impact of legalisation on weekly counts of cannabis-related harms. RESULTS The final SARIMA intervention (step) parameter indicated a post-legalisation increase of 14.7 (95% confidence interval [CI] 5.0; 24.3, p < 0.01) weekly youth cannabis-related disorder/poisoning presentations to Ontario/Alberta emergency department settings, equivalent to an increase of 20.0% (95% CI 6.2%; 33.9%). There was no evidence of associations between cannabis legalisation and comparison series of youth alcohol, opioid or appendicitis emergency department episodes. DISCUSSION/CONCLUSION Our findings require replication and extension but are consistent with the possibility that the implementation of the Cannabis Act was associated with an increase in youth cannabis-related presentations to Ontario/Alberta emergency departments.
Collapse
Affiliation(s)
- Russell C Callaghan
- University of Northern British Columbia, Northern Medical Program, Prince George, Canada.,Centre for Addiction and Mental Health, Human Brain Laboratory, Toronto, Canada.,University of Victoria, Canadian Institute for Substance Use Research, Victoria, Canada
| | - Marcos Sanches
- Centre for Addiction and Mental Health, Biostatistics Core, Toronto, Canada
| | - Julia Vander Heiden
- University of Northern British Columbia, Northern Medical Program, Prince George, Canada.,University of Victoria, Canadian Institute for Substance Use Research, Victoria, Canada
| | - Stephen J Kish
- Centre for Addiction and Mental Health, Human Brain Laboratory, Toronto, Canada
| |
Collapse
|
18
|
Elser H, Humphreys K, Kiang MV, Mehta S, Yoon JH, Faustman WO, Matthay EC. State Cannabis Legalization and Psychosis-Related Health Care Utilization. JAMA Netw Open 2023; 6:e2252689. [PMID: 36696111 PMCID: PMC9925044 DOI: 10.1001/jamanetworkopen.2022.52689] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 12/06/2022] [Indexed: 01/26/2023] Open
Abstract
Importance Psychosis is a hypothesized consequence of cannabis use. Legalization of cannabis could therefore be associated with an increase in rates of health care utilization for psychosis. Objective To evaluate the association of state medical and recreational cannabis laws and commercialization with rates of psychosis-related health care utilization. Design, Setting, and Participants Retrospective cohort design using state-level panel fixed effects to model within-state changes in monthly rates of psychosis-related health care claims as a function of state cannabis policy level, adjusting for time-varying state-level characteristics and state, year, and month fixed effects. Commercial and Medicare Advantage claims data for beneficiaries aged 16 years and older in all 50 US states and the District of Columbia, 2003 to 2017 were used. Data were analyzed from April 2021 to October 2022. Exposure State cannabis legalization policies were measured for each state and month based on law type (medical or recreational) and degree of commercialization (presence or absence of retail outlets). Main Outcomes and Measures Outcomes were rates of psychosis-related diagnoses and prescribed antipsychotics. Results This study included 63 680 589 beneficiaries followed for 2 015 189 706 person-months. Women accounted for 51.8% of follow-up time with the majority of person-months recorded for those aged 65 years and older (77.3%) and among White beneficiaries (64.6%). Results from fully-adjusted models showed that, compared with no legalization policy, states with legalization policies experienced no statistically significant increase in rates of psychosis-related diagnoses (medical, no retail outlets: rate ratio [RR], 1.13; 95% CI, 0.97-1.36; medical, retail outlets: RR, 1.24; 95% CI, 0.96-1.61; recreational, no retail outlets: RR, 1.38; 95% CI, 0.93-2.04; recreational, retail outlets: RR, 1.39; 95% CI, 0.98-1.97) or prescribed antipsychotics (medical, no retail outlets RR, 1.00; 95% CI, 0.88-1.13; medical, retail outlets: RR, 1.01; 95% CI, 0.87-1.19; recreational, no retail outlets: RR, 1.13; 95% CI, 0.84-1.51; recreational, retail outlets: RR, 1.14; 95% CI, 0.89-1.45). In exploratory secondary analyses, rates of psychosis-related diagnoses increased significantly among men, people aged 55 to 64 years, and Asian beneficiaries in states with recreational policies compared with no policy. Conclusions and Relevance In this retrospective cohort study of commercial and Medicare Advantage claims data, state medical and recreational cannabis policies were not associated with a statistically significant increase in rates of psychosis-related health outcomes. As states continue to introduce new cannabis policies, continued evaluation of psychosis as a potential consequence of state cannabis legalization may be informative.
Collapse
Affiliation(s)
- Holly Elser
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia
- Center for Population Health Sciences, Stanford University, Palo Alto, California
| | - Keith Humphreys
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Mathew V. Kiang
- Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California
| | - Swapnil Mehta
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Jong H. Yoon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
- Division of Psychiatry, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - William O. Faustman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
- Division of Psychiatry, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Ellicott C. Matthay
- Department of Population Health, New York University Grossman School of Medicine, New York
| |
Collapse
|
19
|
Boury H, Hall W, Fischer B. Developments and Changes in Primary Public Health Outcome Indicators Associated with the Legalization of Non-Medical Cannabis Use and Supply in Canada (2018): A Comprehensive Overview. Int J Ment Health Addict 2022:1-15. [PMID: 36589471 PMCID: PMC9794107 DOI: 10.1007/s11469-022-00986-9] [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] [Accepted: 12/05/2022] [Indexed: 12/28/2022] Open
Abstract
Canada legalized non-medical cannabis use and supply for adults in 2018. We examined developments and changes associated with the legalization policy reform on key indicators for public health, namely cannabis (including frequent/problematic) use prevalence, cannabis-related hospitalizations, cannabis-impaired driving, and cannabis sourcing. We identified peer-reviewed and "grey" study data that featured population-level or other quasi-representative samples and comparable outcome data for pre- and post-legalization periods, including possible trends of changes over time. Cannabis use has increased in select population groups, with use modes shifting away from smoking. Evidence on cannabis-related hospitalizations (e.g., for mental health) is mixed. The prevalence of cannabis-impaired driving appears to be generally steady but THC exposure among crash-involved drivers may have increased. Increasing proportions of users obtain cannabis products from legal sources but some-especially regular-users continue to use illicit sources. Overall, data suggest a mixed and inconclusive picture on cannabis legalization's impacts on essential public health indicators, including select extensions in trends from pre-legalization.
Collapse
Affiliation(s)
- Himani Boury
- Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Suite 2400, 515 W. Hastings Street, Vancouver, BC V6B 5K3 Canada
- School of Public Health, Queens University, Kingston, Canada
| | - Wayne Hall
- Faculty of Health and Behavioural Sciences, National Centre for Youth Substance Use Research, University of Queensland, 17 Upland Road, St Lucia, Australia
| | - Benedikt Fischer
- Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Suite 2400, 515 W. Hastings Street, Vancouver, BC V6B 5K3 Canada
- School of Population Health, University of Auckland, 85 Park Road, Auckland, New Zealand
- Department of Psychiatry, Federal University of Sao Paulo, R. Sena Madureira, São Paulo, 1500 Brazil
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5S2S1 Canada
| |
Collapse
|
20
|
Schäfer I. Substance Use in the Population-A Plea for a Balanced Discussion. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:525-526. [PMID: 36384920 PMCID: PMC9677534 DOI: 10.3238/arztebl.m2022.0286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Ingo Schäfer
- Center of Interdisciplinary Addiction Research (ZIS), University of Hamburg, c/o Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany,*Zentrum für Interdisziplinäre Suchtforschung (ZIS), Universität Hamburg c/o Klinik für Psychiatrie und Psychotherapie Universitätsklinikum Hamburg-Eppendorf Martinistr. 52, 20246 Hamburg, Germany
| |
Collapse
|