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Chen B, Fullerton L, Smolinske S, Seifert S, Tuuri R. The Impact of Legalizing Recreational Cannabis on the Children of a Neighboring State. Pediatr Emerg Care 2024:00006565-990000000-00506. [PMID: 39140555 DOI: 10.1097/pec.0000000000003262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
OBJECTIVES In the United States, cannabis is legal for adult recreational use in 24 states and Washington, DC. Unintentional pediatric cannabis exposures have increased in many states following legalization.We evaluated the relationship between recreational cannabis legalization and the rates of unintentional pediatric exposures in a neighboring state that had not undergone legalization. METHODS We obtained cannabis exposure cases for children 0-12 years from the New Mexico Poison and Drug Information Center electronic database. Only deidentified patient data from closed-case exposure encounters were abstracted. Data were grouped as precommercial and postcommercial availability in neighboring Colorado, demarcated by January 2014. We coded cannabis products as edible, not edible, or unknown. For bivariable comparisons, we used odds ratios, risk ratio, χ2 test, and Wilcoxon rank sum test. We chose a type 1 error rate of 0.05 to determine significance. RESULTS There were 269 exposures over 24 years of calls. Following neighboring legalization, the median number of exposures per year increased from 4 (interquartile range 2, 5) to 24.5 (16.5, 34), the median age increased from 1.9 to 3.0 (P = 0.007), and the relative risk of the exposure involving edible products was double (relative risk = 2.0, 95% confidence interval = 1.6, 2.6). The severity of the exposures' medical effects also increased (P = 0.008). CONCLUSIONS The number, severity, and type of pediatric cannabis exposures in New Mexico changed after neighboring recreational cannabis legalization. States neighboring those undergoing cannabis legalization should be prepared to respond to increased acute exposures in children.
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Affiliation(s)
- Benny Chen
- From the Children's Hospital Colorado, Aurora, CO
| | | | | | | | - Rachel Tuuri
- University of New Mexico Hospital, Albuquerque, NM
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2
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Imtiaz S, Nigatu YT, Ali F, Elton-Marshall T, Rehm J, Rueda S, Hamilton HA. Changes in medical cannabis use in Ontario, Canada (2014 to 2019): Trajectory of trends, medical authorization patterns and association with recreational cannabis legalization. Prev Med Rep 2024; 44:102805. [PMID: 39035360 PMCID: PMC11259860 DOI: 10.1016/j.pmedr.2024.102805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/24/2024] [Accepted: 06/21/2024] [Indexed: 07/23/2024] Open
Abstract
Objectives We characterized trends in medical cannabis use; examined characteristics associated with medical cannabis use without medical authorization; and examined the association between recreational cannabis legalization and medical cannabis use in Ontario, Canada. Methods Data were from a repeated, population-based, cross-sectional survey of adults (N = 19,543; 2014-2019). Cannabis use was categorized as either medical cannabis use, recreational cannabis use or no cannabis use. The analytical strategy included jointpoint regression, logistic regression and multinomial logistic regression. Results Medical cannabis use increased from 4 % to 11 % (Annual Percentage Change [APC]: 25 %, 95 % Confidence Interval [CI]: 17 %-33 %) and recreational cannabis use increased from 9 % to 15 % (APC: 9 %, 95 % CI: 3 %-15 %) between 2014 and 2019. Being 18 to 29 years old compared with being 65+ years old was associated with an increased likelihood of medical cannabis use without medical authorization (Odds Ratio [OR]: 4.05, 95 % CI: 2.12-7.72), while being of fair or poor self-perceived health compared with excellent, very good or good self-perceived health (OR: 0.61, 95 % CI: 0.40-0.95) was associated with a decreased likelihood of medical cannabis use without medical authorization. Recreational cannabis legalization was associated with an increased likelihood of medical cannabis use compared with no cannabis use (OR: 1.48, 95 % CI: 1.19-1.85) and of recreational cannabis use compared with no cannabis use (OR: 1.35, 95 % CI: 1.11-1.65). Conclusions Although medical cannabis use increased, it was largely used without medical authorization. Guidance and education that encourages medical usage under clinical supervision is recommended, and mitigation of known barriers to medical cannabis authorization.
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Affiliation(s)
- Sameer Imtiaz
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada
| | - Yeshambel T. Nigatu
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada
| | - Farihah Ali
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, Ontario M5T 3M7, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada
- Institute of Medical Science, University of Toronto, Room 2374, 1 King’s College Circle, Toronto, Ontario M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, Ontario M5T 1R8, Canada
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya Str., 8, B. 2, 119992 Moscow, Russian Federation
| | - Sergio Rueda
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada
- Institute of Medical Science, University of Toronto, Room 2374, 1 King’s College Circle, Toronto, Ontario M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Hayley A. Hamilton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, Ontario M5T 3M7, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada
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Nigatu YT, Imtiaz S, Elton-Marshall T, Rueda S, Hamilton HA. Changes in modes of cannabis consumption pre- and post-legalization and their correlates among adults in Ontario, Canada: 2017-2022. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:557-565. [PMID: 39042877 DOI: 10.1080/00952990.2024.2369905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 07/25/2024]
Abstract
Background: Despite an increase in the varieties of cannabis products available for consumption, limited evidence is available about the patterns of cannabis consumption methods before and after legalization.Objectives: To examine the changes in modes of cannabis use and their correlates among adults in Ontario, Canada both prior to and following cannabis legalization in 2018.Methods: Data were utilized from the 2017 to 2022 Centre for Addiction and Mental Health's (CAMH) Monitor study, a repeated cross-sectional survey of adults 18 years of age and older (n = 2,665; 56% male). The surveys employed a regionally stratified sampling design using computer-assisted telephone interviews and web surveys. Multinomial regression was performed to examine different modes of cannabis use.Results: The exclusive use of cannabis through ingestion methods increased from 4.0% in 2017 to 16.6% in 2022 (p < .001). However, the exclusive use of inhalation-based cannabis decreased from 49.4% in 2017 to 25.5% in 2022 (p < .001). Relative to inhalation-based modes, adults were about five times more likely to use ingestion-based modes in 2020 [RRR = 4.65 (2.94-7.35)] and 2022 [RRR = 4.75 (2.99-7.55)] than in 2019, after accounting for sociodemographic factors.Conclusions: Ingestion-based cannabis use among adults increased fourfold between 2017 and 2022, a period during which recreational cannabis use was legalized in Canada. The increase was especially evident after the legalization of cannabis edibles.
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Affiliation(s)
- Yeshambel T Nigatu
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sergio Rueda
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Hayley A Hamilton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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4
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Stall NM, Shi S, Malikov K, Wang S, Rochon PA, Hillmer MP, Zipursky JS. Edible Cannabis Legalization and Cannabis Poisonings in Older Adults. JAMA Intern Med 2024; 184:840-842. [PMID: 38767898 PMCID: PMC11106709 DOI: 10.1001/jamainternmed.2024.1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/05/2024] [Indexed: 05/22/2024]
Abstract
This cross-sectional study examines the association between edible cannabis legalization and emergency department visits for cannabis poisonings in older adults.
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Affiliation(s)
- Nathan M. Stall
- Division of General Internal Medicine and Geriatrics, Sinai Health and the University Health Network, Toronto, Ontario, Canada
- Women’s Age Lab and Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Shengli Shi
- Digital and Analytics Strategy Division, Ontario Ministry of Health, Toronto, Canada
| | - Kamil Malikov
- Digital and Analytics Strategy Division, Ontario Ministry of Health, Toronto, Canada
| | - Sping Wang
- Digital and Analytics Strategy Division, Ontario Ministry of Health, Toronto, Canada
| | - Paula A. Rochon
- Women’s Age Lab and Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Michael P. Hillmer
- Digital and Analytics Strategy Division, Ontario Ministry of Health, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Jonathan S. Zipursky
- Department of Medicine, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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5
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Walsh PS, Dupont AS, Lipshaw MJ, Visotcky A, Thomas DG. Cannabis Legalization and Resource Use for Ingestions by Young Children. Pediatrics 2024; 153:e2024065881. [PMID: 38690624 PMCID: PMC11153323 DOI: 10.1542/peds.2024-065881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/27/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE In conjunction with widening legalization, there has been a rapid rise in unintentional cannabis ingestions in young children. We sought to determine if the legal status of recreational cannabis was associated with resource use in young children with cannabis poisoning. METHODS This retrospective cross-sectional study of the Pediatric Health Information System included emergency department encounters between January 2016 and April 2023 for children <6 years of age with a diagnosis indicating cannabis ingestion. The primary exposure was recreational cannabis legalization status in the state in which the encounter occurred. We used logistic regression models to determine the association of recreational cannabis legality with resource utilization outcomes, adjusting for demographic covariates. RESULTS We included 3649 children from 47 hospitals; 29% of encounters occurred in places in which recreational cannabis was legal. Compared with environments in which recreational cannabis was illegal, cannabis-legal locations had lower uses of advanced neuroimaging (24% vs 35%; adjusted odds ratio [aOR], 0.65; 95% confidence interval [CI]: 0.55-0.77), lumbar puncture (1.6% vs 3.8%; aOR, 0.42; 95% CI: 0.24-0.70), ICU admission (7.9% vs 11%; aOR, 0.71; 95% CI: 0.54-0.93), and mechanical ventilation (0.8% vs 2.9%; aOR, 0.30; 95% CI: 0.14-0.58). Urine testing was more common in places in which recreational cannabis was legal (71% vs 58%; aOR, 1.87; 95% CI: 1.59-2.20). CONCLUSIONS State-level legalization of recreational cannabis was associated with a significant decrease in the utilization of advanced medical resources in cases of cannabis intoxication in children. These findings suggest the need for a focus on policies and procedures to minimize invasive testing in cases of cannabis intoxication in children.
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Affiliation(s)
- Patrick S. Walsh
- Department of Pediatrics, Section of Pediatric Emergency Medicine
| | - Amanda S. Dupont
- Department of Pediatrics, Section of Pediatric Emergency Medicine
| | - Matthew J. Lipshaw
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alexis Visotcky
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Danny G. Thomas
- Department of Pediatrics, Section of Pediatric Emergency Medicine
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Donnan J, Johnston K, Coombs M, Najafizada M, Bishop L. Exploring consumer preferences for cannabis edible products to support public health policy: A discrete choice experiment. PLoS One 2024; 19:e0292336. [PMID: 38753807 PMCID: PMC11098505 DOI: 10.1371/journal.pone.0292336] [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: 09/18/2023] [Accepted: 02/22/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND In October 2019, cannabis edibles were legalized for sale in Canada for non-medical use. This move was intended to improve public safety by regulating contents (including a maximum 10 mg tetrahydrocannabinol (THC) per package) and packaging to prevent accidental ingestion or over consumption. This study aimed to explore consumer preferences for cannabis edibles to inform cannabis policy. METHODS We explored the relative importance and trade-offs consumers make for attributes of cannabis edibles using a discrete choice experiment. Attributes included type of edible, price, THC content, cannabis taste, package information, product consistency, product recommendations, and Health Canada regulation. Participants lived in Canada, were 19 years of age or older, and purchased a cannabis edible in the last 12 months. A multinomial logit (MNL) model was used for the base model, and latent class analysis to assess preference sub-groups. This study was approved by the institutional ethics committee. RESULTS Among 684 participants, the MNL model showed that potency was the most relevant attribute, followed by edible type. A two-group latent class model revealed two very distinct preference patterns. Preferences for group 1 (~65% of sample) were driven primarily by edible type, while for group 2 (~35% of sample) were driven almost entirely by THC potency. CONCLUSION This study found that consumer preferences for ~65% of consumers of cannabis edibles are being met through regulated channels. The remaining ~35% are driven by THC potency at levels that are not currently available on the licensed market. Attracting this market segment will require reviewing the risks and benefits of restricting THC package content.
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Affiliation(s)
- Jennifer Donnan
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Karissa Johnston
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Michael Coombs
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Maisam Najafizada
- Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Lisa Bishop
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
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7
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Grant C, Plebon-Huff S, Perwaiz S, Abramovici H, Bélanger RE. Serious and life-threatening events associated with non-medical cannabis use in Canadian children and youth. Paediatr Child Health 2024; 29:3-4. [PMID: 38332980 PMCID: PMC10848119 DOI: 10.1093/pch/pxad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/06/2023] [Indexed: 02/10/2024] Open
Affiliation(s)
- Christina Grant
- Division of Adolescent Medicine, Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Sieara Plebon-Huff
- Controlled Substances and Cannabis Branch, Office of Cannabis Science and Surveillance, Health Canada, Ottawa, Ontario, Canada
| | - Shahid Perwaiz
- Controlled Substances and Cannabis Branch, Office of Cannabis Science and Surveillance, Health Canada, Ottawa, Ontario, Canada
| | - Hanan Abramovici
- Controlled Substances and Cannabis Branch, Office of Cannabis Science and Surveillance, Health Canada, Ottawa, Ontario, Canada
| | - Richard E Bélanger
- Department of Paediatrics, Centre mère-enfant Soleil, CHU de Québec, Université Laval, Québec City, Québec, Canada
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8
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Myran DT, Gaudreault A, McCarthy SDS, Pugliese M, Tanuseputro P, Finkelstein Y. Unintentional pediatric poisonings before and during the COVID-19 pandemic: A population-based study. Am J Emerg Med 2024; 76:185-192. [PMID: 38086185 DOI: 10.1016/j.ajem.2023.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVES The impact of coronavirus disease 2019 (COVID-19) on unintentional pediatric poisonings is unclear. We examined changes in emergency department (ED) visits and hospitalizations for poisonings before and during the COVID-19 pandemic. We compared changes in cannabis vs non-cannabis poisoning events given the recent legalization of cannabis in October 2018 and cannabis edibles in January 2020. STUDY DESIGN Interrupted time-series (ITS) analyses of changes in population-level ED visits and hospitalizations for poisonings in children aged 0-9 years in Ontario, Canada (annual population of 1.4 million children), over two time periods: pre-pandemic (January 2010-March 2020) and pandemic (April 2020-December 2021). RESULTS Overall, there were 28,292 ED visits and 2641 hospitalizations for unintentional poisonings. During the pandemic, poisonings per 100,000 person-years decreased by 14.6% for ED visits (40.15 pre- vs. 34.29 during) and increased by 35.9% for hospitalizations (3.48 pre- vs. 4.73 during). ED visits dropped immediately (Incidence Rate Ratio [IRR], 0.76; 95% CI, 0.70-0.82) at the onset of the pandemic, followed by a gradual return to baseline (quarterly change, IRR 1.04, 95%CI 1.03-1.06), while hospitalizations had an immediate increase (IRR 1.34; 95% CI, 1.08-1.66) and no gradual change. The only increase in poisonings was for cannabis which had a 10.7-fold for ED visits (0.45 to 4.83 per 100,000 person-years) and a 12.1-fold increase for hospitalizations (0.16 to 1.91 per 100,000 person-years). Excluding cannabis, there was no overall increase in poisoning hospitalizations. CONCLUSIONS The COVID-19 pandemic was not associated with increases in any type of unintentional pediatric poisonings, with the exception of cannabis poisonings. Increased cannabis poisonings may be explained by the legalization of non-medical cannabis edibles in Canada in January 2020.
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Affiliation(s)
- Daniel T Myran
- 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; Bruyère Research Institute, Ottawa, Ontario, Canada.
| | - Adrienne Gaudreault
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Stephen D S McCarthy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael Pugliese
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- 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; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Yaron Finkelstein
- Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada; Departments of Pediatrics and Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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Argandykov D, Raybould TA, Gervasini A, Hwabejire J, Flaherty MR. Recreational cannabis legalization and pediatric exposures in Massachusetts, United States. Inj Prev 2024:ip-2023-045052. [PMID: 38233190 DOI: 10.1136/ip-2023-045052] [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: 01/19/2024]
Abstract
INTRODUCTION In Massachusetts, US, medical cannabis legalisation was associated with increased paediatric cannabis exposure cases, including emergency department (ED) visits and hospitalizations. The impact of recreational cannabis legalisation (RCL) on paediatric exposures in Massachusetts has yet to be studied. METHODS To compare the incidences before and after RCL in Massachusetts, US, we queried the data on paediatric cannabis exposure cases in 2016-2021 from the Centre for Healthcare and Analysis and Injury Surveillance Programme at the Massachusetts Department of Public Health. The pre-and post-legalisation phases comprised the periods between 2016-2018 and 2019-2021, respectively. Cannabis-related exposure cases included ED visits and hospitalizations among children and young adolescents of 0-19 years old. RESULTS During the 6-year period (2016-2021), 2357 ED visits and 538 hospitalizations related to cannabis exposure among children and teenagers (0-19 years) were reported in Massachusetts. The incidence of ED visits for all age groups increased from 18.5 per 100 000 population before RCL to 31.0 per 100 000 population (incidence rate ratio (IRR), 1.6; 95% CI, 1.5 to 1.8). Children in the age groups of 0-5 and 6-12 years experienced the highest increase in cannabis-related ED visits. Additionally, the incidence of hospitalisation due to cannabis intoxication substantially increased following RCL (IRR, 2.2; 95% CI, 1.8 to 2.7), a 126% increase. CONCLUSIONS Cannabis-related ED visits and hospitalizations among children and teenagers increased after recreational cannabis became legal in Massachusetts, US. Further efforts are warranted to prevent the unintentional impact of RCL, especially considering substantial increases in cannabis exposure cases among young children.
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Affiliation(s)
- Dias Argandykov
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Toby A Raybould
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alice Gervasini
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - John Hwabejire
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Michael R Flaherty
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Pediatric Critical Care Medicine, Mass General for Children, Boston, Massachusetts, USA
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10
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Allaf S, Lim JS, Buckley NA, Cairns R. The impact of cannabis legalization and decriminalization on acute poisoning: A systematic review. Addiction 2023; 118:2252-2274. [PMID: 37496145 PMCID: PMC10952774 DOI: 10.1111/add.16280] [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: 02/19/2023] [Accepted: 05/25/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND AND AIMS Many countries have recently legalized medicinal and recreational cannabis. With increasing use and access come the potential for harms. We aimed to examine the effect of cannabis legalization/decriminalization on acute poisoning. METHODS A systematic review and meta-analysis registered with PROSPERO (CRD42022323437). We searched Embase, Medline, Scopus and Cochrane Central Register of Controlled Trials from inception to March 2022. No restrictions on language, age or geography were applied. Abstracts from three main clinical toxicology conferences were hand-searched. Included studies had to report on poisonings before and after changes in cannabis legislation, including legalization and decriminalization of medicinal and recreational cannabis. Where possible, relative risk (RR) of poisoning after legalization (versus before) was calculated and pooled. Risk of bias was assessed with ROBINS-I. RESULTS Of the 1065 articles retrieved, 30 met inclusion criteria (including 10 conference abstracts). Studies used data from the United States, Canada and Thailand. Studies examined legalization of medicinal cannabis (n = 14) and decriminalization or legalization of recreational cannabis (n = 21). Common data sources included poisons centre records (n = 18) and hospital presentations/admissions (n = 15, individual studies could report multiple intervention types and multiple data sources). Most studies (n = 19) investigated paediatric poisoning. Most (n = 24) reported an increase in poisonings; however, the magnitude varied greatly. Twenty studies were included in quantitative analysis, with RRs ranging from 0.81 to 29.00. Our pooled estimate indicated an increase in poisoning after legalization [RR = 3.56, 95% confidence interval (CI) = 2.43-5.20], which was greater in studies that focused on paediatric patients (RR = 4.31, 95% CI = 2.30-8.07). CONCLUSIONS Most studies on the effect of medicinal or recreational cannabis legalization/decriminalization on acute poisoning reported a rise in cannabis poisoning after legalization/decriminalization. Most evidence is from US legalization, despite legalization and decriminalization in many countries.
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Affiliation(s)
- Sara Allaf
- Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyNSWAustralia
| | - Jessy S. Lim
- Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyNSWAustralia
| | - Nicholas A. Buckley
- New South Wales Poisons Information CentreThe Children’s Hospital at WestmeadSydneyNSWAustralia
- Faculty of Medicine and Health, School of Medical Sciences, Biomedical Informatics and Digital HealthThe University of SydneySydneyNSWAustralia
| | - Rose Cairns
- Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyNSWAustralia
- New South Wales Poisons Information CentreThe Children’s Hospital at WestmeadSydneyNSWAustralia
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11
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Manthey J, Armstrong MJ, Hayer T, Myran DT, Pacula RL, Queirolo R, Rehm J, Wirth M, Zobel F. How to interpret studies on the impact of legalizing cannabis. Addiction 2023; 118:2242-2243. [PMID: 37544768 DOI: 10.1111/add.16314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Jakob Manthey
- Centre of Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Michael J Armstrong
- Department of Finance, Operations and Information Systems, Brock University, St Catharines, Canada
| | - Tobias Hayer
- Institute of Public Health and Nursing Research, Department for Health and Society, University of Bremen, Bremen, Germany
| | - Daniel T Myran
- Bruyère Research Institute, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Rosalie Liccardo Pacula
- Price School of Public Policy and Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, California, Los Angeles, USA
| | - Rosario Queirolo
- Department of Social Sciences, Universidad Católica del Uruguay, Montevideo, Uruguay
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- World Health Organization/Pan American Health Organization Collaborating Centre, Centre for Addiction and Mental Health, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Program on Substance Abuse, Public Health Agency of Catalonia, Program on Substance Abuse and designated WHO CC, Public Health Agency of Catalonia, Barcelona, Spain
| | - Marielle Wirth
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
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12
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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.
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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
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13
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Toce MS, Dorney K, D'Ambrosi G, Monuteaux MC, Paydar-Darian N, Raghavan VR, Bourgeois FT, Hudgins J. Resource utilization among children presenting with cannabis poisonings in the emergency department. Am J Emerg Med 2023; 73:171-175. [PMID: 37696075 DOI: 10.1016/j.ajem.2023.09.002] [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: 06/09/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Exploratory pediatric cannabis poisonings are increasing. The aim of this study is to provide a national assessment of the frequency and trends of diagnostic testing and procedures in the evaluation of pediatric exploratory cannabis poisonings. METHODS This is a retrospective cross-sectional study of the Pediatric Health Information Systems database involving all cases of cannabis poisoning for children age 0-10 years between 1/2016 and 12/2021. Cannabis poisoning trends were assessed using a negative binomial regression model. A new variable named "ancillary testing" was created to isolate testing that would not confirm the diagnosis of cannabis poisoning or be used to exclude co-ingestion of acetaminophen or aspirin. Ancillary testing was assessed with regression analyses, with ancillary testing as the outcomes and year as the predictor, to assess trends over time. RESULTS A total of 2001 cannabis exposures among 1999 children were included. Cannabis exposures per 100,000 ED visits increased 68.7% (95% CI, 50.3, 89.3) annually. There was a median of 4 (IQR 2.0, 6.0) diagnostic tests performed per encounter. 64.5% of encounters received blood tests, 28.8% received a CT scan, and 2.4% received a lumbar puncture. Compared to White individuals, Black individuals were more likely to receive ancillary testing (OR 1.52 [95% CI, 1.23, 1.89]). Compared to those 2-6 years, those <2 years were more likely to receive ancillary testing (OR 1.55 [95% CI, 1.19, 2.02). We found no significant annual change in the odds of receiving ancillary testing (OR 1.04 [95% CI, 0.97, 1.12]). CONCLUSIONS We found no change in the proportion of encounters associated with ancillary testing, despite increases in exploratory cannabis poisonings over the study period. Given the increasing rate of pediatric cannabis poisonings, emergency providers should consider this diagnosis early in the evaluation of a pediatric patient with acute change in mental status. While earlier use of urine drug screening may reduce ancillary testing and invasive procedures, even a positive urine drug screen does not rule out alternative pathologies and should not replace a thoughtful evaluation.
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Affiliation(s)
- Michael S Toce
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States of America; Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America.
| | - Kate Dorney
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
| | - Gabrielle D'Ambrosi
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
| | - Michael C Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
| | - Niloufar Paydar-Darian
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
| | - Vidya R Raghavan
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
| | - Florence T Bourgeois
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America; Computational Health Informatics Program (CHIP), Boston Children's Hospital, Boston, MA, United States of America
| | - Joel Hudgins
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
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14
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Varin M, Champagne A, Venugopal J, Li L, McFaull SR, Thompson W, Toigo S, Graham E, Lowe AM. Trends in cannabis-related emergency department visits and hospitalizations among children aged 0-11 years in Canada from 2015 to 2021: spotlight on cannabis edibles. BMC Public Health 2023; 23:2067. [PMID: 37872564 PMCID: PMC10591397 DOI: 10.1186/s12889-023-16987-9] [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: 04/25/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Cannabis poisonings among children are of public health concern. Existing evidence from the US and from four provinces in Canada (Quebec, Ontario, Alberta, British Columbia) indicate an increase in pediatric cannabis-related poisonings since the legalization of cannabis. This study evaluates trends in cannabis-related poisoning pediatric emergency department (ED) visits and hospitalizations in Canada and addresses a gap in literature by describing trends and context around cannabis edible-related poisoning cases using data from a Canadian sentinel surveillance system. METHODS Mixed-methods using data from two administrative data sources and one injury/poisoning sentinel surveillance system to estimate age-specific rates of cannabis-related poisonings ED visits (Ontario and Alberta), edible-related events (sentinel surveillance Canada), and hospitalizations (Canada with the exception of Quebec) among children between the ages of 0 to 11 from 2015/2016 to 2021. Annual absolute changes were calculated to quantify the magnitude of change between each age-specific rate. Joinpoint regression was used for trend analysis. A thematic analysis was completed to gain a better understanding of cannabis edible-related poisoning cases in the ED. RESULTS The pediatric age-specific rates for cannabis-related poisoning ED visits (average annual percent change (AAPC) Ontario: 98.2%, 95% CI: 79.1, 119.2; AAPC Alberta: 57.4%, 95% CI: 36.7, 81.2), hospitalizations (AAPC: 63.4%, 95% CI: 42.0, 87.9) and cannabis edible-related events (AAPC: 122.8%, 95% CI: 64.0, 202.6) increased significantly from 2015 to 2021. Almost half of all pediatric edible-related events involved gummy edible products (48.8%, n = 143). Based on the thematic analysis, 88% cannabis edible-related events were attributed to inadvertent ingestion due to access to such products or lack of safe storage practices. CONCLUSION Age-specific rates of cannabis-related poisoning ED visits (Ontario and Alberta) and hospitalizations (Canada with the exception of Quebec) have increased since cannabis legalization, with the largest increase in rates occurring from 2019 to 2020. A similar increase in the rate of cannabis edible-related cases from sentinel surveillance data underscores the importance of monitoring this outcome. Public health messaging and national public health promotion strategies targeted towards raising awareness on the risks associated with consuming illegal cannabis and safe storage of cannabis could help mitigate cannabis poisonings among children.
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Affiliation(s)
| | | | | | - Le Li
- Public Health Agency of Canada, Ottawa, ON, Canada
| | | | | | | | - Eva Graham
- Public Health Agency of Canada, Ottawa, ON, Canada
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15
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Pepin LC, Simon MW, Banerji S, Leonard J, Hoyte CO, Wang GS. Toxic Tetrahydrocannabinol (THC) Dose in Pediatric Cannabis Edible Ingestions. Pediatrics 2023; 152:e2023061374. [PMID: 37635689 DOI: 10.1542/peds.2023-061374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE The study characterizes cannabis toxicity in relation to tetrahydrocannabinol (THC) dose in pediatric edible cannabis ingestions. METHODS This is a retrospective review of children aged <6 years presenting with edible cannabis ingestions of known THC dose within a pediatric hospital network (January 1, 2015-October 25, 2022). Cannabis toxicity was characterized as severe if patients exhibited severe cardiovascular (bradycardia, tachycardia/hypotension requiring vasopressors or intravenous fluids, other dysrhythmias), respiratory (respiratory failure, apnea, requiring oxygen supplementation), or neurologic (seizure, myoclonus, unresponsiveness, responsiveness to painful stimulation only, requiring intubation or sedation) effects. Cannabis toxicity was characterized as prolonged if patients required >6 hours to reach baseline. The relationship between THC dose and severe and prolonged toxicity was explored using multivariable logistic regression and receiver operator characteristic curve analyses. RESULTS Eighty patients met inclusion. The median age was 2.9 years. The median THC ingestion was 2.1 mg/kg. Severe and prolonged toxicity was present in 46% and 74%, respectively. THC dose was a significant predictor of severe (adjusted odds ratio 2.9, 95% confidence interval: 1.8-4.7) and prolonged toxicity (adjusted odds ratio 3.2, 95% confidence interval: 1.6-6.5), whereas age and sex were not. Area under the curve was 92.9% for severe and 87.3% for prolonged toxicity. THC ingestions of ≥1.7 mg/kg can predict severe (sensitivity 97.3%) and prolonged toxicity (sensitivity 75.4%). CONCLUSIONS The THC dose of edible cannabis correlates to the degree of toxicity in children <6 years old. The threshold of 1.7 mg/kg of THC may guide medical management and preventive regulations.
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Affiliation(s)
- Lesley C Pepin
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, Colorado
| | - Mark W Simon
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, Colorado
| | - Shireen Banerji
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, Colorado
| | - Jan Leonard
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado, Aurora, Colorado
| | - Christopher O Hoyte
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, Colorado
- Department of Emergency Medicine, University of Colorado Hospital, Aurora, Colorado
| | - George S Wang
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, Colorado
- University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado
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16
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Lorenzo M, Beno S. Evolving threat of pediatric ingestions: a discussion of cannabis and button batteries and their implications for children. Curr Opin Pediatr 2023; 35:316-323. [PMID: 36876321 DOI: 10.1097/mop.0000000000001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
PURPOSE OF REVIEW Pediatric button battery and cannabis ingestions are rising in incidence and have the potential for significant harm. This review will focus on the clinical presentation and complications of these two common inadvertent ingestions in children, as well as recent regulatory efforts and advocacy opportunities. RECENT FINDINGS The rising incidence of cannabis toxicity in children has corresponded with its legalization across several countries in the last decade. Inadvertent pediatric cannabis intoxication is most commonly due to the ingestion of edible forms discovered by children in their own home. The clinical presentation can be nonspecific, therefore clinicians should have a low threshold for including it on their differential diagnosis. Button battery ingestions are also increasing in incidence. While many children are asymptomatic at presentation, button battery ingestions can quickly cause esophageal injury and lead to several serious and potentially life-threatening complications. Prompt recognition and removal of esophageal button batteries is essential for reducing harm. SUMMARY Cannabis and button battery ingestions are important for physicians who take care of children to recognize and manage appropriately. Given their rising incidence, there are many opportunities for policy improvements and advocacy efforts to make a difference in preventing these ingestions altogether.
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Affiliation(s)
- Melissa Lorenzo
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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17
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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.
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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
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18
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Sellers EM, Romach MK. Psychedelics: Science sabotaged by Social Media. Neuropharmacology 2023; 227:109426. [PMID: 36693562 DOI: 10.1016/j.neuropharm.2023.109426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
The substantial challenges facing high and low dose psychedelic drug development to achieve regulatory approval have been documented in the scientific literature. These limitations have not deterred drug developers and social media from repeatedly misleading patients, the public and health professionals. Developing "micro doses" of psychedelics overcomes many of the scientific and regulatory challenges of high dose psychedelics. If micro-dosing could be shown to be efficacious and safe for long term use, it could be administered in the typical model for treatment of mental disorders. Such a model would be more cost effective than the high dose/intense psychotherapy model currently described and could be readily available to all individuals who need another medication option. Outpatient psychotherapeutic agents have a clear route for approval and would be unlikely to be burdened by the extensive Risks Evaluation and Mitigation Strategy needed for high dose use. There may be a different therapeutic role for both high and low dose psychedelic agents. This article is part of the Special Issue on "National Institutes of Health Psilocybin Research Speaker Series".
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Affiliation(s)
- Edward M Sellers
- , Department of Pharmacology & Toxicology, Medicine and Psychiatry, University of Toronto, Toronto, ON, M5S 4K2, Canada; DL Global Partners Inc., 78 Baby Point Crescent, Toronto, ON, M6S 2C1, Canada.
| | - Myroslava K Romach
- , Departments of Psychiatry and Surgery, University of Toronto, Toronto, ON, M5S 4K2, Canada; DL Global Partners Inc., 78 Baby Point Crescent, Toronto, ON, M6S 2C1, Canada
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19
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Myran DT, Friesen EL, Dickson S, Konikoff L, Arora G, Tanuseputro P. Access to legal cannabis market in Canada over the four years following non-medical cannabis legalisation. Drug Alcohol Rev 2023. [PMID: 36933893 DOI: 10.1111/dar.13650] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 03/20/2023]
Abstract
INTRODUCTION An increasing number of countries are inthe process of legalising non-medical cannabis. We described how the legal market has changed over the first 4 years following legalisation in Canada. METHODS We collected longitudinal data on operating status and location of all legal cannabis stores in Canada for the first 4 years following legalisation. We examined per capita stores and sales, store closures, and the drive time between stores and each neighbourhood in Canada. We compared measures between public and private retail systems. RESULTS Four years after legalisation, there were 3305 cannabis stores open in Canada (10.6 stores per 100,000 individuals aged 15+ years). Canadians spent $11.85CAD a month on cannabis per individual aged 15+ years, and 59% of neighbourhoods were within a 5-minute drive of a cannabis store. Over 4 years, per capita stores and per capita sales increased each year by an average of 122.3% and 91.7%, respectively, with larger increases in private versus public systems (4.01 times greater for per capita stores and 2.46 times greater for per capita sales). The annual increase in per capita stores and sales during the first 3 years was 6.0 and 15.5 times greater, respectively, than the increase in the fourth year following legalisation. Over 4 years, 7% of retail store locations permanently closed. DISCUSSION AND CONCLUSION The legal cannabis market in Canada expanded enormously over the first 4 years following legalisation, with considerable variation in access between jurisdictions. The rapid retail expansion has implications for evaluation of health impacts of non-medical legalisation.
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Affiliation(s)
- Daniel Thomas Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada.,ICES, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Erik Loewen Friesen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,ICES Central, Toronto, Canada
| | - Sarah Dickson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Institut du Savoir Montfort, Ottawa, Canada
| | - Lauren Konikoff
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Gaurav Arora
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,ICES, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada.,Bruyere Research Institute, Ottawa, Canada
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20
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Myran DT, Pugliese M, Tanuseputro P, Taljaard M. Response to Smyth & McCarron: Increases in cannabis-attributable emergency department visits during different phases of the pre- and post-legalization period are multi-factorial. Addiction 2023; 118:980-982. [PMID: 36738192 DOI: 10.1111/add.16152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Daniel T Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Ottawa, Ontario, Canada
| | - Michael Pugliese
- Institute for Clinical Evaluative Sciences (ICES), Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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21
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Johnson-Arbor K. Letter to the Editor: Regional Cannabis Edible Variability in the United States. Cannabis Cannabinoid Res 2023; 8:207-208. [PMID: 36577052 DOI: 10.1089/can.2022.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Kelly Johnson-Arbor
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
- National Capital Poison Center, Washington, District of Columbia, USA
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22
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Myran DT, Tanuseputro P, Auger N, Konikoff L, Talarico R, Finkelstein Y. Pediatric Hospitalizations for Unintentional Cannabis Poisonings and All-Cause Poisonings Associated With Edible Cannabis Product Legalization and Sales in Canada. JAMA HEALTH FORUM 2023; 4:e225041. [PMID: 36637814 PMCID: PMC9857209 DOI: 10.1001/jamahealthforum.2022.5041] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Importance Canada legalized cannabis in October 2018 but initially prohibited the sale of edibles (eg, prepackaged candies). Starting in January 2020, some provinces permitted the sale of commercial cannabis edibles. The association of legalizing cannabis edibles with unintentional pediatric poisonings is uncertain. Objective To evaluate changes in proportions of all-cause hospitalizations for poisoning due to cannabis in children during 3 legalization policy periods in Canada's 4 most populous provinces (including 3.4 million children aged 0-9 years). Design, Setting, and Participants This repeated cross-sectional study included all hospitalizations in children aged 0 to 9 years in Ontario, Alberta, British Columbia, and Quebec between January 1, 2015, and September 30, 2021. Exposures Prelegalization (January 2015 to September 2018); period 1, in which dried flower only was legalized in all provinces (October 2018 to December 2019); and period 2, in which edibles were legalized in 3 provinces (exposed provinces) and restricted in 1 province (control province) (January 2020 to September 2021). Main Outcomes and Measures The primary outcome was the proportion of hospitalizations due to cannabis poisoning out of all-cause poisoning hospitalizations. Data analysis was performed using descriptive statistics and Poisson regression models. Results During the 7-year study period, there were 581 pediatric hospitalizations for cannabis poisoning (313 [53.9%] boys; 268 [46.1%] girls; mean [SD] age, 3.6 [2.5] years) and 4406 hospitalizations for all-cause poisonings. Of all-cause poisoning hospitalizations, the rate per 1000 due to cannabis poisoning before legalization was 57.42 in the exposed provinces and 38.50 in the control province. During period 1, the rate per 1000 poisoning hospitalizations increased to 149.71 in the exposed provinces (incidence rate ratio [IRR], 2.55; 95% CI, 1.88-3.46) and to 117.52 in the control province (IRR, 3.05; 95% CI, 1.82-5.11). During period 2, the rate per 1000 poisoning hospitalizations due to cannabis more than doubled to 318.04 in the exposed provinces (IRR, 2.16; 95% CI, 1.68-2.80) but remained similar at 137.93 in the control province (IRR, 1.18; 95% CI, 0.71-1.97). Conclusions and Relevance This cross-sectional study found that following cannabis legalization, provinces that permitted edible cannabis sales experienced much larger increases in hospitalizations for unintentional pediatric poisonings than the province that prohibited cannabis edibles. In provinces with legal edibles, approximately one-third of pediatric hospitalizations for poisonings were due to cannabis. These findings suggest that restricting the sale of legal commercial edibles may be key to preventing pediatric poisonings after recreational cannabis legalization.
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Affiliation(s)
- Daniel T. Myran
- 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
| | - Peter Tanuseputro
- 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,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada,Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Nathalie Auger
- University of Montreal Hospital Centre, Montreal, Quebec, Canada,Institut national de santé publique du Quebec, Montreal, Quebec, Canada,Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, 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
| | - Yaron Finkelstein
- Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada,Departments of Paediatrics and Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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Tassone F, Di Ciano P, Liu Y, Rueda S. On offer to Ontario consumers three years after legalization: A profile of cannabis products, cannabinoid content, plant type, and prices. Front Psychiatry 2023; 14:1111330. [PMID: 36873222 PMCID: PMC9978145 DOI: 10.3389/fpsyt.2023.1111330] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Cannabis was legalized in Canada in October 2018, regulating the production, distribution, sale, and possession of dried cannabis and cannabis oils. Additional products were legalized 1 year later, including edibles, concentrates, and topicals, with new lines of commercial products coming to market. Ontario is the most populous province in Canada and has the largest cannabis market with the highest number of in-person retail stores and the most cannabis products available online. This study aims to create a profile of products available to consumers three years after legalization by summarizing types of products, THC and CBD potency, plant type, and prices of product sub-categories. METHODS We extracted data from the website of the Ontario Cannabis Store (OCS)-the public agency overseeing the only online store and sole wholesaler to all authorized in-person stores-in the first quarter of 2022 (January 19-March 23). We used descriptive analyses to summarize the data. A total of 1,771 available products were mapped by route of administration into inhalation (smoking, vaping, and concentrates), ingestible (edibles, beverages, oils, and capsules) and topical. RESULTS Most inhalation products included ≥20%/g THC (dried flower: 94%; cartridges: 96%; resin: 100%) while ingestible products had similar proportions of THC and CBD content. Indica-dominant products tend to be more prominent in inhalation products while sativa-dominant products tend to be more prominent in ingestible products. The average sale price of cannabis was 9.30 $/g for dried flower, 5.79 $/0.1g for cartridges, 54.82 $/g for resin, 3.21 $/unit for soft chews, 1.37 $/ml for drops, 1.52 $/unit for capsules, and 39.94 $/product for topicals. DISCUSSION In summary, a wide variety of cannabis products were available to Ontarians for different routes of administration and provides numerous indica-dominant, sativa-dominant, and hybrid/blend options. The current market for inhalation products however is geared towards the commercialization of high-THC products.
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Affiliation(s)
- Felicia Tassone
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Patricia Di Ciano
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Yuxin Liu
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sergio Rueda
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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