Cannabis-related emergency department visits by youth increased five-fold in Ontario between 2003 and 2017

Cannabis-related emergency department visits and subsequent hospitalizations for adolescents and young adults in Ontario have increased nearly five-fold from 2003 to 2017, according to a new study led by the CHEO Research Institute.

The study "Cannabis-related emergency department visits by youths and their outcomes in Ontario: a trend analysis" published in CMAJ Open (Canadian Medical Association Journal) highlights an important emerging public health problem and a trend that is persistent and accelerating.

"It's troubling to see such a dramatic rise in pediatric cannabis-related emergency department visits, even before legalization," said the study's lead author, Dr. Melanie Bechard, a Researcher and Emergency Department physician at CHEO, a pediatric health-care and research centre in Ottawa. "The social reasons behind this surge are not found in the data used for this study, but the significant increase in visits should be a warning to families and doctors. More research is needed to identify the causes of this increase and the health and social consequences of cannabis-related visits for these youths."

The study examined more than 14.5 million administrative records of visits to emergency departments in Ontario from 2003 to 2017. The investigators found that the rates of youth with a cannabis-related visit to the emergency department increased. So did the medical severity of cannabis visits and the likelihood that an ED patient with cannabis intoxication would be admitted to the hospital.

"It's important to be aware that cannabis-related emergency department visits in youth were on the rise even before the 2018 legalization of recreational cannabis use for adults 18 and older in Canada. Post-legalization and with cannabis edibles, such as chocolates and gummies, now available throughout Canada, these rates may continue to rise," said Dr. Bechard, also an Assistant Professor of Pediatrics at the University of Ottawa. "We suggest that emergency department clinicians maintain a high index of suspicion for cannabis exposure in young people presenting to the emergency department. Suppose a young person has unexplained decreased consciousness or agitation; in that case, doctors should ask about possible cannabis exposure early in the visit."

The study did not aim to explain why there was an increase in cannabis-related emergency department visits. The goal was to provide an overview of an emerging population health issue that needs to be further examined and researched. One possible explanation for the increase in cannabis-related emergency department visits is that doctors may have become more aware of how prevalent cannabis use is. Another possible explanation is that some youths are consuming more potent cannabis products, or efficient modes of drug administration, such as vaping which can give a user a large and rapid dose of cannabis.

"A recent study showed an increased rate of cannabis poisoning in young children under 10 in Canada. Along with our study, this reinforces that parents must be aware of the risks associated with cannabis in youth and properly store and lock any cannabis products in the home," advised Dr. Bechard.