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Clinical Toxicology Volume 60, 2022 - Issue 5
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Clinical Research

Impact of marijuana legalization on cannabis-related visits to the emergency department

Nicole V. Tolana Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA;b Harvard Medical School, Boston, MA, USAORCID Iconhttps://orcid.org/0000-0002-7239-1843View further author information
ORCID Icon,
Tolumofe Tereboa Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USAORCID Iconhttps://orcid.org/0000-0002-6041-9458View further author information
ORCID Icon,
Peter R. Chaib Harvard Medical School, Boston, MA, USA;c Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women’s Hospital, Boston, MA, USA;d The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA;e The Fenway Institute, Boston, MA, USAORCID Iconhttps://orcid.org/0000-0003-0955-4117View further author information
ORCID Icon,
Timothy B. Ericksonb Harvard Medical School, Boston, MA, USA;c Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women’s Hospital, Boston, MA, USA;f Harvard Humanitarian Initiative, Cambridge, MA, USAORCID Iconhttps://orcid.org/0000-0002-1809-4805View further author information
ORCID Icon,
Bryan D. Hayesb Harvard Medical School, Boston, MA, USA;g Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USAORCID Iconhttps://orcid.org/0000-0001-7349-6770View further author information
ORCID Icon,
Sacha N. Uljonb Harvard Medical School, Boston, MA, USA;h Department of Pathology, Massachusetts General Hospital, Boston, MA, USAORCID Iconhttps://orcid.org/0000-0001-5190-6652View further author information
ORCID Icon,
Athena K. Petridesa Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA;b Harvard Medical School, Boston, MA, USAView further author information
,
Christiana A. Demetrioui Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus;j The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, CyprusView further author information
&
Stacy E. F. Melansona Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA;b Harvard Medical School, Boston, MA, USACorrespondence[email protected]
ORCID Iconhttps://orcid.org/0000-0002-4209-6085View further author information
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Pages 585-595 | Received 20 Sep 2021, Accepted 22 Nov 2021, Published online: 22 Dec 2021
 
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Abstract

Background

Cannabis is widely used in the United States despite federal laws. In US states that have progressed toward legalization, there have been various reported impacts on cannabis-related emergency department (ED) visits. However, studies on the impact of legalization in Massachusetts (MA) EDs are lacking.

Methods

Cannabinoid immunoassay (THC IA) results and cannabis-related ICD-10 codes were obtained for consecutive patient ED visits at two academic medical centers in Boston, MA over the following legalization periods (January 2012–December 2019): decriminalized (DEC), before medical dispensaries (MED BD), medical dispensaries available (MED DISP), before recreational dispensaries (REC BD) and recreational dispensaries available (REC DISP). Trends and monthly positivity rates for THC IA and ICD-10 codes were determined for these legalization periods.

Results

There was an increase in both THC IA (p < .0001) and cannabis-related ICD-10 codes (p < .0001) in the ED as legalization progressed at both institutions. Positivity rates significantly increased by 7% for THC IA and 0.4% for ICD-10 codes. Increases in THC IA positivity were seen in females, patients aged 30–39, older adults (>59 years), and those in the highest income tertile. There was an increasing trend in amphetamine positivity and decreasing trend in opiate positivity in patients with positive THC IA. Unlike THC IA, significant trends per patient demographics were not seen with ICD-10 codes.

Conclusions

Legalization of marijuana in MA has led to an increase in cannabis use as indicated by both increasing rates of positive THC IA results, in older adults, as well as increasing cannabis-related ICD-10 codes. Data suggest a steady increase in THC use associated with legalization that was not associated with an increase in opiate, fentanyl, or cocaine use. We recommend using ED THC IA positivity, an objective laboratory measure, to monitor THC use and the impact of state-specific progression in cannabis legalization.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by National Institutes of Health. PRC/TBE funded by NIH R44DA051106. PRC is funded by NIH K23DA044874, the Hans and Mavis Lopater Psychosocial Foundation and Defense Advanced Research Projects Agency.

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