The rate of cannabis-induced and cannabis-involved disorder emergency department (ED) visits rose nearly 50% between 2019 and 2020, according to a new study by Truveta Research. Despite this trend, clinicians may not feel empowered to treat cannabis-related conditions.
The medical community uses the term cannabis-induced ED to describe what is known as cannabis-induced psychosis. Cannabis-involved ED visits can be used to refer to any cannabis-related visit.
The study’s findings were not surprising to Dr. Lewis Nelson, chair of the department of emergency medicine and chief of the division of medical toxicology and addiction medicine at Rutgers New Jersey Medical School.
One of the key drivers of the increase in cannabis-related ED visits is “clearly increased availability,” Nelson said.
“The other factor is that the cannabis of today is not like the cannabis of the 1970s,” he told Addiction Treatment Business. “It’s extremely high potency comparatively.”
The study analyzed more than 33.5 million emergency department visits between 2019 and 2023, which included nearly 19,000 emergency department encounters from more than 14,500 people.
The rate of cannabis-induced disorder ED visits per 10,000 ED visits was found to be 3.9 in 2019. One year later, the rate was 5.7, an increase of 46.2%. The rate of cannabis-induced psychosis visits continued to increase through 2023.
“The substantial and sustained rise in the rate of cannabis-induced disorder visits between 2019 and 2023 suggests a growing impact on individuals’ health, raising questions about the potential short- and long-term consequences of increased cannabis use,” the study’s authors wrote.
While cannabis products have become stronger, driving increased numbers of ED visits, people increasingly believe cannabis to be safe.
“The fact that it’s legal sort of legitimizes it,” Nelson said.
Extremely potent cannabis products, sometimes found in colorful wrapping and candy-like formulations, are thought to be a driver of ED visits among an even more vulnerable population.
A CDC study found significant increases in cannabis-involved ED visits during the COVID-19 pandemic among children under 10 years old.
The study’s findings were consistent with National Poison Data System data, which found that instances of children younger than 6 years old ingesting edible cannabis increased by 1,375% from 2017 to 2021.
“Improving clinicians’ awareness of rising cannabis-involved ED visits might aid in early diagnosis of cannabis intoxication among young persons,” the authors of the CDC study wrote.
The authors also recommended increasing adults’ knowledge about safe cannabis storage, helping young people find coping mechanisms and changing cannabis packaging to be less appealing to young people.
Nelson predicted that as cannabis becomes more socially acceptable and widely available, ED visits will continue to increase.
“There probably is going to be a direct correlation with the legal status, the availability, and the risk of ED visits, psychosis and everything else cannabis-related,” he said.
Research has yet to determine if increased legality will spur more ED visits.
One study published in JAMA Network Open in January of 2023 did find evidence of increased rates of psychosis-related healthcare utilization among men aged 55-64 years associated with recreational cannabis policies. Still, its results were too imprecise to draw conclusions about an overall population.
“I don’t view this study as providing conclusive evidence that state cannabis legalization doesn’t lead to increases in psychosis-related health care utilization,” the study’s senior author, Dr. Ellicott Matthay, assistant professor of population health at the NYU Grossman School of Medicine, told Addiction Treatment Business in an email.
“I view this study as saying: ‘There might be a problem here, or there might not,’” she continued. “We don’t know yet.”
Matthay said it was difficult to comment on the Truveta data because of the lack of detail regarding its methods but that its conclusions were “not unprecedented.”
“In my own work in California, we’ve found that calls to Poison Control for cannabis exposures involving health harms increased more than 60% following state recreational cannabis legalization,” Matthay said.
The study’s first author, Dr. Holly Elser, resident physician in neurology at the University of Pennsylvania, said Truveta’s findings were striking, and that she would be curious to see if these findings differ by region or across population subgroups.
“Future research that examines the relationship between state policy, individual-level cannabis use and individual-level health outcomes will be important,” Elser said.
Despite increases in ED visits, there is no treatment for cannabis use disorder, Nelson said. Many clinicians may feel helpless to address cannabis-related problems, he added.
“I am not sure that the average clinician is going to be receptive to this message [about the implications of cannabis and cannabis-induced psychosis],” Nelson said. “There’s a certain social acceptability, there’s a certain feeling that this isn’t really something I can fix.”
New treatment methods for cannabis use disorder would be exciting, Nelson said, but that the industry’s best tools would involve harm reduction, including warnings about the potency of cannabis.