Crocker Candice E, Carter Alix J E, Emsley Jason G, Magee Kirk, Atkinson Paul, Tibbo Philip G
Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada.
Front Psychiatry. 2021 Feb 15;12:640222. doi: 10.3389/fpsyt.2021.640222. eCollection 2021.
Cannabis use is a modifiable risk factor for the development and exacerbation of mental illness. The strongest evidence of risk is for the development of a psychotic disorder, associated with early and consistent use in youth and young adults. Cannabis-related mental health adverse events precipitating Emergency Department (ED) or Emergency Medical Services presentations can include anxiety, suicidal thoughts, psychotic or attenuated psychotic symptoms, and can account for 25-30% of cannabis-related ED visits. Up to 50% of patients with cannabis-related psychotic symptoms presenting to the ED requiring hospitalization will go on to develop schizophrenia. With the legalization of cannabis in various jurisdiction and the subsequent emerging focus of research in this area, our understanding of who (e.g., age groups and risk factors) are presenting with cannabis-related adverse mental health events in an emergency situation is starting to become clearer. However, for years we have heard in popular culture that cannabis use is less harmful or no more harmful than alcohol use; however, this does not appear to be the case for everyone. It is evident that these ED presentations should be considered another aspect of potentially harmful outcomes that need to be included in knowledge mobilization. In the absence of a clear understanding of the risk factors for mental health adverse events with cannabis use it can be instructive to examine what characteristics are seen with new presentations of mental illness both in emergency departments (ED) and early intervention services for mental illness. In this narrative review, we will discuss what is currently known about cannabis-related mental illness presentations to the ED, discussing risk variables and outcomes both prior to and after legalization, including our experiences following cannabis legalization in Canada. We will also discuss what is known about cannabis-related ED adverse events based on gender or biological sex. We also touch on the differences in magnitude between the impact of alcohol and cannabis on emergency mental health services to fairly present the differences in service demand with the understanding that these two recreational substances may impact different populations of individuals at risk for adverse events.
使用大麻是精神疾病发生和加重的一个可改变的风险因素。最强的风险证据是与青少年和青年早期及持续使用相关的精神障碍的发生。导致急诊科（ED）就诊或紧急医疗服务出诊的与大麻相关的心理健康不良事件可包括焦虑、自杀念头、精神病性或轻度精神病性症状，且可占与大麻相关的ED就诊的25%-30%。因与大麻相关的精神病性症状到ED就诊且需要住院治疗的患者中，高达50%会继而发展为精神分裂症。随着大麻在各个司法管辖区合法化以及该领域随后出现的研究重点，我们对于在紧急情况下出现与大麻相关的不良心理健康事件的人群（例如年龄组和风险因素）的理解开始变得更加清晰。然而，多年来我们在流行文化中听到，使用大麻的危害比饮酒小或不比饮酒大；然而，似乎并非对每个人都是如此。显然，这些ED就诊情况应被视为潜在有害后果的另一个方面，需要纳入知识传播中。在对使用大麻导致心理健康不良事件的风险因素缺乏清晰认识的情况下，审视在急诊科（ED）和精神疾病早期干预服务中精神疾病新病例所呈现的特征可能具有指导意义。在这篇叙述性综述中，我们将讨论目前已知的与大麻相关的精神疾病到ED就诊的情况，讨论合法化之前和之后的风险变量及结果，包括我们在加拿大大麻合法化后的经历。我们还将讨论基于性别或生物性别的与大麻相关的ED不良事件的已知情况。我们也会提及酒精和大麻对紧急心理健康服务影响程度的差异，以便在理解这两种消遣性物质可能影响不同风险人群发生不良事件的情况下，公正地呈现服务需求的差异。
