Ball Ian M, Priestap Fran, Parry Neil, Pace Jacob, Vogt Kelly N
From the Department of Surgery, Western University, London, Ont. (Vogt, Parry); the Division of Emergency Medicine, Department of Medicine, Western University, London, Ont. (Pace, Ball); and the London Health Sciences Trauma Program, London, Ont. (Priestap).
Can J Surg. 2021 Jul 23;64(4):E403-E406. doi: 10.1503/cjs.000620.
The federal Cannabis Act came into force on Oct. 17, 2018, in Canada, making Canada only the second country in the world to legalize the cultivation, acquisition, possession and consumption of cannabis and its by-products. This provided a unique opportunity to evaluate the impact of this legislation on drug-related trauma.
We performed a prospective observational study on the use of cannabis and other illicit drugs in the trauma population at a lead Canadian trauma centre in London, Ontario, in the 3 months before (July 1 to Sept. 30, 2018) and 3 months after (Nov. 1, 2018, to Jan. 31, 2019) the legalization of cannabis in Canada. We defined cannabis use as a positive cannabinoid screen result at the time of assessment by the trauma team. We also screened for opioids, amphetamines and cocaine.
A total of 210 patients were assessed by our trauma service between July 1 and Sept. 30, 2018, and 141 patients were assessed between Nov. 1, 2018, and Jan. 31, 2019. Motor vehicle collisions were the most common cause of trauma both before (101 [48.1%]) and after (67 [47.5%]) legalization. The mean Injury Severity Score was 17.6 (standard deviation [SD] 13.0) and 19.7 (SD 14.8), respectively. Drug screens were done in 88 patients (41.9%) assessed before legalization and 99 patients (70.2%) assessed after legalization. There was no difference in the rate of positive cannabinoid screen results before and after legalization (22 [25%] v. 22 [22%]). There was a trend toward higher rates of positive cannabinoid screen results (2/10 [20%] v. 5/8 [62%]) and positive toxicology screen results (5/10 [50%] v. 6/8 [75%]) after legalization among patients with penetrating trauma, but our sample was too small to achieve statistical significance.
We found no difference in the rates of positive cannabinoid screen results among patients assessed at our trauma centre in the 3 months before and the 3 months after legalization of cannabis; however, there was a trend toward an increase in the rates of positive results of toxicology screens and cannabinoid screens among those with penetrating trauma. These preliminary single-centre data showing no increased rates of cannabis use in patients with trauma after legalization are reassuring.
2018年10月17日，加拿大联邦《大麻法案》生效，使加拿大成为世界上第二个将大麻及其副产品的种植、获取、持有和消费合法化的国家。这为评估该立法对与毒品相关创伤的影响提供了独特机会。
我们对安大略省伦敦市一家主要的加拿大创伤中心创伤人群在加拿大麻合法化前3个月（2018年7月1日至9月30日）和合法化后3个月（2018年11月1日至2019年1月31日）使用大麻和其他非法药物的情况进行了一项前瞻性观察研究。我们将大麻使用定义为创伤团队评估时大麻素筛查结果呈阳性。我们还对阿片类药物、苯丙胺和可卡因进行了筛查。
2018年7月1日至9月30日期间，我们的创伤服务部门共评估了210例患者，2018年11月1日至2019年1月31日期间评估了141例患者。机动车碰撞是合法化前后创伤的最常见原因，合法化前为101例（48.1%），合法化后为67例（47.5%）。平均损伤严重度评分分别为17.6（标准差[SD]13.0）和19.7（SD 14.8）。合法化前评估的88例患者（41.9%）和合法化后评估的99例患者（70.2%）进行了药物筛查。合法化前后大麻素筛查结果阳性率无差异（22例[25%]对22例[22%]）。穿透性创伤患者合法化后大麻素筛查结果阳性率（2/10[20%]对5/8[62%]）和毒理学筛查结果阳性率（5/10[50%]对6/8[75%]）有升高趋势，但我们的样本量太小，无法达到统计学显著性。
我们发现在大麻合法化前3个月和合法化后3个月在我们创伤中心接受评估的患者中，大麻素筛查结果阳性率没有差异；然而，穿透性创伤患者中毒理学筛查和大麻素筛查结果阳性率有升高趋势。这些初步的单中心数据显示合法化后创伤患者中大麻使用率没有增加，令人安心。
