Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Clin Toxicol (Phila). 2022 May;60(5):585-595. doi: 10.1080/15563650.2021.2012576. Epub 2021 Dec 22.
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.
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.
There was an increase in both THC IA ( < .0001) and cannabis-related ICD-10 codes ( < .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.
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.
尽管存在联邦法律，大麻在美国仍被广泛使用。在美国各州向合法化方向发展的过程中，据报道，与大麻相关的急诊部（ED）就诊情况出现了各种影响。然而，缺乏关于马萨诸塞州（MA）ED 中合法化影响的研究。
在波士顿的两家学术医疗中心，连续患者 ED 就诊时，获得大麻素免疫分析（THCIA）结果和大麻相关 ICD-10 代码，这些就诊时间处于以下合法化阶段：去刑事化（DEC）、医疗药房开业前（MEDBD）、医疗药房开业后（MEDDISP）、娱乐性药房开业前（RECBD）和娱乐性药房开业后（RECDISP）。为这些合法化阶段确定了 THCIA 和 ICD-10 代码的趋势和每月阳性率。
在这两个机构，随着合法化的推进，ED 中的 THCIA（ < .0001）和大麻相关 ICD-10 代码（ < .0001）均有所增加。THCIA 的阳性率显著增加了 7%，而 ICD-10 代码的阳性率则增加了 0.4%。THCIA 阳性率在女性、30-39 岁的患者、老年人（>59 岁）和收入最高三分位数的患者中增加。在阳性 THCIA 的患者中，安非他命阳性率呈上升趋势，阿片类药物阳性率呈下降趋势。与 THCIA 不同，THCIA 阳性患者的 ICD-10 代码在患者人口统计学方面没有显著趋势。
马萨诸塞州大麻合法化导致大麻使用增加，这表现为阳性 THCIA 结果的比例增加，老年人比例增加，以及大麻相关 ICD-10 代码增加。数据表明，随着合法化的推进，THC 的使用呈稳步增加，而阿片类药物、芬太尼或可卡因的使用并未增加。我们建议使用 ED THCIA 阳性率，这是一种客观的实验室测量方法，以监测 THC 使用情况和大麻合法化在各州的进展情况。
