Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Clin Toxicol (Phila). 2023 Apr;61(4):248-259. doi: 10.1080/15563650.2023.2177552.
Many states in the United States have progressed towards legalization of marijuana including decriminalization, medicinal and/or recreational use. We studied the impact of legalization on cannabis-related emergency department visits in states with varying degrees of legalization.
Seventeen healthcare institutions in fifteen states (California, Colorado, Connecticut, Florida, Iowa, Kentucky, Maryland, Massachusetts, Missouri, New Hampshire, Oregon, South Carolina, Tennessee, Texas, Washington) participated. Cannabinoid immunoassay results and cannabis-related International Classification of Diseases (ninth and tenth versions) codes were obtained for emergency department visits over a 3- to 8-year period during various stages of legalization: no state laws, decriminalized, medical approval before dispensaries, medical dispensaries available, recreational approval before dispensaries and recreational dispensaries available. Trends and monthly rates of cannabinoid immunoassay and cannabis-related International Classification of Diseases code positivity were determined during these legalization periods.
For most states, there was a significant increase in both cannabinoid immunoassay and International Classification of Diseases code positivity as legalization progressed; however, positivity rates differed. The availability of dispensaries may impact positivity in states with medical and/or recreational approval. In most states with no laws, there was a significant but smaller increase in cannabinoid immunoassay positivity rates.
States may experience an increase in cannabis-related emergency department visits with progression toward marijuana legalization. The differences between states, including those in which no impact was seen, are likely multifactorial and include cultural norms, attitudes of local law enforcement, differing patient populations, legalization in surrounding states, availability of dispensaries, various ordering protocols in the emergency department, and the prevalence of non-regulated cannabis products.
美国许多州已经朝着大麻合法化的方向发展，包括非刑事化、药用和/或娱乐用途。我们研究了在不同程度合法化的州，大麻合法化对与大麻相关的急诊就诊的影响。
十五个州的十七家医疗机构（加利福尼亚州、科罗拉多州、康涅狄格州、佛罗里达州、爱荷华州、肯塔基州、马里兰州、马萨诸塞州、密苏里州、新罕布什尔州、俄勒冈州、南卡罗来纳州、田纳西州、得克萨斯州、华盛顿州）参与了这项研究。在大麻合法化的不同阶段，我们获得了 3 至 8 年期间急诊就诊的大麻免疫分析结果和与大麻相关的国际疾病分类（第九和第十版）代码：无州法律、非刑事化、在药房开业前获得医疗批准、有药房、在药房开业前获得娱乐批准和有娱乐药房。在这些合法化期间，我们确定了大麻免疫分析和与大麻相关的国际疾病分类代码阳性率的趋势和月度率。
对于大多数州，随着大麻合法化的推进，大麻免疫分析和国际疾病分类代码阳性率都显著增加；然而，阳性率有所不同。医疗和/或娱乐批准的州的药房可用性可能会影响阳性率。在没有法律的大多数州，大麻免疫分析阳性率显著增加，但增幅较小。
随着大麻合法化的推进，各州可能会经历与大麻相关的急诊就诊人数增加。各州之间的差异，包括那些没有影响的州，可能是多方面的，包括文化规范、地方执法部门的态度、不同的患者群体、周边州的合法化、药房的可用性、急诊部门的各种订购协议，以及非监管大麻产品的流行。
