Injury Prevention Research Office, Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada.
Health Sciences Library, St. Michael's Hospital, Toronto, Ontario, Canada.
Public Health. 2023 Aug;221:87-96. doi: 10.1016/j.puhe.2023.06.012. Epub 2023 Jul 8.
To determine the effect of recreational cannabis legalization (RCL) and/or recreational cannabis commercialization (RCC) on emergency department (ED) visits, hospitalizations, and deaths due to substance use, injury, and mental health among those aged 11 years and older.
A systematic review of six electronic databases up to February 1, 2023. Original, peer-reviewed articles with interrupted time series or before and after designs were included. Four independent reviewers screened articles and assessed risk of bias. Outcomes with 'critical' risk of bias were excluded. Protocol registered on PROSPERO (# CRD42021265183).
After screening and risk of bias assessment, 29 studies were included which examined ED visits or hospitalizations for cannabis use or alcohol (N = 10), opioid mortality (N = 3), motor vehicle fatalities or injury (N = 11), and intentional injury/mental health (N = 5). Rates or number of cannabis-related hospitalizations increased after RCL in Canada and the USA. Immediate increases in rates of cannabis-related ED visits were found after both RCL and RCC in Canada. Rates of traffic fatalities increased after RCL and RCC in certain jurisdictions in the USA.
RCL was associated with increased rates of cannabis-related hospitalizations. RCL and/or RCC was associated with increased rates of cannabis-related ED visits, consistently shown across sex and age groups. The effect on fatal motor vehicle incidents was mixed, with observed increases found after RCL and/or RCC. The effect of RCL or RCC on opioids, alcohol, intentional injury, and mental health is not clear. These results inform population health initiatives and international jurisdictions considering RCL implementation.
确定休闲大麻合法化（RCL）和/或休闲大麻商业化（RCC）对 11 岁及以上人群因物质使用、伤害和心理健康导致的急诊就诊、住院和死亡的影响。
系统检索了截至 2023 年 2 月 1 日的六个电子数据库。纳入了具有中断时间序列或前后设计的原始同行评审文章。四名独立评审员筛选文章并评估偏倚风险。具有“关键”偏倚风险的结局被排除在外。方案在 PROSPERO 上注册（#CRD42021265183）。
经过筛选和偏倚风险评估，纳入了 29 项研究，这些研究检查了急诊就诊或因大麻或酒精（N=10）、阿片类药物死亡率（N=3）、机动车死亡或伤害（N=11）和故意伤害/心理健康（N=5）住院的情况。在加拿大和美国，RCL 后大麻相关住院率增加。在加拿大，RCL 和 RCC 后立即发现与大麻相关的 ED 就诊率增加。在美国某些司法管辖区，RCL 和 RCC 后交通死亡人数增加。
RCL 与大麻相关住院率增加有关。RCL 和/或 RCC 与大麻相关 ED 就诊率增加有关，在不同性别和年龄组中均得到一致观察。致命机动车事故的影响不一致，在 RCL 和/或 RCC 后观察到增加。RCL 或 RCC 对阿片类药物、酒精、故意伤害和心理健康的影响尚不清楚。这些结果为人口健康计划和正在考虑实施 RCL 的国际司法管辖区提供了信息。
