Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia.
New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, NSW, Australia.
Addiction. 2023 Dec;118(12):2252-2274. doi: 10.1111/add.16280. Epub 2023 Jul 26.
Many countries have recently legalized medicinal and recreational cannabis. With increasing use and access come the potential for harms. We aimed to examine the effect of cannabis legalization/decriminalization on acute poisoning.
A systematic review and meta-analysis registered with PROSPERO (CRD42022323437). We searched Embase, Medline, Scopus and Cochrane Central Register of Controlled Trials from inception to March 2022. No restrictions on language, age or geography were applied. Abstracts from three main clinical toxicology conferences were hand-searched. Included studies had to report on poisonings before and after changes in cannabis legislation, including legalization and decriminalization of medicinal and recreational cannabis. Where possible, relative risk (RR) of poisoning after legalization (versus before) was calculated and pooled. Risk of bias was assessed with ROBINS-I.
Of the 1065 articles retrieved, 30 met inclusion criteria (including 10 conference abstracts). Studies used data from the United States, Canada and Thailand. Studies examined legalization of medicinal cannabis (n = 14) and decriminalization or legalization of recreational cannabis (n = 21). Common data sources included poisons centre records (n = 18) and hospital presentations/admissions (n = 15, individual studies could report multiple intervention types and multiple data sources). Most studies (n = 19) investigated paediatric poisoning. Most (n = 24) reported an increase in poisonings; however, the magnitude varied greatly. Twenty studies were included in quantitative analysis, with RRs ranging from 0.81 to 29.00. Our pooled estimate indicated an increase in poisoning after legalization [RR = 3.56, 95% confidence interval (CI) = 2.43-5.20], which was greater in studies that focused on paediatric patients (RR = 4.31, 95% CI = 2.30-8.07).
Most studies on the effect of medicinal or recreational cannabis legalization/decriminalization on acute poisoning reported a rise in cannabis poisoning after legalization/decriminalization. Most evidence is from US legalization, despite legalization and decriminalization in many countries.
许多国家最近已经将医用和娱乐用大麻合法化。随着使用和获取的增加，潜在的危害也随之而来。我们旨在研究大麻合法化/非刑罪化对急性中毒的影响。
系统综述和荟萃分析在 PROSPERO（CRD42022323437）中注册。我们从成立到 2022 年 3 月，在 Embase、Medline、Scopus 和 Cochrane 中央对照试验注册中心进行了检索。没有对语言、年龄或地理位置施加限制。从三个主要的临床毒理学会议的摘要中进行了手工检索。纳入的研究必须报告大麻立法变更前后的中毒情况，包括医用和娱乐用大麻的合法化和非刑罪化。在可能的情况下，计算并汇总了合法化后（与之前相比）中毒的相对风险（RR）。使用 ROBINS-I 评估偏倚风险。
在检索到的 1065 篇文章中，有 30 篇符合纳入标准（包括 10 篇会议摘要）。研究使用了来自美国、加拿大和泰国的数据。研究检查了医用大麻的合法化（n=14）和娱乐用大麻的非刑罪化或合法化（n=21）。常见的数据来源包括中毒中心记录（n=18）和医院就诊/入院记录（n=15，个别研究可以报告多种干预类型和多种数据来源）。大多数研究（n=19）调查了儿科中毒。大多数（n=24）报告中毒增加；然而，幅度差异很大。20 项研究纳入定量分析，RR 范围为 0.81 至 29.00。我们的汇总估计表明，合法化后中毒增加[RR=3.56，95%置信区间（CI）=2.43-5.20]，在关注儿科患者的研究中更为明显（RR=4.31，95%CI=2.30-8.07）。
大多数关于医用或娱乐用大麻合法化/非刑罪化对急性中毒影响的研究报告称，合法化/非刑罪化后，大麻中毒的发生率上升。大多数证据来自美国的合法化，尽管许多国家已经合法化和非刑罪化。
