{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T12:38:08Z","timestamp":1780317488161,"version":"3.54.1"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:00:00Z","timestamp":1615939200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:00:00Z","timestamp":1615939200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Emerg Med"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>On October 17, 2018, the Cannabis Act decriminalized the recreational use of cannabis in Canada. This study seeks to determine how legalization of cannabis has impacted emergency department (ED) visits for acute cannabis intoxication.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We conducted a retrospective chart review at an academic ED in Hamilton, Ontario. We assessed all visits with a cannabis-related ICD-10 discharge code 6 months before and after legalization (October 17, 2018) to determine cases of acute cannabis intoxication. The primary outcome was the rate of ED visits. Secondary outcomes included number of visits distributed by age, length of stay, co-ingestions, and clinical course in the emergency department (investigations and treatment).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>There was no difference in the overall rate of ED visits following legalization (2.44 vs. 2.94 visits\/1000, <jats:italic>p<\/jats:italic>\u2009=\u20090.27). However, we noted a 56% increase in visits among adults aged 18\u201329 (<jats:italic>p<\/jats:italic>\u2009=\u20090.03). Following legalization, a larger portion of patients required observation without interventions (25% vs 48%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Bloodwork and imaging studies decreased (53% vs. 12%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05; 29% vs. 2%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05); however, treatment with benzodiazepines increased (24% vs. 51%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Legalization was not associated with a change in the rate of cannabis-related ED visits in our study. More research is needed regarding changing methods of cannabis ingestion and trends among specific age groups.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12873-021-00428-0","type":"journal-article","created":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T10:02:54Z","timestamp":1615975374000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Acute cannabis intoxication in the emergency department: the effect of legalization"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9726-9967","authenticated-orcid":false,"given":"Robert","family":"Baraniecki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Puru","family":"Panchal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danya Deepsee","family":"Malhotra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Aliferis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaka","family":"Zia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,17]]},"reference":[{"issue":"2","key":"428_CR1","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1002\/phar.1187","volume":"33","author":"LM Borgelt","year":"2013","unstructured":"Borgelt LM, Franson KL, Nussbaum AM, Wang GS. The pharmacologic and clinical effects of medical cannabis. Pharmacotherapy. 2013;33(2):195\u2013209. https:\/\/doi.org\/10.1002\/phar.1187.","journal-title":"Pharmacotherapy."},{"key":"428_CR2","series-title":"Statistics Canada","volume-title":"Licensed cannabis industry statistics","author":"Government of Canada SC","year":"2018","unstructured":"Government of Canada SC. Licensed cannabis industry statistics. Statistics Canada; 2018. (Table 36-10-0283-01)."},{"key":"428_CR3","volume-title":"Economic Analysis Division and Health Analysis Division, Statistics Canada","author":"R Macdonald","year":"2017","unstructured":"Macdonald R, Rotermann M. Experimental estimates of cannabis consumption in Canada, 1960 to 2015. In: Economic Analysis Division and Health Analysis Division, Statistics Canada; 2017."},{"key":"428_CR4","first-page":"15","volume-title":"National Cannabis Survey, first quarter 2019","author":"Statistics Canada","year":"2019","unstructured":"Statistics Canada. National Cannabis Survey, first quarter 2019. 2019;(11):15."},{"issue":"2","key":"428_CR5","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1192\/bjp.178.2.101","volume":"178","author":"CH Ashton","year":"2001","unstructured":"Ashton CH. Pharmacology and effects of cannabis: a brief review. Br J Psychiatry. 2001;178(2):101\u20136. https:\/\/doi.org\/10.1192\/bjp.178.2.101.","journal-title":"Br J Psychiatry"},{"issue":"3","key":"428_CR6","doi-asserted-by":"publisher","first-page":"6","DOI":"10.29173\/aar93","volume":"2","author":"M Yeung","year":"2019","unstructured":"Yeung M, Janz K, Weaver C, Saah-Haines R, Lang E. Cannabis in the emergency department: the impact of cannabis legalization on cannabis and opioid-related presentations. Alberta Acad Rev. 2019;2(3):6\u20136. https:\/\/doi.org\/10.29173\/aar93.","journal-title":"Alberta Acad Rev"},{"issue":"1","key":"428_CR7","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1016\/j.annemergmed.2016.01.004","volume":"68","author":"HS Kim","year":"2016","unstructured":"Kim HS, Monte AA. Colorado cannabis legalization and its effect on emergency care. Ann Emerg Med. 2016;68(1):71\u20135. https:\/\/doi.org\/10.1016\/j.annemergmed.2016.01.004.","journal-title":"Ann Emerg Med"},{"key":"428_CR8","doi-asserted-by":"publisher","unstructured":"Agaku I, Omaduvie U, Vardavas C, Filippidis F. Cannabis use is associated with reduced harm perception towards illicit drugs and experimentation with new psychoactive substances among European adolescents and young adults. Eur Respir J.\u00a02015;46:PA5118. https:\/\/doi.org\/10.1183\/13993003.congress-2015.PA5118.","DOI":"10.1183\/13993003.congress-2015.PA5118"},{"issue":"1","key":"428_CR9","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1177\/0143034399201004","volume":"20","author":"ER Danseco","year":"1999","unstructured":"Danseco ER, Kingery PM, Coggeshall MB. Perceived risk of harm from marijuana use among youth in the USA. Sch Psychol Int. 1999;20(1):39\u201356. https:\/\/doi.org\/10.1177\/0143034399201004.","journal-title":"Sch Psychol Int"},{"issue":"7","key":"428_CR10","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1001\/jamapediatrics.2013.140","volume":"167","author":"GS Wang","year":"2013","unstructured":"Wang GS, Roosevelt G, Heard K. Pediatric marijuana exposures in a medical marijuana state. JAMA Pediatr. 2013;167(7):630\u20133. https:\/\/doi.org\/10.1001\/jamapediatrics.2013.140.","journal-title":"JAMA Pediatr"},{"issue":"7","key":"428_CR11","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1097\/01.NAJ.0000541420.13348.d8","volume":"118","author":"E Mechcatie","year":"2018","unstructured":"Mechcatie E. The impact of legalization of medical and recreational marijuana. AJN Am J Nurs. 2018;118(7):16. https:\/\/doi.org\/10.1097\/01.NAJ.0000541420.13348.d8.","journal-title":"AJN Am J Nurs"},{"issue":"4","key":"428_CR12","doi-asserted-by":"publisher","first-page":"557","DOI":"10.5811\/westjem.2019.4.39935","volume":"20","author":"BA Roberts","year":"2019","unstructured":"Roberts BA. Legalized cannabis in Colorado emergency departments: a cautionary review of negative health and safety effects. West J Emerg Med. 2019;20(4):557\u201372. https:\/\/doi.org\/10.5811\/westjem.2019.4.39935.","journal-title":"West J Emerg Med"},{"issue":"4","key":"428_CR13","doi-asserted-by":"publisher","first-page":"E111","DOI":"10.1503\/cmaj.109-5703","volume":"191","author":"S Brown","year":"2019","unstructured":"Brown S. Emergency physicians and public health experts call for tight regulations on cannabis edibles and concentrates. CMAJ. 2019;191(4):E111\u20132. https:\/\/doi.org\/10.1503\/cmaj.109-5703.","journal-title":"CMAJ."},{"issue":"7","key":"428_CR14","doi-asserted-by":"publisher","first-page":"E162","DOI":"10.1503\/cmaj.191305","volume":"192","author":"JS Zipursky","year":"2020","unstructured":"Zipursky JS, Bogler OD, Stall NM. Five things to know about edible cannabis. CMAJ. 2020;192(7):E162. https:\/\/doi.org\/10.1503\/cmaj.191305.","journal-title":"CMAJ."},{"issue":"5","key":"428_CR15","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1111\/ajad.12401","volume":"25","author":"SI Woodruff","year":"2016","unstructured":"Woodruff SI, Shillington AM. Sociodemographic and drug use severity differences between medical marijuana users and non-medical users visiting the emergency department. Am J Addict. 2016;25(5):385\u201391. https:\/\/doi.org\/10.1111\/ajad.12401.","journal-title":"Am J Addict"},{"key":"428_CR16","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.abrep.2015.05.004","volume":"2","author":"G Yeomans-Maldonado","year":"2015","unstructured":"Yeomans-Maldonado G, Patrick ME. The effect of perceived risk on the combined used of alcohol and marijuana: results from daily surveys. Addict Behav Rep. 2015;2:33\u20136. https:\/\/doi.org\/10.1016\/j.abrep.2015.05.004.","journal-title":"Addict Behav Rep"},{"issue":"23","key":"428_CR17","doi-asserted-by":"publisher","first-page":"2219","DOI":"10.1056\/NEJMra1402309","volume":"370","author":"ND Volkow","year":"2014","unstructured":"Volkow ND, Baler RD, Compton WM, Weiss SRB. Adverse health effects of marijuana use. N Engl J Med. 2014;370(23):2219\u201327. https:\/\/doi.org\/10.1056\/NEJMra1402309.","journal-title":"N Engl J Med"}],"container-title":["BMC Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12873-021-00428-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12873-021-00428-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12873-021-00428-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T10:07:28Z","timestamp":1615975648000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcemergmed.biomedcentral.com\/articles\/10.1186\/s12873-021-00428-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,17]]},"references-count":17,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["428"],"URL":"https:\/\/doi.org\/10.1186\/s12873-021-00428-0","relation":{},"ISSN":["1471-227X"],"issn-type":[{"value":"1471-227X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,17]]},"assertion":[{"value":"6 July 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Hamilton Integrated Research and Ethics Board at its onset (project number 7141-C). As this was a retrospective chart review, the requirement to obtain individual consent was waived by the Research Ethics Board.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"32"}}