Cannabis-Related Visits Surge, Especially Among Children and Older Adults
Cannabis-associated ED visits increased significantly, and specific subgroups of patients are at higher risk.1 “We saw a gap in the literature on how often Americans were reporting to EDs for cannabis-associated reasons using recent data. With the constantly evolving cannabis landscape, such information is critical from a public health perspective,” says Doug Roehler, PhD, MPH, an epidemiologist at the CDC’s National Center for Injury Prevention and Control.
Roehler and colleagues studied trends in cannabis-associated visits from 2006-2018, using data from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project’s Nationwide Emergency Department Sample. From 2006 to 2014, cannabis-associated ED visits increased, on average, by 12.1% annually. The rate increased 17.3% from 2016 to 2017, and increased 11.1% from 2017 to 2018. Notably, patients age 0-14 years recorded some of the largest increases in cannabis-associated visits from 2017 to 2018.
In another study, researchers found a higher number of cannabis-involved ED visits for children age 0-11 years during 2020 and 2021.2 “We suspect that the youth cases may be due to increases in unintentional ingestions of edibles that were not safely stored,” Roehler offers.
Older adults (age 65 years and older) also stood out. For this group, researchers suspect lack of education in how to safely consume cannabis is the cause of the surge in ED visits. “Legally available product can have extremely high THC concentrations, and older Americans are increasingly turning to cannabis to treat ailments,” Roehler explains.
When a patient presents to the ED with a cannabis-associated visit, especially if the patient is a child, it is a “golden opportunity,” Roehler says. Providers can discuss safe storage practices with the parent or guardian, including where they can purchase lock boxes.
If an older patient presents with a cannabis-associated complaint, clinicians could offer referrals to trained providers to prevent future visits. “Most physicians have not received training on safe cannabis use while in medical school, given how new this policy shift is,” Roehler notes. “In states where nonmedical adult use of cannabis is legal, it is important for clinicians to be trained in cannabis safety practices and treatment.”
Legalization of cannabis has led to more ED visits for cannabis ingestions in adults and children, reports Jason Chu, MD, an associate professor of emergency medicine at Columbia University Medical Center. Chu has seen some patients who were unfamiliar with the delay of symptom onset with oral cannabis products, consumed too much, and presented to the ED with severe symptoms.
In Chu’s experience, when adults and adolescents come to the ED, they usually present with severe symptoms of anxiety, panic, paranoia, hallucinations, confusion, or sedation. Young children often present with nonspecific symptoms, including drowsiness, ataxia, lethargy, or stupor.3
In those cases, EPs often are unaware of the cannabis ingestion. Encephalopathy, sepsis, meningitis, and seizures are all part of the differential diagnoses. “Without a history of ingestion, children with CNS depression from cannabis product ingestion can be difficult to diagnose,” Chu says.
In addition to asthma exacerbation and pneumothorax, patients who use cannabis vape products can experience an acute respiratory failure syndrome known as EVALI (e-cigarette or vaping product use-associated lung injury). Patients report flu-like symptoms of fatigue, fevers, cough, shortness of breath, chest pain, nausea, vomiting, and abdominal cramps.4 “They will often be tachypneic, tachycardic, and hypoxic,” Chu notes.
- Roehler DR, Hoots BE, Holland KM, et al. Trends and characteristics of cannabis-associated emergency department visits in the United States, 2006-2018. Drug Alcohol Depend 2022;232:109288.
- Radhakrishnan L, Carey K, Hartnett KP, et al. Pediatric emergency department visits before and during the COVID-19 pandemic—United States, January 2019-January 2022. MMWR Morb Mortal Wkly Rep 2022.
- Chen YC, Klig JE. Cannabis-related emergencies in children and teens. Curr Opin Pediatr 2019;31:291-296.
- Adapa S, Gayam V, Konala VM, et al. Cannabis vaping-induced acute pulmonary toxicity: Case series and review of literature. J Investig Med High Impact Case Rep 2020;8:2324709620947267.
When a patient presents to the ED with a cannabis-associated visit, this is a chance for providers to offer more education to prevent future problems.
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