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Abstract
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Ever since Colorado legalized marijuana for recreational use in 2012, clinicians, researchers, and policy makers have used Colorado's experience as an example of the consequences cannabis appears to have on the health care system. This study by Wang et al1 adds to the growing body of literature describing potential complications associated with cannabis and supports what frontline emergency care personnel have uncomfortably felt for several years: emergency department (ED) visits increase when cannabis is more readily available.
The investigators took advantage of a natural variation in exposure to recreational cannabis dispensaries across various jurisdictions in Colorado to evaluate whether vomiting episodes treated in the ED increased after legalization of cannabis.1 Although adverse effects due to cannabis have been recognized for decades, cannabinoid hyperemesis syndrome (CHS), a form of intractable cyclic vomiting associated with chronic and higher potency cannabis, has increased worldwide since first reported in 2004 and is one of the most frustrating cannabis problems to manage in busy EDs.2 Early data from 2 academic EDs in Colorado published shortly after legalization described an increase in their ED visits for CHS.3 In this study, Wang et al1 hypothesized that a similar increase would be noted in EDs across the entire state as new dispensaries opened. They used cannabis dispensary data from the Colorado Department of Revenue and ED claims involving vomiting from the Colorado Hospital Association and linked those vomiting claims to the location of dispensaries in the patient's zip code address. As expected, after legalization, overall ED visits for vomiting increased by 29% over 5 years; most substantially, counties with new recreational dispensaries saw larger increases in both percentage and population-adjusted rates of ED vomiting visits.
The authors acknowledge their inability to confirm a direct link between legalization of cannabis and the sudden large increase in vomiting cases,1 but the data in this cleverly designed study are consistent with earlier smaller studies in Colorado and elsewhere. The conclusion in Wang et al1 that growth in new dispensaries was associated with an increase in vomiting cases treated in EDs makes sense--increasing availability of cannabis will naturally lead to increased complications. Their data are compelling and deserve thoughtful attention...
Language: en |