Changes in Cannabis-Attributable Hospitalizations Following Nonmedical Cannabis Legalization in Canada

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Abstract
Canada legalized nonmedical cannabis for adult use in October 2018.1 There is increasing recognition that regular and heavy cannabis use is associated with various adverse health concerns, including psychosis, increased anxiety, depression, altered brain functioning, and cannabis dependence and addiction.2-5 Cannabis use results in a large number of health system encounters, including emergency department (ED) visits and hospitalizations, and is the leading cause of hospitalizations for substance use in Canadian youth.6 ED visits due to cannabis have also been increasing rapidly over time in the US and Europe.7,8 However, the impact of nonmedical cannabis legalization on health care visits due to cannabis remains unclear. Several studies have investigated changes over time in ED visits due to cannabis in two provinces (Alberta or Ontario) in Canada following legalization.9-14 Two brief reports have also examined changes in hospitalizations due to cannabis—a potentially more severe and specific indicator of cannabis-related health harms—in Ontario and Quebec.15,16 Studies to date have used differing lengths of follow-up and not compared changes following legalization in health service use due to cannabis between provinces or at the national level. This is an important gap, as prior work has established substantial variation in key cannabis policies, including product types and store access.1,17,18 Consequently, limited information is available about how cannabis retail policies may be associated with changes in cannabis harms postlegalization. In addition, to date, studies on changes in health service use due to cannabis following legalization have not directly compared changes across different types of presentations (eg, changes in visits for psychosis vs visit for intoxication), which limits knowledge about the kinds of cannabis harms that may have increased the most following legalization.

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