The effect of cannabis legalisation on Emergency Care 

Medical cannabis application guidelines are to be reviewed, announced Associate Health Minister Peter Dunne this week. Co-incidently a paper was published* in the Annals of Emergency Medicine on the effect on Emergency Care of legalising medical marijuana use in Colorado. Alas, this article is behind a paywall.  It does not have a lot of detail. However, it is relevant to the New Zealand debate.  Not so much as to any possible change in guidelines on applications made to the minister, but rather to the effect a broader legalisation of marijuana for medical purposes may  have an on our emergency departments. i.e. just one of the many factors which need to be taken into account in the debate.

In 2009 the prosecution of marijuana users and suppliers was halted in the state of Colarado where the use of medical marijuana had been previously legalised and licensed.  Within 2 years the number of registered medical marijuana licences increased 24 times from 5000 to nearly 120,000.  This was not the only effect:

  • The percentage of 18 to 25 year olds reporting marijuana use increased from 35% to 43%
  • The percentage of those aged 26+ perceiving marijuana posed “great risk” dropped from 45% to 31%.

While these numbers may reflect in part the readiness to be “honest” after the law change, the following statistic probably is truly related to increased use:

  • The hospitalisations after marijuana use nearly doubled from 15 per 100,000 hospitalisations to 28 per 100,000 hospitalisations.

As the authors concluded:

“It is clear that marijuana availability and use in Colorado significantly increased after the commercialization of medical marijuana. Providers in states with impending legalization measures should become familiar with the symptoms and management of acute marijuana intoxication, as well as understand the effects on chronic diseases frequently observed in the ED.”

I was fascinated that in a population of 5.4 million there were nearly 120,000 licensed medical marijuana users in Colorado.  That is 1 in 45 people! That strikes me as amazingly high proportion. However, I guess that it all depends on just what medicinal purposes may mean.  The process to get a license (at least now), seems relatively easy involving a few simple forms.  The Physician recommends the number of plants to be grown and ticks a box stating one of eight conditions: Cancer, Glaucoma, HIV or AIDS positive, Cachexia, Severe Nausea, Severe Pain, Persistent muscle spasms, Seizures.  The patient sends in a form too, with $15.

According to the latest statistics on the Colorado medical marijuana registry there are currently 107,000 active patients registered with an average age of 43. 21-40 year olds comprised 43% pf the patients.  93% report severe pain.  Hmmm… it seem Colorado has an epidemic of “severe” pain amongst their young adults.

——————–

ps. Before you jump in with comments, recognise that there is a lot of misconception around medical cannabis in New Zealand. Minister Peter Dunne cleared some of them up in a press release in January. (eg did you know that there is already a cannabis product approved for therapeutic use?).

Note: Recreational marijuana became legal in Colorado in 2014.

Disclaimer:  I an not an expert in the field, merely I came across this article because it was published in a journal I access for my other research concerning emergency departments.  If you believe the methods to measure these things, Ann Emerg Med is the top ranked Emergency medicine journal

*Kim, H., & Monte, A. A. (2016). Colorado Cannabis Legalization and Its Effect on Emergency Care. Annals of Emergency Medicine, http://doi.org/10.1016/j.annemergmed.2016.01.004

Photo: Public Domain, from Wikipedia.

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