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What emergency departments should expect as cannabis legalization expands in Germany

Narrative ReviewModerate evidence
The takeaway

Based on trends from Canada and other countries, Germany can expect rising cannabis-related emergency visits following legalization, with acute intoxication, panic attacks, and cannabinoid hyperemesis syndrome as the most common presentations.

Emergency physicians, public health officials in newly legalizing jurisdictions, and researchers studying legalization's health system impacts.

Canada's cannabis hospital admissions doubled post-legalization

What the researchers found

In Canada after legalization, cannabis use among those 15+ rose from 15% to 25%, and hospital admissions doubled from 15 to 32 per 100,000. Acute intoxication with anxiety and panic attacks was the most common emergency presentation.

Why it matters

Germany legalized cannabis use in 2024. Emergency physicians need to anticipate increased cannabis-related presentations and recognize conditions like cannabinoid hyperemesis syndrome, which can mimic other abdominal emergencies.

The numbers in context

Canada post-legalization: cannabis use rose from 15% (2017) to 25% (2021). Hospital admissions doubled from 15/100,000 (2017) to 32/100,000 (2022). European cannabis use prevalence estimated at 8%.

How the study worked

Narrative review of cannabis-related emergency trends from countries that have legalized, supplemented with descriptive data from Germany's Poison Control Center North.

What this study cannot tell us

Narrative review without systematic search methodology. Cross-country comparisons may not account for cultural, regulatory, and healthcare system differences. German data is still preliminary.

How to read the evidence

Narrative review synthesizing observational data from multiple countries. Provides useful pattern recognition but lacks systematic rigor.

When this study was published

Published in 2025.

The bigger picture

As more countries legalize cannabis, the emergency medicine implications become a global concern. Patterns from early-legalizing countries provide useful forecasts for newly legalizing jurisdictions.

Questions still open

  • Will Germany's specific regulatory model produce different emergency patterns than Canada's? How many cannabis emergencies go unrecognized due to nonspecific symptoms?

Common questions

Do emergency room visits increase after cannabis legalization?
Based on Canada's experience, yes. Hospital admissions for cannabis-related issues doubled from 15 to 32 per 100,000 between 2017 and 2022 following legalization.
What are the most common cannabis emergencies?
Acute intoxication with anxiety and panic attacks is the most common presentation. Cannabinoid hyperemesis syndrome, causing severe cyclical vomiting and abdominal pain, is another recognized condition.

Read the original research

Cannabis-Associated Emergencies in the Emergency Department.

Deutsches Arzteblatt international, 122(17), 467-471

Citation

Eichhorn, David; Schaper, Andreas; Iwersen-Bergmann, Stefanie; Ondruschka, Benjamin; Weber-Papen, Sabrina; Bernhard, Michael. (2025). Cannabis-Associated Emergencies in the Emergency Department.. Deutsches Arzteblatt international, 122(17), 467-471. https://doi.org/10.3238/arztebl.m2025.0074

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