A review of 422 pediatric ER charts found a significant increase in positive cannabinoid tests after cannabis legalization, with 43% of those patients presenting with suicidal ideation.
Emergency physicians, pediatricians, mental health providers, and policymakers evaluating legalization impacts on youth.
43% of cannabis-positive pediatric ER visits involved suicidal ideation
What the researchers found
71% of cases with positive cannabinoid drug screens presented after cannabis legalization in November 2016. The majority of cases (78%) were ages 15-17. The most common chief complaint was suicidal ideation (43%), followed by vomiting (8%), nausea (5%), trauma (5%), and altered mental status (5%).
Why it matters
The high rate of suicidal ideation among cannabis-positive youth in the ER suggests either a direct relationship between cannabis use and suicidality, or that cannabis use clusters with other risk factors. Either way, it signals a need for clinical vigilance.
The numbers in context
422 charts reviewed. 71% of cases after legalization (Z=7.72, p<.01). 78% were ages 15-17. 43% presented with suicidal ideation. 27% had tachycardia, 18% had hypertension. 28% tested positive for at least one other drug (amphetamine most common at 13%).
How the study worked
Descriptive retrospective chart review of 422 pediatric patients under 18 with positive urine drug screens for cannabinoids in the ED, from March 2013 to June 2020.
What this study cannot tell us
Retrospective chart review cannot establish causation between cannabis use and suicidal ideation. Single-center study. Positive drug screen does not confirm acute intoxication. Temporal association with legalization does not prove legalization caused the increase.
How to read the evidence
Large retrospective chart review with significant statistical findings, but single-center and unable to establish causation.
When this study was published
Published in 2022, covering March 2013 to June 2020.
The bigger picture
The post-legalization increase in cannabis-positive pediatric ER visits, combined with the high rate of suicidal ideation, raises questions about youth access and the intersection of cannabis use with mental health crises.
Questions still open
- Is the suicidal ideation related to cannabis intoxication, withdrawal, or an underlying shared risk factor? Has the trend continued or accelerated since 2020?
Common questions
Did pediatric ER visits for cannabis increase after legalization?
What symptoms do teens show in the ER after using cannabis?
Read the original research
Varied Presentations of Pediatric Patients With Positive Cannabinoid Tests.
Cureus, 14(3), e23493
Citation
Harvey, Taylor; Gomez, Ramon; Wolk, Brian; Ozcan, Ali. (2022). Varied Presentations of Pediatric Patients With Positive Cannabinoid Tests.. Cureus, 14(3), e23493. https://doi.org/10.7759/cureus.23493
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