After Michigan legalized marijuana, 17.3% of cannabis toxicity ER visits involved anxiety, with these patients more likely to be younger and have ingested edibles.
Emergency medicine physicians, psychiatrists, and cannabis policy researchers.
17.3% anxiety presentationsamong cannabis toxicity ED visits, with edible users at higher risk
What the researchers found
Of 1,135 cannabis toxicity ED visits, 196 (17.3%) presented with anxiety including panic attacks (11.7%), aggression/manic behavior (9.2%), and hallucinations (6.1%). Anxiety patients were younger, more likely to have used edibles, and had more psychiatric comorbidities.
Why it matters
Cannabis-induced anxiety is a significant ED presentation that clinicians must recognize and manage appropriately, especially as edible use and legalization expand.
The numbers in context
1,135 patients across 7 EDs over 24 months. 17.3% had anxiety. 82.7% had other toxicity (intoxication, CHS). Panic attacks 11.7%, aggression 9.2%, hallucinations 6.1%. Edible ingestion more common in anxiety group.
How the study worked
Retrospective cohort analysis of consecutive patients with ICD-10 F12 codes across seven emergency departments over 24 months post-legalization.
Who was studied
1,135 patients evaluated for acute cannabis toxicity across 7 Michigan EDs.
What this study cannot tell us
Retrospective design. Single state post-legalization. ICD-10 coding may miss some cases. Cannot determine pre-legalization baseline rates.
How to read the evidence
Multi-center retrospective cohort providing useful clinical epidemiology post-legalization.
When this study was published
Data from the first 24 months after Michigan recreational cannabis legalization.
The bigger picture
This study quantifies a specific clinical consequence of cannabis legalization — increased ED visits for cannabis-induced anxiety — and identifies edible use as a particular risk factor.
Replication
Multi-center Michigan study; replication in other legalized states would strengthen findings.
Funding
Not specified in abstract
Conflicts of interest
Not specified in abstract
Questions still open
- Would better dosing guidance for edibles reduce anxiety-related ED visits?
- Are current ED protocols adequate for cannabis-induced anxiety?
Read the original research
Cannabis-Induced Anxiety Disorder in the Emergency Department.
Cureus, 15(4), e38158
Citation
Keung, Man Yee; Leach, Erin; Kreuser, Kaitlin; Emmerich, Bradley W; Ilko, Steven; Singh, Matthew; Sapp, Thomas; Barnes, Mariah; Ouellette, Lindsey; Jones, Jeffrey S. (2023). Cannabis-Induced Anxiety Disorder in the Emergency Department.. Cureus, 15(4), e38158. https://doi.org/10.7759/cureus.38158