Only 25% of cannabis-coded ER visits were actually attributable to cannabis use
A chart review of cannabis-coded ED visits found only 25.74% were actually at least partially attributable to cannabis, with these patients being more often young, Caucasian males.
Quick Facts
What This Study Found
Of all ED visits with cannabis ICD-CM codes, detailed chart review determined only 25.74% were at least partially attributable to cannabis. These patients were more often young, Caucasian, and male compared to the overall ED population (all p values significant). The remaining ~75% had cannabis codes incidental to the visit reason.
Key Numbers
25.74% actually attributable to cannabis; patients more often young, Caucasian, male (all p<0.05); ~75% had cannabis codes incidental to visit.
How They Did This
Retrospective chart review of ED visits identified by cannabis ICD-9 and ICD-10-CM codes between 2012 and 2016, with pre-specified attribution criteria and inter-rater reliability assessment.
Why This Research Matters
Administrative data studies often use cannabis ICD codes to estimate cannabis-related ED burden. This study shows that 75% of such visits are not actually caused by cannabis, meaning published estimates of cannabis-related ED visits may be grossly inflated.
The Bigger Picture
This has major implications for cannabis policy debates. Claims about "dramatic increases in cannabis-related ER visits" based on ICD codes may be measuring coding practices rather than actual cannabis harms. Better attribution methods are needed.
What This Study Doesn't Tell Us
Single hospital system; retrospective chart review with inherent subjectivity; 2012-2016 data may not reflect current patterns; attribution criteria were pre-specified but novel; cannot determine what fraction of the 25% were primarily vs secondarily caused by cannabis.
Questions This Raises
- ?How should cannabis-attributable ED visits be defined and measured?
- ?Are policy claims about cannabis ED burden based on inflated administrative data?
Trust & Context
- Key Stat:
- Only 25.74% of cannabis-coded ED visits were actually cannabis-related
- Evidence Grade:
- Moderate: systematic chart review with pre-specified criteria and inter-rater reliability, but single center.
- Study Age:
- Published 2020.
- Original Title:
- Why do patients come to the emergency department after using cannabis?
- Published In:
- Clinical toxicology (Philadelphia, Pa.), 58(6), 453-459 (2020)
- Authors:
- Shelton, Shelby K(2), Mills, Eleanor(2), Saben, Jessica L, Devivo, Michael, Williamson, Kayla, Abbott, Diana, Hall, Katelyn E, Monte, Andrew A
- Database ID:
- RTHC-02840
Evidence Hierarchy
Looks back at existing records to find patterns.
What do these levels mean? →Frequently Asked Questions
How many ER visits are truly caused by cannabis?
This study found only about 26% of ED visits coded for cannabis were actually attributable to cannabis use. The rest had cannabis codes incidentally, meaning published statistics based on coding data may overestimate cannabis-related ER visits by about 4-fold.
Who goes to the ER for cannabis-related problems?
Among the visits truly attributable to cannabis, patients were more often young, Caucasian, and male compared to the overall ED population.
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Cite This Study
https://rethinkthc.com/research/RTHC-02840APA
Shelton, Shelby K; Mills, Eleanor; Saben, Jessica L; Devivo, Michael; Williamson, Kayla; Abbott, Diana; Hall, Katelyn E; Monte, Andrew A. (2020). Why do patients come to the emergency department after using cannabis?. Clinical toxicology (Philadelphia, Pa.), 58(6), 453-459. https://doi.org/10.1080/15563650.2019.1657582
MLA
Shelton, Shelby K, et al. "Why do patients come to the emergency department after using cannabis?." Clinical toxicology (Philadelphia, 2020. https://doi.org/10.1080/15563650.2019.1657582
RethinkTHC
RethinkTHC Research Database. "Why do patients come to the emergency department after using..." RTHC-02840. Retrieved from https://rethinkthc.com/research/shelton-2020-why-do-patients-come
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.