Youth cannabis-related ED visits increased amid COVID-19 pandemic

Youth cannabis-related ED visits increased amid COVID-19 pandemic | Image Credit: © annette shaff - © annette shaff - stock.adobe.com.

After examination of the National Syndromic Surveillance Program (NSSP) data to understand how trends related to cannabis-involved emergency department (ED) visits among those younger than 25 years in the United States changed, the Centers for Disease Control and Prevention (CDC) found that more visits occurred during the COVID-19 pandemic compared to 2019.

The findings were published in a recent CDC Morbidity and Mortality Weekly Report (MMWR), which noted that 539,106 cannabis-related ED visits occurred in the United States for individuals younger than 25 years from December 30, 2018, to January 1, 2023. Analyzing data from a weekly average of 1671 EDs that consistently report data, the CDC quantified and stratified cannabis ED visit rates by age group and sex using: Mean weekly number of ED visits related to cannabis, number of cannabis-involved ED visits per 10,000 ED visits (rates of cannabis-involved ED visits), overall visit ratios (rate of cannabis-involved ED visits amid study period divided by the 2019 reference period), and visit ratios by sex (female cannabis-involved ED visits divided by rate of male ED visits in the same time frame.) From 2020 to 2022, 4 time periods were analyzed: weeks 1 to 11 (prepandemic in 2020), weeks 12 to 23, weeks 24 to 36, and weeks 37 to 53 (second half of school year, summer, and first half of school year, respectively.)

For children 10 years or younger, the average number of weekly cannabis-involved ED visits was between 30.4 (weeks 12-23, 2020) to 71.5 (weeks 24-36, 2022) during the pandemic, compared to prepandemic periods (range = 18.7 to 23.2 [weeks 1-11, 2019 to weeks 1-11, 2020]). Of those aged 11 to 14 years, weekly mean ED visits involving cannabis ranged from 69.8 (weeks 12-23, 2020) to 209.3 (weeks 12-23, 2022) during the pandemic, compared to the prepandemic average of 90.5 (weeks 24-36, 209) to 138.5 visits (weeks 1-11, 2020). Adolescents and young adults (15-24 years) averaged between 2275.8 (weeks 12-23, 2020) to 2813.2 visits (weeks 12-23, 2021) during the pandemic compared to 2117.5 (weeks 1-11, 2019) to 2531.1 (weeks 1-11, 2020) visits prior to the pandemic period.

Children younger than 10 years hit a pandemic peak of 71.5 mean weekly visits during summer of 2022. For those aged 10 years or younger, ED visit rates fell amid weeks 12 to 23 in 2021 (second half of school year) but increased and peaked during the summer of 2022 at 4.0. Ratios per 10,000 ED visits involving cannabis in this age group ranged from 2.4 to 5.8 (weeks 37-53, 2021 to weeks 1-11, 2021).

The pandemic peak in mean weekly visits of 209.3 occurred for individuals aged 11 to 14 years during weeks 12 to 23 of 2022 (second half of 2021-2022 school year). In the same age group, cannabis-involved ED visits increased starting in 2020. In this time frame, female ratios were higher (range = 1.5 to 2.7 [weeks 37-53, 2020 to weeks 1-11, 2022]) than among males (range = 0.9 to 1.6 [weeks 24-36, 2021 to weeks 1-11, 2022]). Though visit ratios by sex were not statistically significantly different at the start of the pandemic, “ED visit rates among females surpassed those among males and remained higher than rates among males throughout the study period.”

Of cannabis-related ED visits for people younger than 25 years, over 90% occurred among the 15-to-24-year age group, which had a peak mean weekly number of visits of 2813.2 (weeks 12-23, 2021). In all age groups except those aged 15 to 24 years, cannabis-involved ED visits began to increase before the COVID-19 pandemic, potentially related to expansion of legalizing cannabis use at state-levels. Overall, results from the report demonstrated that cannabis-involved ED visits for individuals under 25 years increased during the pandemic.

ED visit rates during the pandemic for individuals aged 10 years or younger “far exceeded” rates before it, consistent with National Poison Data System data from 2017 to 2021, which demonstrated that cannabis ingestion cases among children aged 6 years and younger increased by 1375%.

Use as a coping mechanism for pandemic-related stressors, increased availability, and increased unintentional ingestions (related to confusing packing that could appeal to youth), could all be factors that contributed to an increase in cannabis-involved ED visits amid the COVID-19 pandemic. Safe and secure storage of cannabis by using adults is important to protect children. Packaging restrictions that decrease appeal to youth could be implemented by states, while schools, coalitions, and communities can incorporate “evidence-based youth substance use prevention interventions to address changing patterns of cannabis use during the pandemic.” According to the report, efforts combining these strategies could hinder the rise in cannabis-involved ED visits among the youth and young adult patient population.

Reference:

Roehler DR. Cannabis-involved emergency department visits among persons aged <25 years before and during the covid-19 pandemic — United States, 2019–2022. MMWR Morb Mortal Wkly Rep. 2023;72. doi:10.15585/mmwr.mm7228a1