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Cited by 22Cannabis and Cannabinoid ResearchSubstance Abuse Treatment and OutcomesOpioid Use Disorder Treatment

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Associations between recreational cannabis legalization and cannabis-related emergency department visits by age, gender, and geographic status in Ontario, Canada: An interrupted time series study

Open access
Kim, Chungah, Chum, Antony, Nielsen, Andrew, Allin, Sara, Penney, Tarra L., Rittenbach, Katherine, MacMaster, Frank P., O’Campo, Patricia·2022·PLOS ONE
DOI 10.1371/journal.pone.0268718PMC PMC9604957
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Abstract

Legalization of recreational cannabis in Ontario included the legalization of flower and herbs (Phase 1, October 2018), and was followed by the deregulation of cannabis retailers and sales of edibles (Phase 2, February 2020). Research on the impact of cannabis legalization on acute care utilization is nascet; no research has investigated potential age, gender, and geographically vulnerable subgroup effects. Residents living in Northern Ontario not only have higher levels of substance use problems, but also have inadequate access to primary healthcare. Our study investigated the impact of Ontario’s recreational cannabis policy (including Phase 1 and 2) on cannabis-attributable emergency department (ED) visits, and estimated the impact separately for different age and gender groups, with additional analyses focused on Northern Ontarians. We created a cohort of adults (18 and over) eligible for provincial universal health insurance with continuous coverage from 2015–2021 (n = 14,900,820). An interrupted time series was used to examine the immediate impact and month-to-month changes in cannabis-related ED visits associated with Phase 1 & 2 for each subgroup. While Northern Ontario has higher rates of cannabis-related ED visits, both Northern and Southern Ontario show similar patterns of changes. Phase 1 was associated with significant increases in adults 25–64, with the strongest increases seen in women 45–64. Month-to-month trends were flattened in most groups compared to pre-legalization. Phase 2 was associated with significant immediate increases for adults aged 18–44 in both genders, but the increases were larger in women than men. No significant month-to-month changes were detected in this period. While current preventive efforts are largely focused on reducing cannabis-related harms in youths and younger adults, our results show that adults 25–64, particularly women, have been significantly impacted by cannabis policies. Further research on gender-specific cannabis dosage and targeted interventions for adult women should be investigated. Legalization did not appear to have a differential impact on Northern versus Southern Ontario, but higher rates of ED visits in the North should be addressed.

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  1. Rush B, Kirkby C, Furlong A. NE LHIN Addiction Services Review [Internet]. North East Local Health Integration Network; 2016 Mar [cited 2022 Mar 15]. Available from: https://vmcdn.ca/files/sudbury/pdfs-for-web/ne-lhin-addiction-services-review-full-report.pdf
  2. Public Health Ontario. Indicators for Monitoring Cannabis-Related Health Outcomes [Internet]. Ontario, Canada; 2019 Oct [cited 2022 Mar 15]. Available from: https://www.publichealthontario.ca/-/media/documents/R/2019/rapid-review-cannabis-indicators.pdf

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Metadata

Authors
Kim, C., Chum, A., Nielsen, A., Allin, S., Penney, T. L., Rittenbach, K., MacMaster, F. P., & O’Campo, P.
Affiliations
  • York University (CA)
  • Canadian Institute for Health Information (CA)
  • University of Toronto (CA)
  • Alberta Health Services (CA)
Corresponding author
Chum, Antony
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2022-10-26
Volume
17
Issue
10
Pages
e0268718
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0268718
PMC
PMC9604957
OpenAlex
W4307309194
Cited by
22
References
22
Citations by year
2026: 7 · 2025: 2 · 2024: 6 · 2023: 7
FWCI
2.24
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Canadian Institutes of Health Research (Project Grant FRN# 173447)
  • Canada Research Chair program (CRC-2021-00269)
Topics
  • Health Sciences › Medicine › Pharmacology (medical) › Cannabis and Cannabinoid Research
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
recreational cannabis legalization, cannabis policy, acute care utilization, age differences, gender differences, Northern Ontario, southern Ontario, cannabis edibles, adult women
MeSH terms
Adolescent, Adult, Canada, Cannabis, Emergency Service, Hospital, Female, Humans, Legislation, Drug, Male, Ontario, Cannabinoid Receptor Agonists, Interrupted Time Series Analysis

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