Report highlights increase in cannabis-involved ED visits among US youth during pandemic

By Tarun Sai LomteJul 19 2023Reviewed by Sophia Coveney

A recent study published in the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report examined the trends in cannabis-involved emergency department (ED) visits during the coronavirus disease 2019 (COVID-19) pandemic in the United States (US).

Background

Nearly 19% of US individuals aged 12 or older used cannabis in 2021. Legalizing medical or non-medical cannabis has increased its availability and use by adults. Moreover, the risk perception of cannabis use has waned in youth. 

The COVID-19 pandemic further increased substance use among younger populations. Nevertheless, statistically significant increases in cannabis-involved ED visits have been reported even before the pandemic began. 

The study and findings

In the present study, researchers described the trends in cannabis-involved ED visits in individuals under 25 in the US during the COVID-19 pandemic. The CDC examined data from the National Syndromic Surveillance Program (NSSP).

Collaborating with local and state health departments, the CDC defined cannabis-involved ED visits using diagnosis codes and chief complaint texts. 

The changes in the rates of cannabis-involved ED visits from 2019 to 2022 were estimated, stratified by sex and age. Four periods were analyzed each year, weeks 1-11, 12-23, 24-36, and 37-53. Weeks 12-23 and 37-53 represented the second and first halves of the school year, respectively, whereas weeks 24-36 represented summer. 

The pre-pandemic periods included 2019 and weeks 1-11 in 2020. The researchers calculated the average weekly number of cannabis-involved ED visits, rates of cannabis-involved ED visits per 10,000 ED visits, overall visit ratios stratified by sex for each year, and female-to-male visit ratios. The overall visit ratios during 2020-22 were compared with corresponding weeks in 2019. 

Findings

In the US, more than 539,000 cannabis-involved ED visits were reported among individuals < 25 years between December 30, 2018, and January 1, 2023. The weekly mean number of cannabis-involved ED visits among children aged 10 or younger increased from 30.4 in weeks 12-23 in 2020 to 71.5 during weeks 24-36 in 2022 relative to pre-pandemic weeks 1-11 in 2019 (18.7) and 2020 (23.2).  

In the 11-14 age group, the weekly average (of ED visits) increased from 138.5 during pre-pandemic weeks in 2020 to 209.3 during weeks 12-23 in 2022. In individuals aged 15-24, the weekly average increased from 2275.8 during weeks 12-23 in 2020 to 2813.2 during the corresponding weeks in 2021. The peak number of visits among children under 10 occurred in the summer of 2022. 

Cannabis-involved ED visit rates in children aged 10 or younger declined during weeks 12-23 in 2021 and increased afterward, peaking during weeks 24-36 in 2022; overall, the visit ratios in this age group ranged between 2.4 and 5.8 per 10,000 ED visits. In the 11-14 age group, the weekly average peaked at 209.3 during weeks 12-23 in 2022. 

Higher visit ratios were observed in females than males; visit ratios by sex were not significantly different in the pre-pandemic period of 2020. Notably, most cannabis-involved ED visits (> 90%) occurred in the 15-24 age group, peaking at 2813.2 during weeks 12-23 in 2021. Visit rates remained consistently elevated in this age group from 2020 to the summer of 2021; nevertheless, visit rates were similar to baseline levels during weeks 12-23 in 2021 and 2022. 

Conclusions

The study noted increases in all individuals under 25 years during the pandemic that remained consistently higher than pre-pandemic levels. Most ED visits were recorded in the 15-24 age group. Notably, the NSSP data were not nationally representative, limiting the generalizability of the findings. 

Furthermore, syndromic surveillance data are not considered final, given their near real-time updates; as such, results may change with updates to medical record information. 
Several factors might have contributed to the increases in cannabis-involved ED visits, such as increased use to cope with COVID-19 pandemic-related stressors and availability in states with legal markets, among others. 

Schools, coalitions, and communities should introduce evidence-based interventions to prevent substance use. States should implement restrictions on packaging to reduce youth appeal. Together, these can help alleviate the growing rates of cannabis-involved ED visits among youth.