■越来越多的国家已经或正在考虑将大麻合法化。一个令人担忧的问题是,大麻合法化将导致大麻使用增加,进而导致焦虑症的患病率更高。我们检查了安大略省涉及大麻的焦虑症的急诊科(ED)就诊的变化,在涉及医疗和非医疗大麻合法化的时期内。
■这项重复的基于人群的横断面研究确定了安大略省居民对焦虑症的所有急诊就诊,加拿大在2008年至2022年间年龄在10-105岁之间(n=1570万人)。我们使用中断的时间序列分析来检查四个政策期间大麻参与和酒精参与(控制条件)的即时和渐进变化:医用大麻合法化(2008年1月至2015年11月)。扩大医疗准入(2015年12月至2018年9月),限制非医用大麻合法化(2018年10月至2020年2月),以及与COVID-19大流行(2020年3月至2022年12月)重叠的商业化。使用泊松模型生成具有95%置信区间的发病率比率。
■在14年的研究中,有438,700人接受了一次或多次焦虑症的ED访视,其中3880人(0.89%)参与了大麻,6329人(1.45%)参与了酒精.在商业化/COVID-19期间,与大麻相关的焦虑症的月发病率比合法化前高出156%(每10万人中0.11比0.29),相比之下,饮酒增加了27%(0.27vs0.35/110,000)。在研究期间,每100,000人参与大麻的焦虑ED就诊率逐渐增加,在扩大医疗准入后没有立即或逐渐的变化。有限制的合法化或商业化/COVID-19。然而,在商业化/COVID-19期间,焦虑障碍ED总就诊次数和酒精参与的焦虑障碍ED总就诊次数大幅下降.因此,在此期间,与大麻有关的焦虑症就诊比例立即相对增加了31.4%(发生率比率[IRR],1.31;95%CI1.05-1.65)。
■我们发现,在涉及医疗和非医疗大麻合法化的14年期间,与大麻有关的焦虑症ED就诊相对增加。这些发现可能反映了使用大麻引起的焦虑症问题增加,使用大麻增加焦虑症的自我药疗,或者两者兼而有之。在研究的最后阶段,参与大麻的焦虑ED就诊比例有所增加,但可能是市场商业化的结果,指示COVID-19或两者兼有,并进行持续监测。
■加拿大卫生研究院(资助#452360)。
UNASSIGNED: An increasing number of countries have or are considering legalizing cannabis. One concern is that
legalization of cannabis will result in increased cannabis use and in turn a higher prevalence of anxiety disorders. We examined changes in emergency department (ED) visits for anxiety disorders with cannabis involvement in Ontario, over a period that involved medical and non-medical cannabis
legalization.
UNASSIGNED: This repeated cross-sectional population-based study identified all ED visits for anxiety disorders from residents of Ontario, Canada aged 10-105 between 2008 and 2022 (n = 15.7 million individuals). We used interrupted time series analyses to examine immediate and gradual changes in cannabis-involvement and alcohol-involvement (control condition) over four policy periods: medical cannabis legalization (January 2008-November 2015), expanded medical access (December 2015-September 2018), non-medical cannabis legalization with restrictions (October 2018-February 2020), and commercialization which overlapped with the COVID-19 pandemic (March 2020-December 2022). Poisson models were used to generate incidence rate ratios with 95% confidence intervals.
UNASSIGNED: Over the 14-year study, there were 438,700 individuals with one or more ED visits for anxiety disorders of which 3880 (0.89%) individuals had cannabis involvement and 6329 (1.45%) individuals had alcohol involvement. During the commercialization/COVID-19 period monthly rates of anxiety disorders with cannabis-involvement were 156% higher (0.11 vs 0.29 per 100,000 individuals) relative to the pre-
legalization period, compared to a 27% increase for alcohol-involvement (0.27 vs 0.35 per 1100,000 individuals). Rates of anxiety ED visits with cannabis involvement per 100,000 individuals increased gradually over the study period with no immediate or gradual changes after expanded medical access,
legalization with restrictions or commercialization/COVID-19. However, during the commercialization/COVID-19 period there were large declines in total anxiety disorder ED visits and anxiety disorder ED visits with alcohol-involvement. Consequently, during this period there was an immediate 31.4% relative increase in the proportion of anxiety visits with cannabis-involvement (incidence rate ratio [IRR], 1.31; 95% CI 1.05-1.65).
UNASSIGNED: We found large relative increases in anxiety disorder ED visits with cannabis involvement over a 14-year period involving medical and non-medical cannabis
legalization. These findings may reflect increasing anxiety disorder problems from cannabis use, increasing self-medication of anxiety disorders with cannabis use, or both. The proportion of anxiety ED visits with cannabis involvement increased during the final period of the study but could have been the results of the market commercialization, COVID-19 or both and ongoing monitoring is indicated.
UNASSIGNED: Canadian Institutes of Health Research (grant #452360).