A trend in cannabis usage as reflected by emergency department admissions

Context : Although recreational cannabis is not yet legalized in Israel, there is an increase in the cannabis prescription rate, which is the highest in the world. Aims: to study among individuals admitted to the emergency department (ED) in a big tertiary medical center in the biggest municipal city in Israel, positively screened cannabis prevalence change over the years, and their characteristics. Methods: Between January 2016 and June 2024, of all ED admitted individuals, those who were screened for urine toxicology drugs (n=20,022) were studied for cannabis trends and characteristics. Results: Individuals screened for toxicology increased from 0.7% in 2016 to 1.3% in 2024. The proportion of cannabis tested positive (16.8%) slightly increased from 15.4% in 2016 to 17.6% in 2024, with a significant increase trend (linear association p=0.026) among the aged <40 years group (n=8814) from 23% in 2016 to 26.3% in 2024. Within the <40y group, those who screened positive for cannabis (24.4%) had a higher proportion of males (p<0.001) and Israeli-born individuals (p=0.03). More of them tested positive for opioids (p<0.001), cocaine (p<0.001), ecstasy (MDMA) (p<0.001), amphetamines (p<0.001) methamphetamines (p<0.001) and benzodiazepine (p=0.005), and had prescription for opioids (p=0.013), but fewer were hospitalized (p<0.001). Of the older aged group (≥40y), also fewer died within 7 days (1.6% vs. 2.9%, p=0.009). Conclusions: The elevation in aged <40y cannabis screened positive is reflected by the general population usage increase. Of those screened, their outcome was better (less hospitalization and deaths). However, a more specific evaluation is needed.