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- W2890739576 abstract "To the Editors: We read with interest the article by Wang et al. [[1]Wang GS Daies SD Halmo LS et al.Impact of marijuana legalization in Colorado on adolescent emergency and urgent care visits.J Adolesc Health. 2018; 63: 239-241Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar] investigating the extent to which marijuana legalization in Colorado has increased adolescent emergency department and urgent care (ED/UC) visits. This is a timely issue and the authors should be commended for attempting to provide empirical information on this topic. It was concluded that marijuana legalization has indeed increased marijuana-related ED/UC visits. In our view the veracity of this claim is questionable for at least two reasons. First, the major dependent variable—“marijuana-related” visits—appears to be too broadly defined to reveal any meaningful information. Patients met this criterion by testing positive for marijuana metabolites on a urine toxicology screen or by receiving an International Classification of Disease discharge code for marijuana use. After only limited use, marijuana metabolites can remain in the body for as long as 2–4 weeks. This, of course, increases the likelihood of individuals testing positive for marijuana relative to other drugs. In addition, urine toxicology results are insufficient for determining whether marijuana was the primary reason for the ED/UC visit as is implied. This point is further bolstered in light of the fact that a substantial number of patients also tested positive for other drugs. Thus, the role of marijuana use in precipitating ED/UC visits cannot be determined from these data. Relatedly, based on International Classification of Disease discharge codes, if a patient simply acknowledged marijuana use at some point in their life, this was interpreted as a marijuana-related ED/UC visit. This strategy seems woefully inadequate because marijuana use could have occurred days, weeks, or years prior to the admission, meaning that the use could have been unrelated to the visit. What's more is that marijuana use among adolescent Coloradans has not increased since legalization, [[2]Cerda M Wall M Fent T et al.Association of state recreational marijuana laws with adolescent marijuana use.JAMA Pediatr. 2017; 171: 142-149https://doi.org/10.1001/jamapediatrics.2016.3624Crossref PubMed Scopus (266) Google Scholar] suggesting factors other than marijuana are responsible for the purported increased ED/UC visits. Second, the manuscript does not address possible mechanisms by which marijuana legalization increased ED/UC visits for adolescents. Marijuana use is legally available to adults aged 21 years and older. It is unclear why the manuscript focuses exclusively on adolescents for whom the drug is not legally available. In conclusion, the dependent measure—“marijuana-related”—was too poorly defined to draw definitive conclusions from the current data. It might be of interest for further studies to investigate the impact of marijuana legalization on adult outcomes. There is no funding attached to this Letter to the Editor." @default.
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- W2890739576 date "2018-09-01" @default.
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- W2890739576 title "Marijuana-Related Visits Were Too Broadly Defined to Draw Meaningful Conclusions" @default.
- W2890739576 doi "https://doi.org/10.1016/j.jadohealth.2018.05.029" @default.
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