A trend in cannabis usage as reflected by emergency department admissions

A trend in cannabis usage as reflected by emergency department admissions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A trend in cannabis usage as reflected by emergency department admissions Oren Miron, David Zeltser, Shaul Schreiber, Miriam Adelson, Einat Peles This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6232319/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. Cannabis Emergency department risk factors trends Figures Figure 1 Figure 2 1. Introduction Cannabis is one of the most consumed substances worldwide [ 1 ] which is an increasing global health concern [ 2 ], in part as over the years, the potency of cannabis has increased over time from 4% in 1995 to 14% in 2019 [ 3 ]. Among lifetime cannabis users, between 8 and 22% will develop Cannabis Use Disorder (CUD), with increased risk reported for men, individuals with comorbid psychiatric disorders, and those suffering from adverse childhood events[ 4 , 5 ]. The world expansion of recreational cannabis legalization is associated with trends in increasing hospitalizations, emergency department visits, potential increases in serious/violent crimes, and other harms [ 6 ]. However, varying legalization models may show different impacts on population-level outcomes. A study that evaluated legislation and perception in Israel and the USA [ 7 ] found that lower perceived risk and greater perceived social norms were associated with current use, greater use intentions, and greater intentions to use in the home or near children if legal. In Israel, in 2011, the Israel Medical Cannabis Agency was established to regulate medical cannabis [ 8 ]. Since 2013, cannabis has been legally prescribed in Israel for 12 specific medical indications in various fields, among them psychiatry, pain management, and palliative care. Physicians who are trained and certified by the Israel Ministry of Health may prescribe cannabis with one or more of these indications [ 9 ]. The license for medical cannabis increased substantially from about 600 in 2011, 16,000 in 2016, and 60,000 in 2020 and achieved a maximum number in Dec 2023 (140,000). The indication among more than half was noncancer chronic pain [ 10 ]. By mid-2024, the number of licenses for medical cannabis was reduced to 120,000, parallel to the change in license regulations. While cannabis for pain is highly prescribed, cannabis for non-pain has not yet been legalized in Israel (January 2025). This was despite the non-medical cannabis use for adults (≥ 18 years old) was decriminalized in 2019 [ 11 ], and two bills to allow non-medical cannabis sales passed preliminary readings in Israel’s parliament in 2020 [ 12 ]. In 2017, 27.0% of Israeli adults reported past-year cannabis use [ 13 ], a substantial increase from that reported by a national survey in 2009 of 9% [ 14 ]. However, an online representative sample of 4,025 responders in 2018 found only 9% self-reported of cannabis use [ 15 ]. We hypothesized that even though legalization is not yet established in Israel, the substantial increase in cannabis prescriptions for pain may reflect abuse [ 16 ], and may be observed by admitted ED individuals as well. We aimed to study the proportion of cannabis over the years among individuals admitted to a big General Hospital’s ED in the biggest municipal city in Israel. Specifically, we studied at-risk groups, among the selected clinically suspected group who underwent toxicology screening. 2. Methods The hospital’s IRB (‘Helsinki Committee’) approved the study analyses TASMC-0503-22. 2.1. Data source De-identified admissions data was retrieved from the TASMC emergency department (ED) database using an electronic format. All screened at admissions to the ED or when admitted to the hospital between 2016 and June 2024 for toxicology drugs were included in the data analyses. Variables included urine immunoassay with qualitative binary results (positive/negative) of any toxicology tests in the ED. Sociodemographic variables (sex, age, immigrant), past diagnosis of blood-transmitted disease (antibodies for HIV and hepatitis C, antigen for hepatitis B), chronic medications (prescriptions for opioids, benzodiazepines that may be abused and antidepressant (SSRI and tricyclic) as cannabis is associated with depression. Hospitalized and death within 7 days from ED admission were taken. 2.2. Statistical Analyses Data analysis was performed using the R-statistical software on a Windows computer and SPSS version 29. We calculated the ratio of emergency department visitors who underwent a drug test and prescription drugs. Significant trend changes by half-year intervals were tested using chi-square linear association. A comparison between positive and negative tested patients characterized individuals with a positive test for drugs. Logistic regression was used to describe cannabis tested positive, including variables with p < 0.1 in univariate analyses. 3. Results 3.1. Cannabis positive trend The study included 20,022 individuals admitted to the ED between 2016 and June 2024 who were all screened for toxicology drugs. During that period, the overall number of ER admissions did not change and was about 100,000 per year. However, the proportion of admitted individuals who underwent toxicological testing nearly doubled from 0.7% in 2016 to 1.3% in 2024. Of all screened patients, 3361 (16.8%) tested positive for cannabis. Their proportion slightly increased from 15.4% in 2016 to 17.6% in 2024. Stratified by age group, the cannabis proportion was highest in younger patients (< 40 y), and their proportion increased from 23% in 2016 to 26.3% in 2024 (linear association 4.9, p = 0.026) (Fig. 1 ) with a non-significant increase from 7.7–12% by 40 + age group (linear association p = 0.13). At that period time benzodiazepine screened positive reduced from 27.2% in 2016 to 16.2% in 2024 (linear association p < 0.001), cocaine screened positive increased from 3.3 to 4.8%, with a peak of 8.9% at 2020, (linear association p = 0.052), opioids screened positive reduced from 15.4–8.3% in 2022, but since 2023 (when fentanyl test was added) slightly increased to 14% in 2024 (linear association p = 0.09). Stratified by age groups, the < 40 age group (Fig. 2 a) showed benzodiazepine screened positive reduced (linear association p = 0.002), cocaine screened positive increased (linear association p = 0.01) and opioids screened did not change (linear association p = 0.6). The aged 40 + group (Fig. 2 b) showed benzodiazepine screened positive reduced (linear association p = 0.002), no trend changes in cocaine screened positive (linear association p = 0.2) and opioids screened positive reduced (linear association p = 0.005). 3.2. Characteristics of being positive for Cannabis (Table 1 ) Table 1 Characteristics of being positive vs. negative for cannabis (2016–2024) Cannabis 3361(100%) Negative 16661(100%) P value 95% CI Male, sex 2229(66.3) 9300(55.8) < 0.001 1.6(1.4–1.7) Age, y 38.2 ± 15.8 50.1 ± 21.7 < 0.001 Israeli born 2266 (67.4%) 9303 (55.8) < 0.001 1.6 (1.5–1.8) Hepatitis C antibody 653(19.4) 3562(21.4) 0.012 0.9 (0.8-1.0) HIV antibody 7(0.2) 33(0.2) 0.8 Hepatitis B antigen 298(8.9) 1464(8.8) 0.9 Chronic medications Opioid prescription 141(4.2) 589(3.5) 0.07 Prescribed Benzodiazepines 267(7.9) 1380(8.3) 0.5 Prescribed SSRI 144(4.3) 975(5.9) < 0.001 0.7(0.6–0.9) Urine Toxicology Any opioids 476(14.2) 1824(10.9) < 0.001 1.3(1.2–1.5) Ecstasy (MDMA) 209(6.2) 362(2.2) < 0.001 3.0(2.5–3.6) Cocaine 386(11.5) 963(5.8) < 0.001 2.1(1.9–2.4) Benzodiazepines 741(22.0) 3649(21.9) 0.9 Amphetamines 146(4.3) 361(2.2) < 0.001 2.1(1.7–2.5) Methamphetamines 198(5.9) 413(2.5) < 0.001 2.5(2.1–2.9) Phencyclidine 23(0.7) 75(0.5) 0.07 Tricyclic antidepressant 109(3.3) 491(3.0) 0.3 Barbiturate 36(1.1) 191(1.1) 0.8 Treatment & Outcome Hospitalized 1793(53.3) 11333(68.0) < 0.001 0.5(0.5–0.6) Died (within 7 days) 25(0.7) 315(1.9) < 0.001 0.4(0.3–0.6) The 3361 patients (16.8%) who screened positive for cannabis compared with the screened negative group (n = 16,661) (Table 1 ), were younger (38.2 ± 15.8 vs. 50.1 ± 21.7, p < 0.001), had a higher proportion of male (p < 0.001), a higher proportion of Israeli born (p < 0.001), fewer with hepatitis C antibody (0.012), and fewer had SSRI prescriptions (p < 0.001), more of them tested positive for any opioids (p < 0.001), cocaine (p < 0.001), ecstasy (MDMA) (p < 0.001), amphetamines (p < 0.001) and methamphetamines (p < 0.001). Fewer were hospitalized (p < 0.001), and fewer died within 7 days from ED admission (p < 0.001). When comparing within the 8814 young aged < 40y group, 2155 (24.4%) screened positive to cannabis. They had a higher proportion of male (p < 0.001), a higher proportion of Israeli born (p = 0.03), more of them tested positive for any opioids (p < 0.001), cocaine (p < 0.001), ecstasy (MDMA) (p < 0.001), amphetamines (p < 0.001) methamphetamines (p < 0.001), benzodiazepine (p = 0.005) and more had prescription for opioids (p = 0.013). Fewer were hospitalized (p < 0.001). 3.3. Cannabis only vs. cannabis and other substance users (Table 2 ) Table 2 Characteristics of being positive for cannabis only, cannabis & other substances, and negative to cannabis Cannabis only Cannabis & others P value Negative P value* 1870(100%) 1490(100%) 16661(100%) Male, sex 1238(66.2) 991(66.5) 0.9 9300(55.8) < 0.001 Age, y 37.3 ± 15.4 39.5 ± 16.8 < 0.001 50.1 ± 21.7 < 0.001 Israeli born 1284 (68.6%) 982(65.9) 0.1 9303 (55.8) < 0.001 Hepatitis C antibody 294(15.7) 359(24.1) < 0.001 3562(21.4) < 0.001 HIV antibody 2(0.1) 5(0.3) 0.3 33(0.2) 0.3 Hepatitis B antigen 140(7.5) 158(10.6) 0.002 1464(8.8) 0.007 Chronic medications Opioid prescription 34(1.8) 107(7.2) < 0.001 589(3.5) < 0.001 Prescribed Benzodiazepines 86(4.6) 181(12.1) < 0.001 1380(8.3) < 0.001 Prescribed SSRI 64(3.4) 80(5.4) 0.006 975(5.9) < 0.001 Urine Toxicology Any opioids - 476(31.9) < 0.001 1824(10.9) < 0.001 Ecstasy (MDMA) - 209(14.0) < 0.001 362(2.2) < 0.001 Cocaine - 386(25.9) < 0.001 963(5.8) < 0.001 Benzodiazepines - 741(49.7) < 0.001 3649(21.9) 0.9 Amphetamines - 146(9.8) < 0.001 361(2.2) < 0.001 Methamphetamines - 198(13.3) < 0.001 413(2.5) < 0.001 Phencyclidine - 23(1.5) 75(0.5) 0.07 Tricyclic - 109(7.3) 491(3.0) 0.3 Barbiturate - 36(2.4) 191(1.1) 0.8 Treatment & Outcome Hospitalized 955(51.0) 838(56.2) 11333(68.0) < 0.001 Died (within 7days) 16(0.9) 9(0.6) 315(1.9) < 0.001 *Comparison between the three groups Stratified the cannabis into 1870 (55.7%) those with cannabis only and those who tested positive for other substances 1490 (44.3%) (Table 2 ), the only cannabis group were younger (p < 0.001), with fewer hepatitis C antibodies (p < 0.001) and hepatitis B antigen (p = 0.002) positive, fewer with opioid prescription (p < 0.001), BDZ prescriptions (p < 0.001) and SSRI prescription (p = 0.006). Fewer of them were hospitalized (p = 0.003). The groups were comparable in gender, Israeli-born, HIV, and death rate. 3.4. Multivariate analyses As compared with negative cannabis screened, the cannabis-positive group was more likely to be male (OR = 1.6, 95% CI 1.4–1.7, p < 0.001), younger age, (OR = 1.03, 95% CI 1.02–1.03, p < 0.001), Israeli born (OR = 1.3, 95% CI 1.1–1.4, p < 0.001), with SSRI prescription (OR = 1.2, 95% CI 1.0-1.5, p = 0.05), opioid prescription (OR = 1.4, 95% CI 1.3–1.7, p < 0.001), ecstasy/MDMA (OR = 1.7, 95% CI 1.4–2.1, cocaine (OR = 1.4, 95% CI 1.2–1.6, p < 0.001), methamphetamine (OR = 1.4, 95% CI 1.1–1.7, p = 0.003) and less likely to be hospitalized (OR = 0.8, 95% CI 0.7–0.8, p < 0.001). As compared with cannabis use only, the patients with cannabis plus other substances were more likely to have an opioid prescription (OR = 3.2, 95% CI 2.1–4.8, p < 0.001), BDZ prescriptions (OR = 2.4, 95% CI 1.8–3.1, p < 0.001), and to have hepatitis C antibody (OR = 1.6, 95% CI 1.3–1.9, p < 0.001). 4. Discussion Studying the characteristics of ED admission over 8 years in a big tertiary medical center in the biggest municipal city in Israel, we found an elevation in cannabis screened positive proportion among ED admissions. The highest proportion was in the < 40 y age group, who also present a significant trend increase. Moreover, the cannabis proportion in that age group was highest among other substances, benzodiazepine, cocaine, and opioids. While there is a concern that cannabis-related visits may pose a larger resource burden to the healthcare system, one study from Oregon showed that only 1.8% of visits to the ED were cannabis-related [ 17 ]. A case-control cohort study examining individuals in Ontario, Canada, from 2014 to 2017 found that cannabis users had significantly higher odds of an all-cause ED visit (OR 1.22, 95% CI 1.13 to 1.31). Still, the odds of mortality were not affected [ 18 ]. These findings support ours, showing lower mortality within 7 days among individuals with cannabis tested positive. It is important to emphasize that both cannabis only and cannabis plus other tested positive substances had lower mortality within 7 days than non-cannabis tested positive individuals. Moreover, we found lower hospitalization from ED among cannabis-positive patients. However, we may take this with caution as one study that also found lower hospitalization in cannabis users also reported a significant increase in individuals leaving the ED against medical advice/before treatment, which could call this result into question [ 19 ]. Cannabis testing positive does not necessarily reflect cannabis abuse or cannabis use disorder, although the higher proportion of males that we found characterize substance usage. The higher proportion of males was also in those who used cannabis only and no other substances. Thus, looking at the Israelis with cannabis licenses in mid-2024 [ 10 ], most licensed individuals were males (60%), and the most frequent indication was non-cancer chronic pain, 58% among males and 49% among females. This is of interest as women mostly make up most pain patients, suggesting a significant difference from the entire pain population [ 20 ]. As proposed by Zloczower et al. [ 21 ] patients with chronic pain who use cannabis may have diverse reasons for use, which may not represent the entire population of pain patients. Unlike other medications, individuals who seek medical cannabis certification might have motives that extend beyond the management of medical symptoms. On the other hand, there might also be physicians recommending cannabis to patients who are reluctant to be prescribed cannabis in the first place. Taken together, our findings of a higher proportion of males among cannabis positive, either only cannabis as well as cannabis plus other substance use, and the significant exponential trend of "medical" cannabis usage in Israel, which also presents a higher proportion of males suggest that part of the elevation is related to the spread of the "medical" cannabis. We found that cannabis-use-only patients had a lower rate of prescriptions for opioids and benzodiazepines than cannabis plus other substances. Their usage was even lower than the non-cannabis group. Their anti-depressive medication SSRI usage was also the lowest among the other groups, although not statistically significant. Together with a low hepatitis C antibody rate and their youngest age, the cannabis-only group reflects light users with no current severe medical problem. However, we have no another outcome. It is important to mention that the cannabis use outcomes cover several aspects that are not reflected in the medical outcomes. Recently, a meta-analysis [ 22 ] reported school absenteeism and dropout, reduced likelihood of obtaining high academic grades, graduating high school, enrolling in university, and postsecondary degree attainment, and perhaps increased unemployment.A review of the findings and accuracy of mental health adverse events with cannabis use diagnosed in the ED [ 23 ] reported several concerns regarding the ability to disentangle cannabis use adverse events from adverse events associated with the use of multiple recreational substances. In our study, both cannabis groups, with and without other substances, showed a better outcome than the non-cannabis users. However, we checked only hospitalization and death. We did not check for cannabis use disorder, mental illness, psychosis, depression, etc. Further follow-up and more specific evaluation is needed. 4.1. Limitation Of all ED admissions, we studied only individuals who underwent toxicology evaluation. These evaluations were not part of the routine admissions in the ED but rather done following specific requests of a physician.. Therefore, although the characteristics of the groups were stable over the years, the subjective group that underwent toxicology tests may change over the years and may lead to a biased proportion. 5. Conclusions The elevation in cannabis screened positive, particularly in the younger aged group (< 40 years) is reflected by the general population usage increase. The outcome of those screened was better (less hospitalization and deaths). However, outcome of the others and a follow-up (i.e., cannabis use disorder, psychosis, pain, and mental health comorbidity) would give important aspects regarding cannabis usage. Declarations Funding: This study was supported by grant no. 3-18678 From the Chief Scientist Office of the Ministry of Health, Israel Conflict of interest : All authors have no conflict of interests. Data cannot be shared openly, but available from the authors upon reasonable request. Author Contribution S.S and E.P wrote and revised the manuscript. O.M did statistical analyses, D.Z and M.A conseptualized.All athors aproved the final manuscript Acknowledgement This study was supported by grant no. 3-18678 From the Chief Scientist Office of the Ministry of Health, Israel Data Availability Data cannot be shared openly, but available from the authors upon reasonable request. References UNONDC. World drug report 2023. United Nations Office on Drugs and Crime New York, NY. Hammond D, Goodman S, Wadsworth E, Rynard V, Boudreau C, Hall W. Evaluating the impacts of cannabis legalization: the International Cannabis Policy Study. Int J Drug Policy. 2020;77:102698. 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JAMA Pediatr 7, e243674. Crocker CE, Emsley J, Tibbo PG. Mental health adverse events with cannabis use diagnosed in the Emergency Department: what are we finding now and are our findings accurate? Front Psychiatry. 2023;14:1093081. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6232319","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":436532674,"identity":"e2593a88-87a5-4143-a31e-4a81f6524f74","order_by":0,"name":"Oren Miron","email":"","orcid":"","institution":"Ben-Gurion University of the Negev","correspondingAuthor":false,"prefix":"","firstName":"Oren","middleName":"","lastName":"Miron","suffix":""},{"id":436532675,"identity":"28246859-486f-475d-bfdb-5f88334ed88b","order_by":1,"name":"David Zeltser","email":"","orcid":"","institution":"Tel-Aviv Sourasky Medical Center","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Zeltser","suffix":""},{"id":436532676,"identity":"dfbf0d86-2ca3-4456-889b-52292b31b643","order_by":2,"name":"Shaul Schreiber","email":"","orcid":"","institution":"Tel-Aviv Sourasky Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Shaul","middleName":"","lastName":"Schreiber","suffix":""},{"id":436532677,"identity":"0952dc0f-fed3-4cf5-90e9-2d409c5937bb","order_by":3,"name":"Miriam Adelson","email":"","orcid":"","institution":"Dr. Miriam \u0026 Sheldon G. Adelson Clinic for Drug Abuse, Tel-Aviv Sourasky Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Miriam","middleName":"","lastName":"Adelson","suffix":""},{"id":436532678,"identity":"e5c28311-dc83-4cd8-b604-681e175dcaa5","order_by":4,"name":"Einat Peles","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYDACZjBpw8CHEGFuIKzlAEOaBBtChJGAFgawlsNIWhgIaOFn5z34+eOO83VsEtmJHxh+2SQ2sBPQItnMlyxx8MxtCTaJ3M0SjH1piQ2EHGZwmMdA4mAbUAvP2W0MjD2HjQn6xf4wj/GPg23nSNBiwMxjBrTlgAQbe+82BoYfh+UIapE4zGNmcfZMsmQbe+9micSGNDk2Qlr4+88Y36jcYcfPz8y78cOHPzY8/PyHD+DVAgZwYxPbGBjY8KnE1MLwhyj1o2AUjIJRMMIAACRhPoX8rKc4AAAAAElFTkSuQmCC","orcid":"","institution":"Tel-Aviv Sourasky Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Einat","middleName":"","lastName":"Peles","suffix":""}],"badges":[],"createdAt":"2025-03-15 10:53:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6232319/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6232319/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79704057,"identity":"6829b37a-c066-40a2-9335-9ec64c0ce22a","added_by":"auto","created_at":"2025-04-01 17:39:06","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":159859,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage of cannabis screened positive by age group and years\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6232319/v1/e646962760bbe4e3b7c1136c.jpg"},{"id":79704055,"identity":"97c4baf4-941f-40d0-805b-482edbb7143d","added_by":"auto","created_at":"2025-04-01 17:39:06","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":66107,"visible":true,"origin":"","legend":"\u003cp\u003ea: Percentage of drugs screened positive by years age \u0026lt;40\u003c/p\u003e\n\u003cp\u003eb: Percentage of drugs screened positive by years age 40+\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6232319/v1/56cf2234aa3fc341d1859784.png"},{"id":81561523,"identity":"e4bfc78e-a706-404d-9c4d-a8c13799f588","added_by":"auto","created_at":"2025-04-28 14:38:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":926646,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6232319/v1/5e6ca1fd-1db2-4520-9a38-3ab92bdb2aae.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A trend in cannabis usage as reflected by emergency department admissions","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eCannabis is one of the most consumed substances worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] which is an increasing global health concern [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], in part as over the years, the potency of cannabis has increased over time from 4% in 1995 to 14% in 2019 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Among lifetime cannabis users, between 8 and 22% will develop Cannabis Use Disorder (CUD), with increased risk reported for men, individuals with comorbid psychiatric disorders, and those suffering from adverse childhood events[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The world expansion of recreational cannabis legalization is associated with trends in increasing hospitalizations, emergency department visits, potential increases in serious/violent crimes, and other harms [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, varying legalization models may show different impacts on population-level outcomes. A study that evaluated legislation and perception in Israel and the USA [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] found that lower perceived risk and greater perceived social norms were associated with current use, greater use intentions, and greater intentions to use in the home or near children if legal.\u003c/p\u003e \u003cp\u003eIn Israel, in 2011, the Israel Medical Cannabis Agency was established to regulate medical cannabis [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Since 2013, cannabis has been legally prescribed in Israel for 12 specific medical indications in various fields, among them psychiatry, pain management, and palliative care. Physicians who are trained and certified by the Israel Ministry of Health may prescribe cannabis with one or more of these indications [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The license for medical cannabis increased substantially from about 600 in 2011, 16,000 in 2016, and 60,000 in 2020 and achieved a maximum number in Dec 2023 (140,000). The indication among more than half was noncancer chronic pain [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. By mid-2024, the number of licenses for medical cannabis was reduced to 120,000, parallel to the change in license regulations. While cannabis for pain is highly prescribed, cannabis for non-pain has not yet been legalized in Israel (January 2025). This was despite the non-medical cannabis use for adults (\u0026ge;\u0026thinsp;18 years old) was decriminalized in 2019 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and two bills to allow non-medical cannabis sales passed preliminary readings in Israel\u0026rsquo;s parliament in 2020 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In 2017, 27.0% of Israeli adults reported past-year cannabis use [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], a substantial increase from that reported by a national survey in 2009 of 9% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, an online representative sample of 4,025 responders in 2018 found only 9% self-reported of cannabis use [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. We hypothesized that even though legalization is not yet established in Israel, the substantial increase in cannabis prescriptions for pain may reflect abuse [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and may be observed by admitted ED individuals as well. We aimed to study the proportion of cannabis over the years among individuals admitted to a big General Hospital\u0026rsquo;s ED in the biggest municipal city in Israel. Specifically, we studied at-risk groups, among the selected clinically suspected group who underwent toxicology screening.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eThe hospital\u0026rsquo;s IRB (\u0026lsquo;Helsinki Committee\u0026rsquo;) approved the study analyses TASMC-0503-22.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Data source\u003c/h2\u003e \u003cp\u003eDe-identified admissions data was retrieved from the TASMC emergency department (ED) database using an electronic format. All screened at admissions to the ED or when admitted to the hospital between 2016 and June 2024 for toxicology drugs were included in the data analyses. Variables included urine immunoassay with qualitative binary results (positive/negative) of any toxicology tests in the ED. Sociodemographic variables (sex, age, immigrant), past diagnosis of blood-transmitted disease (antibodies for HIV and hepatitis C, antigen for hepatitis B), chronic medications (prescriptions for opioids, benzodiazepines that may be abused and antidepressant (SSRI and tricyclic) as cannabis is associated with depression. Hospitalized and death within 7 days from ED admission were taken.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Statistical Analyses\u003c/h2\u003e \u003cp\u003eData analysis was performed using the R-statistical software on a Windows computer and SPSS version 29. We calculated the ratio of emergency department visitors who underwent a drug test and prescription drugs. Significant trend changes by half-year intervals were tested using chi-square linear association. A comparison between positive and negative tested patients characterized individuals with a positive test for drugs. Logistic regression was used to describe cannabis tested positive, including variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in univariate analyses.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Cannabis positive trend\u003c/h2\u003e \u003cp\u003eThe study included 20,022 individuals admitted to the ED between 2016 and June 2024 who were all screened for toxicology drugs. During that period, the overall number of ER admissions did not change and was about 100,000 per year. However, the proportion of admitted individuals who underwent toxicological testing nearly doubled from 0.7% in 2016 to 1.3% in 2024. Of all screened patients, 3361 (16.8%) tested positive for cannabis. Their proportion slightly increased from 15.4% in 2016 to 17.6% in 2024. Stratified by age group, the cannabis proportion was highest in younger patients (\u0026lt;\u0026thinsp;40 y), and their proportion increased from 23% in 2016 to 26.3% in 2024 (linear association 4.9, p\u0026thinsp;=\u0026thinsp;0.026) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) with a non-significant increase from 7.7\u0026ndash;12% by 40\u0026thinsp;+\u0026thinsp;age group (linear association p\u0026thinsp;=\u0026thinsp;0.13).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAt that period time benzodiazepine screened positive reduced from 27.2% in 2016 to 16.2% in 2024 (linear association p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), cocaine screened positive increased from 3.3 to 4.8%, with a peak of 8.9% at 2020, (linear association p\u0026thinsp;=\u0026thinsp;0.052), opioids screened positive reduced from 15.4\u0026ndash;8.3% in 2022, but since 2023 (when fentanyl test was added) slightly increased to 14% in 2024 (linear association p\u0026thinsp;=\u0026thinsp;0.09). Stratified by age groups, the \u0026lt;\u0026thinsp;40 age group (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003ea) showed benzodiazepine screened positive reduced (linear association p\u0026thinsp;=\u0026thinsp;0.002), cocaine screened positive increased (linear association p\u0026thinsp;=\u0026thinsp;0.01) and opioids screened did not change (linear association p\u0026thinsp;=\u0026thinsp;0.6). The aged 40\u0026thinsp;+\u0026thinsp;group (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eb) showed benzodiazepine screened positive reduced (linear association p\u0026thinsp;=\u0026thinsp;0.002), no trend changes in cocaine screened positive (linear association p\u0026thinsp;=\u0026thinsp;0.2) and opioids screened positive reduced (linear association p\u0026thinsp;=\u0026thinsp;0.005).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Characteristics of being positive for Cannabis (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of being positive vs. negative for cannabis (2016\u0026ndash;2024)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCannabis 3361(100%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNegative 16661(100%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale, sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2229(66.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9300(55.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.6(1.4\u0026ndash;1.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.1\u0026thinsp;\u0026plusmn;\u0026thinsp;21.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsraeli born\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2266 (67.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9303 (55.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.6 (1.5\u0026ndash;1.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatitis C antibody\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e653(19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3562(21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.9 (0.8-1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV antibody\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33(0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatitis B antigen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e298(8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1464(8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpioid prescription\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e141(4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e589(3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrescribed Benzodiazepines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e267(7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1380(8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrescribed SSRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e144(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e975(5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.7(0.6\u0026ndash;0.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrine Toxicology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny opioids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e476(14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1824(10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.3(1.2\u0026ndash;1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEcstasy (MDMA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e209(6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e362(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.0(2.5\u0026ndash;3.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCocaine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e386(11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e963(5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.1(1.9\u0026ndash;2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenzodiazepines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e741(22.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3649(21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmphetamines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e146(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e361(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.1(1.7\u0026ndash;2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMethamphetamines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e198(5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e413(2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.5(2.1\u0026ndash;2.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhencyclidine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23(0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTricyclic antidepressant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e109(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e491(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarbiturate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e191(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment \u0026amp; Outcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitalized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1793(53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11333(68.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.5(0.5\u0026ndash;0.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDied (within 7 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25(0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e315(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.4(0.3\u0026ndash;0.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe 3361 patients (16.8%) who screened positive for cannabis compared with the screened negative group (n\u0026thinsp;=\u0026thinsp;16,661) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), were younger (38.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.8 vs. 50.1\u0026thinsp;\u0026plusmn;\u0026thinsp;21.7, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), had a higher proportion of male (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), a higher proportion of Israeli born (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), fewer with hepatitis C antibody (0.012), and fewer had SSRI prescriptions (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), more of them tested positive for any opioids (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), cocaine (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ecstasy (MDMA) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), amphetamines (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and methamphetamines (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Fewer were hospitalized (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and fewer died within 7 days from ED admission (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). When comparing within the 8814 young aged\u0026thinsp;\u0026lt;\u0026thinsp;40y group, 2155 (24.4%) screened positive to cannabis. They had a higher proportion of male (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), a higher proportion of Israeli born (p\u0026thinsp;=\u0026thinsp;0.03), more of them tested positive for any opioids (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), cocaine (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ecstasy (MDMA) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), amphetamines (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) methamphetamines (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), benzodiazepine (p\u0026thinsp;=\u0026thinsp;0.005) and more had prescription for opioids (p\u0026thinsp;=\u0026thinsp;0.013). Fewer were hospitalized (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Cannabis only vs. cannabis and other substance users (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of being positive for cannabis only, cannabis \u0026amp; other substances, and negative to cannabis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCannabis only\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCannabis \u0026amp; others\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1870(100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1490(100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16661(100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale, sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1238(66.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e991(66.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9300(55.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.3\u0026thinsp;\u0026plusmn;\u0026thinsp;15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.5\u0026thinsp;\u0026plusmn;\u0026thinsp;16.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50.1\u0026thinsp;\u0026plusmn;\u0026thinsp;21.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsraeli born\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1284 (68.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e982(65.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9303 (55.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatitis C antibody\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e294(15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e359(24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3562(21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV antibody\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33(0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatitis B antigen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140(7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e158(10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1464(8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpioid prescription\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107(7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e589(3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrescribed Benzodiazepines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86(4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e181(12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1380(8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrescribed SSRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64(3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80(5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e975(5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrine Toxicology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny opioids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e476(31.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1824(10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEcstasy (MDMA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e209(14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e362(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCocaine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e386(25.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e963(5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenzodiazepines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e741(49.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3649(21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmphetamines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146(9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e361(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMethamphetamines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e198(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e413(2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhencyclidine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTricyclic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109(7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e491(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarbiturate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e191(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment \u0026amp; Outcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitalized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e955(51.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e838(56.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11333(68.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDied (within 7days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e315(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*Comparison between the three groups\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eStratified the cannabis into 1870 (55.7%) those with cannabis only and those who tested positive for other substances 1490 (44.3%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), the only cannabis group were younger (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with fewer hepatitis C antibodies (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and hepatitis B antigen (p\u0026thinsp;=\u0026thinsp;0.002) positive, fewer with opioid prescription (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), BDZ prescriptions (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and SSRI prescription (p\u0026thinsp;=\u0026thinsp;0.006). Fewer of them were hospitalized (p\u0026thinsp;=\u0026thinsp;0.003). The groups were comparable in gender, Israeli-born, HIV, and death rate.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Multivariate analyses\u003c/h2\u003e \u003cp\u003eAs compared with negative cannabis screened, the cannabis-positive group was more likely to be male (OR\u0026thinsp;=\u0026thinsp;1.6, 95% CI 1.4\u0026ndash;1.7, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), younger age, (OR\u0026thinsp;=\u0026thinsp;1.03, 95% CI 1.02\u0026ndash;1.03, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Israeli born (OR\u0026thinsp;=\u0026thinsp;1.3, 95% CI 1.1\u0026ndash;1.4, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with SSRI prescription (OR\u0026thinsp;=\u0026thinsp;1.2, 95% CI 1.0-1.5, p\u0026thinsp;=\u0026thinsp;0.05), opioid prescription (OR\u0026thinsp;=\u0026thinsp;1.4, 95% CI 1.3\u0026ndash;1.7, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ecstasy/MDMA (OR\u0026thinsp;=\u0026thinsp;1.7, 95% CI 1.4\u0026ndash;2.1, cocaine (OR\u0026thinsp;=\u0026thinsp;1.4, 95% CI 1.2\u0026ndash;1.6, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), methamphetamine (OR\u0026thinsp;=\u0026thinsp;1.4, 95% CI 1.1\u0026ndash;1.7, p\u0026thinsp;=\u0026thinsp;0.003) and less likely to be hospitalized (OR\u0026thinsp;=\u0026thinsp;0.8, 95% CI 0.7\u0026ndash;0.8, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eAs compared with cannabis use only, the patients with cannabis plus other substances were more likely to have an opioid prescription (OR\u0026thinsp;=\u0026thinsp;3.2, 95% CI 2.1\u0026ndash;4.8, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), BDZ prescriptions (OR\u0026thinsp;=\u0026thinsp;2.4, 95% CI 1.8\u0026ndash;3.1, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and to have hepatitis C antibody (OR\u0026thinsp;=\u0026thinsp;1.6, 95% CI 1.3\u0026ndash;1.9, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eStudying the characteristics of ED admission over 8 years in a big tertiary medical center in the biggest municipal city in Israel, we found an elevation in cannabis screened positive proportion among ED admissions. The highest proportion was in the \u0026lt;\u0026thinsp;40 y age group, who also present a significant trend increase. Moreover, the cannabis proportion in that age group was highest among other substances, benzodiazepine, cocaine, and opioids.\u003c/p\u003e \u003cp\u003eWhile there is a concern that cannabis-related visits may pose a larger resource burden to the healthcare system, one study from Oregon showed that only 1.8% of visits to the ED were cannabis-related [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. A case-control cohort study examining individuals in Ontario, Canada, from 2014 to 2017 found that cannabis users had significantly higher odds of an all-cause ED visit (OR 1.22, 95% CI 1.13 to 1.31). Still, the odds of mortality were not affected [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. These findings support ours, showing lower mortality within 7 days among individuals with cannabis tested positive. It is important to emphasize that both cannabis only and cannabis plus other tested positive substances had lower mortality within 7 days than non-cannabis tested positive individuals. Moreover, we found lower hospitalization from ED among cannabis-positive patients. However, we may take this with caution as one study that also found lower hospitalization in cannabis users also reported a significant increase in individuals leaving the ED against medical advice/before treatment, which could call this result into question [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCannabis testing positive does not necessarily reflect cannabis abuse or cannabis use disorder, although the higher proportion of males that we found characterize substance usage. The higher proportion of males was also in those who used cannabis only and no other substances. Thus, looking at the Israelis with cannabis licenses in mid-2024 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], most licensed individuals were males (60%), and the most frequent indication was non-cancer chronic pain, 58% among males and 49% among females. This is of interest as women mostly make up most pain patients, suggesting a significant difference from the entire pain population [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. As proposed by Zloczower et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] patients with chronic pain who use cannabis may have diverse reasons for use, which may not represent the entire population of pain patients. Unlike other medications, individuals who seek medical cannabis certification might have motives that extend beyond the management of medical symptoms. On the other hand, there might also be physicians recommending cannabis to patients who are reluctant to be prescribed cannabis in the first place. Taken together, our findings of a higher proportion of males among cannabis positive, either only cannabis as well as cannabis plus other substance use, and the significant exponential trend of \"medical\" cannabis usage in Israel, which also presents a higher proportion of males suggest that part of the elevation is related to the spread of the \"medical\" cannabis.\u003c/p\u003e \u003cp\u003eWe found that cannabis-use-only patients had a lower rate of prescriptions for opioids and benzodiazepines than cannabis plus other substances. Their usage was even lower than the non-cannabis group. Their anti-depressive medication SSRI usage was also the lowest among the other groups, although not statistically significant. Together with a low hepatitis C antibody rate and their youngest age, the cannabis-only group reflects light users with no current severe medical problem. However, we have no another outcome. It is important to mention that the cannabis use outcomes cover several aspects that are not reflected in the medical outcomes. Recently, a meta-analysis [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] reported school absenteeism and dropout, reduced likelihood of obtaining high academic grades, graduating high school, enrolling in university, and postsecondary degree attainment, and perhaps increased unemployment.A review of the findings and accuracy of mental health adverse events with cannabis use diagnosed in the ED [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] reported several concerns regarding the ability to disentangle cannabis use adverse events from adverse events associated with the use of multiple recreational substances. In our study, both cannabis groups, with and without other substances, showed a better outcome than the non-cannabis users. However, we checked only hospitalization and death. We did not check for cannabis use disorder, mental illness, psychosis, depression, etc. Further follow-up and more specific evaluation is needed.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Limitation\u003c/h2\u003e \u003cp\u003eOf all ED admissions, we studied only individuals who underwent toxicology evaluation. These evaluations were not part of the routine admissions in the ED but rather done following specific requests of a physician.. Therefore, although the characteristics of the groups were stable over the years, the subjective group that underwent toxicology tests may change over the years and may lead to a biased proportion.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThe elevation in cannabis screened positive, particularly in the younger aged group (\u0026lt;\u0026thinsp;40 years) is reflected by the general population usage increase. The outcome of those screened was better (less hospitalization and deaths). However, outcome of the others and a follow-up (i.e., cannabis use disorder, psychosis, pain, and mental health comorbidity) would give important aspects regarding cannabis usage.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis study was supported by grant no. 3-18678 From the Chief Scientist Office of the Ministry of Health, Israel\u003c/p\u003e \u003cp\u003e \u003cb\u003eConflict of interest\u003c/b\u003e: All authors have no conflict of interests.\u003c/p\u003e \u003cp\u003eData cannot be shared openly, but available from the authors upon reasonable request.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.S and E.P wrote and revised the manuscript. O.M did statistical analyses, D.Z and M.A conseptualized.All athors aproved the final manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThis study was supported by grant no. 3-18678 From the Chief Scientist Office of the Ministry of Health, Israel\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData cannot be shared openly, but available from the authors upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUNONDC. World drug report 2023. United Nations Office on Drugs and Crime New York, NY.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHammond D, Goodman S, Wadsworth E, Rynard V, Boudreau C, Hall W. Evaluating the impacts of cannabis legalization: the International Cannabis Policy Study. Int J Drug Policy. 2020;77:102698.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElSohly MA, Chandra S, Radwan M, Majumdar CG, Church JC. A Comprehensive Review of Cannabis Potency in the United States in the Last Decade. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021;6:603\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeingold D, Livne O, Rehm J, Lev-Ran S. Probability and correlates of transition from cannabis use to DSM-5 cannabis use disorder: results from a large-scale nationally representative study. Drug Alcohol Rev. 2020;39:142\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeung J, Chan GC, Hides L, Hall WD. What is the prevalence and risk of cannabis use disorders among people who use cannabis? A systematic review and meta-analysis. Addict Behav. 2020;109:106479.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAthanassiou M, Dumais A, Zouaoui I, Potvin S. The clouded debate: A systematic review of comparative longitudinal studies examining the impact of recreational cannabis legalization on key public health outcomes. Front Psychiatry. 2023;13:1060656.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCui Y, LoParco CR, Bar-Zeev Y, Duan Z, Levine H, Abroms LC, et al. Theory-based correlates of cannabis use and intentions among US and Israeli adults: a mixed methods study. Subst Abuse Treat Prev Policy. 2023;18:54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsralowitz R, Reznik A, Zolotov Y, Grinstein-Cohen O, Wacht O, Pruginin I, et al. Toward medical cannabis education in Israel. Complement Ther Med. 2021;58:102709.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLazker M, Zantzifer-Straichman Y, Lavi T, Landsheft Y, Mendelovich S. 2022. Medical cannabis unit report. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gov.il/en/departments/units/cannabis_unit/govil-landing-page\u003c/span\u003e\u003cspan address=\"https://www.gov.il/en/departments/units/cannabis_unit/govil-landing-page\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMOH (Ministry of Health). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gov.il/BlobFolder/reports/licenses-status-sept-2024/he/subjects_cannabis_docs_licenses-status-sept-2024.pdf\u003c/span\u003e\u003cspan address=\"https://www.gov.il/BlobFolder/reports/licenses-status-sept-2024/he/subjects_cannabis_docs_licenses-status-sept-2024.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSomerset SB. Israel Decriminalizes Adult Use Cannabis During CannaTech Conference In Tel Aviv. Forbes. 2019. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.forbes.com/sites/sarabrittanysomerset/2019/04/05/israel-decriminalizes-adult-use-cannabis-during-cannatech-conference-in-tel-aviv/?sh=7125b18a5dff\u003c/span\u003e\u003cspan address=\"https://www.forbes.com/sites/sarabrittanysomerset/2019/04/05/israel-decriminalizes-adult-use-cannabis-during-cannatech-conference-in-tel-aviv/?sh=7125b18a5dff\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 5 Sept 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Times of Israel. 2020. Cannabis legalization bills pass early readings; ultra-Orthodox MKs walk out. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.timesofisrael.com/cannabis-legalization-bills-pass-early-readings-ultra-orthodox-mks-walk-out/\u003c/span\u003e\u003cspan address=\"https://www.timesofisrael.com/cannabis-legalization-bills-pass-early-readings-ultra-orthodox-mks-walk-out/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 5 Sept 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEzrachi Y, Dayan Y, Rosiner I, Harel-Fisch Y. Psychoactive drug use among the adult population in Israel- national epidemiological survey. Jerusalem: Israel Anti-Drug Authority; 2017. (In Hebrew).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBar-Hamburger R, Ezrahi Y, Rosiner I, Nirel R. 2009. Illegal use of drugs and alcohol in Israel 2009, seventh national epidemiological survey. Jerusalem.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBar-Or RL, Kor A, Jaljuli I, Lev-Ran S. The Epidemiology of Substance Use Disorders among the Adult Jewish Population in Israel. Eur Addict Res. 2021;27:362\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarel-Fish Y, Hizi S, Yogev I, Zadok Y. Israel-drug situation and policy. Pompidou group of the council of Europe; 2014. p. 21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHendrickson RG, Dilley JA, Hedberg K, Jeanne TL, Love JS, Thompson JA, et al. The burden of cannabis-attributed pediatric and adult Emergency Department visits. Acad Emerg Med. 2021;28:1444\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVozoris NT, Zhu J, Ryan CM, Chow C-W, To T. 2022. Cannabis use and risks of respiratory and all-cause morbidity and mortality: a population-based, data-linkage, cohort study. BMJ Open Respir Res 9, e001216.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYeung MEM, Weaver CG, Janz K, Haines-Saah R, Lang E. Clearing the air: a study of cannabis-related presentations to urban Alberta emergency departments following legalization. CJEM. 2020;22:776\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBartley EJ, Fillingim RB. Sex differences in pain: A brief review of clinical and experimental findings. Br J Anaesth. 2013;111:52\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZloczower O, Brill S, Zeitak Y, Peles E. Risk and benefit of cannabis prescription for chronic non-cancer pain. J Addict Dis. 2022;40:157\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan O, Daudi A, Ji D, Wang M, Steen JP, Parnian P et al. 2024. Cannabis Use During Adolescence and Young Adulthood and Academic Achievement: A Systematic Review and Meta-Analysis. JAMA Pediatr 7, e243674.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrocker CE, Emsley J, Tibbo PG. Mental health adverse events with cannabis use diagnosed in the Emergency Department: what are we finding now and are our findings accurate? Front Psychiatry. 2023;14:1093081.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cannabis, Emergency department, risk factors, trends","lastPublishedDoi":"10.21203/rs.3.rs-6232319/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6232319/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eContext\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e:\u003c/strong\u003e 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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eAims:\u003c/strong\u003e\u003c/em\u003e 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. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods: \u003c/strong\u003e\u003c/em\u003eBetween 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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/em\u003e 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 \u0026lt;40 years group (n=8814) from 23% in 2016 to 26.3% in 2024. Within the \u0026lt;40y group, those who screened positive for cannabis (24.4%) had a higher proportion of males (p\u0026lt;0.001) and Israeli-born individuals (p=0.03). More of them tested positive for opioids (p\u0026lt;0.001), cocaine (p\u0026lt;0.001), ecstasy (MDMA) (p\u0026lt;0.001), amphetamines (p\u0026lt;0.001) methamphetamines (p\u0026lt;0.001) and benzodiazepine (p=0.005), and had prescription for opioids (p=0.013), but fewer were hospitalized (p\u0026lt;0.001). Of the older aged group (≥40y), also fewer died within 7 days (1.6% vs. 2.9%, p=0.009).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/em\u003e \u0026nbsp;The elevation in aged \u0026lt;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.\u003c/p\u003e","manuscriptTitle":"A trend in cannabis usage as reflected by emergency department admissions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-01 17:39:01","doi":"10.21203/rs.3.rs-6232319/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c6ebdf63-7d53-48c3-a500-c8b7ed18fa0f","owner":[],"postedDate":"April 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-28T14:38:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-01 17:39:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6232319","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6232319","identity":"rs-6232319","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}