Although nine and 29 states have legalized recreational and medical marijuana, respectively, debate continues about the impact of marijuana use by teenagers, with inconsistent results among studies looking at this question (see AJN Reports, October 2017).

A recent study, however, found that marijuana-related ED and urgent care (UC) visits to a tertiary care children's hospital system in Colorado increased significantly over a 10-year period among adolescents, "most notably" in the years after the state legalized medical marijuana in 2009 and recreational marijuana in 2014.

In the retrospective study, the investigators looked at ED/UC visits from 2005 to 2015 by patients ages 13 through 20 years that were determined to be related to marijuana based on diagnostic codes or positive urine drug screens. There were 4,202 such visits during this period and, in 67%, a behavioral health evaluation was also conducted.

The number of ED/UC visits related to marijuana increased from 161 in 2005 to 777 in 2015, during which time those visits that included a behavioral health evaluation increased from 84 to 500. The rate of marijuana-related visits per 1,000 ED/UC visits increased from 1.8 in 2009 to 4.9 in 2015, an increase of high statistical significance. Behavioral health consultations related to marijuana also increased, from 1.2 to 3.2 per 1,000 ED visits during that time. A diagnosis of cannabis use, abuse, and misuse was made at 62% of the 4,202 visits, and a comorbid psychiatric diagnosis was made at 71%, with depression being the most common (39% of total visits), followed by mood disorder (22%).

"As more states begin to legalize marijuana," the authors concluded, "the alarming prevalence of comorbid psychiatric disorders and drug use among adolescents presenting to our ED/UC settings for marijuana-related concerns further supports the need for implementation of comprehensive targeted marijuana education and prevention programs directed at youth, particularly those with concomitant psychiatric illness and drug use."-Elizabeth Mechcatie, MA, BSN

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