In Summary

​A study published in June of 2019 has revealed the forecast for emergency department visits based on the current opioid crisis in Canada and the legalization of cannabis. Researchers observed an increase in the number of emergency department visits at hospitals in Canada, specifically for mental health addiction complaints. It was determined that the opioid crisis will continue to cause issues for emergency departments but that the legalization of cannabis will cause a minimal amount of issues due to the low-risk of addiction. While forecasting the effects of addiction-related emergencies researchers determined that there would be increased waiting times and the length of stay will deteriorate. It is recommended that Psychiatric Emergency Service Units increase their number of beds and that programs aimed at preventing alcohol and opioid addiction will be especially helpful for managing the future influx of patients. 
The opioid crisis is ravaging more than just the emergency rooms in Canada, extending all over North America. Opioids are incredibly dangerous considering their high risk of addiction, often leading to people illegally obtaining opioids or other illicit drugs like heroin. Opioids most commonly act on µ-opioid receptors which affect the reward pathway in the central nervous system, preventing pain and convincing the body that opioids are a great substance. Some doctors are all too willing to overprescribe opioids for chronic pain or during recovery periods leading many to begin their lifelong addiction. Considering the economic cost of dealing with addicts, the emotional cost to families and caretakers, and the promise of cannabis as an anti-nociceptive, the federal government should seriously consider rescheduling cannabis so that it can be more seriously considered as an adjunct or replacement therapy for pain.

In Summary

A recent meta-analysis and systematic review has shown that the liberalization of cannabis use has not increased the amount of reported cannabis use in adolescents. There appeared to be a slight increase in adult cannabis use post-recreational cannabis legalization but not a significant amount to clearly report that trend. These reports may be skewed due to the social stigma that continues to surround cannabis use and therefore prevents participants from accurately reporting their history, but further research in an area where cannabis legalization is likely to occur but hasn't yet would provide an interesting opportunity to confirm these findings. 

​Medical cannabis use has been legalized in 33 states at the time of this blog and legalized for recreational use in 11 states, highlighting the importance of looking into current demographics and legal activity. Some studies have suggested a decrease in adolescent cannabis use as illicit dealers are replaced by state-regulated dispensaries implying that legalization and regulation may actually provide a safer environment for cannabis use and allow better prevention practices for adolescents. Further research would be needed to confirm these hypotheses and previous findings but prove promising for future legalization.

In Summary

Researchers have recently found that the frequency of major birth defects has increased in Colorado since the legalization of cannabis. It has been hypothesized that prenatal exposure to cannabis has caused these birth defects as the reported use of pain relievers, cocaine, alcohol, and tobacco did not increase. The specific birth defects that increased in frequency were atrial septal defect, spina bifida, microcephalus, Down’s syndrome, ventricular septal defect, and patent ductus arteriosus, but further research needs to be conducted to determine any causation.
 
The effect of prenatal exposure to cannabis on birth rates, birth outcomes, and the health of the mother is rather uncertain. Studies focussing on cannabis use during pregnancy are limited and what little has been reported is inconsistent. Currently, governing bodies of obstetricians advise that pregnant mothers cease any cannabis use. If someone who needs cannabis for a medical purpose that improves their quality of life becomes pregnant they need to seek out alternative methods of treatment, even if they are using cannabis because they are resistant to more common treatment methods. Research is needed so that pregnant women can safely continue their medication or so that alternatives can be found so that women do not need to suffer for the duration of their pregnancy and possible breastfeeding period. 

In Summary

 Earlier this July a letter was published providing evidence that adolescent cannabis use may actually decrease post-legalization of medical and recreational cannabis. An analysis of Youth Risk Behavioral Surveys from the past two decades revealed that legalizing medical cannabis had little to no effect on cannabis use among adolescents in 8th and 10th grade but that legalization of recreational cannabis actually led to an overall decrease of adolescent cannabis use across the states. The authors hypothesize that the rate of adolescent use may decrease as illegal drug dealers are replaced by legal, regulated dispensaries. This evidence may prove compelling for the possible rescheduling of cannabis under the federal Controlled Substances Act. 
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Adolescent substance use, like that of alcohol, has been found to be detrimental to brain development. There have been varying results regarding the effects of adolescent cannabis use on brain development yet some caretakers are given special permission to administer cannabis-based products to children experiencing rare forms of epilepsy or other seizure disorders. Cannabis-based medications may be a more ethical and far less dangerous substance to administer to children so that they aren’t set up for a substance use disorder at a young age.  The research focussed on adolescent cannabis use needs to be conducted for better regulations and to better advise the parents and pediatricians of adolescents who have accidentally consumed cannabis or need a cannabis-based medical intervention.  

In Summary

Last summer an op-ed came out in response to cannabis legalization in Canada discussing the risks and benefits of the legalization. The author acknowledges the myriad of health benefits that cannabis has been shown to treat but also brings forth the gaps in our knowledge that still remain. The piece urges physicians to fully discuss the most current information with their patients when recommending cannabis and for at-home cultivators to carefully manage their plants to prevent underage consumption. The author ends the piece on a hopeful note, mentioning that the only certainty of legalization cannabis is that much more robust research will be able to be conducted and provide more information for the public. 
The author emphasizes the research opportunities that have now opened up in Canada due to the legalization of cannabis, highlighting the limitations of cannabis research in the United States. As cannabis is currently ruled a schedule I drug under the Controlled Substances Act the federal government sees no medical benefit in medical cannabis, despite an abundance of research. Researchers around the world have found evidence that cannabinoids, terpenes, and flavonoids can provide novel therapies for various disorders yet research in the US is still extremely limited by the lack of federal funding. Canada’s decision to legalize cannabis opens the door for so many cannabis-based therapies to be developed, and for economic and healthcare reasons, other countries should follow along. 

In Summary

​Researchers have recently found no evidence that the legalization of recreational cannabis increases the risk for small gestational age (SGA) births but may be linked to neonatal intensive care unit (NICU) admissions immediately post-birth. The study merely looks at the prevalence of both SGA and NICU admissions immediately post-legalization of recreational cannabis in Colorado and claims no causation conclusions can be drawn from the gathered data but did note an increase of 1% of NICU admissions per month immediately following legalization. The rate of the SGA births decreased following the new laws meaning cannabis may not affect the growth of a fetus or could improve development but future research is encouraged to ensure these results and identify possible causation for an increase in NICU admissions, which could be due to a myriad of factors. 

This article serves as a call for research so that patients who take cannabis and fall pregnant are fully aware of the possible risks associated with continuing cannabis use during pregnancy. Currently, most obstetricians and gynecologists advise against cannabis use due to the lack of knowledge concerning cannabis and fetal development but those who fall pregnant and rely on cannabis are often left unaware of alternative options. Considering the uncertainty of the effects of cannabis on pregnancy outcomes and the inconsistency between the few studies currently published more research is definitely needed so that pregnant women can continue to receive safe and effective treatment.