High-intensity cannabis use and hospitalization: a prospective cohort study of street-involved youth in Vancouver, Canada

Hudson Reddon,Thomas Kerr,Evan Wood,Kora Debeck,M-J Milloy,Ekaterina Nosova

doi:10.1186/s12954-021-00501-8

Abstract

BackgroundThere is concern that cannabis use negatively affects vulnerable groups such as youth; however, the relationship between cannabis use and health care utilization has not been well characterized in this population. We longitudinally evaluated the association between daily cannabis use and hospitalization among a prospective cohort of street-involved youth.MethodsData were collected from the At-Risk Youth Study (ARYS) in Vancouver, Canada, from September 2005 to May 2015. Participants were interviewed semi-annually and multivariable generalized estimating equation (GEE) logistic regression was used to examine the relationship between daily cannabis use and hospitalization.ResultsA total of 1216 participants (31.2% female) were included in this analysis, and 373 (30.7%) individuals reported hospitalization at some point during the study period. In a multivariable GEE analysis, daily cannabis use was not significantly associated with hospitalization (Adjusted Odds Ratio [AOR] = 1.17, 95% Confidence interval [CI] = 0.84, 1.65). We did observe a significant interaction between daily cannabis use and sex (AOR = 0.51, 95% CI = 0.34, 0.77), whereby cannabis use was associated with a decreased odds of hospitalization among males (AOR = 0.60, 95% CI = 0.47, 0.78), yet was not significantly associated with hospitalization among females (AOR = 1.19, 95% CI = 0.84, 1.67).ConclusionsThe finding that daily cannabis use was not associated with hospitalization among street-involved youth is encouraging given the high rates of cannabis use in this population and the expansion of cannabis legalization and regulation. Future studies, however, are warranted to monitor possible changes in the consequences of cannabis use as cannabis legalization and regulation increase internationally.

Highlights

There is concern that cannabis use negatively affects vulnerable groups such as youth; the relationship between cannabis use and health care utilization has not been well characterized in this population
To account for the sex differences in the prevalence of cannabis use and health outcomes associated with cannabis use, we examined sex × cannabis use interaction effects to determine if the effect of high-intensity cannabis use on hospitalization was different among males and females
530 (43.6%) participants reported at least daily cannabis use in the last 6 months and 151 (12.4%) individuals reported experiencing a hospitalization in the last 6 months

Summary

Introduction

There is concern that cannabis use negatively affects vulnerable groups such as youth; the relationship between cannabis use and health care utilization has not been well characterized in this population. Studies from the USA and Europe have reported elevated rates of hospitalization among people who use cannabis and significant increases in cannabis-related hospitalizations were observed throughout the introduction of cannabis legalization in Colorado [18,19,20]. Prior studies have demonstrated that men and women differ in the prevalence of cannabis use and cannabis use disorder, drug tolerance, health outcomes and treatment-seeking behavior related to cannabis use [21,22,23]. Men typically; initiate cannabis use at a younger age; have greater access to cannabis; are more likely to use frequently and in higher quantities; are more likely to be long-term users; and are twice as likely to be diagnosed with a cannabis use disorder [24, 25]. Many large-scale studies have found that women are significantly more likely than men to access healthcare services including primary and specialty care [28, 29]

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