Abstract
BackgroundThe medical legalization of marijuana has been shown to result in an increased risk of motor vehicle injuries. In Colorado, commercialization of recreational marijuana (initiation of retail sales) occurred on January 1, 2014, resulting in the rapid proliferation of its availability. The objective of this study was to determine whether the proportion of injured patients testing positive for marijuana and other drugs changed two years before and two years after commercialization of recreational marijuana in Colorado.MethodsThis retrospective multi-institutional cohort study included all patients admitted with a traumatic injury to six trauma centers (three centers in Colorado and three centers in states without permissive marijuana laws) from 2012 to 2015. The primary outcome was the rate (%) of a positive urine drug screen (UDS) for marijuana. Generalized linear regression models were used to examine the rate of change over time in the pre-commercialization period relative to the post- commercialization period (via an interaction effect), separately for states with and without recreational marijuana legalization.ResultsThere were 40,591 trauma admissions. In Colorado, the rate of marijuana detected with UDS decreased over time pre-commercialization; this trend reversed post-commercialization, when marijuana detection rates increased significantly over time (interaction p = 0.004). At non-Colorado hospitals, the rate over time of marijuana detection was significantly reduced post-commercialization relative to the pre-commercialization period (p < 0.001).ConclusionThere was an overall increased rate over time of marijuana detected among trauma patients at Colorado hospitals but not at non-Colorado hospitals, suggesting an increased use of marijuana or an increased risk of injury while using marijuana following the commercialization of recreational marijuana in Colorado.
Highlights
The medical legalization of marijuana has been shown to result in an increased risk of motor vehicle injuries
Study variables The following demographic, clinical, and outcome characteristics were obtained from the trauma registries: trauma activation level; admission date; whether a toxicology urine drug screen (UDS) was performed; UDS test results; age, years; gender (M/F); race; mechanism of injury; cause of injury (MVC, fall, sports related, gunshot wound/assault, other injury); injury severity score (ISS); Glasgow coma score on admission (3-8, 9-15); systolic blood pressure on admission (< 90 mmHg or ≥ 90 mmHg); in-hospital mortality; Intensive care unit (ICU) admission
Patient characteristics There were 40,591 injured patients admitted over the study period, including 7463 full trauma activations and 11,267 patients who suffered an Motor vehicle crash (MVC) injury (Fig. 1)
Summary
The medical legalization of marijuana has been shown to result in an increased risk of motor vehicle injuries. (Centers for Disease Control and Prevention, 2018) Marijuana use and intoxication has been shown to increase the risk of traumatic injury, especially fatal motor vehicle crashes (MVCs) (Asbridge et al, 2012; Asbridge et al, 2014; Aydelotte et al, 2017; Li et al, 2012; Salomonsen-Sautel et al, 2014; Couper & (2019) 6:3. A study by Aydelotte et al examined the effect of recreational marijuana legalization on injury by analyzing year-over-year changes in MVC fatality rates before and after recreational legalization of marijuana in Colorado and Washington, the first two states to legalize marijuana, compared to eight control states. The authors report similar MVC crash fatality rates for Washington and Colorado compared to control states (Aydelotte et al, 2017)
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