Yesterday’s Canadian news cycle pumped out a story about the rising average number of children being hospitalized from unintentional cannabis ingestion. This news story has recycled in the media every few months since edible cannabis products became available in January 2020, and I would like to take a few minutes to respond to it.
The correspondence published in the New England Journal of Medicine looks only at hospitalization numbers from 2015 to 2021. Armed with this information alone, the definition of a causative relationship between hospitalizations and cannabis legalization is spurious at best.
1. The authors did not look at the proportion of hospitalizations that occurred from legal cannabis products, vs. illegal cannabis products. It is well reported that non-licensed products are still being sold in Canada, yet this study did not consider this at all.
Report from BNN Bloomberg in 2020 highlights how illicit cannabis still dominates Canada’s system: https://www.bnnbloomberg.ca/illicit-pot-still-dominates-after-two-legal-years-1.1483903
And a report from MBJizDaily in 2021 showing that despite a decline in illicit market share, it is still a large proportion of cannabis sales in Canada: https://mjbizdaily.com/canadas-legal-cannabis-market-continues-to-erode-illicit-markets-share/
2. The authors did not look at the rate of cannabis usage for the same time period in question. Without understanding whether there were changes in cannabis use habits, especially with respect to cannabis use prevalence and frequency, it is reckless to assume an increase in hospitalizations is representative of increased consumer harm in the face of cannabis legalization.
Report from Statistics Canada indicating increases in cannabis use prevalence and frequency since legalization: https://www150.statcan.gc.ca/n1/pub/82-003-x/2021004/article/00001/tbl/tbl01-eng.htm
3. The authors did not evaluate changes in attitude on cannabis consumption from 2015 to 2021. With legalization occurring in 2018, there has been active work on de-stigmatization resulting in increased social acceptability of cannabis. Downstream effects of increased social acceptability may also be contributing factors to increased hospitalizations, and this was not even considered in the study. With less stigma associated with the use of cannabis, there is increased usage and potentially an increased amount of product in the standard household. Increased changes of children obtaining cannabis products will increase their chances of consumption. And with the increased social acceptability and the legalization of cannabis, parents may be significantly more willing to take their children to the hospital for cannabis ingestion than previously before.
Figure is from the Canadian Cannabis Survey 2021 https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/canadian-cannabis-survey-2021-summary.html
At the end of the day, regardless of the mode of consumption, it is the responsibility of the consumer to ensure their products are out of reach of children to prevent harm in the household. As with guns in locked cabinets and alcohol on high shelves, prevention in the household is the first line of defense.
I speak for everyone at Diplomat when I say that we do not advocate for the purchase and consumption of illicit cannabis products. However, should that be the choice for individuals out there, we adamantly encourage all cannabis products alike to be stored safety, in high shelving and/or in lockable areas, away from children.
There is a Latin phrase “cum hoc ergo propter hoc”, roughly translating to “with this, therefore because of this”, that stands to denote that correlation does not imply causation. This is the case for this study. The correlation between edible cannabis legalization and an increased number of children hospitalized, does not mean that one caused the other. To suggest so and to conflate these two concepts is intentionally misleading.
