The impact of recreational cannabis legalization on pediatric emergency department visits in British Columbia, Canada

INTRODUCTION: Canadian youth report some of the highest rates of cannabis use globally, raising concerns about child and youth poisonings from unintentional exposures and recreational use following legalization. This study examines and compares trends in cannabis poisonings among children and youth aged 16 years or younger treated in the emergency department (ED) of a Canadian pediatric hospital before and after the legalization of non-medical cannabis. METHODS: Cannabis-related ED visits at BC Children's Hospital (BCCH) (2016-2021) were identified from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database using injury codes and keyword searches. Key variables included age, sex, intent, method of cannabis use, poisoning intent, season, peer use, and mode of ED arrival. Chi-square tests were used to assess associations between characteristics, and interrupted time series analysis evaluated legalization impact. RESULTS: There were 304 pediatric-related cannabis poisoning ED visits to BCCH between 2016 and 2021, increasing 55.5% from pre-legalization (n = 119) to post-legalization (n = 185). Unintentional poisonings rose from 4% to 12%, mainly involving the ingestion of edibles among children with a median age of 3 years. Ninety percent of cases involved intentional use, with co-consumption with other substances more common than cannabis use only. Interrupted time series analysis showed an upward trend in poisonings from 2016 to 2018, an immediate 48% increase in ED visits following legalization, followed by a decline. CONCLUSION: Findings highlight the need for strengthened substance use prevention efforts, education programs, and continued surveillance to reduce harm among children and youth from intentional use and unintentional cannabis exposures, particularly involving edibles.