The Health Effects of Cannabis and Cannabinoids The Current State of Evidence and Recommendations for Research (2017) / Chapter Skim
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9 Injury and Death
9 Injury and Death
Pages 217-244
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From page 217... ...
These health endpoints are distinguished not only by their status as significant public health issues but also by the extent to which directed public health actions and policy changes hold the potential for lessening their detrimental impacts on population health. Motor vehicle accidents are a leading cause of death and injury in the United States, and occupational injuries, especially those that permanently limit an individual's capacity to perform tasks at home and in the workplace, impose substantial economic burdens on workers, employers, and communities.
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From page 218... ...
(1997) assessed the risk of mortality associated with cannabis use in a cohort of 65,171 individuals ages 15 to 49 years who were enrolled in the Kaiser Permanente Medical Care Program and followed 1The review also addressed the association between cannabis use and health endpoints that are often or always fatal, such as motor vehicle accidents, cancer, and suicide.
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From page 219... ...
. After accounting for potential confounders, women who currently smoked cannabis were not at a significantly increased risk of all-cause mortality compared to those who had never smoked or who had smoked experimentally (RR, 1.09, 95% CI = 0.80–1.48)
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. Among the cohort as a whole, heavy cannabis use was associated with a significantly increased risk of mortality compared with nonuse (HR, 1.4, 95% CI = 1.1–1.8)
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From page 221... ...
Risk estimates are based on cannabis use as of the time of conscription rather than lifetime cannabis exposure and therefore do not account for cannabis use during the ~40 year follow-up period. Similarly, data on potential confounders after the time of conscription is unavailable, so the extent to which they affected study participants and potentially impacted all-cause mortality risk is unknown.
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From page 222... ...
(2015) estimated that in the United States the direct workers' compensation cost of the most severe, nonfatal occupational injuries was over $51 billion in 2010.2 Concurrent with this economic and public health burden is the increasing prevalence of cannabis use among employed U.S.
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From page 223... ...
Compared to participants who did not use illicit drugs in the previous year and who had few other risk factors, those who used cannabis in the previous year had a significantly elevated risk of suffering minor occupational injuries in the past year if they also had several other risk factors (OR, 8.49, 95% CI = 5.37–13.42) , but not if they had few other risk factors (OR, 1.10, 95% CI = 0.47–2.57)
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From page 224... ...
worked for pay. Compared to currently employed students who did not smoke cannabis, those who reported using cannabis on one to nine occasions in the previous 30 days reported a significantly increased risk of occupational injury (OR, 1.37, 95% CI = 1.06–1.77)
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From page 225... ...
Findings from the reviewed studies were mixed, with not all studies showing a statistically significant association between cannabis use and occupational injury. The authors also sought to determine whether chronic cannabis users have cognitive deficits that place them at an increased risk for occupational injuries, and they reported that although some studies suggest an association between cannabis use and reduced cognitive functioning, the impact of any such deficits on the risk of occupational injury has not been determined.
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Participants who stated they had experienced an occupational injury during a specific time period were not asked how many such injuries occurred. As a result, the study may have underestimated the true number and risk of occupational injuries.
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CONCLUSION 9-2 There is insufficient evidence to support or refute a statistical association between general, nonmedical cannabis use and occupational accidents or injuries. MOTOR VEHICLE CRASHES In 2011, motor vehicle crashes (MVCs)
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There were a total of 28 estimates available from these 21 observational studies. The authors of this systematic review limited their analysis to evidence from either casecontrol studies or culpability studies and did not include evidence from cross-sectional or cohort studies.
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Primary Literature The committee did not identify any relevant, good-quality primary literature that reported on the association between cannabis use and motor vehicle crashes and were published subsequent to the data collection period of the most recently published good- or fair-quality systematic review addressing the research question. Of the three identified papers with publication dates during or after 2015 that were not included in Rogeberg and Elvik (2016)
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The bulk of the evidence available describing the association between DUIC and MVCs comes from case-control studies that evaluate the odds of a MVC by DUIC status and from culpability studies which evaluate the odds of culpability in drivers involved in collisions by DUIC status. CONCLUSION 9-3 There is substantial evidence of a statistical association between cannabis use and increased risk of motor vehicle crashes.
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Systematic Reviews The committee did not identify a good- or fair-quality systematic review that reported on the association between cannabis use and overdose injuries or death. Primary Literature The committee identified a number of studies that directly or indirectly reported on the association between acute cannabis intoxication and overdose death in either adults or children.
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From page 232... ...
Colorado law states that a single-serving edible cannabis product should contain no more than 10 mg of THC; however, currently available edible cannabis products such as cookies and brownies, which are otherwise generally understood as single-serving products, may contain as much as 100 mg (or 10 servings) of THC.8 In a study on unintentional pediatric cannabis exposure, Wang et al.
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(2016) reported the prevalence of unintentional pediatric cannabis exposures occurring between 2009 and 2015 at a children's hospital and a poison center in Colorado.
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Another study found that the mean number of calls to poison control centers for unintentional pediatric cannabis exposures increased by 34 percent per year between 2009 and 2015 -- a significant increase that was also significantly greater than the 19 percent annual increase in cannabis-related calls received by poison control centers throughout the rest of the United States during that same period (Wang et al., 2016)
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Overall, the committee identified no study in which cannabis was determined to be the direct cause of overdose death. Several studies report that unintentional pediatric cannabis exposure is associated with potentially serious symptoms, including respiratory depression or failure, tachycardia and other cardiovascular symptoms, and temporary coma.
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9-4(b) here is moderate evidence of a statistical association T between cannabis use and increased risk of overdose injuries, including respiratory distress, among pediatric populations in U.S.
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BOX 9-1 Summary of Chapter Conclusions* There is substantial evidence of a statistical association between cannabis use and: • Increased risk of motor vehicle crashes (9-3)
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. The committee also found moderate evidence of a statistical association between cannabis use and an increased risk of overdose injuries among pediatric populations in states in where cannabis is legal.
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2012. Acute cannabis consumption and motor vehicle collision risk: Systematic review of observational studies and meta analysis.
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2015. State-specific costs of motor vehicle crash deaths.
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2012. Marijuana use and motor vehicle crashes.
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2015. Motor vehicle traffic crashes as a leading cause of death in the United States, 2010 and 2011.
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From page 243... ...
2016. Unintentional pediatric exposures to marijuana in Colorado, 2009–2015.
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