As cannabis legalization continues to spread across the United States, so too does a false sense of safety surrounding its use. Once vilified and now widely celebrated, cannabis has undergone a remarkable transformation in public perception over the past decade. But while society embraces cannabis as a “natural,” “non-addictive,” or even “medicinal” alternative to harder drugs or pharmaceuticals, emerging data tells a far more complex—and concerning—story. According to a new study by Truveta Research, the rate of cannabis-induced emergency room visits rose nearly 50% between 2019 and 2020. This uptick isn’t an isolated event—it’s part of a sustained and growing trend that persisted through 2023, revealing deep gaps in awareness, policy, and clinical preparedness.
And while emergency physicians are seeing more cannabis-induced emergency room visits than ever before, many still feel ill-equipped to diagnose, treat, or intervene effectively. In the words of Dr. Lewis Nelson, chair of the Department of Emergency Medicine and chief of the Division of Medical Toxicology and Addiction Medicine at Rutgers New Jersey Medical School, cannabis-related emergencies are “clearly” increasing—but our systems of care haven’t caught up.
Understanding the Terminology: Cannabis-Induced vs. Cannabis-Involved ED Visits
To understand the scope of this problem, it’s important to distinguish between cannabis-induced and cannabis-involved emergency department visits:
- Cannabis-Induced Disorder ED Visits generally refer to psychiatric or physical health crises where cannabis is the primary cause. The most serious among them is cannabis-induced psychosis, characterized by delusions, hallucinations, paranoia, or disorganized thinking brought on by cannabis use.
- Cannabis-Involved ED Visits, meanwhile, can include any ED encounter where cannabis was present or a contributing factor. This can range from acute intoxication, anxiety, vomiting (cannabinoid hyperemesis syndrome), accidents while under the influence, or unintentional ingestion by children.
These definitions matter because the health system often lacks clear protocols for responding to cannabis-related crises—especially as cannabis-induced emergency room visits continue to rise with few dedicated clinical pathways for intervention.
What the Truveta Study Found
The Truveta Research study analyzed a staggering 33.5 million emergency department visits between 2019 and 2023. Among those, it identified nearly 19,000 cannabis-related ED encounters involving more than 14,500 individuals. The results were striking:
- In 2019, the rate of cannabis-induced disorder visits per 10,000 ED visits was 3.9.
- In 2020, that number jumped to 5.7—an increase of 46.2% in a single year.
- The trend did not plateau or decline—instead, cannabis-induced emergency room visits continued to increase through 2023.
“The substantial and sustained rise in the rate of cannabis-induced disorder visits between 2019 and 2023 suggests a growing impact on individuals’ health,” the study authors wrote, “raising questions about the potential short- and long-term consequences of increased cannabis use.”
Why the Sudden Surge? Availability and Potency
Dr. Nelson isn’t surprised by these findings. In his view, there are two primary drivers behind the surge in cannabis-induced emergency room visits:
- Increased Availability: Legalization has dramatically expanded cannabis access, not only in states that allow recreational use but also through loopholes, unregulated markets, and even online sales of high-THC products.
- Increased Potency: “The cannabis of today is not like the cannabis of the 1970s,” Nelson told Addiction Treatment Business. “It’s extremely high potency comparatively.”
Today’s cannabis concentrates—such as oils, waxes, and shatter—can contain THC levels 10 to 30 times higher than the marijuana flower used decades ago. Edibles, another popular form of consumption, can deliver large doses of THC in just a few bites, often disguised as candy or baked goods. This potency intensifies the risk for acute psychiatric events, accidental overdoses (especially in children), and other cannabis-related harms.
Children Are Particularly Vulnerable
Perhaps most alarming is the growing number of cannabis-induced emergency room visits involving young children.
A CDC study observed a significant increase in cannabis-involved ED visits among children under 10 years old during the COVID-19 pandemic. The situation is exacerbated by the packaging of cannabis edibles, which often resemble candy or snacks, and by the widespread assumption that cannabis is “safe” and doesn’t require secure storage.
Data from the National Poison Data System confirms the trend: between 2017 and 2021, cases of edible cannabis ingestion by children under 6 skyrocketed by 1,375%.
The CDC has urged several public health measures to address this issue:
- Improving clinician awareness for earlier diagnosis of cannabis intoxication in young patients.
- Educating parents and guardians about proper cannabis storage and the risks of unintentional exposure.
- Redesigning cannabis packaging to be less appealing and more child-resistant.
These steps are crucial as cannabis-induced emergency room visits involving children can result in seizures, extreme sedation, and even coma in severe cases.
Is Legalization to Blame? The Research Is Mixed
Does legalizing cannabis cause more cannabis-induced emergency room visits? The answer is complicated.
Some studies have found correlations between state-level legalization and increased cannabis-related harms. For instance, a 2023 study published in JAMA Network Open observed increased psychosis-related healthcare utilization among men aged 55–64 in states with recreational cannabis laws. But the findings weren’t statistically robust enough to draw population-wide conclusions.
“I don’t view this study as providing conclusive evidence that state cannabis legalization doesn’t lead to increases in psychosis-related health care utilization,” said the study’s senior author, Dr. Ellicott Matthay of NYU Grossman School of Medicine. “There might be a problem here, or there might not. We don’t know yet.”
Still, Matthay noted a 60% increase in calls to Poison Control for cannabis-related health harms in California following the state’s legalization. These early signals suggest that cannabis-induced emergency room visits may be indirectly affected by policy shifts that increase public access without adequate safeguards.
What Clinicians Are Facing on the Front Lines
Despite the uptick in cannabis-induced emergency room visits, there is no FDA-approved treatment for cannabis use disorder. And for many providers, this reality leaves them unsure how to respond.
“I am not sure that the average clinician is going to be receptive to this message [about cannabis-induced psychosis],” Nelson admitted. “There’s a certain social acceptability, a certain feeling that this isn’t really something I can fix.”
This sense of helplessness is compounded by lack of training, unclear clinical guidelines, and the absence of dedicated pharmacological treatments. Even seasoned addiction medicine physicians may feel unprepared to treat cannabis-related psychiatric conditions, particularly when symptoms mimic schizophrenia or bipolar disorder.
The Future of Cannabis Care: What Needs to Change
As cannabis-induced emergency room visits continue to climb, it’s clear that a multi-layered response is needed. Dr. Nelson and others in the field suggest several key strategies:
- Harm Reduction Education
Public education campaigns can help users understand the risks of high-potency THC and the connection between cannabis use and psychiatric complications. - Safe Storage Campaigns
Modeled after opioid safety initiatives, cannabis storage campaigns can help prevent unintentional ingestion by children—one of the leading causes of pediatric cannabis ER visits. - Packaging Regulation
Laws mandating plain labeling, child-resistant packaging, and THC limits per edible unit could curb the number of accidental cannabis-induced emergency room visits among minors. - Clinical Training and Early Screening
Hospitals and primary care providers should be trained to screen for cannabis-induced psychosis and recognize cannabis use disorder early. - Policy-Informed Research
More state-by-state research is needed to determine whether legalization correlates with increased cannabis-induced emergency room visits—and what factors mediate that relationship.
Conclusion: A Public Health Challenge That Cannot Be Ignored
The sharp rise in cannabis-induced emergency room visits is not a statistical fluke—it’s a clear signal that cannabis use in the U.S. has reached a tipping point. High-potency products, marketing practices that appeal to children, and a general underestimation of cannabis’ health risks are driving more people to emergency rooms, often with serious psychiatric or physical symptoms.
While cannabis policy continues to evolve, the public health response has lagged behind. Without targeted education, regulation, and clinical support, we risk normalizing a substance that is increasingly associated with ER visits, psychosis, and accidental harm.
It’s time to meet this crisis head-on—with facts, compassion, and a renewed focus on harm reduction and prevention.
