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Soaring rates of vaping among young people and associated problems have resulted in great urgency and important challenges for policymakers. Despite the urgency, policies should be evidence-based and thoughtfully designed. They require effective, collaborative, and well-funded enforcement by federal and state governments. Policymakers should aim to reduce vaping among young people while maintaining avenues to help smokers quit. Finally, policies should be forward-thinking, since the e-cigarette market is rapidly changing and e-cigarette companies can be more agile than regulators.

Published March 25, 2020, at NEJM.org. DOI:  10.1056/NEJMp1917065   

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• PMID: 32187114   DOI: 10.1097/ADM.0000000000000638

Abstract

Objectives: Cannabis is a known teratogen. Data availability addressing both major congenital anomalies and cannabis use allowed us to explore their geospatial relationships.

Methods: Data for the years 1998 to 2009 from Canada Health and Statistics Canada was analyzed in R. Maps have been drawn and odds ratios, principal component analysis, correlation matrices, least squares regression and geospatial regression analyses have been conducted using the R packages base, dplyr, epiR, psych, ggplot2, colorplaner and the spml and spreml functions from package splm.

Results: Mapping showed cannabis use was more common in the northern Territories of Canada in the Second National Survey of Cannabis Use 2018. Total congenital anomalies, all cardiovascular defects, orofacial clefts, Downs syndrome and gastroschisis were all found to be more common in these same regions and rose as a function of cannabis exposure. When Canada was dichotomized into high and low cannabis use zones by Provinces v Territories the Territories had a higher rate of total congenital anomalies 450.026 v 390.413 (O.R. = 1.16 95%C.I. 1.08-1.25, P = 0.000058; attributable fraction in exposed 13.25%, 95%C.I. 7.04-19.04%). In geospatial analysis in a spreml spatial error model cannabis was significant both alone as a main effect (P < 2.0 × 10) and in all its first and second order interactions with both tobacco and opioids from P < 2.0 × 10.

Conclusion: These results show that the northern Territories of Canada share a higher rate of cannabis use together with elevated rates of total congenital anomalies, all cardiovascular defects, Down's syndrome and gastroschisis. This is the second report of a significant association between cannabis use and both total defects and all cardiovascular anomalies and the fourth published report of a link with Downs syndrome and thereby direct major genotoxicity. The correlative relationships described in this paper are confounded by many features of social disadvantage in Canada's northern territories. However, in the context of a similar broad spectrum of defects described both in animals and in epidemiological reports from Hawaii, Colorado, USA and Australia they are cause for particular concern and indicate further research.

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First published:20 February 2020

Abstract - Findings: the initiation of recreational cannabis commercialization was associated with 5.06–5.80 more exposures per 1 000 000 population per quarter (67–77% increase relative to the pre‐legalization average), depending on the composition of comparison states. The increase associated with commercialization was higher among minors than adults (7.97–9.53 versus 3.83–4.21 more exposures), higher among males than females (6.16–7.56 versus 3.76–3.91 more exposures) and higher among exposures with medical consequences than those without medical consequences (4.09–4.79 versus 0.97–1.01 more exposures).

Conclusion: An increase in cannabis exposures reported to the US National Poison Data System was observed following recreational cannabis commercialization in the United States.

https://onlinelibrary.wiley.com/doi/abs/10.1111/add.15019

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