The effect of recreational cannabis legalization on rates of traffic injury in Canada

Abstract

Aims: To measure the impact of Canada's recreational cannabis legalization (RCL) in October 2018 and the subsequent impact of the coronavirus disease 2019 (COVID-19) lockdowns from March 2020 on rates of emergency department (ED) visits and hospitalizations for traffic injury.

Design: An interrupted time series analysis of rates of ED visits and hospitalizations in Canada recorded in population-based databases from January/April 2010 to March 2021.

Setting: ED visits in Ontario and Alberta and hospitalizations in Ontario, Alberta, British Columbia, the Prairies (Manitoba and Saskatchewan) and the Maritimes (Nova Scotia, New Brunswick, Newfoundland and Prince Edward Island).

Participants: Monthly counts of presentations to the ED or hospital for motor vehicle injury or pedestrian/cyclist injury, used to calculate monthly rates per 100 000 population.

Measurements: An occurrence of one or more International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA) code for motor vehicle injury (V20-V29, V40-V79, V30-V39 and V86) and pedestrian/cyclist injury (V01-V09 and V10-V19) within the National Ambulatory Care Reporting System and Discharge Abstract Database.

Findings: There were no statistically significant changes in rates of ED visits and hospitalizations for motor vehicle or pedestrian/cyclist injury after RCL after accounting for multiple testing. After COVID-19, there was an immediate decrease in the rate of ED visits for motor vehicle injury that was statistically significant only in Ontario (level change β = -16.07 in Ontario, 95% CI = -20.55 to -11.60, P = 0.000; β = -10.34 in Alberta, 95% CI = -17.80 to -2.89, P = 0.008; α of 0.004) and no changes in rates of hospitalizations.

Conclusions: Canada's recreational cannabis legalization did not notably impact motor vehicle and pedestrian/cyclist injury. The rate of emergency department visits for motor vehicle injury decreased immediately after COVID-19 lockdowns, resulting in rates below post-recreational cannabis legalization levels in the year after COVID-19.

Keywords: Cannabis policy; emergency department; hospitalization; interrupted time series; motor vehicle injury; pedestrian/cyclist injury; recreational cannabis legalization; traffic injury.