160 Trends of Reported Marijuana Use in a Pediatric Emergency Department

Thirty-three states have legalized recreational and/or medicinal marijuana, leading to normalization of its use, and desensitization of perceived risk. We utilized electronic health record data from a Pediatric ED located in a state which has legalized medicinal marijuana, and examined the changes in reported marijuana use among adolescents, and the relationship between marijuana use, use of other drugs, and risk for substance use disorder (SUD). We implemented a team-based adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) program in a Pediatric ED in January 2018, utilizing the CRAFFT tool to screen patients ages 12-17. Individual CRAFFT responses were examined for the 8,694 of 24,057 (36.1%) patients screened from January 2018 to October 2019. Pearson chi-square tests were used to compare use of reported substances from 2018 to 2019 to identify trends in the use of each substance (alcohol, marijuana, and other drugs). Binary logistic regression was used to examine the predictors of both a positive CRAFFT score (2 or higher in Part B, validated for identifying an SUD) and other drug use. Reported alcohol use decreased from 2018 to 2019, from 8.5% to 7.3% (p=0.04), marijuana use increased from 9.1% to 11.3% (p=0.09), and other drug use did not change (1.9%). 39.2% of those reporting substance use reported using only marijuana. Those reporting alcohol use had 4.9 (95% CI 3.3-7.2) times the odds of other drug use, and those reporting marijuana use had 14.5 (95% CI 9.4-22.4) times the odds, adjusting for age and sex. Among the 1,066 patients with a “Yes” in Part A for whom Part B was completed, those reporting other drug use, marijuana use, and alcohol use had 8.7 (95% CI 5.7-13.4), 5.4 (95% CI 3.5-8.2) and 1.5 (1.1-2.0) times the odds of a positive score, respectively, adjusting for age and sex. Marijuana use is the most prevalent form of reported substance use among adolescents in the ED and is increasing. Marijuana was a stronger predictor than alcohol of a positive CRAFFT, which has an 80% sensitivity and 86% specificity for a SUD. There is an association between reported use of marijuana and reported use of other drugs. Given the increase in social acceptance of marijuana use, and its association with additional drug use, it is critical for health care professionals to identify and address marijuana use with adolescent patients. One limitation of this study is that the version of the CRAFFT programmed into the EHR does not specifically ask about vaping, and therefore may not be capturing all patients who vape THC. Future directions include changing the CRAFFT embedded in the EHR to the CRAFFT 2.1+N, which specifically asks about vaping both marijuana/THC and nicotine. This will allow us to better identify and address the increasing marijuana use in our adolescent population.