Janessa M. Graves, PhD, MPH

Credit: Washington State University

Intentional, suspected suicidal cannabis exposures reported to US poison centers increased in the most recent decade.¹

A team, led by Janessa M. Graves, PhD, MPH, Washington State University College of Nursing, described suicidal cannabis exposures reported to US poison centers between 2009-2021 and compared case characteristics before and during the pandemic.

The Leading Cause of Death

Suicide is currently the leading cause of death in the US for individuals aged 5-64 years. There also is a link between cannabis use and increased suicidal ideation and attempts among adolescents and younger adults. However, this has not found to be true among older adults.

“Concerns for mental well-being across all ages are increasing, bolstered by increasing suicide rates during the COVID-19 pandemic,” the authors wrote. “Concurrently, more states have legalized adult-use cannabis.”

In the study, the investigators examined data from the National Poison Data System (NPDS) for intentional, suspected suicidal cannabis exposures

“Poison centers provide free, confidential support to health care professionals and the public for potential exposures and/or adverse reactions to drugs, chemicals, or poisons,” the authors wrote.

The Data

Data included in the study was from closed cases of cannabis-related human exposures for individuals aged 5 years and older with reason coded as intentional-suspected suicidal.

The investigators compared cases by age group and examined the differences by sex, location, and outcomes using X² tests.

The studying included 18,698 intentional, suspected suicidal cannabis exposures between 2009-2021 with a mean age of 29 years.

A total of 96.5% cases involved more than 1 substance. Exposures in younger and older age group occurred more frequently among females compared to males, while 9.6% of exposures resulted in death or other major outcomes, such as life-threatening or with major residual disability or disfigurement.

For older adults, 19.4% of exposures resulted in death or other major outcomes and there were twice as many cases that involved children aged 5-13 years in 2021 compared to 2019 (3.1% vs 1.3%; P < .001).

Finally, 57% of cases in 2021 involved females compared to 49.8% in 2019 (P <.001) and other substances were involved in 95.4% of 2019 cases compared 92.2% of 2021 cases (P <.001).

“Intentional, suspected suicidal cannabis exposures reported to US poison centers increased from 2009 to 2021,” the authors wrote. “Increases during and after the pandemic were notable and greatest among children and females. Most involved other substances: due to the cross-sectional nature of the data, we could not identify a causal association between cannabis use and a suicide attempt.”

Limitations

There were limitations to the study, mainly that data from the NPDS rely on self-reported exposures by health care facilities or individuals, meaning that reported exposures represent a subset of all exposures. While case documentation is not verified beyond what is reported, NPDS coding maximizes quality and completeness of information. The investigators were also unable to examine individual, environmental, or contextual factors associated with suicidal ideation.

References:

Graves JM, Dilley JA, Klein T, Liebelt E. Suspected Suicidal Cannabis Exposures Reported to US Poison Centers, 2009-2021. JAMA Netw Open. 2023;6(4):e239044. doi:10.1001/jamanetworkopen.2023.9044