Trends in urine screening positive for cannabis of emergency department admissions in Israel 2016–2024

Background: Although recreational cannabis is not yet legalized in Israel, the increase in cannabis prescriptions may lead to an increase in its availability and abuse. Aims: To evaluate temporal changes in the prevalence of cannabis-positive urine toxicology tests among individuals admitted to the emergency department (ED) in a large tertiary medical center in Israel. Methods: Between January/2016 and June/2024, all ED-admitted individuals who had urine toxicology tests (n = 20,022) were included. Results: Screening with urine toxicology increased from 0.7% in 2016 to 1.3% in 2024 (p < 0.001). Of all screened patients, 16.8% (N = 3361) were cannabis-positive, rising from 15.4% (n = 112) in January-June/2016 to 17.6% (n = 246) in January-June/2024 (p < 0.001), with an increasing trend (p = 0.003) among the aged 25-64y group (n = 11901) from 16.6% in January-June/2016 to 22.4% in January-June/2024, and the highest proportion in < 25y age group (n = 2935, 23.8%). Logistic regression showed that later years (OR = 1.03, 95%CI 1.01–1.05), male sex (OR = 1.5, 95%CI 1.4–1.6), younger age (compared with aged ≥ 65, aged < 25, (OR = 4.1, 95%CI 3. 5-4.8), aged 25–64 (OR = 3.3, 95% CI 2.9–3.8)), Israeli-born (OR = 1.3, 95% CI 1.2–1.4), screening positive for opioid(OR = 1.4, 95%CI 1.2–1.5), MDMA (OR = 1.8, 95%CI 1.5–2.2), cocaine (OR = 1.3, 95%CI 1.2–1.5) methamphetamine (OR = 1.4, 95%CI 1.1–1.7) and not being hospitalized (OR = 1.4, 95%CI 1.3–1.5). Conclusions: The exponential increase in cannabis prescriptions was not reflected in the modest increase in the proportion of cannabis-positive urine toxicology samples, that characterized the 25–64 age group. However, results may be biased, as toxicology screens were based on clinical suspicion without standardized ordering criteria, and diagnostic information regarding the ED visit was absent.