We thank Myran and Finkelstein for their thoughtful comments on our article studying the impact of national cannabis legislation on pediatric cannabis-related emergency department (ED) visits.1 We agree with the suggestion that our study did not fully study the impact of the legalization of edible cannabis products for commercial sale, particularly as we did not collect data with sufficient lead time between changes in legislation and analysis of change. Because at the time of publishing, data were heavily confounded because of the impact of coronavirus disease 2019 (COVID-19), we chose not to look at pediatric cannabis-related visits during this time. Thus, we agree that interpretation of our findings does require an awareness that data reflected an immature time period in the commercial sale of edible cannabis products.
However, we were able to look at data from a provincial database looking broadly at the urban zones in Alberta. From February 1, 2020 to November 30, 2020, we did not identify the same ninefold increase suggested by Myran and Finkelstein. In fact, we identified 28.5 visits among those aged 15 to 17 per month, and 11.1 visits per month among those aged 0 to 14. We note these numbers are comparable to our prelegalization averages for those aged 0 to 14 and 15 to 17, at 9.6 visits per month and 25.8 visits per month, respectively, and to our postlegalization averages for those aged 0 to 14 and 15 to 17 at 6.4 visits per month and 25.6 visits per month, respectively.
Nonetheless, we believe there are many confounding factors to any association between the legalization of commercial sale of edible cannabis products and pediatric cannabis-related ED visits. In particular, COVID-19 drove up the sale of cannabis products while also decreasing the likelihood parents would seek emergency care for children suffering from cannabis ingestion.2,3 Additionally, alterations to normal life associated with COVID-19 likely negatively affected youth mental health, potentially acting as a pathway toward substance use.4 These confounders make it difficult to draw strong association between changes in time trends with legalization of commercial edible sales.
Overall, the main message of our study remains unchanged, which is that the legalization of cannabis products for sale and possession in Canada has drastically altered pediatric access and exposure to products, and the acceptability of parents and adolescents presenting to the ED for cannabis-related concerns.