title: Trends in cannabis-related ambulance presentations from 2000 to 2013 in Melbourne, Australia.
abstract: OBJECTIVE
  The current burden of cannabis-related presentations to emergency health services is largely unknown. This paper presents data collected over a 13-year period in metropolitan Melbourne, Australia as part of the Ambo Project, a unique surveillance system that analyses and codes paramedic records for drug-related trends and harms.
  
  
  METHODS
  Cannabis-related ambulance attendances involving 15-59 year olds in metropolitan Melbourne were analysed retrospectively from 2000 to 2013 (n=10,531). Trends and attendance characteristics were compared among cannabis only (CO)-, cannabis and alcohol (CA)- and cannabis with polydrug use (CP)-related attendances. Changes in alcohol and drug involvements in cannabis-related attendances were explored.
  
  
  RESULTS
  Rates of cannabis-related ambulance attendances increased significantly over the study period. Increasing rate of attendances per 100,000 population per year changed from 0.6 (2000-2010) to 5.5 (2010-2013). This sharp change was driven by CO- and CP-related attendances (rate of CA-related attendance increased steadily). The highest increasing rate (15.6) was for CO-related attendances among 15-29 years old males (2010-2013). Crystal methamphetamine became the most common illicit co-intoxicant amongst cannabis presentations in 2013.
  
  
  CONCLUSIONS
  Relative to the total drug-related burden on ambulance services, cannabis-related presentations appear to be a small but significant and increasing problem. Significant changes in trends across other drug involvement and demographic subgroups suggest a possible shift in the cannabis using population and/or a change in using behaviours. Public health strategies should raise awareness of the increased risk posed by cannabis polydrug use and high attendance subpopulations should be determined.
authors.affiliation: Turning Point, Eastern Health, 54-62 Gertrude Street, Fitzroy, Vic 3065, Australia; South London and Maudsley NHS Trust, Addictions Clinical Academic Group, Lorraine Hewitt House, 12-14 Brighton Terrace, Brixton, London SW9 8DG, United Kingdom.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kaar
authors.affiliation: Turning Point, Eastern Health, 54-62 Gertrude Street, Fitzroy, Vic 3065, Australia; Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, Vic 3128, Australia.
authors.forename: Caroline X
authors.initials: CX
authors.lastname: Gao
authors.affiliation: Turning Point, Eastern Health, 54-62 Gertrude Street, Fitzroy, Vic 3065, Australia; Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, Vic 3128, Australia.
authors.forename: Belinda
authors.initials: B
authors.lastname: Lloyd
authors.affiliation: Ambulance Victoria, PO Box 2000, Doncaster, Vic 3108, Australia; Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Vic 3004, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
authors.affiliation: Turning Point, Eastern Health, 54-62 Gertrude Street, Fitzroy, Vic 3065, Australia; Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, Vic 3128, Australia. Electronic address: dan.lubman@monash.edu.
authors.forename: Dan I
authors.initials: DI
authors.lastname: Lubman
mesh_terms: D000293:Adolescent; D000328:Adult; D000552:Ambulances / Q000706:statistics & numerical data*; D001315:Australia / Q000453:epidemiology; D016208:Databases, Factual; D004632:Emergency Medical Services / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology*; D008875:Middle Aged; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology; D055815:Young Adult
keywords: Ambulance; Cannabis; Illicit drug; Overdose