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Rate of cannabis-related ED visits around Thanksgiving (2021–2024)

by | Nov 25, 2025 | Research

Hero banner with the text ‘Cannabis and Thanksgiving’ over a dark blue gradient background featuring faint overlapping line chart elements representing cannabis-related ED visit trends
  • Cannabis-related emergency department (ED) visit rates were significantly higher on Thanksgiving; 25% higher than the Thursday before and 26% higher than the Thursday after the holiday.
  • Rates of cannabis-related ED visits varied by sex and age.

Cannabis use has risen in the United States, fueled in part by expanding legalization, evolving norms, and increased retail access, among others (1, 2). Survey results from 2024 suggest more than 1 in 5 Americans over the age of 12 used cannabis within the last month (3). Historically, April 20th, commonly referred to as “420,” has been associated with high cannabis sales (4, 5). Prior research has shown an increase in cannabis-related emergency department (ED) visits rates on this date each year (6). In recent years, “Green Wednesday”, or the Wednesday before Thanksgiving, has also emerged as a day with high cannabis sales (7–9).

Despite clear increases in cannabis sales prior to Thanksgiving, the extent to which these purchasing patterns contribute to acute healthcare events has not been well understood.  Cannabinoid hyperemesis syndrome (CHS), a condition often linked to prolonged cannabis use, is among the most common causes of cannabis-related ED visits and is characterized by severe abdominal pain, nausea, and vomiting (10–12). In addition to CHS, acute symptoms associated with cannabis use vary widely and may include anxiety or panic attacks, unintentional ingestion (particularly with edibles), and intoxication-related effects (13, 14). Holidays with large gatherings, increased alcohol consumption, or greater availability of cannabis products could influence both the frequency and amount of cannabis intake. We therefore examined whether Thanksgiving was associated with changes in the rate of cannabis-related ED visits.

Methods

Using a subset of Truveta Data, we identified ED visits occurring between October and January for the years 2021 to 2025. Cannabis-related ED visits were defined using a set of diagnostic codes used in previous research (15). These diagnosis codes specifically indicated cannabis use. Although related conditions such as nausea, vomiting, or mental health symptoms can accompany cannabis-related ED visits, we included only visits that explicitly documented cannabis use. For each day, we calculated the proportion of ED visits that were related to cannabis use.

To evaluate holiday-specific changes, we compared the rate of cannabis-related ED visits on Thanksgiving with the Thursday one week prior and the Thursday one week following the holiday. We used a Poisson model to estimate incidence rate ratios for Thanksgiving versus surrounding Thursdays. Daily trends were visualized for Thanksgiving using a ±10-day window. We also examined rates by age and sex for Thanksgiving and the adjacent Thursdays.

You can view this study in its entirety, including full data definitions and code, directly in Truveta Studio (you can use your LinkedIn credentials to access). 

Results

We included 16,201,556 ED visits between October and January of 2021 through 2025. Of those, 0.6% or 90,745 visits were related to cannabis.

Thanksgiving

Across 2021–2024, Thanksgiving consistently showed a significantly higher rates of cannabis-related ED visits compared to the adjacent Thursdays. The rates for cannabis-related ED visits on Thanksgiving were 25.3% higher than the Thursday prior and 26.1% higher than the Thursday after the holiday.  

Daily trends surrounding Thanksgiving showed year-to-year variability, but 2022–2024 demonstrated a clear spike on the holiday. The smallest difference between Thanksgiving and surrounding Thursdays occurred in 2021.

Line chart showing rates of cannabis-related emergency department visits from 10 days before to 10 days after Thanksgiving for years 2021–2024. All four years show a noticeable increase in cannabis-related ED visits on Thanksgiving Day, followed by a decline in the days after. Trend lines vary by year but consistently peak or rise around the holiday.
Demographics

Across all age groups, males experienced higher cannabis-related ED visits than females on all days studied. Rates on Thanksgiving were highest among younger adults, particularly males aged 25–29 and females aged 18-24. Females in the 45-59 and males in the 30-44 age groups also showed a notable increase on Thanksgiving compared to adjacent Thursdays.

Side-by-side bar charts comparing cannabis-related emergency department visit rates by age group and sex before, during, and after Thanksgiving. Female and male groups both show the highest ED visit rates among ages 18–24 and 25–29 on Thanksgiving Day, with lower rates in older age groups. Three colors indicate time periods: prior, Thanksgiving Day, and post-holiday.

Discussion

In this multi-year, retrospective analysis, Thanksgiving was associated with a meaningful and statistically significant increase in cannabis-related ED visits. The elevation on Thanksgiving likely reflects a confluence of social, cultural, and behavioral factors, including the popularization of Green Wednesday (7–9). The holiday setting may prompt higher or less controlled cannabis use, such as alcohol co-use or more than intended consumption, increasing the chance of adverse effects requiring ED care.

Prior research has shown that ED visits related to cannabis increased among young people during the pandemic compared with earlier years, suggesting that stressful circumstances may contribute to higher cannabis use and related acute care needs (15). Additionally, overall cannabis-related ED visits have increased in recent years, and although the highest rates were seen among younger individuals, the greatest increases in rate were among adults over 55 years of age (16). Additional research is needed to explore the age and sex differences seen in this study.

The muted difference between Thanksgiving and surrounding Thursdays in 2021 may reflect how social context shapes cannabis-related ED visits. Ongoing pandemic precautions likely led many people to celebrate in smaller groups or alter their usual Thanksgiving routines (17).  With smaller gatherings and lingering public health recommendations in place, opportunities for shared cannabis use were likely fewer than in later years. This contrast underscores the extent to which holiday-related cannabis presentations may be driven by social behavior associated with large gatherings and a traditionally large meal.

This study is not without limitations. First, to be defined as a cannabis-related ED visit, we required a person to have evidence of a cannabis-related diagnosis code. This approach likely under-captures the true number of cannabis-related ED visits, as documentation depends on clinician coding practices, variability in how symptoms are attributed, and whether patients disclose the cannabis use. Second, we were unable to determine the underlying reason for these visits. Although the ED visits included a diagnosis code associated with cannabis, this does not mean that the patient presented to the ED because of cannabis use. Finally, we did not compare the rates of increase to any other holiday or period known to have high rates of cannabis use, such as Christmas or “420.” Therefore, we cannot say how these trends compare to other days with traditional social gatherings.

Overall, these findings highlight how behavioral patterns surrounding Thanksgiving can shape acute healthcare utilization. Understanding these dynamics may help health systems anticipate changes in ED utilization and inform targeted public health messaging aimed at safe consumption practices during times associated with greater likelihood of adverse outcomes.

 You can view this study in its entirety, including full data definitions and code, directly in Truveta Studio (you can use your LinkedIn credentials to access). 

These are preliminary research findings and not peer reviewed. Data are constantly changing and updating. These findings are consistent with data accessed on November 17, 2025.

Citations

  1. J. P. Caulkins, Changes in self‐reported cannabis use in the United States from 1979 to 2022. Addiction 119, 1648–1652 (2024).
  2. Disa, Marijuana Legality Map (2025). https://disa.com/marijuana-legality-by-state/.
  3. Substance Abuse and Mental Health Services Administration., “Key Substance Use and Mental Health Indicators  in the United States: Results from the 2024 National  Survey on Drug Use and Health” (PEP25-07–007, NSDUH Series H-60, 2025); https://www.samhsa.gov/data/sites/default/files/reports/rpt56287/2024-nsduh-annual-national-report.pdf.
  4. BDSA, After a sluggish start to the year, 420 brings the highest daily cannabis sales in 2022 so far (2022). https://bdsa.com/420-highest-daily-cannabis-sales-in-2022/.
  5. Katharine Baxter, One Month Later What 420 Cannabis Data Tells Us About Consumer Behavior; Sales Trends, adn Event Success in 2025, Cannaspyglass (2025). https://cannaspyglass.com/blog/one-month-later-what-420-cannabis-data-tells-us-about-consumer-behavior-sales-trends-and-event-success-in-2025.
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  7. Greg Morcroft, “Green Wednesday” Cannabis Sales Jump more than 15% From Last Year, Second Busiest Day Of 2022 After 4/20, Nasdaq (2022). https://www.nasdaq.com/articles/green-wednesday-cannabis-sales-jump-more-than-15-from-last-year-second-busiest-day-of-2022.
  8. Weedmaps, How to celebrate Green Wednesday 2025: the cannabis industry’s Black Friday (2025). https://weedmaps.com/learn/cannabis-and-its-evolution/green-wednesday.
  9. Consider it flowers, What is green Wednesday? The holiday every cannabis shopper should know, Consider It Flowers (2025). https://consideritflowers.com/blogs/consider-it-flowers-blog/what-is-green-wednesday-the-holiday-every-cannabis-shopper-should-know.
  10. Todd Neff, The leading cause of marijuana-related ER visits is called CHS or cannabinoid hyperemesis syndrome. What is CHS?, UCHealth (2024). https://www.uchealth.org/today/what-is-chs-cannabinoid-hyperemesis-syndrome-leading-cause-of-marijuana-related-er-visits/.
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