S919 Factors Associated With Cannabis Use Among Inpatients With Inflammatory Bowel Disease Exacerbation

Abstract

Introduction: Opioid use for inflammatory bowel disease (IBD) has been associated with an increased risk of disease complications. Many view cannabis as a safer palliative alternative to opioids for IBD. Cannabis use is common in the IBD population and increasingly legally available both for medical and recreational use. Cannabis does not improve inflammation but may mask IBD symptoms, with an unclear impact on disease outcomes. We sought to investigate cofactors associated with cannabis use as a first step before analysis of its impact on patient clinical outcomes. Methods: We conducted a retrospective review of all adult patients admitted for an IBD exacerbation from 01/01/2016 to 03/01/ 2020 within the Northwell Health Care system. Patients were identified by either a primary or secondary ICD10 code (K50.xx, K51.xx, K52.3), limited to those with an IBD exacerbation defined by administration of IV solumedrol and/or biologic therapy. Pregnant patients and those with IBD related surgeries were excluded. A natural language search of admission documents was performed for the terms “marijuana”, “cannabis”, “pot” and “CBD”. Manual chart review was then performed to confirm cannabis use. IBD disease type, age, gender, race, anxiety, depression, alcohol and tobacco use, Charlson comorbidity index (CCI), inpatient opioid use and length of stay were defined. An adjusted analysis was performed of co-factors to determine any association with cannabis use. Results: A total of 1021 patient admissions met inclusion criteria; 47.40% with Crohn’s disease and 53.09% female, and 66.01% white. Pre-admission cannabis use was reported by 7.25% of patients and was mostly (63%) for recreational use. On multivariable analysis, younger age was associated with cannabis use, as was male gender, African American race, tobacco and alcohol use, and a diagnosis of anxiety and/or depression, Table. CCI was associated with cannabis use on univariable, but not on multivariable analysis. Conclusion: Among inpatients with IBD exacerbation, factors associated with cannabis use included age, gender, African American race, tobacco and alcohol use, along with anxiety and depression. Our findings suggest that among IBD patients, cannabis use may be less associated with disease activity than with other patient characteristics. Further analysis of the impact of Cannabis use on IBD outcomes is needed. Table 1. - Association between pre-admission characteristics and cannabis use (N=1021) Cannabis use Cannabis use (n=74), n (%) No cannabis use (n=947), n (%) Univariable OR (95% CI) p-value Multivariable OR (95% CI) p-value Patient characteristics Age (years) Mean (SD) 36.46 (15.52) 45.97 (20.41) 0.98 (0.96, 0.99) 0.0001 0.96 (0.94, 0.99) 0.0009 Gender Female 22 (29.73) 520 (54.91) 0.35 (0.21, 0.58) < 0.0001 0.28 (0.16, 0.50) < 0.0001 Male 52 (70.27) 427 (45.09) (REF) (REF) Race African American/ Black 21 (28.38) 129 (13.62) 2.51 (1.44, 4.40) 0.0012 2.83 (1.52, 5.27) 0.0011 Asian 3 (4.05) 51 (5.39) 0.91 (0.27, 3.04) 0.8757 1.12 (0.32, 3.97) 0.8622 Other/ Multiracial 9 (12.16) 134 (14.15) 1.04 (0.49, 2.19) 0.9240 1.11 (0.50, 2.47) 0.8016 White 41 (55.41) 633 (66.84) (REF) (REF) Tobacco use Current 17 (22.97) 83 (8.76) 3.31 (1.78, 6.15) 0.0002 2.95 (1.46, 5.96) 0.0025 Former 12 (16.22) 160 (16.90) 1.21 (0.62, 2.38) 0.5800 1.72 (0.79, 3.74) 0.1721 Never 36 (48.65) 581 (61.35) (REF) (REF) Unknown 9 (12.16) 123 (12.99) 1.18 (0.56, 2.52) 0.6664 1.27 (0.50, 3.21) 0.6114 Alcohol use Current 17 (22.97) 162 (17.11) 1.32 (0.71, 2.47) 0.3794 1.03 (0.52, 2.05) 0.9246 Former 6 (8.11) 18 (1.90) 4.2 (1.55, 11.37) 0.0047 3.75 (1.21, 11.59) 0.0218 Never 30 (40.54) 378 (39.92) (REF) (REF) Unknown 21 (28.38) 389 (41.08) 0.68 (0.38, 1.21) 0.1893 0.51 (0.25, 1.04) 0.0647 Clinical characteristics Anxiety Yes 14 (18.92) 91 (9.61) 2.20 (1.18, 4.08) 0.0130 2.76 (1.31, 5.81) 0.0074 No 60 (81.08) 856 (90.39) (REF) (REF) Depression Yes 12 (16.22) 53 (5.60) 3.27 (1.66, 6.43) 0.0006 4.07 (1.80, 9.20) 0.0007 No 62 (83.78) 894 (94.40) (REF) (REF) IBD type Crohn’s disease 42 (56.76) 442 (46.67) 0.67 (0.41, 1.08) 0.0961 -- -- Ulcerative colitis 32 (43.24) 505 (53.33) (REF) -- -- CCI Mean (SD) 1.35 (2.35) 2.23 (2.90) 0.87 (0.78, 0.97) 0.0124 0.97 (0.83, 1.13) 0.7044