Association Of Cannabis Use Research Articles

Cannabis Use in Pregnancy: A State of the Science Review.

With a growing number of states legalizing recreational use, cannabis consumption during pregnancy is increasing. Population-based data and rigorous studies examining the association of cannabis use in pregnancy with perinatal outcomes are limited, but trends include preterm prelabor rupture of membranes, placenta previa, and an increased length of hospital stay. Neonates of pregnant persons who used cannabis during their pregnancy can be at increased risk of low birth weight, preterm birth, neonatal intensive care unit admission, neurocognitive deficits, and infectious and neurologic morbidity and mortality. This state of the science review examines the prevalence of cannabis use in pregnancy, its pharmacodynamics and how that is influenced by pregnancy, and associated adverse perinatal and neonatal outcomes. Implications for health care providers caring for pregnant persons using cannabis, especially in legalized states, are discussed.

Does cannabis use in adolescence predict self-harm or suicide? Results from a Finnish Birth Cohort Study.

ObjectiveLongitudinal studies examining the association between adolescent cannabis use and self‐harm are rare, heterogeneous and mixed in their conclusions. We study this association utilizing a large general population‐based sample with prospective data.MethodsThe Northern Finland Birth Cohort 1986 (n = 6582) with linkage to nationwide register data was used to study the association of self‐reported cannabis use at age 15–16 years and self‐harm and suicide death until age 33 (until year 2018), based on register information. Cox regression analysis with Hazard Ratios (HR) and 95% confidence intervals (CI) was used. Psychiatric disorders, parental psychiatric disorders and other substance use were considered as confounders.ResultsIn all, 6582 (49.2% male) were included in the analysis, and 377 adolescents (5.7%) reported any cannabis use until the age of 15–16 years. Based on register information, 79 (55.7% male) had visited in health care services due to self‐harm, and 22 (90.1% male) had died by suicide. In crude analyses, adolescent cannabis use was associated with self‐harm (HR = 3.93; 95% CI 2.24–6.90). The association between cannabis use and self‐harm remained statistically significant after adjusting for sex, psychiatric disorders at baseline, frequent alcohol intoxications, other illicit drug use, and parental psychiatric disorders (HR 2.06; 95% CI 1.07–3.95). In contrast, the association of cannabis use with suicide did not reach statistical significance even in crude analysis (HR 2.60; 95% CI 0.77–8.78).ConclusionCannabis use in adolescence may increase risk of self‐harm independent of adolescent psychopathology and other substance use.

Abstract 14012: Trends of Cannabis Use Disorder and Its Impact on Outcomes of Acute Ischemic Stroke: 2007-2018

Background: Cannabis is one of the most extensively cultivated illicit drugs internationally. Its legalization and decriminalization in some states of the U.S. has increased its usage. Despite its widespread use, cannabinoid-related cerebrovascular disease is underreported. There are contradicting studies regarding the risk of Acute Ischemic Stroke (AIS) and its outcomes among cannabis users. Hypothesis: Our analysis estimates concurrent Cannabis Usage Disorder (CUD) trends among AIS patients and its impact on AIS outcomes. Methods: Study cohort was derived from the Nationwide Inpatient Sample (NIS) for the years 2007-2018. Hospitalizations due to AIS in the age group of 18-49 were identified using previously validated ICD-9-CM/ICD-10-CM codes. Cochran Armitage trend test and multivariable survey logistic regression modeling were then utilized to analyze temporal trends, predictors, and outcomes. Results: Out of a total 406,987 hospitalizations due to AIS from 2007-2018, 19,614 (4.82%) had concurrent CUD. AIS hospitalizations with concurrent CUD have increased from 3.3% in 2007 to 6.6% in 2018 with a yearly increase of 10% (OR 1.1; 95%CI 1.1-1.1; p<0.01). In multivariable regression analysis, age group 18-34 (OR 2.5; 95% CI 2.3-2.7; p< 0.01); male (OR 1.5; 95%CI 1.4-1.6; p<0.01), African American (OR 2.1; 95% CI 1.9 -2.2, p<0.01), lower socio-economic group (OR 1.3; 95% CI 1.2-1.5, p<0.01), West region (OR 1.5; 95% CI 1.3-1.7, p<0.01), Weight loss (OR 1.3; 95% CI 1.1-1.6, p=0.01), Depression (OR 1.2; 95% CI 1.1-1.3, p =0.001) and other psychiatric disorders were associated with concurrent CUD among AIS patients. After adjusting with confounding factors, CUD was not associated with higher in-hospital mortality (OR 1.0; 95% CI 0.9-1.1, p=0.21) and discharge to facility. Conclusion: Our results show that between 2007 and 2018, hospitalizations due to AIS with concurrent CUD has doubled. This association is significantly higher among 18-34 age group, males, African American, Western US and with concomitant psychiatric disorders. However, CUD was not associated with poor outcomes in AIS. Our study highlights underlying demographic trends and emphasizes the need for further studies to identify the causal association of cannabis use and AIS.

The Association of Cannabis Use and Cigarette Smoking with Psychological Distress Among Adults in California

Background In November 2016, California voters passed the Adult Use of Marijuana Act making recreational cannabis sales legal to adults aged 21and older starting January 1st, 2018. This study aims to understand the relationship of cannabis use and cigarette smoking with serious psychological distress (SPD) in California in light of the legalization of recreational cannabis sales. Methods This cross-sectional study included 42,313 adult participants from the 2017 to 2018 California Health Interview Surveys. We used the Kessler-6 (K6) scale to measure psychological distress in the past 30 days. Multiple logistic regression models were used to examine the association between cannabis/cigarette use and SPD. Results Cannabis use was positively associated with SPD (AOR = 2.48, 95% CI = 1.57, 3.91), but this association was not significantly different before and after recreational cannabis sales legalization in California (AOR = 0.82, 95% CI = 0.72, 2.05). Cigarette smoking was also positively associated with SPD (AOR = 2.76, 95% CI = 2.05, 3.71). Compared to those who used neither cannabis nor cigarettes, sole cannabis users (AOR = 2.51, 95% CI = 1.75, 3.60), sole cigarette smokers (AOR = 3.23, 95% CI = 2.28, 4.60), and dual users of cannabis and cigarettes (AOR = 5.65, 95% CI = 4.04, 7.89) were more likely to report SPD. Dual users were also more likely to report SPD than sole cannabis users (AOR = 2.25; 95% CI = 1.48, 3.43) and sole cigarette smokers (AOR = 1.75; 95% CI = 1.18, 2.59). Conclusions These findings provide evidence for the need to develop effective cessation intervention strategies targeting individuals with SPD to reduce their cannabis use and dual-use of cannabis and cigarettes.

Association of Cannabis Use-Related Predictor Variables and Self-Reported Psychotic Disorders: U.S. Adults, 2001-2002 and 2012-2013.

The authors sought to determine the association of cannabis indicators with self-reported psychotic disorders in the U.S. general population. Participants were from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002; N=43,093) and NESARC-III (2012-2013; N=36,309). Logistic regression was used to estimate standardized prevalences of past-year self-reported psychotic disorders within each survey and to evaluate the association of past-year self-reported psychotic disorders with indicators of nonmedical cannabis use (any use; frequent use [at least three times/week], daily/near-daily use, and DSM-IV cannabis use disorder) compared with those with no past-year nonmedical cannabis use. Whether the strength of associations differed between surveys was indicated by difference-in-difference tests (between-survey contrasts) and ratios of odds ratios between surveys. Self-reported psychotic disorders were significantly more prevalent among participants with any nonmedical cannabis use than those without (2001-2002: 1.65% compared with 0.27%; 2012-2013: 1.89% compared with 0.68%). In 2001-2002, self-reported psychotic disorders were unrelated to either frequent use or daily/near-daily use. However, in 2012 - 2013, compared with nonusers, self-reported psychotic disorders were more common among participants with frequent use and those with daily/near-daily nonmedical cannabis use (2012-2013: 2.79% and 2.52%, respectively, compared with 0.68% among nonusers). Self-reported psychotic disorders were significantly more prevalent among participants with cannabis use disorder than nonusers in both surveys (2001-2002: 2.55% compared with 0.27%; 2012 - 2013: 3.38% compared with 0.68%). The strength of these associations did not change over time. Data from the U.S. general population, especially more recent data, suggest associations between self-reported psychotic disorder and frequent nonmedical cannabis use and cannabis use disorder. Clinicians and policy makers should consider these relationships when monitoring patients and formulating programs.

Cannabis use is associated with prevalent coronary artery disease

Abstract Background Cannabis is the most commonly used illicit drug in the United States and has been associated with an increased risk of acute coronary syndrome (ACS) in multiple observational studies. Purpose The association of cannabis use with prevalent coronary artery disease (CAD) remains unclear. We hypothesized that cannabis use would also be associated with prevalent CAD among a nationally representative sample of patients. Methods This analysis included 12,543 participants (age 39.3±11.6 years, 48.8% male, 35.3% Caucasians) from the National Health and Nutrition Examination Survey years 2011–2018. Cannabis use was defined by self-report. Prevalent CAD was defined by physician diagnosis. Multivariable logistic regression was used to examine the association between cannabis use and prevalent CAD. The consistency of this association was tested among subgroups stratified by race, gender, tobacco smoking status, and comorbidities. Results In this analysis, 53.1% (n=6,650) of participants were ever-cannabis users and 1.1% (n=137) had prevalent CAD. After adjusting for covariates, ever-cannabis users had a 90% increased odds of prevalent CAD compared to never users (p=0.003). Those who had used cannabis at least once per month for at least one year had a 68% increased odds of prevalent CAD (p<0.001). Current cannabis users had a near two-fold increased odds of prevalent CAD [OR (95% CI): 1.98 (1.11 – 3.54), p=0.02]. Similar results were seen with heavy cannabis users [OR (95% CI): 1.99 (1.02 – 3.89), p=0.045]. Multiplicative interaction yielded consistent results among the subgroups analyzed. Conclusion Cannabis use is associated with prevalent CAD. This association remains consistent after adjusting for traditional cardiovascular disease risk factors. This is a novel finding that underscores the potential harmful effects of cannabis use on cardiovascular health and highlights the need for further controlled studies as the drug becomes more accepted by the general population. Funding Acknowledgement Type of funding sources: None.

Association of Cannabis Use and Neurodevelopment Among Adolescents

Source: Albaugh MD, Ottino-Gonzalez J, Sidwell A, et al Association of cannabis use during adolescence with neurodevelopment [published online ahead of print June 16, 2021]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2021.1258Investigators from multiple institutions reviewed data from a longitudinal study to assess the association between cannabis use during adolescence and cerebral cortical thickness development as measured using MRI. Participants were enrolled in the IMAGEN study, conducted across 8 European sites, when they were approximately 14 years old. Using a standard protocol, MRI scans were obtained of the adolescents’ brains at enrollment and a 5-year follow-up visit. In addition, at baseline and at follow-up, study participants completed the European School Survey Project on Alcohol and Other Drugs (ESPAD), in which lifetime use of alcohol, nicotine, and cannabis is self-reported using a 7-point scale with usage ranging from “never” to “>40 times.” Only youths who reported never using cannabis at baseline and had baseline and 5-year data were included in the present study. At the 5-year follow-up, participants also completed the Barratt Impulsiveness Scale, a 30-item self-report that assesses 3 domains of impulsiveness (attentional, non-planning, and motor). Alcohol consumption was estimated at baseline and 5-year follow-up with the Alcohol Use Disorders Identification Test Consumption scale.Cross-sectional regression models were used to assess the association between lifetime cannabis use and local cortical thickness. Longitudinal models were used to identify areas of accelerated age-related cortical thinning associated with cannabis use and to evaluate the association between the 3 domains of impulsiveness as measured by the Barratt Impulsiveness Scale.A total of 799 youths who were cannabis-naïve at baseline were included in the analyses. Mean age of these participants at baseline was 14.0 ±0.4 years, and 56.3% were female. At the 5-year follow-up, 208 participants (26.0%) reported 1-9 lifetime uses of cannabis, and 161 (20.2%) reported 10 to >40 uses. On cross-sectional analysis, there was a dose-dependent, statistically significant negative association between cortical thickness in the left prefrontal and right prefrontal cortices and lifetime cannabis use assessed at the 5-year follow-up. No statistically significant relationships were found between lifetime cannabis use and cortical thickness on baseline MRI results, suggesting that differences observed at follow-up did not precede cannabis use. On longitudinal analysis, statistically significant associations between accelerated age-related thinning in both the left and right prefrontal cortices were found. There was no significant difference in the effects of cannabis on cortical thickness between females and males in either the cross-sectional or longitudinal analyses. Cannabis-related cortical thinning in the right dorsomedial prefrontal cortex was significantly associated with more attentional impulsiveness as measured by the Barratt Impulsiveness Scale.The authors conclude that cannabis use during adolescence was associated with altered neurodevelopment.Dr Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Cannabis use has become more popular and socially accepted in recent years. Many states have decriminalized marijuana use and expanded licensing for dispensaries.1 Nearly 50% of adolescents consider marijuana to be easily accessible, and 28% believe it to have no or low health risks.1 Nearly 1 in 10 persons older than 12 years of age has used marijuana within the past month.2 Large studies of marijuana derivatives, such as tetrahydrocannabinol and cannabidiol, have demonstrated improvement in a range of medical conditions, such as chemotherapy-related nausea, spasticity in multiple sclerosis, and chronic pain.3,4 As marijuana becomes more widely accepted, however, its deleterious effects are often overlooked. This is especially important among adolescents, whose cerebral cortex has not yet fully matured.5 In fact, the current authors describe thinning of the cerebral cortex of adolescent brains based on the cumulative dose of marijuana ingested. In addition, these anatomic effects are associated with a measurable behavioral change: attentional impulsiveness.While the decriminalization of marijuana has resulted in important legal reform, marijuana is best regarded as a drug, akin to alcohol. Use by adolescents ought to be discouraged, except when its medical benefit exceeds its potential harmful effect. While the investigators in the current study do not address the impact of marijuana beyond the 5-year follow-up, other large population studies highlight the association of marijuana use and harmful outcomes, such as respiratory problems, increased depression and anxiety, impaired executive function, poor school performance, and poverty.6,7The current study is the largest longitudinal study of its kind, making an important contribution to ongoing debate of marijuana’s harm and efficacy. Despite marijuana’s increasing popularity, pediatric caregivers should continue to advise caution.Marijuana use among adolescents is associated with cortical thinning and increased impulsiveness.

A molecular explanation of cardiovascular protection through abnormal cannabidiol: Involving the dysfunctional β-adrenergic and ATP-sensitive K+ channel activity in cardiovascular compromised preterm infants.

Growing cannabis efficacy, usage frequency, legal supply, and declining awareness of danger recently led to expanded United States cannabis exposure. In turn, cannabis use among elderly people over 50 has more than tripled in a decade and has contributed toward a positive association of cannabis use with pathological conditions, which include type II diabetes, metabolic syndrome, neurovascular and cardiovascular disease. Remarkably, all these outcome results are mediated by the involvement of the ATP-sensitive K+ channel. Cardiovascular compromise is a common syndrome in preterm infants that leads to incidence and death and has been distinguished by poor systemic flow or hypotension. Conditions of cardiovascular compromise include vasodysregulation and myocardial malfunction through dysfunctional β-adrenergic activity. To avoid organ hypoperfusion progressing to tissue hypoxia-ischemia, inotropic drugs are used. Many premature children, however, respond insufficiently to inotropic activity with adrenergic agonists. The clinical disturbance including myocardial dysfunction through the activation of the ATP-sensitive K+ channel is often involved and the comparative efficacy of the nonpsychotropic cannabinoid, abnormal cannabidiol(Abn-CBD) is not yet known. Therefore, our primary aim was to investigate the molecular exploration of the cannabinoid system specifically Abn-CBD in cardiovascular protection involving dysregulated KATP.

Young adult cannabis use disorder treatment admissions declined as past month cannabis use increased in the U.S.: An analysis of states by year, 2008–2017

ObjectiveThis short communication reports on the association of annual measures of young adult (age 18–24) past month cannabis use with cannabis use disorder (CUD) treatment admissions by state in the U.S. from 2008 to 2017. MethodsAnnual data on percentage of past month cannabis use and the total number of CUD treatment admissions among young adults were acquired for each state from SAMHSA NSDUH and TEDS-A data sets. For each state, the correlation over time between cannabis use and treatment admissions rate was calculated and visualized in a choropleth map. Fixed-effects regression, where effects are fixed by state, was used to investigate the association of cannabis use with treatment admissions rate. ResultsIn 38 out of 50 states, including seven out of the eight states legalizing recreational cannabis during the study period, as young adult cannabis use increased, treatment admissions declined. Cannabis use is significantly and negatively associated with treatment admissions (β = −7.21, 95% CI = −11.88, −2.54), even after controlling for health insurance coverage, criminal justice referral, treatment center availability, and cannabis legalization status. ConclusionsWhile it is possible that across the U.S. more young adults are using cannabis without developing CUD, we speculate that increasing social acceptance of cannabis use, and declining perception of harm, may influence treatment seeking behavior, potentially resulting in growing unmet need for CUD treatment among young adults. Monitoring state-level trends in cannabis use, CUD prevalence, and treatment admissions is key to developing CUD prevention and treatment policies targeted to timely, state-specific conditions.

Cannabis use and obesity-traits: A Mendelian randomization study

BackgroundObservational studies suggested that cannabis use is associated with decreased body fatness; however, observational studies are subject to confounding, making causal inference and determining the direction of these associations difficult. We performed Mendelian randomization (MR) using summary statistics from genome-wide association studies (GWAS) to investigate the potential causal association of cannabis use and obesity-related traits. MethodsWe used 51 single nucleotide polymorphisms (SNPs) associated with lifetime cannabis use at P 1<× 10−5 from a GWAS of 184,765 individuals of European descent and 27 SNPs genome-wide associated with cannabis use disorder as instrumental variables. The GWAS for body mass index (BMI) was derived from a meta-analysis of up to 322,154 individuals, and the GWAS for waist circumference (WC) and waist-hip ratio (WHR) included 210,088 participants. ResultsMR showed that lifetime cannabis use (beta = − 0.018, 95 % confidence interval (CI): − 0.05−0.015; P-value = 0.279, Q-value = 0.279) and cannabis use disorder (beta = 0.023, 95 % CI: 0.023−0.045; P-value = 0.034, Q-value = 0.092) were not associated with BMI. Considering WC and WHR as indicators of obesity, our findings did not support a causal association. Leave-one out analyses and pleiotropy-robust methods did not indicate bias in any of the estimates. ConclusionsOverall, the MR study provides little evidence that cannabis influences obesity related traits.

Use of cannabis in urological cancer patients: A review to evaluate risk for cancer development, therapeutic use, and symptom management.

Recent recreational legalization of cannabis has resulted in an increased interest in the therapeutic effects of cannabis use in cancer patients, with reports of its use in symptom management and as a risk factor for cancer development. The objective of this review was to evaluate the literature on the association of cannabis use with the risk of cancer development, symptom management, and therapeutic management in the urological cancer (UC) patient population. A systematic search of databases and trial registries for papers published from January 1947 to March 2020 on cannabis, symptom and therapeutic management, and cancer development in UC patients was conducted. After screening of full-text articles, data were extracted for evaluation. Studies were eligible if they were in the clinical setting, included ≥5 UC patients, reported use of any cannabis variant, and were written in English. The search retrieved 2456 abstracts, of which 48 full-text articles were reviewed and 21 included in the review. Low-level evidence suggested a correlation between cannabis use and risk for development of testicular cancer. Some support existed for using cannabis for cancer pain and chemotherapy-induced nausea. There was inadequate evidence to substantiate cannabis use as a therapeutic agent for management of UCs. A lack of high-level evidence and robust methodology of the studies limited evaluation of the findings. Given the paucity of data on cannabis use for therapeutic purposes in UC, large, prospective trials with adequate followup times to observe the effect of cannabis use on UCs are warranted to improve the evidence base.

Are Sweet Dreams Made of These? Understanding the Relationship Between Sleep and Cannabis Use.

Introduction: There is widespread literature on the interaction between cannabis use and sleep, yet the mechanisms that underlie this relationship are not well understood. Several factors lead to inconsistencies in this relationship suggesting a nuanced interaction between cannabis and sleep. An important question that remains to be addressed is the temporal relationship between disrupted sleep and cannabis use. This literature review summarizes the existing literature on the association between disrupted sleep and cannabis toward the goal of addressing the question of the chronology of these reported effects. Materials and Methods: We conducted a review of the literature using PubMed to summarize current knowledge on the association between cannabis use and sleep in humans. Results: We identified 31 studies on the association of cannabis use and sleep. The findings from these studies were mixed. Cannabis was associated with a variety of impacts on sleep ranging from beneficial effects, such as reduced sleep-onset latency, to negative outcomes, such as reduced sleep duration and suppressed rapid eye movement oscillations. The chronology of the interaction of cannabis and sleep was unclear, although much of the current literature focus on factors that modulate how cannabis impairs sleep after initial use. Conclusion: There was sufficient evidence to suggest that cannabis use alters circadian rhythms, and hence, negatively impacts sleep. The current literature is largely from studies utilizing self-report measures of sleep; thus, objective measures of sleep are needed. In addition, although there were no empirical studies on the temporal relationship between cannabis use and sleep, the majority of the literature focused on characterizing sleep impairment after cannabis use.

Association of Cannabis Use During Adolescence With Neurodevelopment

Animal studies have shown that the adolescent brain is sensitive to disruptions in endocannabinoid signaling, resulting in altered neurodevelopment and lasting behavioral effects. However, few studies have investigated ties between cannabis use and adolescent brain development in humans. To examine the degree to which magnetic resonance (MR) imaging-assessed cerebral cortical thickness development is associated with cannabis use in a longitudinal sample of adolescents. Data were obtained from the community-based IMAGEN cohort study, conducted across 8 European sites. Baseline data used in the present study were acquired from March 1, 2008, to December 31, 2011, and follow-up data were acquired from January 1, 2013, to December 31, 2016. A total of 799 IMAGEN participants were identified who reported being cannabis naive at study baseline and had behavioral and neuroimaging data available at baseline and 5-year follow-up. Statistical analysis was performed from October 1, 2019, to August 31, 2020. Cannabis use was assessed at baseline and 5-year follow-up with the European School Survey Project on Alcohol and Other Drugs. Anatomical MR images were acquired with a 3-dimensional T1-weighted magnetization prepared gradient echo sequence. Quality-controlled native MR images were processed through the CIVET pipeline, version 2.1.0. The study evaluated 1598 MR images from 799 participants (450 female participants [56.3%]; mean [SD] age, 14.4 [0.4] years at baseline and 19.0 [0.7] years at follow-up). At 5-year follow-up, cannabis use (from 0 to >40 uses) was negatively associated with thickness in left prefrontal (peak: t785 = -4.87, cluster size = 1558 vertices; P = 1.10 × 10-6, random field theory cluster corrected) and right prefrontal (peak: t785 = -4.27, cluster size = 1551 vertices; P = 2.81 × 10-5, random field theory cluster corrected) cortices. There were no significant associations between lifetime cannabis use at 5-year follow-up and baseline cortical thickness, suggesting that the observed neuroanatomical differences did not precede initiation of cannabis use. Longitudinal analysis revealed that age-related cortical thinning was qualified by cannabis use in a dose-dependent fashion such that greater use, from baseline to follow-up, was associated with increased thinning in left prefrontal (peak: t815.27 = -4.24, cluster size = 3643 vertices; P = 2.28 × 10-8, random field theory cluster corrected) and right prefrontal (peak: t813.30 = -4.71, cluster size = 2675 vertices; P = 3.72 × 10-8, random field theory cluster corrected) cortices. The spatial pattern of cannabis-related thinning was associated with age-related thinning in this sample (r = 0.540; P < .001), and a positron emission tomography-assessed cannabinoid 1 receptor-binding map derived from a separate sample of participants (r = -0.189; P < .001). Analysis revealed that thinning in right prefrontal cortices, from baseline to follow-up, was associated with attentional impulsiveness at follow-up. Results suggest that cannabis use during adolescence is associated with altered neurodevelopment, particularly in cortices rich in cannabinoid 1 receptors and undergoing the greatest age-related thickness change in middle to late adolescence.

Burden of arrhythmia in hospitalized patients with cannabis use related disorders: analysis of 2016-2018 national inpatient sample

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cannabis is being more widely use as a recreational substance worldwide. There have been case reports and systematic review describing the association of cannabis use and cardiac arrhythmia (1). Purpose We sought out to measure the prevalence of different types of cardiac arrhythmia in hospitalizations associated with cannabis use disorder. Methods We queried January 2016 to December 2018 National Inpatient Sample (NIS) databases to identify adult (≥18 yrs) hospitalizations in the US with a diagnosis of cannabis use related disorders. Patients with an associated diagnosis of arrhythmias were also identified based on appropriate ICD-10 CM codes. We used the Chi-square test to evaluate the differences between binary or categorical variables, and Student’s t-test for continuous variables. Multivariate logistic regression was used in outcomes analysis to adjust for potential hospital and patient-level confounders (age, sex, race, diabetes, heart failure, chronic kidney disease, anemia, obesity, elixhauser co-morbidity index, hospital location, teaching status, bed size, income status and others). The discharge weights provided in the databases were used to calculate the national estimates. STATA 16.1 software was used to perform all statistical analysis. Results We identified 2,457,544 hospitalizations associated with cannabis use related disorders across three years. Of which, 187,825 (7.6%) were associated with any arrhythmia. We found that atrial fibrillation was the most associated arrhythmia. The complete list of types of arrhythmia and their prevalence are described in Figure-1. Patients with arrhythmia group were older (mean age 50.5 vs 38.3 yrs; P &amp;lt; 0.01) and had higher co-morbidity (% of &amp;gt;3 Elixhauser comorbidity score 94.1% vs 60.6%; P &amp;lt; 0.01). After adjusting for patient and hospital-level confounders, we observed arrhythmia group was associated with higher odds of in-hospital mortality compared to the group without arrhythmia [Odds Ratio (OR): 4.5 (4.09 – 5.00); P &amp;lt; 0.01]. We also observed statistically significant increase in hospitalization length of stay due to the status of any arrhythmia [5.7 vs 5.1 days; P &amp;lt; 0.01]. Conclusion The prevalence of Afib is high in hospitalizations associated with cannabis use. Hospitalizations associated with cannabis use disorder and any arrhythmia are associated with higher in-hospital mortality and LOS. Therefore, all electrocardiograms should be scrutinized in hospitalized cannabis users. However, further prospective studies are necessary to endorse our study results. Abstract Figure.

Trends and Socioeconomic Health Outcomes of Cannabis Use Among Patients With Gastroparesis: A United States Nationwide Inpatient Sample Analysis.

Although cannabis may worsen nausea and vomiting for patients with gastroparesis, it may also be an effective treatment for gastroparesis-related abdominal pain. Given conflicting data and a lack of current epidemiological evidence, we aimed to investigate the association of cannabis use on relevant clinical outcomes among hospitalized patients with gastroparesis. Patients with a diagnosis of gastroparesis were reviewed from the National Inpatient Sample (NIS) database between 2008 and 2014. Gastroparesis was identified by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes with patients classified based on a diagnosis of cannabis use disorder. Demographics, comorbidities, socioeconomic status, and outcomes were compared between cohorts using χ2 and analysis of variance. Logistic regression was then performed and annual trends also evaluated. A total of 1,473,363 patients with gastroparesis were analyzed [n=33,085 (2.25%) of patients with concomitant cannabis use disorder]. Patients with gastroparesis and cannabis use disorder were more likely to be younger and male gender compared with nonusers (36.7±18.8 vs. 51.9±16.8; P<0.001 and 52.9% vs. 33.5%; P<0.001, respectively). Race/ethnicity was different between groups (P<0.001). Cannabis users had a lower median household income and were more likely to have Medicaid payor status (all P<0.001). Controlling for confounders, length of stay, and mortality were significantly decreased for patients with gastroparesis and cannabis use (all P<0.001). While patients with gastroparesis and cannabis use disorder were younger, with a lower socioeconomic status, and disproportionately affected by psychiatric diagnoses, these patients had better hospitalization outcomes, including decreased length of stay and improved in-hospital mortality.

Trends in Prevalence and Outcomes of Cannabis Use Among Chronic Obstructive Pulmonary Disease Hospitalizations: A Nationwide Population-Based Study 2005-2014.

Background: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of mortality in the United States. Due to the ongoing legalization of cannabis, its acceptance, availability, and use in the in-patient population are on the rise. In this retrospective study, we investigated the association of cannabis use with important outcomes in COPD hospitalizations. Methods: The National Inpatient Sample (NIS) data were analyzed from 2005 to 2014. The primary outcome of interest was the trends and outcomes of cannabis use among COPD hospitalizations, including in-hospital mortality, pneumonia, sepsis, and respiratory failure. Results: We identified 6,073,862 hospitalizations, 18 years of age or older, with COPD using hospital discharge codes. Of these, 6,049,316 (99.6%) were without cannabis use, and 24,546 (0.4%) were admitted with cannabis use. The majority of COPD hospitalizations with cannabis use were aged 50-64 (60%). Cannabis use was associated with lower odds of in-hospital mortality (odds ratio [OR] 0.624 [95% confidence interval (CI) 0.407-0.958]; p=0.0309) and pneumonia (OR 0.882 [95% CI 0.806-0.964]; p=0.0059) among COPD hospitalizations. Cannabis use also had lower odds of sepsis (OR 0.749 [95% CI 0.523-1.071]; p=0.1127) and acute respiratory failure (OR 0.995 [95% CI 0.877-1.13]; p=0.9411), but it was not statistically significant. Conclusions: Among hospitalized patients with a diagnosis of COPD, cannabis users had statistically significant lower odds of in-hospital mortality and pneumonia compared to noncannabis users. The association between cannabis use and these favorable outcomes deserves further study to understand the interaction between cannabis use and COPD.

Association of Cannabis Use With Self-harm and Mortality Risk Among Youths With Mood Disorders

Cannabis use and cannabis use disorder (CUD) are common among youths and young adults with mood disorders, but the association of CUD with self-harm, suicide, and overall mortality risk is poorly understood in this already vulnerable population. To examine associations of CUD with self-harm, suicide, and overall mortality risk in youths with mood disorders. A population-based retrospective cohort study was performed using Ohio Medicaid claims data linked with death certificate data. The analysis included 204 780 youths (aged 10-24 years) with a diagnosis of mood disorders between July 1, 2010, and December 31, 2017, who were followed up to 365 days from the index diagnostic claim until the end of enrollment, the self-harm event, or death. Statistical analysis was performed from April 4 to July 17, 2020. Physician-diagnosed CUD defined using outpatient and inpatient claims from 180 days prior to the index mood disorder diagnostic claim through the 365-day follow-up period. Nonfatal self-harm, all-cause mortality, and deaths by suicide, unintentional overdose, motor vehicle crashes, and homicide. Marginal structural models using inverse probability weights examined associations between CUD and outcomes. This study included 204 780 youths (133 081 female participants [65.0%]; mean [SD] age at the time of mood disorder diagnosis, 17.2 [4.10] years). Cannabis use disorder was documented for 10.3% of youths with mood disorders (n = 21 040) and was significantly associated with older age (14-18 years vs 10-13 years: adjusted risk ratio [ARR], 9.35; 95% CI, 8.57-10.19; and 19-24 years vs 10-13 years: ARR, 11.22; 95% CI, 10.27-12.26), male sex (ARR, 1.79; 95% CI, 1.74-1.84), Black race (ARR, 1.39; 95% CI, 1.35-1.44), bipolar or other mood disorders (bipolar disorders: ARR, 1.24; 95% CI, 1.21-1.29; other mood disorders: ARR, 1.20; 95% CI, 1.15-1.25), prior history of self-harm (ARR, 1.66; 95% CI, 1.52-1.82), previous mental health outpatient visits (ARR, 1.26; 95% CI, 1.22-1.30), psychiatric hospitalizations (ARR, 1.66; 95% CI, 1.57-1.76), and mental health emergency department visits (ARR, 1.54; 95% CI, 1.47-1.61). Cannabis use disorder was significantly associated with nonfatal self-harm (adjusted hazard ratio [AHR], 3.28; 95% CI, 2.55-4.22) and all-cause mortality (AHR, 1.59; 95% CI, 1.13-2.24), including death by unintentional overdose (AHR, 2.40; 95% CI, 1.39-4.16) and homicide (AHR, 3.23; 95% CI, 1.22-8.59). Although CUD was associated with suicide in the unadjusted model, it was not significantly associated in adjusted models. Cannabis use disorder is a common comorbidity and risk marker for self-harm, all-cause mortality, and death by unintentional overdose and homicide among youths with mood disorders. These findings should be considered as states contemplate legalizing medical and recreational marijuana, both of which are associated with increased CUD.

The association of cannabis use with quality of life and psychosocial functioning in psychosis

BackgroundCannabis use is highly prevalent among people with a psychotic disorder. They often report sociality, coping with unpleasant affect and having positive experiences as important reasons for cannabis use, suggesting that cannabis improves their quality of life (QoL) and psychosocial functioning. However, based on previous studies we hypothesize that cannabis use is negatively associated with long-term subjective QoL and psychosocial functioning in people with a psychotic disorder. MethodsWe included 2994 people with a psychotic disorder (36.4% female), mean age 44.4 (SD 11.9), mean illness duration 17.2 years (SD 11.1), who participated in two yearly routine outcome assessments between 2014 and 2018 (interval 9–15 months) from the naturalistic PHAMOUS cohort study. Linear regression analyses were used to examine whether first assessment cannabis use was associated with QoL (ManSA) and psychosocial functioning (HoNOS). Changes in outcomes between assessments were analyzed with AN(C)OVA, to examine differences between continuers (n = 255), discontinuers (n = 85), starters (n = 83) and non-users (n = 2571). ResultsAt first assessment, 11.4% was using cannabis. They had lower QoL (B = −2.93, p < 0.001) and worse psychosocial functioning (B = 1.03, p = 0.002) than non-users. After one year, changes in QoL and psychosocial functioning were not significantly different between continuers, starters, discontinuers and non-users. ConclusionsCannabis users were less satisfied with their family relations and financial situation and showed more aggressive and disruptive behavior and self-harm than non-users. These differences are likely the result of patients having used cannabis for many years. Starting or discontinuing cannabis did not lead to changes in QoL and psychosocial functioning within one year.

Cannabis Use and Low-Back Pain: A Systematic Review

Introduction: The potential use of cannabis and cannabinoid products for the treatment of low-back pain is an important area for investigation. As one of the leading reasons to visit a primary care provider, low-back pain results in a significant burden of disease in both the United States' economic and health care systems. Given the current opioid epidemic, it is important to seek novel analgesics and understand their efficacy for myriad pain conditions, including low-back pain. Materials and Methods: A systematic review was performed using multiple online databases to assess the association of cannabis use and low-back pain in the literature. Results: A total of 124 articles were produced via our search methods, 73 abstracts in total were screened, 16 articles underwent full-text review, and 6 articles were included in qualitative synthesis. Discussion: This systematic literature review reveals a lack of primary research investigating cannabis as a potential treatment of low-back pain and highlights the need for further investigation with well-designed clinical trials. There remain substantial political and legal barriers to performing such research. Conclusion: Although there is a considerable body of work on the usage of cannabinoid products for many medical conditions, including the treatment of chronic pain, more directed clinical research into their utility as an analgesic for low-back pain and related symptoms needs to be addressed.

Association of Cannabis Use With All-Cause and Cause-Specific Mortality Among Younger- and Middle-Aged U.S. Adults

Cannabis is frequently used and increasingly legalized in the U.S., and 27.7 million Americans aged ≥12 years are currently using cannabis. However, the public health effects of cannabis use in the general population remain unclear. This study examines the associations of cannabis use with all-cause and cause-specific mortality in U.S. adults. The study included 14,818 adults (aged 20-59 years) who participated in the National Health and Nutrition Examination Survey from 2005 to 2014 and were free of cardiovascular disease or cancer at baseline. Survey participants were linked to mortality records through December 31, 2015. The outcomes included all-cause mortality, cardiovascular disease mortality, and cancer mortality. All statistical analyses were conducted in 2019. During 86,453 person-years of observation, 304 deaths occurred, including 39 deaths from cardiovascular disease and 79 deaths from cancer. After adjustment for a variety of potential confounders, the hazard ratios for all-cause mortality, cardiovascular disease mortality, and cancer mortality among cannabis ever users, compared with the ratios among nonusers, were 1.14 (95% CI=0.81, 1.59), 2.29 (95% CI=1.10, 4.78), and 0.67 (95% CI=0.40, 1.14), respectively. The hazard ratios for cardiovascular disease mortality among cannabis users, compared with those among nonusers, were 1.65 (95% CI=0.57, 4.89) if the use was first initiated at age ≥18 years and 3.00 (95% CI=1.41, 6.38) if the use was first initiated before age 18 years. Cannabis use was significantly associated with an increased risk of cardiovascular disease mortality among U.S. adults, especially among those who started using cannabis before age 18 years. The reasons and mechanisms underlying this association will require future research.