Association Of Marijuana Use Research Articles

S470 Association of Marijuana Use With Colorectal Neoplasia

S470 Association of Marijuana Use With Colorectal Neoplasia

S223 Association of Marijuana Use and the Severity of Idiopathic Acute Pancreatitis

S223 Association of Marijuana Use and the Severity of Idiopathic Acute Pancreatitis

EPH127 Association of Marijuana Use With Poor Mental Health Among Non-Institutionalized Adults in the US

EPH127 Association of Marijuana Use With Poor Mental Health Among Non-Institutionalized Adults in the US

Abstract 13812: Daily Marijuana Use is Associated With Incident Heart Failure: “All of Us” Research Program

Background: With the increasing state-level legalization of marijuana across the United States, its use has increased exponentially, especially among the youth. However, a lot remains unknown concerning its cardiovascular health implications. We sought to assess the association between the frequency of marijuana use and new-onset heart failure (HF). Methods: Using the NIH-sponsored “All of Us” Research Program, we performed a prospective analysis of participants’ survey data and Electronic Health records (EHR). We excluded patients with a baseline EHR diagnosis of HF. Marijuana use was defined as any unprescribed use or if prescribed, use beyond prescribed doses, and was collected using the NM ASSIST instrument. We determined the association between the frequency of marijuana use and incident HF using Cox proportional hazards models adjusted for demographic and socioeconomic factors, diabetes mellitus, hypertension, hyperlipidemia, BMI, alcohol use and smoking status. Results: From a final population of 156,999, there were 2958 events within a median follow-up time of 45 months. Compared to never users, daily marijuana users had an increased risk of incident HF (aHR - 1.34, 95% CI 1.04-1.72). In subgroup analyses, frequency of marijuana use was not associated with incident HFrEF nor HFpEF. There was no evidence of effect modification by age, sex at birth nor smoking status. The relationship was attenuated after addition of coronary artery disease diagnosis as a time varying covariate in our main model (aHR - 1.27, 95% CI 0.99-1.62). Implication: Data on the cardiovascular effects of marijuana use is limited. To our knowledge this is the first prospective analysis on the association of marijuana use and HF. Our study suggests daily marijuana use is associated with HF. More research into the cardiovascular effects of marijuana is needed to enable clinicians provide the public with high quality information on the health implications of marijuana and to guide policies.

Investigating the co-occurrence of marijuana use and prescription opioid misuse with multiple suicide attempts among adolescents with a history of suicidal ideation

This study investigated the co-occurrent association of marijuana use and prescription opioid misuse with multiple suicide attempts among adolescents with a history of suicidal ideation. Data came from the 2019 Youth Risk Behavior Survey. The sample was comprised of adolescents ages 14–18 who reported suicidal ideation during the past year (n = 2,562). Multinomial logistic regression was used to examine the co-occurring association of marijuana use and prescription opioid misuse with multiple suicide attempts. Of the 2,562 adolescents who experienced suicidal ideation, 19.2 % also attempted suicide multiple times during the past year and 19.0 % reported ever using marijuana and misusing prescription opioids, 8.8 % misused prescription opioids only, and 33.3 % used marijuana only. In the multivariate model, for adolescents who used marijuana and misused prescription opioid, the risk of attempting suicide once was 1.77 times higher (RRR = 1.77, 95 % CI = 1.22–2.59) and the risk of multiple suicide attempts was 3.23 times higher (RRR = 3.23, 95 % CI = 1.95–5.33) when compared to adolescents who had never used marijuana nor misused prescription opioid. The risk of multiple suicide attempts was greater for bisexual and racial/ethnic minority adolescents and adolescents who felt sad or hopeless. Interventions that prevent prescription opioid misuse among adolescents may be effective in mitigating suicide attempts.

Exploring associations between affect and marijuana use in everyday life via specification curve analysis.

Although frequently hypothesized, the evidence for associations between affect and marijuana use in everyday life remains ambiguous. Inconsistent findings across existing work may be due, in part, to differences in study design and analytic decisions, such as study inclusion criteria, the operationalization of affect, or the timing of affect assessment. We used specification curves to assess the robustness of the evidence for affect predicting same-day marijuana use and marijuana use predicting next-day affect across several hundred models that varied in terms of decisions that reflect those typical in this literature (e.g., whether to average affect prior to marijuana use or select the affect report closest in time to marijuana use). We fitted these curves to data from two ecological momentary assessment studies of regular marijuana and/or alcohol using college students (N = 287). Results provided robust evidence that marijuana use was slightly less likely following experiences of negative affect and slightly more likely following positive affect. Specification curves suggested that differences in previous findings are most likely a function of the specific emotion items used to represent affect rather than differences in inclusion criteria, the temporal assessment and modeling of affect, or the covariates added to the model. There was little evidence for an association between marijuana use and next-day affect. Overall, our findings provide evidence against the predictions made by affect reinforcement models in college students and suggest that future research should model the associations of marijuana use with discrete emotional states rather than general negative and positive affect. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perceived neighborhood disorder as a moderator of the relationship between marijuana use and disinhibition in a sample of emerging adult African American females

Disinhibition is associated with myriad risk-taking behaviors and adverse outcomes. Both marijuana use and poor neighborhood conditions have been associated with disinhibition. However, the extent to which neighborhood disorder interacts with marijuana use to influence disinhibition has not been studied, extensively. A better understanding of these relationships has implications for designing more effective tailored place-based interventions that aim to reduce risk taking behaviors and related adverse social and health outcomes associated with marijuana use. Thus, the purpose of this study was to examine the interactive effects of perceived neighborhood disorder and marijuana use on disinhibition. The sample included 120 African American female residents of disadvantaged neighborhoods (Mage = 23.6 ± 3.46). We employed hierarchical linear regression analysis to examine the interactive effects of marijuana use and perceived neighborhood disorder on disinhibition, while controlling for age and education. The interaction term was marginally significant (b = 5.66; t(109) = 1.72, p = .08). Next, the conditional effects were explored. Results indicated the association of marijuana use with disinhibition was stronger for females in the higher neighborhood disorder group, compared to those in the lower neighborhood disorder group (10.40 and 4.51, respectively). Our findings support the need for more research on the potential of neighborhood disorder to amplify the effects of marijuana use on disinhibition and related neurobehavioral traits. The identification of contextual moderators and high-risk sub-groups will aid in the design of more tailored place-based interventions that aim to reduce risk-taking behavior among those most vulnerable.

Relationship Between Marijuana Use and Overactive Bladder (OAB): A Cross-Sectional Research of NHANES 2005 to 2018

BackgroundCurrent research is starting to focus on the medical value of marijuana and the possible health problems it can cause. Previous studies have shown that marijuana can relieve lower urinary tract symptoms, which can pose a significant public health burden. In this study, we assessed the association between regular marijuana use and overactive bladder as part of low urinary tract symptoms. MethodsData from the National Health and Nutrition Examination Survey 2005-2018 were obtained for analysis. The Overactive Bladder Symptom Score scale was used to define the presence of overactive bladder for each participant. Multivariate logistic regression and ordinal logistic regression were used to analyze the association of marijuana use with the onset and severity of overactive bladder, respectively. ResultsWe found that approximately 24% of the US population reported regular marijuana use. Compared with nonregular users, regular marijuana users were younger, thinner, more likely to be male, smokers, low-income, less educated, unmarried, and non-Hispanic White/Black. Multivariate logistic regression revealed that marijuana exposure may be an independent risk factor for overactive bladder (odds ratio 1.39; 95% confidence interval, 1.16-1.66). Ordinal logistic regression results showed that marijuana exposure was associated with the severity of overactive bladder (odds ratio 1.45; 95% confidence interval, 1.30-1.60). Moreover, all frequencies of regular use showed almost consistent effects on the onset and severity of overactive bladder. ConclusionRegular marijuana use may increase the risk of overactive bladder. Our data do not support the evidence for the use of cannabinoids in the medical treatment of patients with overactive bladder, especially given the thorny health problems caused by marijuana.

Association of Marijuana Use with Nausea and Vomiting of Pregnancy

To evaluate if marijuana use is associated with nausea and vomiting in early pregnancy. Our secondary objective was to compare prescription antiemetic use among patients with and without marijuana use.

Association of cannabinoid receptor modulation with normal and abnormal skeletal remodelling: A systematic review and meta-analysis of in vitro, in vivo and human studies

To address the inconsistent findings from studies that used different models to explore the role of classical cannabinoid type 1 (CB1) and 2 (CB2) receptors in skeletal remodelling, we searched Medline, Web of Science and Embase for relevant studies from inception to June 23, 2020. We identified 38 in vitro, 34 in vivo and 9 human studies. A meta-analysis of in vitro studies showed that exposure to the inverse-agonists AM251 (mean difference [MD]:−26.75, 95% confidence interval [CI]:−45.36,−8.14, p = 0.005), AM630 (standardised[std.] MD:−3.11, CI:−5.26,−0.97, p = 0.004; SR144528, std.MD:−4.88, CI −7.58,−2.18, p = 0.0004) and CBD (std.MD:−1.39, CI −2.64,−0.14, p = 0.03) is associated with reduced osteoclastogenesis, whereas the endocannabinoid 2-AG (std.MD:2.00, CI:0.11–3.89, p = 0.04) and CB2-selective agonist HU308 (MD:19.38, CI:11.75–27.01, p < 0.00001) were stimulatory. HU308 also enhanced osteoblast differentiation (std.MD:2.22, CI:0.95–3.50, p = 0.0006) and activity (std.MD:2.97, CI:1.22–4.71, p = 0.0008). In models of bone loss, CB1/2 deficiency enhanced peak bone volume (std.MD:3.70, CI:1.77–5.63, p = 0.0002) but reduced bone formation (std.MD:−0.54, CI:−0.90,−0.17, p = 0.004) in female mice. In male rats, CB1/2 deficiency (std.MD:2.31, CI:0.30–4.33, p = 0.02) and AM251 or CBD treatments (std.MD:2.19, CI:0.46–3.93, p = 0.01) enhanced bone volume. CB1/2 deficiency (std.MD:9.78, CI:4.96–14.61, p < 0.0001) and AM251 or AM630 treatments (std.MD:28.19, CI:19.13–37.25, p < 0.0001) were associated with osteoprotection. The CB2-selective agonists JWH133 and 4Q3C enhanced bone volume in arthritic rodents (std.MD:14.45, CI:2.08–26.81, p = 0.02). In human, CB2 SNPs (AA:rs2501431, MD:−0.28, CI:−0.55,−0.01, p = 0.04; CC:rs2501432, MD:−0.29, CI:−0.56,−0.02, p = 0.03) were associated with reduced bone mineral density, however the association of Marijuana use remains unclear. Thus, CB1/2 modulation is associated with altered bone metabolism, however findings are confounded by low study number and heterogenicity of models.

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.

Association between marijuana use and nonmedical prescription opioid use in the United States: are we shifting from one epidemic to another?

The United States (US) is grappling with a severe opioid epidemic. Marijuana is emerging as a therapy for pain management and an alternative to opioids, but little evidence supports its long-term benefits.This study aims to examine the association of marijuana use among patients on prescription pain relievers in a retrospective cross-sectional study using zero-inflated negative binomial regression. The recipients of prescription pain medicines were identified using National Survey on Drug Use and Health (2015-2017). Irrespective of the state marijuana laws, marijuana use days were 34% higher and odds of having zero days of marijuana use were 73% lower in those using nonmedical prescription opioids vs. not (IRR = 1.34, p < 0.0001; OR = 0.27, p < 0.0001, respectively). In the absence of consequential evidence supporting marijuana for pain management and more states venturing into legalizing it, there needs to be more caution as the country struggles to recover from one epidemic.

The relationship between marijuana use and psychosocial variables in living kidney donor candidates.

We investigate whether marijuana use in living kidney donor candidates is associated with psychosocial risk factors that place donors at higher risk for adverse outcomes and the unique associations between marijuana use and donor candidacy. Medical records of 757 living kidney donor candidates were reviewed. Patients were grouped into marijuana users/abstainers; demographic, psychiatric, and substance use variables were compared. Multivariate logistic regression assessed the independent association of marijuana use on committee approval for donation. Marijuana use was associated with lack of health insurance, legal history, lower education level, active and history of substance use disorder, active psychiatric disorder, history of multiple psychiatric diagnoses, and history of suicidality. Marijuana users were also more likely to be young, male, unmarried, and less likely to be approved for donation by the multidisciplinary selection committee. This latter association persisted in multivariate models. This is the first study to show that marijuana use is associated with psychosocial factors that could impact behavioral adherence following kidney donation, while reducing chances of committee approval for kidney donation. Special attention to potential overlay between psychosocial risk factors and marijuana use should be considered when evaluating kidney donors, particularly in context of increasingly legal use.

Independent association of marijuana use and poor oral hygiene with HPV-negative but not HPV-positive head and neck squamous cell carcinomas.

Sexual behavior is associated with human papillomavirus (HPV)-positive head and neck cancer, whereas tobacco and alcohol use are associated with HPV-negative cancer. A case-control study was designed to investigate additional demographic and behavioral factors independently associated with these distinct oral cancers. From 2011 to 2014, 249 newly diagnosed oral cavity and oropharyngeal squamous cell carcinoma (OSCC) cases were matched (1:2) on age, gender, and self-identified race to 498 controls without a cancer history attending the outpatient otolaryngology clinic at The Ohio State University in Columbus. Cases were stratified by detection of high-risk HPV DNA and RNA in tumors. Demographic and behavioral data were collected using an audio computer-assisted self-interview, and associations with HPV-positive versus HPV-negative OSCCs were investigated by use of univariable and multivariable conditional logistic regression models. After adjustment for oral sexual behavior, the odds of HPV-positive cancer decreased with the patient's years of education. Annual income, tobacco smoking, alcohol drinking, marijuana smoking, and poor oral hygiene were not associated with HPV-positive OSCC. In contrast, the odds of HPV-negative OSCC increased independently with decreased annual income, decreased with a high number of marijuana hit-years, and increased with fewer than annual dental visits after adjustment for lifetime tobacco and alcohol use. Sexual behavior and education were not associated with HPV-negative OSCC. The distinct risk-factor profiles for HPV-positive and HPV-negative OSCC are confirmed and extended in this case-control study, thus supporting 2 principal etiological pathways for OSCC development. Sexually acquired human papillomavirus (HPV) infection is an established cause of tonsil and base of tongue cancers. This study compared and contrasted risk factors for HPV-positive and HPV-negative oral cancers. Low number of years of education and sexual behavior are associated with HPV-positive cancer. In contrast, low annual income, infrequent dental visits, and tobacco and alcohol use are associated with HPV-negative cancers. Long-term marijuana use appears protective for HPV-negative cancer. Public health efforts to address these modifiable risk factors may prevent oral cancer.

Polytobacco use among a nationally-representative sample of black high school students

BackgroundStudies of the patterns of polytobacco use have increased. However, understanding the patterns of using multiple tobacco products among Black adolescents is minimal. This study identified the patterns of polytobacco use among U.S. Black adolescents.MethodsLatent class analysis (LCA) was used to identify patterns of adolescent polytobacco use among a representative sample of Black youth from the 2017 Youth Risk Behavior Survey (n = 2782). Ever and recent (past 30 day) use of cigarettes, electronic cigarettes, cigars, and dip or chewing tobacco were used as latent class indicators. Multinomial regression was conducted to identify the association if smoking adjusting for sex, age, grade, and marijuana use.ResultsMost students were in the 9th grade (29%), e-cigarette users (21%) and were current marijuana users (25%). Three profiles of tobacco use were identified: Class 1: Non-smokers (81%), Class 2: E-cigarette Users (14%), and Class 3: Polytobacco Users (5%). Black adolescent Polytobacco users were the smallest class, but had the highest conditional probabilities of recent cigarette use, e-cigarette use, ever smoking cigars or chewing tobacco. Ever and current use of marijuana were associated with increased odds of being in the e-cigarette user versus non-smoker group, and current marijuana use was associated with increased odds of polytobacco use (aOR = 24.61, CI = 6.95–87.11).ConclusionsFindings suggests the need for targeted interventions for reducing tobacco use and examining the unique effects of polytobacco use on Black adolescents. Findings confirm a significant association of marijuana use with tobacco use.

Evaluating the Longitudinal Association of Marijuana Use and Adverse Kidney Outcomes

Evaluating the Longitudinal Association of Marijuana Use and Adverse Kidney Outcomes

Maternal Marijuana Exposure, Feto-Placental Weight Ratio, and Placental Histology.

Marijuana use is associated with placenta-mediated adverse pregnancy outcomes including fetal growth restriction, but the mechanism remains uncertain. The objective was to evaluate the association between maternal marijuana use and the feto-placental weight ratio (FPR). Secondarily, we aimed to compare placental histology of women who used marijuana to those who did not. This was a secondary analysis of singleton pregnancies enrolled in a multicenter and case-control stillbirth study. Prior marijuana use was detected by electronic medical record abstraction or cord homogenate positive for 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid. Prior tobacco use was detected by self-report or presence of maternal serum cotinine. Stillbirths and live births were considered separately. The primary outcome was FPR. Association of marijuana use with FPR was estimated with multivariable linear modeling adjusted for fetal sex, preterm birth, and tobacco use. Comparisons between groups for placental histology were made using Chi-square and stratified by live birth and stillbirth, term and preterm deliveries, and fetal sex. Of 1,027 participants, 224 were stillbirths and 803 were live births. Overall, 41 (4%) women used marijuana during the pregnancy. The FPR ratio was lower among exposed offspring but reached statistical significance only for term stillbirths (mean 6.84 with marijuana use vs. mean 7.8 without use, p < 0.001). In multivariable modeling, marijuana use was not significantly associated with FPR (p = 0.09). There were no differences in histologic placental features among those with and without marijuana use overall or in stratified analyses. Exposure to marijuana may not be associated with FPR. Similarly, there were no placental histologic features associated with marijuana exposure. Further study of the influence of maternal marijuana use on placental development and function is warranted to better understand the association between prenatal marijuana use and poor fetal growth. · Maternal marijuana exposure was not associated with the feto-placental weight ratio.. · Marijuana exposure was not associated with differences in placental histology.. · Concerning trend toward lower feto-placental weight ratios among marijuana-exposed stillbirths..

Lifetime marijuana use in relation to cadmium body burden of US adults: results from the national health and nutrition examination surveys, 2009–2016

ObjectivesLow-level cadmium exposure has been linked to chronic diseases, but the importance of marijuana use as a source of cadmium remains unknown. We aimed to determine the association of marijuana use with blood cadmium (BCd) and urinary cadmium (UCd) levels. MethodsWe abstracted data from the National Health and Nutrition Examination Surveys, 2009–2016. We modeled lifetime marijuana exposure accounting for both duration and frequency of exposure. We used adjusted ratio of geometric means (ARM) and 95% confidence intervals (95% CIs) to compare outcomes among groups of marijuana exposure, relative to never users. The UCd level was adjusted for creatinine excretion. ResultsWe included 163,250 adults (mean age, 38.7 years; 50% women). The ARM of BCd was 1.28 (95% CI = 1.04, 1.57), 1.40 (95% CI = 1.11, 1.76), and 1.77 (95% CI = 1.51, 2.09) in current users with <2 uses per week, 2–3 uses per week, and ≥4 uses per week, respectively. Marijuana use for ≥15 years was associated with both higher cadmium burden in adults with <2 uses per week (ARM of 1.30 (95% CI = 1.04–1.62) for BCd and 1.48 (95% CI: 1.05, 2.09) for UCd or ≥4 uses per week (ARM of 1.69 (95% CI = 1.40, 2.05) for BCd and 1.38 (95% CI = 1.11, 1.72) for UCd. In former users, marijuana use was significantly associated with higher UCd levels in those with ≥15 years of use [ARM of 1.39 (95% CI = 1.14, 1.69) for those with <2 uses/week and 1.51 (95% CI = 1.19, 1.92) for those with ≥4 uses/week]. ConclusionsThe BCd level was higher in both current and former marijuana users than in never users. Marijuana use was also associated with higher UCd levels after a long-term use.

Incident testicular cancer in relation to using marijuana and smoking tobacco: A systematic review and meta-analysis of epidemiologic studies

BackgroundRecent epidemiologic studies identified credible associations between marijuana smoking and risk of nonseminomatous testicular germ cell tumors (TGCTs), but did not distinguish exposure to cannabinoid compounds from exposure to other constituents of smoke. MethodsWe implemented a systematic review of scholarly literature followed by random effects meta-analysis to quantitatively synthesize published data relating incident TGCT to each of 2 exposure histories: ever using marijuana, and ever smoking tobacco. ResultsWe identified four epidemiologic studies of marijuana use and 12 of tobacco smoking. Summary data concur with earlier reports of a specific association of marijuana use with nonseminoma, summary odds ratio [sOR] = 1.71 (95% confidence interval [CI] 1.12–2.60), and identify a positive association, sOR = 1.18 (95% CI 1.05–1.33), between tobacco smoking and all TGCT. ConclusionsAvailable data accord with positive associations between incident TGCT and each exposure, implicating both cannabinoid compounds and other constituents of smoke. Etiologic interpretation awaits epidemiologic studies that assess associations between tobacco smoking and nonseminomatous TGCT, investigating not only these exposures but also both co-use of tobacco and marijuana and smoke-free sources of cannabinoids, while adequately evaluating potential confounding among all of these exposures.

Is marijuana use associated with decreased use of prescription opioids? Toxicological findings from two US national samples of drivers

BackgroundState governments in the United States are increasingly viewing marijuana legalization as a policy option for controlling the opioid epidemic under the premise that marijuana is a less harmful substitute for opioids. The purpose of this study is to assess whether marijuana use is associated with decreased odds of prescription opioid use.MethodsA cross-sectional study design was applied to toxicological testing data from two national samples of drivers: 1) the 2011–2016 Fatality Analysis Reporting System (FARS) and 2) the 2013–2014 National Roadside Survey of Alcohol and Drug Use by Drivers (NRS). Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) estimated from multivariable logistic regression models were used to assess the associations of marijuana use with prescription opioid use and alcohol use.ResultsAmong the 47,602 drivers from the FARS, 15.7% tested positive for marijuana and 6.9% positive for prescription opioids. Compared with drivers testing negative for marijuana, those testing positive for marijuana were 28% more likely to test positive for prescription opioids (adjusted OR = 1.28, 95% CI = 1.15–1.42). Among the 7881 drivers from the NRS, 7.9% tested positive for marijuana and 4.5% positive for prescription opioids. Relative to drivers testing negative for marijuana, those testing positive for marijuana were twice as likely to test positive for prescription opioids (adjusted OR = 2.03, 95% CI = 1.29–3.20). In both study samples, marijuana use was associated with significantly increased odds of alcohol positivity.ConclusionsDrivers who test positive for marijuana are significantly more likely to test positive for prescription opioids. Longitudinal studies with rigorous designs and toxicological testing data are needed to further address the substitution hypothesis between marijuana and prescription opioids.