Effects Of Marijuana Use Research Articles

Longitudinal examination of marijuana use and physical teen dating violence: Antisocial peers and impulsivity as mediators

BackgroundPrior studies have shown that marijuana use is often associated with physical teen dating violence. However, few studies have examined the longitudinal mediating effects of associating with antisocial peers and impulsivity on this relationship. Also, few studies have estimated the cascading developmental impact of marijuana use and antisocial peer association, predicting the continued marijuana use and antisocial peer associations while considering the risk of impulsivity in physical teen dating violence. Thus, the current study utilized the problem behavior theory and an alternative path to physical dating violence to address these limitations. ObjectiveThe current study tested the longitudinal effects of marijuana use on physical teen dating violence and the indirect effects of antisocial peer association and impulsivity on this relationship (M = 12.29); 52.1 % of males and 47.9 % of females participated. MethodsAdolescents completed questionnaires at baseline and were assessed six months later (n = 836). Generalized structural equation modeling (GSEM) and cross-lagged mediation models were used first to analyze the direct effect of lifetime marijuana use on physical dating violence and antisocial peer association and impulsivity as potential mediators of this relationship. Then, the cross-lagged mediation models were used to estimate the alternative path to physical teen dating violence using lifetime marijuana use and antisocial peer association as predictors at baseline and continued antisocial peer association, marijuana use, and impulsivity at the subsequent wave as mediators. ResultsResults suggested that marijuana use at baseline was not positively associated with physical teen dating violence over time. The association with antisocial peers but not impulsivity mediated the relationship between marijuana use and physical dating violence. Cross-lagged mediation results suggested that marijuana use at baseline positively predicted antisocial peer association in the subsequent wave, which led to an increase in physical teen dating violence. Further, antisocial peer association at baseline is positively associated with continued antisocial peer association at the subsequent wave; thus, antisocial peer association is positively related to physical teen dating violence when controlling for depressive symptoms, family support, number of dates, and parental monitoring. ConclusionThese results suggest though marijuana use alone is not statistically associated with physical teen dating violence, it does increase the risk of antisocial social peer associations that could increase adolescents' likelihood to engage in physical teen dating violence. Further, the onset of antisocial peer association could persist over time, thus serving as a risk factor for physical teen dating violence over time.

M65 - Examining the Effects of Marijuana Use on Cognition in Persons With and Without HIV

M65 - Examining the Effects of Marijuana Use on Cognition in Persons With and Without HIV

Assessment of Marijuana Use During Pregnancy and its Effects on Neonatal Outcomes

Background: According to the American College of Obstetricians and Gynecologists (ACOG), marijuana is the most used drug during pregnancy, and its self-reported prevalence ranges from ~2% to 7%. ACOG currently recommends against marijuana use during pregnancy due to inconclusive data regarding its safety and health effects. However, we know that THC readily crosses the placenta and can reach high fetal concentrations on repeated exposures. Several reports have linked adverse infant outcomes, such as low birth weight and abnormal neurological development, to marijuana use in pregnancy. Yet, many pregnant women continue to use marijuana throughout gestation as they believe it is safe, highlighting the role that education on marijuana use in pregnancy may aid in decreasing its usage. Furthermore, the growing legalization of marijuana may lead to further increase in marijuana use during pregnancy. Purpose: We aimed to identify the reported use of marijuana during pregnancy in our patient population, prior to legalization, and examine its effects on maternal and neonatal outcomes. We hypothesized that those who reported using marijuana during pregnancy would have higher rates of maternal complications and adverse neonatal outcomes. Methods: A retrospective chart review (IRB #21-823) was conducted which included pregnant women and their neonates who were admitted and delivered in 2019 at HSHS St. John’s Hospital in Springfield, Illinois to assess marijuana use prior to legalization and to investigate neonatal outcomes of infants who were exposed to marijuana, including the need for respiratory support or assisted ventilation after delivery. Other data extracted included demographic characteristics, the mother’s medical and obstetrical history, intrapartum and postpartum events and all documented substance use during pregnancy including tobacco, marijuana and illicit drugs. A logistic regression was used to assess marijuana use as a predictor of respiratory outcomes in infants. Odds ratios with 95% confidence intervals (CI) are reported. Results: In our study, 599 charts were reviewed. Of those, 69 reported marijuana use during pregnancy, or 11.5%, which importantly, is higher than the reported national average of 2-7%. Previous studies have shown a high correlation between marijuana, tobacco and illicit drug use. Additionally, studies have demonstrated that tobacco and illicit drug use result in poor neonatal outcomes. Therefore, we focused on a subpopulation of mothers who only reported marijuana use during pregnancy to remove these confounders. As a result, 112 subjects were removed from the analysis who reportedly used tobacco and/or other illicit drugs in addition to marijuana in order to exclusively focus on the effect of maternal marijuana use on neonatal outcomes. In this subpopulation of 477 subjects, the rate of marijuana use was 5.5% (lower than the overall population), but the effects of marijuana on neonatal outcomes was found to be significant. Demographics were as follows: mean age 28.2 ± 0.25 years; race, ethnicity: 76% White, non-Hispanic and 23% were other (i.e., African American/black, Asian, native Hawaiian/pacific islander, white and Hispanic, non-white and Hispanic or another race). In this subpopulation, admission to the NICU and small for gestational age were not significantly different between marijuana users and non-users. However, marijuana users did have higher odds of preterm birth (OR=3.8, CI: 1.5-9.6; p=0.004). Additionally, marijuana users had increased odds of having an infant that required respiratory support (OR=3.9, CI: 1.4-10.3; p=0.005) and assisted ventilation (OR=4.6, CI: 1.6-13.1; p=0.003). Yet, no adverse maternal outcomes were associated with exclusive marijuana use. Conclusion: Rates of marijuana use during pregnancy in our population is higher than the reported national average. Moreover, infants whose mothers exclusively used marijuana during pregnancy experienced higher rates of neonatal complications. Thorough screening and counseling regarding marijuana use in pregnancy and during breastfeeding is recommended, although there is no uniform process at this time. Implementing a standardized screening methodology and approach to education on the adverse neonatal effects of marijuana use in pregnancy during prenatal visits may be an effective intervention to improve neonatal outcomes in our patient population. This education is of particular importance in light of the recent legalization of marijuana.

Brain Function and Marijuana: Are there Changes after Abstinence of Consumption? Preliminary Results.

The legalization of cannabis use and false claims about the plant Cannabis sativa to be considered a pharmaceutical product have been found to increase consumption, lower risk perception, and lead to more health problems, without reducing criminal activity. Brain function, typically assessed by neuropsychological tests, shows abnormalities with acute marijuana use, but inconsistent results have been published after abstinence, with a maximum follow-up of 28 days. Our previous research, using neuropsychological tests and brain perfusion single photon emission computed tomography (neuroSPECT), demonstrated consistent abnormalities in brain function among schoolchildren who consume marijuana compared to their non-consuming peers. The aim of this study is to investigate whether brain function changes in 20 adult marijuana users after 6 months of abstinence. Comparison of neuropsychological tests (Rey Complex Figure; Porteus Maze; Four subtests of WAIS-IV Intellectual Tests; STROOP; D2) and perfusion neuroSPECT (functional images), obtained in relation to recent consumption and after 6 months of serial drug-screening test confirmed abstinence. In a one-year period (2020-2021) only five compliant participants were recruited. The COVID-19 pandemic was a limiting factor. Preliminary results of neuropsychological tests, functional brain perfusion images and limited statistical analysis are presented. The results of the neuropsychological tests of the three subjects who completed the abstinence period so far show some improvement in working memory and attention after abstinence. NeuroSPECT shows disorganized hypoperfusion of variable severity in relation to recent consumption, involving areas associated with cognitive function such as the posterior cingulate and temporal lobes, in our five initially enrolled patients, when compared to a normal database. Of these, only two participants have already been re-evaluated with neuroSPECT after 6 months of abstinence, one of whom showed some improvement on the post-abstinence images. We analyze the methodological challenges of this research, including the pandemic, to incorporate the appropriate corrections in the next phase of our investigation. Our final findings may provide clinicians and users with information about the long-term effects of marijuana use on brain function.

Effects of Marijuana Use in Patients Undergoing Abdominal Free Flap Breast Reconstruction.

Marijuana use has been associated with vascular inflammation and clotting, resulting in endothelial damage and arteritis. As marijuana use rises in the United States, few studies have evaluated its impact on surgical outcomes and wound healing in free flap breast reconstruction. A retrospective cohort study of patients undergoing abdominal free flap breast reconstruction between 2016 and 2022 at a large metropolitan healthcare system was performed. Patient demographics, comorbidities, procedural details, and complications were analyzed. Minor complications were defined as skin or fat necrosis not requiring intervention, nipple loss, any wound requiring management in the clinic, hematoma, and seroma. Major complications were defined as reoperation, flap loss, cardiac or thromboembolic events, and hospital readmission. Active marijuana users were those with marijuana use within 12 weeks of surgery. In total, 168 patients underwent 276 deep inferior epigastric artery-based flaps for breast reconstruction. There were 21 active marijuana users. There were no significant differences in patient demographics, cancer treatment, or minor and major complications. However, there were higher rates of active nicotine use (P = 0.001) and anxiety/depression amongst active marijuana users (P = 0.002). Active users had higher rates of bilateral breast reconstruction (P = 0.029), but no significant differences in other operative details. Active marijuana use of unknown frequency may be safe in patients undergoing breast free flap reconstruction. Advising marijuana abstinence preoperatively may not alter patient outcomes. Further studies of greater sample size are needed to evaluate marijuana's impact on outcomes associated with breast reconstruction using free flap.

The effect of marijuana use in adolescence on college and graduate degree attainment

We estimate the long-term effect of using marijuana in adolescence on college and graduate degree attainment measured approximately 20 years later. We rely on the first two waves (1994–1996) and the fifth wave (2016–2018) of the National Longitudinal Study of Adolescent to Adult Health and estimate instrumental variables models that exploit the network structure at the second degree by using marijuana use status of friends of friends who are not themselves friends of the respondent in order to instrument for the respondent’s marijuana use. Our models also include school and grade fixed effects. Marijuana use in adolescence leads to a large reduction in the likelihood of college and graduate degree attainment by the time respondents are aged 33–43 years old.

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.

1.47 Effects of Marijuana Use in Pregnancy

1.47 Effects of Marijuana Use in Pregnancy

Effect of Preoperative Marijuana on Patient Outcomes and Opioid Use after Lumbar Decompression.

Retrospective Cohort Study. Our study aims to analyze the effect of preoperative marijuana use on outcomes and postoperative opioid use in patients who have undergone lumbar decompression without fusion. All patients >18years of age who underwent lumbar decompression from 2017-2022 with documented preoperative marijuana use at our academic institution were retrospectively identified. A 3:1 propensity match incorporating demographics, procedure type, and levels decompressed was performed to compare preoperative marijuana users and non-users. 1-year preoperative and postoperative opioid consumption in milligrams of morphine equivalents and postoperative outcomes including readmissions, reoperations, and complications, were obtained. A multivariate regression model was performed to measure the effect of marijuana use on the likelihood of a spine reoperation. Of the 340 included patients, 85 were preoperative marijuana users. There were no significant differences in medical complications, 90-day readmissions, or opioid consumption preoperatively or postoperatively (P > .05). We identified a trend towards patients who used marijuana having more reoperations for any cause (20.0% vs 11.37%, P = .067). Multivariate logistic regression analysis suggested that preoperative marijuana use was a significant predictor of all-spine reoperations (OR = 2.06, P = .036). In lumbar decompression patients, preoperative marijuana use does not impact opioid consumption, readmissions, or medical complications, but is a significant predictor of future postoperative reoperations. Additional research is necessary to further explore the role of marijuana use in spine surgery.

The long-term effects of marijuana use on mental health outcomes

The long-term effects of marijuana use on mental health outcomes

Weeding out the Truth: A Survey Experiment on the Role of Scientific Evidence in Shaping Public Opinion on Marijuana Policy

PurposeThis study aims to explore the extent to which different forms of scientific research on the criminogenic effects of marijuana use impact public opinion on marijuana-related policy issues. MethodsWe conducted an experimental priming survey using Qualtrics, targeting heads of households in South Carolina with associated email addresses. Multiple OLS regression models were employed to analyze single-item and aggregate scores of our dependent variables. ResultsOur findings reveal that, except for the policy regarding the immediate release of a convicted offender, scientific research on the criminogenic effects of marijuana use did not significantly or substantively influence public perceptions of cannabis policies. Factors such as perceptions of police legitimacy, legal orientation, trust in law enforcement, and conservative or moderate political inclinations were significantly correlated with various outcomes. ConclusionsRespondents primed with research suggesting a link between marijuana use and an increased likelihood of engaging in violent and property crimes were more inclined to disapprove of releasing non-violent cannabis offenders from incarceration. However, exposure to scientific research generally did not influence participants' support or disapproval of other policies promoting the liberalization of marijuana-related policies. The study also discusses potential research and policy implications.

Prospective, longitudinal study to isolate the impacts of marijuana use on neurocognitive functioning in adolescents.

Policies to legalize possession and use of marijuana have been increasingly supported across the United States. Although there are restrictions on use in minors, many substance abuse scientists anticipate that these policy changes may alter use patterns among adolescents due to its wider availability and a softening of beliefs about its potentially harmful consequences. Despite the possibility that these policies may increase the prevalence of use among adolescents, the effects of marijuana on neurodevelopment remain unclear, clouding arguments in favor of or opposition to these policies. The present prospective, longitudinal study was designed to isolate the neurodevelopmental consequences of marijuana use from its precursors during adolescence-a period of heightened vulnerability for both substance use and disrupted development due to environmental insults. Early adolescents who were substance-naïve at baseline (N = 529, aged 10-12) were recruited and tracked into adolescence when a subgroup initiated marijuana use during one of three subsequent waves of data collection, approximately 18 months apart. Results suggest that marijuana use may be specifically related to a decline in verbal learning ability in the short term and in emotion recognition, attention, and inhibition in the longer-term. These preliminary findings suggest that marijuana use has potential to adversely impact vulnerable neurodevelopmental processes during adolescence. Intensive additional investigation is recommended given that state-level policies regulating marijuana use and possession are rapidly shifting in the absence of good scientific information.

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.

Use of Marijuana to Promote Well-Being: Effects of Use and Prohibition in the Daily Lives of Brazilian Adults

Marijuana is the most widely used illicit drug worldwide. From an occupational perspective, its use is paradoxical in that although it can be harmful to health and has criminal consequences, it can also promote well-being. This study examined predictors of well-being to determine the effects of marijuana use and its prohibition on the daily lives of Brazilian adults. This cross-sectional study used an anonymous online questionnaire with a final sample of 2637 respondents. Utilizing logistic regression, variables were selected pertaining to use and prohibition risks, benefits of use, and harm reduction associated with the socioeconomic characteristics of the respondents. Using marijuana for fun was most likely among those self-identified as male, trans/non-binary people, college graduates, and those with higher incomes. Living with family members and using less frequently proved to be protective against the adverse effect of "getting high." Indigenous peoples and youth were more likely to report trouble with the police due to marijuana use; individuals with higher education and longer use of marijuana reported more frequent use of harm reduction strategies; people who identified their color as yellow were more likely to report daily use compared to people who identified their color as white; women and people with higher income were less likely to report daily use. Social class, race, gender, and generation were predictors of well-being associated with marijuana use and its prohibition, indicating an interaction between different dimensions involving the use of illicit substances. Identifying the effects of the use and prohibition of marijuana in promoting well-being, from the conception of drug use as a non-sanctioned occupation, can broaden the understanding of this complex human phenomenon, with health and criminal repercussions, subsidizing the development of approaches more equitable and adequate into occupational therapy to reduce personal and social harm.

PSAT327 Can Cannabis Use Lead to Central Hypothyroidism

Abstract Background Marijuana has been legalized for medical use in 36 states and for recreational use in 18 states. Its effects on thyroid function and hypothalamic-pituitary-thyroid axis in humans is not known. Clinical Case 72 years old male presented to his primary care physician with occasional difficulty swallowing. He reported fatigue for 4-5 years, trouble falling asleep for 2 months, weight gain 8 pounds over last few weeks, occasional diarrhea, and intermittent episodes of heat intolerance. His past medical history included controlled type 2 diabetes mellitus, recurrent herpes simplex infection, arthritis of hip joints, short-term memory loss, anemia, carpal tunnel syndrome and benign prostatic hyperplasia. Medications included glimepiride, lisinopril, acyclovir, tamsulosin, finasteride, escitalopram. He had been smoking marijuana regularly since he was a teenager. He denied using any other supplements. His physical exam was normal with stable vital signs and normal BMI. His labs showed a low TSH (0.096 mcIU/mL, n: 0.358-3.8 mcIU/mL), normal free T4 (0.90 ng/dL, n: 0.76-1.46 ng/dL), normal total T3 (70 ng/dL, n: 60-180 ng/dL). Review of his labs showed low TSH for last 4 years progressively getting worse with normal free T4 levels. TSH-receptor antibody and TPO Antibody level were negative. His white cell count, hemoglobin and platelets were normal. His electrolytes, kidney function and liver function tests were also normal. Thyroid Ultrasound showed 2 small sub-centimeter hypoechoic nodules in the left thyroid lobe. Two years ago, a radioactive Iodine scan showed normal iodine uptake. A recent radioactive iodine uptake scan showed generalized decreased iodine uptake with no evidence of graves’ disease or toxic multinodular goiter. Conclusion Currently there are no controlled studies on the effect of marijuana use on thyroid function in humans. A cross-sectional analysis using National Health and Nutrition Examination Survey (NHANES) from 2007 to 2012 showed recent marijuana use was significantly associated with lower levels of TSH but was not associated with thyroid dysfunction (1). This study suggests that marijuana use is associated with low TSH levels. This could be due to hypothalamic suppression of TSH or may indicate a protective role against hypothyroidism. Older studies in rodents showed that cannabis exposure may lead to suppression of TSH and hypothalamic function (2). The data related to human subjects is scarce. Therefore, pathophysiologic mechanisms are speculative, although animal data support potential mechanism of hypothalamic suppression.

Marijuana use and DNA methylation-based biological age in young adults

BackgroundMarijuana is the third most commonly used drug in the USA and efforts to legalize it for medical and recreational use are growing. Despite the increase in use, marijuana’s effect on aging remains understudied and understanding the effects of marijuana on molecular aging may provide novel insights into the role of marijuana in the aging process. We therefore sought to investigate the association between cumulative and recent use of marijuana with epigenetic age acceleration (EAA) as estimated from blood DNA methylation.ResultsA random subset of participants from The Coronary Artery Risk Development in Young Adults (CARDIA) Study with available whole blood at examination years (Y) 15 and Y20 underwent epigenomic profiling. Four EAA estimates (intrinsic epigenetic age acceleration, extrinsic epigenetic age acceleration, PhenoAge acceleration, and GrimAge acceleration) were calculated from DNA methylation levels measured at Y15 and Y20. Ever use and cumulative marijuana-years were calculated from the baseline visit to Y15 and Y20, and recent marijuana use (both any and number of days of use in the last 30 days) were calculated at Y15 and Y20. Ever use of marijuana and each additional marijuana-year were associated with a 6-month (P < 0.001) and a 2.5-month (P < 0.001) higher average in GrimAge acceleration (GAA) using generalized estimating equations, respectively. Recent use and each additional day of recent use were associated with a 20-month (P < 0.001) and a 1-month (P < 0.001) higher GAA, respectively. A statistical interaction between marijuana-years and alcohol consumption on GAA was observed (P = 0.011), with nondrinkers exhibiting a higher GAA (β = 0.21 [95% CI 0.05, 0.36], P = 0.008) compared to heavy drinkers (β = 0.05 [95% CI − 0.09, 0.18], P = 0.500) per each additional marijuana-year. No associations were observed for the remaining EAA estimates.ConclusionsThese findings suggest cumulative and recent marijuana use are associated with age-related epigenetic changes that are related to lifespan. These observed associations may be modified by alcohol consumption. Given the increase in use and legalization, these findings provide novel insight on the effect of marijuana use on the aging process as captured through blood DNA methylation.

Analysis of STEMI and NSTEMI in a Community Cohort of Marijuana Users.

Marijuana is the most commonly used illicit drug in the United States. Current research has yet to come to a consensus on its association with acute coronary syndrome (ACS). Herein, we aimed to analyze how marijuana use relates to acute ST elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Using a retrospective study design, we gathered data from August 2014 to September 2020 on all percutaneous coronary interventions (PCIs) done at Brookdale University Hospital Medical Center (BUHMC) in patients with NSTEMI and STEMI. To compare marijuana users (MUs) with non-users, t-tests and Chi-square tests were used. A total of 195 patients were included, with mean age at presentation of 47 years old; 59 were females (30.3%) and 136 were males (69.7%). We identified 37 patients who were MUs. MUs were younger than non-users (P < 0.01), had higher rates of alcohol (P = 0.025), opiate (P = 0.004) and cigarette (P ≤ 0.001) use. On admission, MUs had lower creatinine (P = 0.031), blood urea nitrogen (BUN) (P = 0.031), pro-B-type natriuretic peptide (PBNP) (P = 0.052), BMI (P = 0.014) and lower right coronary artery (RCA) disease (P = 0.026). After logistic regression analyses, results showed that the severity of coronary artery disease (CAD) and admission diagnosis of STEMI or NSTEMI were not found to be significantly related to marijuana use. Age, alcohol, cigarette, creatinine, BUN, PBNP, BMI and RCA disease were significantly related to marijuana use. There was a negative correlation between marijuana use and RCA disease (MUs = 29.7% vs. non-users = 50%, P = 0.026). There was no significant association with STEMI, NSTEMI or the severity of CAD. As daily cannabis use is on the rise, more researches are needed to further determine the effects of marijuana use on CAD.

Self-reported marijuana use and its effects on overall approval in potential living kidney donors.

Past and present substance use is an important part of the psychosocial evaluation of potential living kidney donors (LKDs). Increasing state legalizations and social acceptance of marijuana (MJ) use can create challenges for transplant centers. We investigated the frequency of reporting MJ use, and its effect on the LKD evaluation. A retrospective chart review was performed on all living donor candidates from December 2016 to December 2019 for reports of MJ use, both on an electronic intake form and during clinical evaluation with a licensed social worker (SW). Active MJ use was defined as current use or use within 1 year of evaluation. Baseline characteristics between MJ users and non-users were compared at each step of donor evaluation. We explored variables associated with MJ use including additional consults and testing during the donor evaluation. Overall approval and donation rates for living donors with active MJ use were compared to non-users. Additionally, 1-year donor follow-up was compared between the two groups. Results of 1818 living donor candidates who completed the intake form, 132 admitted to active MJ use. Compared to non-users, MJ users were more likely to be younger, male, single, renting a home, and with a lower level of education. Thirty three out of 338 candidates who completed a social work evaluation reported MJ use. Compared to non-users, MJ users were more frequently classified as moderate or high risk on SW evaluation, and often required a toxicology screen or psychiatry visit for clearance to donate. Altogether 24.2% of MJ users versus 9.5% of non-users discontinued their evaluation (p<.01). Altogether 42.4% of MJ users versus 56.1% of non-users donated their kidney (p=.13). For those who donated, MJ users were less likely than non-users to follow up at 1 year (57.1%vs. 83.0, p-value .02). MJ users were often asked to complete additional steps in their evaluation before an approval decision was made, which may have led to the higher rate of donor drop out observed in this group. Further research is needed to assess the effects of MJ use on living donor candidacy, as well as any effects of MJ use on long-term donor outcomes.

The Effect of Preoperative Marijuana Use on Surgical Outcomes, Patient-Reported Outcomes, and Opioid Consumption Following Lumbar Fusion.

Retrospective Cohort Study. To (1) investigate the effect of marijuana use on surgical outcomes following lumbar fusion, (2) determine how marijuana use affects patient-reported outcomes measures (PROMs), and (3) determine if marijuana use impacts the quantity of opioids prescribed. Patients > 18years of age who underwent primary one- or two-level lumbar fusion with preoperative marijuana use at our institution were identified. A 3:1 propensity match incorporating patient demographics and procedure type was conducted to compare preoperative marijuana users to non-marijuana users. Patient demographics, surgical characteristics, surgical outcomes (90-day all-cause and 90-day surgical readmissions, reoperations, and revision surgeries), pre- and postoperative narcotic usage, and PROMs were compared between groups. Multivariate regression models were created to determine the effect of marijuana on surgical reoperations patient-reported outcomes (PROMs) 1-year postoperatively. Of the 259 included patients, 65 used marijuana preoperatively. Multivariate logistic regression analysis demonstrated that marijuana use (OR = 2.28, P = .041) significantly increased the likelihood of having a spine reoperation. No other surgical outcome was found to be significantly different between groups. Multivariate linear regression analysis showed that marijuana use was not significantly associated with changes in 1-year postoperative PROMs (all, P > .05). The quantity of pre- and postoperative opioids prescriptions was not significantly different between groups (all, P > .05). Preoperative marijuana use increased the likelihood of a spine reoperation for any indication following lumbar fusion, but it was not associated with 90-day all cause readmission, surgical readmission, the magnitude of improvement in PROMs, or differences in opioid consumption. III.

Marijuana Use and its Effect on Clinical Outcomes and Revision Rates in Patients Undergoing Anterior Cervical Discectomy and Fusion.

A retrospective cohort study. To determine if (1) preoperative marijuana use increased complications, readmission, or reoperation rates following anterior cervical discectomy and fusion (ACDF), (2) identify if preoperative marijuana use resulted in worse patient-reported outcome measures (PROMs), and (3) investigate if preoperative marijuana use affects the quantity of opioid prescriptions in the perioperative period. A growing number of states have legalized recreational and/or medical marijuana, thus increasing the number of patients who report preoperative marijuana use. The effects of marijuana on clinical outcomes and PROMs in the postoperative period are unknown. All patients 18 years of age and older who underwent primary one- to four-level ACDF with preoperative marijuana use at our academic institution were retrospectively identified. A 3:1 propensity match was conducted to compare patients who used marijuana versus those who did not. Patient demographics, surgical characteristics, clinical outcomes, and PROMs were compared between groups. Multivariate regression models measured the effect of marijuana use on the likelihood of requiring a reoperation and whether marijuana use predicted inferior PROM improvements at the one-year postoperative period. Of the 240 patients included, 60 (25.0%) used marijuana preoperatively. Multivariate logistic regression analysis identified marijuana use (odds ratio=5.62, P <0.001) as a predictor of a cervical spine reoperation after ACDF. Patients who used marijuana preoperatively had worse one-year postoperative Physical Component Scores of the Short-Form 12 (PCS-12) ( P =0.001), Neck Disability Index ( P =0.003), Visual Analogue Scale (VAS) Arm ( P =0.044) and VAS Neck ( P =0.012). Multivariate linear regression found preoperative marijuana use did not independently predict improvement in PCS-12 (β=-4.62, P =0.096), Neck Disability Index (β=9.51, P =0.062), Mental Component Scores of the Short-Form 12 (MCS-12) (β=-1.16, P =0.694), VAS Arm (β=0.06, P =0.944), or VAS Neck (β=-0.44, P =0.617). Preoperative marijuana use increased the risk of a cervical spine reoperation after ACDF, but it did not significantly change the amount of postoperative opioids used or the magnitude of improvement in PROMs. Levwl III.