Habitual Marijuana Use Research Articles

Implications of Peri Operative Cannabis Use in Adolescents and Young Adults

<h3>Introduction</h3> Massachusetts legalized cannabis use for both medical and recreational use in 2014. Since then, adolescent recreational and medicinal use of cannabinoids has increased. <h3>Identification of the Problem</h3> There were increased requests by surgical patients post-operatively regarding resuming cannabis use post-operatively. <h3>EBP Question/Purpose</h3> <b>PICO question. Databases utilized.</b> The purpose was to understand best practice regarding post-operative pain management for patients who frequently use cannabis using the PICO question ‘<i>In adolescence and young adults (AYA), does the habitual use of marijuana versus no use increase the need for pain management interventions post-operatively?',</i> and the CINAHL, PubMed, Google Scholar, and Cochrane databases. <h3>Methods/Evidence</h3> The initial search returned 20 articles, which were critically appraised using the Johns Hopkins Evidence-Based Practice Appraisal Tool. One post-operative pain management expert opinion was obtained. In five articles, patients who reported using cannabinoids had higher pain scores, required more narcotics, and exhibited a poorer quality of sleep in the early post-operative period. Three articles found no difference in pain scores, narcotic use or length of stay for post-operative patients reporting cannabis use. These articles focused primarily on the orthopedic population, making it difficult to determine its' effects in other patient populations. Additionally, small sample sizes and older patients make the results difficult to interpret for a pediatric population. Four articles identified the multisystem effects of cannabinoids and its interaction with anesthetic agents, which may lead to serious complications for the patient. <h3>Significance of Findings/Outcomes</h3> There are conflicting findings regarding the use of cannabis as an effective post-operative pain management strategy and no practice change is currently recommended. However, the current available evidence can assist nurses caring for post-operative patients that utilize cannabis. Limited high quality studies were found, possibly due to the lack of federal research funding as cannabis is considered an illegal substance at the federal level. <h3>Implications for perianesthesia nurses and future research</h3> The evidence is useful to educate post-anesthesia care unit (PACU) nurses about how to screen for cannabis use and post-operative care considerations in the PACU setting. Considerations include the importance of eliciting and quantifying a history of cannabis use, consideration of cannabis weaning, additional post-operative nausea, vomiting prophylaxis, anticipated increased post-operative analgesic requirements, and maintaining vigilance for cannabis withdrawal syndrome. Adolescent-specific research is needed.

Substance abuse among university students in Egypt: prevalence and correlates.

Drug abuse is a global challenge with harmful effects on health, wealth and wellbeing of nations. University students report more habitual use of marijuana, cocaine, hallucinogens and illicit drugs than noncollege students report. To identify the prevalence of tobacco use, alcohol and drug abuse and to identify some factors associated with drug abuse. A cross-sectional study recruiting 2552 students from all faculties hosted by Kafr El-Sheikh University during the academic year 2018-2019. Data were collected using a structured self-administered questionnaire. The prevalence of current drug abuse was 8.9% for cigarette smoking, followed by tranquilizers (4.3%), hashish (3.6%), alcohol (2.7%), bhang (1.4%) and tramadol (1.0%). Men reported significantly greater use of cigarettes, alcohol, tramadol, hashish and bhang than women. Students of practical colleges were found to smoke cigarettes and abuse hashish significantly more than their peers in other colleges. Risk factors associated with drug abuse were mainly related to gender and college type. There is a need to design and implement programmes to raise awareness and provide supportive services for prevention and management of drug abuse among university students tailored according to their needs.

The Self-Report Habit Index: Assessing habitual marijuana, alcohol, e-cigarette, and cigarette use

BackgroundSubstance use is partially driven by habitual processes that occur automatically in response to environmental cues and may be central to users’ identities. This study was designed to validate the Self-Report Habit Index (SRHI) for assessing habitual marijuana, alcohol, cigarette, and e-cigarette use. MethodsWe examined the SRHI’s psychometrics in separate samples of adult marijuana (Ns = 189;170), alcohol (Ns = 100;133), cigarette (Ns = 58;371), and e-cigarette (N = 239) users. ResultsA 6-item, single-factor solution evidenced good fit across substances (CFI marijuana/alcohol/cigarettes/e-cigarettes = 0.996/0.997/0.996/0.994, RMSEA = 0.046/0.047/0.067/0.068, SRMR = 0.017/0.017/0.010/0.015) and internal consistency (α = 0.88/0.94/0.95/0.91). The SRHI was scalar invariant for sex and race. However, independent-samples t-tests indicated only that women endorsed stronger habitual e-cigarette use and that men endorsed stronger habitual marijuana use. The SRHI also was scalar invariant by product type in dual-users (cigarettes/e-cigarettes[N = 371]; alcohol/cigarettes [n = 58]), although differences in habit strength only were observed for cigarettes versus e-cigarettes, with dual-users reporting stronger habitual cigarette use. Finally, the SRHI predicted frequency of marijuana, alcohol, cigarette, and e-cigarette use (np2 [marijuana/alcohol/cigarettes/e-cigarettes] = 0.37/0.48/0.31/0.17) and quantity of alcohol and cigarette use (np2 = 0.43/0.33). ConclusionsThe SRHI is a psychometrically sound measure of adults’ habitual substance use. The SRHI detected mean differences by sex and substance type and predicted the frequency of using each substance. Future research should determine if the SRHI is appropriate for use with other substances or age groups (e.g., adolescents), how it relates to task-based, behavioral measures of habit strength, and the degree to which habit predicts the development or maintenance of addiction.

Effects of Marijuana Smoking on the Lung

Regular smoking of marijuana by itself causes visible and microscopic injury to the large airways that is consistently associated with an increased likelihood of symptoms of chronic bronchitis that subside after cessation of use. On the other hand, habitual use of marijuana alone does not appear to lead to significant abnormalities in lung function when assessed either cross-sectionally or longitudinally, except for possible increases in lung volumes and modest increases in airway resistance of unclear clinical significance. Therefore, no clear link to chronic obstructive pulmonary disease has been established. Although marijuana smoke contains a number of carcinogens and cocarcinogens, findings from a limited number of well-designed epidemiological studies do not suggest an increased risk for the development of either lung or upper airway cancer from light or moderate use, although evidence is mixed concerning possible carcinogenic risks of heavy, long-term use. Although regular marijuana smoking leads to bronchial epithelial ciliary loss and impairs the microbicidal function of alveolar macrophages, evidence is inconclusive regarding possible associated risks for lower respiratory tract infection. Several case reports have implicated marijuana smoking as an etiologic factor in pneumothorax/pneumomediastinum and bullous lung disease, although evidence of a possible causal link from epidemiologic studies is lacking. In summary, the accumulated weight of evidence implies far lower risks for pulmonary complications of even regular heavy use of marijuana compared with the grave pulmonary consequences of tobacco.

Marijuana use and long-term mortality among survivors of acute myocardial infarction

Smoking marijuana has been reported to increase risk of myocardial infarction (MI) immediately after use, but less is known about the long-term impact of marijuana use among patients with established coronary disease. The Determinants of MI Onset Study is a multicenter inception cohort study of myocardial infarction (MI) patients enrolled in 1989 to 1996 and followed up for mortality using the National Death Index. In an initial analysis of 1,935 MI survivors followed up for a median of 3.8 years, we found an increased mortality rate among marijuana users. The current article includes 3,886 Determinants of MI Onset Study patients followed up for up to 18 years. We used Cox proportional hazards models to calculate the hazard ratio and 95% CI for the association between marijuana use and mortality and a propensity score matched analysis to further control confounding. Over up to 18 years of follow-up, 519 patients died, including 22 of the 109 reporting marijuana use in the year before their MI. There was no statistically significant association between marijuana use and mortality. Compared with nonusers, the mortality rate was 29% higher (95% CI 0.81-2.05, P = .28) among those reporting any marijuana use. Habitual marijuana use among patients presenting with acute MI was associated with an apparent increased mortality rate over the following 18 years that did not reach nominal statistical significance. Larger studies with repeated measures of marijuana use are needed to definitively establish whether there are adverse cardiovascular consequences of smoking marijuana among patients with established coronary heart disease.

Impact of Changes in Regular Use of Marijuana and/or Tobacco On Chronic Bronchitis

We sought to evaluate possible changes in the prevalence of chronic bronchitis in relation to continuing or changing smoking status for marijuana and/or tobacco. For this purpose we followed 299 participants in a longitudinal cohort study of the impact of heavy habitual use of marijuana alone or with tobacco on respiratory symptoms over a mean of 9.8 years during which subjects underwent repeated administration of a detailed drug use and respiratory questionnaire at intervals of ≥1 yr. Using logistic regression, we calculated odds ratios to assess the relationship between chronic bronchitic symptoms and smoking status for marijuana and tobacco at the first visit (current smoking versus never smoking) and at the last follow-up visit (continuing smoking versus, separately, never smoking and former smoking). We found that continuing smokers of either marijuana or tobacco had a significantly increased likelihood of having chronic bronchitis at follow-up compared to both never smokers and former smokers. On the other hand, former smokers of either substance were no more likely to have chronic respiratory symptoms at follow-up than never smokers. These findings demonstrate the benefit of marijuana smoking cessation in resolving pre-existing symptoms of chronic bronchitis.

Association between marijuana use and transitional cell carcinoma

Objectives Marijuana smoking has been implicated as a causative factor in traditionally tobacco-related tumors of the head and neck and of the lung. When associated with marijuana use, such tumors occur in a much younger patient population than do similar tumors in tobacco smokers. Owing to the large number of young men with a history of marijuana presenting with transitional cell carcinoma to VA facilities, this study was designed to compare the marijuana use among young (aged less than 60 years) transitional cell carcinoma patients with that among age-matched controls. Methods Fifty-two men aged less than 60 years presenting consecutively with transitional cell carcinoma and 104 age-matched controls (defined by having no history of transitional cell carcinoma, hematuria, or irritative voiding symptoms, as well as unremarkable results on urinalysis and urine cytology) completed questionnaires about exposure to various potential carcinogens, including radiation, Agent Orange, smoked or processed meats, dyes, tobacco, and marijuana. Results Of the 52 transitional cell carcinoma patients, 46 (88.5%) reported a history of habitual marijuana usage, and 72 (69.2%) of the age-matched controls gave a history of habitual marijuana use. This difference was statistically significant ( P = 0.008). In those with transitional cell carcinoma, marijuana use significantly correlated with tumor stage, grade, and number of recurrences. Conclusions Marijuana smoking might increase the risk of transitional cell carcinoma.

Smoked Marijuana as a Cause of Lung Injury

In many societies, marijuana is the second most commonly smoked substance after tobacco. While delta9-tetrahydrocannabinol (THC) is unique to marijuana and nicotine to tobacco, the smoke of marijuana, like that of tobacco, consists of a toxic mixture of gases and particulates, many of which are known to be harmful to the lung. Although far fewer marijuana than tobacco cigarettes are generally smoked on a daily basis, the pulmonary consequences of marijuana smoking may be magnified by the greater deposition of smoke particulates in the lung due to the differing manner in which marijuana is smoked. Whereas THC causes modest short-term bronchodilation, regular marijuana smoking produces a number of long-term pulmonary consequences, including chronic cough and sputum, histopathologic evidence of widespread airway inflammation and injury and immunohistochemical evidence of dysregulated growth of respiratory epithelial cells, that may be precursors to lung cancer. The THC in marijuana could contribute to some of these injurious changes through its ability to augment oxidative stress, cause mitochondrial dysfunction, and inhibit apoptosis. On the other hand, physiologic, clinical or epidemiologic evidence that marijuana smoking may lead to chronic obstructive pulmonary disease or respiratory cancer is limited and inconsistent. Habitual use of marijuana is also associated with abnormalities in the structure and function of alveolar macrophages, including impairment in microbial phagocytosis and killing that is associated with defective production of immunostimulatory cytokines and nitric oxide, thereby potentially predisposing to pulmonary infection. In view of the growing interest in medicinal marijuana, further epidemiologic studies are needed to clarify the true risks of regular marijuana smoking on respiratory health.

Marijuana use and car crash injury

To investigate the relationship between marijuana use prior to driving, habitual marijuana use and car crash injury. Population based case-control study in Auckland, New Zealand. Case vehicles were all cars involved in crashes in which at least one occupant was hospitalized or killed anywhere in the Auckland region, and control vehicles were a random sample of cars driving on Auckland roads. The drivers of 571 case and 588 control vehicles completed a structured interview. Self reported marijuana use in the 3 hours prior to the crash/survey and habitual marijuana use over the previous 12 months were recorded, along with a range of other variables potentially related to crash risk. The main outcome measure was hospitalization or death of a vehicle occupant due to car crash injury. Acute marijuana use was significantly associated with car crash injury, after controlling for the confounders age, gender, ethnicity, education level, passenger carriage, driving exposure and time of day (OR 3.9, 95% CI 1.2-12.9). However, after adjustment for these confounders plus other risky driving at the time of the crash (blood alcohol concentration, seat-belt use, travelling speed and sleepiness score), the effect of acute marijuana intake was no longer significant (OR 0.8, 95% CI 0.2-3.3). There was a strong significant association between habitual use and car crash injury after adjustment for all the above confounders plus acute use prior to driving (OR 9.5, 95% CI 2.8-32.3). This population-based case-control study indicates that habitual use of marijuana is strongly associated with car crash injury. The nature of the relationship between marijuana use and risk-taking is unclear and needs further research. The prevalence of marijuana use in this driving population was low, and acute use was associated with habitual marijuana use, suggesting that intervention strategies may be more effective if they are targeted towards high use groups.

Predictors of Treatment Contact Among Individuals with Cannabis Dependence

Epidemiological studies have repeatedly shown that cannabis is the most commonly used illegal drug in the United States. Furthermore, individuals with cannabis dependence have high rates of comorbid substance use disorders and depression. A significant proportion of individuals with addictive disorders develop withdrawal symptoms, cannot control their drug use despite substantial adverse psychosocial consequences, and frequently have a coexisting psychiatric disorder. Nevertheless, only a minority of persons with cannabis dependence ever seek treatment. We were unable to locate epidemiological reports regarding treatment seeking behavior among persons with cannabis dependence. Epidemiological studies of populations with substance disorders have observed that employment, higher educational level, previous use of treatment, major depression, and a co‐occurring substance dependency increased the probability of seeking treatment for alcohol dependence. Thus we hypothesized that the same variables would predict service use among persons with cannabis dependence. The main findings of this study were that persons with cannabis dependence were more likely to contact a professional during the past year if they previously sought treatment and had alcohol dependence with major depression. Prospective, longitudinal studies of adolescents would increase our understanding of the processes by which individuals identify themselves as having problems related to their habitual use of marijuana, and why some seek help while others do not.

Coronary no-flow and ventricular tachycardia associated with habitual marijuana use

A 34-year-old man reported heart fluttering and near syncope a few hours after marijuana smoking. In the emergency department, he was found to have a right bundle-branch–type ventricular tachycardia. The patient underwent a successful electric cardioversion. Coronary angiography showed no pericardial artery stenosis yet very slow coronary blood flow. Clinical tachycardia was also inducible in the electrophysiologic laboratory. After verapamil therapy and cessation of marijuana, his coronary flow normalized and ventricular tachycardia was no longer inducible in the electrophysiologic laboratory. Marijuana use might affect coronary microcirculation and cause ventricular tachycardia. Verapamil therapy and cessation of smoking might be curative.

Effects of Smoked Marijuana on the Lung and Its Immune Defenses

Abstract Habitual marijuana smoking may cause a number of potentially harmful effects on the lung, including the following: (1) acute and chronic bronchitis; (2) extensive histopathologic alterations in the cells lining the bronchial passages that could impair mucociliary clearance or predispose to malignancy; (3) increased accumulation of inflammatory cells (alveolar macrophages) in the lung; and (4) impairment in the function of these important immune-effector cells, including their ability to kill microorganisms and to produce protective pro-inflammatory cytokines. The major potential pulmonary consequences of habitual marijuana use are pulmonary infection and respiratory cancer. Infectious complications could be due to smoking-related damage to the muco-ciliary clearance mechanism, marijuana-related impairment in the antimicrobial function of alveolar macrophages and/or fungal or bacterial contamination of marijuana. Patients with pre-existing immune deficits due to AIDS could be particularly suscepti...

Effects of Marijuana on the Lung and its Defenses against Infection and Cancer

Habitual marijuana use may lead to the following effects on the lung: (1) acute and chronic bronchitis; (2) extensive microscopic abnormalities in the cells lining the bronchial passages, some of which may be pre-malignant; (3) overexpression of molecular markers of progression to lung cancer in bronchial tissue; (4) abnormally increased accumulation of inflammatory cells (alveolar macrophages) in the lung; and (5) impairment in the function of these immune-effector cells (reduced ability to kill micro-organisms and tumour cells) and in their ability to produce protective inflammatory cytokines. Clinically, the major pulmonary consequences that may ensue from regular marijuana use are pulmonary infections and respiratory cancer. Infections of the lung are more likely in marijuana users due to a combination of smoking-related damage to the ciliated cells in the bronchial passages (the lung's first line of defense against inhaled micro-organisms) and marijuana-related impairment in the function of alveolar macrophages (the principal immune cells in the lung responsible for defending it against infection). Patients with pre-existing immune deficits due to AIDS or cancer chemotherapy might be expected to be particularly vulnerable to marijuana-related pulmonary infections. Furthermore, biochemical, cellular, genetic, animal and human studies all suggest that marijuana may be an important risk factor for the development of respiratory cancer. However, proof that habitual use of marijuana does in fact lead to respiratory cancer must await the results of well-designed case-control epidemiologic studies that should now be feasible after the passage of 30 years since the initiation of widespread marijuana use among young individuals in our society in the mid-1960s.

Heavy habitual marijuana smoking does not cause an accelerated decline in FEV1 with age.

To assess the possible role of daily smoking of marijuana in the development of chronic obstructive pulmonary disease (COPD), we evaluated the effect of habitual use of marijuana with or without tobacco on the age-related change in lung function (measured as FEV1) in comparison with the effect of nonsmoking and regular tobacco smoking. A convenience sample of 394 healthy young Caucasian adults (68% men; age: 33 +/- 6 yr; mean +/- SD) including, at study entry, 131 heavy, habitual smokers of marijuana alone, 112 smokers of marijuana plus tobacco, 65 regular smokers of tobacco alone, and 86 nonsmokers of either substance were recruited from the greater Los Angeles community. FEV1 was measured in all 394 participants at study entry and in 255 subjects (65 %) on up to six additional occasions at intervals of > or = 1 yr (1.7 +/- 1.1 yr) over a period of 8 yr. Random-effects models were used to estimate mean rates of decline in FEV1 and to compare these rates between smoking groups. Although men showed a significant effect of tobacco on FEV1 decline (p < 0.05), in neither men nor women was marijuana smoking associated with greater declines in FEV1 than was nonsmoking, nor was an additive effect of marijuana and tobacco noted, or a significant relationship found between the number of marijuana cigarettes smoked per day and the rate of decline in FEV1. We conclude that regular tobacco, but not marijuana, smoking is associated with greater annual rates of decline in lung function than is nonsmoking. These findings do not support an association between regular marijuana smoking and chronic COPD but do not exclude the possibility of other adverse respiratory effects.

Decreased serum cotinine levels in smokers of both tobacco and marijuana as compared with smokers of tobacco only

Serum and salivary cotinine levels were determined in tobacco smokers (n=125) tobacco (n=47) or who smoked both marijuana and tobacco (n=78) as part of a field study of the pulmonary effects of heavy, habitual use of marijuana alone or with tobacco. After adjustment for current daily amount of tobacco use and time since the last tobacco cigarette was smoked, the smokers of both marijuana and tobacco were found to have lower levels of cotinine then those who smoked only tobacco, in serum [258±113 ng/ml (S.D.) and 332±109, respectively; p=0.003] and in saliva (331±170 and 395±170, respectively; p=0.058). Serum cotinine showed a significantly negative relationship to the daily amount of marijuana currently smoked ( p=0.026). Possible explanations include inhibition by marijuana component(s) of the enzymes that participate in the conversion of nicotine to cotinine, differences in nicotine absorption patterns between the two groups of tobacco smokers, and acceleration of cotinine metabolism by marijuana smoking. Carefully controlled pharmacokinetic studies, not possible in a large-scale survey such as this one, are required both to confirm the differences in blood cotinine levels observed between the dual smokers of tobacco only and to define more clearly nicotine-marijuana interactions.

Laboratory Detection of Marijuana Use

Frequent smoking of cannabis (marijuana) has been shown to be associated with a decline in social, mental, and perceptual skills and, during adolescence, with maladaptive emotional development. Urinalysis for the detection of such use can be a useful tool for the physician responsible for treatment and counseling of adolescents who develop habitual use of marijuana. Primary methods for urinalysis detection of cannabis use include the homogeneous enzyme immunoassay (EMIT) and the radioimmunoassay. These and other methods are discussed along with the issues of "false" results (both positive and negative) and the "limits of interpretation" that can be placed on a positive urine result. The pharmacokinetics and metabolism of the active constituents of cannabis are described as well as the interpretation of urinalysis results as they relate to use patterns. Guidelines are presented for the primary care physician for selecting candidates for such testing and for the use of such tests in the treatment or counseling of adolescents for whom marijuana abuse has become a psychological and social problem.