History Of Marijuana Use Research Articles

Health concerns, access to care, and trust in research and researchers among community members with bipolar disorder

BackgroundData are needed on differences in community-dwelling populations with bipolar disorder (BP) regarding trust in research and access to care. We characterized community members by lifetime history of bipolar disorder. We hypothesized that those with BP would have less trust in research, visit a health provider less, and participate less in research than those without BP. We also hypothesized that those with BP would be more likely to have a history of marijuana (MJ) use.MethodsA cross-sectional design was used for this analysis. The study population consisted of 12,489 members (78.0%) from the HealthStreet community engagement program who were interviewed by a Community Health Worker about health history and demographics.ResultsAmong the sample, the rate of BP was 10.6% (n = 1326). Those reporting BP were more likely than those who did not (n = 11,163), to report muscle, bone, and mental health problems, to be younger, female, to have visited the doctor in the past 12 months, to be interested in participating in research, and be current MJ users. Trust did not differ between BP groups.ConclusionsOur analysis found that persons with BP had higher access to care and more interest in research, thus our primary hypothesis was rejected. Our secondary hypothesis, that persons with BP were more likely to have a history of MJ use was upheld. These findings are important because they address a crucial gap in the literature surrounding BP and lay the groundwork for future community-level research.

Drug Use Stigma and Public Preferences for Public Health Versus Legal System Responses

This study explored what perceptions and beliefs about substances and substance users, personal experiences, and network experiences with substance use were related to people’s preferences for public health and legal system responses to substance use. Social context was also considered, including location of residence, political ideology, and a sense of insecurity. Data were from the Nebraska Annual Social Indicators Survey, a cross-sectional omnibus mail survey of public attitudes in Nebraska, conducted in fall 2021. Approximately 1700 adults completed the survey. Controlling for demographic characteristics, the study found stigmatized attitudes about substance use, limited or no personal history with substance use, rural residence, and political conservatism were associated with more support for legal system responses. In contrast, less stigmatized attitudes about substance use, personal history of marijuana use, urban residence, political liberalism, and a sense of security were all associated with more support for public health responses.

Pedestrians injuries in the north east region of Jamaica: a cross sectional study

ABSTRACT To describe the sociodemographic data of injured pedestrians, temporal patterns of injury, injury patterns, and the independent predictors of hospital admission. A two year cross-sectional study was conducted at the Saint Ann’s Bay Regional Hospital in pedestrians with injuries post collision with a motor vehicle. A census was performed in all patients who received either emergency room treatment, hospital admission, or surgical intervention. A 30-item interviewer questionnaire was administered to collect the data. A logical regression model was used to determine independent predictors for hospital admission. Ninety pedestrians were included. Age range: 6-86 years old (Mean=39.9). Males were 63.3%, 75.6% were employed, 31% had a chronic illness and 27% reported marijuana use. Most injuries occurred in April, lowest injury rates occurred in August and September. Twenty two percent of collisions occurred on Saturdays. Most injuries occurred at 5pm and 3pm. Many (54.4%) had a fracture, 73.5% were closed. Approximately 32% had contusions and 6.7% had lacerations. Independent predictors of admission were history of marijuana use and having a fracture. Those with history of marijuana use were 4.21 times more likely to be admitted. Those with fractures were 7.10 times more likely to be admitted. Injury patterns spanned a wide age range. They often involved a high energy mechanism of injury as evidenced by the frequency of fractures, hospital admission and surgery intervention rates. The data also suggests a need to implement marijuana testing programmes in our road users.

Marijuana use among community-dwelling older adults: A population-based study.

There is a paucity of population-level data on marijuana use and mental health and functioning in older adults. We analyzed cross-sectional data (n=910) from a well-characterized cohort, the Monongahela-Youghiogheny Healthy Aging Team (MYHAT) study. MYHAT is an age-stratified random sample of the population age 65years and older from a small-town in the USA. Half the sample was female and half were over 75 (Mean age=77). Most participants were non-Hispanic White. Marijuana use was assessed by self-report and symptoms of mood disorders were screened using the modified Centers for Epidemiological Studies-Depression Scale and the Generalized Anxiety Disorder screener. Cognition was assessed by the Mini-Mental State Examination and a neuropsychological test battery; functioning using the OARS Activities of Daily Living and Instrumental Activities of Daily Living; and overall assessment using the Clinical Dementia Rating (CDR®). One in five MYHAT participants had a history of marijuana use and 5% reported recent use, primarily for pain (41%) and recreation/relaxation (37%). Recent use was associated with cigarette and alcohol use, symptoms of depression or anxiety, and impairments in attention. Twenty-percent of community-dwelling older adults living in a US state where recreational marijuana use is illegal had a history of marijuana use. Recent marijuana use was less common but, consistent with prior research, associated with other substance use and poorer mental health.

Impact of deceased organ donor marijuana use on donor culture positivity and solid organ transplant recipient outcomes

With the increasing prevalence of marijuana use in the US, many deceased organ donors have a history of marijuana use, raising concerns about infectious risks to transplant recipients. We performed a multicenter retrospective cohort study in which exposed donors were those with recent marijuana use (in the prior 12 months) and unexposed donors were those with no recent marijuana use. Primary outcomes included the following: (1) positive donor cultures for bacteria or fungi, (2) recipient infection due to bacteria or fungi within 3 months posttransplant, and (3) recipient graft failure or death within 12 months posttransplant. Multivariable regression was used to evaluate the relationship between donor marijuana use and each outcome. A total of 658 recipients who received organs from 394 donors were included. Recent marijuana use was not associated with donor culture positivity (aOR: 0.84, 95% CI: 0.39-1.81, P = .65), recipient infection (aHR: 1.02, 95% CI: 0.76-1.38, P = .90), or recipient graft failure or death (aHR: 1.65, 95% CI: 0.90-3.02, P = .11). Our data suggest that organs from donors with a history of recent marijuana use do not pose significant infectious risks in the early posttransplant period.

Immunoassay Urine Drug Testing among Patients Receiving Opioids at a Safety-Net Palliative Medicine Clinic

Background: Few studies have examined the use of immunoassay urine drug testing of cancer patients in palliative care clinics. Objectives: We examined the frequency of immunoassay urine drug test (UDT) abnormalities and the factors associated with aberrancy at a safety-net hospital palliative medicine clinic. Methods: A retrospective review of the electronic medical records of consecutive eligible patients seen at the outpatient palliative medicine clinic in a resource-limited safety-net hospital system was conducted between 1 September 2015 and 31 December 2020. We collected longitudinal data on patient demographics, UDT findings, and potential predictors of aberrant results. Results: Of the 913 patients in the study, 500 (55%) underwent UDT testing, with 455 (50%) having the testing within the first three visits. Among those tested within the first three visits, 125 (27%) had aberrant UDT results; 44 (35%) of these 125 patients were positive for cocaine. In a multivariable regression model analysis of predictors for aberrant UDT within the first three visits, non-Hispanic White race (odds ratio (OR) = 2.13; 95% confidence interval (CI): 1.03–4.38; p = 0.04), history of illicit drug use (OR = 3.57; CI: 1.78–7.13; p < 0.001), and history of marijuana use (OR = 7.05; CI: 3.85–12.91; p < 0.001) were independent predictors of an aberrant UDT finding. Conclusion: Despite limitations of immunoassay UDT, it was able to detect aberrant drug-taking behaviors in a significant number of patients seen at a safety-net hospital palliative care clinic, including cocaine use. These findings support universal UDT monitoring and utility of immunoassay-based UDT in resource-limited settings.

A Suspected Case of Carbon Monoxide Poisoning Consistent with Fentanyl Toxicity.

A 28-year-old male with a history of marijuana use presented to an outside hospital with acute bilateral hearing loss, confusion, bleeding from the mouth, and inability to stand. Cardiac troponin (cTn) I was 3.55 ng/mL (<0.05 ng/mL), and B-natriuretic peptide (BNP) was 197 pg/mL (<100 pg/mL). Conversely, the electrocardiogram scans showed no evidence of ischemic or injury pattern, and chest X-rays were unremarkable, decreasing the probability of acute coronary syndrome. Drugs of abuse were suspected, and urine drug testing by immunoassay was ordered. At the admission hospital, immunoassay urine drug screen results were negative for amphetamines, barbiturates, benzodiazepines, tetrahydrocannabinol, cocaine, methadone, phencyclidine, and opiates. It should also be noted that no opioids/opiates, including fentanyl, were administered at the admission hospital. Aspartate aminotransferase (AST) was 2444 U/L (13–62 U/L), and alanine transaminase (ALT) was 1959 U/L (8–70 U/L). The uric acid level was 11.1 mg/dL (3.5–7.2 mg/dL), blood urea nitrogen was 36 mg/dL (7–22 mg/dL), creatinine was 4.05 mg/dL (0.60–1.30 mg/dL), and creatinine kinase was 48 073 U/L (63–473 U/L). His white blood cell count was high at 10.8 K/µL (4.16–9.95 K/µL), with a high automated neutrophil percentage of 89%. Venous blood gas pH was 7.36 (7.30–7.40), pO2 was 26 mmHg (30–40 mmHg), pCO2 was 44 mmHg (41–51 mmHg), and HCO3 25 mEq/L (23.0–31.0 mmol/L).

Cannabis Unveiled: An Exploration of Marijuana’s History, Active Compounds, Effects, Benefits, and Risks on Human Health

Marijuana, also known as cannabis, is a psychoactive drug that comes from the Cannabis plant. Marijuana can be smoked, vaporized, or consumed through edibles in a variety of ways. Perception changes, changes in mood, and problems with coordination are all possible side effects. Marijuana is used for both recreational and medical purposes to treat a variety of health conditions. The literature review on the effects of marijuana on the human body has increased in recent years as more states legalize its use. It is important to investigate the benefits and harmful effects of marijuana on individuals due to the widespread use of cannabis-derived substances like marijuana for medical, recreational, and combined purposes. The paper will review different aspects of marijuana in 4 main domains. A thorough discussion of marijuana’s definition, history, mechanism of action, pharmacokinetics, and effects on human cells will be given in the first domain. The second domain will concentrate on marijuana’s negative effects, while the third domain will look at marijuana’s possible positive impacts, such as its usage in controlling multiple sclerosis, treating obesity, lowering social anxiety, and managing pain. The fourth domain will concentrate on marijuana’s effects on anxiety, educational attainment, and social consequences. Additionally, this paper also will provide a highlight of the history of marijuana use and governmental legislation, both of which play a significant role in determining how the public views marijuana. In conclusion, this paper provides a comprehensive review of marijuana’s effects, which may be of interest to a large readership. This review adds to the continuing discussion about the use of marijuana by analyzing the data that is currently available about the possible advantages and disadvantages of marijuana usage.

1161: CANNABIS INTOXICATION: A RARE CAUSE OF LACTIC ACIDOSIS

Introduction: Lactic acidosis is common in critically ill patients and has a variety of etiologies. While sepsis, hemorrhage, and shock are the most common causes of lactic acidosis, a subset of patients have no obvious cause. Drug and medication toxicity remains a rare cause of lactic acidosis that providers often fail to recognize. Here, we present a rare case of lactic acidosis due to acute marijuana intoxication. Description: A 26-year-old male with no prior history of marijuana use was brought into the emergency department with complaints of shortness of breath and palpitations after ingesting ice cream containing cannabis. Per EMS, the patient was found screaming for help due to his symptoms but evidently with altered mentation. On arrival, the patient was febrile to 101.9 F with a heart rate of 156 bpm; he was normotensive and saturating well on room air with a normal respiratory rate. Laboratory studies were significant for an elevated lactate level of 4, a white blood cell count of 11, and a urine drug screen positive for THC. The patient was given empiric broad-spectrum antibiotics, 2 liters of lactated ringer’s, and IV naloxone with no improvement in mental status. Studies and physical examination did not reveal any source of infection. After careful monitoring, the patient’s mental status recovered and lactic acid cleared with supportive measures. The patient was later discharged safely home with appropriate follow-up. Discussion: Poisoning is one of the leading causes of injury-related casualties in the United States, and lactic acidosis is a widely used predictor to stratify patients who are at increased risk for mortality. Elevated lactate levels result from an imbalance between lactate metabolism and production. Synthetic cannabinoids have been established as rare causes of lactic acidosis. Chronic marijuana use has been associated with lactic acidosis by way of thiamine deficiency and gastrointestinal beriberi corrected promptly with vitamin administration. There are no reported cases linking acute marijuana use and lactic acidosis development in the absence of infection, hemodynamic compromise, or seizures. It is important to keep drug ingestion and intoxication in mind as important causes of lactic acidosis in the absence of other apparent etiologies.

Central stress response among deprived and continuing marijuana users and nonusers.

We examined central nervous system [CNS] stress responses among deprived and continuing heavy marijuana users and nonusers. Participants (N = 210; 46.7% female; Mage = 21.99; 91.4% White, 94.3% Non-Hispanic) were heavy marijuana users (N = 134) and nonusers (N = 76). Heavy users were randomly assigned to a 3-day marijuana deprivation condition (N = 68) or to continue using regularly (N = 66). Participants completed two threat-of-shock stressor tasks that manipulated stressor predictability by varying shock probability or timing. We measured central stress responses via startle potentiation (stressor conditions minus matched no-stressor condition). We examined two group contrasts (heavy use: all heavy users vs. nonusers; deprivation: deprived vs. continuing heavy users) on startle potentiation overall and moderated by stressor predictability (unpredictable vs. predictable). Deprivation did not affect startle potentiation overall (timing task: p = .184; probability task: p = .328) or differently by stressor predictability (timing task: p = .147; probability task: p = .678). Heavy use did not affect startle potentiation overall (timing task: p = .213; probability task: p = .843) or differently by stressor predictability (timing task: p = .655; probability task: p = .273). Posthoc analyses showed mixed evidence of general startle reactivity × deprivation interaction on startle potentiation overall (timing task: p = .019; probability task: p = .056) and differently by stressor predictability (probability task: p = .024; timing task: p = .364). A history of marijuana use or acute deprivation did not alter central stress responses despite prominent theoretical expectations. This study adds to growing research on central stress responses in individuals with a history of drug use and begins to parse moderating roles of individual differences and stressor characteristics. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Effect of Self-Reported Marijuana Use on Post-Operative Opiate Needs in The Spinal Fusion Surgery Patient

<h3>Introduction</h3> Legalization of recreational and medical marijuana is on the rise across the United States. As the popularity of cannabis is growing, more patients with a history of use are being seen in the hospital setting. <h3>Identification of the problem</h3> As nurses in the PACU and inpatient Orthopedic setting, we felt there was a correlation between patients' history of marijuana use and increased narcotic requirements. When we started to search for information on this topic, we found research was limited due to the federal illegality of marijuana. <h3>Purpose of the Study</h3> The purpose of this study was to determine if marijuana usage prior to spinal surgery affected post-operative opiate needs. We measured the usage of opiates by self-reported marijuana users postoperatively. <h3>Methodology</h3> The study design is correlational, investigating the relationship between the pre-operative marijuana use and post-operative narcotic need. We attended our Orthopedic Academy-Spinal Class to introduce our study. If the patients were willing to participate, they were asked to sign an informed consent and complete a survey regarding pain scores and at home pain management, which included marijuana use. Post operatively the EMR was reviewed, and all narcotic usage was documented and converted into milliequivalents of morphine. <h3>Results</h3> Once the conversions were complete, we studied the correlation between those who reported marijuana use (comparison group) with those who denied use (control group). Except for post op day 2, the comparison group received more narcotic than the control group. <h3>Discussion and Implications</h3> Nowknowing that a patient's history of marijuana use does play a role in narcotic requirements post operatively, it can help nurses better plan their care. When a patient reports marijuana use during the preoperative assessment, the nurse can advocate for multi-modal pain control to start preoperatively. Postoperatively, this knowledge can reinforce the importance of finding an appropriate pain management regimen. Personalized and detailed education on pain management after discharge may decrease risk of readmission for pain control. <h3>Conclusion</h3> With our finding we can better educate staff and patients to help optimize their post-operative pain management. More research is needed on this topic to help better understand the correlation and the implication marijuana use has on nursing care.

Recreational Marijuana Use Leading to Thrombosis in a Patient with Minimal Cardiovascular Risk Factors

Marijuana is one of the most commonly used psychotropic drugs in the United States. Recent legalization of cannabis and decriminalization in multiple jurisdictions in the United States has contributed to its increased availability and social acceptance, especially in young adults. The overall prevalence of cardiovascular disease in young adults has been increasing as a consequence of marijuana use. However, there remains a paucity of knowledge on its adverse effects, especially with regards to the cardiovascular system. Here, we present a case of a young adult with a history of marijuana use and minimal cardiovascular risk factors who presents following a seizure episode and was found to have coronary artery thrombosis. A high degree of suspicion, along with a better understanding of the biochemical pathways involved in cannabis associated myocardial ischemia is extremely important to treat this condition promptly and prevent fatal outcomes. After the legalization of cannabis in various states in the United States, there is an increasing need to understand and educate the public regarding health hazards, especially on the cardiovascular system.

Cannabis Use in Patients with Head and Neck Cancer and Radiotherapy Outcomes

<h3>Purpose/Objective(s)</h3> Marijuana use in the population is increasing as states continue to allow for both medicinal and recreational use. As such, the prevalence of marijuana use among patients presenting for treatment of head and neck cancer (HNC) is likely to increase as well. Anecdotally, patients are asking about marijuana use during cancer treatment and, to date, oncology professionals treating HNC are lacking sufficient data to aid in advising their patients on use during cancer care. Further, the impact of marijuana use on survival and local control in HNC is not well understood. The current study examines the associations between marijuana use and the management and outcomes in patients with HNC squamous cell carcinoma. <h3>Materials/Methods</h3> IRB approval was obtained for a retrospective evaluation in our institutional database. Two-hundred eighty patients with detailed psychosocial and substance abuse history who were treated with either definitive or adjuvant radiotherapy between August 2018 and March 2020 were included in the analyses. Overall survival (OS) and disease-free survival (DFS) were compared between current marijuana users and non-users using Kaplan-Meier curves and log-rank tests. <h3>Results</h3> 148 patients with HNC were included (mean age=62.1 yrs, SD=9.1), 78% were male, 73% were white, 22% were black. 62% of patients had SCCa of the oropharynx, 20% SCCa of the larynx, and 14% SCCa of the oral cavity. 51% were treated with definitive chemoradiotherapy, while 32% had primary surgery. 30% were current tobacco users and 70% had ever used tobacco (mean = 43.33 PY). 15% of patients reported marijuana use at time of initial diagnosis and 34% reported a history of marijuana use. Older patients and males were more likely to be currently using marijuana (p=.005 & p=.04, respectively). Current marijuana users were more likely to require narcotic pain medications and require a greater number of types of pain medications during treatment (p=0.002 and p=0.007, respectively). There were no differences between current and historical/never users on self-reported worst pain, weight loss or enteral feeding tube use during treatment, or objective measures of treatment toxicity. Additionally, there were no other significant differences between current or historical/never users were found on cancer variables or primary treatment type. <h3>Conclusion</h3> Marijuana use in patients with HNSCCa is common and little is known about patient and oncological outcomes. There were no significant differences between current and past marijuana users and non-users on clinicopathological variables, adherence, or oncologic outcomes. Marijuana use in HNC may result in more difficulty managing pain during treatment. Further research is needed to better understand marijuana use during cancer treatment, particularly frequency and method of use (i.e., smoking vs. edibles/oils), outcomes, and quality of life.

A 17-Year-Old Girl with a Recent History of Marijuana Use Presented with Pneumomediastinum and Pneumopericardium and Tested Positive for SARS-CoV-2 Infection on Hospital Admission

Patient: Female, 17-year-oldFinal Diagnosis: Pneumomediastinum • pneumopericardiumSymptoms: Abdominal pain • diarrhea • nausea • vomitingMedication: —Clinical Procedure: Recovered • symptomatic and supportive careSpecialty: Pediatrics and NeonatologyObjective:Unusual clinical courseBackground:Pneumomediastinum and pneumopericardium have been reported to occur in people who regularly smoke marijuana and have also been reported in patients with COVID-19 pneumonia due to infection with SARSCoV-2. This report is of a 17-year-old girl with a history of marijuana use who presented with pneumomediastinum and pneumopericardium and was found to be positive for SARS-CoV-2 infection on hospital admission by Abbott ID NOW testing.Case Report:A 17-year-old girl presented to the emergency room with a 3-day history of abdominal pain, nausea, and vomiting and a 1-day history of diarrhea. She had a history of daily marijuana use and lived with her grandmother who was presumed to be positive for COVID-19, based on symptoms. Her admission laboratory results were unremarkable except for pyuria, which was suspicious for urinary tract infection. The patient’s nasopharyngeal swab was positive for SARS-CoV-2 infection. Owing to abdominal pain, a computed tomography (CT) scan of the abdomen and pelvis was obtained, which was concerning for pneumomediastinum and pneumopericardium. A CT scan of the thorax confirmed the findings. A contrast-enhanced barium esophagogram was performed and was unremarkable. The patient was admitted to the pediatric intensive care unit for observation and supportive care.Conclusions:This report shows the importance of current testing for SARS-CoV-2 infection in patients of all ages who present acutely to the hospital. It also highlights the importance of obtaining a full social and medical history so that symptoms and signs from causes other than SARS-CoV-2 infection are not missed.

Marijuana use among adult liver transplant candidates and recipients.

Data regarding marijuana (MJ) use among liver transplant (LT) candidates are limited. We set out to determine the incidence and pre- and post-LT outcomes of adult LT candidates with a self-reported history of MJ use. Baseline clinical characteristics, waitlist, and post-LT outcomes of adult LT candidates from January 2010 to March 2017 were compared. Among 2690 LT candidates, 630(23%) and 298(11%) reported a history of MJ use and use within the past 12months, respectively. Although the proportion of MJ users increased over time(β=.76, p=.03), the proportion listed and transplanted did not change. Listing for LT increased with male (OR 1.24, 95% CI 11.01-1.52), MELD score (OR 1.08, 95% CI 1.01-1.15), HCC (OR 1.83, 95% CI 1.39-2.41) but decreased among MJ users (OR 0.67, 95% CI 0.50-0.91, p=.01). The median time to listing was longer among MJ users compared to non-users (115 vs. 87days, p<.0005). Post-LT survival was similar in 83MJ users and 306 non-users. The proportion of MJ users among LT candidates is increasing. MJ users have a greater burden of psychosocial issues which may contribute to longer evaluations and lower rate of LT listing. Post-LT survival was not impacted by self-reported MJ use history.

A Case of Three-Vessel Coronary Artery Disease Associated With Marijuana Use

Marijuana is one of the most popular psychotropic drugs among adolescents and young adults. With the recent surge in marijuana use across the United States, it is very important for physicians to understand the clinical implications associated with marijuana use. In this case report, we discuss a case of a young adult who presented to the emergency department with chest pain and was found to have three-vessel coronary artery disease (CAD). The patient did not have any significant past medical history or family history of cardiac diseases but reported a significant history of marijuana use. This case report aims to add to the growing area of research on the association between myocardial infarction (MI) and marijuana use.

Treatment of Cannabinoid Hyperemesis Syndrome-Associated Nausea with Haloperidol: A Case Report

Introduction: Because of the rising prevalence of cannabis abuse, cannabinoid hyperemesis syndrome (CHS) was recognized as a new medical diagnosis in 2004. Despite the syndrome’s growing prevalence, many providers are unfamiliar with its diagnosis and treatment, and there is little data to back up clinical knowledge and treatment recommendations. For many years, haloperidol has been widely used as an antiemetic, despite a lack of evidence-based clinical data on efficacy and side effects. We present the case of a female who presented to the emergency room with suspected CHS and was treated with haloperidol. Case: A 34-year-old African-American woman with diabetes and a history of marijuana use presented to the emergency department with refractory nausea and vomiting. Her urine drug screen came back positive for THC, but she denied using marijuana prior to this admission. She stated that she was following her current medication regimen. She denied drinking alcohol and smoking cigarettes. Multiple doses of ondansetron, promethazine, scopolamine, and metoclopramide had no effect on the patient. After two days of treatment with haloperidol 5 mg by mouth every 8 hours, nausea and vomiting subsided. Discussion: Haloperidol was able to control nausea and vomiting in six previous case reports of CHS. However, haloperidol was administered intravenously in five of the reports, and the route of administration was not specified in the sixth. To the best of our knowledge, we are the first to demonstrate the benefit of oral haloperidol for CHS. Conclusion: Although cessation of marijuana use is required for long-term resolution of CHS, our case and six others show the benefit of using IV haloperidol for acute management and oral for relapse prevention. More extensive clinical trials are needed to confirm haloperidol’s therapeutic role in patients presenting with CHS symptoms.

Marijuana use–induced spontaneous pneumomediastinum

The presence of air in the mediastinum is a rare finding called pneumomediastinum. Spontaneous pneumomediastinum is typically benign. Marijuana use has been rarely reported to cause pneumomediastinum. Our case series presents two young men with no significant past medical history who had a history of marijuana use and developed pneumomediastinum after multiple episodes of intractable vomiting. The pathophysiology of spontaneous pneumomediastinum in marijuana users includes cyclic vomiting or microperforation of the esophagus or barotrauma during breathing maneuvers. Most cases can be managed conservatively.

S3545 Pneumomediastinum and Pneumopericardium in a Teenager With Coronavirus Disease 2019 (COVID-19)

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has been declared pandemic by the World Health Organization (WHO) with the rapidly increasing number of infectious cases. The current literature is deficient regarding pediatric population data. We report a case of a seventeen-year-old female, known history of marijuana use, presented to the emergency department with complaints of abdominal pain, nausea, and vomiting and was found to have pneumopericardium and pneumomediastinum. CASE DESCRIPTION/METHODS: The patient presented to the emergency room with a three days history of abdominal pain, nausea, and vomiting and one day history of diarrhea. She lived with her grandmother who was presumed to be COVID-19 positive based on symptoms. Her admission labs revealed pyuria suspicious for urinary tract infection. The remainder of her serology was unremarkable. Patient’s nasal swab was PCR positive for SARS-CoV-2. Due to abdominal pain, a CT-Scan of the abdomen and pelvis was obtained which was concerning for pneumomediastinum and pneumopericardium. CT-scan thorax confirmed the findings and revealed extensive subcutaneous emphysema in the neck soft tissue. Contrast Barium Esophagogram was done which was unremarkable, without any extraluminal contrast leakage. The patient was admitted to the pediatric intensive care unit for observation and supportive care. DISCUSSION: The patient recovered to her baseline with the supportive treatment and did not require any respiratory support during the hospital stay.

Marijuana Use, Sexual Behaviors, and Prevalent Sexually Transmitted Infections Among Sexually Experienced Males and Females in the United States: Findings From the National Health and Nutrition Examination Surveys.

Several national guidelines consider illicit drug use as an indication for testing and/or counseling for some sexually transmitted infections (STIs). The legal and social landscape of marijuana use is changing, and its relevance with STI risk is unclear. Sex-specific prevalence of T. vaginalis and/or C. trachomatis infection was examined by past-year marijuana use (no vs yes) among 2958 sexually experienced, 20- to 39-year-old participants of the 2013-2016 National Health and Nutrition Examination Surveys. Prevalence ratios (PRs) with 95% confidence intervals [CIs] were estimated by Poisson regression. Adjusted PRs (aPR) were estimated following propensity score covariate-adjustment accounting for sociodemographics, alcohol use, injection drug use, depression, and age at sexual debut. Past-year marijuana use was reported by 27.3% and 36.3% of females and males, respectively. Male and female past-year marijuana users were more likely to have new and multiple sexual partners in the past year (P < 0.05). Past-year marijuana use was associated with prevalent C. trachomatis and/or T. vaginalis infection among females (7.4% vs. 2.9%; PR, 2.57 [95% CI, 1.62-4.07]) and males (4.0% vs. 1.1%; PR, 3.59 [95% CI, 1.96-6.58]), but this association was attenuated after propensity score covariate adjustment among females (aPR, 1.15 [95% CI, 0.72-1.83]) and males (aPR, 2.10 [95% CI, 0.88-5.02]). Additional adjustment for new or multiple sexual partners further attenuated the associations (aPRs, 1.02 [95% CI, 0.65-1.51] and 1.91 [95% CI, 0.82-4.47] for females and males, respectively). Sexually transmitted infection prevalence was higher among persons with a past-year history of marijuana use; however, this association was not significant after accounting for measured confounders. Additional work is needed to characterize STI prevalence by the mode, duration, and frequency of marijuana use.