Marijuana Users Research Articles

Survey: Societal norms more impactful than policy on marijuana use patterns

A newly published study based on a survey of European marijuana users makes the argument that a country's policies toward drug use are not a primary driver of individuals' using habits. The survey's results suggest that even in countries with the most liberal policies toward recreational use, many of those who use marijuana engage in self‐regulation based on societal norms.

Association between secondhand marijuana smoke and respiratory infections in children.

Little is known about the effects of secondhand marijuana smoke on children. We aimed to determine caregiver marijuana use prevalence and evaluate any association between secondhand marijuana smoke, childhood emergency department (ED) or urgent care (UC) visitation, and several tobacco-related illnesses: otitis media, viral respiratory infections (VRIs), and asthma exacerbations. This study was a cross-sectional, convenience sample survey of 1500 subjects presenting to a pediatric ED. The inclusion criteria were as follows: caregivers aged 21-85 years, English- or Spanish-speaking. The exclusion criteria were as follows: children who were critically ill, medically complex, over 11 years old, or using medical marijuana. Of 1500 caregivers, 158 (10.5%) reported smoking marijuana and 294 (19.6%) reported smoking tobacco. Using negative-binomial regression, we estimated rates of reported ED/UC visits and specific illnesses among children with marijuana exposure and those with tobacco exposure, compared to unexposed children. Caregivers who used marijuana reported an increased rate of VRIs in their children (1.31 episodes/year) compared to caregivers with no marijuana use (1.04 episodes/year) (p = 0.02). Our cohort did not report any difference with ED/UC visits, otitis media episodes, or asthma exacerbations, regardless of smoke exposure. However, caregivers of children with secondhand marijuana smoke exposure reported increased VRIs compared to children with no smoke exposure. Approximately 10% of caregivers in our study were regular users of marijuana. Prior studies have shown that secondhand tobacco smoke exposure is associated with negative health outcomes in children, including increased ED utilization and respiratory illnesses. Prior studies have shown primary marijuana use is linked to negative health outcomes in adults and adolescents, including increased ED utilization and respiratory illnesses. Our study reveals an association between secondhand marijuana smoke exposure and increased VRIs in children. Our study did not find an association between secondhand marijuana smoke exposure and increased ED or UC visitation in children.

Recurrent Marijuana Induced Myocarditis: A Case Report

Thirty-Three states in the US have passed laws to legalize marijuana usage, increasing its prevalence by 50% within the last year. Though society generally regards cannabis as safe, the exponential increase in users can evince dangerous side effects in patients presenting to physicians, such as the case presented below. A 37-year-old female presented to the ED with chest pain and an initial troponin of 24 that peaked at 29. The coronary arteries were found to be angiographically normal. She was discharged without any definitive diagnosis. Now 38, she again presented with complaints of crushing, substernal chest pain radiating down her left arm, unrelieved by nitro. Since the onset of pain, she progressively developed shortness of breath, nausea, diaphoresis, and anxiety, stating that she felt like she “was going to die.” Her presentation and impending sense of doom were ominous harbingers for a myocardial infarction; concerns that were validated with an initial troponin of 11.4. EKG showed normal sinus rhythm with nonspecific ST changes. CT Angiogram showed no evidence of pulmonary thrombo-embolism or dissection. Significant CAD leading to this extent of troponin elevation was not suspected as the patient had a normal angiogram a year prior. Stress-Induced Cardiomyopathy was unlikely based on the unremarkable echocardiogram findings. Coronary-Thrombus was considered, however, the hypercoagulable workup was negative along with lack of coronary thrombus on prior angiogram. Under these circumstances, the only explanation for the extent of troponin elevation was myocarditis. Viral infections are the most common cause of myocarditis, however the patient denied any associated symptoms. After ruling out viral etiologies, we subsequently evaluated and eliminated rheumatological disorders and medication-induced myocarditis. The patient’s history revealed that she led a healthy lifestyle, but had struggled with chronic back pain, which led to her cannabis use. By the time of her admission, she smoked up to 1.5 grams of cannabis a day, and stated that chest pain began immediately following smoking cannabis. Her previous episodes also correlated with her cannabis usage. Given the strong correlation of the patient’s symptoms with cannabis use, we theorized her cardiac stress was resultant from it, and recommended that she discontinue its use. To date there have been four reported cases of cannabis-induced myocarditis, making this a fifth case. Of note, the contaminants of marijuana may be variable and include substances like aluminum from soil or pesticides in grass that could traverse the marijuana plant. Inhaling such components has been correlated with an upregulation of cannabinoid receptors in platelets, vascular smooth muscle, and endothelium. CB1R activation has been observed to induce oxidative stress, inflammation, and fibrosis of the cardiomyocyte. With increased cannabis use, it is imperative that we document adverse events to definitively connect its use to cardiac damage.

Taxing Disability: A Critical Look into the Medical Cannabis Regime under the New Cannabis Act, 2018

Medical marijuana users represent many people with disabilities in Canada. Recent legislative attempts have allowed people with disabilities to access cannabis as medicine, however the landscape is ever changing. The Cannabis Act was recently introduced, legalizing marijuana for all; however, people with disabilities have not been accounted for when it comes to the issue of access to medicine. Those who rely on cannabis as medicine and those who enjoy it recreationally are now part of the same system, for better or worse. The new medical marijuana regime, under the new Cannabis Act, boasts a “two-stream” process, and it claims that it will be maintaining and improving the old medical regime alongside the new recreational regime. The applicable taxes tell a different story. Medical marijuana has always been subject to sales tax despite being effectively prescribed by doctors to manage and treat many disabilities and illnesses. Now, with the enactment of the Cannabis Act, medical marijuana is subject to an excise tax too—colloquially known as the “sin tax.” Recreational and medical marijuana are subject to the same taxation scheme, making any notion of a “two-stream” process nonsensical and blatantly unfair. The purpose of this article is to provide insight into the varying faults concerning the medical marijuana regime in Canada, with specific emphasis on the issue of taxation. In the simplest terms, taxing medical marijuana is taxing medicine and effectively taxing people with disabilities. Broken down into five parts, this article discusses the underlying reasons for the taxes surrounding medical marijuana, provides a case study of the most important tax case for medical marijuana users, scrutinizes the lack of recognition of medical marijuana as a proper prescription, outlines the ways to improve legislation, and, finally, explores a potential Charter challenge that can be effectively brought against this taxation.

Why do Americans use marijuana?

BackgroundMarijuana is the most commonly used illicit drug in the United States; yet, little is known about why adults use it. We examined the prevalence of past-month marijuana use by users’ reasons for use—medical, recreational, and both—and identified correlates of each group. MethodsData from 20 states, which participated in the 2017–2019 Behavioral Risk Factor Surveillance System and fielded the marijuana use module, and multinomial logistic regression analysis were used to identify risk factors for past-month marijuana use by reason for use. User profiles were developed to illustrate how states’ policy environments influenced reported reasons for use. ResultsThe average predicted probabilities of past-month marijuana use for medical, recreational, and both reasons were 28.6 %, 38.2 %, and 33.1 %, respectively. Age, gender, marital and employment status, income, mode and frequency of administration, and health status were associated with reasons for use. The reasons that young adult males who were infrequent marijuana users and binge drinkers gave for their marijuana use varied by state policy environment—in legal states, the average predicted probabilities were 5.3 % lower for recreational reasons and 5.0 % higher for both reasons. Reported reasons for past-month marijuana use did not significantly differ by state policy environment among daily users who were older women in poor mental and physical health. DiscussionSignificant differences existed in the characteristics of past-month marijuana users by reasons for use. Our estimates can serve as a baseline against which post-legalization marijuana users’ reasons for use can be compared as state policy environments shift.

Daily Users of Marijuana with Sickle Cell Disease Report More Severe Pain Crisis Yet Have Similar Rates of Admission to Non-Users

▪Introduction: Pain in sickle cell disease (SCD) starts as episodes of recurrent pain and progresses to chronic pain with age. Pain is typically treated with opioids which are often insufficient. One reason for this may be that opioids likely do not effectively treat neuropathic or inflammatory pain in SCD. Cannabinoids, such as marijuana, alleviate neuropathic pain and reduce inflammation. Our SCD patients report marijuana improves their pain and studies in murine models of SCD show cannabinoids reduce mast cell activation, inflammation, and hyperalgesia. Medical marijuana is now legal in 28 states and 4 of them list SCD as a qualifying condition. However, there are minimal data on the use of marijuana in SCD. Thus, we performed a pilot study of adults with SCD who use daily marijuana. Our hypothesis was that daily marijuana users would have worse pain scores from non-daily users which drives their drug use. Our secondary hypotheses were that daily marijuana users may have decreased levels of opioid use, hospital utilization, quality of life measures (QoL) or inflammation.Methods: We conducted a cross-sectional pilot study of adults living with SCD who do and do not use daily marijuana. Subjects were enrolled at scheduled clinic visits, any subject not at their heathy baseline was excluded. Subjects were asked if they had used marijuana in the past 30 days, reasons for use, and rate of use. Subjects who reported daily use were compared to those who used less often or reported no marijuana use. Our primary outcome was pain as defined by Adult Sickle Cell Quality of Life measurement information system (ASCQ-Me) pain domains. ASCQ-Me has separate domains for pain crisis frequency, pain crisis severity, and 7-day pain interference which allows for measurement of both crisis pain and chronic pain. Our secondary outcomes were differences in hospital utilization, opioid use, QoL measures included in ASCQ-ME: sleep, stiffness, social impact and emotional impact, Patient Reported Outcome Measurement Information System domains for nausea and anxiety, and inflammation as demonstrated by WBC and platelet counts, C reactive protein (CRP), markers of mast cell and neutrophil activation and endothelial damage. Hospital utilization (total annual admissions and emergency room visits) was assessed by medical record review over a one-year period (1/1/2016 to 12/31/2016). Weekly opioid use was estimated by review of dispensed prescriptions using the Connecticut Prescription Monitoring Program converted into average weekly oral morphine equivalents. Flow cytometry was performed for levels of: neutrophils and activated neutrophils, monocytes, non-classical and inflammatory monocytes, circulating endothelial cells (CECs) and endothelial progenitor cells (EPCs). The R statistical software program was used to perform t-tests and Wilcoxon rank-sum tests where normality was not met to compare daily users to non-daily users. Significance was set at p<0.05.Results: We enrolled 29 subjects,16 (55%) of whom reported marijuana use in the past 30 days and of those 6 (21%) reported daily marijuana use. Pain relief was endorsed as a reason for marijuana use in 93% of users and 100% of daily users. There was no difference in mean age (32.0 SD 8.6 vs 32.4 SD 12.6 years p=1.0) or gender (% female: 67 vs 52% p=0.7) between groups. Daily marijuana users had higher pain crisis severity scores (61.7 vs 50.0 p=0.03). There was no significant difference in scores for pain crisis frequency, pain interference, or other QoL measures (Table). Daily users had similar median annual admissions and emergency room visits to non-daily users (1.0 (IQR 0.25-1.0) vs 2.0 (IQR 0 - 5.0) admissions p=0.3; 1.0 (IQR 0.25-1.75) vs 0 (IQR 0-1.5) ED visits p=0.6) and used similar doses of weekly opioids (274.5 [IQR 91.5-3447.9] vs 28.6 [IQR 3.03-135.6] mg weekly po morphine equivalents p=0.5). There were no differences in CRP, CBC, CECs or EPCs, or in levels of all neutrophils and monocytes types.Conclusion: In our pilot study, we found daily marijuana users reported more severe pain crisis, but had similar rates of hospital utilization and similar amounts of opioids dispensed. We posit that patients with more severe pain crisis may use daily marijuana to effectively treat their pain allowing them to have similar hospital and opioid utilization to those with less severe pain. Larger prospective studies should be performed to test these hypotheses. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Cannabinoids Tetrahydrocannabinol, Cannabinol, Cannabidiol, Tetrahydrocannabivarin and 11-nor-9-carboxy-∆9-THC in Hair.

The cannabinoids tetrahydrocannabinol (THC), tetrahydrocannabivarin (THCV), cannabidiol (CBD), cannabinol (CBN) and (-)-11-nor-9-carboxy-∆9-tetrahydrocannabinol (THC-COOH) were determined in 4,773 hair samples. Confirmation of THC-COOH was by GC-MS-MS (gas chromatography--mass spectrometry-mass spectrometry). Confirmation of THC, THCV, CBN and CBD was by LC-MS-MS (liquid chromatoraphy--mass spectrometry-mass spectrometry) on an AB Sciex QTRAP 6500+ LC-MS-MS. The purpose of this work was not to utilize any analyte other than THC-COOH as indicative of ingestion, but to assess the absence or presence, and relative concentrations, of the other cannabinoid analytes in hair of marijuana users vs. primarily CBD users. In this regard, 10% of samples contained significantly higher concentrations of CBD relative to THC than the other 90%. A concentration of CBD that is five times greater than that of THC was proposed as good evidence of primarily CBD ingestion. THC concentrations in the samples ranged from below the limit of detection (5 pg/mg) to 47,808 pg/mg hair, varying widely in the relationship between parent THC and the metabolite THC-COOH. CBN was present in most samples, but concentrations relative to THC decreased with increasing THC concentrations. Only 26% of the samples contained THCV detectable by the method. When present, THCV concentrations averaged 1.77% of THC. A limitation of this study is the lack of subject histories to determine the types and amounts of products used and the mode of ingestion. Also, not all THC from external contamination may be removed. Nonetheless, the data provide a useful guide as to what cannabinoids may be found in hair, at what concentrations and under conditions of marijuana use vs. likely primarily CBD use.

E-cigarette and marijuana use and the attainment of obesity prevention guidelines among U.S. adolescents.

The study objectives were to examine the associations of exclusive and dual use of e-cigarettes and marijuana and the attainment of the "Let's Go! 5-2-1-0" obesity prevention guidelines and perceptions of weight status among U.S. adolescents. Data from the 2017 Youth Risk Behavior Survey, a school-based nationally representative cross-sectional study, were analyzed (N=12,578). Participants were categorized based on their past 30-day e-cigarette and marijuana use as: non-users, exclusive e-cigarette users, exclusive marijuana users, and dual users. Adjusted logistic regression models were conducted. Of adolescents, 5.2% were exclusive e-cigarette users, 10.3% were exclusive marijuana users, and 7.4% were dual users. Compared to non-users, exclusive e-cigarette users were more likely (aOR=1.55, 95%CI=1.16-2.07) to meet the physical activity recommendation. Compared to dual-users, exclusive e-cigarette users were more likely (aOR=1.47, 95%CI=1.10-1.97) to meet the screen time recommendation. Compared to non-users, exclusive marijuana users were at increased odds to meet the fruit/vegetable recommendation (aOR=1.33, 95%CI=1.03-1.71), but were at decreased odds to meet the sugar-sweetened beverages recommendation (aOR=0.81, 95%CI=0.65-0.99). Compared to exclusive e-cigarette users, exclusive marijuana users were less likely to meet the screen time (aOR=0.71, 95%CI=0.54-0.93) and physical activity recommendations (aOR=0.60, 95%CI=0.43-0.84). Compared with dual users, exclusive marijuana users were more likely (aOR=1.38, 95%CI=1.01-1.88) to perceive themselves as slightly/very overweight. Compared to non-users, dual users were less likely to meet the sugar-sweetened beverages recommendation (aOR=0.63, 95%CI=0.46-0.87). Adolescent current marijuana users and dual users were less likely to meet obesity prevention guidelines. Prevention efforts are needed to reduce e-cigarette and marijuana use and increase adherence to these guidelines.

The relationship between income generation, increasing substance dependence and the risk of relapse: a cross-sectional study of drug treatment facilities

ABSTRACT Objective This study explores the relationship between income generation, increasing substance dependence, and the risk of relapse among drug treatment inpatients after their primary drug treatment in the Philippines. Methods We collected 632 patients’ data using a survey questionnaire at five drug treatment facilities – two each in Metro Manila (Luzon), Cebu and Iloilo (Visayas), and Davao City (Mindanao) – representing the Philippines’ three principal geographical regions, from July to September 2019. Results Participants who reported substance dependence were distributed as follows: 20 (42.55%) high nicotine dependent users, 49 (41.88%) alcohol users, 51 (39.53%) methamphetamine users, and 35 (52.24%) cannabis or marijuana users. All were found among poor- to low-income earners. The adjusted odds ratios for the past-30-day substance use were calculated from occupations (formal, informal) of men and women using multiple logistic regression, and the results were: AOR = 7.96, 95% CI = 4.61–13.73 and AOR = 3.96, 95% CI = 1.69–9.24, respectively, with p < .005. Conclusions Policymakers should facilitate economic interventions (livelihood/training skills) and prevention programs to address drug relapse among low- to poor-income earners admitted to rehabilitation centers for primary drug treatment (six months).

Does marijuana usage have impacts on motor and executive functioning?

Family Medicine Residency Program, Southern Illinois University Decatur, Decatur, IL The authors declare no conflicts of interest.

Framingham Heart Study (FHS) 10-Year Cardiovascular Risk Is Associated With Marijuana Use in the Miami Adult Studies on HIV (MASH) Cohort

Abstract Objectives Illicit drug use can lead to adverse cardiovascular events; it is an additional risk factor for cardiovascular disease. Thus, we sought to determine the association between CVD and drug use in people living with HIV (PLWH) using the FHS 10-year risk. Methods Participants were selected from the MASH cohort. Demographics, anthropometrics, bioimpedance analysis, and fasting blood samples were collected by trained personnel. HIV Viral Load (VL, copies/ml) was abstracted from medical charts. Urine toxicology was used to determine current illicit drug use. Descriptive statistics were used to analyze demographics, HIV status, and VL (undetectable VL &amp;lt; 50 copies/ml). CVD (10-year risk) score was calculated using a formula based on CVD risk factors. An independent sample t-test was used to compare the mean CVD risk score between drug users and non-users. Linear regression was used to find an association between drug users and CVD 10-year risk while controlling for sex and infection status. Results Participants’ mean age was 54.6 ± 7.9 years (n = 1034), 58% male and 63.8% Black. About 46.8% were PLWH and 90.9% had an undetectable VL. The average CVD 10-year risk of all participants was 15.1% and 49.6% of participants used illicit substances. A univariate linear regression showed a positive association between FHS 10-year risk and marijuana use (b = 2.260 SE = 1.036, 95% CI: 0.227–4.293; P = 0.029). After adjusting for sex and HIV status the association remained significant (b = 2.322 SE = 1.028, 95% CI: 0.304–4.340; P = 0.024). Comparing the mean 10-year risk between groups, a significant difference between marijuana users and non-users was seen regardless of infection status and age (95% CI: −4.293- −0.227; P = 0.029). Separating by sex, only males showed a significant difference in 10-year risk when comparing marijuana users to non-users irrespective of infection status and age (95% CI: −6.394- −0.8373; P = 0.011). No association was determined between 10-year risk and other substances, including cocaine, fentanyl, and amphetamines. Conclusions Marijuana use seems to be a strong predictor of CVD risk in minority populations. However, other substances of abuse did not exhibit a cardiovascular effect regardless of HIV status or sex. Further studies are needed to examine the relationship between the use of marijuana and CVD. Funding Sources National Institute on Drug Abuse.

Examining Use and Dual Use of Tobacco Products and Marijuana among Minnesota Adults

Background An increasing number of states are legalizing the medicinal and/or recreational use of marijuana. Adult perceptions of harm have decreased and marijuana use has increased. This is in contrast to declining cigarette smoking. In this article we examine independent use and dual use of marijuana and tobacco products. Methods Data are from the 2018 Minnesota Adult Tobacco Survey (N = 6055). Estimates were calibrated on sex, race, location, and education from the American Community Survey. Results In 2018, 15.4% of adults smoked cigarettes in the past 30 days, 7.6% used marijuana and 6.0%, 3.0%, and 1.1% used e-cigarettes, cigars, and waterpipe, respectively. Use of marijuana and cigarettes was 3.3% and use of marijuana and e-cigarettes was 2.2%. Among past 30-day marijuana users, 89.7% smoked it as a joint, blunt, or in waterpipes, 22.1% vaped it in an e-cigarette or a vaping device. Across multinomial regression models, marijuana use and dual use with tobacco products was more likely among males, younger age groups, and African Americans. Conclusions As policies to expand the sale and use of marijuana are considered, states should anticipate the need to monitor trends and to plan surveys of sufficient sample size with specific questions on marijuana use. Understanding the proportion of the population that uses both marijuana and tobacco has implications for prevention and treatment of both substances.

Impact of pre-operative recreational marijuana use on outcomes two years after orthopaedic surgery.

The purpose of this study was to investigate the relationship between recreational marijuana use and patient-reported outcomes two years after orthopaedic surgery. We hypothesized that pre-operative recreational marijuana use would be associated with less pain, better function, and better mental health measures two years after orthopaedic surgery. Patients were retrospectively analyzed from a prospective orthopaedic registry at a single urban institution. A total of 1710 patients completed the pre-operative assessment and 1103 patients (64.5%) completed the two-year follow-up questionnaires. The cohort was then divided into two groups based on reported preoperative recreational marijuana usage, and statistical analysis was performed to determine if marijuana use was associated with two-year outcomes. Multivariable analysis was used to control for confounding variables. Marijuana use was reported by 47 (4.3%) patients. Significantly worse scores for two-year PROMIS Anxiety (53.2 vs. 49.2, p = 0.005), PROMIS Depression (51.1 vs. 46.5, p = 0.001), Met Expectations (63.1 vs. 74.4, p = 0.024), Surgical Satisfaction Questionnaire-8 (71.7 vs. 80.4, p = 0.005), and Numeric Satisfaction Scale (75.6 vs. 83.1, p = 0.041) were associated with marijuana use. Marijuana users also had less improvement of Numeric Pain Scores at the operative site (- 1.8 vs. - 2.7, p = 0.037) and greater decrease in Marx activity scores for lower extremities (- 12.3 vs. - 3.9, p = 0.024). Marijuana use was not an independent predictor of any outcome measure in the multivariable analysis. Marijuana use was associated with worse mental health scores, lower activity level, less pain relief, and worse satisfaction two years after orthopaedic surgery. However, after controlling for confounding variables, marijuana use was not predictive of any two-year outcome measure. Cross-sectional study.

Cognitive and affective responses to marijuana prevention and educational messaging

BackgroundPerceptions of risk of using marijuana have decreased significantly in the US over the last decade, while marijuana use has increased. In order to educate people on the risks associated with marijuana use, large-scale health messaging campaigns have been deployed to educate the public about the risks associated with marijuana use, particularly in states where medical or recreational marijuana is legal. Few studies have examined how messages about marijuana affect the audiences’ cognitive and emotional responsivity to these messages. MethodsTo address this knowledge gap, this study used psychophysiological assessment (heart rate, skin conductance, facial action coding) and self-report measures to explore the impact of different marijuana risk messages on real-time cognitive and affective responses and self-reported message receptivity, likeability, and intentions to use marijuana in a sample of 50 young adult marijuana users and non-users. Each participant saw six messages. Three messages were used from each of two campaigns, representing one of three risks (cognitive ability, driving, health harms). ResultsPsychophysiological responses showed that the driving-themed messages for both campaigns had the greatest cognitive resource allocation to encoding the message, the greatest arousal, and the most positive emotional response, regardless of user status. Self-reports showed a less consistent pattern. ConclusionsOverall, psychophysiological measures provided a more consistent picture of message processing and effects than self-report measures. Findings from this study provide immediately useful data for improving the development and effectiveness of marijuana health-risk prevention campaigns by elucidating cognitive and emotional processes that could be targeted in future programs.

The Medico-economic Impacts of Marijuana Use on the Outcomes and In-hospital Mortality in Patients with Atrial Fibrillation – Nationwide Database study

Introduction Cannabinoid users are at high risk of developing atrial arrhythmias. We sought to investigate the outcomes and the economic impact of marijuana use on patients with atrial fibrillation utilizing the National Inpatient Sample. Materials and Methods Patients with atrial fibrillation were identified in the National Inpatient Sample (NIS) database between 2012 and 2014 using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), who subsequently were divided into two groups, those with and without marijuana smoking. The primary outcome was all-cause in-hospital mortality in the two groups. Secondary outcomes were in-hospital morbidities, required procedures and complications. We also evaluated the length of hospital stay and the cost of hospitalization. Logistic regression model was performed to address potential confounding factors. Results: The marijuana-users group had no significant increase of in-hospital mortality (OR: 1.24; 95% CI: 0.51 - 3.01, p = 0.632). However, marijuana users were predominantly younger males and less likely to undergo cardiac surgery (OR: 0.54, 95% CI 0.37 - 0.78, p = 0.001). Moreover, marijuana users are more likely to have a lower cost of hospitalization when compared to non-users ($28,916 vs $32,303, p = 0.001). Conclusion: Cannabinoid use was not associated with an increase in mortality among patients admitted with atrial fibrillation. However, marijuana users were younger, had fewer comorbidities, and cardiac surgeries with associated lower hospitalization costs. Admittedly, given the growing popularity of these products, further large prospective studies are needed to investigate the safety and evaluate different integral associations of cannabis use with worse cardiac outcomes in atrial arrhythmias patients, particularly those with atrial fibrillation.

Integrative medicine and plasma cell disorders.

e20044 Background: Recent advancements in the treatment of plasma cell disorders (PCD) have led to a revolution in treatment options. Despite improved outcomes, patients have unmet symptom management needs. Integrative medicine (IM) is a method for addressing symptoms in cancer, but its use and efficacy is poorly defined in PCD patients. This analysis describes the utilization of IM among myeloma patients and explores associations with symptom burden. Methods: For 3 months, a 70-question online survey was hosted on HealthTree.org, an online resource for myeloma patients and researchers created by the HealthTree Foundation. The survey included questions about demographics, PCD type, disease stage, complementary practice use, PHQ-2 score (depression screen), and quality of life (sum of 6 interference items; possible score range 0-6). Mean outcome values were compared between IM users and non-users using two-sample t-tests. Proportions of supplement users and IM users were compared between patients currently on myeloma-specific treatment and patients not currently on treatment using chi-square tests. Results: Of 195 total respondents, 17 were excluded for not completing the survey section on IM practices. Median age range was 60-69 years old, 61% were female, 91% were non-Hispanic white, and 57% were overweight or obese. Plasma cell subtypes were active myeloma (81%), smoldering myeloma (12%), MGUS (3%), amyloidosis (2%), and plasmacytoma (1%), and 72% of patients were currently on cancer-specific treatment. On a scale of 1-10 (1=very uncomfortable; 10=very comfortable), patients reported a mean score of 3.7 when discussing IM therapies with their oncologist. The top 10 IM modalities reported were aerobic exercise (83%), nutrition (67%), natural products (60%), strength exercise (52%), support groups (48%), breathing exercises (44%), meditation (42%), yoga (40%), mindfulness-based stress reduction (38%), and massage (38%). Those who participated in meditation had significantly higher PHQ-2 scores (worse depression) than non-participants (1.1 vs. 0.8; p=0.05). Users of support groups (3.4 vs. 2.7; p=0.04), medicinal marijuana (4.0 vs. 2.9; p=0.03), or vitamin C (3.6 vs. 2.7; p=0.01) reported higher mean interference (worse quality of life) than non-users. Compared to patients currently on cancer treatment for PCD, untreated patients were significantly more likely to use curcumin (58% vs. 41%; p=0.04) or green tea (44% vs. 17%; p&lt;0.001), were less likely to use medicinal marijuana (6% vs. 18%; p=0.05), and reported significantly lower fatigue (p=0.02). Conclusions: This international survey-based analysis reveals that most patients participated in IM modalities, though felt uncomfortable discussing them with their oncologist. It is unclear if the use of some IM modalities were due to symptom burden or lead to higher symptom burden. This study provides a foundation in the understanding of IM use in PCD, but more research is needed to evaluate its efficacy.

217 Sleep in heavy marijuana users after smoking differing THC doses compared to controls

Abstract Introduction Sleep disturbances are commonly reported by chronic marijuana (MJ) users and often identified as reasons for MJ relapse and/or other drug use. In the current study we compared the sleep architecture of 12 heavy MJ users to 11 normal controls. Methods Participants in the marijuana group met DSM-V criteria for cannabis use disorder but were otherwise healthy individuals. On the first study day, individuals smoked (1330-1400 hr) 11 puffs from a cannabis cigarette (7% THC). During the next four days, under varying experimental contingencies participants smoked an average of 4.58 (±3.48) day 1, 4.92 (±3.62) day 2, 4.75 (±3.52) day 3, and 4.17 (±3.56) day 4 puffs from cannabis cigarettes (7% THC). Their sleep was recorded the first four study nights using standard polysomnography procedures at Henry Ford Sleep and Research Center Hospital, under an 8-hr fixed time in bed (2300-0700 hr). Controls (n=11) had no history of illicit drug use or medical illness and were not shift workers. Neither group reported a history of sleep-related disorders. PSG recordings were scored using Rechtschaffen and Kales standard criteria. Sleep measures included sleep efficiency (total sleep time/time in bed * 100), latency to persistent sleep, and percent of time spent in Stage 1, 2, 3/4, and rapid eye movement (REM). Results PSGs taken across all four nights of inpatient stay showed that MJ users spent significantly more time in REM sleep compared to controls (means 24.91, 24.64, 24.42, 24.13 vs 18.81, p&amp;lt;.001) and less time in stage 3/4 sleep (means 4.33, 4.79, 4.53, 6.91 vs 15.68, p&amp;lt;.001). MJ users showed reduced sleep efficiency compared to controls on night 4 (means 82.03 vs 90.32, p=0.039), and increased latency to persistent sleep on night 1 (means 6.04 vs 17.77, p=0.026). Conclusion These data show reduced sleep efficiency, lightened sleep (reduced stage 3/4), as well as an increased duration during REM sleep in heavy MJ users during decreased use, findings that are predictive of relapse in other drug abuse populations. Support (if any) NIH/NIDA R21 DA040770 (LHL)

Association Between Glutathione Levels in the Anterior Cingulate Cortex and Distress Intolerance in Marijuana-Using Adolescents

Marijuana (MJ) use, mental, and physiological stressors increase oxidative stress in the brain. Additionally, psychological symptoms including distress intolerance are risk factors for MJ use. Glutathione (GSH), the most abundant antioxidant in the brain, protects against oxidative stress. However, the relationship between MJ use, brain GSH levels and distress intolerance remains unknown. Therefore, in this study, we examined levels of GSH in the anterior cingulate cortex (ACC) and its relationship with distress intolerance in adolescent MJ users and healthy controls.

The Role of Safety Behaviors in the Relationship between Social Anxiety and Marijuana Use Problems

Background: Social anxiety has been associated with higher levels of and more problematic marijuana use. Research suggests that safety behaviors may play a role in the development and maintenance of marijuana problems. However, the safety behaviors that are most commonly associated with social anxiety have not been investigated, nor has the potential moderating role of gender on this relationship. Method: A diverse sample of regular marijuana users (N = 279) completed measures of social anxiety, safety behaviors related to social situations, and marijuana use problems. Results: Social anxiety and safety behavior use were both positively correlated with marijuana use problems. These relationships were stronger in men than in women. Among men only, tendencies to use safety behaviors to cope with social situations accounted for the relationship between social anxiety symptoms and marijuana-related problems. Discussion: The avoidant coping style that characterizes safety behaviors in social anxiety may also underlie problematic patterns of marijuana use, particularly for men. The present study is the first to report an association between safety behaviors in social situations and marijuana use problems and suggests the importance of examining the effect of reducing safety behaviors in social situations, in regular marijuana users with comorbid social anxiety.

Reasons for Marijuana Use and Its Perceived Effectiveness in Therapeutic and Recreational Marijuana Users Among People Living with HIV in Florida.

Therapeutic and recreational marijuana use are common among people living with HIV (PLWH). However, the distinction between perceived "therapeutic" and "recreational" use is blurred, with little information about the specific reasons for use and perceived marijuana effectiveness in adults with chronic conditions. We aimed to compare reasons for use and reason-specific perceived marijuana effectiveness between therapeutic and recreational users among PLWH. In 2018-2019, 213 PLWH currently using marijuana (mean age 48 years, 59% male, 69% African American) completed a questionnaire assessing their specific reasons for using marijuana, including the "main reason." Participants were categorized into one of three motivation groups: therapeutic, recreational, or both equally. For each specific reason, participants rated marijuana effectiveness as 0-10, with 10 being the most effective. The mean effectiveness scores were compared across the three motivation groups via ANOVA, with p <0.05 considered statistically significant. The most frequent main reasons for marijuana use in the therapeutic (n=63, 37%), recreational (n=48, 28%), and both equally (n=59, 35%) categories were "Pain" (21%), "To get high" (32%), and "To relax" (20%), respectively. Compared to recreational users, therapeutic and both equally users provided significantly higher mean effectiveness scores for "Pain," and "To reduce anger." The "Both equally" group also provided significantly higher mean effectiveness scores for "To feel better in general," "To get high," and "To relax" compared to the other two categories. There is a significant overlap in self-reported reasons for marijuana use in primarily therapeutic or recreational users. Perceived marijuana effectiveness was lowest among recreational users.