1
|
Cil G, Winters KC, Austin SC, Kittelman A, Smolkowski K, Westling E, Seeley JR. Legalization and retail availability of recreational marijuana and adolescent use in schools. Health Econ 2024; 33:107-120. [PMID: 37801408 DOI: 10.1002/hec.4763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 08/01/2023] [Accepted: 09/01/2023] [Indexed: 10/08/2023]
Abstract
Legalization of use and retail sales of recreational marijuana in U.S. states and the associated potential increase in access to marijuana and normalization of its use by adults could lead to increased use by adolescents. Studies have found that states with legal recreational marijuana have higher rates of adolescent use and frequency of use compared to states without legal use. We examined changes in student office discipline referrals (ODRs) for substance use offenses in Oregon middle and high schools before and after the legalization of recreational marijuana relative to comparison schools in other states. We found that rates of substance use related ODRs in middle schools increased by 0.14 per 100 students (30% of the mean) with legalization relative to comparison schools. This increase was moderated by the presence of a marijuana outlet within one mile of the school. We found no statistically discernible changes in high school ODRs. Marijuana use in adolescence has been linked to negative health and social consequences, including academic problems, mental health issues, and impaired driving. Potential adverse impact on adolescents and investments in school-based prevention programs could be important considerations for policymakers and public health officials when evaluating marijuana legalization.
Collapse
Affiliation(s)
- Gulcan Cil
- Oregon Research Institute, Oregon, Springfield, USA
- Oregon Health & Science University, Center for Evidence-based Policy, Portland, Oregon, USA
| | | | | | - Angus Kittelman
- University of Oregon, Oregon, Eugene, USA
- University of Missouri, Columbia, Missouri, USA
| | | | | | | |
Collapse
|
2
|
Ortega A. The highs and the lows: Recreational marijuana laws and mental health treatment. Health Econ 2023; 32:2173-2191. [PMID: 37391873 DOI: 10.1002/hec.4726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/30/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023]
Abstract
Recreational marijuana laws (RMLs) continue to grow in popularity, but the effects on mental health treatment are unclear. This paper uses an event-study within a difference-in-differences framework to study the short-run impact of state RMLs on admissions into mental health treatment facilities. The results indicate that shortly after a state adopts an RML, they experience a decrease in the average number of mental health treatment admissions. The findings are driven by white, Black, and Medicaid-funded admissions and are consistent for both male and female admissions. The results are robust to alternative specifications and sensitivity analysis.
Collapse
|
3
|
Pottieger M, Rowland L, DiSantis KI. Assessing Increases in Cannabis-Related Diagnoses in US Hospitals by Regional Policy Status. Popul Health Manag 2022; 25:738-743. [PMID: 36219744 DOI: 10.1089/pop.2022.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cannabis policy is rapidly changing and more individuals are using cannabis nationally. Despite increased use and known adverse outcomes to cannabis use, there is a lack of understanding of health care utilization for cannabis-related conditions. The objectives of this study were: (1) To understand the change in the incidence of cannabis-related diagnoses from 2012 to 2015 nationally and (2) to describe the relationship between regional cannabis policies and changes in the incidence of cannabis-related diagnoses from 2012 to 2015. National Inpatient Sample (NIS) data from the Healthcare Cost and Utilization Project for 2012 and 2015 were analyzed using SPSS software for incidence of cannabis diagnoses. Previously defined NIS regions were assigned a policy status related to medical and recreational cannabis laws. Comparisons were made at the national and regional levels to better understand change in incidence of diagnoses. From 2012 to 2015, there was a 26.7% increase in cannabis-related diagnoses in the inpatient setting nationally. All 9 regions showed increases in the incidence of cannabis-related diagnoses ranging from 15.5% to 41.9% regardless of cannabis policy. As cannabis policy increased legal access, cannabis-related diagnoses increased nationally and regionally across the United States from 2012 to 2015 regardless of cannabis policy. Continued tracking of cannabis-related diagnoses is needed to identify where interventions are necessary to reduce negative impacts of increased cannabis use.
Collapse
Affiliation(s)
- Michael Pottieger
- Department of Public Health and College of Health Sciences, Arcadia University, Philadelphia, Pennsylvania, USA.,Department of Medical Science, College of Health Sciences, Arcadia University, Philadelphia, Pennsylvania, USA
| | - Leslie Rowland
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Katherine I DiSantis
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
4
|
Wu G, Willits DW. The Impact of Recreational Marijuana Legalization on Simple Assault in Oregon. J Interpers Violence 2022; 37:NP23180-NP23201. [PMID: 35229672 DOI: 10.1177/08862605221076169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
There has been heightened public concern about the implications of recreational marijuana legalization to public safety. Prior research on this issue has primarily focused on Colorado and Washington State-the two states that first legalized recreational marijuana in the U.S.-and on legalization's impact on major crimes. This study extends this line of research to Oregon (OR, legalized in late 2014) and examines the impact of legalization on a less serious form of violent crime-simple assault. Using Uniform Crime Reporting (UCR) Program data from 2007 to 2017 and a quasi-experimental research design, this study found that counties in OR have experienced increases in simple assault rate following legalization, relative to rates in the 19 non-legalized states. Findings suggest the need for more scholarly efforts to explore the potential impact of marijuana legalization on different subtypes of violent crime in other legalized states.
Collapse
Affiliation(s)
- Guangzhen Wu
- Department of Sociology, 7060The University of Utah, Salt Lake City, USA
| | - Dale W Willits
- Department of Criminal Justice and Criminology, 6760Washington State University, Pullman, USA
| |
Collapse
|
5
|
Benz MB, Aston ER, Mercurio AN, Metrik J. The Potential Impact of Legalization of Recreational Cannabis among Current Users: A Qualitative Inquiry. J Psychoactive Drugs 2021; 54:233-240. [PMID: 34396923 DOI: 10.1080/02791072.2021.1959966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Given legislative initiatives in Rhode Island pertaining to consideration of cannabis legalization for recreational purpose, a qualitative inquiry was conducted regarding anticipated changes in use among recreational cannabis users in Rhode Island. Five focus groups were conducted with recreational cannabis users (N = 31; 6-7 per group). Participants were queried about anticipated impact of legalization on their use patterns. Themes were identified using applied thematic analysis. Participants discussed (1) a desire to maintain the status quo due to satisfaction with local cannabis regulations and their current use behaviors, (2) how and why cannabis use may change, including pros and cons of legalization, and (3) anticipated changes in purchasing behavior given display and legitimacy of legal dispensaries. While participants anticipate use levels and prevalence may remain relatively stable following legislation changes, findings suggest possible changes related to mode of administration and location of use. Public health concerns exist related to high-risk potencies and use of cannabis in edible form; therefore, trialing of new cannabis products has important clinical implications should legalization occur in Rhode Island.
Collapse
Affiliation(s)
- Madeline B Benz
- Psychology Department, Clark University, Worcester, MA, USA.,Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Elizabeth R Aston
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Heath, Providence, RI, USA
| | - Alana N Mercurio
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Heath, Providence, RI, USA
| | - Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Heath, Providence, RI, USA.,Collaborative Addiction & Recovery Services, Providence Veterans Affairs Medical Center, Providence, RI, USA
| |
Collapse
|
6
|
Carlini BH, Harwick R, Garrett S. Anytime is the Right Time: A Content Analysis of Marijuana Ads in Freely Distributed Print Media in Western Washington State, USA. Subst Use Misuse 2020; 55:806-817. [PMID: 31876238 DOI: 10.1080/10826084.2019.1703749] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Cannabis advertisement content in print media has not yet been studied, despite youth high exposure to them. This study analyzes cannabis ads content in two publications in Western Washington State, USA. Methods: Content analysis of 305 cannabis advertisements published in 2017 in two free print publications was performed with support of NVivo software. A deductive approach was utilized, leveraging alcohol advertisement studies' coding frames and adding cannabis-specific codes in an iterative process. Coding was performed using a two-step analytical procedure. Results: Ads depicted the use of cannabis as part of everyday life and coopted mainstream events such as holidays to promote sales. Ads of cannabis products emphasized lifestyles that conveyed enjoyment of time in nature; such as scenes of people sitting by waterfalls, contemplating natural landscapes, paddle boarding, and canoeing. A sizeable proportion of the cannabis ads shared with alcohol ads an emphasis on the personal and social rewards of using these products, rather than product features, such as quality and taste. Conclusions: In WA State, cannabis use ads content tend to focus on solitude and outdoor recreation rather than parties and team sports, a common theme in alcohol ads. While the themes differ from alcohol, marijuana marketing mimics strategies used by alcohol industries, such as promoting the identification of their products with lifestyles and values considered appealing to attract new consumers. Many ads presented content known to appeal to youth, with content designed to elicit responses based on emotions rather than cognition.
Collapse
Affiliation(s)
- Beatriz H Carlini
- Alcohol and Drug Abuse Institute (ADAI), University of Washington, Seattle, WA, USA
| | - Robin Harwick
- Alcohol and Drug Abuse Institute (ADAI), University of Washington, Seattle, WA, USA
| | - Sharon Garrett
- Alcohol and Drug Abuse Institute (ADAI), University of Washington, Seattle, WA, USA
| |
Collapse
|
7
|
Hasan SS, Shaikh A, Ochani RK, Ashrafi MM, Ansari ZN, Abbas SH, Abbasi MK, Ashraf MA, Ali W. Perception and practices regarding cannabis consumption in Karachi, Pakistan: A cross-sectional study. J Ethn Subst Abuse 2019; 20:471-489. [PMID: 31566085 DOI: 10.1080/15332640.2019.1667287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Several studies have been carried out regarding the awareness and usage of cannabis around the world, especially in developed countries. Pakistan ranks amongst the top nations in regards to cannabis consumption. However, the amount of literature shedding light on people's perception, knowledge and practices are scarce. Therefore, the authors sought to establish a baseline study to ignite the discussion on the possibility of cannabis' induction in the medical field in Pakistan, and additionally provide a foundation for further research. The purpose of this study was to investigate the level of understanding and consumption practices in Karachi with respondents from different socio-economic backgrounds, age groups and gender regarding cannabis use and assessing the awareness of the general population. The null hypothesis is that the usage of cannabis does not have a significant correlation with age, gender, or socio-economic status of a population. We conducted a cross-sectional study in November 2018 using convenience sampling and interviewed 518 individuals for their gender, age, and socio-economic status, to determine their knowledge, attitudes, and practices regarding cannabis usage. The participants were questioned about their knowledge and its source. Attitudes were judged using three and five-point Likert scales while questions regarding practices centered upon the past and current usage of cannabis. One-way analysis of variance and chi-square tests were used as the primary statistical tests. Out of the 518 people who responded, more than half of the respondents were males (n = 340, 65.6%). The majority was familiar with the use of cannabis (n = 514, 99.2%), and the different ways in which it is consumed (n = 435, 84%). About one-third of the participants happened to consume cannabis (n = 168, 32.4%), and a quarter mentioned recreational use/curiosity as the principal reason (n = 134, 25.9%). Majority of the respondents agreed upon the harmful effects of consuming cannabis (n = 364, 70.3%), while when compared to other inimical drugs, half of them believed it to be less harmful (n = 259, 50%). Besides, an overwhelming majority stated, that if they were to consume cannabis, they would not consider taking permission from their parents/guardians (n = 441, 85.2%). Concerning legality, three-fifths of the participants chose cannabis to remain illegal in Pakistan (n = 307, 59.3%) and, for not consuming/quitting cannabis, the primary reason chosen was its harmful consequences (n = 210, 40.5%). Our study revealed that knowledge about usage of cannabis still requires a great deal of attention. Only individuals from higher socio-economic backgrounds have a positive attitude towards cannabis usage and are aware of it. There is an urgent need for awareness programs that especially reach out to the lower socio-economic status population, who otherwise do not have access to essential information resources. We also found that males were more likely to be consumers and to have more knowledge about cannabis, therefore, it is equally important to educate females about this topic so that an informed discussion about cannabis use and its medical benefits can be generated in Pakistan.
Collapse
Affiliation(s)
- Syed Saboor Hasan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Asim Shaikh
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Rohan Kumar Ochani
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Zunaira Navid Ansari
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Hina Abbas
- Department of Pathology, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Wajid Ali
- Department of Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
8
|
Jaladi PR, Patel V, Kuduva Rajan S, Rashid W, Madireddy S, Ajibawo T, Imran S, Patel RS. Arrhythmia-related Hospitalization and Comorbid Cannabis Use Disorder: Trend Analysis in US Hospitals (2010-2014). Cureus 2019; 11:e5607. [PMID: 31700720 PMCID: PMC6822885 DOI: 10.7759/cureus.5607] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective To study the trends of arrhythmia hospitalizations with cannabis use disorders (CUDs) in terms of demographic characteristics and inpatient outcomes. Methods We used the nationwide inpatient sample (NIS) data during the post-legalization period (2010-2014) and included 570,556 arrhythmia inpatients (age, 15-54 years), and 14,426 inpatients had comorbid CUD (2.53%). We used the linear-by-linear association test and independent-sample T-test for assessing the change in hospital outcomes in inpatients with CUD. Results Arrhythmia hospitalizations with CUD increased by 31% (2010-2014). This increasing trend was seen in adults (45-54 years, P < 0.001) and was predominant in males (77.6%). Hypertension (40.6%), hyperlipidemia (17.6%), and obesity (15%) were prevalent medical comorbidities with variable trends over the five years. Among substance use disorders, tobacco (50.9%), and alcohol (31.4%) were major comorbidities with a variable trend (P = 0.003 for each). There was a 71.4% increase in the inpatient mortality rate between 2010 (0.7%) and 2014 (1.2%). The mean length of stay was three days, and the total hospitalization charges have been increasing (P < 0.001), averaging $35,812 per hospital admission. Conclusion Chronic cannabis use or abuse worsens hospitalization outcomes in arrhythmic patients, and more clinical studies are needed to study the causal association between these conditions due to the rising mortality risk.
Collapse
Affiliation(s)
- Paul Rahul Jaladi
- Internal Medicine, Rajiv Gandhi Institute of Medical Sciences, Kadapa, IND
| | | | | | - Wahida Rashid
- Internal Medicine, Dhaka Medical College, Dhaka, BGD
| | | | - Temitope Ajibawo
- Internal Medicine, Brookdale University Hospital and Medical Center, New York, USA
| | - Sundus Imran
- Neurology, Indiana University School of Medicine, Indianapolis, USA
| | | |
Collapse
|
9
|
Madireddy S, Patel RS, Ravat V, Ajibawo T, Lal A, Patel J, Patel R, Goyal H. Burden of Comorbidities in Hospitalizations for Cannabis Use-associated Intractable Vomiting during Post-legalization Period. Cureus 2019; 11:e5502. [PMID: 31511820 PMCID: PMC6716962 DOI: 10.7759/cureus.5502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective The aim of this study was to observe the trends of intractable vomiting and cannabis use disorder (CUD) with demographic characteristics, medical and psychiatric comorbidities, and hospitalization outcomes. Methods We conducted a retrospective cohort study using the nationwide inpatient sample (2010 to 2014). Patients aged 16-50 years discharged with a primary diagnosis of intractable vomiting and CUD were included (N = 9,601). We used the linear-by-linear association chi-square test and independent-sample T-test for measuring the categorical and continuous data, respectively. Results The number of intractable vomiting hospitalizations with CUD had an increasing trend (P < 0.001) with a 28.6% increase over five years. About half of the study population included young (16-30 years, 48.4%) males (57.2%). There was a decreasing trend (P = 0.041) in the prevalence of intractable vomiting with CUD in non-Hispanic Whites and Blacks, whereas there was 778% increase in Hispanics. The mean length of stay was 3.2 days which had a decreasing linear trend, and total hospital charges showed an increasing trend (P < 0.001), averaging $22,890. Electrolyte disorders (55.3%), hypertension (25.3%), chronic lung disease (11.9%), and deficiency anemia (10.3%) constituted the majority of comorbidities, with anemia showing a statistically significant increasing trend (P = 0.004). Anxiety disorders increased from 20.8% to 30.8% over five years, whereas depression decreased from 19.2% to 16.4% (P < 0.001). Concomitant tobacco abuse/dependence was present in 41.2% of patients with CUD. Conclusion The results of our study show that the intractable vomiting hospitalizations related to CUD have increased significantly over a five-year period. The general public and healthcare practitioners should be made aware of the paradoxical gastrointestinal side effects of cannabis.
Collapse
Affiliation(s)
| | | | | | - Temitope Ajibawo
- Internal Medicine, Brookdale University Hospital and Medical Center, New York, USA
| | - Anthony Lal
- Internal Medicine, Windsor University Medical School, Basseterre, KNA
| | - Jenil Patel
- Epidemiology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Riddhi Patel
- Epidemiology, The University of Texas School of Public Health at Houston, Houston, USA
| | - Hemant Goyal
- Department of Gastroenterology & Hepatology, The Wright Center of Graduate Medical Education, Scranton, Pa, Scranton, USA
| |
Collapse
|
10
|
Tanco K, Dumlao D, Kreis R, Nguyen K, Dibaj S, Liu D, Marupakula V, Shaikh A, Baile W, Bruera E. Attitudes and Beliefs About Medical Usefulness and Legalization of Marijuana among Cancer Patients in a Legalized and a Nonlegalized State. J Palliat Med 2019; 22:1213-1220. [PMID: 31386595 DOI: 10.1089/jpm.2019.0218] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: There is a growing preference for the use of marijuana for medical purposes, despite limited evidence regarding its benefits and potential safety risks. Legalization status may play a role in the attitudes and preferences toward medical marijuana (MM). Objectives: The attitudes and beliefs of cancer patients in a legalized (Arizona) versus nonlegalized state (Texas) regarding medical and recreational legalization and medical usefulness of marijuana were compared. Settings/Subjects: Two hundred adult cancer patients were enrolled from outpatient Palliative Care centers at Banner MD Anderson Cancer Center in Gilbert, AZ (n = 100) and The University of Texas MD Anderson Cancer Center in Houston, TX (n = 100). Design and Measurements: Adult cancer patients seen by the Palliative Care teams in the outpatient centers were evaluated. Various physical and psychosocial assessments were conducted, including a survey of attitudes and beliefs toward marijuana. Results: The majority of individuals support legalization of marijuana for medical use (Arizona 92% [85-97%] vs. Texas 90% [82-95%]; p = 0.81) and belief in its medical usefulness (Arizona 97% [92-99%] vs. Texas 93% [86-97%]; p = 0.33) in both states. Overall, 181 (91%) patients supported legalization for medical purposes whereas 80 (40%) supported it for recreational purposes (p < 0.0001). Patients preferred marijuana over current standard treatments for anxiety (60% [51-68%]; p = 0.003). Patients found to favor legalizing MM were younger (p = 0.027), had worse fatigue (p = 0.015), appetite (p = 0.004), anxiety (p = 0.017), and were Cut Down, Annoyed, Guilty, and Eye Opener-Adapted to Include Drugs (CAGE-AID) positive for alcohol/drugs (p < 0.0001). Conclusion: Cancer patients from both legalized and nonlegalized states supported legalization of marijuana for medical purposes and believed in its medical use. The support for legalization for medical use was significantly higher than for recreational use in both states.
Collapse
Affiliation(s)
- Kimberson Tanco
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Donato Dumlao
- Subspecialty Palliative Care in Medical Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Rebecca Kreis
- Subspecialty Palliative Care in Medical Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Kristy Nguyen
- Department of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Seyedeh Dibaj
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diane Liu
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Ayesha Shaikh
- Subspecialty Palliative Care in Medical Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Walter Baile
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
11
|
Desai R, Patel U, Goyal H, Rimu AH, Zalavadia D, Bansal P, Shah N. In-hospital outcomes of inflammatory bowel disease in cannabis users: a nationwide propensity-matched analysis in the United States. Ann Transl Med 2019; 7:252. [PMID: 31355219 DOI: 10.21037/atm.2019.04.63] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Literature suggests the role of cannabis (marijuana) as an anti-inflammatory agent. However, the impact of recreational marijuana usage on in-hospital outcomes of inflammatory bowel disease (IBD) remains indistinct. We assessed the outcomes of Crohn's disease (CD) as well as ulcerative colitis (UC) with vs. without recreational marijuana usage using a nationally illustrative propensity-matched sample. Methods The Nationwide Inpatient Sample datasets (2010-2014) were queried to identify adults with CD and UC hospitalizations with cannabis use and linked complications using ICD-9 CM codes. Categorical and continuous variables were compared between propensity-matched cohorts using Chi-square and Student's t-test, respectively. Primary endpoints were in-hospital complications, whereas secondary endpoints were the discharge disposition, mean length of stay (LOS) and hospital charges. Results Propensity-matched cohorts included 6,002 CD (2,999 cannabis users & 3,003 non-users) and 1,481 UC (742 cannabis users & 739 non-users) hospitalizations. In CD patients, prevalence of colorectal cancer (0.3% vs. 1.2%, P<0.001), need for parenteral nutrition (3.0% vs. 4.7%, P=0.001) and anemia (25.6% vs. 30.1%, P<0.001) were lower in cannabis users. However, active fistulizing disease or intraabdominal abscess formation (8.6% vs. 5.9%, P<0.001), unspecific lower gastrointestinal (GI) hemorrhage (4.0% vs. 2.7%, P=0.004) and hypovolemia (1.2% vs. 0.5%, P=0.004) were higher with recreational cannabis use. The mean hospital stay was shorter (4.2 vs. 5.0 days) with less hospital charges ($28,956 vs. $35,180, P<0.001) in cannabis users. In patients with UC, cannabis users faced the higher frequency of fluid and electrolyte disorders (45.1% vs. 29.6%, P<0.001), and hypovolemia (2.7% vs. <11) with relatively lower frequency of postoperative infections (<11 vs. 3.4%, P=0.010). No other complications were significant enough for comparison between the cannabis users and non-users in this group. Like CD, UC-cannabis patients had shorter mean hospital stay (LOS) (4.3 vs. 5.7 days, P<0.001) and faced less financial burden ($30,393 vs. $41,308, P<0.001). Conclusions We found a lower frequency of colorectal cancer, parenteral nutrition, anemia but a higher occurrences of active fistulizing disease or intraabdominal abscess formation, lower GI hemorrhage and hypovolemia in the CD cohort with cannabis usage. In patients with UC, frequency of complications could not be compared between the two cohorts, except a higher frequency of fluid and electrolyte disorders and hypovolemia, and a lower frequency of postoperative infections with cannabis use. A shorter LOS and lesser hospital charges were observed in both groups with recreational marijuana usage.
Collapse
Affiliation(s)
- Rupak Desai
- Research Fellow, Atlanta VA Medical Center, Decatur, GA, USA
| | - Upenkumar Patel
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, NY, USA
| | - Hemant Goyal
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | | | - Dipen Zalavadia
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | - Pardeep Bansal
- Division of Gastroenterology, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | | |
Collapse
|
12
|
Donnelly J, Young M. The Legalization of Medical/ Recreational Marijuana: Implications for School Health Drug Education Programs. J Sch Health 2018; 88:693-698. [PMID: 30133781 DOI: 10.1111/josh.12669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/01/2018] [Accepted: 01/06/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND More than half of US states have legalized medical marijuana. Several states have also legalized it for recreational use. In spite of states' actions, marijuana remains illegal under federal law. It remains to be seen, however, if the Trump administration will enforce federal law in states that have legalized marijuana. For now, it appears the move toward state legalization of marijuana will increase. Because of its legal status, research concerning the medical benefits of marijuana has been limited. METHODS We reviewed the literature pertaining to medical use and legalization of marijuana. RESULTS Available research shows that marijuana can benefit some conditions. There are also concerns about harmful effects on both individual and public health and whether legalization will lead to increased marijuana use among youth. Each of these elements has implications for school-based drug education programs. Researchers have shown that the 10 states with the highest rate of past month marijuana use by youth all have legalized recreational and/or medical use of marijuana, whereas none of the 10 states with the lowest rate of past month marijuana use by youth, has legalized marijuana. In the debate over legalization schools can potentially serve as a community resource, providing accurate information concerning marijuana. CONCLUSIONS Teachers and parents should continue to discourage young people from using marijuana (as well as alcohol, tobacco, and other drugs).
Collapse
Affiliation(s)
- Joseph Donnelly
- Department of Public Health, Montclair State University, Montclair, NJ 07043
| | | |
Collapse
|
13
|
Patel RS, Katta SR, Patel R, Ravat V, Gudipalli R, Patel V, Patel J. Cannabis Use Disorder in Young Adults with Acute Myocardial Infarction: Trend Inpatient Study from 2010 to 2014 in the United States. Cureus 2018; 10:e3241. [PMID: 30410847 PMCID: PMC6214647 DOI: 10.7759/cureus.3241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective This study determines the trend of acute myocardial infarction (AMI) in cannabis users. Demographic characteristics, hospitalization outcomes, and utilization of primary treatment modalities were evaluated in AMI inpatient population. Methods The study used data from the nationwide inpatient sample (NIS) for the years 2010-2014. We identified patients with AMI as the primary diagnosis (N = 379,843) and patients with cannabis use disorder as the secondary diagnosis. We used Pearson’s chi-square (χ2) test and independent sample t-test for measuring the categorical and continuous data, respectively. Results Inpatient admissions for AMI among cannabis users increased by 32% (P = 0.001). The overall mean age of cannabis users with AMI (41 years) remained stable with no significant differences observed across age groups. AMI was predominant in male cannabis users (79.1%), and there was a 38.3% increase in the prevalence in female cannabis users over five years (P < 0.001). About one-third of the cannabis users with AMI were covered by medicaid with a 70.5% pike (21% in 2010 to 37.5% in 2014; P < 0.001). There was a strong linear trend in nonelective admissions for AMI in cannabis users (P = 0.003) along with a moderate-to-severe morbidity (P = 0.001). Mean length of inpatient stay had a decreasing linear trend (P = 0.003), whereas hospitalization costs were increasing (P = 0.024), averaging $65,879 per admission for AMI. Cannabis users had a strong linear increasing trend (P = 0.007), with a 60% increase in in-hospital mortality (1.0% in 2010 to 1.6% in 2014). Conclusion Due to the risk of AMI, as seen in numerous case reports, the trend of emergency admission and severe morbidity due to AMI in cannabis users is also increasing. Also, cannabis users have a higher healthcare cost to manage AMI, yet the in-hospital mortality has risen tremendously over the last few years. It is imperative to know that chronic cannabis worsens the outcomes in AMI patients, and more clinical studies are needed to show the association of episodic use in cannabis abusers and AMI.
Collapse
Affiliation(s)
| | | | - Riddhi Patel
- Epidemiology/Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, USA
| | - Virendrasinh Ravat
- Infectious Disease, Clinical Infectious Disease Specialist, Las Vegas, USA
| | | | | | - Jenil Patel
- Epidemiology/Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, USA
| |
Collapse
|
14
|
Desai R, Shamim S, Patel K, Sadolikar A, Kaur VP, Bhivandkar S, Patel S, Savani S, Mansuri Z, Mahuwala Z. Primary Causes of Hospitalizations and Procedures, Predictors of In-hospital Mortality, and Trends in Cardiovascular and Cerebrovascular Events Among Recreational Marijuana Users: A Five-year Nationwide Inpatient Assessment in the United States. Cureus 2018; 10:e3195. [PMID: 30402363 PMCID: PMC6200442 DOI: 10.7759/cureus.3195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Recent trends in the legalization of marijuana in many states are increasing the popularity of recreational marijuana use. Since current data on hospitalizations in marijuana users is sparse, we evaluated the primary reasons for admissions, procedures and associated healthcare burden in hospitalized recreational marijuana users. Methods The National Inpatient Sample (NIS) for the years 2010–2014 was queried for the hospitalizations with a history of recreational marijuana usage using applicable ICD-9 CM codes. Descriptive statistics were used to report frequency (N) and percentage (%). Discharge weights were applied to achieve national estimates. The predictors of in-hospital mortality in recreational marijuana users were assessed using a two-way hierarchical multivariate regression after adjusting for the confounders. Results We analyzed 465,959 (weighted n=2,317,343) hospitalizations with a history of recreational marijuana use. Among psychiatric disorders, most prominent primary discharge diagnoses were mood disorders (20.6%), schizophrenia/other psychotic disorders (10.6%), and substance/alcohol-related disorders (10.4%). Suicide and intentional self-inflicted injury (3.6%) was the leading cause of emergency admission. The most common non-psychiatric primary discharge diagnoses were diabetes mellitus with chronic complications (2.2%), acute myocardial infarction (AMI) (1.2%), nonspecific chest pain (1.1%), congestive cardiac failure (CHF) (1%), arrhythmia (0.8%), and hypertension (0.8%). Acute cerebrovascular diseases were noted in 1.1% and epilepsy in 1.8% of patients. Alcohol/drug rehabilitation and detoxification (6.9%) and psychiatric evaluation/therapy (3.9%) were the most evident psychiatric procedures whereas most frequent non-psychiatric procedures were diagnostic coronary arteriography (1%), percutaneous transluminal coronary angioplasty (0.7%), and echocardiogram (0.7%). Top independent predictors of in-hospital mortality were coagulopathy (OR 5.94), AMI (OR 4.59), pulmonary circulation disorder (OR 2.95), CHF (OR 2.02), renal failure (OR 1.91), coronary atherosclerosis (OR 1.34) and peripheral vascular disorder (OR 1.31). Major cardiovascular and cerebrovascular events also showed increasing trends among users. Conclusion We established the most frequent psychiatric and non-psychiatric causes of admissions and procedures in recreational marijuana users, which may pose a significant healthcare burden and increase the odds of in-hospital mortality.
Collapse
Affiliation(s)
- Rupak Desai
- Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, USA
| | - Sofia Shamim
- Family Medicine, Dekalb Medical Centre, Atlanta, USA
| | - Krupa Patel
- Medicine, Avalon University School of Medicine, Willemstad, CUW
| | - Ashish Sadolikar
- Department of Internal Medicine and Psychiatry, Florida International University, Miami, USA
| | | | - Siddhi Bhivandkar
- Department of Psychiatry, Smolensk State Medical University, Smolensk, RUS
| | - Smit Patel
- Neurology, Hartford Hospital, Hartford, USA
| | | | - Zeeshan Mansuri
- Psychiatry, Texas Tech University Health Sciences Center at Odessa, Midland, USA
| | | |
Collapse
|
15
|
Abstract
The National Academies of Sciences, Engineering, and Medicine has found substantial evidence that cannabis (plant) is effective for the treatment of chronic pain in adults, and moderate evidence that oromucosal cannabinoids (extracts, especially nabiximols) improve short-term sleep disturbances in chronic pain. The paradoxical superiority of the cannabis plant over cannabinoid molecules represents a challenge for the medical community and the established processes that define modern pharmacy. The expanding and variable legalization of cannabis in multiple states nationwide represents an additional challenge for patients and the medical community because recreational and medicinal cannabis are irresponsibly overlapped. Cannabis designed for recreational use (containing high levels of active ingredients) is increasingly available to patients with chronic pain who do not find relief with current pharmacologic entities, which exposes patients to potential harm. This article analyzes the available scientific evidence to address controversial questions that the current state of cannabis poses for health care professionals and chronic pain patients and sets the basis for a more open discussion about the role of cannabis in modern medicine for pain management. A critical discussion on these points, the legal status of cannabis, and considerations for health care providers is presented.
Collapse
Affiliation(s)
- E Alfonso Romero-Sandoval
- Department of Anesthesiology, Pain Mechanisms Laboratory, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jack E Fincham
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, South Carolina
| | - Ashley L Kolano
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, South Carolina
| | - Brandi N Sharpe
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, South Carolina
| | - P Abigail Alvarado-Vázquez
- Department of Anesthesiology, Pain Mechanisms Laboratory, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
16
|
Abstract
Recreational and medicinal marijuana uses have become more prevalent in recent years. Women's health nurses are increasingly likely to encounter pregnant women who use or have used marijuana. Research has found that inadequate screening for substance use, inadequate knowledge about the effects of marijuana use, and punitive counseling are barriers to women's understanding of the importance of seeking treatment for substance use. Provision of evidence-based counseling, education, and resources support women and strengthen the patient-provider relationship. Women's health nurses can gain a basic understanding of the effects of perinatal marijuana use and create a plan for women who have positive screening results. This article reviews two recent studies that examine marijuana use during pregnancy and suggest interventions that women's health nurses can implement.
Collapse
|
17
|
Abstract
BACKGROUND Currently, only four states have legalized recreational marijuana use for adults over 21 years of age. Therefore, little is known about the influence that legalization will have on adolescent marijuana use. OBJECTIVES This study examines how marijuana legalization has impacted the frequency and consequences of adolescent use in a sample of participants in a school-based, substance use intervention. We hypothesized that adolescents enrolled in the intervention in years after marijuana legalization would present with more problematic use compared to those enrolled prior, and that changes in the perceived risk of marijuana would be a mechanism of problematic use. METHODS Participants were 262 students enrolled in a school-based substance use intervention in 2010 to 2015. The Customary Drinking and Drug Use Record, Alcohol and Drug Use Consequences Questionnaire, and a decisional balance matrix were used to assess marijuana frequency, negative consequences, and perceived risk of use. A mediation model was used to test the degree to which marijuana legalization may lead to increased frequency and consequences of use through perceived risk. RESULTS Findings indicated a significantly positive correlation between marijuana-related consequences and perceived risk post legalization. Despite relatively equal use between both groups, adolescents in the legalization group experienced higher levels of perceived risk and increased negative consequences. CONCLUSIONS/IMPORTANCE Due to the rising legalization status of marijuana in the United States, it is imperative that psychoeducation is provided to adults and adolescents about the consequences of underage marijuana use.
Collapse
Affiliation(s)
- Ashley C Estoup
- a Clinical Psychology, Seattle Pacific University , Seattle , Washington , USA
| | | | - Malini Varma
- a Clinical Psychology, Seattle Pacific University , Seattle , Washington , USA
| | - David G Stewart
- a Clinical Psychology, Seattle Pacific University , Seattle , Washington , USA
| |
Collapse
|