51
|
Verma A, Nanda V, Kabi A, Baid H. Marijuana-induced acute myocardial infarction in a young adult male. BMJ Case Rep 2021; 14:14/7/e243335. [PMID: 34257123 DOI: 10.1136/bcr-2021-243335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 27-year-old man presented to the emergency department of a tertiary care centre with complaints of acute onset breathing difficulty and retrosternal chest discomfort of 6 hours' duration. On primary survey, he was dyspnoeic with a room air saturation of 85% and a blood pressure of 80/50 mm Hg. A bedside ultrasound revealed an ejection fraction of around 40%, with hypokinesia of interventricular septum, left ventricular apex and anterior wall with bilateral multiple B lines in all lung zones. A 12 lead ECG showed ST segment elevation in leads V2-V6. He sustained a cardiac arrest. Return of spontaneous circulation was achieved following high-quality cardiopulmonary resuscitation. After successful resuscitation, the patient underwent primary percutaneous coronary intervention and recovered fully from the event. On further evaluation, an acute binge of marijuana smoking prior to the onset of symptoms was identified as the cause of the acute coronary syndrome.
Collapse
Affiliation(s)
- Aakash Verma
- Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vivek Nanda
- Emergency Medicine, KD Hospital, Ahmedabad, India
| | - Ankita Kabi
- Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Himanshi Baid
- Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
52
|
Torsades de Pointes due to Excessive Marijuana Use in a Susceptible Patient. Case Rep Cardiol 2021; 2021:6621496. [PMID: 34336299 PMCID: PMC8292089 DOI: 10.1155/2021/6621496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
There are several recent reports of tetrahydrocannabinol vaping-related sudden cardiac arrest, and the mechanisms are unclear. We report a unique case of a 19-year-old female who suffered documented prolonged QTc leading to Torsades de pointes and cardiac arrest in the setting of frequent marijuana wax vaping. While she demonstrated normal baseline QTc measurements years earlier, she was found to have a genetic predisposition to QTc prolongation (genetic mutation, family history of prolonged QTc), suggesting that specific patient populations are at higher risk of these adverse events. The patient was acutely managed with isoproterenol to increase the heart rate and was discharged on nadolol after placement of an implantable cardioverter-defibrillator. Marijuana wax vaping and dabbing may cause fatal Torsades de pointes in susceptible patients, and further research is required to identify these patients a priori.
Collapse
|
53
|
Malviya A, Khan SA, Gupta A, Mishra A. Chronic Marijuana Consumption Leading to High-Grade Atrioventricular Block in a Young Male. Cureus 2021; 13:e16202. [PMID: 34367805 PMCID: PMC8341202 DOI: 10.7759/cureus.16202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 02/02/2023] Open
Abstract
Cannabis usage is increasing throughout the world for both medicinal and recreational purposes. Several countries and states have legalized cannabis, and physicians can expect to encounter more patients who use or abuse cannabis. Adverse cardiovascular effects of cannabis like myocardial infarction, cardiomyopathy, and arrhythmias have been well described but bradyarrhythmia is rare and the mechanisms are not well pronounced. A 26-year-old male with a history of chronic cannabis smoking presented with complaints of dizziness and recurrent syncope. The heart rate at presentation was 42 beats per minute and the rest of the physical examination was unremarkable. There was an atrioventricular (AV) block in the ECG and a subsequent electrophysiological study (EPS) showed a high-grade supra-Hisian (nodal) AV block with prolonged His-ventricular (HV) interval. The urinary screen was positive for tetrahydrocannabinol metabolite (11-Nor-9-carboxy THC). After ruling out other possible causes, a diagnosis of high-grade AV block due to chronic cannabis use was made. A dual-chamber pacemaker was implanted and the patient was discharged in stable condition. The arrhythmia did not improve completely at the three-month follow-up. We report a novel finding in cannabis-induced bradyarrhythmia. High-grade AV block with the electrophysiologic determination of the site of conduction blockade has not been reported previously. The mechanism of bradyarrhythmia is thought to be mediated by increased vagal tone. However, prolonged HV interval and persistent nature of block indicate that direct toxic effects of cannabis, through cannabinoid receptors 1 (CB1R), on the cardiac conduction system cannot be ruled out. Also, the possibility of cannabis arteritis involving microvasculature should be kept.
Collapse
Affiliation(s)
- Amit Malviya
- Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Shakeel A Khan
- Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Anunay Gupta
- Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Animesh Mishra
- Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| |
Collapse
|
54
|
Bliss L, McGowan B, Rahman A. A Rare Pediatric Case of Marijuana-Induced Reversible Cerebral Vasoconstriction Syndrome. Pediatr Neurol 2021; 120:33-35. [PMID: 34000447 DOI: 10.1016/j.pediatrneurol.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Laura Bliss
- Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Bridget McGowan
- Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Anisa Rahman
- Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| |
Collapse
|
55
|
Chiu RG, Patel S, Siddiqui N, Nunna RS, Mehta AI. Cannabis Abuse and Perioperative Complications Following Inpatient Spine Surgery in the United States. Spine (Phila Pa 1976) 2021; 46:734-743. [PMID: 33769411 DOI: 10.1097/brs.0000000000004035] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
MINI Due to its complicated legal status, the effects of cannabis on elective spine surgery patients have not been well studied. In this nationwide analysis, we find that cannabis abuse is associated with higher perioperative thromboembolism and neurologic complications, respiratory complications, sepsis, length of stay, hospital charges, and rates of unfavorable discharge disposition.
Collapse
Affiliation(s)
- Ryan G Chiu
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
| | - Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
| | - Neha Siddiqui
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
- Carle Illinois College of Medicine, University of Illinois, Champaign, IL
| | - Ravi S Nunna
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
| |
Collapse
|
56
|
King DD, Stewart SA, Collins-Yoder A, Fleckner T, Price LL. Anesthesia for Patients Who Self-Report Cannabis (Marijuana) Use Before Esophagogastroduodenoscopy: A Retrospective Review. AANA JOURNAL 2021; 89:205-212. [PMID: 34042571 PMCID: PMC8764743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Increasing numbers of patients are using cannabis before procedures that require anesthesia. This study set out to examine the impact of cannabis use on anesthetic agent requirements, associated cardiac and respiratory morbidity, and overall satisfaction levels in patients undergoing esophagogastroduodenoscopy (EGD). This involved a retrospective review of patients undergoing EGD at a single center. Fortyseven, self-reported cannabis users were identified and 23 were successfully cross-matched with control participants for comparison purposes. The Wilcoxon signed rank test was used to evaluate differences in propofol administration between the 2 groups, and the McNemar test was used to test for differences in fentanyl and ketamine administration. No statistically significant differences were observed in propofol, fentanyl, or ketamine administration in the cannabis group compared with the control group. No adverse cardiac or respiratory events were reported within 30 days for either group. This study was specific to EGD procedures of short duration, and larger studies are needed to confirm results of no consequence in cannabis users undergoing anesthesia. Future studies should consider cannabis users who undergo anesthesia for diverse procedure types of various durations.
Collapse
Affiliation(s)
- Daniel D King
- is an assistant clinical professor at Northeastern University in Boston, Massachusetts, and a staff nurse anesthetist at Good Samaritan Medical Center in Brockton, Massachusetts.
| | - Scott A Stewart
- is the chair of the Department of Anesthesiology at Good Samaritan Medical Center in Brockton, Massachusetts
| | - Angela Collins-Yoder
- is a clinical professor in the Capstone College of Nursing at The University of Alabama. She is also a critical care nurse specialist at Sacred Heart in Pensacola, Florida
| | - Tara Fleckner
- is a project coordinator in the Tufts Clinical and Translational Science Institute at Tufts University in Boston, Massachusetts
| | - Lori Lyn Price
- is a senior statistician in the Tufts Clinical and Translational Science Institute at Tufts University
| |
Collapse
|
57
|
Matta A, Elenizi K, Elbaz M, Roncalli J. Left main coronary artery thrombus after cannabis consumption: a case report. Eur Heart J Case Rep 2021; 5:ytab179. [PMID: 34222781 PMCID: PMC8244647 DOI: 10.1093/ehjcr/ytab179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/09/2020] [Accepted: 04/21/2020] [Indexed: 11/27/2022]
Abstract
Background Left main coronary thrombus is a rare angiographic finding associated with serious outcomes such as sudden death and cardiogenic shock. Rupture of an underlying atherosclerotic plaque is the main risk factor. The role of cannabis consumption in the pathophysiology of acute cardiovascular disease is controversial. Case presentation We present a case of non-ST-elevation myocardial infarction characterized by a mobile left main coronary thrombus in a young male cannabis consumer successfully treated with manual aspiration, dual anti-platelet, and unfractionated heparin therapy. Conclusion Cannabis consumption could be a risk factor for coronary artery thrombosis. The pathophysiology mechanism of action is not well understood. Reaching an optimal management is a potential challenge for physicians.
Collapse
Affiliation(s)
- Anthony Matta
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse , 1 Avenue Jean Poulhès, 31059 Toulouse, France
- Faculty of medicine, Holy Spirit University of Kaslik , Kaslik, Lebanon
| | - Khaled Elenizi
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse , 1 Avenue Jean Poulhès, 31059 Toulouse, France
- Department of Internal Medicine, College of Medicine, Prince Sattam bin Abdulaziz University , Alkharj 11942, Saudi Arabia
| | - Meyer Elbaz
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse , 1 Avenue Jean Poulhès, 31059 Toulouse, France
| | - Jerome Roncalli
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse , 1 Avenue Jean Poulhès, 31059 Toulouse, France
| |
Collapse
|
58
|
Ibn Hadj Amor H, Touil I, Boukriba S, Bouchnak S, Kraiem S, Rouabhia R. Case Report: Spontaneous simultaneous coronary and carotid dissection in a young cannabis user. F1000Res 2021; 10:387. [PMID: 34164116 PMCID: PMC8204189 DOI: 10.12688/f1000research.52606.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/20/2022] Open
Abstract
Due to legalization of its consumption in some countries and its medical use as well as low toxic potential, cannabis remains the most widely used drug around the world and the rate of usage is only increasing. Nevertheless, there are several case reports of vascular complications following cannabis use even in young people without cardiovascular risk factors. We report the case of a cannabis smoker presenting to the emergency room for an ischemic stroke associated with an acute coronary syndrome related to a spontaneous simultaneous double dissection of the carotid artery and the left anterior descending artery, with a favourable outcome under medical treatment. This case shows the seriousness of complications due to the cannabis consumption, hence the need to limit or even prohibit its consumption.
Collapse
Affiliation(s)
| | - Imen Touil
- Pneumology Department, Taher Sfar university hospital, Mahdia, 5100, Tunisia
| | - Seif Boukriba
- Radiology Department, Rabta University Hospital, Tunis, 1007, Tunisia
| | - Skander Bouchnak
- Cardiology Department, Taher Sfar university hospital, Mahdia, 5100, Tunisia
| | - Salma Kraiem
- Cardiology Department, Taher Sfar university hospital, Mahdia, 5100, Tunisia
| | - Ramzi Rouabhia
- Cardiology Department, Taher Sfar university hospital, Mahdia, 5100, Tunisia
| |
Collapse
|
59
|
Shah S, Patel S, Paulraj S, Chaudhuri D. Association of Marijuana Use and Cardiovascular Disease: A Behavioral Risk Factor Surveillance System Data Analysis of 133,706 US Adults. Am J Med 2021; 134:614-620.e1. [PMID: 33181103 DOI: 10.1016/j.amjmed.2020.10.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Marijuana is the most commonly used psychoactive drug, while its effects on cardiovascular health are not well known and remain a subject of interest. METHODS We used the pooled 2016-2018 data from the Behavioral Risk Factor Surveillance System to perform a cross-sectional analysis evaluating the association of marijuana and cardiovascular disease among US adults who never smoked cigarettes. RESULTS Among US adults ages 18-74 years, when compared with nonusers, frequent marijuana use was associated with 88% higher odds of myocardial infarction or coronary artery disease (adjusted odds ratio [aOR] 1.88; 95% confidence interval [CI], 1.15-3.08), and 81% higher odds of stroke (aOR 1.81; 95% CI, 1.14-2.89). Among the premature cardiovascular disease group, frequent marijuana users had 2.3 times higher odds of myocardial infarction or coronary artery disease (aOR 2.27; 95% CI, 1.20-4.30), and 1.9 times higher odds of stroke (aOR 1.92; 95% CI, 1.07-3.43). In terms of the modality of marijuana use, frequent marijuana smoking had 2.1 times higher odds of myocardial infarction or coronary artery disease (aOR 2.07; 95% CI, 1.21-3.56), and 1.8 times higher odds of stroke (aOR 1.84; 95% CI, 1.09-3.10). A similar association was observed in the premature cardiovascular disease group who smoked marijuana (aOR [for myocardial infarction or coronary artery disease] 2.64; 95% CI, 1.37-5.09; aOR [for stroke] 2.00; 95% CI, 1.05-3.79). No association was observed between marijuana use in any form other than smoking and cardiovascular disease, across all age groups. CONCLUSION Frequent marijuana smoking is associated with significantly higher odds of stroke and myocardial infarction or coronary artery disease, with a possible role in premature cardiovascular disease.
Collapse
Affiliation(s)
- Siddharth Shah
- Division of Cardiology, State University of New York Upstate Medical University, Syracuse.
| | - Siddharth Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham
| | | | - Debanik Chaudhuri
- Division of Cardiology, State University of New York Upstate Medical University, Syracuse
| |
Collapse
|
60
|
Bougrine R, Boutaybi M, Boulouiz S, Elouafi N, Bazid Z. Severe Myocardial Infarction Caused by Excessive Cannabis Consumption. Cureus 2021; 13:e14643. [PMID: 33903847 PMCID: PMC8064037 DOI: 10.7759/cureus.14643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The cardiovascular effects of cannabis are not well known. Cannabis use has been shown to cause arrhythmia, including ventricular tachycardia, sudden death, and increase in the risk of myocardial infarction (MI). We report a 62-year-old woman with chronic cannabis abuse inducing MI complicated by cardiogenic shock, chronic dilated cardiomyopathy, and atrial fibrillation.
Collapse
Affiliation(s)
- Ramia Bougrine
- Cardiology, Mohammed I University/Mohammed VI University Hospital, Oujda, MAR
| | - Mohamed Boutaybi
- Cardiology, Mohammed I University/Mohammed VI University Hospital, Oujda, MAR
| | - Soumia Boulouiz
- Cardiology, Mohammed I University/Mohammed VI University Hospital, Oujda, MAR
| | - Noha Elouafi
- Cardiology, Mohammed I University/Mohammed VI University Hospital, Oujda, MAR
| | - Zakaria Bazid
- Cardiology, Mohammed I University/Mohammed VI University Hospital/Epidemiological Laboratory of Clinical Research and Public Health, Oujda, MAR
| |
Collapse
|
61
|
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a condition characterized by thunderclap headache and associated vasospasm of the cerebral vasculature. A multitude of factors are considered to potentially predispose to the development of RCVS. These potential precipitants include numerous illicit drugs. In this study, we investigated the role of illicit drugs as a precipitating factor for RCVS, through systematic review of the relevant literature. We found the strongest evidence for cannabis, but a relative lack of evidence to support other illicit drugs, particularly as individual precipitating factors. We also identified a lack of the consistent application of diagnostic criteria for RCVS, which undoubtedly hampers advancement of knowledge in this field. Consistent adherence to diagnostic criteria will be important for future studies. Ultimately, a prospective registry of RCVS cases would be advantageous to advance understanding of the condition and its underlying causes.
Collapse
Affiliation(s)
- Katherine Short
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Hedley C A Emsley
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom.,Department of Neurology, Royal Preston Hospital, Preston, United Kingdom
| |
Collapse
|
62
|
Lim W, Suhail M, Galligan S. A Case of Three-Vessel Coronary Artery Disease Associated With Marijuana Use. Cureus 2021; 13:e14481. [PMID: 34007737 PMCID: PMC8120919 DOI: 10.7759/cureus.14481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- William Lim
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Maham Suhail
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Sean Galligan
- Internal Medicine/Cardiology, Richmond University Medical Center, Staten Island, USA
| |
Collapse
|
63
|
Pharmacology and adverse effects of new psychoactive substances: synthetic cannabinoid receptor agonists. Arch Pharm Res 2021; 44:402-413. [PMID: 33811300 DOI: 10.1007/s12272-021-01326-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/25/2021] [Indexed: 01/07/2023]
Abstract
Over the last decade, new psychoactive substances (NPS) have continuously been the focus of the international society since their emergence on the illicit drug market. NPS can be classified into six groups including; synthetic cannabinoid receptor agonists (SCRAs), stimulants, opioids, dissociatives, sedatives/hypnotics, and classic hallucinogens with psychoactive effects. These are sold as "herbal incense," "bath salts," "legal highs," and "research chemicals". They can be synthesized easily with slight changes in the chemical moieties of known psychoactive substances. NPS are sold worldwide via on- and off-line markets without proper scientific evaluation regarding their safety or harmfulness. Abuse of NPS poses a serious public health issue, and systematic studies on their adverse effects are lacking. Therefore, it would be meaningful to collect currently available data in order to understand NPS and to establish viable solutions to cope with the various health issues related to them. In this article, we reviewed the general pharmacological characteristics, recent findings, and adverse effects of representative NPS; SCRAs. SCRAs are known as the most commonly abused NPS. Most SCRAs, cannabinoid receptor 1 and cannabinoid receptor 2 agonists, are often associated with severe toxicities, including cardiotoxicity, immunotoxicity, and even death, unlike natural cannabinoid Δ9-Tetrahydrocannabinol.
Collapse
|
64
|
Shaffer BL, Davis GM, Incitti MA, Piper BJ, Entler BV. Application of medical cannabis in unstable angina and coronary artery disease: A case report. Medicine (Baltimore) 2021; 100:e25172. [PMID: 33726006 PMCID: PMC7982176 DOI: 10.1097/md.0000000000025172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/04/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE First discovered in 1990, the endocannabinoid system (ECS) was initially shown to have an intimate relationship with central areas of the nervous system associated with pain, reward, and motivation. Recently, however, the ECS has been extensively implicated in the cardiovascular system with contractility, heart rate, blood pressure, and vasodilation. Emerging data demonstrate modulation of the ECS plays an essential role in cardio metabolic risk, atherosclerosis, and can even limit damage to cardiomyocytes during ischemic events. PATIENT CONCERNS This case describes a 63-year-old man who presented to a primary care physician for a medical cannabis (MC) consult due to unstable angina (UA) not relieved by morphine or cardiac medications; having failed all first- and second-line polypharmaceutical therapies. The patient reported frequent, unprovoked, angina and exertional dyspnea. DIAGNOSIS Having a complex cardiac history, the patient first presented 22 years ago after a suspected myocardial infarction. He re-presented in 2010 and underwent stent placement at that time for inoperable triple-vessel coronary artery disease (CAD) which was identified via percutaneous transluminal coronary angioplasty. UA developed on follow-up and, despite medical management over the past 6 years, became progressively debilitating. INTERVENTIONS AND OUTCOMES In conjunction with his standard cardiac care, patient had a gradual lessening of UA-related pain, including frequency and character, after using an edible form of MC (1:1 cannabidiol:Δ9-tetrahydrocannabinol). Following continued treatment, he ceased long-term morphine treatment and described the pain as no longer crippling. As demonstrated by his exercise tolerance tests, the patient experienced an improved functional capacity and reported an increase in his daily functioning, and overall activity. LESSONS This case uniquely highlights MC in possibly reducing the character, quality, and frequency of UA, whereas concordantly improving functional cardiac capacity in a patient with CAD. Additional case reports are necessary to verify this.
Collapse
Affiliation(s)
| | | | | | - Brian J. Piper
- Geisinger Commonwealth School of Medicine, Scranton
- Center for Pharmacy Innovation and Outcomes, Forty Fort, PA
| | | |
Collapse
|
65
|
Bouquet E, Pain S, Eiden C, Jouanjus E, Richard N, Fauconneau B, Pérault-Pochat MC. Adverse events of recreational cannabis use reported to the French addictovigilance network (2012-2017). Br J Clin Pharmacol 2021; 87:3925-3937. [PMID: 34282851 DOI: 10.1111/bcp.14812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 12/24/2022] Open
Abstract
AIMS To describe the adverse events (AEs) of recreational cannabis use in France between 2012 and 2017. METHODS AEs related to recreational cannabis use, alone or in combination with alcohol and/or tobacco reported to the French Addictovigilance Network were analysed (excluding cannabidiol and synthetic cannabinoids). RESULTS Reporting of AEs tripled between 2012 (n = 179, 6.3%, 95% confidence interval [CI] = 5.4-7.2) and 2017 (n = 562, 10.1%, 95% CI = 9.3-10.9), reaching 2217 cases. They concerned mainly men (76.4%) and users aged between 18 and 34 years (18-25: 30.9%; 26-34: 26.3%, range: 12-84 years). Cannabis was mainly inhaled (71.6%) and exposure was most often chronic (64.2%). Many types of AEs were reported: psychiatric (51.2%), neurological (15.6%), cardiac (7.8%) and gastrointestinal (7.7%), including unexpected AEs (n = 34, 1.1%). The most common effect was dependence, ranging from 10.1% (95% CI = 7.9-12.3) to 20.3% (95% CI = 17.3-23.2) over the study period. Cannabinoid hyperemesis syndrome (n = 87, 2.8%) emerged from 2015. Deaths accounted for 0.2% of all AEs (4 men and 3 women aged on average 35 years). A chronic pattern of cannabis use was reported in 4 of them (intracranial hypertension in the context of lung cancer, suicide, cerebral haematoma, neonatal death with concomitant chronic alcohol use), while in the other cases the toxicological analysis identified cannabis use (ruptured aneurysm and unknown aetiology). CONCLUSION This study showed a multitude of AEs related to recreational cannabis use, including unexpected AEs and deaths. It highlights the problem of dependence and the emergence of cannabinoid hyperemesis syndrome.
Collapse
Affiliation(s)
- Emilie Bouquet
- Addictovigilance Center, Department of Clinical Pharmacology, Poitiers University Hospital, France
| | - Stéphanie Pain
- Addictovigilance Center, Department of Clinical Pharmacology, Poitiers University Hospital, France.,INSERM U-1084, Experimental and Clinical Neurosciences Laboratory, University of Poitiers, Poitiers, France
| | - Céline Eiden
- Addictovigilance Center, Montpellier University Hospital, France
| | - Emilie Jouanjus
- Addictovigilance Center, Toulouse University Hospital, France
| | - Nathalie Richard
- French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France
| | - Bernard Fauconneau
- Addictovigilance Center, Department of Clinical Pharmacology, Poitiers University Hospital, France
| | - Marie-Christine Pérault-Pochat
- Addictovigilance Center, Department of Clinical Pharmacology, Poitiers University Hospital, France.,INSERM U-1084, Experimental and Clinical Neurosciences Laboratory, University of Poitiers, Poitiers, France
| | | |
Collapse
|
66
|
Yang PK, Odom EC, Patel R, Loustalot F, Coleman King S. Nonmedical Marijuana Use and Cardiovascular Events: A Systematic Review. Public Health Rep 2021; 137:62-71. [PMID: 33636088 PMCID: PMC8721763 DOI: 10.1177/0033354920988285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Although marijuana use has increased since 2012, the perceived risk of adverse outcomes has decreased. This systematic review summarizes articles that examined the association between nonmedical marijuana use (ie, observed smoking, self-report, or urinalysis) and cardiovascular events in observational or experimental studies of adults aged ≥18. METHODS We searched Medline, EMBASE, PsycInfo, CINAHL, Cochrane Library Database, and Global Health from January 1, 1970, through August 31, 2018. Of 3916 citations, 16 articles fit the following criteria: (1) included adults aged ≥18; (2) included marijuana/cannabis use that is self-reported smoked, present in diagnostic coding, or indicated through a positive diagnostic test; (3) compared nonuse of cannabis; (4) examined events related to myocardial infarction, angina, acute coronary syndrome, and/or stroke; (5) published in English; and (6) had observational or experimental designs. RESULTS Of the 16 studies, 4 were cohort studies, 8 were case-control studies, 1 was a case-crossover study, 2 were randomized controlled trials, and 1 was a descriptive study. Studies ranged from 10 participants to 118 659 619 hospitalizations. Marijuana use was associated with an increased likelihood of myocardial infarction within 24 hours in 2 studies and stroke in 6 studies. Results of studies suggested an increased risk for angina and acute coronary syndrome, especially among people with a history of a cardiovascular event. CONCLUSION This review suggests that people who use marijuana may be at increased risk for cardiovascular events. As states expand new laws permitting marijuana use, it will be important to monitor the effect of marijuana use on cardiovascular disease outcomes, perhaps through the inclusion of data on nonmedical marijuana use in diverse national and local surveillance systems.
Collapse
Affiliation(s)
- Peter K. Yang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA,Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Erika C. Odom
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA,US Public Health Service, US Department of Health and Human Services, Washington, DC, USA,Erika C. Odom, PhD, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention, 4770 Buford Hwy, Building 102, MS F-77, Chamblee, GA 30341, USA.
| | - Roshni Patel
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA,US Public Health Service, US Department of Health and Human Services, Washington, DC, USA
| | - Sallyann Coleman King
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA,US Public Health Service, US Department of Health and Human Services, Washington, DC, USA
| |
Collapse
|
67
|
Peng H, Shahidi F. Cannabis and Cannabis Edibles: A Review. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2021; 69:1751-1774. [PMID: 33555188 DOI: 10.1021/acs.jafc.0c07472] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cannabis is an excellent natural source of fiber and various bioactive cannabinoids. So far, at least 120 cannabinoids have been identified, and more novel cannabinoids are gradually being unveiled by detailed cannabis studies. However, cannabinoids in both natural and isolated forms are especially vulnerable to oxygen, heat, and light. Therefore, a diversity of cannabinoids is associated with their chemical instability to a large extent. The research status of structural conversion of cannabinoids is introduced. On the other hand, the use of drug-type cannabis and the phytocannabinoids thereof has been rapidly popularized and plays an indispensable role in both medical therapy and daily recreation. The recent legalization of edible cannabis further extends its application into the food industry. The varieties of legal edible cannabis products in the current commercial market are relatively monotonous due to rigorous restrictions under the framework of Cannabis Regulations and infancy of novel developments. Meanwhile, patents/studies related to the safety and quality assurance systems of cannabis edibles are still rare and need to be developed. Furthermore, along with cannabinoids, many phytochemicals such as flavonoids, lignans, terpenoids, and polysaccharides exist in the cannabis matrix, and these may exhibit prebiotic/probiotic properties and improve the composition of the gut microbiome. During metabolism and excretion, the bioactive phytochemicals of cannabis, mostly the cannabinoids, may be structurally modified during enterohepatic detoxification and gut fermentation. However, the potential adverse effects of both acute and chronic exposure to cannabinoids and their vulnerable groups have been clearly recognized. Therefore, a comprehensive understanding of the chemistry, metabolism, toxicity, commercialization, and regulations regarding cannabinoid edibles is reviewed and updated in this contribution.
Collapse
Affiliation(s)
- Han Peng
- Department of Biochemistry Memorial University of Newfoundland, St. John's, Newfoundland, Canada A1B 3X9
| | - Fereidoon Shahidi
- Department of Biochemistry Memorial University of Newfoundland, St. John's, Newfoundland, Canada A1B 3X9
| |
Collapse
|
68
|
Takakuwa KM, Schears RM. The emergency department care of the cannabis and synthetic cannabinoid patient: a narrative review. Int J Emerg Med 2021; 14:10. [PMID: 33568074 PMCID: PMC7874647 DOI: 10.1186/s12245-021-00330-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/05/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cannabis is the most prevalent illegal drug used and the second most common cause of ED drug-related complaints in the USA. Recently, newer more potent strains, concentrated THC products, and consumption methods have become available. OBJECTIVE Our first objective was to define cannabis use in the USA and provide a summary background on its current preparations, pharmacokinetics, vital sign and physical exam findings, adverse effects, and laboratory testing. Our second objective, using the aforementioned summary as relevant background information, was to present and summarize the care and treatment of the most commonly reported cannabis-related topics relevant to ED physicians. METHODS We first performed an extensive literature search of peer-reviewed publications using New PubMed and Cochrane Central Register of Controlled Trials to identify the most commonly reported cannabis-related topics in emergency care. Once the six topic areas were identified, we undertook an extensive narrative literature review for each section of this paper using New PubMed and Cochrane Central Register of Controlled Trials from the inception of the databases to September 30, 2020. RESULTS The six subject areas that were most frequently reported in the medical literature relevant to cannabis-related ED care were acute intoxication/overdose, pediatric exposure, cannabinoid hyperemesis syndrome, cannabis withdrawal, e-cigarette or vaping product use-associated lung injury (EVALI), and synthetic cannabinoids. CONCLUSION As cannabis becomes more widely available with the adoption of state medical cannabis laws, ED-related cannabis visits will likely rise. While cannabis has historically been considered a relatively safe drug, increased legal and illegal access to newer formulations of higher potency products and consumption methods have altered the management and approach to ED patient care and forced physicians to become more vigilant about recognizing and treating some new cannabis-related life-threatening conditions.
Collapse
Affiliation(s)
- Kevin M Takakuwa
- Society of Cannabis Clinicians, PO Box 27574, San Francisco, CA, 94127, USA.
| | | |
Collapse
|
69
|
Pasha AK, Clements CY, Reynolds CA, Lopez MK, Lugo CA, Gonzalez Y, Shirazi FM, Abidov A. Cardiovascular Effects of Medical Marijuana: A Systematic Review. Am J Med 2021; 134:182-193. [PMID: 33186596 DOI: 10.1016/j.amjmed.2020.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/25/2022]
Abstract
Utilization of marijuana as a medicinal agent is becoming increasingly popular, and so far, 25 states have legalized it for medical purposes. However, there is emerging evidence that marijuana use can result in cardiovascular side effects, such as rhythm abnormalities, syncope/dizziness, and myocardial infarction, among others. Further, there are currently no stringent national standards or approval processes, like Food and Drug Administration (FDA) evaluation, in place to assess medical marijuana products. This review includes the largest up-to-date pooled population of patients with exposure to marijuana and reported cardiovascular effects. Although purported as benign by many seeking to advance the use of marijuana as an adjunctive medical therapy across the country, marijuana is associated with its own set of cardiovascular risks and deserves further definitive study and the same level of scrutiny we apply in research of all other types of medications. When used as a medicinal agent, marijuana should be regarded accordingly, and both clinical providers and patients must be aware of potential adverse effects associated with its use for early recognition and management.
Collapse
Affiliation(s)
- Ahmed K Pasha
- Hospital Internal Medicine, Mayo Clinic Health System, Mankato, Minn
| | | | | | | | | | | | - Farshad M Shirazi
- Arizona Poison and Drug Information Center, University of Arizona, Tucson
| | - Aiden Abidov
- Cardiology Section, John D. Dingell VA Medical Center, Detroit, Mich.
| |
Collapse
|
70
|
Mosaed S, Liu JHK, Minckler DS, Fitzgerald RL, Grelotti D, Sones E, Shiels CR, Weinreb RN, Marcotte TD. The Effect of Inhaled Cannabis on Intraocular Pressure in Healthy Adult Subjects. Ophthalmology 2021. [DOI: 10.17925/opht.2021.15.1.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
71
|
Mégarbane B, Oberlin M, Alvarez JC, Balen F, Beaune S, Bédry R, Chauvin A, Claudet I, Danel V, Debaty G, Delahaye A, Deye N, Gaulier JM, Grossenbacher F, Hantson P, Jacobs F, Jaffal K, Labadie M, Labat L, Langrand J, Lapostolle F, Le Conte P, Maignan M, Nisse P, Sauder P, Tournoud C, Vodovar D, Voicu S, Claret PG, Cerf C. Management of pharmaceutical and recreational drug poisoning. Ann Intensive Care 2020; 10:157. [PMID: 33226502 PMCID: PMC7683636 DOI: 10.1186/s13613-020-00762-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/09/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Poisoning is one of the leading causes of admission to the emergency department and intensive care unit. A large number of epidemiological changes have occurred over the last years such as the exponential growth of new synthetic psychoactive substances. Major progress has also been made in analytical screening and assays, enabling the clinicians to rapidly obtain a definite diagnosis. METHODS A committee composed of 30 experts from five scientific societies, the Société de Réanimation de Langue Française (SRLF), the Société Française de Médecine d'Urgence (SFMU), the Société de Toxicologie Clinique (STC), the Société Française de Toxicologie Analytique (SFTA) and the Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP) evaluated eight fields: (1) severity assessment and initial triage; (2) diagnostic approach and role of toxicological analyses; (3) supportive care; (4) decontamination; (5) elimination enhancement; (6) place of antidotes; (7) specificities related to recreational drug poisoning; and (8) characteristics of cardiotoxicant poisoning. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology. RESULTS The SRLF-SFMU guideline panel provided 41 statements concerning the management of pharmaceutical and recreational drug poisoning. Ethanol and chemical poisoning were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for all recommendations. Six of these recommendations had a high level of evidence (GRADE 1±) and six had a low level of evidence (GRADE 2±). Twenty-nine recommendations were in the form of expert opinion recommendations due to the low evidences in the literature. CONCLUSIONS The experts reached a substantial consensus for several strong recommendations for optimal management of pharmaceutical and recreational drug poisoning, mainly regarding the conditions and effectiveness of naloxone and N-acetylcystein as antidotes to treat opioid and acetaminophen poisoning, respectively.
Collapse
Affiliation(s)
- Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, AP-HP, INSERM MURS-1144, University of Paris, 2 Rue Ambroise Paré, Paris, 75010 France
| | - Mathieu Oberlin
- Emergency Department, HuManiS Laboratory (EA7308), University Hospital, Strasbourg, France
| | - Jean-Claude Alvarez
- Department of Pharmacology and Toxicology, Inserm U-1173, FHU Sepsis, Raymond Poincaré Hospital, AP-HP, Paris-Saclay University, Garches, France
| | - Frederic Balen
- Emergency Department, Toulouse University Hospital, Toulouse, France
| | - Sébastien Beaune
- Department of Emergency Medicine, Ambroise Paré Hospital, AP-HP, INSERM UMRS-1144, Paris-Saclay University, Boulogne-Billancourt, France
| | - Régis Bédry
- Hospital Secure Unit, Pellegrin University Hospital, Bordeaux, France
| | - Anthony Chauvin
- Emergency Department, Hôpital Lariboisière, AP-HP, Paris, France
| | - Isabelle Claudet
- Pediatric Emergency Department Children’s Hospital CHU Toulouse, Toulouse, France
| | - Vincent Danel
- Department of Emergency Medicine, University Hospital of Grenoble, Grenoble, France
| | - Guillaume Debaty
- 5525, University Grenoble Alps/CNRS/CHU de Grenoble Alpes/TIMC-IMAG UMR, Grenoble, France
| | | | - Nicolas Deye
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, AP-HP, INSERM U942, University of Paris, Paris, France
| | - Jean-Michel Gaulier
- Laboratory of Toxicology, EA 4483 - IMPECS - IMPact de L’Environnement Chimique Sur La Santé Humaine, University of Lille, Lille, France
| | | | - Philippe Hantson
- Intensive Care Department, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Frédéric Jacobs
- Polyvalent Intensive Care Unit, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, Clamart, France
| | - Karim Jaffal
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, AP-HP, INSERM MURS-1144, University of Paris, 2 Rue Ambroise Paré, Paris, 75010 France
| | - Magali Labadie
- Poison Control Centre of Bordeaux, University Hospital of Bordeaux, Bordeaux, France
| | - Laurence Labat
- Laboratory of Toxicology, Federation of Toxicology APHP, Lariboisière Hospital, INSERM UMRS-1144, University of Paris, Paris, France
| | - Jérôme Langrand
- Poison Control Center of Paris, Federation of Toxicology, Fernand-Widal-Lariboisière Hospital, AP-HP, INSERM UMRS-1144, University of Paris, Paris, France
| | - Frédéric Lapostolle
- SAMU 93-UF Recherche-Enseignement-Qualité, Inserm, U942, Avicenne Hospital, AP-HP, Paris-13 University, Bobigny, France
| | - Philippe Le Conte
- Department of Emergency Medicine, University Hospital of Nantes, Nantes, France
| | - Maxime Maignan
- Emergency Department, Grenoble University Hospital, INSERM U1042, Grenoble Alpes University, Grenoble, France
| | - Patrick Nisse
- Poison Control Centre, University Hospital of Lille, Lille, France
| | - Philippe Sauder
- Intensive Care Unit, University Hospital of Strasbourg, Strasbourg, France
| | | | - Dominique Vodovar
- Poison Control Center of Paris, Federation of Toxicology, Fernand-Widal-Lariboisière Hospital, AP-HP, INSERM UMRS-1144, University of Paris, Paris, France
| | - Sebastian Voicu
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, AP-HP, INSERM MURS-1144, University of Paris, 2 Rue Ambroise Paré, Paris, 75010 France
| | - Pierre-Géraud Claret
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Charles Cerf
- Intensive Care Unit, Foch Hospital, Suresnes, France
| |
Collapse
|
72
|
Cannabis and tramadol addiction: Do they imply additive risk for acute myocardial infarction in adults younger than 45 years? Anatol J Cardiol 2020; 24:316-325. [PMID: 33122481 PMCID: PMC7724384 DOI: 10.14744/anatoljcardiol.2020.67206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Acute myocardial infarction (AMI) is the main cause of cardiovascular events worldwide. AMI commonly occurs in elderly patients because of atherosclerotic process related to common risk factors. Consequently, the rupture of atheromatous plaque with deleterious sequela is the common etiology of the disease. However, there are less studied etiological factors in youth compared with the usual population. Therefore, this study aimed to examine the risk profile of Egyptian youth presenting with AMI. METHODS A study was conducted in 106 patients aged ≤45 years admitted with AMI in our university hospital to explore their clinical profile risk factors. RESULTS In the study, 71 (67%) and 35 (33%) patients presented with ST elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Anterior wall MI was predominant in 49 patients (46.2%). Moreover, 93 patients (88%) were smokers, 31 (29.2%) used tramadol, 43 (40.6%) smoked cannabis, 50 (47.2%) had poor sleeping habits, 29 (27.4%) had high stress levels, 37 (34.9%) had hypertension, and 22 (20.8%) had diabetes. Twenty (18.9%) patients had a family history of premature coronary artery disease. High and low high-density lipoprotein (HDL) levels were observed in 20 (18.9%) and 47 (44.3%) patients, respectively. The left anterior descending artery (LAD) was involved in 56% of the studied population associated with tramadol use. A significant association was found between both tramadol use and cannabis smoking and presence of heavy thrombus burden on coronary angiography. CONCLUSION AMI in Egyptian youth was predominantly observed in men, with anterior STEMI as the most common presentation. Cannabis and tramadol addiction were high risk factors for AMI in Egyptian youth.
Collapse
|
73
|
Banerjee A, Gandhi AB, Antony I, Alexander J, Hisbulla M, Kannichamy V, Kaleem I, Mishra V, Khan S. Role of Cannabis in the Incidence of Myocardial Infarction: A Review. Cureus 2020; 12:e11097. [PMID: 33240693 PMCID: PMC7681753 DOI: 10.7759/cureus.11097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Legalizing cannabis use in various states in the United States has caused increased substance abuse, mostly among young people. There are very little data focussing on marijuana use and myocardial infarction (MI) incidence. The objective of the study is to analyze the published papers for cannabis-induced MI and derive a strong relation between cannabis use and MI and understand the pathophysiology. An online search was conducted in PubMed, Google Scholar, and PubMed Central to find relevant publications examining patients who developed MI due to cannabis use. Out of 32 articles that were identified for this review, 17 are case reports, one is a letter to the editor, eight are observational studies, and six are review articles. Many studies have proposed different mechanisms by which cannabis affects the body. Our study shows that marijuana can precipitate MI even if it is used for the first time. Limited data is available to comment on the mortality of patients after cannabis-induced MI. These findings highlight the necessity for public awareness to prevent the ill-effects of cannabis, especially for teenagers and older people.
Collapse
Affiliation(s)
- Amit Banerjee
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Arohi B Gandhi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ishan Antony
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Josh Alexander
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mohamed Hisbulla
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Vishmita Kannichamy
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ifrah Kaleem
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Vinayak Mishra
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| |
Collapse
|
74
|
Kramer A, Sinclair J, Sharpe L, Sarris J. Chronic cannabis consumption and physical exercise performance in healthy adults: a systematic review. J Cannabis Res 2020; 2:34. [PMID: 33526096 PMCID: PMC7819470 DOI: 10.1186/s42238-020-00037-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/04/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The effects of chronic cannabis consumption on physiological parameters of athletic performance are investigated to determine whether chronic cannabis consumption negatively affects athletic performance; improves performance, potentially via enhanced recovery; or has no effect at all. METHODS A systematic review of the literature (cross-sectional, longitudinal, and intervention studies) concerning the effects of cannabis consumption on sports performance outcomes, e.g. VO2Max (maximal oxygen uptake), PWC (physical work capacity) up to January 2020 was conducted using the PubMed, CINAHL, Medline, PsycArticles, PsycInfo, SPORTDiscus, Psychology and Behavioural Sciences Collection, and Health Source: Nursing/Academic Edition databases. After screening and additional forward searching, four articles were found to fit the inclusion criteria. RESULTS Resting heart rate was the only physiological measure that significantly differed between groups, and only in one of the four studies included herein. The strongest predictors of athletic performance (VO2Max and PWC) were not found to be significantly different between groups in any of the included studies. Chronic cannabis consumption had no significant effect on athletic performance. The included studies did not assess other elements, such as recovery or endurance. CONCLUSION No evidence exists for ergogenic or ergolytic effects from chronic cannabis consumption. In some sports, advantages may plausibly be conveyed by psychotropic enhancement or pain reduction. Further research (particularly longitudinal or interventional studies) is required to determine whether cannabis, or constituents thereof, may provide indirect supplemental benefits to athletes.
Collapse
Affiliation(s)
- Andrew Kramer
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
- School of Psychology, Western Sydney University, Penrith, Australia.
| | - Justin Sinclair
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Lara Sharpe
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
- Department of Psychiatry, The Melbourne Clinic, Professorial Unit, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
75
|
Nayak SK, Pradhan BK, Banerjee I, Pal K. Analysis of heart rate variability to understand the effect of cannabis consumption on Indian male paddy-field workers. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.102072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
76
|
Cannabis and acute myocardial infarction. JAAPA 2020; 33:23-26. [PMID: 32740110 DOI: 10.1097/01.jaa.0000668804.51594.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Marijuana is one of the most commonly consumed psychotropic drugs in the world. It has been associated with adverse cardiovascular reactions including acute coronary syndrome, but this information is not widely known among emergency medicine clinicians. This article describes cannabis use as a contributing factor to acute myocardial infarction in a young woman with chest pain.
Collapse
|
77
|
Greiner KS, Lo JO, Speranza RJ, Rincón M, Burwick RM. Marijuana use and pregnancy outcomes among women with hypertension in pregnancy. J Matern Fetal Neonatal Med 2020; 35:2286-2293. [PMID: 32627608 DOI: 10.1080/14767058.2020.1785422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Marijuana has vasoconstrictive properties and its use has been associated with increased blood pressure in the general population. Yet, there are limited data on marijuana use and adverse outcomes among women with hypertension in pregnancy, even though these disorders are associated with severe maternal and fetal morbidity and mortality. Since marijuana is currently the most commonly used illicit drug in pregnancy, there is an urgent need to better understand the potential association between marijuana use and hypertension in pregnancy.Objective: To determine the adverse prenatal effects of marijuana use in women with hypertension in pregnancy.Study design: We conducted a retrospective cohort study among individuals with hypertension in pregnancy that delivered ≥23 weeks' gestation at Oregon Health & Science University (October 2013-September 2018). The primary exposure assessed was marijuana use, identified by chart review of documented patient self-report or positive urine toxicology screen. Individuals were stratified into two groups by marijuana use: use during pregnancy versus never used. Primary outcomes included composite adverse maternal and neonatal outcomes. Secondary outcomes included individual maternal outcomes, rarer neonatal outcomes and severe features of preeclampsia. Differences were analyzed by Fisher's exact, t-test, and logistic regression. Significance was determined by alpha = 0.05 for primary outcomes and alpha = 0.01 for secondary outcomes.Results: From 11,825 deliveries, 1,613 (13.6%) were classified with hypertension in pregnancy. A total of 117 individuals (7.3%) used marijuana during pregnancy, 1,110 (68.2%) had never used marijuana and 396 (24.6%) had unknown marijuana use and were excluded, leaving 1,217 individuals in this analysis. Women using marijuana in pregnancy were more likely to be younger, non-Hispanic White, publicly insured and using other substances compared to women who did not use marijuana. There were no differences in the overall distribution of hypertensive disorders, including preeclampsia with severe features, in women who used marijuana versus those who did not (p = .80). In multivariable analyses, after adjusting for maternal factors and other substance use, marijuana use was not associated with adverse maternal (aOR 1.23, 95% CI 0.43-3.50, p = .69) or neonatal (aOR 0.90, 95% CI 0.28-2.89, p = .86) outcomes.Conclusions: Marijuana use in pregnancy was not associated with maternal or neonatal outcomes or worsened hypertensive disease among women with hypertension in pregnancy after adjusting for maternal characteristics, including use of other substances. Our data highlight the need to consider use of other substances when evaluating the association between marijuana use in pregnancy and adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Karen S Greiner
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Jamie O Lo
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Rosa J Speranza
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mónica Rincón
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Richard M Burwick
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
78
|
Ramaekers JG, Mason NL, Theunissen EL. Blunted highs: Pharmacodynamic and behavioral models of cannabis tolerance. Eur Neuropsychopharmacol 2020; 36:191-205. [PMID: 32014378 DOI: 10.1016/j.euroneuro.2020.01.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/22/2019] [Accepted: 01/12/2020] [Indexed: 02/07/2023]
Abstract
Acute exposure to cannabis comes with neurocognitive impairment, leading to increased risk of human error and injury. Evidence however indicates that such acute effects are less prominent in chronic users, suggesting cannabis tolerance. Models of cannabis tolerance stress the importance of neurobiological or behavioral adaptations following repeated cannabis exposure. The pharmacodynamic model relates neuroadaptive changes in the brain to a blunted response to cannabis. Downregulation of CB1 receptors in chronic cannabis users has been associated with a normalization of dopaminergic output from the ventral tegmental area to the mesolimbic circuit, and a reduction of impairment during acute cannabis exposure. Such neuroadaptions are absent in occasional users, who show strong increments of dopamine and glutamate levels in the striatum, a loss of functional connectivity within the mesolimbic circuit and neurocognitive impairments when exposed to cannabis. Evidence for a behavioral model of cannabis tolerance that poses that users can have volitional control to overcome functional impairment during cannabis intoxication is relatively weak, and at best shows limited control over a limited number of behavioral functions. Cannabis tolerance is most likely to occur in users that consume high doses of cannabis continuously, at a high pace, for a prolonged period of time. Knowledge on frequency, dose and duration of cannabis use that is needed to achieve, maintain or lessen tolerance however is very limited, but will be of importance in the context of cannabis therapeutics and in legal settings when evaluating the impact of cannabis exposure on human function.
Collapse
Affiliation(s)
- J G Ramaekers
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, the Netherlands.
| | - N L Mason
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, the Netherlands
| | - E L Theunissen
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, the Netherlands
| |
Collapse
|
79
|
Richards JR. Mechanisms for the Risk of Acute Coronary Syndrome and Arrhythmia Associated With Phytogenic and Synthetic Cannabinoid Use. J Cardiovasc Pharmacol Ther 2020; 25:508-522. [PMID: 32588641 DOI: 10.1177/1074248420935743] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Phytogenic cannabinoids from Cannabis sativa and synthetic cannabinoids are commonly used substances for their recreational and medicinal properties. There are increasing reports of cardiotoxicity in close temporal association with cannabinoid use in patients with structurally normal hearts and absence of coronary arterial disease. Associated adverse events include myocardial ischemia, conduction abnormalities, arrhythmias, and sudden death. This review details the effects of phytogenic and synthetic cannabinoids on diverse receptors based on evidence from in vitro, human, and animal studies to establish a molecular basis for these deleterious clinical effects. The synergism between endocannabinoid dysregulation, cannabinoid receptor, and noncannabinoid receptor binding, and impact on cellular ion flux and coronary microvascular circulation is delineated. Pharmacogenetic factors placing certain patients at higher risk for cardiotoxicity are also correlated with the diverse effects of cannabinoids.
Collapse
Affiliation(s)
- John R Richards
- Department of Emergency Medicine, 70083University of California Davis Medical Center, Sacramento, California, CA, USA
| |
Collapse
|
80
|
Kalenderoglu A, Orum MH, Karadag AS, Kustepe A, Celik M, Egilmez OB, Eken-Gedik D. Increases in retinal nerve fiber layer thickness may represent the neuroprotective effect of cannabis: an optical coherence tomography study. J Addict Dis 2020; 38:280-290. [DOI: 10.1080/10550887.2020.1754109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Aysun Kalenderoglu
- Department of Psychiatry, Adiyaman University, Faculty of Medicine, Adiyaman, Turkey
| | | | - Ayse Sevgi Karadag
- Department of Ophthalmology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Ali Kustepe
- Adiyaman University Training and Research Hospital, Adiyaman, Turkey
| | - Mustafa Celik
- Department of Psychiatry, Private Yuzyil Hospital, Istanbul, Turkey
| | - Oguzhan Bekir Egilmez
- Department of Psychiatry, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Dilay Eken-Gedik
- Physical Therapy and Rehabilitation, Private Park Hospital, Adiyaman, Turkey
| |
Collapse
|
81
|
San Luis CV, O'Hana S Nobleza C, Shekhar S, Sugg R, Villareal DJ, Mehta T, Gangadhara S. Association between recent cannabinoid use and acute ischemic stroke. Neurol Clin Pract 2020; 10:333-339. [PMID: 32983613 DOI: 10.1212/cpj.0000000000000888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 04/07/2020] [Indexed: 11/15/2022]
Abstract
Background Studies that have analyzed the association between cannabis use and acute ischemic stroke (AIS) have provided conflicting results. In this study, we aim to determine the association of recent cannabis use detected through urine drug screen (UDS) among patients admitted with AIS. Methods A retrospective observational study was performed using the medical records database. All patients aged 18 years and older admitted from January 1, 2015, to December 31, 2017, who underwent urine toxicology testing on admission were included in the analysis. Multivariate logistic regression analysis was performed to analyze independent association between recent cannabis use and AIS. Results A total of 9,350 patients were determined to have undergone UDS during admission, and 18% (1,643) of this had a positive urine cannabis test. Unadjusted risk ratio showed a 50% decrease in risk of AIS among cannabis users (risk ratio = 0.505, 95% confidence interval [CI] 0.425-0.600). The effect was lost after adjusting for age, race, ethnicity, sickle cell disease, dyslipidemia, hypertension, obesity, diabetes mellitus, cigarette smoking, atrial fibrillation, and other cardiac conditions (odds ratio 1.038, 95% CI 0.773-1.394). Conclusion This is one of the few studies analyzing the association of recent cannabis use and AIS using admission urine toxicology test independent of polysubstance use. Although our study has limitations, we did not find an independent association between recent cannabis use and the incidence of AIS. Further studies using urine toxicology tests with larger sample size and including dosage of cannabis exposure should be conducted.
Collapse
Affiliation(s)
- Carmela V San Luis
- Department of Neurology (CVSL), University of Mississippi Medical Center; Division of Neurosciences Critical Care (COHSN), Department of Neurology, University of Mississippi Medical Center, Jackson; Division of Cerebrovascular Diseases (SS, RS, SG), Department of Neurology, University of Mississippi Medical Center, Jackson; Information Technology (DJV), CAP College Foundation, Inc., The Digitalized Distance Education, Makati City, Philippines; and Department of Neurology (TM), Neurosurgery and Radiology, University of Minnesota, Minneapolis
| | - Christa O'Hana S Nobleza
- Department of Neurology (CVSL), University of Mississippi Medical Center; Division of Neurosciences Critical Care (COHSN), Department of Neurology, University of Mississippi Medical Center, Jackson; Division of Cerebrovascular Diseases (SS, RS, SG), Department of Neurology, University of Mississippi Medical Center, Jackson; Information Technology (DJV), CAP College Foundation, Inc., The Digitalized Distance Education, Makati City, Philippines; and Department of Neurology (TM), Neurosurgery and Radiology, University of Minnesota, Minneapolis
| | - Shashank Shekhar
- Department of Neurology (CVSL), University of Mississippi Medical Center; Division of Neurosciences Critical Care (COHSN), Department of Neurology, University of Mississippi Medical Center, Jackson; Division of Cerebrovascular Diseases (SS, RS, SG), Department of Neurology, University of Mississippi Medical Center, Jackson; Information Technology (DJV), CAP College Foundation, Inc., The Digitalized Distance Education, Makati City, Philippines; and Department of Neurology (TM), Neurosurgery and Radiology, University of Minnesota, Minneapolis
| | - Rebecca Sugg
- Department of Neurology (CVSL), University of Mississippi Medical Center; Division of Neurosciences Critical Care (COHSN), Department of Neurology, University of Mississippi Medical Center, Jackson; Division of Cerebrovascular Diseases (SS, RS, SG), Department of Neurology, University of Mississippi Medical Center, Jackson; Information Technology (DJV), CAP College Foundation, Inc., The Digitalized Distance Education, Makati City, Philippines; and Department of Neurology (TM), Neurosurgery and Radiology, University of Minnesota, Minneapolis
| | - Darren J Villareal
- Department of Neurology (CVSL), University of Mississippi Medical Center; Division of Neurosciences Critical Care (COHSN), Department of Neurology, University of Mississippi Medical Center, Jackson; Division of Cerebrovascular Diseases (SS, RS, SG), Department of Neurology, University of Mississippi Medical Center, Jackson; Information Technology (DJV), CAP College Foundation, Inc., The Digitalized Distance Education, Makati City, Philippines; and Department of Neurology (TM), Neurosurgery and Radiology, University of Minnesota, Minneapolis
| | - Tapan Mehta
- Department of Neurology (CVSL), University of Mississippi Medical Center; Division of Neurosciences Critical Care (COHSN), Department of Neurology, University of Mississippi Medical Center, Jackson; Division of Cerebrovascular Diseases (SS, RS, SG), Department of Neurology, University of Mississippi Medical Center, Jackson; Information Technology (DJV), CAP College Foundation, Inc., The Digitalized Distance Education, Makati City, Philippines; and Department of Neurology (TM), Neurosurgery and Radiology, University of Minnesota, Minneapolis
| | - Shreyas Gangadhara
- Department of Neurology (CVSL), University of Mississippi Medical Center; Division of Neurosciences Critical Care (COHSN), Department of Neurology, University of Mississippi Medical Center, Jackson; Division of Cerebrovascular Diseases (SS, RS, SG), Department of Neurology, University of Mississippi Medical Center, Jackson; Information Technology (DJV), CAP College Foundation, Inc., The Digitalized Distance Education, Makati City, Philippines; and Department of Neurology (TM), Neurosurgery and Radiology, University of Minnesota, Minneapolis
| |
Collapse
|
82
|
Mura P, Underner M, Brunet B. [Cannabis: Similarities and differences with tobacco]. Rev Mal Respir 2020; 37:479-487. [PMID: 32381378 DOI: 10.1016/j.rmr.2020.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/09/2019] [Indexed: 11/28/2022]
Abstract
Nicotine is the specific psychoactive substance of tobacco while tetrahydrocannabinol (THC) is the specific component of cannabis. The inhalation technique of cannabis is different from that of tobacco smoking: the volume of puffs is larger, inhalation is deeper, and pulmonary retention time is longer. Cannabis addiction is difficult to evaluate, both products often being smoked concomitantly. The principle physical side effects of cannabis affect organs and functions in a similar way to tobacco: pulmonary, cardiovascular, endocrine and stomatological. Gastrointestinal complications such as cannabinoid hyperemesis are specific to cannabis. Some psychological effects of THC may be acute (altered time and space perception, sensory disability, decreased vigilance, mood and dissociative disorders, hallucinations and delirium, impaired learning and memory, impaired cognitive and motor performance, panic attacks and anxiety) or chronic (lack of motivation, disorganisation of thoughts, increase in frequency and severity of schizophrenic crises). Cannabis can also be implicated in traffic and workplace accidents. Synthetic cannabinoids have increased psychotropic and somatic effects due to a greater affinity for brain cannabinoid receptors.
Collapse
Affiliation(s)
- P Mura
- Service de toxicologie et pharmacocinétique, CHU de La-Milétrie, BP 577, 86021 Poitiers, France.
| | - M Underner
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 86021 Poitiers, France
| | - B Brunet
- Service de toxicologie et pharmacocinétique, CHU de La-Milétrie, BP 577, 86021 Poitiers, France
| |
Collapse
|
83
|
Reddy V, Grogan D, Ahluwalia M, Salles ÉL, Ahluwalia P, Khodadadi H, Alverson K, Nguyen A, Raju SP, Gaur P, Braun M, Vale FL, Costigliola V, Dhandapani K, Baban B, Vaibhav K. Targeting the endocannabinoid system: a predictive, preventive, and personalized medicine-directed approach to the management of brain pathologies. EPMA J 2020; 11:217-250. [PMID: 32549916 PMCID: PMC7272537 DOI: 10.1007/s13167-020-00203-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/10/2020] [Indexed: 02/07/2023]
Abstract
Cannabis-inspired medical products are garnering increasing attention from the scientific community, general public, and health policy makers. A plethora of scientific literature demonstrates intricate engagement of the endocannabinoid system with human immunology, psychology, developmental processes, neuronal plasticity, signal transduction, and metabolic regulation. Despite the therapeutic potential, the adverse psychoactive effects and historical stigma, cannabinoids have limited widespread clinical application. Therefore, it is plausible to weigh carefully the beneficial effects of cannabinoids against the potential adverse impacts for every individual. This is where the concept of "personalized medicine" as a promising approach for disease prediction and prevention may take into the account. The goal of this review is to provide an outline of the endocannabinoid system, including endocannabinoid metabolizing pathways, and will progress to a more in-depth discussion of the therapeutic interventions by endocannabinoids in various neurological disorders.
Collapse
Affiliation(s)
- Vamsi Reddy
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA USA
| | - Dayton Grogan
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA USA
| | - Meenakshi Ahluwalia
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA USA
| | - Évila Lopes Salles
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA USA
| | - Pankaj Ahluwalia
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA USA
| | - Hesam Khodadadi
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA USA
| | - Katelyn Alverson
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA USA
| | - Andy Nguyen
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA USA
| | - Srikrishnan P. Raju
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA USA
- Brown University, Providence, RI USA
| | - Pankaj Gaur
- Georgia Cancer Center, Augusta University, Augusta, GA USA
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
| | - Molly Braun
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- VISN 20 Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, USA
| | - Fernando L. Vale
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA USA
| | | | - Krishnan Dhandapani
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA USA
| | - Babak Baban
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA USA
| | - Kumar Vaibhav
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA USA
| |
Collapse
|
84
|
Farra YM, Eden MJ, Coleman JR, Kulkarni P, Ferris CF, Oakes JM, Bellini C. Acute neuroradiological, behavioral, and physiological effects of nose-only exposure to vaporized cannabis in C57BL/6 mice. Inhal Toxicol 2020; 32:200-217. [PMID: 32475185 DOI: 10.1080/08958378.2020.1767237] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: The rapid increase of cannabis consumption reinforces the need to elucidate the health hazards of this practice. The presence of fine particulate matter in cannabis smoke and vapor poses a major concern, as it may contribute to cardiopulmonary disease. To facilitate the assessment of risks associated with cannabis inhalation, we developed and characterized a method for exposing mice to cannabis in a way that mimics the delivery of the drug to the airways of smokers. Materials and Methods: Cannabis (10.3% THC, 0.05% CBD) was vaporized to generate aerosols with a reproducible particle profile. Aerosols were acutely delivered to male, adult C57BL/6 mice via a nose-only exposure system. Serum THC levels were measured for increasing cannabis doses. Blood pressure and heart rate were recorded at baseline and following exposure. Behavioral response to cannabis inhalation in the open field was documented. Awake neurological activity upon cannabis exposure was monitored using BOLD fMRI.Results and Discussion: Cannabis aerosols contained particles with count median diameter of 243 ± 39 nm and geometric standard deviation of 1.56 ± 0.06. Blood serum THC levels increased linearly with aerosolized mass and peaked at 136 ± 5 ng/mL. Cannabis inhalation decreased heart rate and blood pressure but promoted anxiety-like behavior. Observed differences in BOLD activation volumes linked cannabis to increased awareness to sensory stimuli and reduced behavioral arousal.Conclusions: Quantified physiological, behavioral, and neurological responses served as validation for our mouse model of cannabis inhalation. Animal models of aerosol exposure will be instrumental for uncovering the health outcomes of chronic cannabis use.
Collapse
Affiliation(s)
- Yasmeen M Farra
- Department of Bioengineering, Northeastern University, Boston, MA, USA
| | - Matthew J Eden
- Department of Bioengineering, Northeastern University, Boston, MA, USA
| | - James R Coleman
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA, USA
| | - Praveen Kulkarni
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA, USA
| | - Craig F Ferris
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA, USA
| | - Jessica M Oakes
- Department of Bioengineering, Northeastern University, Boston, MA, USA
| | - Chiara Bellini
- Department of Bioengineering, Northeastern University, Boston, MA, USA
| |
Collapse
|
85
|
Archie SR, Cucullo L. Cerebrovascular and Neurological Dysfunction under the Threat of COVID-19: Is There a Comorbid Role for Smoking and Vaping? Int J Mol Sci 2020; 21:E3916. [PMID: 32486196 PMCID: PMC7312781 DOI: 10.3390/ijms21113916] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 01/08/2023] Open
Abstract
The recently discovered novel coronavirus, SARS-CoV-2 (COVID-19 virus), has brought the whole world to standstill with critical challenges, affecting both health and economic sectors worldwide. Although initially, this pandemic was associated with causing severe pulmonary and respiratory disorders, recent case studies reported the association of cerebrovascular-neurological dysfunction in COVID-19 patients, which is also life-threatening. Several SARS-CoV-2 positive case studies have been reported where there are mild or no symptoms of this virus. However, a selection of patients are suffering from large artery ischemic strokes. Although the pathophysiology of the SARS-CoV-2 virus affecting the cerebrovascular system has not been elucidated yet, researchers have identified several pathogenic mechanisms, including a role for the ACE2 receptor. Therefore, it is extremely crucial to identify the risk factors related to the progression and adverse outcome of cerebrovascular-neurological dysfunction in COVID-19 patients. Since many articles have reported the effect of smoking (tobacco and cannabis) and vaping in cerebrovascular and neurological systems, and considering that smokers are more prone to viral and bacterial infection compared to non-smokers, it is high time to explore the probable correlation of smoking in COVID-19 patients. Herein, we have reviewed the possible role of smoking and vaping on cerebrovascular and neurological dysfunction in COVID-19 patients, along with potential pathogenic mechanisms associated with it.
Collapse
Affiliation(s)
- Sabrina Rahman Archie
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA;
| | - Luca Cucullo
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA;
- Center for Blood-Brain Barrier Research, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
| |
Collapse
|
86
|
Osborne AJ, Pearson JF, Noble AJ, Gemmell NJ, Horwood LJ, Boden JM, Benton MC, Macartney-Coxson DP, Kennedy MA. Genome-wide DNA methylation analysis of heavy cannabis exposure in a New Zealand longitudinal cohort. Transl Psychiatry 2020; 10:114. [PMID: 32321915 PMCID: PMC7176736 DOI: 10.1038/s41398-020-0800-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/11/2020] [Accepted: 03/20/2020] [Indexed: 12/24/2022] Open
Abstract
Cannabis use is of increasing public health interest globally. Here we examined the effect of heavy cannabis use, with and without tobacco, on genome-wide DNA methylation in a longitudinal birth cohort (Christchurch Health and Development Study, CHDS). A total of 48 heavy cannabis users were selected from the CHDS cohort, on the basis of their adult exposure to cannabis and tobacco, and DNA methylation assessed from whole blood samples, collected at approximately age 28. Methylation in heavy cannabis users was assessed, relative to non-users (n = 48 controls) via the Illumina Infinium® MethylationEPIC BeadChip. We found the most differentially methylated sites in cannabis with tobacco users were in the AHRR and F2RL3 genes, replicating previous studies on the effects of tobacco. Cannabis-only users had no evidence of differential methylation in these genes, or at any other loci at the epigenome-wide significance level (P < 10-7). However, there were 521 sites differentially methylated at P < 0.001 which were enriched for genes involved in neuronal signalling (glutamatergic synapse and long-term potentiation) and cardiomyopathy. Further, the most differentially methylated loci were associated with genes with reported roles in brain function (e.g. TMEM190, MUC3L, CDC20 and SP9). We conclude that the effects of cannabis use on the mature human blood methylome differ from, and are less pronounced than, the effects of tobacco use, and that larger sample sizes are required to investigate this further.
Collapse
Affiliation(s)
- Amy J. Osborne
- grid.21006.350000 0001 2179 4063School of Biological Sciences, University of Canterbury, Christchurch, 8041 New Zealand
| | - John F. Pearson
- grid.29980.3a0000 0004 1936 7830Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, 8011 New Zealand
| | - Alexandra J. Noble
- grid.21006.350000 0001 2179 4063School of Biological Sciences, University of Canterbury, Christchurch, 8041 New Zealand
| | - Neil J. Gemmell
- grid.29980.3a0000 0004 1936 7830Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, 9054 New Zealand
| | - L. John Horwood
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago Christchurch, Christchurch, 8011 New Zealand
| | - Joseph M. Boden
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago Christchurch, Christchurch, 8011 New Zealand
| | - Miles C. Benton
- grid.419706.d0000 0001 2234 622XHuman Genomics, Institute of Environmental Science and Research, Kenepuru Science Centre, Porirua, 5240 New Zealand
| | - Donia P. Macartney-Coxson
- grid.419706.d0000 0001 2234 622XHuman Genomics, Institute of Environmental Science and Research, Kenepuru Science Centre, Porirua, 5240 New Zealand
| | - Martin A. Kennedy
- grid.29980.3a0000 0004 1936 7830Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, 8011 New Zealand
| |
Collapse
|
87
|
Viswanath A, Barreveld AM, Fortino M. Assessment and Management of the High-Risk Dental Patient with Active Substance Use Disorder. Dent Clin North Am 2020; 64:547-558. [PMID: 32448458 DOI: 10.1016/j.cden.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Every dentist cares for patients with a history of substance use disorder (SUD), regardless of a patient's socioeconomic status, education, or ethnicity. SUD is a global epidemic, with approximately 8% of the general US population meeting diagnostic criteria for a SUD and more than 20% of the global population experiencing a SUD. The importance of understanding how to identify substance use, manage patients with a SUD, and offer appropriate referral is essential for all dental professionals. In 2005, the American Dental Association published, "Statement on Provision of Dental Treatment for Patients with Substance Use Disorders."
Collapse
Affiliation(s)
- Archana Viswanath
- Department of Oral and Maxillofacial Surgery, Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA; Department of Diagnostic Sciences, Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA
| | - Antje M Barreveld
- Department of Anesthesiology, Tufts University School of Medicine, 1 Kneeland Street, Boston, MA 02111, USA; Pain Management Services, Substance Use Services, Newton-Wellesley Hospital, Newton, MA, USA
| | - Matthew Fortino
- Department of Diagnostic Sciences, Center for Pain Medicine, Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA; Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
88
|
Richards JR, Blohm E, Toles KA, Jarman AF, Ely DF, Elder JW. The association of cannabis use and cardiac dysrhythmias: a systematic review. Clin Toxicol (Phila) 2020; 58:861-869. [DOI: 10.1080/15563650.2020.1743847] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- John R. Richards
- Department of Emergency Medicine, University of California Davis Health System, Sacramento, CA, USA
| | - Eike Blohm
- Department of Emergency Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Kara A. Toles
- Department of Emergency Medicine, University of California Davis Health System, Sacramento, CA, USA
| | - Angela F. Jarman
- Department of Emergency Medicine, University of California Davis Health System, Sacramento, CA, USA
| | - Dylan F. Ely
- Department of Emergency Medicine, University of California Davis Health System, Sacramento, CA, USA
| | - Joshua W. Elder
- Department of Emergency Medicine, University of California Davis Health System, Sacramento, CA, USA
| |
Collapse
|
89
|
Siddiqui MT, Bilal M, Singh A, Olivier-Cabrera S, Lebovics E, Schorr-Lesnick B, Dworkin B, Kirby DF. Prevalence of cannabis use has significantly increased in patients with cyclic vomiting syndrome. Neurogastroenterol Motil 2020; 32:e13806. [PMID: 31990435 PMCID: PMC9206874 DOI: 10.1111/nmo.13806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder which leads to multiple hospitalizations and causes significant impairment of quality of life. Cannabis use is common in patients with CVS, and there are limited data on the national trends in the prevalence of its use in the United States. METHODS We used the National Inpatient Sample (NIS) database from 2005 to 2014 and identified hospitalizations with a primary diagnosis of CVS by utilizing the International Classification of Diseases, 9th revision Clinical Modification (ICD-9 CM) coding system. The primary objective of the study was to analyze the prevalence and trends in cannabis use in CVS patients. We also assessed healthcare resource utilization associated with cannabis use. RESULTS A total of 129 090 hospitalizations with a primary diagnosis of CVS were identified and included in the study. In the United States, the overall rate of cannabis use among these patients was 104 per 1000 hospitalizations (N = 13 460). Over the last decade, the prevalence of cannabis use increased by 10-fold, from 2.2% in 2005 to 21.2% in 2014. CONCLUSION Our analysis of the national database suggests that nearly 1 in 5 CVS hospitalizations have concurrent cannabis use. This prevalence is significantly rising over the last decade, perhaps due to changing legislation and increased utilization of cannabis. Age younger than 35, male gender, African American and Native American race, personal history of alcohol abuse and tobacco use were some of the strongest predictors of cannabis use.
Collapse
Affiliation(s)
- Mohamed Tausif Siddiqui
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mohammad Bilal
- Department of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sarah Olivier-Cabrera
- Department of Medicine, Division of Gastroenterology and Hepatology, New York Medical College, Valhalla, New York
| | - Edward Lebovics
- Department of Medicine, Division of Gastroenterology and Hepatology, New York Medical College, Valhalla, New York
| | - Beth Schorr-Lesnick
- Department of Medicine, Division of Gastroenterology and Hepatology, New York Medical College, Valhalla, New York
| | - Brad Dworkin
- Department of Medicine, Division of Gastroenterology and Hepatology, New York Medical College, Valhalla, New York
| | - Donald F Kirby
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
90
|
Vakharia RM, Sodhi N, Anis HK, Ehiorobo JO, Mont MA, Roche MW. Patients Who Have Cannabis Use Disorder Have Higher Rates of Venous Thromboemboli, Readmission Rates, and Costs Following Primary Total Knee Arthroplasty. J Arthroplasty 2020; 35:997-1002. [PMID: 31973970 DOI: 10.1016/j.arth.2019.11.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/06/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Studies have shown that cannabis can interfere with hematological parameters and platelet morphology. The purpose of this study is to investigate whether patients with cannabis use disorder undergoing primary total knee arthroplasty (TKA) have higher rates of (1) venous thromboemboli (VTEs); (2) readmissions; and (3) costs. METHODS Study group patients undergoing primary TKA were identified from a large, nationwide database. Patients who had a history of VTEs, deep vein thromboses (DVTs), pulmonary emboli (PEs), and coagulopathies before their TKA were excluded. Study group patients were matched to controls in a 1:4 ratio by age, sex, a comorbidity index, and medical comorbidities. The query yielded 18,388 patients (cannabis = 3680; controls = 14,708). Outcomes analyzed included rates of 90-day VTEs, DVTs, and PEs, in addition to 90-day readmissions and costs. A P value less than .01 was considered statistically significant. RESULTS Patients who have cannabis use disorder were found to have significantly higher incidence and odds (2.79% vs 1.78%; odds ratio [OR], 1.58; P < .0001) of VTEs, DVTs (2.41% vs 1.44%; OR, 1.68; P < .0001), and PEs (0.97% vs 0.62%; P = .01). Readmissions were significantly higher (27.03% vs 23.18%; OR, 1.22; P < .0001) in patients who have cannabis use disorder. Patients with cannabis use disorder have significantly higher day of surgery ($14,024.88 vs $12,127.49; P < .0001) and 90-day costs ($19,155.45 vs $16,315.00; P < .0001). CONCLUSION This study found that patients who have a cannabis use disorder have higher rates of thromboembolic complications, readmission rates, and costs following primary TKA compared to a matched cohort.
Collapse
Affiliation(s)
- Rushabh M Vakharia
- Holy Cross Hospital, Orthopaedic Research Institute, Fort Lauderdale, FL
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Hiba K Anis
- Department of Orthopaedic Surgery, Cleveland Clinic Hospital, Cleveland, OH
| | - Joseph O Ehiorobo
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY; Department of Orthopaedic Surgery, Cleveland Clinic Hospital, Cleveland, OH
| | - Martin W Roche
- Holy Cross Hospital, Orthopaedic Research Institute, Fort Lauderdale, FL
| |
Collapse
|
91
|
Perisetti A, Rimu AH, Khan SA, Bansal P, Goyal H. Role of cannabis in inflammatory bowel diseases. Ann Gastroenterol 2020; 33:134-144. [PMID: 32127734 PMCID: PMC7049239 DOI: 10.20524/aog.2020.0452] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022] Open
Abstract
For many centuries, cannabis (marijuana) has been used for both recreational and medicinal purposes. Currently, there are about 192 million cannabis users worldwide, constituting approximately 3.9% of the global population. Cannabis comprises more than 70 aromatic hydrocarbon compounds known as cannabinoids. Endogenous circulating cannabinoids, or endocannabinoids, such as anandamide and 2-arachidonoyl-glycerol, their metabolizing enzymes (fatty acid amide hydrolase and monoacylglycerol lipase) and 2 G-protein coupled cannabinoid receptors, CB1 and CB2, together represent the endocannabinoid system and are present throughout the human body. In the gastrointestinal (GI) tract, the activated endocannabinoid system reduces gut motility, intestinal secretion and epithelial permeability, and induces inflammatory leukocyte recruitment and immune modulation through the cannabinoid receptors present in the enteric nervous and immune systems. Because of the effects of cannabinoids on the GI tract, attempts have been made to investigate their medicinal properties, particularly for GI disorders such as pancreatitis, hepatitis, and inflammatory bowel diseases (IBD). The effects of cannabis on IBD have been elucidated in several small observational and placebo-controlled studies, but with varied results. The small sample size and short follow-up duration in these studies make it difficult to show the clear benefits of cannabis in IBD. However, cannabis is now being considered as a potential drug for inflammatory GI conditions, particularly IBD, because of its spreading legalization in the United States and other countries and the growing trend in its use. More high-quality controlled studies are warranted to elucidate the mechanism and benefits of cannabis use as a possible option in IBD management.
Collapse
Affiliation(s)
- Abhilash Perisetti
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences (Abhilash Perisetti)
| | - Afrina Hossain Rimu
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX (Afrina Hossain Rimu)
| | - Salman Ali Khan
- University of Arkansas for Medical Sciences, AR (Salman Ali Khan)
| | - Pardeep Bansal
- Department of Gastroenterology, Regional Hospital and Moses Taylor Hospital, PA (Pardeep Bansal)
| | - Hemant Goyal
- Department of Medicine, The Wright Center for Graduate Medical Education (Hemant Goyal), USA
| |
Collapse
|
92
|
Ozturk HM, Yetkin E, Ozturk S. Synthetic Cannabinoids and Cardiac Arrhythmia Risk: Review of the Literature. Cardiovasc Toxicol 2020; 19:191-197. [PMID: 31030341 DOI: 10.1007/s12012-019-09522-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Synthetic cannabinoids (SCBs) are widely used recreational substances especially among adults. Although they have been considered as safe during the marketing process, our knowledge about their adverse effects has evolved since years. SCBs are associated with various cardiac events including acute myocardial infarction and sudden cardiac death. There is also growing evidence that SCBs are associated with cardiac arrhythmia development both in acute and chronic exposure. SCBs have been shown to be associated with both supraventricular and ventricular arrhythmias. However, the exact mechanism of the SCB related arrhythmia remains unknown. Understanding the exact association and possible mechanisms may help us to identify high risk patients at an early stage and to develop treatment modalities to prevent or reverse the arrhythmic effects of SCBs.
Collapse
Affiliation(s)
| | - Ertan Yetkin
- Department of Cardiology, Istinye University Liv Hospital, Istanbul, Turkey
| | - Selcuk Ozturk
- Cardiology Clinic, Ankara Education and Research Hospital, Ankara, Turkey.
| |
Collapse
|
93
|
Burt JR, Agha AM, Yacoub B, Zahergivar A, Pepe J. Marijuana use and coronary artery disease in young adults. PLoS One 2020; 15:e0228326. [PMID: 31995626 PMCID: PMC6988970 DOI: 10.1371/journal.pone.0228326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/10/2020] [Indexed: 11/19/2022] Open
Abstract
Background Marijuana is the most popular drug of abuse in the United States. The association between its use and coronary artery disease has not yet been fully elucidated. This study aims to determine the frequency of coronary artery disease among young to middle aged adults presenting with chest pain who currently use marijuana as compared to nonusers. Methods In this retrospective study, 1,420 patients with chest pain or angina equivalent were studied. Only men between 18 and 40 years and women between 18 and 50 years of age without history of cardiac disease were included. All patients were queried about current or prior cannabis use and underwent coronary CT angiography. Each coronary artery on coronary CT angiography was assessed based on the CAD-RADS reporting system. Results A total of 146 (10.3%) out of 1,420 patients with chest pain were identified as marijuana users. Only 6.8% of the 146 marijuana users had evidence of coronary artery disease on coronary CT angiography. In comparison, the rate was 15.0% among the 1,274 marijuana nonusers (p = 0.008). After accounting for other cardiac risk factors in a multivariate analysis, the negative association between marijuana use and coronary artery disease on coronary CT angiography diminished (p = 0.12, 95% CI 0.299–1.15). A majority of marijuana users were younger than nonusers and had a lower frequency of hypertension and diabetes than nonusers. There was no statistical difference in lipid panel values between the two groups. Only 2 out of 10 marijuana users with coronary artery disease on coronary CT angiography had hemodynamically significant stenosis. Conclusion Among younger patients being evaluated for chest pain, self-reported cannabis use conferred no additional risk of coronary artery disease as detected on coronary CT angiography.
Collapse
Affiliation(s)
- Jeremy R. Burt
- Department of Radiology & Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
- * E-mail:
| | - Ali M. Agha
- Department of Internal Medicine, McGovern Medical School at University of Texas - Houston, Houston, Texas, United States of America
| | - Basel Yacoub
- Department of Radiology & Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Aryan Zahergivar
- Department of Radiology & Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Julie Pepe
- Translational Research Institute, AdventHealth Orlando, Orlando, Florida, United States of America
| |
Collapse
|
94
|
Cannabis use and outcomes after aneurysmal subarachnoid hemorrhage: A nationwide retrospective cohort study. J Clin Neurosci 2020; 72:98-101. [PMID: 31973920 DOI: 10.1016/j.jocn.2019.12.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/31/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cannabis is the most consumed recreational drug in the world. It is possible that cannabis has an association with an increased risk of vasospasm-related strokes and delayed cerebral ischemia (DCI), which are major causes of morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH). Hence, this study aimed to explore the independent relationship between cannabis use and outcomes after aSAH using the 2016 United States Nationwide Inpatient Sample. METHODS This study was conducted using the 2016 National Inpatient Sample with ICD-10 codes. Multivariate logistic regression was used to examine the association between cannabis use, the primary (inpatient mortality) and secondary outcomes. RESULTS There were 42,394 patients identified with aSAH, of whom 925 were identified as cannabis users. Cannabis users and non-users were similar in terms of severity of aSAH. Although the unadjusted mortality rate was lower among cannabis users (16%) than non-users (22%), (p = 0.04), both the age-adjusted odds ratio (OR) (0.83, 95% confidence interval (CI): 0.56; 1.24) and the multivariate-adjusted OR (0.87, 95% CI: 0.54; 1.42) did not reach statistical significance. Secondary outcomes did not reach statistical significance. CONCLUSION In this nationwide cohort, cannabis users with aSAH had similar outcomes compared to nonusers. However, these results are likely limited by underreporting of cannabis use. Future prospective studies are needed to elucidate the pathophysiology and association between cannabis and outcomes following aSAH.
Collapse
|
95
|
Mistry T, Balavenkatasubhramanian J, Gurumoorthi P, Shankar B. Perioperative care in a patient with acute psychosis: Challenges and management. BALI JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.4103/bjoa.bjoa_24_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
96
|
Kariyanna PT, Smith LR, Patwa K, Salifu MO, McFarlane IM. Marijuana and Microcirculation: A Review. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2020; 8:284-288. [PMID: 32775630 PMCID: PMC7410519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Marijuana is the most widely used recreational drug across the United States. Ongoing efforts to legalize marijuana, as well as the drug's increasing popularity contribute to the marijuana's reputation as having a low risk profile. Marijuana's association with adverse cardiovascular events, such as arrhythmia and vasospasm is well-documented. We synthesized what is known about how marijuana use pertains to and is implicated endothelial cell damage and its effects on microcirculation. THC exerts effects through the cannabinoid receptors, CB1 and CB2. The downstream effects of CB1 activation point to a role for this receptor in atherogenesis and vasospasm, likely by precipitating oxidative stress. Endothelial cells, when exposed to reactive oxygen species, provide a stimulus for vasoconstriction with a diminished ability for vasodilation. This phenomenon has manifested itself in cases of coronary vasospastic angina, and coronary slow and no flow that have resulted from marijuana use, as confirmed by cardiac catheterization reports that showed no evidence of obstructive lesions that could otherwise be responsible for the patients' symptoms. Marijuana users suffer from acute ischemic stroke at higher rates than non-users. Several theories have been proposed to support this observation, namely marijuana induced reversible cerebral vasoconstriction syndrome, and mitochondrial damage caused by oxidative stress that disproportionately affects cerebral vasculature. As marijuana use continues to grow, so does the important of elucidating the drug's effect on endothelial cells and microcirculation. Further studies should investigate the temporal association between marijuana and endothelial damage, as well as the possibility of recovery from such injury, and whether there is therapeutic potential in cannabinoid receptors.
Collapse
|
97
|
A young patient with acute myocardial infarction due to bonsai treated with glycoprotein IIbIIIa inhibitor. Anatol J Cardiol 2020; 25:352-354. [PMID: 33960311 DOI: 10.14744/anatoljcardiol.2020.59056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
98
|
Patel RS, Manocha P, Patel J, Patel R, Tankersley WE. Cannabis Use Is an Independent Predictor for Acute Myocardial Infarction Related Hospitalization in Younger Population. J Adolesc Health 2020; 66:79-85. [PMID: 31611137 DOI: 10.1016/j.jadohealth.2019.07.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/28/2019] [Accepted: 07/29/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE This study aimed to evaluate the risk of various substances in young acute myocardial infarction (AMI) inpatients and analyze patient demographics and hospital outcomes for significant substance use risk factors. METHODS We conducted a retrospective analysis of the Nationwide Inpatient Sample data (2010-2014). Patients (aged 15-22 years) with a primary diagnosis for AMI (N = 1,694) were compared with non-AMI (N = 9,465,255) inpatients for odds ratio (OR) of substance use by logistic regression model, adjusted for demographics, medical risk factors, and comorbid substance use. RESULTS Tobacco (28.4%) and cannabis (14.9%) use were most prevalent in AMI inpatients. Cocaine (OR = 3.9), amphetamine (OR = 2.3), and cannabis (OR = 1.3) users were at higher risk of AMI hospitalizations. Higher proportion of cannabis users (14.7%) had major severity of illness at admission and higher mean total charge ($53,608) compared with that seen in cocaine and amphetamine users. Angioplasty was used more in cannabis users (19.4%) than others. The in-hospital mortalities were 2.7% and 2% in overall AMI cohort and cannabis users, respectively, and none in cocaine and amphetamine users. CONCLUSIONS Our study demonstrates a higher prevalence and significant odds of AMI inpatients with cannabis use, along with the potential cost burdens because of severe morbidity and higher use of treatment modalities. Physicians need to familiarize themselves with rising use of cannabis and other substances in adolescent and younger population and the typical presentations of cannabis-induced myocardial infarction.
Collapse
Affiliation(s)
| | - Pankaj Manocha
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - Jenil Patel
- Department of Epidemiology, University of Arkansas for Medical Sciences (UAMS) College of Public Health, Little Rock, Arkansas
| | - Riddhi Patel
- Department of Epidemiology, University of Texas Health College of Public Health, Houston, Texas
| | | |
Collapse
|
99
|
Ladha KS, Manoo V, Virji AF, Hanlon JG, Mclaren-Blades A, Goel A, Wijeysundera DN, Kotra LP, Ibarra C, Englesakis M, Clarke H. The Impact of Perioperative Cannabis Use: A Narrative Scoping Review. Cannabis Cannabinoid Res 2019; 4:219-230. [PMID: 31872058 PMCID: PMC6922064 DOI: 10.1089/can.2019.0054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
As countries progressively embrace the legalization of both medicinal and recreational cannabis, there remains a significant knowledge gap when it comes to the perioperative uses of cannabis, as well as the management of cannabis users. This review summarizes the information available on the subject based on existing published studies. Articles outlining the physiological changes occurring in the human body during acute and chronic use of cannabis (outside the context of anesthesia) are also taken into consideration as understanding these changes allows a more calculated approach to better anticipate patients' needs in the perioperative setting. Common questions facing the anesthesiologist at each phase of the perioperative period will be addressed and a systematic approach to the effect of cannabinoids on various organ systems will also be presented. Issues unique to cannabis use such as cannabis withdrawal syndrome and alterations in post-operative pain processing will also be discussed. To date, the number of studies available for guidance is small and study designs are markedly heterogenous, if not limited, making conclusions challenging. While the currently available information can assist in making decisions, further studies of larger scale are eagerly anticipated to help guide future patient care.
Collapse
Affiliation(s)
- Karim S. Ladha
- Department of Anesthesia and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of Anesthesiology and Pain Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Varuna Manoo
- Department of Anesthesiology and Pain Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Ali-Faizan Virji
- Department of Anesthesiology and Pain Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - John G. Hanlon
- Department of Anesthesia and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of Anesthesiology and Pain Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Alexander Mclaren-Blades
- Department of Anesthesiology and Pain Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Akash Goel
- Department of Anesthesiology and Pain Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Duminda N. Wijeysundera
- Department of Anesthesia and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of Anesthesiology and Pain Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada
- Department of Anesthesia and the Institute of Health Policy, Management and Evaluation, Toronto, Canada
| | - Lakshmi P. Kotra
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Carlos Ibarra
- Department of Anesthesiology and Pain Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, Toronto, Canada
| | - Hance Clarke
- Department of Anesthesiology and Pain Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
100
|
Archie SR, Cucullo L. Harmful Effects of Smoking Cannabis: A Cerebrovascular and Neurological Perspective. Front Pharmacol 2019; 10:1481. [PMID: 31920665 PMCID: PMC6915047 DOI: 10.3389/fphar.2019.01481] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/15/2019] [Indexed: 12/16/2022] Open
Abstract
Apart from being used as a medicine, cannabis or marijuana is the most widely abused recreational drug all over the world. The legalization and decriminalization of cannabis in Canada and various states of USA may be the underlying reason of the widespread popularity of it among young population. Various studies have reported about the relationship between cannabis use and different detrimental effects like cardiovascular, cerebrovascular, and neurological complications among different age groups. Specifically, the young population is getting adversely affected by this, harmful yet, readily accessible recreational drug. Although the mechanism behind cannabis mediated neurological and cerebrovascular complications has not been elucidated yet, the results of these studies have confirmed the association of these diseases with cannabis. Given the lack of comprehensive study relating these harmful complications with cannabis use, the aim of this narrative literature review article is to evaluate and summarize current studies on cannabis consumption and cerebrovascular/neurological diseases along with the leading toxicological mechanisms.
Collapse
Affiliation(s)
- Sabrina Rahman Archie
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, United States
| | - Luca Cucullo
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, United States.,Center for Blood Brain Barrier Research, Texas Tech University Health Sciences Center, Amarillo, TX, United States
| |
Collapse
|