1
|
Walker M, Carpino M, Lightfoot D, Rossi E, Tang M, Mann R, Saarela O, Cusimano MD. The effect of recreational cannabis legalization and commercialization on substance use, mental health, and injury: a systematic review. Public Health 2023; 221:87-96. [PMID: 37429043 DOI: 10.1016/j.puhe.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE To determine the effect of recreational cannabis legalization (RCL) and/or recreational cannabis commercialization (RCC) on emergency department (ED) visits, hospitalizations, and deaths due to substance use, injury, and mental health among those aged 11 years and older. METHODS A systematic review of six electronic databases up to February 1, 2023. Original, peer-reviewed articles with interrupted time series or before and after designs were included. Four independent reviewers screened articles and assessed risk of bias. Outcomes with 'critical' risk of bias were excluded. Protocol registered on PROSPERO (# CRD42021265183). RESULTS After screening and risk of bias assessment, 29 studies were included which examined ED visits or hospitalizations for cannabis use or alcohol (N = 10), opioid mortality (N = 3), motor vehicle fatalities or injury (N = 11), and intentional injury/mental health (N = 5). Rates or number of cannabis-related hospitalizations increased after RCL in Canada and the USA. Immediate increases in rates of cannabis-related ED visits were found after both RCL and RCC in Canada. Rates of traffic fatalities increased after RCL and RCC in certain jurisdictions in the USA. CONCLUSIONS RCL was associated with increased rates of cannabis-related hospitalizations. RCL and/or RCC was associated with increased rates of cannabis-related ED visits, consistently shown across sex and age groups. The effect on fatal motor vehicle incidents was mixed, with observed increases found after RCL and/or RCC. The effect of RCL or RCC on opioids, alcohol, intentional injury, and mental health is not clear. These results inform population health initiatives and international jurisdictions considering RCL implementation.
Collapse
Affiliation(s)
- M Walker
- Injury Prevention Research Office, Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - M Carpino
- Injury Prevention Research Office, Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - D Lightfoot
- Health Sciences Library, St. Michael's Hospital, Toronto, Ontario, Canada
| | - E Rossi
- Injury Prevention Research Office, Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - M Tang
- Injury Prevention Research Office, Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - R Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - O Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - M D Cusimano
- Injury Prevention Research Office, Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada.
| |
Collapse
|
2
|
Lau G, Ang JY, Kim N, Gabbe BJ, Mitra B, Dietze PM, Reeder S, Beck B. Prevalence of alcohol and other drug use in patients presenting to hospital for fall-related injuries: a systematic review. Inj Prev 2022; 28:381-393. [PMID: 35508365 DOI: 10.1136/injuryprev-2021-044513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Alcohol and other drug (AOD) use is a key preventable risk factor for serious injuries. Prevention strategies to date have largely focused on transport injuries, despite AOD use being a significant risk factor for other injury causes, including falls. This systematic review aimed to report the prevalence of AOD use in patients presenting to hospital for fall-related injuries. METHODS This systematic review includes studies published in English after the year 2010 that objectively measured the prevalence of AOD use in patients presenting to hospital for a fall-related injury. Screening, data extraction and risk of bias assessments were completed by two independent reviewers. Data were presented using narrative synthesis and, where appropriate, meta-analyses. RESULTS A total of 12 707 records were screened. Full texts were retrieved for 2042 records, of which 29 were included. Four studies reported the combined prevalence of any alcohol and/or drug use, generating a pooled prevalence estimate of 37% (95% CI 25% to 49%). Twenty-two records reported on the prevalence of acute alcohol use alone and nine reported specifically on the prevalence of drugs other than alcohol, with prevalence ranging from 2% to 57% and 7% to 46%, respectively. The variation in prevalence estimates likely resulted from differences in toxicology testing methods across studies. CONCLUSIONS AOD exposure was common in hospitalised fall-related injuries. However, research addressing prevalence across different types of falls and the use of drugs other than alcohol was limited. Future research should address these areas to improve our understanding of which populations should be targeted in AOD and injury prevention strategies . PROSPERO REGISTRATION NUMBER CRD42020188746.
Collapse
Affiliation(s)
- Georgina Lau
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jia Ying Ang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nayoung Kim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Health Data Research UK, Swansea University, Swansea, UK
| | - Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Paul M Dietze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia.,National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Sandra Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia .,Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| |
Collapse
|
3
|
Zhang JC, Carnide N, Holness L, Cram P. Cannabis use and work-related injuries: a cross-sectional analysis. Occup Med (Lond) 2021; 70:570-577. [PMID: 33108459 DOI: 10.1093/occmed/kqaa175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Although the association of cannabis use with automobile accidents has been well-studied, the impact of cannabis on workplace safety and injuries is less clear. AIMS The purpose of this study was to examine the relationship between work-related injury and cannabis use in the past year. METHODS We performed a cross-sectional analysis of the Canadian Community Health Survey (2013-16) of working individuals. We used multiple logistic regression modelling to calculate the odds of experiencing a work-related injury (defined as non-repetitive strain injury) among workers who reported using cannabis more than once during the prior 12 months as compared to non-users. We repeated the analysis among participants working in high injury risk occupational groups only. RESULTS Among the 136 536 working participants, 2577 (2%) had a work-related injury in the last 12 months. Of these 2577 who had a work-related injury, 4% also reported being a cannabis user in the same period. We found no association between past-year cannabis use and work-related injury (odds ratio for work injury among users 0.81, 95% confidence interval 0.66-0.99). The association was unchanged in the subgroup analysis limited to high injury risk occupational groups. CONCLUSIONS We found no evidence that cannabis users experienced higher rates of work-related injuries. While awaiting prospective studies, occupational medicine practitioners should take a risk-based approach to drafting workplace cannabis policies.
Collapse
Affiliation(s)
- J C Zhang
- Department of Occupational Medicine, University of Toronto, Toronto, Ontario, Canada
| | - N Carnide
- Institute for Work & Health, Toronto, Ontario, Canada
| | - L Holness
- Department of Occupational Medicine, University of Toronto, Toronto, Ontario, Canada.,Centre for Research Expertise in Occupational Disease, Toronto, Ontario, Canada
| | - P Cram
- Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Cunningham CO, Starrels JL, Zhang C, Bachhuber MA, Sohler NL, Levin FR, Minami H, Slawek DE, Arnsten JH. Medical Marijuana and Opioids (MEMO) Study: protocol of a longitudinal cohort study to examine if medical cannabis reduces opioid use among adults with chronic pain. BMJ Open 2020; 10:e043400. [PMID: 33376181 PMCID: PMC7778768 DOI: 10.1136/bmjopen-2020-043400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION In the USA, opioid analgesic use and overdoses have increased dramatically. One rapidly expanding strategy to manage chronic pain in the context of this epidemic is medical cannabis. Cannabis has analgesic effects, but it also has potential adverse effects. Further, its impact on opioid analgesic use is not well studied. Managing pain in people living with HIV is particularly challenging, given the high prevalence of opioid analgesic and cannabis use. This study's overarching goal is to understand how medical cannabis use affects opioid analgesic use, with attention to Δ9-tetrahydrocannabinol and cannabidiol content, HIV outcomes and adverse events. METHODS AND ANALYSES We are conducting a cohort study of 250 adults with and without HIV infection with (a) severe or chronic pain, (b) current opioid use and (c) who are newly certified for medical cannabis in New York. Over 18 months, we collect data via in-person visits every 3 months and web-based questionnaires every 2 weeks. Data sources include: questionnaires; medical, pharmacy and Prescription Monitoring Program records; urine and blood samples; and physical function tests. Using marginal structural models and comparisons within participants' 2-week time periods (unit of analysis), we will examine how medical cannabis use (primary exposure) affects (1) opioid analgesic use (primary outcome), (2) HIV outcomes (HIV viral load, CD4 count, antiretroviral adherence, HIV risk behaviours) and (3) adverse events (cannabis use disorder, illicit drug use, diversion, overdose/deaths, accidents/injuries, acute care utilisation). ETHICS AND DISSEMINATION This study is approved by the Montefiore Medical Center/Albert Einstein College of Medicine institutional review board. Findings will be disseminated through conferences, peer-reviewed publications and meetings with medical cannabis stakeholders. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03268551); Pre-results.
Collapse
Affiliation(s)
- Chinazo O Cunningham
- Division of General Internal Medicine, Montefiore Health System, Bronx, New York, USA
| | - Joanna L Starrels
- Division of General Internal Medicine, Montefiore Health System, Bronx, New York, USA
| | - Chenshu Zhang
- Division of General Internal Medicine, Montefiore Health System, Bronx, New York, USA
| | - Marcus A Bachhuber
- Section of Community and Population Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Nancy L Sohler
- School of Medicine, City University of New York, New York, New York, USA
| | - Frances R Levin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Haruka Minami
- Psychology Department, Fordham University, Bronx, New York, USA
| | - Deepika E Slawek
- Division of General Internal Medicine, Montefiore Health System, Bronx, New York, USA
| | - Julia H Arnsten
- Division of General Internal Medicine, Montefiore Health System, Bronx, New York, USA
| |
Collapse
|
5
|
Abbs E, Brown R, Guzman D, Kaplan L, Kushel M. Risk Factors for Falls in Older Adults Experiencing Homelessness: Results from the HOPE HOME Cohort Study. J Gen Intern Med 2020; 35:1813-1820. [PMID: 31965522 PMCID: PMC7280424 DOI: 10.1007/s11606-020-05637-0] [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: 08/28/2019] [Revised: 11/13/2019] [Accepted: 01/03/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND More than half of homeless adults are of age ≥ 50 years. Falls are a common cause of morbidity in older adults in the general population. Risk factors for falls in the general population include poor health, alcohol use, and exposure to unsafe environments. Homeless adults aged ≥ 50 have a high prevalence of known risk factors and face additional potential risks. OBJECTIVES To examine the prevalence of and risk of falling in a cohort of older homeless adults. DESIGN Longitudinal cohort study with participant interviews every 6 months for 3 years; data were analyzed using generalized estimating equations (GEEs). PARTICIPANTS Three hundred fifty adults aged ≥ 50, homeless at study entry, recruited via population-based sampling. MEASURES The dependent variable is any falls in prior 6 months; independent variables include individual (i.e., illness, behaviors) and social/environmental (i.e., social support, experiencing violence, living unsheltered) factors. RESULTS Over three quarters of participants were men (77.1%) and Black (79.7%). The median age was 58 (IQR 54, 61). At baseline, one third (33.7%) reported a fall in the prior 6 months. At follow-up visits, 23.1% to 31.2% of participants reported having fallen. In GEE models, individual risk factors (non-Black race, being a women, older age, functional impairment, urinary incontinence, history of stroke, and use of assistive devices, opioid, and marijuana) were associated with increased odds of falls. Environmental and social factors (spending any nights unsheltered (adjusted odds ratio (AOR) = 1.42, CI = 1.10-1.83) and experiencing physical assault (AOR = 1.67, CI = 1.18-2.37) were also associated. CONCLUSIONS Older homeless adults fall frequently. Likely contributors include having a high prevalence of conditions that increase the risk of falls, compounded by heightened exposure to unsafe environments. Fall prevention in this population should target those at highest risk and address modifiable environmental conditions. Providing shelter or housing and addressing substance use could reduce morbidity from falls in homeless older adults.
Collapse
Affiliation(s)
- Elizabeth Abbs
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Rebecca Brown
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA.,Division of Geriatric Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, San Francisco, CA, USA
| | - David Guzman
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,Center for Vulnerable Populations, University of California, San Francisco, UCSF Box 1364, San Francisco, CA, 94143, USA
| | - Lauren Kaplan
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,Center for Vulnerable Populations, University of California, San Francisco, UCSF Box 1364, San Francisco, CA, 94143, USA
| | - Margot Kushel
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA. .,Center for Vulnerable Populations, University of California, San Francisco, UCSF Box 1364, San Francisco, CA, 94143, USA.
| |
Collapse
|
6
|
Biasutti WR, Leffers KSH, Callaghan RC. Systematic Review of Cannabis Use and Risk of Occupational Injury. Subst Use Misuse 2020; 55:1733-1745. [PMID: 32441179 DOI: 10.1080/10826084.2020.1759643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Aim: A range of nations, including countries of the European Union, Australia, and the Americas have recently implemented or proposed reforms to how they control cannabis use, thereby departing from traditional approaches of criminal prohibition that have dominated throughout most of the twentieth century. Given these policy developments and the widespread global use of cannabis, it is critically important to understand the possible risks associated with cannabis use in relation to major societal harms. Methods: This systematic review investigates the potential link between cannabis use and occupational injury. Consequently, it appraises all available current literature from five databases, following Cochrane and PRISMA guidelines. Results: Seven of the 16 reviewed studies show evidence supporting a positive association between cannabis use and occupational injury. One study shows evidence supporting a negative association and the remaining eight studies show no evidence of a significant relation. None of the studies assessed cannabis-related impairment. Only three of the reviewed studies show clear evidence that cannabis use preceded the occupational-injury event. Conclusion: The current body of evidence does not provide sufficient evidence to support the position that cannabis users are at increased risk of occupational injury. Further, the study quality assessment suggests significant biases in the extant literature are present due to potential confounding variables, selection of participants, and measurement of exposures and outcomes. Future high-quality evidence will be needed to elucidate the relation between cannabis use and occupational injury.
Collapse
Affiliation(s)
- Wade R Biasutti
- Northern Medical Program, University of British Columbia, Prince George, British Columbia
| | - Kurt S H Leffers
- Northern Medical Program, University of British Columbia, Prince George, British Columbia
| | - Russell C Callaghan
- Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia; Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, British Columbia, Canada
| |
Collapse
|
7
|
Mokwena K. Social and public health implications of the legalisation of recreational cannabis: A literature review. Afr J Prim Health Care Fam Med 2019; 11:e1-e6. [PMID: 31793317 PMCID: PMC6890535 DOI: 10.4102/phcfm.v11i1.2136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/23/2019] [Accepted: 08/09/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND After many years of legal struggles for the legalisation of recreational use of cannabis, the Constitutional Court of South Africa ruled in favour of the applicants in September 2018. Although the ruling issued caution regarding the social challenges accompanying this legalisation, it did not address how the country would deal with the societal consequences of this ruling. AIM The aim of this article was to discuss the social and public health implications of the legalisation of recreational cannabis on South Africa. METHODS Literature review on the social, health and legal impacts of legalisation of cannabis, considering experiences of other countries that have legalised cannabis. RESULTS The legalisation brings a range of significant negative consequences, which include an expected increase in the number of users and the subsequent undesirable effects on the physical, mental and social health of communities. CONCLUSION In terms of financial, infrastructural and human resources, South Africa cannot afford the consequences of the legalisation of recreational cannabis. Poor communities, children and the youth will carry the brunt of the scourge of cannabis use.
Collapse
Affiliation(s)
- Kebogile Mokwena
- Department of Social and Behavioural Health Sciences, Sefako Makgatho Health Sciences University, Pretoria.
| |
Collapse
|
8
|
Abstract
AIMS Although injuries have been linked to worse mental health, little is known about this association among the general population in low- and middle-income countries (LAMICs). This study examined the association between injuries and depression in 40 LAMICs that participated in the World Health Survey. METHODS Cross-sectional information was obtained from 212 039 community-based adults on the past 12-month experience of road traffic and other (non-traffic) injuries and depression, which was assessed using questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview. Multivariable logistic regression analysis and meta-analysis were used to examine associations. RESULTS The overall prevalence (95% CI) of past 12-month traffic injury, other injury, and depression was 2.8% (2.6-3.0%), 4.8% (4.6-5.0%) and 7.4% (7.1-7.8%), respectively. The prevalence of traffic injuries [range 0.1% (Ethiopia) to 5.1% (Bangladesh)], and other (non-traffic) injuries [range 0.9% (Myanmar) to 12.1% (Kenya)] varied widely across countries. After adjusting for demographic variables, alcohol consumption and smoking, the pooled OR (95%CI) for depression among individuals experiencing traffic injury based on a meta-analysis was 1.72 (1.48-1.99), and 2.04 (1.85-2.24) for those with other injuries. There was little between-country heterogeneity in the association between either form of injury and depression, although for traffic injuries, significant heterogeneity was observed between groups by country-income level (p = 0.043) where the pooled association was strongest in upper middle-income countries (OR = 2.37) and weakest in low-income countries (OR = 1.46). CONCLUSIONS Alerting health care providers in LAMICs to the increased risk of worse mental health among injury survivors and establishing effective trauma treatment systems to reduce the detrimental effects of injury should now be prioritised.
Collapse
|
9
|
Abstract
OBJECTIVE This study tested longitudinal associations between cannabis use and cardiometabolic risk factors that underlie the development of cardiovascular diseases. METHODS Participants were men from the youngest cohort of the Pittsburgh Youth Study who were followed prospectively from approximately age 7 to 32 years (N = 253). Frequency of cannabis use was assessed yearly from approximately ages 12 to 20 years and again at approximately ages 26, 29, and 32 years. The following cardiometabolic risk factors were assessed during a laboratory visit at approximately age 32 years: body mass index (BMI), waist-hip ratio, high- and low-density lipoprotein cholesterol, triglycerides, fasting glucose, insulin resistance, blood pressure, interleukin 6, and C-reactive protein. RESULTS Greater cannabis exposure was associated with relatively lower BMI (β = -0.31, p < .001), smaller waist-hip ratio (β = -0.23, p = .002), better high- (β = 0.14, p = .036) and low-density lipoprotein cholesterol (β = -0.15, p = .026), lower triglycerides (β = -0.17, p = .009), lower fasting glucose (β = -0.15, p < .001) and insulin resistance (β = -0.21, p = .003), lower systolic (β = -0.22, p < .001) and diastolic blood pressure (β = -0.15, p = .028), and fewer metabolic syndrome criteria (β = -0.27, p < .001). With exception of BMI, cannabis users' mean levels on cardiometabolic risk factors were generally below clinical cutoffs for high risk. Most associations between cannabis use and cardiometabolic risk factors remained after adjusting for tobacco use, childhood socioeconomic status, and childhood health. However, after adjusting for adult BMI, these associations were no longer apparent, and mediation tests suggested that cannabis users' relatively lower BMI might explain their lower levels of risk on other cardiometabolic risk factors. CONCLUSIONS Cannabis use is associated with lower BMI, and lower BMI is related to lower levels of risk on other cardiometabolic risk factors.
Collapse
|
10
|
Chung C, Salottolo K, Tanner A, Carrick MM, Madayag R, Berg G, Lieser M, Bar-Or D. The impact of recreational marijuana commercialization on traumatic injury. Inj Epidemiol 2019; 6:3. [PMID: 30714081 PMCID: PMC6360194 DOI: 10.1186/s40621-019-0180-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The medical legalization of marijuana has been shown to result in an increased risk of motor vehicle injuries. In Colorado, commercialization of recreational marijuana (initiation of retail sales) occurred on January 1, 2014, resulting in the rapid proliferation of its availability. The objective of this study was to determine whether the proportion of injured patients testing positive for marijuana and other drugs changed two years before and two years after commercialization of recreational marijuana in Colorado. METHODS This retrospective multi-institutional cohort study included all patients admitted with a traumatic injury to six trauma centers (three centers in Colorado and three centers in states without permissive marijuana laws) from 2012 to 2015. The primary outcome was the rate (%) of a positive urine drug screen (UDS) for marijuana. Generalized linear regression models were used to examine the rate of change over time in the pre-commercialization period relative to the post- commercialization period (via an interaction effect), separately for states with and without recreational marijuana legalization. RESULTS There were 40,591 trauma admissions. In Colorado, the rate of marijuana detected with UDS decreased over time pre-commercialization; this trend reversed post-commercialization, when marijuana detection rates increased significantly over time (interaction p = 0.004). At non-Colorado hospitals, the rate over time of marijuana detection was significantly reduced post-commercialization relative to the pre-commercialization period (p < 0.001). CONCLUSION There was an overall increased rate over time of marijuana detected among trauma patients at Colorado hospitals but not at non-Colorado hospitals, suggesting an increased use of marijuana or an increased risk of injury while using marijuana following the commercialization of recreational marijuana in Colorado.
Collapse
Affiliation(s)
- Christine Chung
- Trauma Research Department, Swedish Medical Center, Englewood, CO, 80113, USA
| | - Kristin Salottolo
- Trauma Research Department, Swedish Medical Center, Englewood, CO, 80113, USA.,Trauma Research Department, Penrose-St Francis Health Services, Colorado Springs, CO, USA.,Trauma Research Department, Medical City Plano, Plano, TX, USA.,Trauma Research Department, St. Anthony Hospital, Lakewood, CO, USA.,Trauma Research Department, Wesley Medical Center, Wichita, KS, USA.,Trauma Research Department, Research Medical Center, MO, Kansas City, US, USA
| | - Allen Tanner
- Trauma Research Department, Penrose-St Francis Health Services, Colorado Springs, CO, USA
| | | | - Robert Madayag
- Trauma Research Department, St. Anthony Hospital, Lakewood, CO, USA
| | - Gina Berg
- Trauma Research Department, Wesley Medical Center, Wichita, KS, USA
| | - Mark Lieser
- Trauma Research Department, Research Medical Center, MO, Kansas City, US, USA
| | - David Bar-Or
- Trauma Research Department, Swedish Medical Center, Englewood, CO, 80113, USA. .,Trauma Research Department, Penrose-St Francis Health Services, Colorado Springs, CO, USA. .,Trauma Research Department, Medical City Plano, Plano, TX, USA. .,Trauma Research Department, St. Anthony Hospital, Lakewood, CO, USA. .,Trauma Research Department, Wesley Medical Center, Wichita, KS, USA. .,Trauma Research Department, Research Medical Center, MO, Kansas City, US, USA.
| |
Collapse
|
11
|
Salottolo K, Peck L, Tanner Ii A, Carrick MM, Madayag R, McGuire E, Bar-Or D. The grass is not always greener: a multi-institutional pilot study of marijuana use and acute pain management following traumatic injury. Patient Saf Surg 2018; 12:16. [PMID: 29946360 PMCID: PMC6007004 DOI: 10.1186/s13037-018-0163-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/24/2018] [Indexed: 12/26/2022] Open
Abstract
Background Widespread legislative efforts to legalize marijuana have increased the prevalence of marijuana use and abuse. The effects of marijuana on pain tolerance and analgesic pain management in the acute pain setting have not been reported. Although marijuana has been shown to have antinociceptive effects and is approved for medical use to treat chronic pain, anecdotal evidence suggests marijuana users admitted with traumatic injuries experience poorer pain control than patients who do not use marijuana. We hypothesized that marijuana users would report higher pain scores and require more opioid analgesia following traumatic injury. Methods This retrospective pilot study included all patients involved in motor vehicle crashes, consecutively admitted to four trauma centers from 1/1/2016–4/30/2016. Marijuana status was examined as non-use and use, and was further categorized as chronic and episodic use. We performed a repeated measures mixed model to examine the association between marijuana use and a) average daily opioid consumption and b) average daily pain scores (scale 0–10). Opioid analgesics were converted to be equianalgesic to 1 mg IV hydromorphone. Results Marijuana use was reported in 21% (54/261), of which 30% reported chronic use (16/54). Marijuana use was reported more frequently in Colorado hospitals (23–29%) compared to the hospital in Texas (6%). Drug use with other prescription/street drugs was reported in 9% of patients. Other drug use was a significant effect modifier and results were presented after stratification by drug use. After adjustment, marijuana users who did not use other drugs consumed significantly more opioids (7.6 mg vs. 5.6 mg, p < 0.001) and reported higher pain scores (4.9 vs. 4.2, p < 0.001) than non-marijuana users. Conversely, in patients who used other drugs, there were no differences in opioid consumption (5.6 mg vs. 6.1 mg, p = 0.70) or pain scores (5.3 vs. 6.0, p = 0.07) with marijuana use compared to non-use, after adjustment. Chronic marijuana use was associated with significantly higher opioid consumption compared to episodic marijuana use in concomitant drug users (11.3 mg vs. 4.4 mg, p = 0.008) but was similar in non-drug users (p = 0.41). Conclusion These preliminary data suggest that marijuana use, especially chronic use, may affect pain response to injury by requiring greater use of opioid analgesia. These results were less pronounced in patients who used other drugs.
Collapse
Affiliation(s)
- Kristin Salottolo
- 1Trauma Research Department, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO 80113 USA.,2Trauma Research Department, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO 80228 USA.,Trauma Research Department, Medical City Plano, 3901 West 15th Street, Plano, TX 75075 USA.,4Trauma Research Department, Penrose Hospital, 2222 N Nevada Drive, Colorado Springs, CO 80907 USA
| | - Laura Peck
- 5Trauma Services Department, Swedish Medical Center, 499 E. Hampden Ave, Englewood, CO 80113 USA
| | - Allen Tanner Ii
- 6Trauma Services Department, Penrose Hospital, 2222 N Nevada Drive, Colorado Springs, CO 80907 USA
| | - Matthew M Carrick
- Trauma Services Department, Medical City Plano, 3901 W 15th St, Plano, TX 75075 USA
| | - Robert Madayag
- 8Trauma Services Department, St. Anthony Hospital, 11600 West 2nd Place, Lakewood, CO 80228 USA
| | - Emmett McGuire
- 5Trauma Services Department, Swedish Medical Center, 499 E. Hampden Ave, Englewood, CO 80113 USA
| | - David Bar-Or
- 1Trauma Research Department, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO 80113 USA.,2Trauma Research Department, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO 80228 USA.,Trauma Research Department, Medical City Plano, 3901 West 15th Street, Plano, TX 75075 USA.,4Trauma Research Department, Penrose Hospital, 2222 N Nevada Drive, Colorado Springs, CO 80907 USA
| |
Collapse
|
12
|
Mason MJ, Zaharakis NM, Russell M, Childress V. A pilot trial of text-delivered peer network counseling to treat young adults with cannabis use disorder. J Subst Abuse Treat 2018; 89:1-10. [PMID: 29706169 DOI: 10.1016/j.jsat.2018.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 01/20/2023]
Abstract
Approximately 1.8 million young adults aged 18 to 25 had a Cannabis Use Disorder (CUD) in the past year. Unfortunately, engaging young adults in treatment is very challenging. Creative approaches to treat cannabis disorders such as integrating mobile technology with evidence-based treatments are warranted. In light of these challenges, we developed a text message-delivered version of Peer Network Counseling (PNC-txt), which is a substance use intervention that focuses on peer relations. PNC-txt engages participants in 16 automated, personalized text interactions over 4weeks. We conducted a randomized controlled trial to test the efficacy of PNC-txt against a waitlist control group with 30 treatment seeking young adults (ages 18-25) who met DSM-5 criteria for CUD. Self-report and urine analyses were used to test outcomes at the three-month follow-up. The PNC-txt group significantly reduced their cannabis use related problems as well as cannabis cravings, compared to the control group. PNC-txt participants also had a significantly greater percentage with urines negative for cannabis metabolites compared to controls. Moderation analysis showed that CUD severity level moderated treatment, suggesting that PNC-txt is more effective for participants with medium and high levels of CUD severity. All effect sizes ranged from medium to large. Results from this pilot trial are promising and warrant further research on PNC-txt for addressing cannabis use disorder.
Collapse
Affiliation(s)
- Michael J Mason
- Center for Behavioral Health Research, University of Tennessee, Knoxville, TN, United States.
| | - Nikola M Zaharakis
- Department of Psychology, Arizona State University, Tempe, AZ, United States
| | - Michael Russell
- Department of Biobehavioral Health, Pennsylvania State University, United States
| | - Victoria Childress
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States
| |
Collapse
|
13
|
Abstract
Nearly half of all states have legalized medical marijuana or recreational-use marijuana. As more states move toward legalization, the effects on injured patients must be evaluated. This study sought to determine effects of cannabis positivity at the time of severe injury on hospital outcomes compared with individuals negative for illicit substances and those who were users of other illicit substances. A Level I trauma center performed a retrospective chart review covering subjects over a 2-year period with toxicology performed and an Injury Severity Score (ISS) of more than 16. These individuals were divided into the negative and positive toxicology groups, further divided into the marijuana-only, other drugs-only, and mixed-use groups. Differences in presenting characteristics, hospital length of stay, intensive care unit (ICU) stays, ventilator days, and death were compared. A total of 8,441 subjects presented during the study period; 2,134 (25%) of these had toxicology performed; 843 (40%) had an ISS of more than 16, with 347 having negative tests (NEG); 70 (8.3%) substance users tested positive only for marijuana (MO), 323 (38.3%) for other drugs-only, excluding marijuana (OD), and 103 (12.2%) subjects showed positivity for mixed-use (MU). The ISS was similar for all groups. No differences were identified in Glasgow Coma Scale (GCS), ventilator days, blood administration, or ICU/hospital length of stay when comparing the MO group with the NEG group. Significant differences occurred between the OD group and the NEG/MO/MU groups for GCS, ICU length of stay, and hospital charges. Cannabis users suffering from severe injury demonstrated no detrimental outcomes in this study compared with nondrug users.
Collapse
|
14
|
Martín-Rodríguez MDM, Pulido J, Jiménez-Mejías E, Hoyos J, Lardelli-Claret P, Barrio G. Consistent association between hypnotics/sedatives and non-traffic injuries. Results from a national household survey. ACCIDENT; ANALYSIS AND PREVENTION 2017; 106:379-384. [PMID: 28715729 DOI: 10.1016/j.aap.2017.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 05/24/2017] [Accepted: 06/22/2017] [Indexed: 06/07/2023]
Abstract
AIM To quantify the relationship between patterns of psychostimulants, hypnotics/sedatives and alcohol consumption and the frequency of unintentional non-traffic injuries (UNTIs) requiring medical assistant in Spain. METHODS We carried out a cross sectional study using a randomized pooled sample from two household surveys on psychoactive drugs use (n=51,649 subjects aged 15-64 years). We estimated the magnitude of the association between the use of psychostimulants and hypnotics/sedatives in the last 12 months as well as alcohol consumption in the last 30days with the occurrence of UNTIs in the last 12 months (falls, knocks/bumps and cuts) by building several logistic regression models, which took into account the effect of sociodemographic characteristics and the use of other psychoactive drugs (including cannabis). The presence of interactions between age or gender with drug use was also assessed. RESULTS Psychostimulants use was associated with a higher frequency of UNTIs (aOR=1.24; 95%CI:1.03-1.49). The strongest association was found with cuts (aOR=1.64; 95%CI:1.10-2.43). An association between hypnotics/sedatives and UNTIs was also found in each type of injury and was higher with regular use (>=30days) than with non-regular use (<30days). The age modified the association between hypnotic/sedatives and knocks/bumps, being higher in the 35-64 years group (aOR=2.34; 95%CI:1.78-3.06) than in the 15-34 years group (aOR=1.59; 95%CI:1.14-2.21). Regarding alcohol, an increased risk of UNTIs was also observed in all types of UNTIs, even with moderate use, being the association higher for cuts in heavy drinkers (aOR=2.41; 95%CI:1.63-3.57). CONCLUSIONS Our results reveal a consistent relationship between hypnotics/sedatives and UNTIs, especially in regular users. Additional research should apply longitudinal designs to establish causal relationships and to gain an in-depth knowledge in this area in order to specific public health interventions.
Collapse
Affiliation(s)
- María Del Mar Martín-Rodríguez
- Servicio de Medicina Preventiva, Complejo Hospitalario Universitario Insular-Materno Infantil, Avenida Marítima, s/n. 35016. Las Palmas. Spain
| | - José Pulido
- Escuela Nacional de Sanidad. Instituto de Salud Carlos III. Avenida Monforte de Lemos, 3-5, Pabellón 7, 28029. Madrid, Spain; CIBER Epidemiología y Salud Pública (CIBERESP). Avenida Monforte de Lemos, 3-5. Pabellón 11. 28029 Madrid. Spain.
| | - Eladio Jiménez-Mejías
- CIBER Epidemiología y Salud Pública (CIBERESP). Avenida Monforte de Lemos, 3-5. Pabellón 11. 28029 Madrid. Spain; Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Granada. Granada, Avenida de Madrid, 11. 18012. Granada, Spain; Instituto de Investigación Biosanitaria de Granada. C/ Doctor Azpitarte 4 4ª Planta. Edificio Licinio de la Fuente, 18012 Granada. Spain
| | - Juan Hoyos
- CIBER Epidemiología y Salud Pública (CIBERESP). Avenida Monforte de Lemos, 3-5. Pabellón 11. 28029 Madrid. Spain
| | - Pablo Lardelli-Claret
- CIBER Epidemiología y Salud Pública (CIBERESP). Avenida Monforte de Lemos, 3-5. Pabellón 11. 28029 Madrid. Spain; Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Granada. Granada, Avenida de Madrid, 11. 18012. Granada, Spain; Instituto de Investigación Biosanitaria de Granada. C/ Doctor Azpitarte 4 4ª Planta. Edificio Licinio de la Fuente, 18012 Granada. Spain
| | - Gregorio Barrio
- Escuela Nacional de Sanidad. Instituto de Salud Carlos III. Avenida Monforte de Lemos, 3-5, Pabellón 7, 28029. Madrid, Spain
| |
Collapse
|
15
|
Cordovilla-Guardia S, Lardelli-Claret P, Vilar-López R, López-Espuela F, Guerrero-López F, Fernández-Mondéjar E. The effect of central nervous system depressant, stimulant and hallucinogenic drugs on injury severity in patients admitted for trauma. GACETA SANITARIA 2017; 33:4-9. [PMID: 28784303 DOI: 10.1016/j.gaceta.2017.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/08/2017] [Accepted: 06/16/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The effect of drugs other than alcohol on severity of trauma remains unclear. Pooled data analyses in previous studies that grouped substances with opposite effects on the central nervous system (CNS) may have masked the influence of substances on injury severity. The aim was to analyze the effect of stimulant, hallucinogenic and depressant drugs other than alcohol on injury severity in trauma patients. METHODS The presence of alcohol, stimulant drugs (cocaine, amphetamines and methamphetamines), depressant drugs (benzodiazepines, opiates, methadone and barbiturates) and hallucinogenic drugs (THC and PCP) was analyzed in 1187 patients between 16 and 70 years old admitted to a trauma hospital between November 2012 and June 2015. Injury severity was determined prospectively as the Injury Severity Score. A multivariate analysis was used to quantify the strength of association between exposure to substances and trauma severity, using the presence of alcohol as a stratification variable. RESULTS Drugs other than alcohol were found in 371 patients (31.3%): 32 (2.7%) stimulants, 186 (15.3%) depressants, 78 (6.6%) hallucinogenics and 75 (5.6%) polydrug use. The presence of CNS depressant substances was associated with increased injury severity only in patients also exposed to alcohol, with an adjusted odds ratio of 4.63 (1.37-15.60) for moderate injuries and 7.83 (2.53-24.21) for severe. CONCLUSION CNS depressant drugs had a strong influence on injury severity in patients who screened positive for alcohol consumption.
Collapse
Affiliation(s)
- Sergio Cordovilla-Guardia
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain; Doctoral Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain.
| | - Pablo Lardelli-Claret
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain; CIBER of Epidemiology and Public Health, Granada, Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Raquel Vilar-López
- Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain; Mind, Brain and Behavior Research Centre, University of Granada, Granada, Spain
| | - Fidel López-Espuela
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | - Francisco Guerrero-López
- Instituto de Investigación Biosanitaria IBS, Granada, Spain; Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Enrique Fernández-Mondéjar
- Instituto de Investigación Biosanitaria IBS, Granada, Spain; Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Granada, Granada, Spain
| |
Collapse
|
16
|
Choi NG, Marti CN, DiNitto DM, Choi BY. Older adults’ marijuana use, injuries, and emergency department visits. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:215-223. [DOI: 10.1080/00952990.2017.1318891] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Namkee G. Choi
- University of Texas at Austin School of Social Work, Austin, TX, USA
| | - C. Nathan Marti
- University of Texas at Austin School of Social Work, Austin, TX, USA
| | - Diana M. DiNitto
- University of Texas at Austin School of Social Work, Austin, TX, USA
| | - Bryan Y. Choi
- Warren Alpert Medical School, Department of Emergency Medicine, Brown University, Providence, RI, USA
| |
Collapse
|
17
|
Cordovilla-Guardia S, Vilar-López R, Lardelli-Claret P, Navas J, Guerrero-López F, Fernández-Mondéjar E. Ingreso en cuidados intensivos por un traumatismo relacionado con el consumo de alcohol o drogas, un «momento propicio de enseñanza» para el inicio del cambio. ENFERMERIA INTENSIVA 2017; 28:4-12. [DOI: 10.1016/j.enfi.2016.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/18/2016] [Accepted: 12/22/2016] [Indexed: 01/24/2023]
|
18
|
Hasin DS, Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, Jung J, Pickering RP, Ruan WJ, Smith SM, Huang B, Grant BF. Prevalence of Marijuana Use Disorders in the United States Between 2001-2002 and 2012-2013. JAMA Psychiatry 2015; 72:1235-42. [PMID: 26502112 PMCID: PMC5037576 DOI: 10.1001/jamapsychiatry.2015.1858] [Citation(s) in RCA: 706] [Impact Index Per Article: 78.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE Laws and attitudes toward marijuana in the United States are becoming more permissive but little is known about whether the prevalence rates of marijuana use and marijuana use disorders have changed in the 21st century. OBJECTIVE To present nationally representative information on the past-year prevalence rates of marijuana use, marijuana use disorder, and marijuana use disorder among marijuana users in the US adult general population and whether this has changed between 2001-2002 and 2012-2013. DESIGN, SETTING, AND PARTICIPANTS Face-to-face interviews conducted in surveys of 2 nationally representative samples of US adults: the National Epidemiologic Survey on Alcohol and Related Conditions (data collected April 2001-April 2002; N = 43,093) and the National Epidemiologic Survey on Alcohol and Related Conditions-III (data collected April 2012-June 2013; N = 36,309). Data were analyzed March through May 2015. MAIN OUTCOMES AND MEASURES Past-year marijuana use and DSM-IV marijuana use disorder (abuse or dependence). RESULTS The past-year prevalence of marijuana use was 4.1% (SE, 0.15) in 2001-2002 and 9.5% (SE, 0.27) in 2012-2013, a significant increase (P < .05). Significant increases were also found across demographic subgroups (sex, age, race/ethnicity, education, marital status, income, urban/rural, and region). The past-year prevalence of DSM-IV marijuana use disorder was 1.5% (0.08) in 2001-2002 and 2.9% (SE, 0.13) in 2012-2013 (P < .05). With few exceptions, increases in the prevalence of marijuana use disorder between 2001-2002 and 2012-2013 were also statistically significant (P < .05) across demographic subgroups. However, the prevalence of marijuana use disorder among marijuana users decreased significantly from 2001-2002 (35.6%; SE, 1.37) to 2012-2013 (30.6%; SE, 1.04). CONCLUSIONS AND RELEVANCE The prevalence of marijuana use more than doubled between 2001-2002 and 2012-2013, and there was a large increase in marijuana use disorders during that time. While not all marijuana users experience problems, nearly 3 of 10 marijuana users manifested a marijuana use disorder in 2012-2013. Because the risk for marijuana use disorder did not increase among users, the increase in prevalence of marijuana use disorder is owing to an increase in prevalence of users in the US adult population. Given changing laws and attitudes toward marijuana, a balanced presentation of the likelihood of adverse consequences of marijuana use to policy makers, professionals, and the public is needed.
Collapse
Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York2Mailman School of Public Health, Columbia University, New York, New York3New York State Psychiatric Institute, New York
| | - Tulshi D Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Bradley T Kerridge
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Risë B Goldstein
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - S Patricia Chou
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Haitao Zhang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Jeesun Jung
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Roger P Pickering
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - W June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Sharon M Smith
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Boji Huang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Bridget F Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| |
Collapse
|
19
|
Greydanus DE, Kaplan G, Baxter LE, Patel DR, Feucht CL. Cannabis: The never-ending, nefarious nepenthe of the 21st century: What should the clinician know? Dis Mon 2015; 61:118-75. [DOI: 10.1016/j.disamonth.2015.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
20
|
Lank PM, Crandall ML. Outcomes for older trauma patients in the emergency department screening positive for alcohol, cocaine, or marijuana use. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 40:118-24. [PMID: 24588418 DOI: 10.3109/00952990.2014.880450] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Substance use among older adults is an increasing concern, with the prevalence of substance use in older populations expected to double in the next decade. Drug and alcohol use is associated with trauma risk and outcomes, but little is known about the specific risk for older trauma patients. OBJECTIVES To evaluate the association between drug and alcohol use and trauma outcomes among adults aged 55 years and older. METHODS This retrospective observational study included older adults from the Illinois Trauma Registry between 1999 and 2009. Exclusion criteria were age younger than 55 years or absent date of birth, ethanol level, or urine drug screen (UDS). Alcohol intoxication was defined as ethanol level greater than 80 mg/dL. UDS was used to screen cocaine and marijuana use. Analyses, for both the alcohol and the marijuana/cocaine groups, compared outcomes for patients with negative vs. positive screens. RESULTS 21 320 patients were included in the alcohol analysis and 17 077 in the drug analysis. Compared to non-intoxicated patients, alcohol-intoxicated patients had significantly (p < 0.001) lower in-hospital mortality, decreased ICU admission, decreased intubation rate, and shorter hospital length of stay. Patients screening positive for cocaine or marijuana had significantly longer lengths of stay with increased ICU admission compared with those who screened negative. CONCLUSION Among older trauma patients, this study shows significant associations with multiple trauma outcomes, including one between elevated ethanol concentrations and improved outcomes. Future research into the causes of these findings could inform the care of older trauma patients and aid in prevention of injuries.
Collapse
|
21
|
Mason MJ, Zaharakis N, Benotsch EG. Social networks, substance use, and mental health in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2014; 62:470-477. [PMID: 24848433 DOI: 10.1080/07448481.2014.923428] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The relationship between social network risk (alcohol-using close friends), perceived peer closeness, substance use, and psychiatric symptoms was examined to identify risk and protective features of college students' social context. PARTICIPANTS Six hundred and seventy undergraduate students enrolled in a large southeastern university. METHODS An online survey was administered to consenting students. RESULTS Students with risky networks were at a 10-fold increase of hazardous drinking, 6-fold increase for weekly marijuana use, and 3-fold increase for weekly tobacco use. College students' who feel very close to their peers were protected against psychiatric symptoms yet were at increased risk for marijuana use. Perceived closeness of peers was highly protective against psychiatric symptoms, adding a natural preventive effect for a population at great risk for mental illness. CONCLUSIONS RESULTS support targeting college students through network-oriented preventive interventions to address substance use as well as mental health.
Collapse
Affiliation(s)
- Michael J Mason
- a Department of Psychiatry , Virginia Commonwealth University , Richmond , Virginia
| | | | | |
Collapse
|
22
|
Greydanus DE, Hawver EK, Greydanus MM, Merrick J. Marijuana: current concepts(†). Front Public Health 2013; 1:42. [PMID: 24350211 PMCID: PMC3859982 DOI: 10.3389/fpubh.2013.00042] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 09/23/2013] [Indexed: 12/12/2022] Open
Abstract
Marijuana (cannabis) remains a controversial drug in the twenty-first century. This paper considers current research on use of Cannabis sativa and its constituents such as the cannabinoids. Topics reviewed include prevalence of cannabis (pot) use, other drugs consumed with pot, the endocannabinoid system, use of medicinal marijuana, medical adverse effects of cannabis, and psychiatric adverse effects of cannabis use. Treatment of cannabis withdrawal and dependence is difficult and remains mainly based on psychological therapy; current research on pharmacologic management of problems related to cannabis consumption is also considered. The potential role of specific cannabinoids for medical benefit will be revealed as the twenty-first century matures. However, potential dangerous adverse effects from smoking marijuana are well known and should be clearly taught to a public that is often confused by a media-driven, though false message and promise of benign pot consumption.
Collapse
Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University School of Medicine , Kalamazoo, MI , USA
| | - Elizabeth K Hawver
- Department of Pediatric and Adolescent Medicine, Western Michigan University School of Medicine , Kalamazoo, MI , USA
| | - Megan M Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University School of Medicine , Kalamazoo, MI , USA
| | - Joav Merrick
- National Institute of Child Health and Human Development , Jerusalem , Israel ; Health Services, Division for Intellectual and Developmental Disabilities, Ministry of Social Affairs and Social Services , Jerusalem , Israel ; Division of Pediatrics, Hadassah Hebrew University Medical Center, Mt. Scopus Campus , Jerusalem , Israel ; Kentucky Children's Hospital, University of Kentucky College of Medicine , Lexington, KY , USA
| |
Collapse
|
23
|
Cannabis use and related harms in the transition to young adulthood: A longitudinal study of Australian secondary school students. J Adolesc 2013; 36:519-27. [DOI: 10.1016/j.adolescence.2013.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 02/20/2013] [Accepted: 03/02/2013] [Indexed: 11/19/2022]
|