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Potukuchi PK, Moradi H, Park F, Kaplan C, Thomas F, Dashputre AA, Sumida K, Molnar MZ, Gaipov A, Gatwood JD, Rhee C, Streja E, Kalantar-Zadeh K, Kovesdy CP. Cannabis Use and Risk of Acute Kidney Injury in Patients with Advanced Chronic Kidney Disease Transitioning to Dialysis. Cannabis Cannabinoid Res 2023; 8:138-147. [PMID: 34597156 PMCID: PMC9940810 DOI: 10.1089/can.2021.0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: The current social and legal landscape is likely to foster the medicinal and recreational use of cannabis. Synthetic cannabinoid use is associated with acute kidney injury (AKI) in case reports; however, the association between natural cannabis use and AKI risk in patients with advanced chronic kidney disease (CKD) is unknown. Materials and Methods: From a nationally representative cohort of 102,477 U.S. veterans transitioning to dialysis between 2007 and 2015, we identified 2215 patients with advanced CKD who had undergone urine toxicology (UTOX) tests within a year before dialysis initiation and had inpatient serial serum creatinine levels measured within 7 days after their UTOX test. The exposure of interest was cannabis use compared with no use as ascertained by the UTOX test. We examined the association of this exposure with AKI using logistic regression and inverse probability of treatment weighting with extensive adjustment for potential confounders. Results: The mean age of the overall cohort was 61 years; 97% were males, 51% were African Americans, 97% had hypertension, 76% had hyperlipidemia, and 75% were diabetic. AKI occurred in 56% of the cohort, and in multivariable-adjusted analysis, cannabis use (when compared with no substance use) was not associated with significantly higher odds of AKI (odds ratio 0.85, 95% confidence interval 0.38-1.87; p=0.7). These results were robust to various sensitivity analyses. Conclusions: In this observational study examining patients with advanced CKD, cannabis use was not associated with AKI risk. Additional studies are needed to characterize the impact of cannabis use on risk of kidney disease and injury.
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Affiliation(s)
- Praveen K. Potukuchi
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Institute for Health Outcomes and Policy, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Hamid Moradi
- Division of Nephrology and Hypertension, University of California-Irvine, Orange, California, USA
- Nephrology Section, Long Beach VA Medical Center, Long Beach, California, USA
| | - Frank Park
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Cameron Kaplan
- USC Gehr Family Center for Health Systems Science and Innovation, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Fridtjof Thomas
- Division of Biostatistics, Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ankur A. Dashputre
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Institute for Health Outcomes and Policy, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Miklos Z. Molnar
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Abduzhappar Gaipov
- Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan
| | - Justin D. Gatwood
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Nashville, Tennessee, USA
| | - Connie Rhee
- Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California-Irvine, Orange, California, USA
| | - Elani Streja
- Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California-Irvine, Orange, California, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California-Irvine, Orange, California, USA
| | - Csaba P. Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee, USA
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Roth W, Tam M, Bi C, Kim J, Lewis J, Ho R, Apollonio DE. Changes in California cannabis exposures following recreational legalization and the COVID-19 pandemic. Clin Toxicol (Phila) 2021; 60:632-638. [PMID: 34871128 DOI: 10.1080/15563650.2021.2006212] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Since 2012, eighteen states and the District of Columbia have legalized recreational cannabis. Past research suggests this policy change is associated with increased cannabis exposures however this has not yet been studied in California, despite its status as the world's largest legal cannabis market. METHODS This observational, retrospective study analyzed trends in cannabis exposures reported to the California Poison Control System (CPCS) from 2010 to 2020. We assessed shifts in exposures before and after the legalization of recreational cannabis in November 2016, the establishment of recreational retail sales in January 2018, and the institution of a statewide shelter-in-place order due to the COVID-19 pandemic in March 2020 using interrupted time-series analysis and reviewed all records to identify specific products associated with exposures. RESULTS Between 2010 and 2020 edible exposures increased from near zero to 79% of exposures in 2020. Cannabis exposures significantly increased following recreational legalization in 2016 (by an estimated 2.07 exposures per month [CI: 0.60, 3.55]; p < 0.01) and initiation of retail sales in 2018 (0.85 [CI: 0.12, 1.58]; p < 0.05). There was no significant change in cannabis exposures following the first shelter-in-place order of the COVID-19 pandemic (1.59 [CI: -1.61, 3.68]; p = 0.43). Cannabis exposures for those thirteen and under increased significantly both after recreational legalization (1.04 [CI: 0.38, 1.70]) and after the opening of the retail sales market (0.73 [CI: 0.34, 1.12]), but not following the shelter-in-place order (1.59 [CI: -1.61, 3.68]), nor was there a significant change for those older than thirteen. CONCLUSIONS Our findings suggest that cannabis legalization is linked to increased exposures, particularly for products such as gummies and candy edibles among children under the age of thirteen. Clinicians should be aware of these risks and communicate them to patients, and policymakers should consider stronger regulations on packaging to reduce these exposures.Key pointsQuestion: How have cannabis exposures changed following legalization of recreational use, the opening of the recreational retail sales market, and the institution of shelter-in-place orders during the COVID-19 pandemic?Findings: In this retrospective review of 10,757 cases reported to the California Poison Control System (CPCS) between 2010 and 2020, exposures increased significantly after the legalization of recreational cannabis use and the opening of the recreational retail sales market, particularly among children, who primarily consumed candies and gummies.Meaning: Stronger regulation of cannabis edibles that mimic other products is warranted to decrease exposures among children.
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Affiliation(s)
- Winter Roth
- School of Pharmacy, University of California, San Francisco, CA, USA
| | - Mitchell Tam
- School of Pharmacy, University of California, San Francisco, CA, USA
| | - Carrie Bi
- School of Pharmacy, University of California, San Francisco, CA, USA
| | - June Kim
- School of Pharmacy, University of California, San Francisco, CA, USA
| | - Justin Lewis
- California Poison Control System, San Francisco, CA, USA
| | - Raymond Ho
- California Poison Control System, San Francisco, CA, USA
| | - Dorie E Apollonio
- School of Pharmacy, University of California, San Francisco, CA, USA
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Alisauskiene R, Johnsen E, Gjestad R, Kroken RA, Jørgensen HA, Løberg EM. The Influence of Substance Use on Side Effects of Olanzapine, Quetiapine, Risperidone, and Ziprasidone in Psychosis. Subst Use Misuse 2021; 56:1880-1891. [PMID: 34369263 DOI: 10.1080/10826084.2021.1958858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Side effects restrict the optimal use of antipsychotics. Little is known about the influence of substance use on side effects. The aim of this study was to compare antipsychotic side effects in patients with psychosis with and without substance use, while also taking medication history and diagnosis into consideration. METHODS All patients (n = 226, mean age 34, females 33%) diagnosed with schizophrenia spectrum disorders (SSD; F20-F29) or other psychosis (F30-F32; F10-F19), were treated with olanzapine, quetiapine, risperidone or ziprasidone, and were assessed at baseline, 4-weeks, 14-weeks, and 27-weeks. The UKU-Side Effects Self-Rating Scale version was used to evaluate the side effect profiles, and the information on substance use was based on the Clinician Drug Use Scale. RESULTS At baseline, 30% of the patients used substances, 54% were diagnosed with SSD, and 47% were antipsychotic naïve. The occurrence of side effects in total was not different in patients with substance use compared to without after 4-weeks of treatment, nor in the follow-up period. At 4-weeks there were some group differences in relation to substance use, diagnosis, and medication history for single side effects. Patients with substance use showed more increased dream activity, less reduced salivation, and more gynecomastia. Patients with SSD showed less neurological side effects, orgasm dysfunction, and tension/inner unrest. The medication naïve patients showed increased hypokinesia/akinesia. CONCLUSION Substance use alone does not influence the general magnitude of side effects of antipsychotic medication and does not indicate a different prescription practice in patients with psychosis and substance use.
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Affiliation(s)
- Renata Alisauskiene
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
| | - Erik Johnsen
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rolf Gjestad
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rune A Kroken
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hugo A Jørgensen
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Else-Marie Løberg
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.,Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
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Cheng P, Zagaran A, Rajabali F, Turcotte K, Babul S. Setting the baseline: a description of cannabis poisonings at a Canadian pediatric hospital prior to the legalization of recreational cannabis. Health Promot Chronic Dis Prev Can 2020; 40:193-200. [PMID: 32529979 PMCID: PMC7367428 DOI: 10.24095/hpcdp.40.5/6.08] [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] [Indexed: 01/31/2023]
Abstract
INTRODUCTION This study describes the events and circumstances preceding children aged 16 years or younger being treated for cannabis poisoining in the emergency department (ED) of a Canadian pediatric hospital. METHODS We extracted cannabis poisoning treated in the ED at British Columbia Children's Hospital (BCCH) between 1 January, 2016 and 31 December, 2018, from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database. The poisonings were distinguished by the inadvertent or intentional ingestion of cannabis. We reviewed the hospital's electronic health information system and the patients' health records to obtain additional information on the context, including spatial and temporal characteristics. RESULTS Of the 911 poisonings treated at BCCH, 114 were related to intentional cannabis use (12.5%). Fewer than 10 poisonings resulted from inadvertent ingestions by children and the median age for these was 3 years. All inadvertent ingestion occurred at home and involved cannabis belonging to the patient's family. The vast majority of poisonings resulted from the intentional use of cannabis only (28.9%) or cannabis use with other psychoactive substances (co-ingestions; 71.1%). The median patient age was 15 years. Most patients reported consuming cannabis through inhalation with peers. Cannabis and co-ingestion poisonings were more often reported on weekdays than weekends. The consumption of cannabis leading to poisoning more often occurred in private residences. Patients with cannabis poisoning more often sought medical treatment themselves or were helped by their family. CONCLUSION The characteristics of cannabis poisonings among children are described for the three-year period prior to recreational cannabis legalization in Canada in order to set a baseline for future comparisons. Implications for improving injury prevention initiatives and policies are discussed.
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Affiliation(s)
- Phoebe Cheng
- Canadian Hospitals Injury Reporting and Prevention Program, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Atousa Zagaran
- Canadian Hospitals Injury Reporting and Prevention Program, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Fahra Rajabali
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Kate Turcotte
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Shelina Babul
- Canadian Hospitals Injury Reporting and Prevention Program, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
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Affiliation(s)
- Leslie Mendoza Temple
- Integrative Medicine Program, Illinois Department of Public Health, NorthShore University HealthSystem, Chicago, IL, USA
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
- Medical Cannabis Advisory Board, Illinois Department of Public Health, Chicago, IL, USA
| | - Jerrold B. Leikin
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
- Northshore University HealthSystem - OMEGA Glenbrook Hospital Glenview, IL, USA
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6
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Alisauskiene R, Løberg EM, Gjestad R, Kroken RA, Jørgensen HA, Johnsen E. The influence of substance use on the effectiveness of antipsychotic medication: a prospective, pragmatic study. Nord J Psychiatry 2019; 73:281-287. [PMID: 31140342 DOI: 10.1080/08039488.2019.1622152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Psychosis is associated with a high prevalence of substance use, leading to worsened prognosis. Less is known about how comorbid substance abuse may influence the effectiveness of antipsychotic medications. The aim of this study was to compare the effectiveness of second generation antipsychotics in patients with psychosis with and without substance use. Methods: All patients (n = 226) were aged >18 years old had symptom level scores of ≥4 on selected psychosis items on the Positive and Negative Syndrome Scale and met ICD-10 diagnostic criteria for psychosis. Information on substance use was collected based on the Clinician Drug Use Scale. Patients were grouped at baseline according to the presence of substance use, medication history and diagnosis group. Clinical symptoms at baseline and changes at follow-up were assessed with the PANSS. Results: At baseline about 30% of the patients used substances, most frequently cannabis followed by methamphetamine. About half (47%) of the patients had no prior exposure to antipsychotic medication at inclusion. Patients who had consumed substances showed no substantial differences in the PANSS score reduction as a result of antipsychotic medication compared to patients without substance. There were, however, some group differences in relation to pattern of change that were influenced by medication history. Substance use was found to be related to stronger reduction of positive symptoms from week 4 to week 27. Conclusion: Substance use alone did not influence antipsychotic effectiveness in this sample of patients with psychosis.
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Affiliation(s)
| | - Else-Marie Løberg
- a Division of Psychiatry , Haukeland University Hospital , Bergen , Norway.,b Department of Addiction Medicine , Haukeland University Hospital , Bergen , Norway.,c Department of Clinical Psychology , University of Bergen , Bergen , Norway
| | - Rolf Gjestad
- a Division of Psychiatry , Haukeland University Hospital , Bergen , Norway.,d Centre for Research and Education in Forensic Psychiatry , Haukeland University Hospital , Bergen , Norway
| | - Rune A Kroken
- a Division of Psychiatry , Haukeland University Hospital , Bergen , Norway.,e Department of Clinical Medicine , University of Bergen , Bergen , Norway
| | - Hugo A Jørgensen
- a Division of Psychiatry , Haukeland University Hospital , Bergen , Norway
| | - Erik Johnsen
- a Division of Psychiatry , Haukeland University Hospital , Bergen , Norway.,e Department of Clinical Medicine , University of Bergen , Bergen , Norway
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7
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Breitbarth AK, Morgan J, Jones AL. E-cigarettes-An unintended illicit drug delivery system. Drug Alcohol Depend 2018; 192:98-111. [PMID: 30245461 DOI: 10.1016/j.drugalcdep.2018.07.031] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/12/2018] [Accepted: 07/04/2018] [Indexed: 12/15/2022]
Abstract
Since the introduction of electronic cigarettes (e-cigarettes) in 2003, the technology has advanced allowing for greater user modifications, with users now able to control voltage, battery power, and constituents of the e-cigarette liquid. E-cigarettes have been the subject of a growing body of research with most research justifiably focused on the chemical makeup and risk analysis of chemicals, metals, and particulates found in e-cigarette liquids and vapor. Little research to date has focused on assessing the risks associated with the drug delivery unit itself and its potential for use as an illicit drug delivery system. In light of this, a range of illicit drugs was researched focusing on pharmacodynamics, usual method of administration, the dosage required for toxicity, toxic effects, and evidence of existing use in e-cigarettes in both literature and online illicit drug forums. A systematic literature search found evidence of current use of e-cigarettes to vape almost all illicit drug types analyzed. This presents both a potential population health risk and a management issue for clinicians. It also raises the issue of policing illicit drugs due to potential altered characteristic smells and storage within e-cigarette fluids. E-cigarettes are a viable illicit drug delivery system with evidence both inside and outside of the formal medical literature detailing their potential use for drug delivery of a wide range of illicit and legal drugs.
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Affiliation(s)
| | - Jody Morgan
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Alison L Jones
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
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8
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Park F, Potukuchi PK, Moradi H, Kovesdy CP. Cannabinoids and the kidney: effects in health and disease. Am J Physiol Renal Physiol 2017; 313:F1124-F1132. [PMID: 28747360 PMCID: PMC5792153 DOI: 10.1152/ajprenal.00290.2017] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/17/2017] [Accepted: 07/17/2017] [Indexed: 01/01/2023] Open
Abstract
Consumption of cannabis and various related products (cannabinoids) for both medicinal and recreational use is gaining popularity. Furthermore, regulatory changes are fostering a cultural shift toward increasing liberalization of cannabis use, thereby increasing the likelihood of even larger numbers of individuals being exposed in the future. The two different types of receptors (CB1 and CB2) that are activated by the pharmacologically active ingredients of cannabis are found in numerous tissues, including the kidneys. Experimental studies suggest that stimulation of these receptors using pharmacologic agents or their naturally occurring ligands could have both deleterious and beneficial effects on the kidneys, depending on receptor distribution, type of renal insult, or the timing of the activation during acute or chronic states of kidney injury. To date, the mechanisms by which the CB1 or CB2 receptors are involved in the pathology of these renal conditions remain to be fully described. Furthermore, a better understanding of the impact of exocannabinoids and endocannabinoids on the renal system may lead to the development of new drugs to treat kidney disease and its complications. Given the increasing public health relevance of cannabis exposure, it is clear that more research is necessary to clarify the various physiological and pathophysiological effects of cannabis and related analogs on the kidney. This will help limit the deleterious effects of these substances while promoting their potential beneficial impact on renal function in various types of kidney diseases.
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Affiliation(s)
- Frank Park
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Praveen K Potukuchi
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Hamid Moradi
- Division of Nephrology and Hypertension, University of California-Irvine, Orange, California
- Nephrology Section, Long Beach VA Medical Center, Long Beach, California; and
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee;
- Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee
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9
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Zhang MW, Ho RCM. The Cannabis Dilemma: A Review of Its Associated Risks and Clinical Efficacy. JOURNAL OF ADDICTION 2015; 2015:707596. [PMID: 26539302 PMCID: PMC4619948 DOI: 10.1155/2015/707596] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/16/2015] [Indexed: 12/24/2022]
Abstract
Cannabis, also known as marijuana, has 9-tetrahydrocannabinol as the main constituent. There has been strict legislation governing the utilization of cannabis locally and worldwide. However, there has been an increasing push to make cannabis legalized, in view of its potential medical and therapeutic effects, for various medical disorders ranging from development disorders to cancer treatment, and being an adjunctive medication for various neurological conditions. It is the aim of this review paper to explore the evidence base for its proposed therapeutic efficacy and to compare the evidence base supporting its proposed therapeutic efficacy with its known and well-researched medical and psychiatric side effects.
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Affiliation(s)
- Melvyn Weibin Zhang
- National Addiction Management Service, Institute of Mental Health, Singapore 539747
| | - Roger C. M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119054
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