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Bando JM, Tashkin DP, Barjaktarevic IZ. Impact of Marijuana Use on Lung Health. Semin Respir Crit Care Med 2024. [PMID: 38968961 DOI: 10.1055/s-0044-1785679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
The widespread use of marijuana in the context of increasing legalization has both short- and long-term health implications. Although various modes of marijuana use-smoked, vaped, or ingested-may lead to a wide scope of potential systemic effects, we focus here on inhalational use of marijuana as the most common mode with the lung as the organ that is most directly exposed to its effects. Smoked marijuana has been associated with symptoms of chronic bronchitis and histopathologic changes in airway epithelium, but without consistent evidence of long-term decline in pulmonary function. Its role in immunomodulation, both for risk of infection and protection against a hyperinflammatory host response to infection, has been suggested in animal models and in vitro without conclusive extrapolation to humans. Marijuana smoke contains carcinogens like those found in tobacco, raising concern about its role in lung cancer, but evidence is mixed and made challenging by concurrent tobacco use. Vaping may offer a potential degree of harm reduction when compared with smoking marijuana with reduction of exposure to several toxins, including carbon monoxide, and reduction in chronic respiratory symptoms. However, these potential benefits are counterbalanced by risks including vaping-associated lung injury, potentially more intense drug exposure, and other yet not well-understood toxicities. As more states legalize marijuana and the federal government considers changing this from a Schedule I to a Schedule III controlled substance, we anticipate an increase in prospective medical studies concerning the risks related to marijuana use. This review is based on currently available data concerning the impact of inhaled marijuana on lung health.
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Affiliation(s)
- Joanne M Bando
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Donald P Tashkin
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Igor Z Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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2
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Wang RJ, Bhakta NR. The Puzzle of Marijuana Use and Forced Vital Capacity. Ann Am Thorac Soc 2024; 21:683-691. [PMID: 38271695 PMCID: PMC11109910 DOI: 10.1513/annalsats.202312-1010cme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/23/2024] [Indexed: 01/27/2024] Open
Abstract
In study after study, marijuana use has been found to be associated with increased forced vital capacity (FVC). This is puzzling, because marijuana is commonly consumed by inhalation of its smoke, and smoke exposure of any kind is not generally considered a cause of increased FVC. Although this observation was first made decades ago, a satisfactory explanation remains elusive. In this review we survey the evidence supporting the relationship between marijuana use and increased FVC, discuss potential threats to validity when inferring causation, and, presupposing a possible causal relationship, pose two key questions. First, what are possible physiologic or pathophysiologic mechanisms by which marijuana use might increase FVC? Second, why might this effect be consistently observed with marijuana use but not with tobacco use? Explanations for the first question include lung and chest growth and remodeling from strenuous marijuana smoke inhalation and reductions in lung elastic recoil from marijuana smoke exposure. Explanations for the second include differences between marijuana and tobacco in smoke composition and patterns of consumption, such as smoking topography. Finally, the possibility that smoke, whether from marijuana or tobacco, might have nonmonotonic effects on FVC depending on the degree of exposure is explored. In synthesizing a curated breadth of epidemiologic and physiologic science, we leverage a perplexing observation to generate potential insights and avenues for further research into the biological effects of smoke, from marijuana or otherwise, on the respiratory system.
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Affiliation(s)
- Richard J Wang
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Nirav R Bhakta
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California
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3
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Kaiber DB, Chrusciel JH, Martins M, Mattos B, Gomes M, Wearick-Silva LE, Donadio MVF, Friedrich F, Jones MH, Viola TW. Changes in lung function in adolescents with substance use disorders: an exploratory study. J Bras Pneumol 2023; 49:e20230274. [PMID: 37991075 PMCID: PMC10760415 DOI: 10.36416/1806-3756/e20230274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/16/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE To compare lung function between adolescents with and without substance use disorder (SUD). METHODS This was an observational, cross-sectional exploratory study. The sample consisted of 16 adolescents with SUD and 24 age-matched healthy controls. The adolescents in the clinical group were recruited from a psychiatric inpatient unit for detoxification and rehabilitation; their primary diagnosis was SUD related to marijuana, cocaine, or polysubstance use. Questionnaires and pulmonary function tests were applied for clinical evaluation. RESULTS We found that FVC, FEV1, and their percentages of the predicted values were significantly lower in the adolescents with SUD than in those without. Those differences remained significant after adjustment for BMI and the effects of high levels of physical activity. The largest effect size (Cohen's d = 1.82) was found for FVC as a percentage of the predicted value (FVC%), which was, on average, 17.95% lower in the SUD group. In addition, the years of regular use of smoked substances (tobacco, marijuana, and crack cocaine) correlated negatively with the FVC%. CONCLUSIONS This exploratory study is innovative in that it demonstrates the early consequences of smoked substance use for the lung health of adolescents with SUD.
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Affiliation(s)
- Daniela Benvenutti Kaiber
- . Programa de Pós-Graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - João Henrique Chrusciel
- . Programa de Pós-Graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Maiara Martins
- . Programa de Pós-Graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Bernardo Mattos
- . Programa de Pós-Graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Miguel Gomes
- . Programa de Pós-Graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Luis Eduardo Wearick-Silva
- . Grupo de Pesquisa em Exercício Físico, Comportamento e Cognição - GPECC - Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Márcio Vinícius Fagundes Donadio
- . Laboratório de Atividade Física em Pediatria, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
- . Departamento de Fisioterapia, Faculdad de Medicina y Ciencias de la Salud, Universitat International de Catalunya - UIC - Barcelona, España
| | - Frederico Friedrich
- . Programa de Pós-Graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
- . Laboratório de Fisiologia Respiratória, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Marcus Herbert Jones
- . Programa de Pós-Graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
- . Laboratório de Fisiologia Respiratória, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Thiago Wendt Viola
- . Programa de Pós-Graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
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Underner M, Perriot J, Peiffer G, Brousse G, Jaafari N. [Bronchial diseases and heroin use. A systematic review]. Rev Mal Respir 2023; 40:783-809. [PMID: 37925326 DOI: 10.1016/j.rmr.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/11/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION Heroin use can cause respiratory complications including asthma, chronic obstructive pulmonary disease (COPD) and bronchiectasis (BD). OBJECTIVES A general review of the literature presenting the data on the relationships between heroin consumption and bronchial complications, while underlining the difficulties of diagnosis and management. DOCUMENTARY SOURCES Medline, 1980-2022, keywords "asthma" or "bronchospasm" or "COPD" or "bronchiectasis" and "heroin" or "opiate" or "opiates", with limits pertaining to "Title/Abstract". Concerning asthma, 26 studies were included, as were 16 for COPD and 5 for BD. RESULTS Asthma and COPD are more prevalent among heroin addicts, who are less compliant than other patients with their treatment. The authors found a positive association between frequency of asthma exacerbations, admission to intensive care and heroin inhalation. Late diagnosis of COPD worsens the course of the disease; emphysema and BD are poor prognostic factors. CONCLUSION Bronchial diseases in heroin users can be identified by means of respiratory function exploration and chest CT scans. These tests should be performed frequently in view of optimizing their care, which includes their weaning themselves from addictive substances.
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Affiliation(s)
- M Underner
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Laborit, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France.
| | - J Perriot
- Dispensaire Émile-Roux, CLAT, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - G Peiffer
- Service de pneumologie, CHR Metz-Thionville, 57038 Metz, France
| | - G Brousse
- Service d'addictologie, CHU de Clermont-Ferrand, université Clermont Auvergne, 63100 Clermont-Ferrand, France
| | - N Jaafari
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Laborit, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France
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Vásconez-González J, Delgado-Moreira K, López-Molina B, Izquierdo-Condoy JS, Gámez-Rivera E, Ortiz-Prado E. Effects of Smoking Marijuana on the Respiratory System: A Systematic Review. Subst Abus 2023; 44:249-260. [PMID: 37728136 DOI: 10.1177/08897077231186228] [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: 09/21/2023]
Abstract
BACKGROUND The prevalence of marijuana use and its derivatives has surged over the past century, largely due to increasing legalization globally. Despite arguments advocating its benefits, marijuana smoking exposes the lungs to harmful combustion byproducts, leading to various respiratory issues such as asthma, pneumonia, emphysema, and chronic obstructive pulmonary disease. METHODS We embarked on an extensive literature search, utilizing PubMed/Medline, Scopus, Web of Science, and Google Scholar databases, identifying 200 studies. After the elimination of duplicates, and meticulous review of abstracts and full texts, 55 studies were included in our analysis. RESULTS Current literature demonstrates that marijuana use negatively impacts lung function, triggering symptoms like chronic cough, sputum production, and wheezing, and diminishing FEV1/FVC ratio in spirometry tests. Moreover, prolonged or chronic marijuana use augments the risk of respiratory function impairment. While the carcinogenic effects of marijuana are still contested, a weak correlation between marijuana use and lung cancer has been observed in some studies. Additionally, instances of other pathologies linked to marijuana use have been reported, including the development of COPD, pulmonary bullae, spontaneous pneumothorax, pleuritic pain, chronic pulmonary aspergillosis, hemoptysis, and pulmonary Langerhans cell histiocytosis. CONCLUSIONS The evidence underscores that marijuana use is detrimental to respiratory health. In light of the escalating trend of marijuana use, particularly among the youth, it is imperative to advocate public health messages discouraging its consumption.
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Affiliation(s)
- Jorge Vásconez-González
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito, Ecuador
- Pontificia Universidad Católica del Ecuador, Tecnologias PUCE-TEC, Quito, Ecuador
| | - Karen Delgado-Moreira
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito, Ecuador
| | - Belén López-Molina
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito, Ecuador
| | - Juan S Izquierdo-Condoy
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito, Ecuador
| | - Esteban Gámez-Rivera
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito, Ecuador
| | - Esteban Ortiz-Prado
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito, Ecuador
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Shah S, Schwenk ES, Sondekoppam RV, Clarke H, Zakowski M, Rzasa-Lynn RS, Yeung B, Nicholson K, Schwartz G, Hooten WM, Wallace M, Viscusi ER, Narouze S. ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids. Reg Anesth Pain Med 2023; 48:97-117. [PMID: 36596580 DOI: 10.1136/rapm-2022-104013] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/08/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The past two decades have seen an increase in cannabis use due to both regulatory changes and an interest in potential therapeutic effects of the substance, yet many aspects of the substance and their health implications remain controversial or unclear. METHODS In November 2020, the American Society of Regional Anesthesia and Pain Medicine charged the Cannabis Working Group to develop guidelines for the perioperative use of cannabis. The Perioperative Use of Cannabis and Cannabinoids Guidelines Committee was charged with drafting responses to the nine key questions using a modified Delphi method with the overall goal of producing a document focused on the safe management of surgical patients using cannabinoids. A consensus recommendation required ≥75% agreement. RESULTS Nine questions were selected, with 100% consensus achieved on third-round voting. Topics addressed included perioperative screening, postponement of elective surgery, concomitant use of opioid and cannabis perioperatively, implications for parturients, adjustment in anesthetic and analgesics intraoperatively, postoperative monitoring, cannabis use disorder, and postoperative concerns. Surgical patients using cannabinoids are at potential increased risk for negative perioperative outcomes. CONCLUSIONS Specific clinical recommendations for perioperative management of cannabis and cannabinoids were successfully created.
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Affiliation(s)
- Shalini Shah
- Dept of Anesthesiology & Perioperative Care, UC Irvine Health, Orange, California, USA
| | - Eric S Schwenk
- Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Hance Clarke
- Anesthesiology and Pain Medicine, Univ Toronto, Toronto, Ontario, Canada
| | - Mark Zakowski
- Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Brent Yeung
- Anesthesiology and Perioperative Care, University of California Irvine, Irvine, California, USA
| | | | - Gary Schwartz
- AABP Integrative Pain Care, Melville, New York, USA.,Anesthesiology, Maimonides Medical Center, Brooklyn, New York, USA
| | | | - Mark Wallace
- Anesthesiology, Division of Pain Medicine, University of California San Diego, La Jolla, California, USA
| | - Eugene R Viscusi
- Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Samer Narouze
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
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Abstract
Human beings have used marijuana products for centuries. Relatively recent data showing extensive cannabinoid receptors, particularly in the brain, help to explain the impacts of cannabinoids on symptoms/diseases, such as pain and seizures, with major nervous system components. Marijuana can cause bronchitis, but a moderate body of literature suggests that distal airway/parenchymal lung disease does not occur; marijuana does not cause chronic obstructive pulmonary disease and probably does not cause lung cancer, distinctly different from tobacco. Potentials for cognitive impairment and for damage to the developing brain are contextually important as its beneficial uses are explored.
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Affiliation(s)
- Manish Joshi
- Pulmonary and Critical Care Division, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR 72205, USA; Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA.
| | - Anita Joshi
- Department of Epidemiology, Fay W. Boozman College Public Health, University of Arkansas for Medical Sciences, 4300 West Markham, Little Rock, AR 72205, USA
| | - Thaddeus Bartter
- Pulmonary and Critical Care Division, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR 72205, USA; Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
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8
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Association between secondhand marijuana smoke and respiratory infections in children. Pediatr Res 2022; 91:1769-1774. [PMID: 34321605 DOI: 10.1038/s41390-021-01641-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/20/2021] [Accepted: 04/20/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Little is known about the effects of secondhand marijuana smoke on children. We aimed to determine caregiver marijuana use prevalence and evaluate any association between secondhand marijuana smoke, childhood emergency department (ED) or urgent care (UC) visitation, and several tobacco-related illnesses: otitis media, viral respiratory infections (VRIs), and asthma exacerbations. METHODS This study was a cross-sectional, convenience sample survey of 1500 subjects presenting to a pediatric ED. The inclusion criteria were as follows: caregivers aged 21-85 years, English- or Spanish-speaking. The exclusion criteria were as follows: children who were critically ill, medically complex, over 11 years old, or using medical marijuana. RESULTS Of 1500 caregivers, 158 (10.5%) reported smoking marijuana and 294 (19.6%) reported smoking tobacco. Using negative-binomial regression, we estimated rates of reported ED/UC visits and specific illnesses among children with marijuana exposure and those with tobacco exposure, compared to unexposed children. Caregivers who used marijuana reported an increased rate of VRIs in their children (1.31 episodes/year) compared to caregivers with no marijuana use (1.04 episodes/year) (p = 0.02). CONCLUSIONS Our cohort did not report any difference with ED/UC visits, otitis media episodes, or asthma exacerbations, regardless of smoke exposure. However, caregivers of children with secondhand marijuana smoke exposure reported increased VRIs compared to children with no smoke exposure. IMPACT Approximately 10% of caregivers in our study were regular users of marijuana. Prior studies have shown that secondhand tobacco smoke exposure is associated with negative health outcomes in children, including increased ED utilization and respiratory illnesses. Prior studies have shown primary marijuana use is linked to negative health outcomes in adults and adolescents, including increased ED utilization and respiratory illnesses. Our study reveals an association between secondhand marijuana smoke exposure and increased VRIs in children. Our study did not find an association between secondhand marijuana smoke exposure and increased ED or UC visitation in children.
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Tashkin DP, Tan WC. Inhaled Marijuana and the Lung. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2822-2829. [PMID: 35609784 DOI: 10.1016/j.jaip.2022.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
Although vaping has recently increased as a mode of inhaling marijuana and has been associated with numerous and sometimes fatal cases of acute severe lung injury, smoking remains the most common method of inhaling marijuana and has been studied more extensively. Smoking marijuana has been shown to produce modest but significant short-term bronchodilation both in healthy subjects and those with asthma. Long-term effects of habitual marijuana smoking include the following: 1) symptoms of chronic bronchitis (increased cough, sputum production and wheezing); 2) modest effects on lung function in cross-sectional studies (no significant decrease in forced expired volume in 1 second [FEV1) but mild reductions in FEV1/forced vital capacity ratio [FEV1/FVC], an increase in FVC and other lung volumes, reductions in specific airway conductance, and variable effects of maximal mid-expiratory flow rates and diffusing capacity; and 3) variable effects on age-related decline in FEV1 in longitudinal studies. Most cohort and case-control studies have failed to show that marijuana smoking is a significant risk-factor for lung cancer despite the presence of pro-carcinogenic components in marijuana smoke, although further study is warranted. The question whether marijuana smoking is associated with asthma is unclear and requires further investigation. Although delta-9 tetrahydrocannabinol (THC), the principal psychoactive component of marijuana, has immunomodulatory properties that hypothetically could increase the risk of pneumonia, the few available studies in marijuana smokers have failed to find an increased risk of pneumonia in immunocompetent users, although effects in immunosuppressed individuals have been variable.
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Affiliation(s)
- Donald P Tashkin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA Health Sciences, Los Angeles, CA 90095, USA
| | - Wan-Cheng Tan
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, V6Z 1Y6, Canada
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Pagano C, Navarra G, Coppola L, Avilia G, Bifulco M, Laezza C. Cannabinoids: Therapeutic Use in Clinical Practice. Int J Mol Sci 2022; 23:ijms23063344. [PMID: 35328765 PMCID: PMC8952215 DOI: 10.3390/ijms23063344] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 12/14/2022] Open
Abstract
Medical case reports suggest that cannabinoids extracted from Cannabis sativa have therapeutic effects; however, the therapeutic employment is limited due to the psychotropic effect of its major component, Δ9-tetrahydrocannabinol (THC). The new scientific discoveries related to the endocannabinoid system, including new receptors, ligands, and mediators, allowed the development of new therapeutic targets for the treatment of several pathological disorders minimizing the undesirable psychotropic effects of some constituents of this plant. Today, FDA-approved drugs, such as nabiximols (a mixture of THC and non-psychoactive cannabidiol (CBD)), are employed in alleviating pain and spasticity in multiple sclerosis. Dronabinol and nabilone are used for the treatment of chemotherapy-induced nausea and vomiting in cancer patients. Dronabinol was approved for the treatment of anorexia in patients with AIDS (acquired immune deficiency syndrome). In this review, we highlighted the potential therapeutic efficacy of natural and synthetic cannabinoids and their clinical relevance in cancer, neurodegenerative and dermatological diseases, and viral infections.
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Affiliation(s)
- Cristina Pagano
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy or (C.P.); (G.N.); (L.C.); (G.A.)
| | - Giovanna Navarra
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy or (C.P.); (G.N.); (L.C.); (G.A.)
| | - Laura Coppola
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy or (C.P.); (G.N.); (L.C.); (G.A.)
| | - Giorgio Avilia
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy or (C.P.); (G.N.); (L.C.); (G.A.)
| | - Maurizio Bifulco
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy or (C.P.); (G.N.); (L.C.); (G.A.)
- Correspondence: (M.B.); or (C.L.)
| | - Chiara Laezza
- Institute of Endocrinology and Experimental Oncology, IEOS CNR, Via Pansini 5, 80131 Naples, Italy
- Correspondence: (M.B.); or (C.L.)
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Jeffers AM, Glantz S, Byers A, Keyhani S. Sociodemographic Characteristics Associated With and Prevalence and Frequency of Cannabis Use Among Adults in the US. JAMA Netw Open 2021; 4:e2136571. [PMID: 34846523 PMCID: PMC8634054 DOI: 10.1001/jamanetworkopen.2021.36571] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Cannabis use has increased, but there are few studies on frequent and daily cannabis use among US adults. Individuals who engage in higher frequency use may suffer more health consequences. OBJECTIVE To examine frequency of cannabis use and associated factors among US adults. DESIGN, SETTING, AND PARTICIPANTS This survey study included data from 21 US states and 2 US territories reported in the Behavioral Risk Factor Surveillance System surveys from 2016 to 2019. Cross-sectional data on US adults ages 18 years and older were used to estimate demographic, socioeconomic, and behavioral risk factors for cannabis use, taking into account the survey strata and sampling weights for the 4 years of combined data. Using a multivariable ordinal logistic analysis, the association of demographic, socioeconomic status, and behavioral risk factors with past month cannabis frequency were examined. EXPOSURES Sociodemographic characteristic, ie, age, gender, race and ethnicity, educational attainment, employment status, and annual household income. MAIN OUTCOMES AND MEASURES Ordinal categorization of number of days of cannabis use in the past 30 days in terms of nonuse, infrequent use (1-5 days), frequent use (6-29 days), and daily use. RESULTS Among the 387 179 respondents, 58 009 (27.9%) were ages 18 to 34 years, 186 923 (50.3%) were ages 35 to 64 years, and 142 225 (21.8%) were age 65 years or older (mean [SD] age, 48.3 [0.1] years). The sample included 28 345 (9.8%) Black, 36 697 (22.6%) Hispanic, and 292 210 (57.3%) White respondents. Smoking was the most common form of cannabis use. The frequency of cannabis use varied significantly by age, gender, race, marital status, education, and employment. Higher frequency cannabis use was associated with younger age (ages 18-34 years: adjusted odds ratio [aOR],4.12; 95% CI, 3.63-4.68; ages 35-64 years: aOR,2.22; 95% CI, 1.98-2.49), Black (aOR, 1.46; 95% CI, 1.33-1.71) and Native American (aOR, 1.25; 95% CI, 1.04-1.52) race, and less educational attainment (high school or less: aOR,1.09; 95% CI, 1.02-1.17; some college: aOR,1.27; 95% CI, 1.19-1.35). Being married (aOR, 0.54; 95% CI, 0.51-0.58) or identifying as Asian (aOR, 0.60; 95% CI, 0.51-0.71) or Hispanic (aOR, 0.71; 95% CI, 0.65-0.77) was associated with lower-frequency cannabis use after accounting for other baseline factors. CONCLUSIONS AND RELEVANCE This nationally based study found that higher-frequency cannabis use is more common among young and racial minority populations, as well as respondents with low socioeconomic status. Given the known and emerging negative health effects of cannabis use, more attention may need to be paid to high-frequency use among underserved populations in the form of screening, risk stratification, and treatment.
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Affiliation(s)
- Abra M. Jeffers
- formerly of Center for Tobacco Control Research & Education, University of California, San Francisco
| | - Stanton Glantz
- Center for Tobacco Control Research & Education, University of California, San Francisco
| | - Amy Byers
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Section of Mental Health Services, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Salomeh Keyhani
- formerly of Center for Tobacco Control Research & Education, University of California, San Francisco
- Division of Internal Medicine, Department of Medicine, University of California, San Francisco
- Section of General Internal Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
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Maggirwar SB, Khalsa JH. The Link between Cannabis Use, Immune System, and Viral Infections. Viruses 2021; 13:v13061099. [PMID: 34207524 PMCID: PMC8229290 DOI: 10.3390/v13061099] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 01/11/2023] Open
Abstract
Cannabis continues to be the most used drug in the world today. Research shows that cannabis use is associated with a wide range of adverse health consequences that may involve almost every physiological and biochemical system including respiratory/pulmonary complications such as chronic cough and emphysema, impairment of immune function, and increased risk of acquiring or transmitting viral infections such as HIV, HCV, and others. The review of published research shows that cannabis use may impair immune function in many instances and thereby exerts an impact on viral infections including human immune deficiency virus (HIV), hepatitis C infection (HCV), and human T-cell lymphotropic type I and II virus (HTLV-I/II). The need for more research is also highlighted in the areas of long-term effects of cannabis use on pulmonary/respiratory diseases, immune dysfunction and the risk of infection transmission, and the molecular/genetic basis of immune dysfunction in chronic cannabis users.
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Affiliation(s)
- Sanjay B. Maggirwar
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA;
- Correspondence:
| | - Jag H. Khalsa
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA;
- Medical Consequences of Drug Abuse and Infections Branch, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20852, USA
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Gracie K, Hancox RJ. Cannabis use disorder and the lungs. Addiction 2021; 116:182-190. [PMID: 32285993 DOI: 10.1111/add.15075] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/04/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022]
Abstract
Cannabis is one of the world's most widely used recreational drugs and the second most commonly smoked substance. Research on cannabis and the lungs has been limited by its illegal status, the variability in strength and size of cannabis cigarettes (joints), and the fact that most cannabis users also smoke tobacco, making the effects difficult to separate. Despite these difficulties, the available evidence indicates that smoking cannabis causes bronchitis and is associated with changes in lung function. The pattern of effects is surprisingly different from that of tobacco. Whereas smoking cannabis appears to increase the risk of severe bronchitis at quite low exposure, there is no convincing evidence that this leads to chronic obstructive pulmonary disease. Instead, cannabis use is associated with increased central airway resistance, lung hyperinflation and higher vital capacity with little evidence of airflow obstruction or impairment of gas transfer. There are numerous reports of severe bullous lung disease and pneumothorax among heavy cannabis users, but convincing epidemiological data of an increased risk of emphysema or alveolar destruction are lacking. An association between cannabis and lung cancer remains unproven, with studies providing conflicting findings.
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Affiliation(s)
- Kathryn Gracie
- Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
| | - Robert J Hancox
- Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand.,Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Underner M, Peiffer G, Perriot J, Jaafari N. [Asthma and cannabis, cocaine or heroin use]. Rev Mal Respir 2020; 37:572-589. [PMID: 32653338 PMCID: PMC7345369 DOI: 10.1016/j.rmr.2020.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/09/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The use of cannabis, cocaine or heroin can be responsible for many respiratory complications including asthma. OBJECTIVES The aim of this systematic literature review of data was to expose the relations between cannabis, cocaine or heroin use and asthma. RESULTS Cannabis, cocaine or heroin use by inhalation may be responsible for respiratory symptoms (cough, wheezing), asthma onset, acute asthma exacerbations (which may require intubation and invasive ventilation) or deaths related to asthma. Lower adherence to asthma treatment is also observed. Cannabis induces a rapid bronchodilator effect. In contrast, its chronic use may induce a decrease in specific airway conductance. Studies on forced expiratory volume in one second (FEV1) reduction or decline are discordant. CONCLUSION Cannabis, cocaine or heroin use must be considered in cases of acute respiratory symptoms or asthma exacerbation in young persons and practitioners must help illicit substance users to stop their consumption.
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Affiliation(s)
- M Underner
- Consultation de tabacologie, unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France.
| | - G Peiffer
- Service de pneumologie, CHR Metz-Thionville, 57038 Metz, France
| | - J Perriot
- Dispensaire Émile-Roux, CLAT 63, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - N Jaafari
- Consultation de tabacologie, unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France
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Tan WC, Bourbeau J, Aaron SD, Hogg JC, Maltais F, Hernandez P, Marciniuk DD, Chapman KR, To T, FitzGerald JM, Walker BL, Road J, Zheng L, Zhou G, Yau T, Benedetti A, O'Donnell D, Sin DD. The effects of marijuana smoking on lung function in older people. Eur Respir J 2019; 54:13993003.00826-2019. [PMID: 31537703 DOI: 10.1183/13993003.00826-2019] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/06/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Previous studies have associated marijuana exposure with increased respiratory symptoms and chronic bronchitis among long-term cannabis smokers. The long-term effects of smoked marijuana on lung function remain unclear. METHODS We determined the association of marijuana smoking with the risk of spirometrically defined chronic obstructive pulmonary disease (COPD) (post-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity ratio <0.7) in 5291 population-based individuals and the rate of decline in FEV1 in a subset of 1285 males and females, aged ≥40 years, who self-reported use (or non-use) of marijuana and tobacco cigarettes and performed spirometry before and after inhaled bronchodilator on multiple occasions. Analysis for the decline in FEV1 was performed using random mixed effects regression models adjusted for age, sex and body mass index. Heavy tobacco smoking and marijunana smoking was defined as >20 pack-years and >20 joint-years, respectively. RESULTS ∼20% of participants had been or were current marijuana smokers with most having smoked tobacco cigarettes in addition (83%). Among heavy marijuana users, the risk of COPD was significantly increased (adjusted OR 2.45, 95% CI 1.55-3.88). Compared to never-smokers of marijuana and tobacco, heavy marijuana smokers and heavy tobacco smokers experienced a faster decline in FEV1 by 29.5 mL·year-1 (p=0.0007) and 21.1 mL·year-1 (p<0.0001), respectively. Those who smoked both substances experienced a decline of 32.31 mL·year-1 (p<0.0001). INTERPRETATION Heavy marijuana smoking increases the risk of COPD and accelerates FEV1 decline in concomitant tobacco smokers beyond that observed with tobacco alone.
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Affiliation(s)
- Wan C Tan
- The University of British Columbia, Center for Heart Lung Innovation, St Pauls's Hospital, Vancouver, BC, Canada
| | - Jean Bourbeau
- Research Institute McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - James C Hogg
- The University of British Columbia, Center for Heart Lung Innovation, St Pauls's Hospital, Vancouver, BC, Canada
| | - François Maltais
- Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec City, QC, Canada
| | - Paul Hernandez
- Dept of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Darcy D Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kenneth R Chapman
- Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada
| | - Teresa To
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - J Mark FitzGerald
- University of British Columbia, Dept of Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | | | - Jeremy Road
- University of British Columbia, Dept of Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - Liyun Zheng
- The University of British Columbia, Center for Heart Lung Innovation, St Pauls's Hospital, Vancouver, BC, Canada
| | - Guohai Zhou
- The University of British Columbia, Center for Heart Lung Innovation, St Pauls's Hospital, Vancouver, BC, Canada
| | - Trevor Yau
- The University of British Columbia, Center for Heart Lung Innovation, St Pauls's Hospital, Vancouver, BC, Canada
| | - Andrea Benedetti
- Research Institute McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Denis O'Donnell
- Division of Respiratory and Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Don D Sin
- The University of British Columbia, Center for Heart Lung Innovation, St Pauls's Hospital, Vancouver, BC, Canada
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Tashkin DP, Roth MD. Pulmonary effects of inhaled cannabis smoke. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:596-609. [PMID: 31298945 DOI: 10.1080/00952990.2019.1627366] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: The smoke generated from cannabis delivers biologically active cannabinoids and a number of combustion-derived toxins, both of which raise questions regarding the impact of cannabis smoking on lung function, airway inflammation and smoking-related lung disease.Objectives: Review the potential effects of cannabis smoking on respiratory symptoms, lung function, histologic/molecular alterations in the bronchial mucosa, smoking-related changes in alveolar macrophage function and the potential clinical impact of cannabis smoking on chronic obstructive pulmonary disease, lung cancer and pulmonary infections.Methods: Focused literature review.Results: The carcinogens and respiratory toxins in cannabis and tobacco smoke are similar but the smoking topography for cannabis results in higher per-puff exposures to inhaled tar and gases. The frequency of chronic cough, sputum and wheeze and the presence of airway mucosal inflammation, goblet cell and vascular hyperplasia, metaplasia and cellular disorganization are similar between cannabis smokers and tobacco smokers. Cannabis smoke has modest airway bronchodilator properties but of unclear clinical significance. While clear evidence exists for progression to obstructive lung disease and emphysema in chronic tobacco smokers, the effects from habitual cannabis use are less clear. Evidence suggests that alveolar macrophages from cannabis smokers have deficits in cytokine production and antimicrobial activity not present in cells from tobacco smokers.Conclusions: Solid conclusions regarding the respiratory consequences of regular cannabis smoking are difficult to make due to a relative paucity of literature, confounding by concurrent tobacco smoking and reports of conflicting outcomes. Additional well-controlled clinical studies on the pulmonary consequences of habitual cannabis use are needed.
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Affiliation(s)
- Donald P Tashkin
- Department of Medicine, Division of Pulmonary & Critical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Michael D Roth
- Department of Medicine, Division of Pulmonary & Critical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Awad OGAN. Impact of habitual marijuana and tobacco smoke on severity of chronic rhinosinusitis. Am J Otolaryngol 2019; 40:583-588. [PMID: 31109805 DOI: 10.1016/j.amjoto.2019.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/07/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Health concerns around cannabis (marijuana) use have focused on the possible relationship with psychosis and lower airway health, however; the effect of cannabis smoking on upper airway health has received less attention. The aim of this study is to investigate difference between exclusive tobacco cigarettes smoking compared with tobacco plus cannabis smoking regarding severity of chronic rhinosinusitis (CRS). MATERIAL AND METHODS A prospective cross-sectional study with two groups of CRS patients recruited (Group 1: tobacco cigarettes smokers; 100 patients and group 2: tobacco cigarettes smokers and also cannabis users; 100 patients). Recruitment occurred in a general practice in Egypt. Cannabis use was recorded by self-report. Severity of CRS was assessed and compared between 2 groups using SNOT-20 questionnaire, Lund-Mackay CT score and Lund-Kennedy (LK) endoscopy Score. RESULTS Group 2 patients (tobacco plus cannabis smokers) had significantly higher mean of assessment cores (SNOT-20 (P = 0.005), Lund-Mackay CT score (P = 0.006) and Lund-Kennedy (LK) endoscopy Score (P = 0.005)). Group 2 patients also had significantly higher mean of facial pain/pressure, difficulty sleep, and wake at night, lack of sleep, wake up tired, fatigue, reduced productivity, reduced concentration, frustration/restless/irritable, sad and embarrassed compared to patients in group 1. CONCLUSION Adult patients who smoked tobacco cigarettes plus cannabis mixed with tobacco had greater health related quality of life burden and more severe CRS compared to patients who smoked tobacco cigarettes only.
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18
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Abstract
Increasing cannabis use and legalisation highlights the paucity of data we have on the safety of cannabis smoking for respiratory health. Unfortunately, concurrent use of tobacco among marijuana smokers makes it difficult to untangle individual effect of marijuana smoking. Chronic cannabis only smoking has been shown in large cohort studies to reduce forced expiratory volume in 1 s/forced vital capacity via increasing forced vital capacity in chronic use contrary to the picture seen in tobacco smoking. The cause of this is unclear and there are various proposed mechanisms including respiratory muscle training secondary to method of inhalation and acute anti-inflammatory effect and bronchodilation of cannabis on the airways. While cannabis smoke has been shown to increase symptoms of chronic bronchitis, it has not been definitively shown to be associated with shortness of breath or irreversible airway changes. The evidence surrounding the development of lung cancer is less clear; however, preliminary evidence does not suggest association. Bullous lung disease associated with marijuana use has long been observed in clinical practice but published evidence is limited to a total of 57 published cases and only one cross-sectional study looking at radiological changes among chronic users which did not report any increase in macroscopic emphysema. More studies are required to elucidate these missing points to further guide risk stratification, clinical diagnosis and management. Key points Cannabis smoking has increased and is likely to increase further with relaxation of legalisation and medicinal use of cannabinoids.Chronic marijuana smoking often produces symptoms similar to those of chronic tobacco smoking such as cough, sputum production, shortness of breath and wheeze.Cessation of marijuana smoking is associated with a reduction in respiratory symptoms and no increased risk of chronic bronchitis.Spirometry changes seen in chronic marijuana smokers appear to differ from those in chronic tobacco smokers. In chronic marijuana smokers there is an increase in FVC as opposed to a definite decrease in FEV1.Multiple case series have demonstrated peripheral bullae in marijuana smokers, but no observational studies have elucidated the risk.There is currently no clear association between cannabis smoking and lung cancer, although the research is currently limited. Educational aims To update readers on legalisation of recreational and medicinal cannabis.To summarise the evidence base surrounding the respiratory effects of inhaled marijuana use.To provide clinicians with an understanding of the main differences between cannabis and tobacco to be able to apply this to patient education.To highlight common respiratory problems among cannabis users and the need for recreational drug history taking.
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Affiliation(s)
- Luis Ribeiro
- Imperial College London Institute of Clinical Sciences, National Heart and Lung Institute, London, UK
| | - Philip W Ind
- Respiratory Medicine, Hammersmith Hospital, London, UK
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Ghasemiesfe M, Ravi D, Vali M, Korenstein D, Arjomandi M, Frank J, Austin PC, Keyhani S. Marijuana Use, Respiratory Symptoms, and Pulmonary Function: A Systematic Review and Meta-analysis. Ann Intern Med 2018; 169:106-115. [PMID: 29971337 PMCID: PMC6231497 DOI: 10.7326/m18-0522] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The health effects of smoking marijuana are not well-understood. Purpose To examine the association between marijuana use and respiratory symptoms, pulmonary function, and obstructive lung disease among adolescents and adults. Data Sources PubMed, Embase, PsycINFO, MEDLINE, and the Cochrane Library from 1 January 1973 to 30 April 2018. Study Selection Observational and interventional studies published in English that reported pulmonary outcomes of adolescents and adults who used marijuana. Data Extraction Four reviewers independently extracted study characteristics and assessed risk of bias. Three reviewers assessed strength of evidence. Studies of similar design with low or moderate risk of bias and sufficient data were pooled. Data Synthesis Twenty-two studies were included. A pooled analysis of 2 prospective studies showed that marijuana use was associated with an increased risk for cough (risk ratio [RR], 2.04 [95% CI, 1.02 to 4.06]) and sputum production (RR, 3.84 [CI, 1.62 to 9.07]). Pooled analysis of cross-sectional studies (1 low and 3 moderate risk of bias) showed that marijuana use was associated with cough (RR, 4.37 [CI, 1.71 to 11.19]), sputum production (RR, 3.40 [CI, 1.99 to 5.79]), wheezing (RR, 2.83 [CI, 1.89 to 4.23]), and dyspnea (RR, 1.56 [CI, 1.33 to 1.83]). Data on pulmonary function and obstructive lung disease were insufficient. Limitation Few studies were at low risk of bias, marijuana exposure was limited in the population studied, cohorts were young overall, assessment of marijuana exposure was not uniform, and study designs varied. Conclusion Low-strength evidence suggests that smoking marijuana is associated with cough, sputum production, and wheezing. Evidence on the association between marijuana use and obstructive lung disease and pulmonary function is insufficient. Primary Funding Source None. (PROSPERO: CRD42017059224).
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Affiliation(s)
- Mehrnaz Ghasemiesfe
- University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California (M.G., M.A., J.F., S.K.)
| | - Divya Ravi
- The Wright Center for Graduate Medical Education, Scranton, Pennsylvania (D.R.)
| | - Marzieh Vali
- Northern California Institute for Research and Education, San Francisco Veterans Affairs Medical Center, San Francisco, California (M.V.)
| | | | - Mehrdad Arjomandi
- University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California (M.G., M.A., J.F., S.K.)
| | - James Frank
- University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California (M.G., M.A., J.F., S.K.)
| | - Peter C Austin
- University of Toronto, Toronto, Ontario, Canada (P.C.A.)
| | - Salomeh Keyhani
- University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California (M.G., M.A., J.F., S.K.)
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20
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Marijuana use and short-term outcomes in patients hospitalized for acute myocardial infarction. PLoS One 2018; 13:e0199705. [PMID: 29995914 PMCID: PMC6040751 DOI: 10.1371/journal.pone.0199705] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/12/2018] [Indexed: 11/19/2022] Open
Abstract
Marijuana use is increasing worldwide, and it is ever more likely that patients presenting with acute myocardial infarctions (AMI) will be marijuana users. However, little is known about the impact of marijuana use on short-term outcomes following AMI. Accordingly, we compared in-hospital outcomes of AMI patients with reported marijuana use to those with no reported marijuana use. We hypothesized that marijuana use would be associated with increased risk of adverse outcomes in AMI patients. Hospital records from 8 states between 1994–2013 were screened for patients with a diagnosis of AMI. Clinical profiles and outcomes in patients with reported use of marijuana were compared to patients without reported marijuana use. Short-term outcomes were defined as adverse events that occurred during hospitalization for an admitting diagnosis of AMI. The composite primary outcome included death, intraaortic balloon pump placement, (IABP), mechanical ventilation, cardiac arrest, and shock. In total, 3,854 of 1,273,897 AMI patients reported use of marijuana. The marijuana cohort was younger than (47.2 vs. 57.2, respectively) and had less coronary artery disease than the non-marijuana cohort. In multivariable analysis including age, race and common cardiac risk factors, there was no association between marijuana use and the primary outcome (p = 0.53), but marijuana users were more likely to be placed on mechanical ventilation (OR (odds ratio) 1.19, p = 0.004). Interestingly, marijuana-using patients were significantly less likely to die (OR 0.79, p = 0.016), experience shock (OR 0.74, p = 0.001), or require an IABP (OR 0.80, p = 0.03) post AMI than patients with no reported marijuana use. These results suggest that, contrary to our hypothesis, marijuana use was not associated with increased risk of adverse short-term outcomes following AMI. Furthermore, marijuana use was associated with decreased in-hospital mortality post-AMI.
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Abstract
As marijuana smoking prevalence increases in the United States, concern regarding its potential risks to lung health has also risen, given the general similarity in the smoke contents between marijuana and tobacco. Most studies have found a significant association between marijuana smoking and chronic bronchitis symptoms after adjustment for tobacco. Although reports are mixed regarding associations between marijuana smoking and lung function, none have shown a relationship to decrements in FEV1 and few have found a relationship to a decreased ratio of FEV1/FVC, possibly related to an association between marijuana and an increased FVC. A few studies have found a modest reduction in specific airway conductance in relation to marijuana, probably reflecting endoscopic evidence of bronchial mucosal edema among habitual marijuana smokers. Diffusing capacity in marijuana smokers has been normal, and two studies of thoracic high-resolution CT scan have not shown any association of marijuana smoking with emphysema. Although bronchial biopsies from habitual marijuana smokers have shown precancerous histopathologic changes, a large cohort study and a pooled analysis of six well-designed case-control studies have not found evidence of a link between marijuana smoking and lung cancer. The immunosuppressive effects of delta-9 tetrahydrocannabinol raise the possibility of an increased risk of pneumonia, but further studies are needed to evaluate this potential risk. Several cases series have demonstrated pneumothoraces/pneumomediastinum and bullous lung disease in marijuana smokers, but these associations require epidemiologic studies for firmer evidence of possible causality.
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Morris MA, Jacobson SR, Kinney GL, Tashkin DP, Woodruff PG, Hoffman EA, Kanner RE, Cooper CB, Drummond MB, Barr RG, Oelsner EC, Make BJ, Han MK, Hansel NN, O’Neal WK, Bowler RP. Marijuana Use Associations with Pulmonary Symptoms and Function in Tobacco Smokers Enrolled in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2018; 5:46-56. [PMID: 29629404 PMCID: PMC5870739 DOI: 10.15326/jcopdf.5.1.2017.0141] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 01/15/2023]
Abstract
Background: Marijuana is often smoked via a filterless cigarette and contains similar chemical makeup as smoked tobacco. There are few publications describing usage patterns and respiratory risks in older adults or in those with chronic obstructive pulmonary disease (COPD). Methods: A cross-sectional analysis of current and former tobacco smokers from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) study assessed associations between marijuana use and pulmonary outcomes. Marijuana use was defined as never, former (use over 30 days ago), or current (use within 30 days). Respiratory health was assessed using quantitative high-resolution computed tomography (HRCT) scans, pulmonary function tests and questionnaire responses about respiratory symptoms. Results: Of the total 2304 participants, 1130 (49%) never, 982 (43%) former, and 192 (8%) current marijuana users were included. Neither current nor former marijuana use was associated with increased odds of wheeze (odds ratio [OR] 0.87, OR 0.97), cough (OR 1.22; OR 0.93) or chronic bronchitis (OR 0.87; OR 1.00) when compared to never users. Current and former marijuana users had lower quantitative emphysema (P=0.004, P=0.03), higher percent predicted forced expiratory volume in 1 second (FEV1%) (P<0.001, P<0.001), and percent predicted forced vital capacity (FVC%) (p<0.001, P<0.001). Current marijuana users exhibited higher total tissue volume (P=0.003) while former users had higher air trapping (P<0.001) when compared to never marijuana users. Conclusions: Marijuana use was found to have little to no association with poor pulmonary health in older current and former tobacco smokers after adjusting for covariates. Higher forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) was observed among current marijuana users. However, higher joint years was associated with more chronic bronchitis symptoms (e.g., wheeze), and this study cannot determine if long-term heavy marijuana smoking in the absence of tobacco smoking is associated with lung symptoms, airflow obstruction, or emphysema, particularly in those who have never smoked tobacco cigarettes.
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Affiliation(s)
| | | | - Gregory L. Kinney
- 2-Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Donald P. Tashkin
- 3-Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California at Los Angeles
| | - Prescott G. Woodruff
- 4-Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine and Cardiovascular Research Institute, University of California San Francisco, School of Medicine, San Francisco
| | - Eric A. Hoffman
- 5-Departments of Radiology, Medicine and Biomedical Engineering, University of Iowa, Iowa City
| | - Richard E. Kanner
- 6-University of Utah Health Sciences Center, Salt Lake City
- 7-Department of Biostatics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Christopher B. Cooper
- 3-Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California at Los Angeles
| | - M. Brad Drummond
- 8-Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill
| | - R. Graham Barr
- 9-Columbia University, Division of General Medicine, New York, New York
| | | | | | | | | | - Wanda K. O’Neal
- 8-Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill
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Underner M, Perriot J, Peiffer G, Jaafari N. [Asthma and heroin use]. Presse Med 2017; 46:660-675. [PMID: 28734637 PMCID: PMC7126345 DOI: 10.1016/j.lpm.2017.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/11/2017] [Accepted: 06/21/2017] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Heroin use can be responsible for many respiratory complications including asthma. OBJECTIVES Systematic literature review of data on asthma in heroin users. DOCUMENTARY SOURCES Medline®, on the period 1980-2017 with the following keywords: keywords: "asthma" or "bronchospasm" and "heroin" or "opiate" or "opiates", limits "title/abstract"; the selected languages were English or French. Among 97 articles, 67 abstracts have given use to a dual reading to select 23 studies. RESULTS The seven case reports included 21 patients (mean age: 28 years [19-46 years]; sex-ratio: 2.5 [males: 71.5%]). Heroin was inhaled (71.4%), sniffed (19%) or injected by intravenous route (9.5%). Associated addictive substances were tobacco (81%), cannabis (38%), alcohol (4.7%) and cocaine (4.7%). Outcome was fatal in 3 subjects (14.3%). Other studies included one cross-sectional study, 3 case-control studies and 12 longitudinal studies (11 retrospective studies and one prospective study). The proportion of heroin users was higher in asthmatic subjects and the prevalence of asthma and bronchial hyperreactivity was higher in heroin users. Heroin use can be responsible for asthma onset, with a temporal relationship between the onset of heroin use and asthma onset in 28 to 31% of subjects. A positive association between inhaled heroin use and acute asthma exacerbation was observed. Asthma treatment observance was lower in heroin users. In case of asthma exacerbation, heroin users were more likely to seek care in the emergency department, to be admitted in intensive care units and to require intubation and invasive ventilation. Asthma deaths related to heroin use mainly occurred following an intravenous injection (especially in the case of overdose), but also following heroin use by nasal (sniff) or pulmonary route. CONCLUSION Heroin use may be responsible for asthma onset, acute asthma exacerbations (which may require intubation and invasive ventilation) or deaths related to asthma. Heroin use must be sought in case of asthma exacerbation in young persons and practitioners must help heroin users to stop their consumption.
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Affiliation(s)
- Michel Underner
- Université de Poitiers, unité de recherche clinique Pierre-Deniker, centre hospitalier Henri-Laborit, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France.
| | - Jean Perriot
- Centre de tabacologie, dispensaire Émile-Roux, 63100 Clermont-Ferrand, France
| | - Gérard Peiffer
- CHR Metz-Thionville, service de pneumologie, 57038 Metz, France
| | - Nematollah Jaafari
- Université de Poitiers, unité de recherche clinique Pierre-Deniker, centre hospitalier Henri-Laborit, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France
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Effect of cannabis smoking on lung function and respiratory symptoms: a structured literature review. NPJ Prim Care Respir Med 2016; 26:16071. [PMID: 27763599 PMCID: PMC5072387 DOI: 10.1038/npjpcrm.2016.71] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 06/30/2016] [Accepted: 08/21/2016] [Indexed: 11/09/2022] Open
Abstract
As cannabis use increases, physicians need to be familiar with the effects of both cannabis and tobacco on the lungs. However, there have been very few long-term studies of cannabis smoking, mostly due to legality issues and the confounding effects of tobacco. It was previously thought that cannabis and tobacco had similar long-term effects as both cause chronic bronchitis. However, recent large studies have shown that, instead of reducing forced expiratory volume in 1 s and forced vital capacity (FVC), marijuana smoking is associated with increased FVC. The cause of this is unclear, but acute bronchodilator and anti-inflammatory effects of cannabis may be relevant. Bullous lung disease, barotrauma and cannabis smoking have been recognised in case reports and small series. More work is needed to address the effects of cannabis on lung function, imaging and histological changes.
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Papatheodorou SI, Buettner H, Rice MB, Mittleman MA. Recent Marijuana Use and Associations With Exhaled Nitric Oxide and Pulmonary Function in Adults in the United States. Chest 2016; 149:1428-35. [PMID: 26836917 DOI: 10.1016/j.chest.2015.12.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 11/30/2015] [Accepted: 12/30/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The medical and recreational use of marijuana is now legal in some parts of the United States; the health effects are unknown. We aimed to evaluate associations between recent marijuana use and exhaled nitric oxide (eNO) and pulmonary function. METHODS We performed a cross-sectional study of 10,327 US adults participating in the National Health and Nutrition Examination Survey in the years 2007 to 2012. We examined associations between marijuana use and eNO, FEV1, FVC, the FEV1/FVC ratio, and forced expiratory flow (midexpiratory phase) (FEF25%-75%) by weighted linear regression. RESULTS In the study population, there were 4,797 never users, 4,084 past marijuana users, 555 participants who used marijuana 5 to 30 days before the examination, and 891 participants who used marijuana 0 to 4 days before the examination. Current marijuana use in the past 4 days was associated with 13% lower eNO (95% CI, -18% to 8%). FVC was higher in past users (75 mL; 95% CI, 38-112) and current users in the past 5 to 30 days (159 mL; 95% CI, 80-237) and in users within 0 to 4 days of the examination (204 mL; 95% CI, 139-270) compared with never users. All associations remained unchanged and statistically significant in sensitivity analyses excluding current and past tobacco users. CONCLUSIONS Current marijuana use was associated with lower levels of eNO and higher FVC. The lower eNO in marijuana smokers suggests that short-term exposure to marijuana may, like tobacco, acutely affect the pulmonary vascular endothelium and impair airflow through the small airways.
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Affiliation(s)
- Stefania I Papatheodorou
- Cyprus International Institute for Environmental and Public Health in association with the Harvard T. H. Chan School of Public Health, Limassol, Cyprus.
| | | | - Mary B Rice
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA; Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Murray A Mittleman
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA
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Tashkin DP. How beneficial is vaping cannabis to respiratory health compared to smoking? Addiction 2015; 110:1706-7. [PMID: 26471152 DOI: 10.1111/add.13075] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 07/17/2015] [Indexed: 11/28/2022]
Abstract
While vaping cannabis reduces respiratory exposure to toxic particulates in cannabis smoke, the resultant reduction in clinically evident harms to lung health is probably smaller than that likely to result from substituting e-cigarettes for smoked tobacco due to the comparatively greater harms of tobacco than cannabis smoking to lung health.
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Kaar SJ, Gao CX, Lloyd B, Smith K, Lubman DI. Trends in cannabis-related ambulance presentations from 2000 to 2013 in Melbourne, Australia. Drug Alcohol Depend 2015; 155:24-30. [PMID: 26361711 DOI: 10.1016/j.drugalcdep.2015.08.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/28/2015] [Accepted: 08/25/2015] [Indexed: 01/14/2023]
Abstract
AIMS The current burden of cannabis-related presentations to emergency health services is largely unknown. This paper presents data collected over a 13-year period in metropolitan Melbourne, Australia as part of the Ambo Project, a unique surveillance system that analyses and codes paramedic records for drug-related trends and harms. METHODS Cannabis-related ambulance attendances involving 15-59 year olds in metropolitan Melbourne were analysed retrospectively from 2000 to 2013 (n=10,531). Trends and attendance characteristics were compared among cannabis only (CO)-, cannabis and alcohol (CA)- and cannabis with polydrug use (CP)-related attendances. Changes in alcohol and drug involvements in cannabis-related attendances were explored. RESULTS Rates of cannabis-related ambulance attendances increased significantly over the study period. Increasing rate of attendances per 100,000 population per year changed from 0.6 (2000-2010) to 5.5 (2010-2013). This sharp change was driven by CO- and CP-related attendances (rate of CA-related attendance increased steadily). The highest increasing rate (15.6) was for CO-related attendances among 15-29 years old males (2010-2013). Crystal methamphetamine became the most common illicit co-intoxicant amongst cannabis presentations in 2013. CONCLUSIONS Relative to the total drug-related burden on ambulance services, cannabis-related presentations appear to be a small but significant and increasing problem. Significant changes in trends across other drug involvement and demographic subgroups suggest a possible shift in the cannabis using population and/or a change in using behaviours. Public health strategies should raise awareness of the increased risk posed by cannabis polydrug use and high attendance subpopulations should be determined.
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Affiliation(s)
- Stephen J Kaar
- Turning Point, Eastern Health, 54-62 Gertrude Street, Fitzroy, Vic 3065, Australia; South London and Maudsley NHS Trust, Addictions Clinical Academic Group, Lorraine Hewitt House, 12-14 Brighton Terrace, Brixton, London SW9 8DG, United Kingdom
| | - Caroline X Gao
- Turning Point, Eastern Health, 54-62 Gertrude Street, Fitzroy, Vic 3065, Australia; Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, Vic 3128, Australia
| | - Belinda Lloyd
- Turning Point, Eastern Health, 54-62 Gertrude Street, Fitzroy, Vic 3065, Australia; Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, Vic 3128, Australia
| | - Karen Smith
- Ambulance Victoria, PO Box 2000, Doncaster, Vic 3108, Australia; Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Vic 3004, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, 54-62 Gertrude Street, Fitzroy, Vic 3065, Australia; Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, Vic 3128, Australia.
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Baron EP. Comprehensive Review of Medicinal Marijuana, Cannabinoids, and Therapeutic Implications in Medicine and Headache: What a Long Strange Trip It's Been …. Headache 2015; 55:885-916. [PMID: 26015168 DOI: 10.1111/head.12570] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of cannabis, or marijuana, for medicinal purposes is deeply rooted though history, dating back to ancient times. It once held a prominent position in the history of medicine, recommended by many eminent physicians for numerous diseases, particularly headache and migraine. Through the decades, this plant has taken a fascinating journey from a legal and frequently prescribed status to illegal, driven by political and social factors rather than by science. However, with an abundance of growing support for its multitude of medicinal uses, the misguided stigma of cannabis is fading, and there has been a dramatic push for legalizing medicinal cannabis and research. Almost half of the United States has now legalized medicinal cannabis, several states have legalized recreational use, and others have legalized cannabidiol-only use, which is one of many therapeutic cannabinoids extracted from cannabis. Physicians need to be educated on the history, pharmacology, clinical indications, and proper clinical use of cannabis, as patients will inevitably inquire about it for many diseases, including chronic pain and headache disorders for which there is some intriguing supportive evidence. OBJECTIVE To review the history of medicinal cannabis use, discuss the pharmacology and physiology of the endocannabinoid system and cannabis-derived cannabinoids, perform a comprehensive literature review of the clinical uses of medicinal cannabis and cannabinoids with a focus on migraine and other headache disorders, and outline general clinical practice guidelines. CONCLUSION The literature suggests that the medicinal use of cannabis may have a therapeutic role for a multitude of diseases, particularly chronic pain disorders including headache. Supporting literature suggests a role for medicinal cannabis and cannabinoids in several types of headache disorders including migraine and cluster headache, although it is primarily limited to case based, anecdotal, or laboratory-based scientific research. Cannabis contains an extensive number of pharmacological and biochemical compounds, of which only a minority are understood, so many potential therapeutic uses likely remain undiscovered. Cannabinoids appear to modulate and interact at many pathways inherent to migraine, triptan mechanisms ofaction, and opiate pathways, suggesting potential synergistic or similar benefits. Modulation of the endocannabinoid system through agonism or antagonism of its receptors, targeting its metabolic pathways, or combining cannabinoids with other analgesics for synergistic effects, may provide the foundation for many new classes of medications. Despite the limited evidence and research suggesting a role for cannabis and cannabinoids in some headache disorders, randomized clinical trials are lacking and necessary for confirmation and further evaluation.
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Affiliation(s)
- Eric P Baron
- Department of Neurology, Headache Center, Cleveland Clinic Neurological Institute, Cleveland, OH, USA
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Hancox RJ, Shin HH, Gray AR, Poulton R, Sears MR. Effects of quitting cannabis on respiratory symptoms. Eur Respir J 2015; 46:80-7. [PMID: 25837035 DOI: 10.1183/09031936.00228914] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 02/20/2015] [Indexed: 11/05/2022]
Abstract
Smoking cannabis is associated with symptoms of bronchitis. Little is known about the persistence of symptoms after stopping cannabis use. We assessed associations between changes in cannabis use and respiratory symptoms in a population-based cohort of 1037 young adults. Participants were asked about cannabis and tobacco use at ages 18, 21, 26, 32 and 38 years. Symptoms of morning cough, sputum production, wheeze, dyspnoea on exertion and asthma diagnoses were ascertained at the same ages. Frequent cannabis use was defined as ≥52 occasions over the previous year. Associations between frequent cannabis use and respiratory symptoms were analysed using generalised estimating equations with adjustments for tobacco smoking, asthma, sex and age. Frequent cannabis use was associated with morning cough (OR 1.97, p<0.001), sputum production (OR 2.31, p<0.001) and wheeze (OR 1.55, p<0.001). Reducing or quitting cannabis use was associated with reductions in the prevalence of cough, sputum and wheeze to levels similar to nonusers.Frequent cannabis use is associated with symptoms of bronchitis in young adults. Reducing cannabis use often leads to a resolution of these symptoms.
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Affiliation(s)
- Robert J Hancox
- Dept of Preventive and Social Medicine, Dunedin School of Medicine, Dunedin, New Zealand
| | - Hayden H Shin
- Dept of Preventive and Social Medicine, Dunedin School of Medicine, Dunedin, New Zealand
| | - Andrew R Gray
- Dept of Preventive and Social Medicine, Dunedin School of Medicine, Dunedin, New Zealand
| | - Richie Poulton
- Dept of Psychology, University of Otago, Dunedin, New Zealand
| | - Malcolm R Sears
- Firestone Institute for Respiratory Health, Michael de Groote School of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, ON, Canada
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Macleod J, Robertson R, Copeland L, McKenzie J, Elton R, Reid P. Cannabis, tobacco smoking, and lung function: a cross-sectional observational study in a general practice population. Br J Gen Pract 2015; 65:e89-95. [PMID: 25624312 PMCID: PMC4325450 DOI: 10.3399/bjgp15x683521] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/26/2014] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Health concerns around cannabis use have focused on the potential relationship with psychosis but the effect of cannabis smoking on respiratory health has received less attention. AIM To investigate the association between tobacco-only smoking compared with tobacco plus cannabis smoking and adverse outcomes in respiratory health and lung function. DESIGN AND SETTING The design was cross-sectional with two groups recruited: cigarette smokers with tobacco pack-years; cannabis smokers with cannabis joint-years. Recruitment occurred in a general practice in Scotland with 12 500 patients. METHOD Exposures measured were tobacco smoking (pack-years) and cannabis smoking (joint-years). Cannabis type (resin, herbal, or both) was recorded by self-report. Respiratory symptoms were recorded using NHANES and MRC questionnaires. Lung function was measured by spirometry (FEV1/FVC ratio). RESULTS Participants consisted of 500 individuals (242 males). Mean age of tobacco-only smokers was 45 years; median tobacco exposure was 25 pack-years. Mean age of cannabis and tobacco smokers was 37 years; median tobacco exposure was 19 pack-years, rising to 22.5 when tobacco smoked with cannabis. Although tobacco and cannabis use were associated with increased reporting of respiratory symptoms, this was higher among those who also smoked cannabis. Both tobacco and cannabis users had evidence of impaired lung function but, in fully adjusted analyses, each additional joint-year of cannabis use was associated with a 0.3% (95% confidence interval = 0.0 to 0.5) increase in prevalence of chronic obstructive pulmonary disease. CONCLUSION In adults who predominantly smoked resin cannabis mixed with tobacco, additional adverse effects were observed on respiratory health relating to cannabis use.
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Affiliation(s)
- John Macleod
- School of Social and Community Medicine, University of Bristol, Bristol
| | | | | | | | - Rob Elton
- University of Edinburgh, Centre for Population Health Sciences, Edinburgh
| | - Peter Reid
- Respiratory Unit, Western General Hospital, Edinburgh
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Abstract
Marijuana is the most commonly used drug of abuse in the USA. It is commonly abused through inhalation and therefore has effects on the lung that are similar to tobacco smoke, including increased cough, sputum production, hyperinflation, and upper lobe emphysematous changes. However, at this time, it does not appear that marijuana smoke contributes to the development of chronic obstructive pulmonary disease. Marijuana can have multiple physiologic effects such as tachycardia, peripheral vasodilatation, behavioral and emotional changes, and possible prolonged cognitive impairment. The carcinogenic effects of marijuana are unclear at this time. Studies are mixed on the ability of marijuana smoke to increase the risk for head and neck squamous cell carcinoma, lung cancer, prostate cancer, and cervical cancer. Some studies show that marijuana is protective for development of malignancy. Marijuana smoke has been shown to have an inhibitory effect on the immune system. Components of cannabis are under investigation as treatment for autoimmune diseases and malignancy. As marijuana becomes legalized in many states for medical and recreational use, other forms of tetrahydrocannabinol (THC) have been developed, such as food products and beverages. As most research on marijuana at this time has been on whole marijuana smoke, rather than THC, it is difficult to determine if the currently available data is applicable to these newer products.
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Gates P, Jaffe A, Copeland J. Cannabis smoking and respiratory health: consideration of the literature. Respirology 2014; 19:655-62. [PMID: 24831571 DOI: 10.1111/resp.12298] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/16/2014] [Accepted: 03/17/2014] [Indexed: 12/20/2022]
Abstract
The respiratory health effects from tobacco smoking are well described. Cannabis smoke contains a similar profile of carcinogenic chemicals as tobacco smoke but is inhaled more deeply. Although cannabis smoke is known to contain similar harmful and carcinogenic substances to tobacco smoke, relatively little is understood regarding the respiratory health effects from cannabis smoking. There is a need to integrate research on cannabis and respiratory health effects so that gaps in the literature can be identified and the more consistent findings can be consolidated with the purpose of educating smokers and health service providers. This review focuses on several aspects of respiratory health and cannabis use (as well as concurrent cannabis and tobacco use) and provides an update to (i) the pathophysiology; (ii) general respiratory health including symptoms of chronic bronchitis; and (iii) lung cancer.
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Affiliation(s)
- Peter Gates
- National Cannabis Prevention and Information Centre, University of New South Wales Medicine, Sydney, New South Wales, Australia
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Kong G, Singh N, Camenga D, Cavallo D, Krishnan-Sarin S. Menthol cigarette and marijuana use among adolescents. Nicotine Tob Res 2013; 15:2094-9. [PMID: 23884319 DOI: 10.1093/ntr/ntt102] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Menthol cigarette and marijuana use among adolescents is high; however, little is known about dual use in this age. Thus, we examined these rates among 2 samples of adolescents in Connecticut. METHODS Study 1 examined a school-wide survey assessing variables related to cigarettes and marijuana among high school students (N = 837 [13% smokers]), and Study 2 examined these factors using baseline data of high school-aged, treatment-seeking, daily cigarette smokers prior to quitting (N = 132). RESULTS In Study 1, lifetime marijuana use among all adolescents was 33% and past 30-day marijuana use was 21%. Among cigarette smokers, 55% reported smoking menthol cigarettes, 84% reported lifetime marijuana use, and 66% reported past 30-day marijuana use. Multivariate-adjusted logistic regression models indicated that cigarette smokers, when compared with nonsmokers, had greater rates of lifetime (odds ratio [OR] = 10.91) and past 30-day marijuana use (OR = 10.44). Among smokers, use of menthol cigarettes, when compared with use of nonmenthol cigarettes, was associated with greater lifetime (OR = 5.05) but not past 30-day marijuana use. In Study 2 with daily smokers, 59% of adolescents reported use of menthol cigarettes and 66% reported past 30-day marijuana use. Compared with nonmenthol cigarette smokers, menthol cigarette smokers were more likely to report past 30-day marijuana use (OR = 2.44). CONCLUSIONS Cigarette smoking is associated with marijuana use, and among smokers, menthol cigarette smoking further increased the odds of marijuana use. More research on the dual use of marijuana and tobacco is needed to inform prevention and treatment of substance use.
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Affiliation(s)
- Grace Kong
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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[Cannabis use and impairment of respiratory function]. Rev Mal Respir 2013; 30:272-85. [PMID: 23664286 DOI: 10.1016/j.rmr.2013.01.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 01/26/2013] [Indexed: 02/08/2023]
Abstract
Cannabis is the most commonly smoked illicit substance in many countries including France. It can be smoked alone in plant form (marijuana) but in our country it is mainly smoked in the form of cannabis resin mixed with tobacco. The technique of inhaling cannabis differs from that of tobacco, increasing the time that the smoke spends in contact with the bronchial mucosal and its impact on respiratory function. One cigarette composed of cannabis and tobacco is much more harmful than a cigarette containing only tobacco. In cannabis smokers there is an increased incidence of respiratory symptoms and episodes of acute bronchitis. Cannabis produces a rapid bronchodilator effect; chronic use provokes a reduction in specific conductance and increase in airways resistance. Studies on the decline of Forced Expiratory Volume are discordant. Cannabis smoke and tetrahydrocannabinol irritate the bronchial tree. They bring about histological signs of airways inflammation and alter the fungicidal and antibacterial activity of alveolar macrophages. Inhalation of cannabis smoke is a risk factor for lung cancer. Stopping smoking cannabis will bring about important benefits for lung function. This should encourage clinicians to offer patients support in quitting smoking.
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Muetzel RL, Marjańska M, Collins PF, Becker MP, Valabrègue R, Auerbach EJ, Lim KO, Luciana M. In vivo 1H magnetic resonance spectroscopy in young-adult daily marijuana users. NEUROIMAGE-CLINICAL 2013; 2:581-589. [PMID: 23956957 PMCID: PMC3743264 DOI: 10.1016/j.nicl.2013.04.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To date, there has been little work describing the neurochemical profile of young, heavy marijuana users. In this study, we examined 27 young-adult marijuana users and 26 healthy controls using single-voxel magnetic resonance spectroscopy on a 3 T scanner. The voxel was placed in the dorsal striatum, and estimated concentrations of glutamate + glutamine, myo-inositol, taurine + glucose, total choline and total N-acetylaspartate were examined between groups. There were no overall group effects, but two metabolites showed group by sex interactions. Lower levels of glutamate + glutamine (scaled to total creatine) were observed in female, but not male, marijuana users compared to controls. Higher levels of myo-inositol were observed in female users compared to female non-users and to males in both groups. Findings are discussed in relation to patterns of corticostriatal connectivity and function, in the context of marijuana abuse. The neurochemical profile of the basal ganglia was examined in young marijuana users. Glutamate/glutamine levels were lower in female users versus male users and controls. Higher myo-inositol levels were observed in female users as compared to other groups. Neurochemical impacts of marijuana may be particularly pronounced in females.
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Affiliation(s)
- Ryan L Muetzel
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
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Abstract
AIMS Cannabis and tobacco use and misuse frequently co-occur. This review examines the epidemiological evidence supporting the life-time co-occurrence of cannabis and tobacco use and outlines the mechanisms that link these drugs to each other. Mechanisms include (i) shared genetic factors; (ii) shared environmental influences, including (iii) route of administration (via smoking), (iv) co-administration and (v) models of co-use. We also discuss respiratory harms associated with co-use of cannabis and tobacco, overlapping withdrawal syndromes and outline treatment implications for co-occurring use. METHODS Selective review of published studies. RESULTS Both cannabis and tobacco use and misuse are influenced by genetic factors, and a proportion of these genetic factors influence both cannabis and tobacco use and misuse. Environmental factors such as availability play an important role, with economic models suggesting a complementary relationship where increases in price of one drug decrease the use of the other. Route of administration and smoking cues may contribute to their sustained use. Similar withdrawal syndromes, with many symptoms in common, may have important treatment implications. Emerging evidence suggests that dual abstinence may predict better cessation outcomes, yet empirically researched treatments tailored for co-occurring use are lacking. CONCLUSIONS There is accumulating evidence that some mechanisms linking cannabis and tobacco use are distinct from those contributing to co-occurring use of drugs in general. There is an urgent need for research to identify the underlying mechanisms and harness their potential etiological implications to tailor treatment options for this serious public health challenge.
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Affiliation(s)
- Arpana Agrawal
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid, St Louis, MO 63110, USA.
| | - Alan J. Budney
- University of Arkansas for Medical Sciences, Dept. of Psychiatry, 4301 West Markham Street, Slot 843, Little Rock, AK 72205
| | - Michael T. Lynskey
- Washington University School of Medicine, Dept. of Psychiatry, 660 S. Euclid, CB 8134, Saint Louis. MO 63110
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Pletcher MJ, Vittinghoff E, Kalhan R, Richman J, Safford M, Sidney S, Lin F, Kertesz S. Association between marijuana exposure and pulmonary function over 20 years. JAMA 2012; 307:173-81. [PMID: 22235088 PMCID: PMC3840897 DOI: 10.1001/jama.2011.1961] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT Marijuana smoke contains many of the same constituents as tobacco smoke, but whether it has similar adverse effects on pulmonary function is unclear. OBJECTIVE To analyze associations between marijuana (both current and lifetime exposure) and pulmonary function. DESIGN, SETTING, AND PARTICIPANTS The Coronary Artery Risk Development in Young Adults (CARDIA) study, a longitudinal study collecting repeated measurements of pulmonary function and smoking over 20 years (March 26, 1985-August 19, 2006) in a cohort of 5115 men and women in 4 US cities. Mixed linear modeling was used to account for individual age-based trajectories of pulmonary function and other covariates including tobacco use, which was analyzed in parallel as a positive control. Lifetime exposure to marijuana joints was expressed in joint-years, with 1 joint-year of exposure equivalent to smoking 365 joints or filled pipe bowls. MAIN OUTCOME MEASURES Forced expiratory volume in the first second of expiration (FEV(1)) and forced vital capacity (FVC). RESULTS Marijuana exposure was nearly as common as tobacco exposure but was mostly light (median, 2-3 episodes per month). Tobacco exposure, both current and lifetime, was linearly associated with lower FEV(1) and FVC. In contrast, the association between marijuana exposure and pulmonary function was nonlinear (P < .001): at low levels of exposure, FEV(1) increased by 13 mL/joint-year (95% CI, 6.4 to 20; P < .001) and FVC by 20 mL/joint-year (95% CI, 12 to 27; P < .001), but at higher levels of exposure, these associations leveled or even reversed. The slope for FEV(1) was -2.2 mL/joint-year (95% CI, -4.6 to 0.3; P = .08) at more than 10 joint-years and -3.2 mL per marijuana smoking episode/mo (95% CI, -5.8 to -0.6; P = .02) at more than 20 episodes/mo. With very heavy marijuana use, the net association with FEV(1) was not significantly different from baseline, and the net association with FVC remained significantly greater than baseline (eg, at 20 joint-years, 76 mL [95% CI, 34 to 117]; P < .001). CONCLUSION Occasional and low cumulative marijuana use was not associated with adverse effects on pulmonary function.
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Affiliation(s)
- Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 185 Berry St, Ste 5700, San Francisco, CA 94107, USA.
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The impact of comorbid cannabis use disorders on the clinical presentation of social anxiety disorder. J Psychiatr Res 2012; 46:50-6. [PMID: 22047609 DOI: 10.1016/j.jpsychires.2011.09.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 09/12/2011] [Accepted: 09/29/2011] [Indexed: 01/04/2023]
Abstract
Previous research has examined the relationship between social anxiety disorder (SAD) and substance use disorders. Cannabis use disorders (CUDs) are becoming increasingly problematic within the population of individuals with SAD, yet the nature of this comorbidity remains largely unexamined. The aim of the current study from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to examine differences between outpatients with SAD with versus without comorbid CUDs. The current study included 873 outpatients with a current diagnosis of SAD. Patients with SAD and comorbid CUDs (n = 173) were then compared to those with SAD without CUDs (n = 700) on demographic and clinical characteristics. Compared to patients without the comorbidity, patients with comorbid SAD and CUDs were more likely to have a lifetime diagnosis of PTSD and specific phobia and lifetime substance use disorders (including alcohol). SAD patients with comorbid CUDs were also more likely to report better physical health, and fewer limitations related to their physical health. These analyses remained significant after controlling for gender, the presence of other substance use disorders, mood disorders, and other anxiety disorders. Findings of this study suggest that there may be a unique relationship between SAD and CUDs that can potentially impact the clinical presentation of individuals with SAD. Future research is needed to examine the impact of this comorbidity in other patient populations.
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Lee MHS, Hancox RJ. Effects of smoking cannabis on lung function. Expert Rev Respir Med 2011; 5:537-46; quiz 547. [PMID: 21859273 DOI: 10.1586/ers.11.40] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although cannabis (or marijuana) is the world's most widely-used illicit drug, there has been surprisingly little research into its effects on respiratory health. Part of the problem is the inherent difficulty of studying the long-term effects of an illegal habit. It has often been assumed that smoking cannabis will have similar long-term effects to smoking tobacco. Several recent observational studies suggest that this is not the case and that cannabis has quite different effects on the lung function. There are consistent findings that smoking cannabis is associated with large airway inflammation, symptoms of bronchitis, increased airway resistance and lung hyperinflation. The evidence that smoking cannabis leads to features of chronic obstructive pulmonary disease, such as airflow obstruction and emphysema is not convincing. However, there are numerous case reports of bullous emphysema among cannabis smokers. These findings have not been confirmed in systematic analytical studies and probably represent uncommon adverse effects in very heavy cannabis smokers. There is now additional controversial evidence that cannabis is at least an occasional cause of respiratory malignancies, but again the evidence is inconclusive.
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Affiliation(s)
- Marcus H S Lee
- Department of Respiratory Medicine, Waikato Hospital, Pembroke St, Hamilton, New Zealand
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Abstract
Marijuana is the most commonly used illicit drug around the world. It is most often consumed through smoking, placing the respiratory system in direct contact with the toxic constituents of the drug, which are similar to those of tobacco cigarettes. However, accurate study of the adverse effects of marijuana is difficult to perform, owing to marijuana's illegal status, variation in smoking technique, often short duration of use compared with tobacco and the frequently confounding factor of concomitant consumption of both marijuana and tobacco. Despite this, there is evidence to suggest that marijuana can impair lung function, damage large airway mucosa and possibly contribute to bullous disease, while its carcinogenic potential is controversial.
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Affiliation(s)
- Megan L Howden
- Alfred Hospital and Monash University, Prahran 3181, Australia
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Marijuana craving during a public speaking challenge: Understanding marijuana use vulnerability among women and those with social anxiety disorder. J Behav Ther Exp Psychiatry 2011; 42:104-10. [PMID: 20797696 PMCID: PMC2981668 DOI: 10.1016/j.jbtep.2010.07.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 05/28/2010] [Accepted: 07/27/2010] [Indexed: 11/22/2022]
Abstract
Social anxiety disorder (SAD) is associated with risk for developing marijuana dependence, yet it remains unclear whether urge to use marijuana increases in anticipation of social anxiety-provoking situation, during the situation, or afterwards (to avoid post-event processing). The present study examined the timing of marijuana craving in response to a social anxiety task among 60 (50% female; 33% with SAD) marijuana users randomly assigned to either a speech or reading task. Participants completed ratings of marijuana craving at baseline (prior to being informed of task assignment), before, during, and after task. Among women and participants with SAD, the speech task was associated with greater craving than the reading task. This effect was particularly pronounced during the social anxiety induction task. This effect was not observed for men or participants without SAD. Identification of timing of urge to use marijuana has important implications for treatment and relapse prevention of marijuana problems among women and people with SAD (a group at particular risk for marijuana-related problems).
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Bottorff JL, Bissell LJL, Balneaves LG, Oliffe JL, Kang HBK, Capler NR, Buxton JA, O'Brien RK. Health effects of using cannabis for therapeutic purposes: a gender analysis of users' perspectives. Subst Use Misuse 2011; 46:769-80. [PMID: 21138343 DOI: 10.3109/10826084.2010.537732] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this qualitative study was to describe how individuals who self-report therapeutic use of cannabis perceive its health effects. Data from 23 individual interviews were transcribed and analyzed. Understandings of gendered roles and identities were used to explore the data and interpret differences in perceptions. Descriptions of the health benefits of cannabis for therapeutic purposes included cannabis as life preserving, a disease therapy, a medicine for the mind, a means for self-management, and a way to manage addiction. Self-management of risks focused on the potential effects of excessive use, smoking-related risks, and purchasing precautions. Although the reports of women and men were similar in many respects, there were important differences in patterns and practices of use that reflected gender influences. Insights from the study provide direction for developing gender-specific information to support decision making and usage for therapeutic users.
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Affiliation(s)
- Joan L Bottorff
- Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada.
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43
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Tashkin DP. Does smoking marijuana increase the risk of chronic obstructive pulmonary disease? CMAJ 2009; 180:797-8. [PMID: 19364782 DOI: 10.1503/cmaj.090142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Donald P Tashkin
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, USA.
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Tan WC, Lo C, Jong A, Xing L, Fitzgerald MJ, Vollmer WM, Buist SA, Sin DD. Marijuana and chronic obstructive lung disease: a population-based study. CMAJ 2009; 180:814-20. [PMID: 19364790 DOI: 10.1503/cmaj.081040] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Our aim was to determine the combined and independent effects of tobacco and marijuana smoking on respiratory symptoms and chronic obstructive pulmonary disease (COPD) in the general population. METHOD We surveyed a random sample of 878 people aged 40 years or older living in Vancouver, Canada, about their respiratory history and their history of tobacco and marijuana smoking. We performed spirometric testing before and after administration of 200 microg of salbutamol. We examined the association between tobacco and marijuana smoking and COPD. RESULTS The prevalence of a history of smoking in this sample was 45.5% (95% confidence interval [CI] 42.2%-48.8%) for marijuana use and 53.1% (95% CI 49.8%-56.4%) for tobacco use. The prevalence of current smoking (in the past 12 months) was 14% for marijuana use and 14% for tobacco use. Compared with nonsmokers, participants who reported smoking only tobacco, but not those who reported smoking only marijuana, experienced more frequent respiratory symptoms (odds ratio [OR] 1.50, 95% CI 1.05-2.14) and were more likely to have COPD (OR 2.74, 95% CI 1.66-4.52). Concurrent use of marijuana and tobacco was associated with increased risk (adjusted for age, asthma and comorbidities) of respiratory symptoms (OR 2.39, 95% CI 1.58-3.62) and COPD (OR 2.90, 95% CI 1.53-5.51) if the lifetime dose of marijuana exceeded 50 marijuana cigarettes. The risks of respiratory symptoms and of COPD were related to a synergistic interaction between marijuana and tobacco. INTERPRETATION Smoking both tobacco and marijuana synergistically increased the risk of respiratory symptoms and COPD. Smoking only marijuana was not associated with an increased risk of respiratory symptoms or COPD.
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Affiliation(s)
- Wan C Tan
- iCapture Centre for Cardiovascular and Pulmonary Research, St. Paul's Hospital and the University of British Columbia, Vancouver, Canada.
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Buckner JD, Schmidt NB. Social anxiety disorder and marijuana use problems: the mediating role of marijuana effect expectancies. Depress Anxiety 2009; 26:864-70. [PMID: 19373871 PMCID: PMC2773507 DOI: 10.1002/da.20567] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Individuals with social anxiety disorder (SAD) appear particularly vulnerable to marijuana-related problems. Yet, mechanisms underlying this association are unclear. METHODS This study examined the role of marijuana effect expectancies in the relation between SAD and marijuana problems among 107 marijuana users (43.0% female), 26.2% of whom met Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition criteria for SAD. Anxiety and mood disorders were determined during clinical interviews using the Anxiety Disorders Interview Schedule-IV-L (ADIS-IV). RESULTS Analyses (including sex, marijuana use frequency, major depressive disorder, and other anxiety disorders) suggest that SAD was the only disorder significantly associated with past 3-month marijuana problems. Compared to those without SAD, individuals with SAD were more likely to endorse the following marijuana expectancies: cognitive/behavioral impairment and global negative expectancies. Importantly, these expectancies mediated the relations between SAD status and marijuana problems. CONCLUSIONS These data support the contention that SAD is uniquely related to marijuana problems and provide insight into mechanisms underlying this vulnerability.
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Affiliation(s)
- Julia D. Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, Los Angeles,Correspondence to: Julia D. Buckner, Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, USA.
| | - Norman B. Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida
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Buckner JD, Schmidt NB, Lang AR, Small JW, Schlauch RC, Lewinsohn PM. Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence. J Psychiatr Res 2008; 42:230-9. [PMID: 17320907 PMCID: PMC2254175 DOI: 10.1016/j.jpsychires.2007.01.002] [Citation(s) in RCA: 328] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Revised: 01/03/2007] [Accepted: 01/05/2007] [Indexed: 11/24/2022]
Abstract
Social anxiety disorder (SAD) is highly comorbid with alcohol use disorders (AUDs) and cannabis dependence. However, the temporal sequencing of these disorders has not been extensively studied to determine whether SAD serves as a specific risk factor for problematic substance use. The present study examined these relationships after controlling for theoretically-relevant variables (e.g., gender, other Axis I pathology) in a longitudinal cohort over approximately 14 years. The sample was drawn from participants in the Oregon Adolescent Depression Project. After excluding those with substance use disorders at baseline, SAD at study entry was associated with 6.5 greater odds of cannabis dependence (but not abuse) and 4.5 greater odds of alcohol dependence (but not abuse) at follow-up after controlling for relevant variables (e.g., gender, depression, conduct disorder). The relationship between SAD and alcohol and cannabis dependence remained even after controlling for other anxiety disorders. Other anxiety disorders and mood disorders were not associated with subsequent cannabis or alcohol use disorder after controlling for relevant variables. Among the internalizing disorders, SAD appears to serve as a unique risk factor for the subsequent onset of cannabis and alcohol dependence.
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Affiliation(s)
- Julia D Buckner
- Department of Psychology, Florida State University, Tallahassee, FL 32306-1270, USA
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48
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Aldington S, Williams M, Nowitz M, Weatherall M, Pritchard A, McNaughton A, Robinson G, Beasley R. Effects of cannabis on pulmonary structure, function and symptoms. Thorax 2007; 62:1058-63. [PMID: 17666437 PMCID: PMC2094297 DOI: 10.1136/thx.2006.077081] [Citation(s) in RCA: 192] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cannabis is the most widely used illegal drug worldwide. Long-term use of cannabis is known to cause chronic bronchitis and airflow obstruction, but the prevalence of macroscopic emphysema, the dose-response relationship and the dose equivalence of cannabis with tobacco has not been determined. METHODS A convenience sample of adults from the Greater Wellington region was recruited into four smoking groups: cannabis only, tobacco only, combined cannabis and tobacco and non-smokers of either substance. Their respiratory status was assessed using high-resolution CT (HRCT) scanning, pulmonary function tests and a respiratory and smoking questionnaire. Associations between respiratory status and cannabis use were examined by analysis of covariance and logistic regression. RESULTS 339 subjects were recruited into the four groups. A dose-response relationship was found between cannabis smoking and reduced forced expiratory volume in 1 s to forced vital capacity ratio and specific airways conductance, and increased total lung capacity. For measures of airflow obstruction, one cannabis joint had a similar effect to 2.5-5 tobacco cigarettes. Cannabis smoking was associated with decreased lung density on HRCT scans. Macroscopic emphysema was detected in 1/75 (1.3%), 15/92 (16.3%), 17/91 (18.9%) and 0/81 subjects in the cannabis only, combined cannabis and tobacco, tobacco alone and non-smoking groups, respectively. CONCLUSIONS Smoking cannabis was associated with a dose-related impairment of large airways function resulting in airflow obstruction and hyperinflation. In contrast, cannabis smoking was seldom associated with macroscopic emphysema. The 1:2.5-5 dose equivalence between cannabis joints and tobacco cigarettes for adverse effects on lung function is of major public health significance.
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Affiliation(s)
- Sarah Aldington
- Medical Research Institute of New Zealand, P O Box 10055, Wellington 6143, New Zealand
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Tetrault JM, Crothers K, Moore BA, Mehra R, Concato J, Fiellin DA. Effects of marijuana smoking on pulmonary function and respiratory complications: a systematic review. ACTA ACUST UNITED AC 2007; 167:221-8. [PMID: 17296876 PMCID: PMC2720277 DOI: 10.1001/archinte.167.3.221] [Citation(s) in RCA: 253] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The relationship between marijuana smoking and pulmonary function or respiratory complications is poorly understood; therefore, we conducted a systematic review of the impact of marijuana smoking on pulmonary function and respiratory complications. METHODS Studies that evaluated the effect of marijuana smoking on pulmonary function and respiratory complications were selected from the MEDLINE, PsychINFO, and EMBASE databases according to predefined criteria from January 1, 1966, to October 28, 2005. Two independent reviewers extracted data and evaluated study quality based on established criteria. Study results were critically appraised for clinical applicability and research methods. RESULTS Thirty-four publications met selection criteria. Reports were classified as challenge studies if they examined the association between short-term marijuana use and airway response; other reports were classified as studies of long-term marijuana smoking and pulmonary function or respiratory complications. Eleven of 12 challenge studies found an association between short-term marijuana administration and bronchodilation (eg, increases of 0.15-0.25 L in forced expiratory volume in 1 second). No consistent association was found between long-term marijuana smoking and airflow obstruction measures. All 14 studies that assessed long-term marijuana smoking and respiratory complications noted an association with increased respiratory symptoms, including cough, phlegm, and wheeze (eg, odds ratio, 2.00; 95% confidence interval, 1.32-3.01, for the association between marijuana smoking and cough). Studies were variable in their overall quality (eg, controlling for confounders, including tobacco smoking). CONCLUSIONS Short-term exposure to marijuana is associated with bronchodilation. Physiologic data were inconclusive regarding an association between long-term marijuana smoking and airflow obstruction measures. Long-term marijuana smoking is associated with increased respiratory symptoms suggestive of obstructive lung disease.
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Affiliation(s)
- Jeanette M Tetrault
- Clinical Epidemiology Research Center, Department of Veterans Affairs Connecticut Healthcare System, West Haven Veterans Affairs Medical Center, 950 Campbell Avenue, West Haven, CT 06516, USA.
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Buckner JD, Mallott MA, Schmidt NB, Taylor J. Peer influence and gender differences in problematic cannabis use among individuals with social anxiety. J Anxiety Disord 2007; 20:1087-102. [PMID: 16621436 DOI: 10.1016/j.janxdis.2006.03.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Revised: 01/12/2006] [Accepted: 03/03/2006] [Indexed: 11/16/2022]
Abstract
Despite epidemiological reports indicating that individuals with social anxiety disorder (SAD) are at heightened risk for cannabis use disorders (CUD), there is a dearth of research investigating the mechanisms underlying the nature of this co-occurrence. The present study examined the role of a well-established risk factor for cannabis use, peer influence, on the relationship between symptoms of SAD and CUD in a non-referred sample (N = 123). Lifetime symptoms of SAD and CUD were assessed using a structured diagnostic interview. SAD symptoms were significantly correlated with CUD symptoms and this relationship was moderated by peer use of both alcohol and cannabis. Further, a gender effect indicated that the relationship between symptoms of SAD and CUD occurred only in women. Implications of these novel findings are discussed.
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Affiliation(s)
- Julia D Buckner
- Department of Psychology, Florida State University, Tallahassee, FL 32306, USA
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