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Sanayei AM, Mo C, Ballou S, McHenry N, Rangan V, Singh P, Iturrino J, Lembo A, Nee J. Burden and Treatment of Chronic Upper GI Symptoms and Diagnoses: A Nationwide Study. Clin Gastroenterol Hepatol 2024; 22:1307-1314.e2. [PMID: 38278192 DOI: 10.1016/j.cgh.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/17/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND & AIMS Chronic gastrointestinal (GI) symptoms are a common reason for seeking medical care. We aim to determine the rates of ambulatory care use and to characterize demographics, work-up, and treatment (pharmacologic and nonpharmacologic) for patients with chronic upper GI symptoms and conditions in the United States. METHODS Estimates of annual visits for the most common upper GI symptoms and diagnoses including gastroesophageal reflux disease, dyspepsia, nausea and vomiting, and gastroparesis were recorded from the 2007-2015 National Ambulatory Medical Care Surveys. Only chronic conditions, defined as >3 months, were included. We calculated the weighted proportion of ambulatory visits associated with pharmacologic, nonpharmacologic treatment (eg, diet, complementary and alternative medicine), or both. RESULTS A total of 116,184,475 weighted ambulatory visits were identified between the years of 2007 and 2015 for adults (average of 12,909,386 annual visits) with chronic upper GI symptoms and diagnoses. Gastroesophageal reflux disease was the most common reason for an ambulatory visit (n = 11,200,193), followed by dyspepsia (n = 1,232,598), nausea and vomiting (n = 714,834), and gastroparesis (n = 140,312). Pharmacologic treatment was more common than nonpharmacologic treatment (44.7% vs 28.5%). A total of 37.6% of patients were not receiving treatment at the time of the visit. These treatment patterns did not significantly change over the time of our study. Upper endoscopies were the most ordered test, representing 7.5% of all investigated upper GI symptoms. CONCLUSIONS Chronic upper GI symptoms and diagnoses account for a high number of annual health care visits, both in primary care and specialty care. Although there are several treatments, many of these patients are not on any treatments.
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Affiliation(s)
- Ava M Sanayei
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Chen Mo
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sarah Ballou
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nicole McHenry
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Vikram Rangan
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Prashant Singh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
| | - Johanna Iturrino
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Anthony Lembo
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Judy Nee
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Kilani Y, Aljabiri Y, Arshad I, Alsakarneh S, Aldiabat M, Castro Puello P, Vahanyan A, Vikash F, Kumar V, Numan L, Thor S. Cannabis use and cyclical vomiting syndrome: An open debate. Dig Liver Dis 2024; 56:272-280. [PMID: 37880016 DOI: 10.1016/j.dld.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/06/2023] [Accepted: 10/01/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Cyclical vomiting syndrome (CVS) carries a significant financial burden on the U.S. healthcare system due to the recurrent emergency department visits and inpatient hospitalizations. We aimed to update the literature on the predictors of hospital utilization and readmission among individuals admitted with CVS. METHODS This is a retrospective nationwide study of patients hospitalized with a primary diagnosis of CVS. Using weighted data from the National Inpatient Sample (NIS) and the National Readmission Database (NRD), we conducted a multivariate regression analysis to assess predictors of length of stay (LOS), and 30-day readmission. RESULTS Primary admissions for CVS totaled 35,055 in the NIS, and 31,240 in the NRD. 2012 patients (6.4%) were readmitted within 30 days. On multivariate regression, cannabis use was associated with reduced LOS (adjusted Mean Difference (aMD) = -0.53 days, 95% CI: -0.68 to -0.38), and 30-day readmissions (adjusted Hazard Ratio (aHR) = 0.63, 95% CI: 0.54-0.73). DISCUSSION Cannabis use among CVS admissions was associated with reduced LOS and 30-day readmissions; these results could be in fact driven by Cannabis Hyperemesis Syndrome (CHS)-related hospitalizations and the effect of cannabis cessation on decreased symptomatology. ICD-10 coding for CHS should be transitioned to specific codes to improve the differentiation between CVS and CHS-related hospitalizations.
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Affiliation(s)
- Yassine Kilani
- Department of Medicine, Lincoln Medical Center/Weill Cornell Medical College, New York, USA.
| | - Yazan Aljabiri
- Department of Medicine, Washington University in St. Louis, Saint Louis, USA
| | - Iqra Arshad
- Department of Medicine, Saint Louis University School of Medicine, Saint Louis, USA
| | - Saqr Alsakarneh
- Department of Medicine, University of Missouri-Kansas City, Kansas City, USA
| | - Mohammad Aldiabat
- Department of Medicine, Washington University in St. Louis, Saint Louis, USA
| | - Priscila Castro Puello
- Department of Medicine, Lincoln Medical Center/Weill Cornell Medical College, New York, USA
| | - Anush Vahanyan
- Department of Medicine, Lincoln Medical Center/Weill Cornell Medical College, New York, USA
| | - Fnu Vikash
- Department of Medicine, Jacobi Medical Center, New York, NY
| | - Vikash Kumar
- Department of Medicine, Brooklyn Hospital Center, New York, USA
| | - Laith Numan
- Department of Gastroenterology & Hepatology, Saint Louis University, Saint Louis, USA
| | - Savanna Thor
- Division of Gastroenterology & Hepatology, SUNY Downstate Health Sciences University, New York, USA
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Padoan F, Colombrino C, Sciorio F, Piacentini G, Gaudino R, Pietrobelli A, Pecoraro L. Concerns Related to the Consequences of Pediatric Cannabis Use: A 360-Degree View. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1721. [PMID: 38002812 PMCID: PMC10670833 DOI: 10.3390/children10111721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023]
Abstract
Cannabis, a plant known for its recreational use, has gained global attention due to its widespread use and addiction potential. Derived from the Cannabis sativa plant, it contains a rich array of phytochemicals concentrated in resin-rich trichomes. The main cannabinoids, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), interact with CB1 and CB2 receptors, influencing various physiological processes. Particularly concerning is its prevalence among adolescents, often driven by the need for social connection and anxiety alleviation. This paper provides a comprehensive overview of cannabis use, its effects, and potential health risks, especially in adolescent consumption. It covers short-term and long-term effects on different body systems and mental health and highlights the need for informed decision making and public health initiatives, particularly regarding adolescent cannabis use.
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Affiliation(s)
| | | | | | | | | | | | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
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4
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Riha R, Winchell R, Safo D, Gentges J. Cannabinoid Hyperemesis Encounters After Medical Legalization in Oklahoma. Cureus 2023; 15:e46465. [PMID: 37927644 PMCID: PMC10624147 DOI: 10.7759/cureus.46465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Medical cannabis has recently become legal in Oklahoma. Cannabinoid hyperemesis syndrome (CHS) is severe nausea, vomiting, and often abdominal pain typically seen in heavy users of cannabis. The aim of this study is to determine whether emergency department (ED) diagnoses of CHS have increased after medical legalization. Methods We performed a retrospective chart review study of equivalent time periods prior to and after the first legal sales of medical cannabis in Oklahoma. Data were gathered from a single urban ED of adult patients with diagnosed or suspected CHS. We analyzed data using a chi-square analysis of CHS cases as a proportion of total ED visits. Results Diagnosed and suspected CHS visits increased from 43 cases in the eight months preceding the first legal sale to 62 cases in the eight months after legalization. This represents a statistically significant increase in ED visits for CHS (p = 0.026). Total ED encounters were 30,437 and 28,362, respectively, during those time periods. The proportion of visits for CHS was much higher (220/100000 vs 13.3/100000) than previously reported in the literature. The pre-legalization and post-legalization groups did not differ by age, sex, history of GI illness and diabetes, pregnancy, or other drug use. Conclusion We observed a statistically significant increase in ED visits for CHS after the first legal sales of medical cannabis in Oklahoma. Our high proportion of ED visits for CHS could be related to study design, increased provider awareness, high THC levels in Oklahoma's medical cannabis, or increased numbers of cannabis users after legalization. Increases in ED visits for CHS and other cannabinoid-related illnesses must be weighed against the positive effects for cannabis users by policymakers.
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Affiliation(s)
- Randal Riha
- Department of Emergency Medicine, St. John's Ascension, Tulsa, USA
| | - Ryan Winchell
- Department of Emergency Medicine, University of Oklahoma Health Sciences Center, Tulsa, USA
| | - Danielle Safo
- Department of Emergency Medicine, University of Oklahoma Health Sciences Center, Tulsa, USA
| | - Joshua Gentges
- Department of Emergency Medicine, University of Oklahoma Health Sciences Center, Tulsa, USA
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Arfan S, Nair A, Stear T. Atypical Presentation of Diverticulitis in a Young Hispanic Male: A Case Report. Cureus 2023; 15:e37511. [PMID: 37187641 PMCID: PMC10181893 DOI: 10.7759/cureus.37511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
Diverticulitis is a significant contributor to the number of hospital admissions and healthcare costs in Western societies. The authors present the case of an otherwise healthy 33-year-old Hispanic male presenting to the emergency department with complaints of abdominal pain, pneumaturia, and hematochezia. The patient had no underlying risk factors, substantial prior medical history, or typical symptoms of diverticulitis. He was diagnosed with acute diverticulitis with a presumed colovesical fistula. The unique clinical presentation and the intraoperative findings are discussed. The objective of this case report is to make clinicians aware of atypical presentations of acute diverticulitis and guide the appropriate diagnostic workup for young Hispanic males presenting to the emergency departments with complaints of abdominal pain.
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Affiliation(s)
- Sara Arfan
- Department of General Surgery, Windsor University School of Medicine, Cayon, KNA
| | - Ameya Nair
- Department of General Surgery, Saint James School of Medicine St. Vincent, Arnos Vale, VCT
| | - Timothy Stear
- Department of General Surgery, Community First Medical Center, Chicago, USA
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6
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Han BH, Brennan JJ, Orozco MA, Moore AA, Castillo EM. Trends in emergency department visits associated with cannabis use among older adults in California, 2005-2019. J Am Geriatr Soc 2023; 71:1267-1274. [PMID: 36622838 PMCID: PMC10089945 DOI: 10.1111/jgs.18180] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The use of cannabis among older adults is increasing in the United States. While cannabis use has been suggested to help alleviate chronic symptoms experienced by older adults, its potential adverse effects may lead to unintended consequences, including increased acute healthcare utilization related to its use. The objective of this study was to examine trends in cannabis-related emergency department (ED) visits in California. METHODS Using data from the Department of Healthcare Access and Information, we conducted a trend analysis of cannabis-related ED visits from all acute care hospitals in California from 2005 to 2019. For each calendar year, we determined the cannabis-related ED visit rate per 100,000 ED visits for adults aged ≥65 utilizing primary or secondary diagnosis codes. We estimated the absolute and relative changes in overall cannabis-related visit rates during the study period and by subgroup, including age (65-74, 75-84, ≥85), race/ethnicity, sex, payer/insurance, Charlson comorbidity index score, and cannabis-related diagnosis code. RESULTS The cannabis-related ED visit rate increased significantly for adults aged ≥65 and all subgroups (p < 0.001). The overall rate increased from 20.7 per 100,000 visits in 2005 to 395.0 per 100,000 ED visits in 2019, a 1804% relative increase. By race/ethnicity, older Black adults had the highest ED visit rate in 2019 and the largest absolute increase while older males had a higher ED visit rate in 2019 and a greater absolute increase than older women. Older adults with a higher Charlson score had a higher ED visit rate in 2019 and a larger absolute increase during the study period. CONCLUSION Cannabis-related ED visits are increasing among older adults in California and are an adverse effect of cannabis use. Asking about cannabis use and providing education about its use should be a part of routine medical care for older adults.
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Affiliation(s)
- Benjamin H. Han
- Division of Geriatrics, Gerontology, and Palliative Care, University of California San Diego School of Medicine
| | - Jesse J. Brennan
- Department of Emergency Medicine, University of California San Diego School of Medicine
| | - Mirella A. Orozco
- Division of Geriatrics, Gerontology, and Palliative Care, University of California San Diego School of Medicine
| | - Alison A. Moore
- Division of Geriatrics, Gerontology, and Palliative Care, University of California San Diego School of Medicine
| | - Edward M. Castillo
- Department of Emergency Medicine, University of California San Diego School of Medicine
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7
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Razban M, Exadaktylos AK, Santa VD, Heymann EP. Cannabinoid hyperemesis syndrome and cannabis withdrawal syndrome: a review of the management of cannabis-related syndrome in the emergency department. Int J Emerg Med 2022; 15:45. [PMID: 36076180 PMCID: PMC9454163 DOI: 10.1186/s12245-022-00446-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Cannabis-related medical consultations are increasing worldwide, a non-negligible public health issue; patients presenting to acute care traditionally complain of abdominal pain and vomiting. Often recurrent, these frequent consultations add to the congestion of already chronically saturated emergency department(s) (ED). In order to curb this phenomenon, a specific approach for these patients is key, to enable appropriate treatment and long-term follow-up. Objectives This study reviews cannabinoid hyperemesis syndrome (CHS) and cannabis withdrawal syndrome (CWS), in a bid to help promote better understanding and handling of pathologies associated with chronic cannabis use. Following a literature review, we present a novel therapeutic algorithm aimed at guiding clinicians, in a bid to improve long-term outcomes and prevent recurrences. Methods Using the keywords “Cannabis,” “Hyperemesis,” “Syndrome,” “Withdrawal,” and “Emergency Medicine,” we completed a literature review of three different electronic databases (PubMed®, Google scholar®, and Cochrane®), up to November 2021. Results Although often presenting with similar symptoms such as abdominal pain and vomiting, cannabinoid hyperemesis syndrome (CHS) and cannabis withdrawal syndrome (CWS) are the result of two differing pathophysiological processes. Distinguishing between these two syndromes is essential to provide appropriate symptomatic options. Conclusion The correct identification of the underlying cannabis-related syndrome, and subsequent therapeutic choice, may help decrease ED presentations. Our study emphasizes the importance of both acute care and long-term outpatient follow-up, as key processes in cannabis-related disorder treatment.
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Affiliation(s)
- Mohammad Razban
- Department of Internal Medicine, University Hospital of Geneva, Geneva, Switzerland. .,University of Bern, Bern, Switzerland.
| | | | - Vincent Della Santa
- Department of Emergency Medicine, Cantonal Hospital of Neuchatel, Neuchatel, Switzerland
| | - Eric P Heymann
- Department of Emergency Medicine, Cantonal Hospital of Neuchatel, Neuchatel, Switzerland
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8
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Cao Y, Jankowska MM, Yang JA, Shi Y. Spatial and temporal pattern of cannabis use disorder in California 2010-2019. Spat Spatiotemporal Epidemiol 2022; 42:100520. [PMID: 35934327 DOI: 10.1016/j.sste.2022.100520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 05/16/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
As cannabis use is being legalized in an increasing number of states, it is important to understand the changing dynamic of the risk in cannabis use disorder (CUD). Shape-based time-series clustering was used to identify ZIP Code Tabulation Areas (ZCTAs) with similar changing pattern in CUD over time. We conducted a cross-sectional logistic regression analysis to investigate the most recent ZCTA socio-demographic characteristics in relation to the changing CUD rates. The emergency discharge rates generally increased during 2010-2016. Increase during 2017-2019 was found in Sacramento and Santa Barbara County. Approximately 13% of ZCTAs showed an increasing trend of hospitalization discharge during 2017-2019. Males and non-Hispanic Black had larger increase than other groups during 2017-2019. The recent growing trend was found associated with greater racial diversity and rural ZCTAs. The findings from this study hold promise for local public health officials to adjust the cannabis intervention strategies in target districts and improve overall health outcomes.
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Affiliation(s)
- Yanjia Cao
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, La Jolla, CA 92093, United States; Population Sciences, Beckman Research Institute, City of Hope, 1500 E Duarte Rd, Duarte, CA 91010, United States; Department of Geography, The University of Hong Kong.
| | - Marta M Jankowska
- Population Sciences, Beckman Research Institute, City of Hope, 1500 E Duarte Rd, Duarte, CA 91010, United States
| | - Jiue-An Yang
- Population Sciences, Beckman Research Institute, City of Hope, 1500 E Duarte Rd, Duarte, CA 91010, United States
| | - Yuyan Shi
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, La Jolla, CA 92093, United States
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9
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Cameron LD, Fleszar-Pavlović SE, Yepez M, Manzo RD, Brown PM. Beliefs about marijuana use during pregnancy and breastfeeding held by residents of a Latino-majority, rural region of California. J Behav Med 2022; 45:544-557. [PMID: 35378643 PMCID: PMC9304043 DOI: 10.1007/s10865-022-00299-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 02/14/2022] [Indexed: 11/25/2022]
Abstract
Marijuana use among pregnant and breastfeeding women is on the rise and carries risks for infant health and well-being. Decisions to use marijuana while pregnant and breastfeeding are motivated by beliefs that use poses minimal risk to infants and offers benefits to maternal users. Misperceptions and usage trend higher among disadvantaged populations. This study surveyed 401 community residents on beliefs about risks and benefits of marijuana use by pregnant and breastfeeding women. The study utilized techniques to enhance recruitment of Latino and disadvantaged residents of rural communities in California, a state where recreational marijuana use is legal. Analyses revealed substantial endorsement of beliefs about benefits and low risks of marijuana use while pregnant and breastfeeding, many of which run counter to current evidence. Misperceptions were particularly prevalent for cannabis users and male respondents. Trends in valid beliefs, while modest, were higher for Latinos and parents.
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Affiliation(s)
- Linda D Cameron
- Department of Psychological Sciences, University of California Merced, 5200 North Lake Road, Merced, CA, 95343, USA.
- Health Sciences Research Institute, University of California, Merced, CA, USA.
| | - Sara E Fleszar-Pavlović
- Department of Psychological Sciences, University of California Merced, 5200 North Lake Road, Merced, CA, 95343, USA
- Health Sciences Research Institute, University of California, Merced, CA, USA
| | - Marisela Yepez
- Department of Psychological Sciences, University of California Merced, 5200 North Lake Road, Merced, CA, 95343, USA
- Health Sciences Research Institute, University of California, Merced, CA, USA
| | - Rosa D Manzo
- Health Sciences Research Institute, University of California, Merced, CA, USA
| | - Paul M Brown
- Health Sciences Research Institute, University of California, Merced, CA, USA
- Department of Public Health, University of California, Merced, CA, USA
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10
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Rup J, Freeman TP, Perlman C, Hammond D. Cannabis and Mental Health: Adverse Outcomes and Self-Reported Impact of Cannabis Use by Mental Health Status. Subst Use Misuse 2022; 57:719-729. [PMID: 35170396 DOI: 10.1080/10826084.2022.2034872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Cannabis can induce negative outcomes among consumers with mental health conditions. This study examined medical help-seeking behavior, patterns of adverse effects, and perceived impacts of cannabis among consumers with and without mental health conditions. Methods: Data came from the International Cannabis Policy Study, via online surveys conducted in 2018. Respondents included 6,413 past 12-month cannabis consumers aged 16-65, recruited from commercial panels in Canada and the US. Regression models examined differences in adverse health effects and perceived impact of cannabis among those with and without self-reported past 12-month experience of anxiety, depression, PTSD, bipolar disorder, psychosis. Results: Overall, 7% of past 12-month consumers reported seeking medical help for adverse effects of cannabis, including panic, dizziness, nausea. Help-seeking was greater for those with psychosis (13.8%: AOR = 1.78; 1.11-2.87), depression (8.9%: AOR = 1.57; 1.28-1.93), and bipolar disorder (10.1%: AOR = 1.53; 1.44-2.74). Additionally, 54.1% reported using cannabis to manage symptoms of mental health, with higher rates among those with bipolar (90.8%) and PTSD (90.7%). Consumers reporting >1 condition were more likely to perceive positive impacts on friendships, physical/mental health, family life, work, studies, quality of life (all p < .001). Consumers with psychosis were most likely to perceive negative effects across categories. Conclusion: For conditions with substantial evidence suggesting cannabis is harmful, greater help-seeking behaviors and self-perceived negative effects were observed. Consumers with mental health conditions generally perceive cannabis to have a positive impact on their lives. The relationship between cannabis and mental health is disorder specific and may include a combination of perceived benefits and harms.
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Affiliation(s)
- Jennifer Rup
- School of Public Health Sciences, University of Waterloo, ON, Canada
| | - Tom P Freeman
- Department of Psychology, Addiction and Mental Health Group (AIM), University of Bath, Bath, UK
| | - Chris Perlman
- School of Public Health Sciences, University of Waterloo, ON, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, ON, Canada
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Hasin DS, Borodovsky J, Shmulewitz D, Walsh C, Livne O, Struble CA, Aharonovich E, Fink DS, Budney A. Use of highly-potent cannabis concentrate products: More common in U.S. states with recreational or medical cannabis laws. Drug Alcohol Depend 2021; 229:109159. [PMID: 34844095 PMCID: PMC8667084 DOI: 10.1016/j.drugalcdep.2021.109159] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Highly-potent cannabis products, e.g., concentrates, entail greater risks of cannabis-related harms than lower-potency products such as plant or flower material. However, little information is available on whether individuals in U.S. states with recreational cannabis laws (RCL) or medical cannabis laws (MCL) are more likely than individuals in U.S. states without cannabis legalization (no-CL) to use highly-potent forms of cannabis. METHODS Cannabis-using adults in a 2017 online survey (N = 4064) provided information on state of residence and past-month cannabis use, including types of products used, categorized as low-potency (smoked or vaped plant cannabis) or high-potency (vaping or dabbing concentrates). Multivariable logistic regression models generated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for use of high-potency cannabis products by state cannabis legalization status (RCL, MCL, no-CL). RESULTS Compared to participants in no-CL states, participants in RCL states had greater odds of using high-potency concentrate products (aOR=2.61;CI=1.77-3.86), as did participants in MCL-only states (aOR=1.55;CI=1.21-1.97). When participants in RCL states and MCL states were directly compared, those in RCL states had greater odds of using high-potency concentrate products (aOR=1.69;CI=1.27-2.42). DISCUSSION Although the sample was not nationally representative and the cross-sectional data precluded determining the direction of effect, results suggest that use of high-potency cannabis concentrates is more likely among those in RCL states. Clinicians in RCL states should screen cannabis users for harmful patterns of use. Policymakers in states that do not yet have RCL should consider these findings when drafting new cannabis laws, including the specific products permitted and how best to regulate them.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY 10032, USA.
| | - Jacob Borodovsky
- Department of Psychiatry, Dartmouth Geisel School of Medicine, One Medical Center Drive, Lebanon, NH 03756, USA.
| | - Dvora Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Claire Walsh
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Ofir Livne
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Cara A Struble
- Department of Psychiatry, Dartmouth Geisel School of Medicine, One Medical Center Drive, Lebanon, NH 03756, USA.
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - David S Fink
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Alan Budney
- Department of Psychiatry, Dartmouth Geisel School of Medicine, One Medical Center Drive, Lebanon, NH 03756, USA.
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Takakuwa KM, Schears RM. The emergency department care of the cannabis and synthetic cannabinoid patient: a narrative review. Int J Emerg Med 2021; 14:10. [PMID: 33568074 PMCID: PMC7874647 DOI: 10.1186/s12245-021-00330-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/05/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cannabis is the most prevalent illegal drug used and the second most common cause of ED drug-related complaints in the USA. Recently, newer more potent strains, concentrated THC products, and consumption methods have become available. OBJECTIVE Our first objective was to define cannabis use in the USA and provide a summary background on its current preparations, pharmacokinetics, vital sign and physical exam findings, adverse effects, and laboratory testing. Our second objective, using the aforementioned summary as relevant background information, was to present and summarize the care and treatment of the most commonly reported cannabis-related topics relevant to ED physicians. METHODS We first performed an extensive literature search of peer-reviewed publications using New PubMed and Cochrane Central Register of Controlled Trials to identify the most commonly reported cannabis-related topics in emergency care. Once the six topic areas were identified, we undertook an extensive narrative literature review for each section of this paper using New PubMed and Cochrane Central Register of Controlled Trials from the inception of the databases to September 30, 2020. RESULTS The six subject areas that were most frequently reported in the medical literature relevant to cannabis-related ED care were acute intoxication/overdose, pediatric exposure, cannabinoid hyperemesis syndrome, cannabis withdrawal, e-cigarette or vaping product use-associated lung injury (EVALI), and synthetic cannabinoids. CONCLUSION As cannabis becomes more widely available with the adoption of state medical cannabis laws, ED-related cannabis visits will likely rise. While cannabis has historically been considered a relatively safe drug, increased legal and illegal access to newer formulations of higher potency products and consumption methods have altered the management and approach to ED patient care and forced physicians to become more vigilant about recognizing and treating some new cannabis-related life-threatening conditions.
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Affiliation(s)
- Kevin M Takakuwa
- Society of Cannabis Clinicians, PO Box 27574, San Francisco, CA, 94127, USA.
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Zhu JW, Gonsalves CL, Issenman RM, Kam AJ. Diagnosis and Acute Management of Adolescent Cannabinoid Hyperemesis Syndrome: A Systematic Review. J Adolesc Health 2021; 68:246-254. [PMID: 33036874 DOI: 10.1016/j.jadohealth.2020.07.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE This study aimed to synthesize qualitative and quantitative data on the diagnosis and effective management of cannabinoid hyperemesis syndrome (CHS) in the adolescent population. METHODS Using keywords, 1,334 studies published between December 1954 and December 2019 were extracted from MEDLINE via PubMed, Embase via OVID, CINAHL via EBSCO, Web of Science, and the Cochrane Library. Studies were evaluated by two independent reviewers using predetermined inclusion and exclusion criteria. RESULTS The search yielded 148 studies for full-text review, of which 21 were included in this systematic review. A total of 10 articles were related to the diagnosis of CHS, while 11 articles discussed the treatment and management of adolescent cases of CHS. CONCLUSIONS CHS in the adolescent population fulfills the major and minor diagnostic criteria of CHS in the adult population; however, in adolescent patients, CHS may present more frequently in females, with the earliest reported case presenting at age 15 years. There appears to be a substantial proportion (21%) of adolescent patients diagnosed with CHS that have a history of anxiety and depression; however, higher quality studies to assess the prevalence are warranted. Although haloperidol and topical capsaicin cream may provide symptom relief in isolated cases, complete cessation of cannabis use is currently the only known effective treatment.
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Affiliation(s)
- Jie Wei Zhu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Clarelle L Gonsalves
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert M Issenman
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - April J Kam
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
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Quiros JA, Saps M. The Coming Storm: Cannabis Hyperemesis Syndrome in Adolescents. J Adolesc Health 2021; 68:223-224. [PMID: 33541594 DOI: 10.1016/j.jadohealth.2020.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 11/18/2022]
Affiliation(s)
- J Antonio Quiros
- Pediatric Therapeutic Endoscopy Program, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Mount Sinai Kravis Children's Hospital, New York, New York
| | - Miguel Saps
- Chief of Division of Pediatric Gastroenterology, Miller School of Medicine, Hepatology and Nutrition, University of Miami, Miami, Florida
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15
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A Nonopioid, Nonbenzodiazepine Treatment Approach for Intractable Nausea and Vomiting in the Emergency Department. J Clin Gastroenterol 2020; 54:327-332. [PMID: 31567626 DOI: 10.1097/mcg.0000000000001258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
GOAL We sought to assess the feasibility and efficacy of a treatment protocol for nausea and vomiting using the combination of chlorpromazine, a dopamine antagonist antiemetic, and ketamine, a nonopioid analgesic. BACKGROUND Increasing numbers of patients with cannabis use disorder are presenting to emergency departments with a poorly understood syndrome characterized by intractable nausea and vomiting. METHODS This is a prospective, observational study involving a convenience sample of patients with unexplained nausea and vomiting. Subjects were given ketamine 15 mg slow intravenous push and chlorpromazine 12.5 mg intravenous over 15 minutes. Outcomes were number of episodes of emesis after study drug administration; change in nausea severity; change in pain severity; adverse events; and patient satisfaction. RESULTS We enrolled 28 subjects on 30 emergency department visits. Twenty-three subjects (82%) reported at least weekly cannabis use with 19 reporting daily use. Initial symptoms were severe, with median pain and nausea scores both 10. After receiving study medication, the mean decrease in pain score over 120 minutes was 4.1 (95% confidence interval: 3.2, 5.0) and the mean decrease in nausea score was 4.9 (95% confidence interval: 4.0, 5.8). There were no adverse events. All 28 subjects who were asked reported they would want to receive these medications again. CONCLUSION In this single-center study, the majority of patients presenting with intractable nausea and vomiting reported heavy cannabis use, and symptoms were severe. The combination of chlorpromazine plus ketamine resulted in rapid, definitive cessation of symptoms in most of these patients without the need for opioids or benzodiazepines.
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Abstract
Cannabis has long been used for medical and recreational purposes because of its antiemetic, analgesic, and mood effects. Ironically, chronic use of cannabis can result in paradoxical effects, including a condition known as cannabinoid hyperemesis syndrome. Patients with this syndrome often are seen in the ED with cyclic vomiting, nausea, and epigastric pain. Although the definitive treatment of cannabinoid hyperemesis syndrome is discontinuing the causative agent, medical management that includes rehydration is important to prevent complications. Common antiemetic medications are ineffective, but some studies have shown haloperidol and lorazepam to be effective in treating acute symptoms.
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Burden of Persistent Vomiting With Cannabis Use Disorder: Report From 55,549 Hospitalizations in the United States. PSYCHOSOMATICS 2019; 60:549-555. [DOI: 10.1016/j.psym.2019.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 01/17/2023]
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Madireddy S, Patel RS, Ravat V, Ajibawo T, Lal A, Patel J, Patel R, Goyal H. Burden of Comorbidities in Hospitalizations for Cannabis Use-associated Intractable Vomiting during Post-legalization Period. Cureus 2019; 11:e5502. [PMID: 31511820 PMCID: PMC6716962 DOI: 10.7759/cureus.5502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective The aim of this study was to observe the trends of intractable vomiting and cannabis use disorder (CUD) with demographic characteristics, medical and psychiatric comorbidities, and hospitalization outcomes. Methods We conducted a retrospective cohort study using the nationwide inpatient sample (2010 to 2014). Patients aged 16-50 years discharged with a primary diagnosis of intractable vomiting and CUD were included (N = 9,601). We used the linear-by-linear association chi-square test and independent-sample T-test for measuring the categorical and continuous data, respectively. Results The number of intractable vomiting hospitalizations with CUD had an increasing trend (P < 0.001) with a 28.6% increase over five years. About half of the study population included young (16-30 years, 48.4%) males (57.2%). There was a decreasing trend (P = 0.041) in the prevalence of intractable vomiting with CUD in non-Hispanic Whites and Blacks, whereas there was 778% increase in Hispanics. The mean length of stay was 3.2 days which had a decreasing linear trend, and total hospital charges showed an increasing trend (P < 0.001), averaging $22,890. Electrolyte disorders (55.3%), hypertension (25.3%), chronic lung disease (11.9%), and deficiency anemia (10.3%) constituted the majority of comorbidities, with anemia showing a statistically significant increasing trend (P = 0.004). Anxiety disorders increased from 20.8% to 30.8% over five years, whereas depression decreased from 19.2% to 16.4% (P < 0.001). Concomitant tobacco abuse/dependence was present in 41.2% of patients with CUD. Conclusion The results of our study show that the intractable vomiting hospitalizations related to CUD have increased significantly over a five-year period. The general public and healthcare practitioners should be made aware of the paradoxical gastrointestinal side effects of cannabis.
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Affiliation(s)
| | | | | | - Temitope Ajibawo
- Internal Medicine, Brookdale University Hospital and Medical Center, New York, USA
| | - Anthony Lal
- Internal Medicine, Windsor University Medical School, Basseterre, KNA
| | - Jenil Patel
- Epidemiology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Riddhi Patel
- Epidemiology, The University of Texas School of Public Health at Houston, Houston, USA
| | - Hemant Goyal
- Department of Gastroenterology & Hepatology, The Wright Center of Graduate Medical Education, Scranton, Pa, Scranton, USA
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Venkatesan T, Levinthal DJ, Li BUK, Tarbell SE, Adams KA, Issenman RM, Sarosiek I, Jaradeh SS, Sharaf RN, Sultan S, Stave CD, Monte AA, Hasler WL. Role of chronic cannabis use: Cyclic vomiting syndrome vs cannabinoid hyperemesis syndrome. Neurogastroenterol Motil 2019; 31 Suppl 2:e13606. [PMID: 31241817 PMCID: PMC6788295 DOI: 10.1111/nmo.13606] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 03/17/2019] [Accepted: 03/25/2019] [Indexed: 12/13/2022]
Abstract
Cannabis is commonly used in cyclic vomiting syndrome (CVS) due to its antiemetic and anxiolytic properties. Paradoxically, chronic cannabis use in the context of cyclic vomiting has led to the recognition of a putative new disorder called cannabinoid hyperemesis syndrome (CHS). Since its first description in 2004, numerous case series and case reports have emerged describing this phenomenon. Although not pathognomonic, a patient behavior called "compulsive hot water bathing" has been associated with CHS. There is considerable controversy about how CHS is defined. Most of the data remain heterogenous with limited follow-up, making it difficult to ascertain whether chronic cannabis use is causal, merely a clinical association with CVS, or unmasks or triggers symptoms in patients inherently predisposed to develop CVS. This article will discuss the role of cannabis in the regulation of nausea and vomiting, specifically focusing on both CVS and CHS, in order to address controversies in this context. To this objective, we have collated and analyzed published case series and case reports on CHS in order to determine the number of reported cases that meet current Rome IV criteria for CHS. We have also identified limitations in the existing diagnostic framework and propose revised criteria to diagnose CHS. Future research in this area should improve our understanding of the role of cannabis use in cyclic vomiting and help us better understand and manage this disorder.
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Affiliation(s)
- Thangam Venkatesan
- Division of Gastroenterology and HepatologyMedical College of WisconsinMilwaukeeWisconsin
| | - David J. Levinthal
- Division of Gastroenterology, Hepatology, and NutritionUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - B U. K. Li
- Department of PediatricsMedical College of WisconsinMilwaukeeWisconsin
| | - Sally E. Tarbell
- Department of Psychiatry and Behavioral SciencesNorthwestern Feinberg School of MedicineChicagoIllinois
| | | | - Robert M. Issenman
- Division of Pediatric GastroenterologyMcMaster UniversityHamiltonOntarioCanada
| | - Irene Sarosiek
- Division of GastroenterologyTexas Tech University Health Sciences CenterEl PasoTexas
| | | | - Ravi N. Sharaf
- Division of GastroenterologyDepartment of Medicine and Department of Healthcare Policy and ResearchWeill Cornell Medical CenterNew YorkNew York
| | | | | | - Andrew A. Monte
- Department of Emergency MedicineUniversity of Colorado School of MedicineAuroraColorado
| | - William L. Hasler
- Division of GastroenterologyUniversity of Michigan Health SystemAnn ArborMichigan
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Abstract
PURPOSE OF REVIEW To examine the spectrum of emergency department presentations associated with cannabis use or misuse that are currently seen in the pediatric population. RECENT FINDINGS There is a growing concern that pediatric emergency department visits related to cannabis are on the rise, especially given rapidly changing legislation on cannabis and its broad availability in certain areas. These concerns are substantiated in the current literature, as the evidence mounts for an array of emergency department presentations of intentional or accidental cannabis use. The range of presentations documented in the recent literature spans gastrointestinal, psychiatric and cardiorespiratory effects, in addition to traumatic injuries and accidental ingestions by younger children. Complications of chronic cannabis use, such as 'cannabis hyperemesis syndrome', depression, psychosis or cognitive impairment, are now recognized outcomes and even more are likely to emerge. SUMMARY An array of cannabis-related symptoms is possible from acute use or exposure. Common presentations include acute intoxication, hyperemesis, depression and acute physical injuries from impaired psychomotor function. Uncommon presentations include cardiorespiratory effects, and a range of symptoms in young children that include hyperkinesis and coma. Clinical vigilance is needed to suspect and clinically diagnose cannabis exposure in the emergency department.
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Hasin DS, Shmulewitz D, Sarvet AL. Time trends in US cannabis use and cannabis use disorders overall and by sociodemographic subgroups: a narrative review and new findings. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:623-643. [PMID: 30870044 PMCID: PMC6745010 DOI: 10.1080/00952990.2019.1569668] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/10/2018] [Accepted: 12/19/2018] [Indexed: 12/30/2022]
Abstract
Background: Due to significant comorbidity and impairment associated with cannabis use and cannabis use disorder, understanding time trends in cannabis use and cannabis use disorder is an important public health priority.Objectives: To identify trends in cannabis use and cannabis use disorder overall, and by sociodemographic subgroup.Methods: Narrative review of published findings on trends in cannabis use and cannabis use disorders in data from repeated cross-sectional US general population surveys. In addition, in National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2002-2002) and NESARC-III (2012-2013) data, logistic regression was used to examine whether trends differed between subgroups of adults.Results: The review showed that in adults, cannabis use increased over the past decade overall and within sociodemographic subgroups (gender, age, race/ethnicity, income, education, marital status, urbanicity, region, pregnancy status, disability status), with greater increases in men and disabled adults. Most sources also indicated significant increases in cannabis use disorders. New analysis showed significantly greater increases in adult cannabis use and cannabis use disorder in men (p ≤ .0001); young adults (p < .05); Blacks (vs. Whites, p < .01); low income groups (p < .001); never-married p ≤ .0001), and urban residents (p < .05). In adolescents, cannabis use generally decreased, although recent increases were observed in older and non-White adolescents.Conclusion: Cannabis use and cannabis use disorder are increasing in adults, with specific sociodemographic groups at higher risk, and may be increasing in some adolescent subgroups. Studies should determine mechanisms for differential trends to provide information to policymakers and enable informed decisions on cannabis legalization and service planning.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, Columbia University Medical Center, Columbia University, New York, NY, USA
- Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Dvora Shmulewitz
- Department of Psychiatry, Columbia University Medical Center, Columbia University, New York, NY, USA
- Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| | - Aaron L Sarvet
- Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology, T. H. Chan Harvard School of Public Health, Harvard University, Boston, MA, USA
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Adejumo AC, Akanbi O, Adejumo KL, Bukong TN. Reduced Risk of Alcohol-Induced Pancreatitis With Cannabis Use. Alcohol Clin Exp Res 2018; 43:277-286. [DOI: 10.1111/acer.13929] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/13/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Adeyinka Charles Adejumo
- Department of Medicine ; North Shore Medical Center; Salem Massachusetts
- Department of Medicine ; University of Massachusetts Medical School; Worcester Massachusetts
- School of Public Health ; University of Massachusetts Lowell; Lowell Massachusetts
| | - Olalekan Akanbi
- Division of Hospital Medicine ; University of Kentucky College of Medicine; Lexington Kentucky
| | | | - Terence Ndonyi Bukong
- Department of Medicine ; University of Massachusetts Medical School; Worcester Massachusetts
- INRS-Institut Armand-Frappier ; Institut National de la Recherche Scientifique; Laval Québec Canada
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