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PubMed1997

Marijuana use and cancer incidence (California, United States).

The purpose of this retrospective cohort study was to examine the relationship of marijuana use to cancer incidence. The study population consisted of 64,855 examinees in the Kaiser Permanente multiphasic health checkup in San Francisco and Oakland (California, United States), between 1979-85, aged 15 to 49 years, who completed self-administered questionnaires about smoking habits, including marijuana use. Follow-up for cancer incidence was conducted through 1993 (mean length 8.6 years). Compared with nonusers/experimenters (lifetime use of less than seven times), ever- and current use of marijuana were not associated with increased risk of cancer of all sites (relative risk [RR] = 0.9, 95 percent confidence interval [CI] = 0.7-12 for ever-use in men; RR = 1.0, CI = 0.8-1.1 in women) in analyses adjusted for sociodemographic factors, cigarette smoking, and alcohol use. Marijuana use also was not associated with tobacco-related cancers or with cancer of the following sites: colorectal, lung, melanoma, prostate, breast, cervix. Among nonsmokers of tobacco cigarettes, ever having used marijuana was associated with increased risk of prostate cancer (RR = 3.1, CI = 1.0-9.5) and nearly significantly increased risk of cervical cancer (RR = 1.4, CI = 1.0-2.1). We conclude that, in this relatively young study cohort, marijuana use and cancer were not associated in overall analyses, but that associations in nonsmokers of tobacco cigarettes suggested that marijuana use might affect certain site-specific cancer risks.

Adolescent↗

PubMed2005

Marijuana use and its association with adherence to antiretroviral therapy among HIV-infected persons with moderate to severe nausea.

BACKGROUND: Adherence to antiretroviral therapy (ART) is essential to successful treatment of HIV infection. Two recent studies reported a negative correlation between marijuana use and adherence to ART. Some patients, however, report that smoking marijuana improves adherence to ART. This study therefore sought to identify which subgroups of patients may have differential adherence to ART in association with recent marijuana use. METHODS: Cross-sectional survey design within a public health care system for HIV/AIDS. RESULTS: With a 5% refusal rate, 252 patients completed the interview, 175 (69%) were on ART, and 168 (67%) provided ART adherence data. Forty-one subjects (24%), predominantly whites, used marijuana. In bivariate analysis, no association between ART adherence and marijuana use was found (odds ratio [OR] = 0.92, 95% CI = 0.4-1.9). Adherence was positively associated with undetectable plasma virus and negatively associated with alcohol and other illicit drug use. Examining subgroups of patients, among those with nausea, marijuana users were more likely to show an association with adherence than nonusers (OR = 3.3), while among those without nausea, marijuana use was lower associated with adherence (OR = 0.52, P for homogeneity 0.02). This relationship was confirmed in multivariate analyses controlling for the interactions between nausea and marijuana use, in which other illicit drug use remained a factor related to nonadherence. DISCUSSION: These data suggest that medicinal use of marijuana may facilitate, rather than impede, ART adherence for patients with nausea, in contrast to the use of other illicit substances, which were associated with lower rates of ART adherence. To demonstrate any causal relationship between marijuana and adherence would require a longitudinal or controlled study.

Adult↗

PubMed2006

Relationship between adolescent marijuana use and young adult illicit drug use.

: We examined three components of the "gateway theory" in relation to marijuana use: (1) whether adolescent marijuana use predicts young adult drug use, (2) whether this association persists when controlling for similar family background, (3) whether common genetic or environmental factors contribute to the association. The three components were tested in adolescents from the National Longitudinal Study of Adolescent Health assessed twice during adolescence and then re-interviewed 5 years later. Component 1 was tested in 18,286 subjects, component 2 in sibling pairs (n=360) discordant for marijuana use, and component 3 in a genetically informative sub-sample (n=4846). Marijuana use was defined as any use during adolescence, and drug use was defined as self-reported past year use of other illicit drugs besides marijuana. Marijuana users were twice as likely to use illicit drugs as young adults than non-users. Shared environmental factors mediated much of the relationship between adolescent marijuana use and young adult drug use. The association remained, however, even when controlling for familial environmental and other measured factors.

Adolescent↗

PubMed1998

Marijuana use and treatment outcome among opioid-dependent patients.

AIMS: Information concerning the association between marijuana use and opioid dependence and its treatment is needed to determine effective clinical guidelines for addressing marijuana use among opioid abusers. SETTING AND PARTICIPANTS: Marijuana use was assessed in 107 people enrolled in treatment for opioid dependence. DESIGN AND MEASUREMENT: Univariate comparisons of marijuana users and non-users and multivariate regression analyses were performed to examine associations between marijuana use and socio-demographic, psychosocial, medical and substance-use variables. The relationship between marijuana use and treatment outcome was also explored in a subset of this sample who received treatment that included buprenorphine detoxification and behavior therapy (N = 79). FINDINGS: Sixty-six per cent of participants were current marijuana users and almost all (94%) continued to use during treatment. Users were less likely to be married than non-users, and more likely to report financial difficulties, be involved in drug dealing and engage in sharing of needles (p < 0.05). A unique effect of marijuana use on drug dealing and sharing needles was retained after statistically controlling for the influence of heroin and alcohol use and other socio-demographic variables. No significant adverse relations were observed between marijuana use and treatment outcome. CONCLUSION: Pending a more comprehensive understanding of the function and consequences of marijuana use on psychosocial functioning, it appears that progress in treatment for opioid dependence can be made without mandating that patients abstain from marijuana use.

Adult↗

PubMed2004

Marijuana use and cognitive function in HIV-infected people.

The effect of marijuana use on cognitive function is controversial. Although marijuana use is common in HIV-infected individuals for recreational and medicinal purposes, there have been no studies of the impact of marijuana on cognitive function in these subjects. Marijuana also has known immunologic effects, which increases the relevance in HIV-infected patients. We examined the interaction of HIV disease-stage and marijuana use in 282 subjects, stratified by disease stage and frequency of marijuana use. After controlling for the effects of depression, anxiety, and alcohol use, a significant interaction was observed on an overall measure of cognitive impairment. The effect of marijuana use was greatest in subjects with symptomatic HIV infection. Further inspection suggested that this effect was due primarily to performance on memory tasks. These data suggest that although there is minimal impact of marijuana on uninfected individuals or those at early stages of HIV infection, there is a synergistic effect of HIV and marijuana use in patients with advanced HIV disease. This is consistent with other data suggesting that the subtle effects of some conditions may become more manifest in the setting of immunocompromise.

Adult↗

PubMed2006

Risk factors for alcohol and marijuana use among adolescents in foster care.

This study examined the influences of individual and social risk factors on alcohol and marijuana use among a sample of foster care adolescents. Data were collected through baseline structured interviews with 320 adolescents (aged 15-18 years) who resided in foster care placements and participated in a larger evaluation study of an independent living program. Approximately 40% of the adolescents reported alcohol use, 36% reported marijuana use, and 25% reported both alcohol and marijuana use during the 6 months prior to the interview. Final logistic regression models indicated that having friends who used marijuana and other substances and having skipped school remained most predictive of using alcohol, marijuana, or both alcohol and marijuana. Recommendations for substance abuse prevention and treatment for these vulnerable adolescents are proposed.

Adolescent↗

PubMed2004

Comparing the developmental trajectories of marijuana use of African American and Caucasian adolescents: patterns, antecedents, and consequences.

Adolescent marijuana use has tripled recently, and the once-noted race gap between African American and Caucasian adolescents in marijuana use appears to have disappeared. Yet, relatively little research has examined marijuana use among African American adolescents. In this study, we examined developmental trajectories of marijuana use among Caucasian and African American adolescents to identify whether and when differences in marijuana use appear and whether the precursors and outcomes associated with these developmental trajectories differ by race. Findings indicate that both the developmental patterns and outcomes associated with marijuana use are different for African American and Caucasian adolescents. Early-onset Caucasian and mid-onset African American adolescents experienced the greatest number of negative outcomes later in life associated with their marijuana use, suggesting that groups to target for intervention may vary by race.

Adolescent↗

PubMed2006

Adult social behavioral effects of heavy adolescent marijuana use among African Americans.

The authors examined the effects of heavy adolescent marijuana use on employment, marriage, and family formation and tested both dropping out of high school and adult marijuana use as potential mediators of these associations among a community sample of African Americans followed longitudinally from age 6 to age 32-33. They used propensity score matching to reduce selection bias when estimating the effects of heavy adolescent marijuana use. Logistic regression results on the sample matched on sex, and early demographic and behavioral variables showed that adolescent marijuana use has adult social behavioral consequences: Use of marijuana 20 times or more during adolescence was associated with being unemployed and unmarried in young adulthood and having children outside of marriage for both males and females. Dropping out of high school and more frequent adult marijuana use seem to be important parts of the pathway from adolescent marijuana use to negative life outcomes.

Adolescent↗

PubMed2006

Marijuana use, diet, body mass index, and cardiovascular risk factors (from the CARDIA study).

Marijuana use has been associated with increased appetite, high caloric diet, acute increase in blood pressure, and decreases in high-density lipoprotein cholesterol and triglycerides. Marijuana is the most commonly used illicit drug in the United States, but its long-term effects on body mass index (BMI) and cardiovascular risk factors are unknown. Using 15 years of longitudinal data from 3,617 black and white young adults participating in the Coronary Artery Risk Development in Young Adults (CARDIA) study, we assessed whether marijuana use was associated with caloric intake, BMI, and cardiovascular risk factors. Of the 3,617 participants, 1,365 (38%) reported ever using marijuana. Marijuana use was associated with male gender, tobacco smoking, and other illicit drug use. More extensive marijuana use was associated with a higher caloric intake (2,746 kcal/day in never users to 3,365 kcal/day in those who used marijuana for > or = 1,800 days over 15 years) and alcohol intake (3.6 to 10.8 drinks/week), systolic blood pressure (112.7 to 116.5 mm Hg), and triglyceride levels (84 to 100 mg/dl or 0.95 to 1.13 mmol/L, all p values for trend < 0.001), but not with higher BMI and lipid and glucose levels. In multivariate analysis, the associations between marijuana use and systolic blood pressure and triglycerides disappeared, having been mainly confounded by greater alcohol use in marijuana users. In conclusion, although marijuana use was not independently associated with cardiovascular risk factors, it was associated with other unhealthy behaviors, such as high caloric diet, tobacco smoking, and other illicit drug use, which all have long-term detrimental effects on health.

Adolescent↗

PubMed2002

Cardiovascular consequences of marijuana use.

This review describes what is known about effects of marijuana and cannabinoids in relation to human physiological and disease outcomes. The acute physiological effects of marijuana include a substantial dose-dependent increase in heart rate, generally associated with a mild increase in blood pressure. Orthostatic hypotension may occur acutely as a result of decreased vascular resistance. Smoking marijuana decreases exercise test duration in maximal exercise tests, increases the heart rate at submaximal levels of exercise. Tolerance develops to the acute effects of marijuana smoking and delta9-tetrahydrocannibol (THC) over several days to a few weeks. The cardiovascular responses that occur in response to THC are mediated by the autonomic nervous system, with recent findings also demonstrating that the human cannabinoid receptor system plays a role in regulating the cardiovascular response. Although several mechanisms exist by which marijuana use might contribute to the development of chronic cardiovascular conditions or acutely trigger cardiovascular events, there are few data regarding marijuana/THC use and cardiovascular disease outcomes. A large cohort study showed no association of marijuana use with cardiovascular disease hospitalization or mortality. However, acute effects of marijuana use include a decrease of the time until the onset of chest pain in patients with angina pectoris; one study has shown that marijuana may trigger the onset of myocardial infarction. Patients who have coronary heart disease or are at high risk for the development of CHD should be cautioned about the potential hazards of marijuana use as a precipitant for clinical events. Research directions might include more studies of cardiovascular disease outcomes and relationships of marijuana with cardiovascular risk factors, studies of metabolic and physiologic effects of chronic marijuana use that may affect cardiovascular disease risk, increased understanding of the role of the cannabinoid receptor system in cardiovascular regulation, and studies to determine if there is a therapeutic role for cannabinoids in blood pressure control or for neuroprotection after stroke.

Blood Pressure↗

PubMedDate not supplied

Sex differences in marijuana use in the United States.

Marijuana and other cannabis preparations are the most widely used illicit drugs in the United States. A review of the literature reveals a number of sex differences in the epidemiology and adverse medical consequences of marijuana use. In 1995, 6.5% of females and 10.5% of males aged 12 and older reported marijuana use in the previous year. Although 4% more males than females used marijuana, the percentage of males using marijuana between 1994 and 1995 had decreased, whereas the percentage of females using marijuana during that same period had increased. Among females, the age of initiation of use is declining and the prevalence of problems with marijuana is on the rise. Both male and female marijuana users may experience adverse effects of cognitive dysfunction and airway inflammation. However, clinicians should be aware of sex-specific effects of marijuana use, including a possible increased risk of prostate cancer for male users and possible adverse effects on reproductive hormones in female users. Review of the available information on this topic indicates that we have much more to learn about the similarities and differences between males and females with respect to patterns of use, adverse consequences, and vulnerabilities to marijuana.

Cannabis↗

PubMed2006

Prenatal marijuana exposure contributes to the prediction of marijuana use at age 14.

AIM: To evaluate the effects of prenatal marijuana exposure (PME) on the age of onset and frequency of marijuana use while controlling for identified confounds of early marijuana use among 14-year-olds. DESIGN: In this longitudinal cohort study, women were recruited in their fourth prenatal month. Women and children were followed throughout pregnancy and at multiple time-points into adolescence. SETTING AND PARTICIPANTS: Recruitment was from a hospital-based prenatal clinic. The women ranged in age from 18 to 42, half were African American and half Caucasian, and most were of lower socio-economic status. The women were generally light to moderate substance users during pregnancy and subsequently. At 14 years, 580 of the 763 offspring-mother pairs (76%) were assessed. A total of 563 pairs (74%) was included in this analysis. MEASUREMENTS: Socio-demographic, environmental, psychological, behavioral, biological and developmental factors were assessed. Outcomes were age of onset and frequency of marijuana use at age 14. PME predicted age of onset and frequency of marijuana use among the 14-year-old offspring. This finding was significant after controlling for other variables including the child's current alcohol and tobacco use, pubertal stage, sexual activity, delinquency, peer drug use, family history of drug abuse and characteristics of the home environment including parental depression, current drug use and strictness/supervision. CONCLUSIONS: Prenatal exposure to marijuana, in addition to other factors, is a significant predictor of marijuana use at age 14.

Adolescent↗

PubMed1989

Identifying and helping patients who use marijuana.

The physician who suspects that a minor is using marijuana has the responsibility to confirm the diagnosis and to discuss the findings with the patient and parents in a firm, supportive, nonjudgmental manner. Intervention includes ensuring appropriate referral for rehabilitation and providing for follow-up care. Educating the entire family about chemical dependency and monitoring the patient to ensure abstinence from marijuana use are important steps in this process.

Adolescent↗

PubMed2002

Marijuana use among the adolescent children of high-risk drug-abusing fathers.

This study examines marijuana use among children of male drug abusers. Subjects were 83 African-American and European-American male drug abusers, of whom the majority were injection drug users, and their children. Thirty-one of the fathers were HIV-positive and 52 were HIV-negative. Using logistic regression analyses, we explored cross-sectionally the relationship between four psychosocial domains (ie, paternal attributes, adolescent problem behaviors, father-adolescent relations, and environment) and adolescent marijuana use. The father's use of illegal drugs and his failure to cope adaptively predicted adolescent marijuana use, while a close father-child bond predicted less adolescent marijuana use. Adolescent problem behaviors predicted an increased likelihood of marijuana use. Furthermore, hierarchical regression analysis demonstrated that the adolescent's problem behavior mediated the associations between both the father-adolescent relationship and environmental factors with adolescent marijuana use. Reducing the risk factors and enhancing the protective factors within each of the domains could help reduce marijuana use among the adolescent children of drug-abusing fathers. Moreover, if a father is a drug abuser, it is important to help him establish a close bond with his child in order to help attenuate the influence of his drug use on the child's marijuana use.

Adaptation, Psychological↗

PubMed2005

The growth in marijuana use among American youths during the 1990s and the extent of blunt smoking.

Marijuana use among American youths and young adults increased substantially during the 1990s. This paper reviews that trend using data collected 1979-2003 by the National Survey on Drug Use and Health (NSDUH). The data suggest that the increase in marijuana use started first among persons age 12-20. Among 18-20 year-olds, the increase started earlier among whites and blacks than Hispanics, among males before females, and surprisingly in areas that are not part of an MSA as opposed to those with a population in excess of a million. Much of the increase in marijuana use could have been attributable to the growing popularity of blunts. Starting in 2000, the NSDUH explicitly asked youths age 12-17 (but not older respondents) about smoking blunts. Of the 9% of youths who reported past-30-day use of marijuana 2000-03, more than half reported smoking blunts. On the other hand, the data also indicate that blunts have not fully supplanted other ways that youths consume marijuana. Blunts were more common among youths that were black, older, male, and from metropolitan areas. Many blunt smokers reported they had not used marijuana, which suggests that they did not define smoking blunts as marijuana use. Even fewer reported that they had used cigars, suggesting they did not define smoking blunts as cigar use.

Adolescent↗

PubMed1998

Explaining recent increases in students' marijuana use: impacts of perceived risks and disapproval, 1976 through 1996.

OBJECTIVES: Marijuana use among high school seniors increased during most of the 1970s, decreased throughout the 1980s, and has been increasing again during the 1990s. Earlier analyses of the classes of 1976 through 1986 attributed the historic trends during that period to specific changes in views about marijuana. This study examined whether recent increases in marijuana use among seniors and among students in earlier grades reflect similar processes. METHODS: Multivariate regression analyses were conducted on data from large annual nationwide surveys of high school seniors from 1976 through 1996 (approximate n = 61,000) and 8th and 10th graders from 1991 through 1996 (n's = 87,911 and 82,475, respectively). RESULTS: Individual lifestyle factors (grades, truancy, religious commitment, evenings out for recreation) correlated substantially with marijuana use but did not explain the historic changes in marijuana use. Rather, decreases in perceived risk of harmfulness and in disapproval can account for the recent increases in all 3 grades and for earlier decreases among seniors. CONCLUSIONS: These findings indicate that perceived risks and disapproval are important determinants of marijuana use. Accordingly, prevention efforts should include realistic information about risks and consequences of marijuana use.

Adolescent↗

PubMed1984

Marijuana use during pregnancy and decreased length of gestation.

In a prospective study the relationship of marijuana use during pregnancy to infant birth weight and length of gestation was examined in 583 women who delivered single live infants. Eighty-four women used marijuana to varying degrees during pregnancy. Marijuana, alcohol, smoking, and nutritional habits were estimated by repeated interviews. Compared to nonuse, an average use of marijuana six or more times per week during pregnancy was associated with a statistically significant reduction of 0.8 weeks in the length of gestation after consideration of the effects of nicotine, alcohol, parity, mother's prepregnancy weight, and the sex of the infant. With similar adjustments no reduction in birth weight was noted. Among the heavy marijuana users the effect of gestation length was does dependent.

Adult↗

PubMed1997

Marijuana use and mortality.

OBJECTIVES: The purpose of this study was to examine the relationship of marijuana use to mortality. METHODS: The study population comprised 65171 Kaiser Permanente Medical Care Program enrollees, aged 15 through 49 years, who completed questionnaires about smoking habits, including marijuana use, between 1979 and 1985. Mortality follow-up was conducted through 1991. RESULTS: Compared with nonuse or experimentation (lifetime use six or fewer times), current marijuana use was not associated with a significantly increased risk of non-acquired immunodeficiency syndrome (AIDS) mortality in men (relative risk [RR] = 1.12, 95% confidence interval [CI] = 0.89, 1.39) or of total mortality in women (RR = 1.09, 95% CI = 0.80, 1.48). Current marijuana use was associated with increased risk of AIDS mortality in men (RR = 1.90, 95% CI = 1.33, 2.73), an association that probably was not causal but most likely represented uncontrolled confounding by male homosexual behavior. This interpretation was supported by the lack of association of marijuana use with AIDS mortality in men from a Kaiser Permanente AIDS database. Relative risks for ever use of marijuana were similar. CONCLUSIONS: Marijuana use in a prepaid health care-based study cohort had little effect on non-AIDS mortality in men and on total mortality in women.

Acquired Immunodeficiency Syndrome↗