Health-Care Use by Frequent Marijuana Smokers Who Do Not Smoke Tobacco

Kaiser Permanente Center for Health Research, Portland, Oregon 97227-1098.
Western Journal of Medicine 07/1993; 158(6):596-601.
Source: PubMed


Even though marijuana smoke contains carcinogens and more tar than tobacco smoke and marijuana intoxication has been implicated as a risk factor for injuries, relatively little epidemiologic evidence has identified marijuana use as a risk factor for ill health. This study is the first to examine the health effects of smoking marijuana by comparing the medical experience of "daily" marijuana smokers who never smoked tobacco (n = 452) with a demographically similar group of nonsmokers of either substance (n = 450). Marijuana smoking status was determined during multiphasic health checkups at Kaiser Permanente medical centers between July 1979 and December 1985. Medical records were reviewed for as long as 2 years after the checkups. Frequent marijuana smokers had small increased risks of outpatient visits for respiratory illnesses (relative risk [RR] = 1.19; 95% confidence interval [CI] = 1.01, 1.41), injuries (RR = 1.32; CI = 1.10, 1.57), and other types of illnesses (RR = 1.09; CI = 1.02, 1.16) compared with nonsmokers; their risk of being admitted to a hospital was elevated but not statistically significant (RR = 1.51; CI = 0.93, 2.46). Analyses were adjusted for sex, age, race, education, marital status, and alcohol consumption. Daily marijuana smoking, even in the absence of tobacco, appeared to be associated with an elevated risk of health care use for various health problems.

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    • "Though cannabis has been suggested to have moderate overall effects on society (Nutt et al., 2011), studies have shown that cannabis use may be associated with impaired functional outcomes and mental health. It has been found to be associated with impaired educational attainment (Lynskey and Hall, 2000), reduced workplace productivity (Lehman and Simpson, 1992), motor vehicle accidents (National Highway Traffic Safety Administration, 2001), and impaired physical health (Polen et al., 1993). Reports have suggested that cannabis use may be associated with welfare dependence (Schmidt et al., 1998), reduced income (Degenhardt et al., 2007) and impaired interpersonal relationships (Newcomb and Bentler, 1988). "
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    ABSTRACT: Cannabis is the most widely used illicit substance worldwide. The aim of the present study was to assess self-reported Quality of Life (QoL) among cannabis users in a large representative sample. We analyzed data from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC, n=43,093). Health-related QoL was assessed using the Short-form 12-item Health Survey (SF-12). The contribution of cannabis use and cannabis use disorders (CUD) to SF-12 scores was assessed using multiple linear regressions models. The prevalence of cannabis use and CUD in the last 12 months was 4.1% and 1.5%, respectively. Mean SF-12 mental summary scores were significantly lower (indicating a lower QoL) among female and male cannabis users compared to non-users (by 0.6 standard deviations (SD) and 0.3 SD, respectively), and among females and males with CUD compared to those without CUD (by 0.9 SD and 0.4 SD, respectively). Controlling for sociodemographic variables and mental illness, each joint smoked daily was associated with a greater decrease in mental QoL summary scores in females (0.1 SD) compared to males (0.03 SD). Cannabis use and CUD were associated with lower self-reported mental QoL. Specifically, our findings showed that cannabis use and CUD have a more significant effect on self-reported mental health QoL among female users. Assessing severity of cannabis use and impact of CUD should take into account functional and emotional outcomes. This may particularly aid in detecting the impact of cannabis use and CUD on mental health-related QoL among females.
    Drug and alcohol dependence 12/2011; 123(1-3):190-200. DOI:10.1016/j.drugalcdep.2011.11.010 · 3.42 Impact Factor
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    • "Our standard economic framework is based on the premise that individuals do not consume health care for immediate pleasure but rather for the effect that health care has on health status and, consequently, on overall utility or wellbeing (Grossman 1999; Phelps 2002). Illicit drug use is expected to affect health care utilization by causing increased health problems (see previous section), which would normally lead to increased demand for health care (e.g., Mor et al. 1992; Polen et al. 1993; Cherpitel 1999, 2003; French et al. 2000a; McGeary and French 2000; Kushel et al. 2002; Masson et al. 2004). Under this framework, the derived demand for health care is given by HC ¼ fðH ðD; X Þ; X Þ ð 1Þ where HC is a measure of health care utilization (e.g., ER visits, inpatient hospital days), H denotes health problems, D refers to illicit drug use, and X captures individual characteristics that affect the consumption of health care "
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    ABSTRACT: To analyze the relationships between illicit drug use and three types of health services utilization: emergency room utilization, hospitalization, and medical attention required due to injury(s). Waves 1 and 2 (11,253 males and 13,059 females) from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We derive benchmark estimates by employing standard cross-sectional data models to pooled waves of NESARC data. To control for potential bias due to time-invariant unobserved individual heterogeneity, we reestimate the relationships with fixed-effects models. The cross-sectional data models suggest that illicit drug use is positively and significantly related to health services utilization in almost all specifications. Conversely, the only significant (p<.05) relationships in the fixed-effects models are the odds of receiving medical attention for an injury and the number of injuries requiring medical attention for men, and the number of times hospitalized for men and women. Failing to control for time-invariant individual heterogeneity could lead to biased coefficients when estimating the effects of illicit drug use on health services utilization. Moreover, it is important to distinguish between types of drug user (casual versus heavy) and estimate gender-specific models.
    Health Services Research 12/2010; 46(3):877-99. DOI:10.1111/j.1475-6773.2010.01218.x · 2.78 Impact Factor
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    • "Of particular concern are the carcinogenic polynuclear (or " polycyclic " ) aromatic hydrocarbons (PAHs), known byproducts of combustion that are thought to be a major culprit in smoking-related cancers. While there exists no epidemiological evidence that marijuana smokers face a higher risk of smoking-related cancers, studies have found that they do face a higher risk of bronchitis and respiratory infections (Polen et al. 1993, Tashkin 1993). This risk is not thought to be due to cannabinoids, but rather to extraneous byproducts of pyrolysis in the smoke. "
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    ABSTRACT: Cannabis vaporization is a technology designed to deliver inhaled cannabinoids while avoiding the respiratory hazards of smoking by heating cannabis to a temperature where therapeutically active cannabinoid vapors are produced, but below the point of combustion where noxious pyrolytic byproducts are formed.This study was designed to evaluate the efficacy of an herbal vaporizer known as the Volcano®, produced by Storz & Bickel GmbH&Co. KG, Tuttlingen, Germany ( Three 200 mg samples of standard NIDA cannabis were vaporized at temperatures of 155°–218°C. For comparison, smoke from combusted samples was also tested.The study consisted of two phases: (1) a quantitative analysis of the solid phase of the vapor using HPLC-DAD-MS (High Performance Liquid Chromatograph-Diode Array-Mass Spectrometry) to determine the amount of cannabinoids delivered; (2) a GC/MS (Gas Chromatograph/ Mass Spectrometer) analysis of the gas phase to analyze the vapor for a wide range of toxins, focusing on pyrene and other polynuculear aromatic hydrocarbons (PAHs).The HPLC analysis of the vapor found that the Volcano delivered 36%–61% of the THC in the sample, a delivery efficiency that compares favorably to that of marijuana cigarettes.The GC/MS analysis showed that the gas phase of the vapor consisted overwhelmingly of cannabinoids, with trace amounts of three other compounds. In contrast, over 111 compounds were identified in the combusted smoke, including several known PAHs.The results indicate that vaporization can deliver therapeutic doses of cannabinoids with a drastic reduction in pyrolytic smoke compounds. Vaporization therefore appears to be an attractive alternative to smoked marijuana for future medical cannabis studies.
    Journal of Cannabis Therapeutics 10/2008; 4(1). DOI:10.1300/J175v04n01_02
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