When the deadly disease that became known as COVID-19 began spreading in late 2019, scientists rushed to answer a crucial question: Who is most at risk? Age, smoking history, high body mass index (BMI), and the presence of other diseases such as diabetes increased the odds. But one suggested risk factor remains unconfirmed more than four years later: the use of cannabis. Over time, evidence has emerged indicating both protective and harmful effects.
The effects of cannabis
A new study conducted by researchers at the Washington University School of Medicine in St. Louis definitely points to this last aspect: cannabioids are linked to an increased risk of serious illness for people affected by COVID-19.
The study, published June 21 on JAMA Network Open analyzed the medical records of 72,501 people seen for COVID-19 at health centers in a major Midwestern health system during the first two years of the pandemic.
The researchers found that people who reported using any form of cannabioids at least once in the year before developing COVID-19 were significantly more likely to need hospitalization and intensive care than people without such history. This elevated risk of serious disease was equal to that from smoking.
“There’s a feeling among the public that cannabis is safe to use, that it’s not as bad for your health as smoking or drinking, that it might even be good for you,” said senior author Li-Shiun Chen , MD, DSc, a professor of psychiatry.
“I think this is because there hasn’t been as much research done on the health effects of cannabis compared to those of tobacco or alcohol. What we have found is that cannabis use is not harmless in the context of COVID-19. People who reported yes to current cannabis use, with any frequency, were more likely to require hospitalization and intensive care than those who did not use cannabis.”
Cannabis use differed from tobacco smoking in one key outcome measure: survival. While smokers were significantly more likely to die from COVID-19 than nonsmokers – a finding that agrees with numerous other studies – the same was not true for cannabis users, the study showed.
“The independent effect of cannabis is similar to the independent effect of tobacco regarding the risk of hospitalization and intensive care,” Chen said. “Regarding the risk of death, the risk of tobacco is clear, but more evidence is needed for cannabis.”
The study analyzed deidentified electronic health records of people who were seen for COVID-19 at BJC HealthCare hospitals and clinics in Missouri and Illinois between February 1, 2020 and January 31, 2022. The records contained data on characteristics demographics such as gender, age, and race; other medical conditions such as diabetes and heart disease; substance use including tobacco, alcohol, cannabis and vaping; and disease outcomes, particularly hospitalization, intensive care unit (ICU) admission, and survival.
COVID-19 patients who reported using cannabis in the previous year were 80% more likely to be hospitalized and 27% more likely to be admitted to intensive care than patients who had not used cannabis, after taking into account tobacco smoking, vaccination, other health conditions, date of diagnosis, and demographic factors.
For comparison, tobacco smokers with COVID-19 were 72% more likely to be hospitalized and 22% more likely to need intensive care than nonsmokers, after adjusting for other factors .
These findings contradict some other research that suggests cannabis may help the body fight viral diseases like COVID-19.
body to fight viral diseases such as COVID-19.
“Most of the evidence suggesting that cannabis is good for you comes from cell or animal studies,” Chen said. “The advantage of our study is that it is conducted in people and uses real health data collected at multiple sites over an extended period of time. All outcomes were verified: hospital admission, intensive care stay, death. Using this dataset, we were able to confirm the well-established effects of smoking, which suggests that the data is reliable.”
The study was not designed to answer the question of why cannabis use might make COVID-19 worse. One possibility is that inhaling marijuana smoke damages delicate lung tissue and makes it more vulnerable to infection, in much the same way that tobacco smoke causes lung damage that puts people at risk for pneumonia, they said. said the researchers.
This isn’t to say that taking edibles is safer than smoking joints. It’s also possible that cannabis, known to suppress the immune system, undermines the body’s ability to fight viral infections, regardless of how it is consumed, the researchers noted.
“We simply don’t know whether edibles are safer,” said first author Nicholas Griffith, MD, a medical resident at Washington University. Griffith was a medical student at Washington University when he conducted the study.
“People were asked a yes or no question: ‘Have you used cannabis in the past year?’ This gave us enough information to determine that if you use cannabis, your health trajectory will be different, but we can’t know how much cannabis you need to use, or whether it makes a difference whether you smoke it or eat edibles. These are questions we would really like to answer. I hope this study opens the door to further research into the health effects of cannabis.”
Heavy cannabis use linked to cardiovascular disease mortality in women
According to a study published online in JAMA Network Open, excessive cannabis use is associated with a significantly increased risk of cardiovascular disease (CVD) mortality among women.
Alexandre Vallée, M.D., Ph.D., of Foch Hospital in Suresnes, France, examined sex-stratified associations between cumulative lifetime cannabis use and all-cause, cardiovascular disease, and mortality. for cancer, using data from volunteers in the UK Biobank population. Data for 121,895 participants were included.
During a median follow-up of 11.80 years, Vallée identified 2,375 total deaths, including 1,411 and 440 deaths from cardiovascular disease and cancer, respectively. After full adjustment, in men, the hazard ratios (95% confidence intervals) were 1.28 (0.90 to 1.81), 0.98 (0.43 to 2.25), and 1.09 (0.71 to 1.67) for all-cause mortality, CVD mortality, and cancer mortality, respectively, for heavy cannabis users compared to non-users.
In women, the corresponding hazard ratios (95% confidence intervals) after full adjustment were 1.49 (0.92 to 2.40), 2.67 (1.19 to 4.32), and 1.61 (0.91 to 2.83) among heavy cannabis users compared to non-users.
After full adjustment, heavy cannabis use was associated with a significantly increased risk of all-cause mortality, cardiovascular disease mortality, and cancer mortality among women who currently smoke tobacco and with cardiovascular disease mortality among women who currently smoke tobacco. they never smoke tobacco. Heavy cannabis use has been associated with a significantly increased risk of cancer mortality in current male tobacco users.
“Individuals who use cannabis should be considered for appropriate cardiovascular risk reduction strategies, especially among women,” Vallée writes.
High rates of depression and anxiety in people who use both tobacco and cannabis
According to a study published this week in the open-access journal PLOS ONE by Nhung Nguyen of the University, people who use both tobacco and cannabis are more likely to report anxiety and depression than those who used only tobacco or those who used neither. two substances. of California, San Francisco, United States and colleagues.
Tobacco and cannabis are among the most commonly used substances worldwide, and their concomitant use is increasing in the context of increasing cannabis legalization. In the new study, researchers analyzed substance use and mental health data from 53,843 U.S. adults who participated in online surveys as part of the COVID-19 Citizens Health Study, which collected data from 2020 to 2022.
Overall, 4.9% of participants reported using tobacco only, 6.9% reported using cannabis only, and 1.6% reported co-use. Among people in the co-use group, 26.5% reported anxiety and 28.3% reported depression, while among people who used neither tobacco nor cannabis, rates of anxiety and depression were 10.6%. and 11.2%.
The study found that the likelihood of having these mental health disorders was about 1.8 times greater for co-users than non-users. Co-use and exclusive use of cannabis were also associated with a greater likelihood of suffering from anxiety compared to tobacco use alone.
This study cannot determine causality. However, the authors conclude that concurrent tobacco and cannabis use is associated with poor mental health and suggest that integrating mental health support with tobacco and cannabis cessation programs may help address this link.
The authors add: “Both tobacco and cannabis use is linked to reduced mental well-being.”
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