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How cannabis products are being used by cancer patients and survivors in the United States is poorly understood. This study reviewed observational data to understand the modes, patterns, reasons, discontinuation, and adverse experiences of cannabis use. Of the studies identified, 27 studies met the inclusion criteria. The intercoder agreement was strong 0. Study samples were approximately equal proportions of men and women and majority White participants. The prevalence of cannabis use based on national samples ranged between 4. Younger age, male gender, being a current or former smoker, and higher socioeconomic status were associated with greater likelihood of cannabis use. The main motive for cannabis use was management of symptoms due to cancer or cancer treatment such as pain, nausea, lack of sleep, and anxiety. A majority of the participants across studies reported that cannabis helped reduce these symptoms. Lack of symptom improvement, side effects such as fatigue and paranoia, cost, and social stigma were identified as some of the reasons for discontinuing cannabis use. It appears that cannabis may help cancer patients and survivors manage symptoms. However, more longitudinal studies are needed to determine whether positive experiences of cannabis use outweigh adverse experiences over time in this vulnerable population. Cannabis use among cancer patients and survivors in the United States has gained increased attention in recent years as medicinal and recreational use of cannabis become more normalized 1. Following ballot approvals or legislation, 22 states and the District of Columbia allow medical and nonmedical recreational cannabis use, an additional 18 states allow medical only, and federal policy changes are in process 2. Cannabis use may be particularly attractive to cancer patients and survivors for its potential in managing symptoms due to cancer and cancer treatment 3. Currently there is a lack of understanding of how cannabis is being used by cancer patients and survivors in the United States. A recent study found that cancer patients who used cannabis reported statistically lower levels of symptom severity compared with nonusers 4. Other studies have also found cannabis use to be associated with lower levels of opioid use and increased adherence to chemotherapy 5 , 6. However, the use of cannabis among cancer patients remains controversial, as it also carries risks such as cognitive impairment and respiratory problems 7 , 8. Thus, understanding the potential benefits and risks of cannabis use is crucial for developing evidence-based recommendations for symptom management and improving the quality of life QoL of cancer patients and survivors. There is also a need to understand sociodemographic and other correlates of cannabis use among cancer patients and survivors. Such knowledge may help health professionals tailor messages regarding cannabis, based on current science, to specific groups of patients. Studies show that there may be sociodemographic differences in the prevalence of cannabis use among cancer patients in the United States Male cancer patients appear more likely to report cannabis use compared with female cancer patients 9. Younger patients, those aged younger than 50 years, may be more likely to use cannabis than older patients Men and younger patients are more likely to experience higher cannabis costs when consuming cannabis during cancer treatment, which may lead to substantial out-of-pocket expenses Cigarette smoking among cancer patients and survivors may be associated with an increased likelihood of cannabis use Further, there is evidence suggesting that smoking cigarettes may decrease the therapeutic effects of cannabis, potentially by altering the way cannabinoids are metabolized and distributed throughout the body In sum, recent findings related to cannabis use among cancer patients and survivors in the United States are scattered. There is, thus, a need for synthesizing the findings from population-based, observational studies to understand prevalence and patterns of cannabis use, sociodemographic and other correlates of cannabis use, and positive and adverse experiences of cannabis use in this vulnerable population. This systematic review attempted to address this need. In addition, this review sought to provide an overview of the current state of research in the area in terms of research design and sample characteristics. A systematic search of the literature was performed using PubMed and PsycINFO, with several combinations of the following and related search words: cannabis, marijuana, cancer patients, cancer survivors, and current treatment. Searches were not restricted by publication date. A manual search was then conducted between May and November Two authors independently reviewed the studies identified through the search for eligibility. To be included in the review, the studies needed to 1 be observational studies focused on cannabis use among cancer patients or survivors as opposed to interventional studies where cannabis was assigned to patients or survivors ; 2 be empirical, survey-based studies as opposed to qualitative studies based on interviews and focus groups ; 3 involve data collection from human participants; 4 have been published in English, peer-reviewed journals; and 5 be studies conducted in the United States. Studies were excluded if they were 1 intervention studies eg, clinical trials where cannabis was provided by researchers to participants; 2 animal studies; 3 review articles ie, any review of the primary literature ; 4 opinion pieces; 5 commentaries; 6 case studies, where data were not provided by participants; 7 studies conducted in countries other than the United States; 8 studies published in non-English languages; and 9 studies published as book chapters or in nonpeer-reviewed journals. Manual searches of the references of the included articles were also performed, and the Web of Science Cited Reference Search tool, which identifies other articles referencing a specific study, was used for key articles. The procedures used in this review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses protocol The search identified studies of which articles were removed as duplicates. All papers from the automated database searches were collated using the Endnote reference management software. After duplicates were deleted, screening was conducted to ensure that studies fulfilled the eligibility criteria. Of the remaining papers, were rejected for not meeting the eligibility criteria based on the review of titles and abstracts. The remaining 45 papers were screened based on the full text. A total of 27 studies were deemed eligible for inclusion in this review. Two reviewers independently assessed the included studies; discrepancies were discussed and resolved by discussion. Intercoder agreement was measured by K statistic. Reasons for exclusion were clearly documented by each reviewer. A data extraction spreadsheet was used to assess whether articles met inclusion criteria and to compare studies. For each study, the first SA and second SC author collected the following information: 1 general characteristics of the study author, publication year, study design, recruitment, and other study and sample characteristics ; 2 cancer characteristics; 3 cannabis use characteristics; and 4 main findings. We were unable to perform meta-analysis because of varied research questions, outcomes, and diverse study designs across studies. Instead, a narrative review was conducted to systematically organize and summarize the evidence using narrative synthesis. Narrative review refers to describing the characteristics of review-eligible studies, identifying common themes or patterns across the literature, and providing an overall interpretation of the findings. This narrative approach is particularly useful when the studies are too diverse or methodologically heterogeneous for statistical integration. Thus, each study was described, followed by comparative analysis and synthesis. Study quality and potential biases were evaluated using the checklist to appraise the information provided regarding each of the following criteria: study participants, sampling methods, validity and reliability of measurement instruments, study follow-up rates, statistical analysis, and consideration of confounding factors. In the current analysis the total number of yes responses was counted for each study. A higher number of yes responses indicated a lower risk of bias. A flow diagram showing the literature search and the results of the study selection process is shown in Figure 1. The K statistic measuring intercoder agreement was strong 0. PRISMA flow diagram for identification, screening, eligibility, and inclusion of studies in the review. Across all included cross-sectional and longitudinal studies, the average number of yes responses was 6. Across the 27 studies , 7 studies were longitudinal 17 , 26 , 27 , 29 , 34 , 39 , 41 , 9 reported cross-sectional data from ongoing longitudinal studies 18 , 21 , , 33 , , and 11 were cross-sectional studies 19 , 20 , 22 , 28 , , 38 , 40 , 42 , Of the 7 longitudinal studies, 2 studies 17 , 29 were prospective and 5 were retrospective studies 26 , 27 , 34 , 39 , Of the studies, 6 were conducted nationwide 18 , 21 , 23 , 24 , 32 , 43 , and 2 of the studies were conducted in 13 states and 2 US territories ie, Guam and Puerto Rico 36 , Only 4 of the 27 studies were conducted in the western United States ie, California, Oregon, and Washington 19 , 20 , 28 , A total of 12 studies 19 , 20 , 23 , 28 , 31 , , 40 , 42 , 43 reported survey response rates, which ranged from Regarding incentives for research participation, 3 studies 25 , 38 , 40 indicated having provided monetary compensation, while 1 study 23 indicated not having provided any form of compensation. The rest of the 23 studies did not report information on incentives. Supplementary Table 1 available online summarizes the participant characteristics across studies. Participant demographics across studies varied in age and ethnicity. The lowest reported mean age was Across 27 studies, 9 studies 17 , 18 , 20 , 21 , 24 , 30 , did not report cancer-related characteristics of the cancer patients or cancer survivors. The remaining studies reported different types of cancer-related characteristics: 18 studies reported cancer types ie, gastrointestinal, genitourinary, gynecological, head and neck, hematological, lymphoma, thoracic cancer 19 , 20 , 23 , , , , 11 studies reported cancer stage ie, stage I, stage II, stage III, or stage IV 19 , 20 , 26 , 27 , 29 , , 39 , 42 , 3 studies reported cancer site ie, colon, larynx, oral cavity, oropharynx, rectum 20 , 28 , 35 , and 2 studies 19 , 31 reported cancer status ie, active or remission. The most frequently 20 of 27 studies reported cancer types, for the samples across studies, were gynecological ie, breast, cervix, endometrium, ovarian, uterine and gastrointestinal ie, colorectal, gallbladder, liver, esophageal, pancreatic cancer. Samples across studies varied in terms of cannabis use prevalence. Supplementary Table 2 available online provides prevalence rates of cannabis use among participants across the 27 studies. The prevalence of cannabis uses among cancer patients and survivors across studies based on national samples ranged between 4. Of the 27 studies, 20 17 , 18 , 22 , 23 , , , reported modes of cannabis consumption, which were as follows: 1 smoking, 2 vaping, 3 topical application, and 4 ingestion of edible products. The frequencies of cannabis use ie, daily, weekly, or monthly were reported in 13 of the 27 studies , 28 , 31 , 32 , 37 , Both cannabidiol CBD and tetrahydrocannabinol THC were commonly used, either alone 19 or in combination 25 , 29 , 30 , 34 , 39 , 40 , 42 , 43 across these 9 studies. A total of 8 studies 17 , 19 , 25 , 32 , 33 , 40 , 42 , 43 reported cannabis acquisition history and indicated that cancer patients and survivors acquire cannabis mainly through medical dispensaries Among the 8 studies that reported cannabis acquisition history, participants in 3 studies reported having a registration card for medical marijuana. Four studies 32 , 38 , 40 , 43 assessed where participants obtained information on cannabis. The information sources identified were newspaper, television, websites and blogs, social media, friends and family members, physician, nurse, pharmacist in dispensary, movies or documentaries, coworker or colleague, and advertisements. The most frequently accessed sources of information for cannabis were websites and blogs Table 1 summarizes the findings of the reviewed studies. Included study findings on cannabis use among cancer patient and survivors a. Symptoms: severe or chronic pain Adverse effects: cloudy thinking is the symptom that worsened the most Cancer pain: African American participants were estimated to have a mean least pain score of 1. Symptoms vs relief effects: pain Symptoms: patients who took at least 1 dose of medical marijuana pain improvement Adverse effect: impaired mental functioning feeling fuzzy or foggy; 5. Reason for cannabis use: pain Meghani et al. Studies found young age to be associated with a more positive and open-minded attitude toward cannabis use 18 , 23 , 25 , Generally, younger individuals were found to show higher prevalence of cannabis use 18 , 23 , 25 , 35 , except for 1 study 30 in which older age was associated with increased medical cannabis use. Three studies showed higher cannabis use among men 26 , 27 , Three studies also examined the likelihood of cannabis use based on marital status 26 , 35 , Their findings were mixed. One study with cancer patients reported greater cannabis use among single 26 or unmarried 36 individuals, whereas another study with cancer survivors reported greater use among married individuals Studies generally indicated that cancer patients and survivors use cannabis for management of symptoms due to cancer or cancer treatment 17 , , 34 , These symptoms included pain, loss of appetite, nausea, lack of sleep, and increased anxiety. Across the 27 studies, 13 studies 17 , , 34 , reported that cannabis use resulted in symptom reduction. Generally, these studies reported that individuals experienced subjective relief in various domains such as pain, appetite, nausea, sleep, and anxiety. Three studies reported that individuals who use cannabis are more likely to report lower subjective pain 22 , 24 , Another study found that cannabis use was associated with moderate mitigation of itching Two studies found that initiation of regular cannabis use reduced the use of prescribed opioids use among cancer patients 19 , Raghunathan et al. A total of 6 studies assessed the adverse effects of cannabis use 17 , 31 , 37 , 39 , 41 , Of the 6 studies, 3 found minimal adverse effects 17 , 39 , Generally observed adverse effects included cloudy thinking 31 , 41 , 42 , decreased energy 31 , impaired mental functioning 42 , dry mouth 42 , and paranoid thinking 42 and anxiety Three studies linked higher depression with increased cannabis use 26 , 36 , Two studies identified factors that led patients to discontinue using cannabis 29 , These included lack of symptom improvement, adverse effects fatigue and paranoia , and cost and social stigma. QoL was evaluated in 3 studies 20 , 34 , These studies found that cancer patients and survivors who used cannabis had lower QoL than those who did not use cannabis. The evaluation of QoL in each these 3 studies was conducted by using a different QoL instrument. For example, Calcaterra et al. The FACT-C includes subcategories that focus on physical, social, emotional, functional well-being, and colorectal cancer-related concerns. Studies found that individuals who are current smokers or who have history of smoking tobacco are more likely to use cannabis 18 , 27 , 35 , The current review set out to synthesize findings of population-based, observational studies on cannabis use among cancer patients and survivors in the United States. In particular, we attempted to examine the current state of the research in terms of research design, regions where the research has been conducted, and sample characteristics. In addition, we attempted to synthesize the findings in terms of cannabis use prevalence and characteristics among cancer patients and survivors, reasons for cannabis use, positive and adverse experiences of cannabis use, and sociodemographic and other correlates of cannabis use. According to Mahurin et al. Weiss et al. Only 3 among the currently reviewed studies 18 , 23 , 38 reported on sampling methods, suggesting a possible methodological limitation. However, 6 studies 18 , 21 , 23 , 24 , 32 , 43 analyzed large national datasets, likely utilizing more rigorous sampling approaches, though specific details about sampling were not provided. Moreover, 9 studies 18 , 21 , , 33 , collected data as part of parent longitudinal studies; hence, it is possible that sampling strategies for these studies have been described elsewhere. In general, however, as noted by the majority of the studies themselves, studies were mostly based on selective samples, which may have limited their generalizability. Future studies based on rigorous sampling methods may be needed to better understand cannabis use among cancer patients and survivors in the United States. Types of cannabis reported in the studies also varied in that some studies focused on the mode of consumption eg, smoking, eating edibles , while others focused on the cannabinoid type ie, THC and CBD. A recent study reported that oral ie, sublingual cannabis products may be associated with short-term improvements in chronic pain but increased risk for dizziness and sedation Most studies reported age to be negatively associated with cannabis use; however, 1 study 30 noted that older age was associated positively with medicating with cannabis for symptom management. There is a possibility that the association between age and cannabis use among cancer patients and survivors may be partly explained by the purpose of cannabis use 10 , Future studies need to examine how reasons for using cannabis are associated with cannabis use among cancer patients and survivors. One study examined racial differences between White and African American cancer patients, finding that African American cancer patients who did not use cannabis reported statistically lower pain scores than White patients, whereas no difference was observed among those who use cannabis No other studies examined racial and ethnic differences in this current review, which implies that future studies should consider involving more ethnically diverse samples so that analyses pertaining to racial and ethnic differences are possible. Cannabis-related policy changes have been shown to increase rates of cannabis use across most racial and ethnic populations, but it is currently unclear how cannabis policies affect cannabis use in cancer patients across racial and ethnic groups The current evidence suggests that specific symptoms of pain, nausea and vomiting, loss of appetite and cachexia, anxiety, sleep disturbance, and medical trauma prompt patients with cancer to medicate with cannabis 1. However, there is also some evidence suggesting that short- and long-term cannabis use may have adverse neuropsychological effects Thus, the oncologists recommending medical cannabis may need to carefully evaluate the potential risks and benefits of cannabis use for individual cancer patients. In specialty services where many patients use cannabis for medical purposes, such as oncology, less than one-third of clinicians report feeling comfortable with their knowledge of medical cannabis, or of recommending its use Cancer patients desired to receive information about cannabis use during their treatment from the oncology providers Oncologists can play a vital role in reducing the stigma associated with cannabis use and ensuring that patients have access to accurate information to make informed decisions about their health care. Through evidence-based evaluation, communication, patient education, and collaboration with other health professionals, oncologists may guide patients in making informed decisions about incorporating medical cannabis into their overall cancer treatment plan. Oncologists can collaborate with pharmacists and palliative care specialists to ensure comprehensive and coordinated care for their patients. Importantly, however, all health-care providers must consider potential side effects, drug interactions, and individual patient factors when considering medical cannabis as part of a comprehensive treatment plan. The present study also revealed that cancer patients and survivors who used cannabis had lower QoL than those who did not use cannabis. But the use of diverse measurement tools for assessing QoL across the studies 20 , 34 , 35 poses a challenge when synthesizing and comparing the results. For instance, Calcaterra et al. Even though both studies had a primary focus on symptom assessment—based QoL, they employed different instruments to measure QoL and were based in clinical settings. In addition, Newcomb et al. Calcaterra et al. However, Nathan et al. This methodological diversity underscores the need for care while interpreting and integrating the findings from these studies. Future research should prioritize standardizing QoL measurement tools for cancer patients and survivors using cannabis to ensure more consistent and comparable assessments. There are some limitations to the current systematic review, which are partly related to the limitations across the studies reviewed. A key limitation across studies has been the unstandardized and inconsistent reporting about cannabis product formulation, route of administration, stages, anatomical site of cancer, sampling method, and purpose of cannabis use. We did not assess any differences in medicating with cannabis and cancer type because of predefined scope and objectives of our current review; however, this highlights a potential avenue for future research. Another limitation is that the present review compared heterogeneous studies that used various study designs cohort vs cross-sectional studies ; therefore, we were unable to assess publication bias because of the diverse outcomes reported in the studies. In addition, data from the studies published in languages other than English were not included. This study is statistically for providing an overview of the current state of population-based, observational studies on cannabis use among cancer patients and survivors in the United States. This systematic review synthesized data exclusively from the published literature. A comprehensive search of PubMed and PsycINFO databases was conducted to identify relevant studies published that met the predetermined eligibility criteria. All data analyzed in this systematic review are available in the public domain. The Management of cancer symptoms and treatment-induced side effects with cannabis or cannabinoids. J Natl Cancer Inst Monogr. Google Scholar. Marijuana Legality by State. Accessed August Cannabis use prevalence, patterns, and reasons for use among patients with cancer and survivors in a state without legal cannabis access. Support Care Cancer. Patterns of medical cannabis use among cancer patients from a medical cannabis dispensary in New York State. J Palliat Med. Medical cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain. J Pain. Adherence, safety, and effectiveness of medical cannabis and epidemiological characteristics of the patient population: a prospective study. Front Med. Cannabis use and cognitive dysfunction. Indian J Psychiatry. Marijuana use, respiratory symptoms, and pulmonary function: a systematic review and meta-analysis. Ann Intern Med. Gender differences in medical cannabis use: symptoms treated, physician support for use, and prescription medication discontinuation. J Womens Health Larchmt. Portman D , Donovan K. Age-related differences in cannabis use by cancer patients referred for supportive care. J Clin Oncol. Out-of-pocket costs from cannabis use in patients during cancer treatment at a major U. Associations among marijuana use, health-related quality of life, exercise, depression and sleep in cancer survivors. J Adv Nurs. Associations between cigarette smoking and cannabis dependence: a longitudinal study of young cannabis users in the United Kingdom. Drug Alcohol Depend. Chemistry, metabolism, and toxicology of cannabis: Clinical implications. Iran J Psychiatry. Syst Rev. Critical Appraisal Tools. J Oncol Pract ; 15 4 : e - e Cigarette, e-cigarette, alcohol, and marijuana use by cancer diagnosis status: a longitudinal analysis. Subst Abuse. Non-prescription cannabis use for symptom management amongst women with gynecologic malignancies. Gynecol Oncol Rep. A population-based survey to assess the association between cannabis and quality of life among colorectal cancer survivors. BMC Cancer. Prevalence of cannabis use among individuals with a history of cancer in the United States. Differences between cancer patients and others who use medicinal Cannabis. PLoS One. Dai H , Richter KP. A national survey of marijuana use among US adults with medical conditions, Cannabis use among cancer survivors in the United States: analysis of a nationally representative sample. Am J Hosp Palliat Care. Cannabis use in young adult cancer patients. J Adolesc Young Adult Oncol. Medical marijuana use in head and neck squamous cell carcinoma patients treated with radiotherapy. Medical marijuana utilization in gynecologic cancer patients. Patterns of medical cannabis use among older adults from a cannabis dispensary in New York State. Cannabis Cannabinoid Res. Medical cannabis in cancer patients: a survey of a community hematology oncology population. Am J Clin Oncol. Cannabis use among patients with cutaneous lymphoma: a cross-sectional survey. Complement Ther Med. Impact of cannabis use on least pain scores among African American and white patients with cancer pain: a moderation analysis. J Pain Res. Assessing efficacy and use patterns of medical cannabis for symptom management in elderly cancer patients. Cannabis use is associated with patient and clinical factors in a population-based sample of colorectal cancer survivors. Cancer Causes Control. Poghosyan H , Poghosyan A. Marijuana use among cancer survivors: quantifying prevalence and identifying predictors. Addict Behav. Association between daily and non-daily cannabis use and depression among United States adult cancer survivors. Nurs Outlook. Use and perceptions of opioids versus marijuana among cancer survivors. J Cancer Educ. In the weeds: a retrospective study of patient interest in and experience with cannabis at a cancer center. Medical cannabis use in glioma patients treated at a comprehensive cancer center in Florida. Experience with medical marijuana for cancer patients in the palliative setting. Medical marijuana use for cancer-related symptoms among Floridians: a descriptive study. Pacula RL , Smart R. Medical marijuana and marijuana legalization. Annu Rev Clin Psychol. Cannabis-based products for chronic pain: a systematic review. Health conditions and motivations for marijuana use among young adult medical marijuana patients and non-patient marijuana users. Drug Alcohol Rev. Racial and ethnic differences in cannabis use following legalization in us states with medical cannabis laws. Solowij N , Michie PT. Cannabis and cognitive dysfunction: parallels with endophenotypes of schizophrenia? J Psychiatry Neurosci. J Clin Oncol ; 36 19 : - Cannabis use among patients at a comprehensive cancer center in a state with legalized medicinal and recreational use. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign in through your institution. JNCI Portfolio. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume 8. Article Contents Abstract. Data availability. Author contributions. Conflicts of interest. Journal Article. Cannabis use among cancer patients and survivors in the United States: a systematic review. Oxford Academic. Si Woo Chae, MA. Crissy T Kawamoto, BSc. Kristina T Phillips, PhD. Pallav Pokhrel, PhD. Revision received:. Corrected and typeset:. Select Format Select format. Permissions Icon Permissions. Abstract Background. Figure 1. Open in new tab Download slide. Table 1. Open in new tab. Total sample. Anderson et al. Google Scholar Crossref. Search ADS. Google Scholar PubMed. Published by Oxford University Press. For commercial re-use, please contact journals. Issue Section:. Download all slides. Supplementary data. Views 1, More metrics information. Total Views 1, Email alerts Article activity alert. New issue alert. In progress issue alert. Receive exclusive offers and updates from Oxford Academic. Citing articles via Web of Science 1. Latest Most Read Most Cited Impact of chemotherapy on patients with mismatch repair deficient advanced endometrial carcinomas—a meta-analysis. Cancer care and the coconut tree: all in which it lives, and has come before. More from Oxford Academic. Medicine and Health. Authoring Open access Purchasing Institutional account management Rights and permissions. Get help with access Accessibility Contact us Advertising Media enquiries. Cancer Cancer 4. Cancer survivor Survivor 4. Cancer Survivor Reasons for cannabis use: pain

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Official websites use. Share sensitive information only on official, secure websites. Vin-Raviv colostate. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. The purpose of this paper is to examine the relationship between marijuana use and health outcomes among hospitalized patients, including those hospitalized with a diagnosis of cancer. All models were adjusted for age, gender, race, residential income, insurance, residential region, pain, and number of comorbidities. Keywords: Cancer patients, hospitalized patients, inpatient outcomes, marijuana use. While recreational use of marijuana is legal now legal in 7 states and in the District of Columbia 1. Cancer is a qualifying medical condition in every state that has approved marijuana for medical use 2. Decriminalization of marijuana use and possession in some of these states has led to more widespread use 3. In , the number of cancer registrants in the Colorado Medical Marijuana Registry grew rapidly — from in December to in December 4. Yet, the efficacy and use of marijuana in oncology settings is a subject of complex and controversial debate 8. The limited data on effectiveness contrast with accumulating data suggesting a number of harmful medical effects of marijuana on users 9. Recreational marijuana use has been linked to several adverse health outcomes including addiction, impaired cognition, and mental illness 9 , Additionally, recent evidence suggests that recreational marijuana use may be associated with both cardiovascular and cerebrovascular events 13 , 14 , 15 , and frequent use has been associated with increased risk of myocardial infarction 16 , Research studies have also demonstrated that recreational marijuana uses is associated with subarachnoid hemorrhage, intracerebral hemorrhage, and acute ischemic stroke 18 , In oncology settings, most studies to date have focused specifically on marijuana use among advanced cancer patients 6 , Therefore, the magnitude of side effects due to marijuana could not be accurately assessed. More research is needed to elucidate the potential adverse and beneficial effects of marijuana use on health outcomes 10 , Thus, the purpose of this study was to assess the prevalence of marijuana use among hospitalized patients with and without a primary cancer diagnosis, and its association with health outcomes. By utilizing data from the large Nationwide Inpatient Sample database, we are able to examine relatively rare events, using clinical data to document diagnoses of cancer and marijuana uses. Our definition of marijuana use is similar to the one used by Rumalla et al. Residential region was classified into large metropolitan areas metropolitan areas with 1 million residents or more , small metropolitan areas metropolitan areas with less than 1 million residents , micropolitan areas nonmetropolitan areas adjacent to metropolitan areas and nonmetropolitan or micropolitan areas noncore areas with or without own town according to the version of the Urban Influence Codes 2. Other conditions were excluded as they were part of our study outcomes, for example, myocardial infarction, congestive heart failure, peripheral vascular disease, and cerebrovascular disease. Two study populations were analyzed in this study; all patients regardless of diagnosis, as well as patients with a primary diagnosis of cancer. This study included a total of approximately 3. Marijuana users were less likely to have a diagnosis of cancer 1. Using a multivariable adjusted analysis among all hospitalized patients, marijuana use was associated with significantly reduced odds of heart failure OR: 0. Among cancer patients Table 3 , marijuana use was associated with slightly increased, but not statistically significant odds of heart failure OR: 1. All models were adjusted for age, gender, race, residential income, insurance, residential region, and number of comorbidities. Multivariable adjusted associations between marijuana use c and hospitalization outcomes among ALL patients, Nationwide Inpatient Sample — a. Models adjusted for age, gender, race, residential income, insurance, region, pain, and number of comorbidities. Marijuana is becoming increasingly available to the general population given the rapidly changing landscape surrounding marijuana use and possession policies across the US. There is significant interest in examining the health effects of marijuana among adults in general, but more importantly among those with health conditions or chronic diseases. Among cancer patients, there was a positive but nonsignificant association between marijuana use and heart failure and cardiac disease, and an inverse but nonsignificant association between marijuana use and stroke. However, other studies have failed to observe any increased risk of adverse health outcomes associated with marijuana use 43 , Conflicting results may be due to major differences in study population, underlying health status, source of data on marijuana use e. Therefore, the influence of marijuana use on cardiac outcomes may vary by age due to differing etiological factors. Fewer studies have focused on homogenous study populations using objective measures to assess marijuana use and health outcomes. Consistent with previous findings by Rumalla et al. Rumalla et al. This suggests that complications arising from the use of multiple substances may lead to adverse health outcomes. Other studies where marijuana use was linked with adverse health outcomes such as myocardial infarction and death also reported that patients tended to be younger and have additional risk factors, such as cocaine, tobacco, and alcohol use 17 , Similarly, a 4. Larger prospective studies with objective measures of marijuana use and health outcomes will be needed to better examine these associations. Nevertheless, these findings provide information suggesting that marijuana use is negatively associated with certain health outcomes that may be important for older, sicker population groups. Pain management in this population subgroup is often the main reason for medical marijuana use 27 , 56 , however, we observed similar associations between marijuana use and health outcomes regardless of clinical diagnosis of pain although there is no straightforward and reliable method to identify chronic pain using administrative databases The presented results are subject to certain limitations. First, the analyses were based on a database of inpatient hospitalizations and therefore only health outcomes that were captured during inpatient admissions were included in this study. Second, we evaluate the relationships between a clinical diagnosis of marijuana use with clinical outcomes using the NIS database between and Fourth, the extent to which cannabis use represents medical or recreational use is unknown. No formal coding exists to specify the specific indication, dose, or timing of use. There are also several strengths of this analysis. First, there is very little direct evidence regarding the association between marijuana use and health outcomes among older, sicker adults in the US. Second, the associations between marijuana use and health outcomes were assessed using clinical claims data in a nationally representative dataset, with detailed adjustment for multiple confounders. As the use of both medical and recreational marijuana becomes increasingly prevalent for pain management or other purposes, knowledge and awareness among health care professionals is essential to educate patients about the appropriate use of marijuana. Both health care providers and patients will need to carefully consider the anticipated benefits in light of potentially significant health risks. As a library, NLM provides access to scientific literature. Cancer Med. Find articles by Tomi Akinyemiju. Find articles by Qingrui Meng. Find articles by Swati Sakhuja. Find articles by Reid Hayward. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

Buy marijuana online in Nis