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The old open question of marijuana and healthcare: Flares from NANHES

Published:August 30, 2016DOI:https://doi.org/10.1016/j.ejim.2016.08.016
      The issue about marijuana use and health problems is an old question that has been actual for many years. If, on one hand, the medical interest towards the use of marijuana has been related to its possible application in some clinical conditions that range from pain control to neuromuscular diseases, on the other hand, many implications are strictly linked to the social system, the legal use, the effects on the younger population and also to the ethical consequences [
      • Rubens M.
      Political and medical views on medical marijuana and its future.
      ]. In many states, the use of marijuana still poses a difficult social, political and medical open question [
      • Gulland A.
      Sixty second on…medical marijuana.
      ]. The latter is undoubtedly a disputed matter, running on two parallel pathways where the meeting point is surely hard to find. In fact, the medical doctor is often clamped between the clinical need and the legal duties; therefore, only the scientific evidences can represent a good and strong backing that helps the clinical decision process frequently characterized by the real life scenario [
      • Pacula R.L.
      • Powell D.
      • Heaton P.
      • et al.
      Assessing the effects of medical marijuana laws on marijuana use: The devil is in the details.
      ]. The general word economical and temporary conditions, especially in some countries, require a cautious use of the healthcare system resources along with definite political choices. Given these considerations, the paper by Bhandary et al. [
      • Bhandari S.
      • Hillard C.J.
      • Venkatesan T.
      Marijuana users do not have increased healthcare utilization: A national health and nutrition examination survey (NHANES) study.
      ], sheds some light on the use of marijuana and the healthcare utilization in the US population. The study comes from the National Health and Nutrition Examination Survey (NHANES) based on a large sample of the general population that represents well the real life conditions. No significant association was found between marijuana use and healthcare utilization. Moreover, the latter was not affected by confounding factors as frequency of marijuana use, age and comorbidities. However, as the Authors correctly underline, the population of marijuana users has a significantly higher proportion of smokers, alcohol and polysubstances users, so marijuana is not always a neutral and irrelevant tendency and in particular it appears strictly linked to major habits. On the other side the Family Income to Poverty Ratio reveals that the frequent marijuana users have a better income, suggesting that probably the frequent use of marijuana is not only related to a low social status. The age is an important factor related to healthcare system utilization with younger people that, even if smoking more marijuana, have less chances to have comorbidities and hence to need medical assistance. As all scientific evidences also this study has some limitations, which must be seen as incentives to drive new research that will explain: 1) the effects of cumulative exposure to marijuana in order to find a new clinical score able to identify an epidemiological cut-off as a risk factor for healthcare utilization; 2) the quantitative previous marijuana exposure/marijuana habit or routine use as a risk factor for respiratory disease, emergency visits or psychological disorders; 3) the relation between age, marijuana use and presence of comorbidities; 4) how the social and political context may influence the use and the user of marijuana. However, of fundamental importance will be the future Government support and investments capable to sustain the prospective studies on the health effects of cannabinoids. This would allow having strong evidences that could guide clear and indisputable laws for medical doctors and general population too.
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      References

        • Rubens M.
        Political and medical views on medical marijuana and its future.
        Soc Work Public Health. 2014; 29: 121-131
        • Gulland A.
        Sixty second on…medical marijuana.
        BMJ. 2016; 354: i3962
        • Pacula R.L.
        • Powell D.
        • Heaton P.
        • et al.
        Assessing the effects of medical marijuana laws on marijuana use: The devil is in the details.
        J Policy Anal Manage. 2015; 34: 7-31
        • Bhandari S.
        • Hillard C.J.
        • Venkatesan T.
        Marijuana users do not have increased healthcare utilization: A national health and nutrition examination survey (NHANES) study.
        Eur J Intern Med. 2016; 34: e9-e10

      Linked Article

      • Marijuana users do not have increased healthcare utilization: A National Health and Nutrition Examination Survey (NHANES) study
        European Journal of Internal MedicineVol. 34
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          Nearly half (49%) of Americans say that they have tried marijuana [1]. Although increased legalization of marijuana has led to its widespread use, there is a paucity of data on healthcare utilization due to marijuana use. There are studies suggesting that this change in legalization of marijuana has resulted in an increase in number of emergency department (ED) visits [2,3]. Similarly, chronic marijuana use among gastroenterology patients was noted to be a predictor of increased ED visits [4]. More recently, there has been an interest in a condition called cannabinoid hyperemesis syndrome (CHS) showing an association between chronic, heavy marijuana use and cyclic vomiting potentially resulting in increased healthcare utilization [5–7].
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