Cannabis use patterns and association with hyperemesis: A comprehensive review.

BACKGROUND: Cannabis use in the general population is prevalent and is rising because of increased acceptance of its use, legalization in most US states, and perceived health benefits. Cannabis product potency has dramatically increased with higher delta-9-tetrahydrocannabinol content. Cannabis has documented antiemetic properties and cannabinoid pharmaceuticals are used in disorders like chemotherapy-induced nausea and vomiting. PURPOSE: Forty to eighty percent of cyclic vomiting syndrome (CVS) patients use cannabis products, which reportedly reduce stress as well as nausea and vomiting. Cannabinoid hyperemesis syndrome (CHS) has a presentation similar to CVS, but is associated with longstanding, high dose cannabis use, and is thought to be relieved by sustained cannabis abstinence. Most CHS patients have used cannabis on a daily or near-daily basis for more than 2 years. Compulsive hot-water bathing behaviors are reported by most CHS patients, but are not specific for this disorder as they are also noted by about half of CVS patients. Episodic vomiting associated with cannabis use contributes to extensive health resource use, including emergency department visits and inpatient hospitalizations, and impacts patients and their families negatively. Treatment for CHS overlaps with CVS although cannabis abstinence remains the cornerstone of its management. Challenges associated with cannabis use cessation in CHS include patient skepticism of the role of cannabis as a cause of symptoms, perceived benefits of cannabis, and a lack of other effective therapies. In this review, we highlight cannabis use patterns in the US and discuss diagnosis and management of CHS and gaps in knowledge about this disorder.

Characterization of the effects of cannabinoid receptor deletion on energy metabolism in female C57BL mice.

Background: Despite the evidence that energy balance is regulated differently in females and that the endocannabinoid system is sexually dimorphic, previous studies on the endocannabinoid system and energy balance predominantly used male models. Here, we characterize the effects of cannabinoid receptor deletion on body weight gain and glucose metabolism in female C57BL mice. Methods: Female mice lacking the cannabinoid-1 receptor (CB1R-/-), cannabinoid-2 receptor (CB2R-/-), or both receptors (CB1R-/-/CB2R-/-) and wild-type (WT) mice were fed with a low (LFD; 10% of calories from fat) or high-fat diet (HFD; 45% of calories from fat) for six weeks. Results: Female WT mice fed with HFD gained significantly more weight than WT mice fed with LFD (p < 0.001). Similar pattern was observed for CB2/- mice fed with HFD compared to CB2R-/- mice fed with LFD (p < 0.001), but not for CB1R-/- fed with HFD vs. LFD (p = 0.22) or CB1R-/-/CB2R-/- fed with HFD vs. LFD (p = 0.96). Comparing the 4 groups on LFD, weight gain of CB1R-/- mice was greater than all other genotypes (p < 0.05). When fed with HFD, the deletion of CB1R alone in females did not attenuate weight gain compared to WT mice (p = 0.72). Female CB1R-/-/CB2R-/- mice gained less weight than WT mice when fed with HFD (p = 0.007) despite similar food intake and locomotor activity, potentially owing to enhanced thermogenesis in the white adipose tissue. No significant difference in weight gain was observed for female CB2R-/- and WT mice on LFD or HFD. Fasting glucose, however, was higher in CB2R-/- mice fed with LFD than all other groups (p < 0.05). Conclusion: The effects of cannabinoid receptor deletion on glucose metabolism in female mice were similar to previously published findings on male mice, yet the effects on body weight gain and thermogenesis were attenuated in CB1R-/- mice.

A feasibility study to assess the recruitment and retention of pregnant patients who regularly use cannabis.

OBJECTIVE: To assess first-trimester recruitment and retention of pregnant patients who regularly used cannabis, but not other substances, measured by willingness to participate in a research study, completion of self-administered electronic questionnaires, and willingness to provide urine samples during each trimester of pregnancy. We designed and launched a prospective feasibility study titled, Cannabis Legalization in Michigan (CALM) - Maternal & Infant Health (MIH), in two Michigan clinics after the recreational use of cannabis became legal for adults 21 years and older. RESULTS: Over half (52%) of patients asked to participate in CALM-MIH were consented to the study. Two-thirds (66%) of screened patients initiated prenatal care during their first trimester of pregnancy and 50% used cannabis, of which the majority did not concurrently use other substances. Of those recruited into the prospective study, all participants completed the first-trimester questionnaire and provided urine samples. Study retention was 80% and all participants who completed follow-up assessments were willing to provide urine samples.

Association between sociodemographic factors, clinic characteristics and mental health screening rates in primary care.

BACKGROUND: Screening for mental health problems has been shown to be effective to detect depression and initiate treatment in primary care. Current guidelines recommend periodic screening for depression and anxiety. This study examines the association of patient sociodemographic factors and clinic characteristics on mental health screening in primary care. DESIGN: In this retrospective cohort study, electronic medical record (EMR) data from a 14-month period from 10/15/2021 to 12/14/2022 were analyzed. Data were retrieved from 18 primary care clinics from the Corewell Health healthcare system in West Michigan. The main outcome was documentation of any Patient Health Questionnaire (PHQ-4/PHQ-9/GAD-7) screening in the EMR within the 14-month period at patient level. General linear regression models with logit link function were used to assess adjusted odds ratio (aOR) of having a documented screening. RESULTS: In total, 126,306 unique patients aged 16 years or older with a total of 291,789 encounters were included. The prevalence of 14-month screening was 79.8% (95% CI, 79.6-80.0). Regression analyses revealed higher screening odds for patients of smaller clinics (<5,000 patients, aOR 1.88; 95% CI 1.80-1.98 vs. clinics >10.000 patients), clinics in areas with mental health provider shortages (aOR 1.69; 95% CI 1.62-1.77), frequent visits (aOR 1.80; 95% CI, 1.78-1.83), and having an annual physical / well child visit encounter (aOR 1.52; 95% CI, 1.47-1.57). Smaller positive effect sizes were also found for male sex, Black or African American race, Asian race, Latinx ethnicity (ref. White/Caucasians), and having insurance through Medicaid (ref. other private insurance). DISCUSSION: The 14-month mental health screening rates have been shown to be significantly lower among patients with infrequent visits seeking care in larger clinics and available mental health resources in the community. Introducing and incentivizing mandatory mental health screening protocols in annual well visits, are viable options to increase screening rates.

Trends in cocaine use among United States females of reproductive age, 2005-2019.

BACKGROUND AND OBJECTIVES: The prevalence of cocaine use has increased in the United States, with an estimated 5.5 million people have used it at least once in 2019. We report trends in cocaine use for reproductive age females who participated in the National Survey on Drug Use and Health (NSDUH, 2005-2019). METHODS: Interviewers for NSDUH recruited and assessed a representative sample of the US noninstitutionalized population. The prevalence of cocaine use was estimated annually for females (15-44 years; n = 295,751). Joinpoint regression was then used to test for significant changes in trends. RESULTS: Approximately 2.4% of females (n = 8136) reported past 12-month cocaine use. Joinpoint regression revealed an initial decline in cocaine use prevalence between 2005 and 2011, followed by a robust increase (2011-2019 annual percent change = 5.2; 95% confidence interval = 2.6, 7.8%). This nonlinear trend was observed for all subgroups, except for adolescent and pregnant females for whom a decrease in cocaine use prevalence was observed. DISCUSSION AND CONCLUSIONS: Although the prevalence of cocaine use remains scarce among US females, the uptake in use after a period of initial decline is concerning, highlighting the need for continued public health awareness and action. SCIENTIFIC SIGNIFICANCE: Cocaine use among females of reproductive age is particularly concerning given the increased likelihood of transitioning to disordered use and the risk of use during pregnancy. Previous studies have not reported cocaine use estimates specific to reproductive age females or only reported co-drug use patterns, without detail of specific cocaine use trends.

Cannabis use in the United States and its impact on gastrointestinal health.

In recent years, the legalization and social acceptability of cannabis use have increased in the United States. Concurrently, the prevalence of cannabis use has continued to rise, and cannabis products have diversified. There are growing concerns regarding the health effects of regular and high-potency cannabis use, and new research has shed light on its potentially negative effects. Here, we review evidence of the gastrointestinal (GI) effects of cannabis and cannabinoids. Dysregulation of the endocannabinoid system might contribute to various GI disorders, including irritable bowel syndrome and cyclic vomiting syndrome, and endocannabinoids have been found to regulate visceral sensation, nausea, vomiting, and the gut microbiome. Cannabis has been shown to have antiemetic properties, and the US Food and Drug Administration has approved cannabis-based medications for treating chemotherapy-induced nausea and vomiting. Yet, chronic heavy cannabis use has been linked to recurrent episodes of severe nausea and intractable vomiting (cannabinoid hyperemesis syndrome). Given the considerable heterogeneity in the scientific literature, it is unclear if cannabinoid hyperemesis syndrome is truly a distinct entity or a subtype of cyclic vomiting that is unmasked by heavy cannabis use and the associated dysregulation of the endocannabinoid system. The changes in cannabis legalization, availability, and public risk perceptions have outpaced research in this area and there is a need for robust, prospective, large-scale studies to understand the effects of cannabis use on GI health.

Racial disparities in emergency department utilization among patients with newly diagnosed depression.

OBJECTIVE: To test the hypothesis that racial and ethnic minorities have increased emergency department visit rates, despite being established with a primary care provider. METHODS: In this retrospective cohort study, ED visits without hospital admission in a 12-month period among patients with a new primary care provider-issued diagnosis of depression were assessed. Electronic medical record (EMR) data was obtained from 47 family medicine clinics in a large Michigan-based healthcare system. General linear regression models with Poisson distribution were used to predict frequency of ED visits. RESULTS: A total of 4159 patients were included in the analyses. In multivariable analyses, Black / African American race was associated with an additional 0.90 (95% CI 0.64, 1.16) ED visits and American Indian or Alaska Native race was associated with an additional 1.39 (95% CI 0.92, 1.87) ED visits compared to White or Caucasians (null value 0). These risks were only exceeded by patients who received a prescription for a typical antipsychotic drug agent. CONCLUSION: Despite being established patients at primary care providers and having follow-up encounters, Black / African American and American Indian or Alaska Native patients with depression were considerably more likely to seek ED treatment compared to White/Caucasian patients with depression.

Nausea and vomiting of pregnancy and prenatal cannabis use in a Michigan sample.

BACKGROUND: Nausea and vomiting of pregnancy, also referred to as morning sickness, affects more than 70% of all pregnancies. Symptoms range from mild to severe and, in some cases, can be debilitating, resulting in a reduced quality of life. Moreover, prenatal cannabis use prevalence has doubled in the United States, and cannabis potency, measured by the concentration of delta-9-tetrahydrocannabiniol, has increased from 10% in 2009 to 14% in 2019. State-level recreational legalization of cannabis may contribute to the liberalization of its use and reduced risk perception. Furthermore, the relatively recent discovery of cannabinoid hyperemesis syndrome may contribute to the mischaracterization of morning sickness in individuals who use cannabis during pregnancy. Although cannabis has well-documented antiemetic properties, there is insufficient research on the topic. Therefore, it is essential to establish a tangible understanding of the association between nausea and vomiting of pregnancy and prenatal cannabis use. OBJECTIVE: This study aimed to estimate the degree to which nausea and vomiting of pregnancy might be associated with prenatal cannabis use in a sample of pregnant people in Michigan, a state where recreational cannabis use became legal in December 2018. STUDY DESIGN: This was a prospective study of participants from the Michigan Archive for Research on Child Health, a population-based pregnancy cohort that was recruited using a probability-based sampling approach. Participants were recruited from 22 prenatal clinics located throughout Michigan's lower peninsula. Cross-sectional analyses were performed for data available between October 2017 and January 2022. RESULTS: Among this sample of Michigan pregnant people, 14% (95% confidence interval, 11%-16%) reported cannabis use. Participants who experienced increasing morning sickness severity had higher odds of using cannabis (adjust odds ratio, 1.2; 95% confidence interval, 1.1-1.2). When the sample was restricted to first-trimester morning sickness and cannabis use, the results remained statistically robust. When the direction of the association was reversed, an increase in morning sickness severity was detected among participants who used cannabis during pregnancy (ßadjusted, 0.2; 95% confidence interval, 0.1-0.2). Lastly, the association between prepregnancy cannabis use and first-trimester morning sickness was investigated. Study findings suggest an increase in morning sickness severity among people who used cannabis in the 3 months before pregnancy compared with those who did not use cannabis (ßadjusted, 0.1; 95% confidence interval, 0.003-0.200). CONCLUSION: Study findings indicated a link between nausea and vomiting of pregnancy and prenatal cannabis use. Moreover, this study revealed that using cannabis in the 3 months before pregnancy is associated with first-trimester morning sickness severity. The strengths of our study contribute to the scant epidemiologic evidence in this area of research. More fine-grained, time-specific data on nausea and vomiting of pregnancy and prenatal cannabis use are necessary to draw inferences about cause-effect relationships. Our study might provide a basis to discourage cannabis use during pregnancy until more evidence is collected.

Mental Health Screening Differences in Non-English Speaking Patients: Results From a Retrospective Cohort Study.

PURPOSE: To assess differences in mental health screening based on patient's preferred language. METHODS: For this retrospective cohort study, data for 85 725 unique patients from 10 primary care clinics in West Michigan were analyzed if patients received at least 1 mental health screening with the Patient Health Questionnaire 4 (PHQ-4) within a 12-month period (10/15/2021-10/14/2022). A general linear regression model was used to assess the adjusted odds ratios (aOR) of being screened. RESULTS: Patients having a preferred language other than English (n = 2755) had an 87.0% chance of receiving the recommended mental health screening, compared to 76.7% of English-speaking patients (P < .001). A multivariable model revealed decreased screening odds for Kinyarwanda (aOR 0.29, 95% CI 0.19-0.45) and Persian/Dari/Pashto (aOR 0.46, 95% CI 0.23-0.91) speaking patients and higher screening odds for Spanish (aOR 1.45, 95% CI 1.19-1.77), Bosnian (aOR 2.13, 95% CI 1.11-4.11), and Vietnamese (aOR 2.25 95% CI 1.64-3.08) speaking patients compared to English speaking patients. CONCLUSIONS: Results highlight the inequities between the language groups that are probably the result of the challenges to access multilingual depression and anxiety screening instruments. Furthermore, providers may be prone to bias about who they think "needs" a mental health screening. We suggest that measures are implemented to ensure consistency in mental health screening regardless of a patients' preferred language.

Prescription Psychotherapeutic Drug Use and Nicotine Use among Young People in the United States.

Background: While prescription psychotherapeutic drug use (PPDU) and nicotine use pose substantial problems in isolation, they pose an increased risk in combination. This study aimed to estimate the prevalence of PPDU for young people, stratified by nicotine use status. A trend analysis was used to examine changes in PPDU and nicotine use over time. Methods: We used a cross-sectional population-based sample of young people aged 16-25 years (n = 10,454) from the National Health and Nutrition Examination Survey (NHANES, 2003-2018). For each data cycle, the prevalence of self-reported PPDU and nicotine including pain relievers, sedatives, stimulants, and tranquilizers was estimated. Using Joinpoint regression, we tested for significant changes in trends using a log-linear model and permutation test approach and produced the average data cycle percentage change (ADCPC). Results: From 2003 to 2018, 6.7% of young people had PPDU and 27.3% used nicotine. The prevalence of cigarette smoking decreased while other nicotine product use increased (p's < 0.001). Those who used nicotine were more likely to have PPDU (8.2%; 95% CI = 6.5%, 9.8%) vs. non-nicotine use (6.1%; 95% CI = 5.1%, 7.0%; p = 0.01). Results indicated a decreasing trend for nicotine use (ADCPC = -3.8, 95% CI = -7.2, -0.3; p = 0.04), but not for PPDU (ADCPC = 1.3; 95% CI = -4.7, 7.8; p = 0.61). On further examination, opioid use decreased, sedative use remained stable, and stimulant and tranquilizer use increased over time. Conclusions: From 2003 to 2018, young people who used nicotine had a higher prevalence of PPDU than those who did not. Clinicians should communicate the association between nicotine use and prescription drugs when prescribing or managing young patients' medications.

Cannabis use and gastrointestinal tract illnesses: The National Health and Nutrition Examination Surveys, 2005-2018.

INTRODUCTION: The antiemetic properties of cannabis have motivated its use in the management of chemotherapy-induced nausea and vomiting. Conversely, case reports of intractable vomiting among heavy cannabis users have increasingly appeared in the literature. Studies on cannabis and gastrointestinal tract (GIT) health are scare. Here, we use data for the National Health and Nutrition Examination Surveys (NHANES, 2005-2018) to estimate the association between cannabis use and GIT illness. METHODS: The study sample included non-pregnant adult NHANES participants (20-59 years) without history of cancer or HIV (n = 18,753). Cannabis use was categorised into never, former (0 day in the past 30 days), infrequent (1-2 days), occasional (3-19 days) and frequent (20-30 days) use. Recent GIT illness was defined as experiencing GIT illness with vomiting or diarrhoea that started in the 30 days prior to NHANES. Logistic regression was used to regress GIT illness on cannabis use, adjusting for potential confounders. RESULTS: Compared to never use, frequent cannabis use was associated with higher odds of GIT illness (OR = 1.4; 95% confidence interval 1.04, 1.9). There were no associations between former, infrequent or occasional cannabis use and GIT illness. DISCUSSION AND CONCLUSIONS: Frequent cannabis use is associated with GIT illnesses in a large cross-sectional study of US residents. It is possible that frequent cannabis use adversely affects GIT health, consistent with clinical case reports. Alternatively, patients with GIT illness might self-medicate with cannabis given its antiemetic properties. Prospective studies are needed to understand the effects of cannabis use on GIT health.

Impact of limited English proficiency on the control of diabetes and associated cardiovascular risk factors. The National Health and Nutrition Examination Survey, 2003-2018.

Language barriers pose a challenge to managing health conditions for various personal, interpersonal, and structural reasons. This study estimates the impact of limited English proficiency (LEP) on diabetes mellitus control and associated cardiovascular risk factors in a large representative sample of United States adults. Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES, 2003-18) was used to estimate the impact of language proficiency on glycemic control (glycated hemoglobin [HbA1c]) and cardiovascular risk status (blood pressure [BP] and low-density lipoprotein [LDL]) in adult participants with known diabetes disease. The analysis included descriptive statistics and generalized linear models to adjust for sociodemographic characteristics. The study sample included 5017 participants with self-reported, physician-diagnosed diabetes mellitus. Most participants completed NHANES interview in English (90.8%), whereas some participants completed the interview in Spanish (LEP-Spanish; 6.6%) or requested an interpreter (LEP-interpreter; 2.6%). Compared to English-speaking participants, LEP-interpreter participants were more likely to have HbA1c ≥ 7% (OR = 1.6, 95% CI = 1.1, 2.4) or a combination of HbA1c ≥ 7%, LDL ≥ 2.6 mmol/L, and BP ≥ 130/80 mmHg (OR = 3.1; 95% CI = 1.2, 8.2). We observed no differences in the odds of diabetes control. between English-speaking and LEP-Spanish participants, whereas LEP-interpreter participants had worse diabetes control, possibly owing to the greater likelihood of patient-provider language discordance for non-English non-Spanish-speaking patients. Given that many patients, yet few providers, speak languages other than English or Spanish, innovative ways are needed to facilitate patient-provider communications (e.g., digital communication assistance tools).

Trends and Characteristics of Prenatal Cannabis Use in the U.S., 2002-2019.

INTRODUCTION: The prevalence of prenatal cannabis use has nearly doubled in the U.S. from 2002 to 2017. As cannabis legalization continues to expand, this study aimed to estimate the recent trends in the prevalence of cannabis use, cannabis dependence, and cannabis risk perceptions among U.S. pregnant people. METHODS: The National Survey on Drug Use and Health (2002-2019) was designed to be representative of the U.S. civilian non-institutionalized population. The study sample included pregnant participants (aged 12-44 years; n=15,109). Cannabis consumption was defined as using cannabis at least once in the 30 days before assessment. Past 12‒month cannabis dependence was defined on the basis of the DSM-IV. Joinpoint regression was used to test for significant changes in the trends while controlling for age, race/ethnicity, and family income. Analyses were conducted between August 2021 and April 2022. RESULTS: No evidence of change in the prevalence of prenatal cannabis use was detected between 2016-2017 (5.8%) and 2018-2019 (4.7%) (prevalence difference= -1.1; 95% CI= -2.9, 0.7). The prevalence of cannabis dependence did not change significantly among pregnant people from 2002 to 2019. The percentage of pregnant people perceiving regular cannabis use (1-2 times/week) as a great risk remained stable from 2002 to 2007 (∼53%) and declined sharply after (27%). CONCLUSIONS: Three of 4 pregnant people in the U.S. do not characterize regular cannabis use as a great risk. As cannabis legalization increases, public health efforts are needed to raise awareness of the possible harms associated with cannabis use.

Tobacco cigarette and cannabis use among new mothers.

BACKGROUND AND AIMS: In the United States, the prevalence of cannabis use during pregnancy has increased whereas tobacco smoking has decreased. This study aimed to estimate the prevalence of tobacco cigarette smoking and cannabis use among new mothers, stratified by breastfeeding status. Additionally, trend analysis was used to examine changes in tobacco and cannabis use over time. DESIGN: Cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES, 2001-18). SETTING: United States. PARTICIPANTS: Population-based sample of new mothers (within 2 years of childbirth) aged 20-44 years (n = 1332). MEASUREMENTS: For each NHANES data cycle, the prevalence of tobacco smoking measured by self-report or serum cotinine was estimated. Additionally, we estimated the prevalence of cannabis use measured by self-report. Using Joinpoint Regression, we tested for significant changes in trends and produced the average 'data-cycle' percentage change (APC). FINDINGS: From 2001 to 2018, more than one in five new mothers were tobacco cigarette smokers. New mothers who were breastfeeding were less likely to smoke cigarettes [7.4%, 95% confidence interval (CI) = 4.9%, 10.9% compared with mothers who were not breastfeeding (25.7%, 95% CI = 22.3%, 29.3%]. Results from Joinpoint regression indicated no robust temporal trends for self-reported tobacco smoking (APC = -1.3, 95% CI = -8.6, 6.7; P = 0.7) or for cotinine levels ≥ 4.47 ng/ml (APC = 0.3, 95% CI = -5.0, 5.9; P = 0.9), whereas cannabis use had increased among new mothers (APC = 23.7, 95% CI = 4.8, 46.0; P = 0.02). CONCLUSIONS: Consistent with the increase seen among other subgroups, cannabis use has approximately doubled among US new mothers since 2005. There is no significant evidence of a change in tobacco smoking among US new mothers since 2001.

Visit-to-visit variability in blood pressure among cannabis users participating in the Third National Health and Nutrition Examination Survey.

OBJECTIVE: Blood pressure variability (BPV) has emerged as an important predictor of cardiovascular morbidity and mortality. Plausible biological mechanisms link cannabis use and blood pressure (BP) regulation. Here, we assess the relationship between cannabis use and BPV, measured by the SD and coefficient of variation across three separate study visits. METHODS: Data for individuals (17-59 years, n = 758) participating in the United States Third National Health and Nutrition Examination Survey substudy were used. Associations between cannabis use and mean BP, SBP and DBP variability were estimated. Participants were classified according to recency or lifetime frequency of cannabis use. Generalized linear regressions were used to model BPV as the outcome and cannabis use status as the exposure, adjusting for potential confounding variables. RESULTS: Compared with nonuse, active cannabis use was associated with higher SD (mmHg) of mean BP [ß = 0.97; 95% confidence interval (CI) = 0.22, 1.73], SBP (ß = 0.95; 95% CI = 0.04, 1.85) and DBP (ß = 1.18; 95% CI = 0.28, 2.08). Similar conclusions were obtained when the coefficient of variation was modelled as the outcome. A robust association was not observed for lifetime use frequency. The association between active cannabis use and SBP variability was stronger in the tobacco smoking subgroup, whereas the association between active cannabis use and DBP variability was stronger in the tobacco nonsmoking subgroup. CONCLUSION: Active cannabis use is associated with BPV. Future research is needed to understand the effects of cannabis use on BP regulation.

Trends in heroin use among women of reproductive age in the United States, 2004-2017.

Opioid use during pregnancy has been linked to several adverse outcomes including stillbirth, preterm birth and neonatal abstinence syndrome. Recent data suggest that heroin use has increased in the United States (US) whereas prescription opioid use has decreased. Prevalence estimates for reproductive age women combine heroin and non-medical prescription opioid use, which might mask the increasing heroin trend. The aim of the current study is to estimate the prevalence of heroin use among US women of reproductive age, stratified by pregnancy status. For each year, a representative sample of the US civilian non-institutionalized population is recruited for the National Survey on Drug Use and Health (NSDUH). Pregnancy status and heroin use were assessed in women 15-44 years of age (n = 277,333) using audio computerized-assisted self-interviews. From 2004 to 2017, the prevalence of past 30-day heroin use was 12 per 10,000 reproductive age women (95% confidence interval [CI] = 11, 14). Heroin use has increased from 6 per 10,000 women in 2004-05 to 18 per 10,000 women in 2016-17 (Average percent change = 20.8; 95% 11.2, 31.2). The increase was evident among non-pregnant women, but not among pregnant women. Heroin use remains uncommon among women of reproductive age, yet its prevalence has increased over time. Screening for heroin use might be needed at multiple time points including prior to pregnancy to mitigate adverse outcomes associated with use during pregnancy.

Cannabis use prevalence among individuals with diabetes: The National Survey on Drug Use and Health, 2005-2018.

BACKGROUND: The aim of the current study is to estimate cannabis use prevalence among individuals with diabetes participating in the United States (US) National Survey on Drug Use and Health (NSDUH), 2005-2018. Plausible biological mechanisms link cannabis use and metabolic regulation. Cannabis use can also alter perception and adherence to treatment especially among patients with insulin-dependent diabetes. METHODS: The NSDUH is designed to select and recruit, annually, a representative sample of the non-institutionalized US population (12+ years). Computer-assisted self-interviews gathered information on cannabis use. The current study sample included 30,915 participants who self-reported a physician diagnosis of diabetes. RESULTS: Prevalence of past 30-day cannabis use increased 340% among individuals with diabetes, from 1.7% (95% confidence interval [CI] = 1.1, 2.6) in 2005 to 5.8% (95% CI = 4.7, 7.1) in 2018. Results from the logistic regression model indicated that this increase was robust (odds ratio of cannabis use per NSDUH year = 1.13; 95% CI = 1.10, 1.15). The increase was observed among different sociodemographic subgroups and in states with or without medical cannabis laws. CONCLUSIONS: As cannabis use prevalence increases, screening for use among diabetes patients is needed to optimize outcomes and reduce potential adverse effects.

The Association of Sleep Duration and the Use of Electronic Cigarettes, NHANES, 2015-2016.

Introduction. The unknown effects of electronic cigarettes are public health concerns. One potential effect of electronic cigarette fluid constituents, such as nicotine, may influence sleep. The purpose of this study is to determine if there is an association between sleep duration and electronic cigarette use. METHODS: A retrospective, cross-sectional study was conducted using National Health and Nutrition Examination Survey (NHANES) 2015-2016. Variables of interest included responses to questions concerning electronic cigarette use, hours of sleep, and other variables associated with sleep. Data analyses were conducted with the Rao-Scott chi square test and logistic regression. RESULTS: This study was conducted on 2889 participants, aged 18-65 years, of whom 50.7% were female. Using a bivariate analyses of electronic cigarette usage and sleep duration, participants who never used an electronic cigarette were more likely to have appropriate sleep durations as compared with participants who were currently using electronic cigarettes (P < 0.0001). After adjusting for sociodemographic variables and cigarette smoking, current electronic cigarette use was associated with higher odds of less sleep duration (adjusted odds ratio = 1.82; 95% CI: 1.18, 2.79; P < 0.0001). After adjusting for sociodemographic variables and cigarette smoking, current electronic cigarette use was associated with higher odds of less sleep duration (adjusted odds ratio = 1.82; 95% CI: 1.18, 2.79. CONCLUSIONS: Participants currently using electronic cigarettes are more likely to have less sleep as compared to participants who have never used electronic cigarettes. Implications. With sleep time duration being a major factor for proper body function and repair, this study can serve as confirmation that the use of electronic cigarettes is not a harmless health behavior.

Cannabis use among women of reproductive age in the United States: 2002-2017.

BACKGROUND: In this study of cannabis use in large nationally representative samples of United States (US) women aged 12-44 years, we evaluate variation by pregnancy month and by trimester. We also evaluate cannabis dependence, which might explain why some women continue using cannabis during pregnancy. METHODS: Large nationally representative samples drawn for the US National Surveys on Drug Use and Health included 12-44-year-old women asked about pregnancy month, cannabis use, and cannabis dependence (n = 381,199). For this research, we produced month-specific estimates across four-time intervals (2002-2005, 2006-2009, 2010-2013, 2014-2017). RESULTS: Overall from 2002 to 2017, estimates for non-pregnant women and for pregnant women in Trimester 1 indicate 7%-8% had used cannabis at least once in the 30 days prior to assessment. For pregnancy Month 1, the corresponding estimate is 11%, double Month 3 estimate of 5%. This degree of month-to-month variation is not seen for pregnant women in Trimesters 2 and 3, for whom estimates are 3% and 2%, respectively. Among women using cannabis during pregnancy, an estimated 19% have cannabis dependence, versus an expected value of 13% among non-pregnant women (p < .05). CONCLUSION: Evidence of a possibly ameliorative pregnancy-associated reduction of cannabis use prevalence was seen by Month 3 during pregnancy. Cannabis dependence may help account for cannabis use early during pregnancy. Identification and outreach to reproductive age women with cannabis dependence might decrease prenatal cannabis exposure.