Accuracy and replicability of identifying eyelid tremor as an indicator of recent cannabis smoking.

INTRODUCTION: Cannabis intoxication may increase the risk of motor vehicle crashes. However, reliable methods of assessing cannabis intoxication are limited. The presence of eyelid tremors is among the signs of cannabis use identified under the Drug Evaluation and Classification Program of the International Association of Chiefs of Police. Our objectives were to assess the accuracy and replicability of identifying eyelid tremor as an indicator of recent cannabis smoking using a blinded, controlled study design. METHODS: Adult subjects (N = 103) were recruited into three groups based on their cannabis use history: daily, occasional, and no current cannabis use. Participants' closed eyelids were video recorded for 30 seconds by infrared videography goggles before and at a mean ± standard deviation time of 71.4 ± 4.6 minutes after the onset of a 15-minute interval of ad libitum cannabis flower smoking or vaping. Three observers with expertise in neuro-ophthalmology and medical toxicology were trained on exemplar videos of eyelids to reach a consensus on how to grade eyelid tremor. Without knowledge of subjects' cannabis use history or time point (pre- or post-smoking), observers reviewed each video for eyelid tremor graded as absent, slight, moderate, or severe. During subsequent data analysis, this score was further dichotomized as a consensus score of absent (absent/slight) or present (moderate/severe). RESULTS: Kappa and intraclass correlation coefficient statistics demonstrated moderate agreement among the coders, which ranged from 0.44-0.45 and 0.58-0.61, respectively. There was no significant association between recent cannabis use and the observers' consensus assessment that eyelid tremor was present, and cannabis users were less likely to have tremors (odds ratio: 0.75; 95 percent confidence interval: 0.25, 2.40). The assessment of eyelid tremor as an indicator of recent cannabis smoking had a sensitivity of 0.86, specificity of 0.18, and accuracy of 0.64. DISCUSSION: Eyelid tremor has fair sensitivity but poor specificity and accuracy for identification of recent cannabis use. Inter-rater reliability for assessment of eyelid tremor was moderate for the presence and degree of tremor. The weak association between recent cannabis use and eyelid tremor does not support its utility in identifying recent cannabis use. LIMITATIONS: Videos were recorded at only one time point after cannabis use. Adherence to abstinence could not be strictly supervised. Due to regulatory restrictions, we were unable to control the cannabis product used or administer a fixed Δ9-tetrahydrocannabinol dose. Participants were predominately non-Hispanic and White. CONCLUSIONS: In a cohort of participants with a range of cannabis use histories, acute cannabis smoking was not associated with the presence of eyelid tremor, regardless of cannabis use history, at 70 minutes post-smoking. Additional research is needed to identify the presence of eyelid tremor accurately, determine the relationship between cannabis dose and timeline in relation to last cannabis use to eyelid tremor, and determine how it should be, if at all, utilized for cannabis Drug Recognition Evaluator examinations.

Tobacco/nicotine dependence as a risk factor for substance use disorders and related mental health conditions among cancer patients.

BACKGROUND: Cancer patients often face multiple comorbidities and are at risk for various mental health conditions and substance use disorders. Tobacco/nicotine dependence (TND) is a known risk factor for poor health outcomes and has been associated with psychiatric disorders including substance use disorder. However, the specific relationship between TND and the risk of substance use disorder and mental health conditions among cancer patients remains underexplored. This study aimed to assess the association between TND and the risk of comorbid conditions among cancer patients. METHODS: Data were obtained from a database of electronic health records for patients from the University of California health system. The odds for every condition among cancer patients with TND were calculated and compared with those for cancer patients without TND. ORs were adjusted for gender, ethnicity, and race. RESULTS: Three thousand seven hundred and ninety-one cancer patients with TND had 252,619 total conditions, and 51,711 cancer patients without TND had 2,310,880 conditions. After adjusting for confounders, the condition for which TND most exacerbated risk was psychoactive substance-induced organic anxiety disorder (OR = 16.3, p < 0.001). This appeared consistent with the second, third, and fifth most-exacerbated conditions: stimulant use disorder (OR = 12.8, p < 0.001), cocaine induced mental disorder (OR = 11.0, p < 0.001), and cocaine use disorder (OR = 11.0, p < 0.001). Different conditions exacerbated by TND include acute alcoholic intoxication (OR = 11.4, p < 0.001), opioid use disorder (OR = 7.6, p < 0.001), schizoaffective disorder (OR = 7.4, p < 0.001), and cannabis use disorder (OR = 6.3, p < 0.001). CONCLUSIONS: Our findings reveal a strong association between TND and an increased risk of substance use disorder and mental health conditions among cancer patients. Specifically, cancer patients with TND were at an elevated risk for psychoactive substance-induced organic anxiety disorder, stimulant use disorder, and cocaine-related disorders. Additionally, TND was associated with an increased risk of acute alcoholic intoxication, opioid use disorder, schizoaffective disorder, and cannabis use disorder. These findings underscore the need for comprehensive screening and interventions to address TND and comorbid conditions among cancer patients.

Can I see some ID? Examining validity of the marijuana purchase task among late adolescent cannabis users.

Cannabis demand (i.e., reinforcing value) can be assessed using a marijuana purchase task (MPT; assesses hypothetical purchasing of cannabis at escalating prices) and has been related to use frequency, problems, and cannabis use disorder symptoms in adults. Cannabis demand has yet to be studied in adolescents, which can inform prevention and intervention efforts to reduce cannabis-related risks. The present study sought to validate the MPT with a sample of late adolescent lifetime cannabis users. Participants aged 15-18 years old (n = 115, Mage = 16.9, SD = 0.9) residing in a state with legalized cannabis use completed online assessments at baseline and 6-month follow-up. Convergent and divergent validity was examined, while principal component analysis was conducted to determine the factor structure and assess predictive validity. Three indices, Omax (i.e., maximum expenditure on cannabis), breakpoint (i.e., price suppressing consumption to zero), and alpha (i.e., degree to which consumption decreases with increasing price) were all significantly associated with cannabis use, consequences, craving, and expenditures and significantly differentiated low-risk users and high-risk users as measured by the Cannabis Use Disorders Identification Test-Revised (CUDIT-R). A two-factor solution reflecting amplitude (intensity, alpha, Omax) and persistence (breakpoint, Pmax) was observed. Both factors were associated with cannabis use and consequences in baseline regression models. At follow-up, persistence was associated with consequences; amplitude was not associated with either outcome. These findings provide initial evidence that the MPT is a valid measure for assessing cannabis demand among adolescents and can be used to understand mechanisms of adolescent cannabis use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Initial development and validation of a brief assessment of marijuana demand among young adult college students.

Hypothetical purchase tasks assess substance demand, but the length of purchase tasks makes repeated assessment of state-dependent changes in demand difficult, often limiting clinical utility. Although brief assessments of alcohol and cigarette demand exist, brief measures of cannabis demand do not. College students (N = 209, Mage = 19.92, SD = 1.45; 63% female; 56.9% non-Hispanic Caucasian) who reported using cannabis at least 3 days in the past month, completed an online survey including the full-length marijuana purchase task (MPT), a three-item brief assessment of marijuana demand (BAMD) assessing intensity, Omax and breakpoint, and cannabis use outcomes. Convergent and divergent validity were examined. Independent samples t tests compared demand on the BAMD and MPT based on presence or absence of cannabis use disorder (CUD) symptoms, and one-way between-subject analyses of variance compared effects of CUD severity (mild/moderate/severe) on BAMD indices. All indices were significantly correlated across both assessment measures (ps < .01). Similarly, all indices on both demand measures were significantly correlated with craving, CUD severity, and cannabis-related consequences (ps < .01); whereas only intensity and Omax were significantly correlated with cannabis use frequency (ps < .01). Individuals with (vs. without) CUD symptoms reported significantly greater intensity and Omax (ps < .01) and significant differences in CUD severity on BAMD indices were found as well (ps < .05). The BAMD demonstrated convergent and divergent validity with the MPT. Findings suggest that brief cannabis demand can be easily assessed as an indicator for high-risk cannabis use. Thus, the BAMD may be a useful and clinically relevant tool to assess cannabis demand in real-world settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Validating a brief screening measure for early-onset substance use during adolescence in a diverse, nationwide birth cohort.

The Loeber Risk Score (LRS) was developed to predict early-onset cannabis use in adolescence from late childhood, facilitating early identification. However, the LRS was developed in non-representative historical samples, leaving uncertain its generalizability to children/adolescents across the U.S. today. We externally validated the LRS in a diverse, nationwide cohort (N = 4,898) weighted to the composition of the U.S. Census. Participants in 20 cities completed assessments when youth were approximately 5, 9, and 15 years old. Parents completed the LRS at the age ∼5 and ∼9 interviews. At the age ∼15 interview, youth reported on the onset of alcohol/drug use before age 15, monthly drinking/binge drinking at ages 14-16, and use of cannabis multiple times per month at ages 14-16. First, we validated the LRS measured at age ∼9. Area under the receiver operating curve was 0.62 for onset of cannabis use before age 15, 0.68 for onset of cigarette use before age 15, and 0.62 for use of cannabis multiple times per month at ages 14-16. For drinking outcomes, LRS performance could not be distinguished from chance prediction. The recommended screening cutoff of LRS ≥ 2 identified 24% of children, among whom early-onset cannabis/cigarette use outcomes occurred 1.4-2.2 times more frequently than the general population. The LRS' performance did not vary significantly by sex, race, or ethnicity. When the LRS was measured at age ∼5, AUROC was significantly lower for some outcomes. Together, findings support the LRS measure as a potential tool for identifying children in early or late childhood at risk of early-onset drug use in adolescence.

Self-reported symptoms of cannabis use disorder: Psychometric testing and validation.

Cannabis use disorder (CUD) is commonly assessed using self-report items based on its symptoms as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) that are scored on a dichotomous scale (yes/no) to indicate symptom presence; however, scoring items on a dichotomy may result in relatively limited sensitivity for research. Thus, we developed a 13-item measure of CUD, the Self-Reported Symptoms of CUD (SRSCUD), based on the 11 symptoms described in the DSM-5 that is scored on a 4-point response scale indicating degree of severity. In the present study, we conduct an initial evaluation of the psychometric properties of the SRSCUD. Past-month cannabis users (N = 2,077) were recruited from nine universities in nine states throughout the U.S. Each item of the SRSCUD loaded saliently onto a single factor of CUD symptoms in both exploratory and confirmatory factor analyses. The SRSCUD was strongly correlated with measures of cannabis use, dependence severity, and cannabis-related problems. In addition, the SRSCUD was moderately positively correlated with a well-known risk factor for CUD (coping motives) and moderately negatively correlated with a well-known protective factor for CUD (protective behavioral strategies). These correlations mostly remained statistically significant while controlling for CUD symptom count and diagnosis using dichotomized SRSCUD items. Receiver operator characteristic curve analyses revealed that the SRSCUD had excellent sensitivity/specificity for predicting probable CUD. Although more research evaluating performance of the SRSCUD compared to a clinical diagnosis is needed, we found preliminary evidence for construct validity of this measure. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Is your patient's cannabis use problematic?

Individuals who do not meet DSM-5 criteria for cannabis use disorder may still have problematic use. The screening tool and 5 interventions detailed here can help.

Quantity and frequency of cannabis use in relation to cannabis-use disorder and cannabis-related problems.

BACKGROUND: In almost all of the literature examining the relation between cannabis use and cannabis-related harms, researchers have neglected to include quantity measures of cannabis use. The study aims to assess whether cannabis: (1) quantity predicts harms; and (2) quantity might interact with other key variables (age, gender, and frequency of use) vis-à-vis the outcomes. METHOD: Using the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), the current study (n = 36,309; n = 3,339 past-year cannabis users) employed a logistic-regression approach to assess the cross-sectional relations between the continuous variables of cannabis-use quantity and frequency and two Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5) DSM-5-based outcomes: past-year cannabis-use disorder (CUD) and past-year cannabis-related problems (CRP). RESULTS: In the CUD model, the key variables log quantity [OR = 1.98 (95 % CI, 1.64;2.39), p < 0.001], log frequency [OR = 1.78 (95 % CI, 1.62;1.96), p < 0.001] and the log-quantity-by-log-frequency interaction [OR = 0.83 (95 % CI, 0.75;0.93), p = 0.002] were statistically significant. The final CRP model included the following main predictors: log quantity [OR = 2.13 (95 % CI, 1.70;2.66), p = <0.001], log frequency [OR = 1.50 (95 % CI, 1.36;1.65), p = <0.001], and a log-quantity-by-log-frequency interaction [OR = 0.82 (95 % CI, 0.73;0.93), p = 0.002]. CONCLUSIONS: The quantity-by-frequency interactions in both models showed that the relative effect of quantity on cannabis-use disorders and cannabis-related problems decreased as frequency increased, and vice versa.

Prevalence of obesity among U.S. population with substance dependence.

AIM: To investigate associations between substance dependence and obesity. METHODS: Obesity (body mass index ≥ 30 kg/m2) status and the status of dependence on heroin, stimulant, marijuana, nicotine and alcohol (past-month status for nicotine and past-year status for all others) were identified from the U.S. National Survey on Drug Use and Health (NSDUH, 2015-2017) datasets. SAS Surveylogistic regression was used to estimate adjusted odds ratio (AOR) for the association between each substance dependence and obesity, adjusting for potentially confounding effects of sociodemographic factors and health condition. RESULTS: It was estimated that 10.6 % of noninstitutional U.S. residents aged 12 years or older were nicotine-dependent, 3.0 % alcohol-dependent, 1.0 % marijuana-dependent, 0.6 % stimulant-dependent, and 0.2 % heroin-dependent. Heroin-dependent individuals had 59 % lower odds of obesity relative to their non-dependent counterparts (AOR = 0.41; 95 % CI: 0.28-0.60; p < 0.0001). Lower odds of obesity were also noted for marijuana-dependent (AOR = 0.64; 95 % CI: 0.56-0.73; p < 0.0001), nicotine-dependent (AOR = 0.68; 95 % CI: 0.64-0.72; p < 0.0001) and alcohol-dependent (AOR = 0.77, 95 % CI: 0.69-0.84; p < 0.0001) individuals, but not statistically significant for stimulant-dependent individuals (AOR = 0.84; 95 % CI: 0.68-1.02; p = 0.0825). CONCLUSIONS: Heroin, marijuana, nicotine and alcohol dependence were associated with lower odds of obesity than their non-dependence counterparts. Main findings based on 2015-2017 NSDUH are consistent with findings from our prior report based on clinical trials data from National Institute on Drug Abuse Clinical Trials Network, and other epidemiological evidence in the literature. These findings can alert substance abuse treatment professionals to monitor weight change, especially among weight-concerned substance abusers.

The relationship between cannabis use and cognition in people diagnosed with first-episode psychosis.

Cannabis use is highly prevalent among young people diagnosed with first-episode psychosis (FEP), however, its impact on cognition is still unclear. The aim of the present study was to examine the association of cannabis use with cognition in people diagnosed with FEP. We extended previous research findings by operationalising the comorbid cannabis use, considering recency of cannabis use and use of other illicit substances and including people with a broad spectrum of psychotic diagnoses. A total of 89 people diagnosed with FEP were interviewed about their history of substance use and completed a cognitive test battery assessing verbal memory, verbal fluency and attention. Sixty-one participants were lifetime cannabis users (CU; ≥three times per week for ≥four weeks; 68.5%) and 28 were cannabis non-users (CNU; 31.5%). CU were significantly more likely to be male and exhibited significantly more positive symptoms than CNU. In contrast, CNU displayed significantly more negative symptoms than CU. There were no differences between CU and CNU on neurocognitive tasks of verbal memory, verbal fluency and attention. In conclusion, there was no indication that cannabis use was associated with cognitive impairments in people diagnosed with FEP.

Prevalence of problems with alcohol, marijuana and gambling among patients in a Regional Hospital in Northern Greenland: investigating the potential for brief interventions in a hospital setting.

Problems with alcohol, marijuana and gambling are major public health challenges in Greenland but their prevalence in a hospital setting has not been explored. Healthcare facilities play a significant role in Greenland. One important aspect is their provision of both primary and secondary healthcare services to a small and scattered population while their potential as settings for screening for problems with alcohol, substances and gambling is an unexplored area with large public health potential. This study explored the prevalences of problems with alcohol, marijuana and gambling in a hospital and the potential for the use of a hospital as a setting for screening for alcohol, substance and gambling problems. Patients from the Northern Ilulissat Hospital filled in a self-administered questionnaire regarding their behaviour related to alcohol, marijuana and gambling. Data were weighted and compared to the nationally representative 2018 Health Survey. In the Ilulissat Survey, a large proportion were abstainers but there were still problems related to alcohol, marijuana and gambling indicating a potential for screening in a hospital setting. The results based on data from 2,554 respondents showed that prevalences of problems with alcohol, marijuana and gambling are lower in the Ilulissat Survey compared to the 2018 Health Survey.

Association of High-Potency Cannabis Use With Mental Health and Substance Use in Adolescence.

Importance: Cannabis use is consistently linked to poorer mental health outcomes, and there is evidence that use of higher-potency cannabis increases these risks. To date, no studies have described the association between cannabis potency and concurrent mental health in a general population sample or addressed confounding using longitudinal data. Objective: To explore the association between cannabis potency and substance use and mental health outcomes, accounting for preceding mental health and frequency of cannabis use. Design, Setting, and Participants: This cohort study used data from the Avon Longitudinal Study of Parents and Children, a UK birth cohort of participants born between April 1, 1991, and December 31, 1992. Present data on outcomes and exposures were collected between June 2015 and October 2017 from 1087 participants at 24 years of age who reported recent cannabis use. Exposures: Self-reported type of cannabis most commonly used in the past year, coded to a binary exposure of use of high-potency cannabis or lower-potency cannabis. Main Outcomes and Measures: Outcomes were reported frequency of cannabis use, reported cannabis use problems, recent use of other illicit drugs, tobacco dependence, alcohol use disorder, depression, generalized anxiety disorder, and psychotic-like experiences. The study used secondary data; consequently, the hypotheses were formulated after data collection. Results: Past-year cannabis use was reported by 1087 participants (580 women; mean [SD] age at onset of cannabis use, 16.7 [3.0] years). Of these, 141 participants (13.0%) reported the use of high-potency cannabis. Use of high-potency cannabis was associated with increased frequency of cannabis use (adjusted odds ratio [AOR], 4.38; 95% CI, 2.89-6.63), cannabis problems (AOR, 4.08; 95% CI, 1.41-11.81), and increased likelihood of anxiety disorder (AOR, 1.92; 95% CI, 1.11-3.32). Adjustment for frequency of cannabis use attenuated the association with psychotic experiences (AOR 1.29; 95% CI, 0.67-2.50), tobacco dependence (AOR, 1.42; 95% CI, 0.89-2.27), and other illicit drug use (AOR, 1.29; 95% CI, 0.77-2.17). There was no evidence of association between the use of high-potency cannabis and alcohol use disorder or depression. Conclusions and Relevance: To our knowledge, this study provides the first general population evidence suggesting that the use of high-potency cannabis is associated with mental health and addiction. Limiting the availability of high-potency cannabis may be associated with a reduction in the number of individuals who develop cannabis use disorders, the prevention of cannabis use from escalating to a regular behavior, and a reduction in the risk of mental health disorders.

A chart review of substance use screening and related documentation among adolescents in outpatient pediatric clinics: implications for practice.

BACKGROUND: Despite recent reductions, youth substance use continues to be a concern in the United States. Structured primary care substance use screening among adolescents is recommended, but not widely implemented. The purpose of this study was to describe the distribution and characteristics of adolescent substance use screening in outpatient clinics in a large academic medical center and assess related factors (i.e., patient age, race/ethnicity, gender, and insurance type) to inform and improve the quality of substance use screening in practice. METHODS: We abstracted a random sample of 127 records of patients aged 12-17 and coded clinical notes (e.g., converted open-ended notes to discrete values) to describe screening cases and related characteristics (e.g., which substances screened, how screened). We then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and used multiple logistic regression to identify related factors. RESULTS: Among 127 records, rates of screening by providers were 72% (each) for common substances (alcohol, marijuana, tobacco). The primary method of screening was use of clinical mnemonic cues rather than standardized screening tools. A total of 6% of patients reported substance use during screening. Older age and racial/ethnic minority status were associated with provider screening in multiple logistic regression models. CONCLUSIONS: Despite recommendations, low rates of structured screening in primary care persist. Failure to use a standardized screening tool may contribute to low screening rates and biased screening. These findings may be used to inform implementation of standardized and structured screening in the clinical environment. CLINICAL TRIAL REGISTRATION: not applicable.

What's the Harm in Getting High? Evaluating Associations Between Marijuana and Harm as Predictors of Concurrent and Prospective Marijuana Use and Misuse.

OBJECTIVE: Substantial research has demonstrated the importance of implicit cognitive processes underlying substance use. However, there is a scarcity of research on implicit processes related to marijuana use. We adapted and tested the predictive validity (concurrent and prospective) of an implicit measure evaluating the strength of associations between marijuana and harm based on research demonstrating less marijuana use among individuals who report stronger explicit attitudes of marijuana's harms. METHOD: A community sample of 187 U.S. young adults living in a state with legal recreational marijuana use completed an Implicit Association Test (IAT) evaluating marijuana-harm associations and measures of marijuana use and risk of cannabis use disorder (CUD) over time. RESULTS: The marijuana-harm IAT had good internal consistency, and scores did not vary as a function of biological sex, legal age status for recreational marijuana use, or college student status. Scores did vary as a function of lifetime and recent use such that lifetime and current abstainers had stronger marijuana-harm associations. Zero-inflated negative binomial regression models demonstrated that marijuana-harm IAT scores significantly predicted concurrent risk of CUD and use such that stronger marijuana-harm associations were associated with less use and risk of CUD. Results evaluating outcomes longitudinally found limited support for IAT scores predicting increases in use over time and no support for predicting changes in risk of CUD over time. CONCLUSIONS: Findings provide preliminary evidence that stronger marijuana-harm associations may act as a protective factor against marijuana use and risk of CUD.

Diagnostic sequence of cocaine use disorder in relation to other mental health conditions among college students.

Objective: Cocaine use is increasing. Comorbidities and diagnostic sequencing are needed among college students to inform treatment of cocaine use disorder (CUD). Method: Using electronic medical records from the psychiatric clinic at the student health care center of a large, public university from 2005 to 2015, patients diagnosed with CUD were identified. Their top mental health conditions were identified and assessed to see whether the first diagnosis of these conditions was made (1) before, (2) at the same time as, or (3) after the first diagnosis of CUD. Results: Among the 50 CUD patients, their most common mental health comorbidities were alcohol use disorder, anxiety, depression, and cannabis use disorder. Anxiety and depression were likely to be diagnosed before CUD; alcohol and cannabis use disorders were likely to be diagnosed concurrently with CUD. Conclusion: Diagnostic sequencing can be used to inform screening, workup, and treatment for patients with CUD.

Marijuana use and acute myocardial infarction: A systematic review of published cases in the literature.

BACKGROUND AND OBJECTIVE: Marijuana use has gained popularity following legalization in the US. Marijuana can affect the heart through various mechanisms. This study aims to conduct a systematic review of published case reports of individuals with acute myocardial infarction (AMI) following marijuana use. METHODS: We conducted a systematic review of literature, including case reports, case series, and the letter to the editor on MEDLINE. Forty-six studies were included, with a total number of 62 patients with AMI and marijuana use. RESULTS: The mean age was 27.7 (±10.3) years with male predominance. About 3.7 g marijuana was used for an average of 9.7 years by the patients. From the cases reporting the onset of AMI symptoms, the average time was within 5 h after last marijuana use. The angiographic findings were normal in 36.8% of cases. In 42.1% of individuals, the left anterior descending coronary artery was occluded, making it the most common artery involved, followed by the right coronary artery (10.5%). Most cases were managed medically, followed by thrombectomy and stent placement, and percutaneous transluminal coronary angioplasty (PTCA). Complications included cardio-embolic stroke, and seven deaths were reported. CONCLUSION: It is important to consider episodic marijuana use as a significant risk factor of AMI, particularly in individuals with no cardiac risk factors, as delay in management can result in fatal outcomes including increased risk of mortality.

Cannabis Use Disorder and Perioperative Outcomes in Major Elective Surgeries: A Retrospective Cohort Analysis.

BACKGROUND: Although cannabis is known to have cardiovascular and psychoactive effects, the implications of its use before surgery are currently unknown. The objective of the present study was to determine whether patients with an active cannabis use disorder have an elevated risk of postoperative complications. METHODS: The authors conducted a retrospective population-based cohort study of patients undergoing elective surgery in the United States using the Nationwide Inpatient Sample from 2006 to 2015. A sample of 4,186,622 inpatients 18 to 65 yr of age presenting for 1 of 11 elective surgeries including total knee replacement, total hip replacement, coronary artery bypass graft, caesarian section, cholecystectomy, colectomy, hysterectomy, breast surgery, hernia repair, laminectomy, and other spine surgeries was selected. The principal exposure was an active cannabis use disorder, as defined by International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) diagnostic codes for cannabis dependence and cannabis abuse. The primary outcome was a composite endpoint of in-hospital postoperative myocardial infarction, stroke, sepsis, deep vein thrombosis, pulmonary embolus, acute kidney injury requiring dialysis, respiratory failure, and in-hospital mortality. Secondary outcomes included hospital length of stay, total hospital costs, and the individual components of the composite endpoint. RESULTS: The propensity-score matched-pairs cohort consisted of 27,206 patients. There was no statistically significant difference between patients with (400 of 13,603; 2.9%) and without (415 of 13,603; 3.1%) a reported active cannabis use disorder with regard to the composite perioperative outcome (unadjusted odds ratio = 1.29; 95% CI, 1.17 to 1.42; P < 0.001; Adjusted odds ratio = 0.97; 95% CI, 0.84 to 1.11; P = 0.63). However, the adjusted odds of postoperative myocardial infarction was 1.88 (95% CI, 1.31 to 2.69; P < 0.001) times higher for patients with a reported active cannabis use disorder (89 of 13,603; 0.7%) compared with those without (46 of 13,603; 0.3%) an active cannabis use disorder (unadjusted odds ratio = 2.88; 95% CI, 2.34 to 3.55; P < 0.001). CONCLUSIONS: An active cannabis use disorder is associated with an increased perioperative risk of myocardial infarction.