Recurrent Spontaneous Pneumothorax Secondary to Marijuana and Tobacco Abuse.

Primary spontaneous pneumothorax occurs in patients without apparent clinical lung disease, with a higher incidence in tall, thin males between the ages of 10 and 30. Tension pneumothorax is a life-threatening condition that can develop within minutes due to progressive air accumulation in the pleural space; mechanical pressure can lead to significant cardiorespiratory compromise. Tobacco association with a higher incidence of spontaneous pneumothorax has been well documented, but marijuana and spontaneous pneumothorax connection has not been well studied. However, it has been observed that patients who use marijuana and tobacco simultaneously have a higher incidence of spontaneous tension and larger pneumothoraces, as well as longer postoperative stay and higher recurrence than cigarette-only users. We present a case of a 26-year-old young male with a history only significant for excessive tobacco and marijuana smoking who developed multiple recurrent spontaneous pneumothorax and had to undergo right-sided video-assisted thoracoscopic surgery (VATS) with minimally invasive thoracotomy and had a prolonged hospital stay. With our case report, we hope to add to the evidence the effects of combined marijuana and tobacco smoking on bullous lung disease and pneumothorax while emphasizing the importance of conducting a detailed substance use history in patients with spontaneous pneumothorax.

Cannabis Hyperemesis Syndrome in a Young Patient: A Case Report and Literature Review.

Cannabis hyperemesis syndrome (CHS) is a condition characterized by recurrent episodes of severe vomiting, abdominal pain, and intractable nausea in chronic cannabis users. With the legalization of recreational marijuana in many states, awareness of CHS is crucial to prevent delayed diagnosis or misdiagnosis. This case report presents a 25-year-old male with a history of type 1 diabetes mellitus and chronic cannabis use who presented to the emergency department with vomiting and epigastric pain. Our literature review sheds light on existing treatment options for this syndrome and gives future direction for research.

Variant Angina and Cannabis-Induced Myocarditis: A Rare Presentation of Myocardial Inflammation.

Myocarditis is a rare but serious inflammatory disease of the myocardium, often caused by viral infections. We present a unique case of myocarditis in a previously healthy 29-year-old male who developed symptoms and electrocardiography changes of variant angina following cannabis use. This case report discusses the patient's atypical presentation, diagnostic evaluation, management, and outcome.

Fidelity of implementation of Reptes, an alcohol and cannabis selective prevention program for youngsters.

OBJECTIVE: Implementation fidelity is a key dimension in process evaluation but has been scarcely studied. Reptes is a selective alcohol and cannabis use prevention program performed in vulnerable young people (16-21 years) from different educational and leisure settings. The study aimed to describe the components of this program, its implementation fidelity, and satisfaction among participants and facilitators. METHOD: A descriptive cross-sectional study was conducted. Implementation fidelity was assessed in terms of adherence, dose, participant responsiveness, and quality of the intervention through self-reports completed by 15 facilitators and self-administered questionnaires by 99 youth from the 15 groups completing the program. RESULTS: 70.7% of the groups performed 30 of the 43 planned activities with high use of various teaching methods, except for Information and Communication Technology resources. Fidelity implementation was above 70%. 2/3 groups completed an acceptable intervention and 1/3 completed a qualified intervention. Satisfaction was higher than 7. CONCLUSIONS: Our results show high implementation fidelity and satisfaction compared with those from similar studies.

Substance use, socio-demographic characteristics, and self-rated health of people seeking alcohol and other drug treatment in New South Wales: baseline findings from a cohort study.

OBJECTIVE: To investigate the demographic characteristics, substance use, and self-rated health of people entering treatment in New South Wales public health services for alcohol, amphetamine-type stimulants, cannabis, cocaine, or opioids use, by principal drug of concern. DESIGN: Baseline findings of a cohort study; analysis of data in patient electronic medical records and NSW minimum data set for drug and alcohol treatment services. SETTING, PARTICIPANTS: People completing initial Australian Treatment Outcomes Profile (ATOP) assessments on entry to publicly funded alcohol and other drug treatment services in six NSW local health districts/networks, 1 July 2016 - 30 June 2019. MAIN OUTCOME MEASURES: Socio-demographic characteristics, and substance use and self-rated health (psychological, physical, quality of life) during preceding 28 days, by principal drug of concern. RESULTS: Of 14 087 people included in our analysis, the principal drug of concern was alcohol for 6051 people (43%), opioids for 3158 (22%), amphetamine-type stimulants for 2534 (18%), cannabis for 2098 (15%), and cocaine for 246 (2%). Most people commencing treatment were male (9373, 66.5%), aged 20-39 years (7846, 50.4%), and were born in Australia (10 934, 86.7%). Polysubstance use was frequently reported, particularly by people for whom opioids or amphetamine-type stimulants were the principal drugs of concern. Large proportions used tobacco daily (53-82%, by principal drug of concern group) and reported poor psychological health (47-59%), poor physical health (32-44%), or poor quality of life (43-52%). CONCLUSIONS: The prevalence of social disadvantage and poor health is high among people seeking assistance with alcohol, amphetamine-type stimulants, cannabis, cocaine, or opioids use problems. Given the differences in these characteristics by principal drug of concern, health services should collect comprehensive patient information during assessment to facilitate more holistic, tailored, and person-centred care.

Synthetic Cannabinoids and ST-Elevated Myocardial Infarction: A Case Report and Literature Review.

The use of synthetic cannabinoids and marijuana has been known to be associated with myocardial infarction and coronary vasospasms according to a few case reports published for the pediatric population. The data on the use of synthetic cannabinoids and myocardial infarction in adults however is limited. The adverse effects of these so-called designer drugs have been far-reaching. Here, we describe a case of an adult male with ST-elevated myocardial infarction diagnosed secondary to smoking synthetic cannabinoids.

Myopericarditis Associated With Marijuana Intake: A Case Report and Literature Review.

A 26-year-old male who endorses daily cigarette smoking and marijuana vaping presented to the emergency department with acute onset of left-sided chest pain radiating to the left shoulder. Physical examination was unremarkable, but laboratory investigations showed elevated white blood cells, cardiac biomarkers including troponin and creatine kinase, and mildly elevated C-reactive protein levels and erythrocyte sedimentation rate. Electrocardiogram displayed subtle ST-segment elevation in a diffuse pattern, leading to a diagnosis of acute myopericarditis. The patient was treated with anti-inflammatory medication and supportive care and instructed to cease cannabis use.

Association between Substance Misuse and Outcomes in Critically III Patients with Pneumonia.

Rationale: In patients with pneumonia requiring intensive care unit (ICU) admission, alcohol misuse is associated with increased mortality, but the relationship between other commonly misused substances and mortality is unknown. Objectives: We sought to establish whether alcohol misuse, cannabis misuse, opioid misuse, stimulant misuse, or misuse of more than one of these substances was associated with differences in mortality among ICU patients with pneumonia. Methods: This was a retrospective cohort study of hospitals participating in the Premier Healthcare Database between 2010 and 2017. Patients were included if they had a primary or secondary diagnosis of pneumonia and received antibiotics or antivirals within 1 day of admission. Substance misuse related to alcohol, cannabis, stimulants, and opioids, or more than one substance, were identified from the International Classification of Diseases (Ninth and Tenth Editions). The associations between substance misuse and in-hospital mortality were the primary outcomes of interest. Secondary outcomes included the measured associations between substance misuse disorders and mechanical ventilation, as well as vasopressor and continuous paralytic administration. Analyses were conducted with multivariable mixed-effects logistic regression modeling adjusting for age, comorbidities, and hospital characteristics. Results: A total of 167,095 ICU patients met inclusion criteria for pneumonia. Misuse of alcohol was present in 5.0%, cannabis misuse in 0.6%, opioid misuse in 1.5%, stimulant misuse in 0.6%, and misuse of more than one substance in 1.2%. No evidence of substance misuse was found in 91.1% of patients. In unadjusted analyses, alcohol misuse was associated with increased in-hospital mortality (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.06-1.19), whereas opioid misuse was associated with decreased in-hospital mortality (OR, 0.46; 95% CI, 0.39-0.53) compared with no substance misuse. These findings persisted in adjusted analyses. Although cannabis, stimulant, and more than one substance misuse (a majority of which were alcohol in combination with another substance) were associated with lower odds for in-hospital mortality in unadjusted analyses, these relationships were not consistently present after adjustment. Conclusions: In this study of ICU patients hospitalized with severe pneumonia, substance misuse subtypes were associated with different effects on mortality. Although administrative data can provide epidemiologic insight regarding substance misuse and pneumonia outcomes, biases inherent to these data should be considered when interpreting results.

A Case of Panic Attacks Developing After 10 Years of Chronic Cannabis Use in a Patient With No Prior Psychiatric History.

Cannabis use for medical and recreational purposes is increasing. Inhibitory activity of cannabinoids (CB) at the CB1 and CB2 receptors centrally and peripherally mediate the therapeutic effects that are wielded for palliation of pain, anxiety, inflammation, and nausea in indicated conditions. Cannabis dependence is also associated with anxiety; however, the direction of causality is unknown, such as whether anxiety disorders lead to cannabis use, or whether cannabis contributes to the development of anxiety disorder. The evidence hints that both may have validity. Here we present a case of cannabis-associated panic attacks following 10 years of chronic cannabis dependence in an individual with no prior psychiatric history. The patient is a 32-year-old male with no significant past medical history who presented complaining of five-minute episodes of palpitations, dyspnea, upper extremity paresthesia, subjective tachycardia, and cold diaphoresis occurring in a variety of circumstances for the past two years. His social history was significant for 10 years of smoking marijuana multiple times daily, which he had quit over two years ago. The patient denied past psychiatric history or known anxiety problems. Symptoms were unrelated to activity and only relieved with deep breathing. The episodes were not associated with chest pain, syncope, headache, or emotional triggers. The patient had no family history of cardiac disease or sudden death. The episodes were refractory to the elimination of caffeine, alcohol, or other sugary beverages. The patient had already stopped smoking marijuana when the episodes began. Due to the unpredictable nature of the episodes, the patient reported a growing fear of being in public. On laboratory workup, metabolic and blood panels were within normal limits, as well as thyroid studies. Electrocardiogram showed normal sinus rhythm, and continuous cardiac monitoring revealed no arrhythmias or abnormalities despite the patient indicating multiple triggered events within the duration of monitoring. Echocardiography also showed no abnormalities. With organic cardiac causes of the subjective palpitation episodes ruled out, a psychogenic etiology of the episodes was presumed, and the patient was referred to behavioral health services. In conclusion, cannabis-induced anxiety or panic disorders should be considered in patients with no prior psychiatric history presenting with anxiety-like attacks following a period of cannabis dependence or current use. These patients should be advised to cease cannabis use and referred to behavioral medicine.

Alcohol and cannabinoid binges and daily exposure to nicotine in adolescent/young adult rats induce sex-dependent long-term appetitive instrumental learning impairment.

Adolescence is a critical developmental period, concerning anatomical, neurochemical and behavioral changes. Moreover, adolescents are more sensitive to the long-term deleterious effects of drug abuse. Binge-like consumption of alcohol and marijuana, along with tobacco smoking, is a dangerous pattern often observed in adolescents during weekends. Nevertheless, the long-term effect of their adolescent co-exposure has not been yet experimentally investigated. Long-Evans adolescent male (n = 20) and female (n = 20) rats from postnatal day 30 (P30) until P60 were daily treated with nicotine (0.3 mg/kg, i.p.), and, on two consecutive 'binging days' per week (for a total of eight times), received an intragastric ethanol solution (3 g/kg) and an intraperitoneal (i.p.) dose of cannabinoid 1/2 receptor agonist WIN55,212-2 (1.2 mg/kg). These rats were tested after treatment discontinuation at > P90 for associative food-rewarded operant learning in the two-lever conditioning chambers for six consecutive days on a fixed ratio 1 (FR1) schedule followed by another six days of daily FR2 schedule testing, after 42 days rest. We found the main effects of sex x treatment interactions in FR1 but not in FR2 experiments. Treated females show attenuated operant responses for food pellets during all FR1 and the FR2 schedule, whilst the treated males show an impairment in FR2 but not in the FR1 schedule. Moreover, the treated females' percentage of learners was significantly lower than female controls in FR1 while treated males were lower than controls in FR2. Our findings suggest that intermittent adolescent abuse of common drugs, such as alcohol and marijuana, and chronic tobacco exposure can cause significant long-term effects on motivation for natural reinforcers later in adulthood in both sexes. Females appear to be sensitive earlier to the deleterious effects of adolescent polydrug abuse, with both sexes having an increased likelihood of developing lifelong brain alterations.

Risk factors for cannabis use disorders and cannabis psychosis in Japan: Second report of a survey on cannabis-related health problems among community cannabis users using social networking services.

AIM: To determine the risk factors for cannabis use disorders and cannabis psychosis in Japan based on a 2021 online survey among Japanese users of social network services. METHODS: The 3142 respondents who had used cannabis within the preceding year were categorized into two groups based on the development of cannabis use disorder and/or cannabis psychosis. Analyses were performed to determine these conditions' risk factors. RESULTS: Multivariate analysis revealed that factors significantly associated with cannabis use disorders were "cannabis-use initiation at a young age" (p = 0.004, OR: 0.951, 95% CI [0.920-0.984]), "family history of mental health problems" (p < 0.001, OR: 1.988, 95% CI [1.545-2.556]), "psychiatric disorders preceding cannabis use" (p = 0.039, OR: 1.672, 95% CI [1.026-2.722]), and "use of cannabis products other than dry flower" (p < 0.001, OR: 2.725, 95% CI [1.844-4.026]). Factors significantly associated with cannabis psychosis were "cannabis-use initiation at a young age" (p = 0.011, OR: 0.888, 95% CI [0.811-0.973]) and "family history of mental health problems" (p = 0.002, OR: 2.531, 95% CI [1.400-4. 576]). CONCLUSION: Risk factors for problematic cannabis use were cannabis initiation at a young age, pre-cannabis psychiatric disorders, family history of mental health problems, and the use of cannabis products other than dry flower. However, the causal relationship among these factors remains ambivalent.

Fidelity of implementation of Reptes, an alcohol and cannabis selective prevention program for youngsters / Fidelidad de implementación de Reptes, un programa de prevención selectiva del consumo juvenil de alcohol y cánnabis

Objective: Implementation fidelity is a key dimension in process evaluation but has been scarcely studied.Reptes is a selective alcohol and cannabis use prevention program performed in vulnerable young people(16-21 years) from different educational and leisure settings. The study aimed to describe the componentsof this program, its implementation fidelity, and satisfaction among participants and facilitators.Method: A descriptive cross-sectional study was conducted. Implementation fidelity was assessed interms of adherence, dose, participant responsiveness, and quality of the intervention through self-reportscompleted by 15 facilitators and self-administered questionnaires by 99 youth from the 15 groups com-pleting the program.Results: 70.7% of the groups performed 30 of the 43 planned activities with high use of various teachingmethods, except for Information and Communication Technology resources. Fidelity implementation wasabove 70%. 2/3 groups completed an acceptable intervention and 1/3 completed a qualified intervention.Satisfaction was higher than 7.Conclusions: Our results show high implementation fidelity and satisfaction compared with those fromsimilar studies.(AU)

Objetivo: La fidelidad en la implementación es una dimensión clave en el proceso de evaluación, pero hasido escasamente estudiada. Reptes es un programa de prevención selectiva del consumo de alcohol ycánnabis dirigido a jóvenes vulnerables (16-21a ˜nos) de diferentes espacios educativos y de ocio y tiempolibre. El estudio pretende describir los componentes de este programa, su fidelidad de implementacióny la satisfacción de los/las participantes y los/las facilitadores/as.Método: Se realizó un estudio descriptivo transversal. La fidelidad de implementación fue valorada enclave de adherencia, dosis, capacidad de respuesta de los/las participantes y calidad de la interven-ción a través de los informes autocumplimentados por los/las 15 facilitadores/as del programa y loscuestionarios autocompletados por los/las 99 jóvenes de los 15 grupos que completaron el programa.Resultados: El 70,7% de los grupos realizaron 30 de las 43 actividades planificadas, con un uso elevado delas estrategias de aprendizaje, excepto para los recursos basados en las tecnologías de la información yla comunicación. La fidelidad de implementación se situó por encima del 70%. Dos tercios de los gruposcompletaron una intervención aceptable y un tercio completó una intervención cualificada. La satisfacciónse situó por encima de 7.Conclusiones: Nuestros resultados muestran una alta fidelidad en la implementación y la satisfacción encomparación con estudios similares.(AU)

Management of Hyperhomocysteinemia, Low Vitamin Levels, and Low Cortisol in Cannabis Users: A Report of 2 Cases.

Objective: The purpose of this study was to describe the management of 2 long-term users of cannabis with nutrition and psychotherapy. Clinical Features: A 28-year-old man presented with a medical history of asthma, depression, anxiety, and smoking, and was a long-term user of cannabis for 9 years (usually 3 times a week). A 39-year-old man presented with a medical history of anxiety and fatigue, and was a long-term user of cannabis for 14 years (usually twice a week). Laboratory tests showed altered blood levels of homocysteine, vitamins, and cortisol. Intervention and Outcome: Both patients were given supplements of vitamins (folic acid, methylcobalamin, and pyridoxine), vitamin D, Rhodiola rosea, and L-tyrosine. Psychotherapy also was provided to both patients. After 2 months of treatment, both patients improved and reduced their cannabis consumption. Conclusion: This study describes vitamin deficiencies, low cortisol levels, and hyperhomocysteinemia in 2 cannabis users who were managed with a combination of nutritional supplements and psychotherapy.

Marijuana-induced myocarditis in a 24-year-old man.

As marijuana, the most widely-used illicit drug in adolescents and adults, has some unknown side effects, marijuana abuse has become a public health concern. Also, marijuana affects different organs such as heart in its rate, rhythm and coronary flow; it eventually leads to events such as myocardial infarction and rarely myocarditis. A 24-year-old man without any medical history or cardiovascular risk factors presented with chest pain after marijuana consumption. Based on electrocardiogram, myocardial cytolysis and transthoracic echocardiography acute myocarditis diagnosis was established. A few days later, transthoracic echocardiography showed a small clot in apex with reduced left ventricle ejection fraction, in the absence of local akinesia. The patient was discharged with oral anticoagulant stable and without any symptoms. The myocarditis after marijuana abuse is rare. The physicians should include acute myocarditis in differential diagnosis of a patient with chest pain after using marijuana.

Guideline No. 425a: Cannabis Use Throughout Women's Lifespans - Part 1: Fertility, Contraception, Menopause, and Pelvic Pain.

OBJECTIVE: To provide health care providers with the best evidence on cannabis use with respect to women's health. Areas of focus include general patterns of cannabis use as well as safety of use; care for women who use cannabis; stigma; screening, brief intervention, and referral to treatment; impact on hormonal regulation; reproductive health, including contraception and fertility; sexual function; effects on perimenopausal and menopausal symptoms; and use in chronic pelvic pain syndromes. TARGET POPULATION: The target population includes all women currently using or contemplating using cannabis. OUTCOMES: Open, evidence-informed dialogue about cannabis use, which will lead to improvement in patient care. BENEFITS, HARMS, AND COSTS: Exploring cannabis use through a trauma-informed approach provides the health care provider and patient with an opportunity to build a strong, collaborative, therapeutic alliance. This alliance empowers women to make informed choices about their own care. It also allows for the diagnosis and possible treatment of cannabis use disorders. Use should not be stigmatized, as stigma leads to poor "partnered care" (i.e., the partnership between the patient and care provider). Multiple side effects of cannabis use may be mistaken for other disorders. Currently, use of cannabis to treat women's health issues is not covered by public funding; as a result, individual users must pay the direct cost. The indirect costs of cannabis use are unknown. Thus, health care providers and patients must understand the role of cannabis in women's health issues, so that women can make knowledgeable decisions. EVIDENCE: PubMed, EMBASE, and grey literature were searched to identify studies of "cannabis use and effect on infertility, contraception, perimenopause and menopausal symptoms, and pelvic pain" published between January 1, 2018 and February 18, 2021. All clinical trials, observational studies, reviews (including systematic reviews and meta-analyses), guidelines, and conference consensus statements were included. Publications were screened for relevance. The search terms were developed using the Medical Subject Headings (MeSH) terms and keywords (and variants), including cannabis, cannabinoids, marijuana, dexanabinol, dronabinol, tetrahydrocannabinol; the specific terms to capture women's health were estrogen, estradiol, medroxyprogesterone acetate, vaginal contraception, oral contraceptives, fertilization, amenorrhea, oligomenorrhea, pelvic pain, dysmenorrhea, endometriosis, interstitial cystitis, vulvodynia, and menopause. VALIDATION METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE: All heath care providers who care for women. SUMMARY STATEMENTS: RECOMMENDATIONS.

N-acetilcisteína en pacientes adolescentes con dependencia a cannabinoides: un estudio de cohorte / N-acetylcysteine in adolescent patients with cannabinoid dependence: a cohort study

Actualmente, el trastorno por consumo de cannabinoides se considera un problema de salud pública; basados en la evidencia se realizó un estudio de cohorte en donde se evaluó el cambio del ansia por consumo, a través del cuestionario validado de deseo de marihuana (MCQ-SF) en Colombia, el cual se compone por cuatro dominios para la evaluación del ansia (compulsividad, emotividad, expectativa e intencionalidad). Se evaluó el efecto de la N-acetilcisteína (NAC) en pacientes adolescentes con dependencia a marihuana, como estrategia terapéutica dentro del protocolo institucional en el Hospital Infantil Universitario de San José, Bogotá, Colombia.Se incluyeron pacientes entre los 10 y 19 años con prueba toxicológica positiva para cannabinoides en orina, se analizaron 30 registros de pacientes que cumplieron con los criterios de inclusión y mediante la prueba de t student se determinó si durante el proceso de desintoxicación hubo diferencias de medias en los puntajes.Los resultados fueron significativos en todos los dominios, en la compulsividad el puntaje en aquellos que no recibieron NAC fue 3,34 ± 1,8 comparado con 2,77 ± 1,8 (p 0,0028) de los que sí la recibieron; respecto a la emotividad, fue de 3,63 ± 2,0 comparado con 2,9 ± 1,9 (p 0,0053), en la expectativa fue de 3,88 ± 2,1 respecto a 2,72 ± 1,7 (p 0.0018) y en la intencionalidad de 3,61 ± 2,0 contra 2,75 ± 1,8 (p 0,0138).El uso de la NAC redujo elementos importantes que componen el ansia. Su uso como coadyuvante en el trastorno por dependencia a cannabinoides puede ser razonable y debido a que no se reportaron eventos ni reacciones adversas durante la realización del estudio, se considera un medicamento seguro. (AU)

Currently, cannabinoid use disorder is considered a public health problem; based on the evidence, a cohort study was conducted in which the change in craving was evaluated through the validated marijuana craving questionnaire (MCQ-SF) in Colombia, which is composed of four domains for the assessment of craving (compulsivity, emotionality, expectancy and intentionality). The effect of N-acetylcysteine (NAC) was evaluated in adolescent patients with marijuana dependence as a therapeutic strategy within the institutional protocol at the Hospital Infantil Universitario de San José, Bogotá, Colombia.Patients between 10 and 19 years of age with a positive urine toxicology test for cannabinoids were included. Thirty records of patients who met the inclusion criteria were analysed and a Student’s t-test was used to determine whether there were mean differences in the scores during the detoxification process.The results were significant in all domains, in compulsivity the score in those who did not receive NAC was 3.34 1.8 compared to 2.77 1.8 (p 0.0028) of those who did receive it; in emotionality, it was 3.63 2.0 compared to 2.9 1.9 (p 0.0053), in expectancy it was 3.88 2.1 compared to 2.72 1.7 (p 0. 0018) and in intentionality 3.61 2.0 versus 2.75 1.8 (p 0.0138) (AU)

Accesibilidad al consumo de marihuana en escolarizados colombianos / Marijuana Accessibility Among Colombian School children / Acessibilidade do uso da maconha entre os estudantes colombianos

Introducción: El consumo de marihuana es una problemática de salud pública y cobra relevancia en la población escolar. Objetivo: Describir la accesibilidad de consumo de marihuana por características sociodemográficas, relaciones familiares y de consumo en escolarizados colombianos 2016. Material y métodos: Estudio descriptivo, transversal, secundario del Estudio Nacional de Consumo de Sustancias Psicoactivas en Población Escolar Colombia 2016, con una muestra de 80 018 estudiantes, mediante análisis uni-variado y bivariado. Resultados: A partir del análisis de la muestra de escolares, el promedio de edad de consumo de marihuana es de 15,55 años; el 51,9 % eran mujeres. La mayoría de los escolares estudian en colegios mixtos (96,11 %); un 37,3 % considera que le sería fácil conseguir marihuana; aquellos que manifestaron ser consumidores actuales de mari-huana, los que manifiestan que todos sus amigos son consumidores y aquellos que conviven con un consumidor mostraron ser los que percibían muy fácil acceder a la marihuana (88,0 %, 80,1 % y 71,6 %, respectivamente). Conclusiones: Existe una alta proporción de adolescentes que perciben un acceso muy fácil a la marihuana, y los consumidores o aquellos que se relacionan con consumidores fueron quienes percibían en mayor proporción un fácil acceso a la marihuana. Se sugieren intervenciones que puedan contrarrestar este fenómeno. Palabras clave: estudiantes; factores de riesgo. abuso de marihuana; adolescente.

Introduction: Marijuana use is a public health problem and becomes relevant in the school population. Objective: To describe the accessibility of marijuana use by sociodemographic characteristics, family relationships and consumption in Colombian schoolchildren in 2016. Material and methods: Descriptive, cross-sectional, secondary study of the National Study of Psy-choactive Substance Consumption in Colombia School Population ­ 2016, with a sample of 80,018 students, through univariate and bivariate analysis. Results: After analyzing the sample, the average age of marijuana use is 15.55 years; 51.9% were women. Most of the schoolchildren study in mixed schools (96.11%); 37.3% consider that it would be easy for them to obtain marijuana. Those who stated that they were current users of marijuana, those who stated that all their friends were users, and those who lived with a consumer were the ones who perceived it to be very easy to access marijuana (88.0%, 80.1%, and 71.6%, respectively). Conclusions: There is a high proportion of adolescents who perceive a very easy access to marijuana, consumers or those who are related to consumers were the ones who perceived a greater proportion of easy access to marijuana. Interventions that can counteract this phenomenon are suggested

Introdução: O uso de maconha é uma questão de saúde pública e é relevante para a população escolar. Objetivo: Descrever a acessibilidade do uso da maconha por características sociodemográficas, re-lações familiares e consumo nas crianças colombianas em idade escolar em 2016. Materiais e métodos: estudo descritivo, transversal, secundário do Estudo Nacional do Uso de Subs-tâncias Psicoativas na População Escolar Colombiana 2016, com uma amostra de 80 018 alunos, utilizando análise univariada e bivariada. Resultados: Da análise da amostra Da escola, a idade média de uso da maconha foi de 15,55 anos; 51,9% eram mulheres. A maioria das crianças em idade escolar estudam em escolas coeducacionais (96,11%); 37,3% consideram que seria fácil para elas obter maconha; aqueles que relataram ser usuários atuais de maconha, aqueles que relataram que todos os seus amigos são usuários e aqueles que vivem com um usuário foram aqueles que perceberam ser muito fácil o acesso à maconha (88,0%, 80,1% e 71,6%, respectivamente). Conclusões: Há uma elevada proporção de adolescentes que percebem um acesso muito fácil à maconha, e os usuários ou aqueles que se associam aos usuários foram os mais propensos a perceber um acesso fácil à maconha. São sugeridas intervenções que podem contrariar este fenômeno

Risk of cardiovascular diseases in relation to substance use disorders.

BACKGROUND: Substance use disorder (SUD) has become increasingly prevalent worldwide, this study investigated the associations of SUD and alcohol, cannabis, opioid, or stimulant use disorder with cardiovascular disease (CVD) and 11 major CVD subtypes. METHODS: This study was based on a 20% random sample of residents in British Columbia, Canada, who were aged 18 - 80 years at baseline on January 1, 2015. Using linked administrative health data during 2010 - 2014, we identified people with various SUDs and prevalent CVDs at baseline, and examined the cross-sectional associations between SUDs and CVDs. After excluding people with CVDs at baseline, we followed the cohort for 4 years to identify people who developed incident CVDs, and examined the longitudinal associations between SUDs and CVDs. RESULTS: The cross-sectional analysis at baseline included 778,771 people (mean age 45 years, 50% male), 13,279 (1.7%) had SUD, and 41,573 (5.3%) had prevalent CVD. After adjusting for covariates, people with SUD were 2.7 (95% confidence interval [CI], 2.5 - 2.8) times more likely than people without SUD to have prevalent CVD. The longitudinal analysis included 617,863 people, 17,360 (2.8%) developed incident CVD during the follow-up period. After adjusting for covariates, people with SUD were 1.7 (95% CI, 1.6 - 1.9) times more likely than people without SUD to develop incident CVD. The cross-sectional and longitudinal associations were more pronounced for people with opioid or stimulant use disorder. CONCLUSIONS: People with SUD are more likely to have prevalent CVD and develop incident CVD compared with people without SUD.

Exploring Impact of Marijuana (Cannabis) Abuse on Adults Using Machine Learning.

Marijuana is the most common illicit substance globally. The rate of marijuana use is increasing in young adults in the US. The current environment of legalizing marijuana use is further contributing to an increase of users. The purpose of this study was to explore the characteristics of adults who abuse marijuana (20-49 years old) and analyze behavior and social relation variables related to depression and suicide risk using machine-learning algorithms. A total of 698 participants were identified from the 2019 National Survey on Drug Use and Health survey as marijuana dependent in the previous year. Principal Component Analysis and Chi-square were used to select features (variables) and mean imputation method was applied for missing data. Logistic regression, Random Forest, and K-Nearest Neighbor machine-learning algorithms were used to build depression and suicide risk prediction models. The results showed unique characteristics of the group and well-performing prediction models with influential risk variables. Identified risk variables were aligned with previous studies and suggested the development of marijuana abuse prevention programs targeting 20-29 year olds with a regular depression and suicide screening. Further study is suggested for identifying specific barriers to receiving timely treatment for depression and suicide risk.