Clearing up the smoke: Physical and mental health considerations regarding cannabis use in adolescents with cystic fibrosis

Abstract

The cannabis plant is the most used federally illegal drug in the United States and is widely used by adolescents. Cannabis has complex effects on the body and mind. All health professionals who take care of adolescents with cystic fibrosis (CF) should be aware of the factors impacting cannabis use in CF. Given limited evidence regarding the benefits of cannabis and the significant risks, clinicians have the responsibility to identify risk of cannabis use early, counsel patients about the risks, provide a safe space for ongoing conversations about cannabis use in the context of CF care, and deliver evidence-based interventions.

Alcohol and opiate misuse in adults with cystic fibrosis

“…However, the mean age of individuals with CF in our program is older than the national average (37.6 vs. 21.7 years), and therefore our results may underestimate the prevalence of alcohol and opiate misuse in other centers, as younger adults are at higher risk of substance misuse 31,37 . Adolescents with CF, although also potentially at risk, were not included in our scope, but warrant evaluation as well 4,21,24,25 …”

“…Cannabis was excluded given the evolving legal landscape pertaining to its use during the study period, lack of documentation of formal cannabis use disorder, and complexity of distinguishing the prevalence and consequences of medical use, recreational, and problematic misuse from retrospective chart review. Use of other drugs (e.g., misuse of other prescription medications) was not included due to infrequent, variable documentation 24 …”

“…31,37 Adolescents with CF, although also potentially at risk, were not included in our scope, but warrant evaluation as well. 4,21,24,25 The retrospective nature of this study with inconsistent documentation in our medical records limited reliable assessment of additional variables. We were unable to evaluate several aspects of substance misuse, including: (1) problematic use of other illicit substances (such as cocaine), or of legal drugs such as benzodiazepines or cannabis; (2) whether misuse of alcohol or opiates was currently active or had ever met full DSM-5 criteria for an alcohol or opiate use disorder; and (3) patterns of use (e.g., binge or chronic heavy use).…”

“…It is also established that people with chronic illnesses who develop substance misuse are at risk for poor clinical outcomes; in patients with respiratory diseases, both alcohol and opiate misuse have been linked to an increase in symptoms, decreased adherence to medications, and higher risk of poor pulmonary‐specific outcomes 16–20 . Despite the implications of substance misuse for patients with respiratory disorders, the prevalence and impact in people with CF has been minimally studied 5,21–26 . Accordingly, the CF Foundation (CFF) has designated improving our understanding of mental health comorbidities beyond depression and anxiety—specifically including substance misuse—as a key area of focus for CF mental health research 8 …”

“…[16][17][18][19][20] Despite the implications of substance misuse for patients with respiratory disorders, the prevalence and impact in people with CF has been minimally studied. 5,[21][22][23][24][25][26] Accordingly, the CF Foundation (CFF) has designated improving our understanding of mental health comorbidities beyond depression and anxiety-specifically including substance misuse-as a key area of focus for CF mental health research. 8 Use of other drugs (e.g., misuse of other prescription medications)…”