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Study breakdown

Hospitalized marijuana users had high rates of psychiatric admissions and increasing cardiovascular events over five years

Retrospective CohortModerate evidence
The takeaway

An analysis of 2.3 million hospitalizations among recreational marijuana users from 2010-2014 found mood disorders were the top psychiatric diagnosis, acute myocardial infarction the top cardiovascular diagnosis, and major cardiovascular events showed increasing trends over the period.

Read this if you are concerned about the cardiovascular risks associated with cannabis use or want to understand hospitalization patterns among marijuana users.

2.3 million hospitalizations analyzed; cardiovascular events increasing over 2010-2014

What the researchers found

Researchers analyzed the National Inpatient Sample, identifying over 2.3 million hospitalizations with a recorded history of recreational marijuana use from 2010 to 2014.

The most common psychiatric discharge diagnoses were mood disorders (20.6%), schizophrenia and other psychotic disorders (10.6%), and substance or alcohol-related disorders (10.4%). Suicide and intentional self-injury (3.6%) was the leading cause of emergency admission.

Among non-psychiatric diagnoses, the most common were diabetes with chronic complications (2.2%), acute myocardial infarction (1.2%), nonspecific chest pain (1.1%), and congestive heart failure (1%).

The top independent predictors of in-hospital mortality were coagulopathy (OR 5.94), acute myocardial infarction (OR 4.59), and pulmonary circulation disorder (OR 2.95). Major cardiovascular and cerebrovascular events showed increasing trends among users over the five-year period.

Why it matters

This is one of the largest analyses of hospitalization patterns among marijuana users. The finding that cardiovascular events are increasing among this population, and that cardiac events are strong predictors of in-hospital mortality, provides important safety signal data.

The numbers in context

2,317,343 weighted hospitalizations analyzed. Top psychiatric: mood disorders 20.6%, schizophrenia 10.6%. Suicide/self-injury 3.6% of emergency admissions. AMI 1.2% of non-psychiatric diagnoses. Mortality predictors: coagulopathy OR 5.94, AMI OR 4.59, pulmonary circulation disorder OR 2.95.

How the study worked

Retrospective analysis of the National Inpatient Sample (NIS) for 2010-2014, identifying hospitalizations with ICD-9 codes for recreational marijuana use. Descriptive statistics with discharge weights for national estimates. Multivariate regression for mortality predictors.

What this study cannot tell us

The NIS captures associations, not causation. Marijuana use was identified by ICD-9 codes, which likely undercount actual users and may reflect documentation patterns rather than prevalence. The database cannot distinguish frequency, amount, or route of cannabis use. Confounders like tobacco use, obesity, and other substances were not fully separated from cannabis effects.

How to read the evidence

This large retrospective database analysis provides moderate evidence on hospitalization patterns and trends, though it cannot establish causation between marijuana use and specific conditions.

When this study was published

Published in 2018 using 2010-2014 data (ICD-9 era). Cannabis use patterns and legalization have changed substantially since this period.

The bigger picture

The increasing trend in cardiovascular events among marijuana users parallels both increasing cannabis use in the general population and increasing potency of available products. Whether this represents a causal effect of cannabis on cardiovascular health or reflects changing demographics of users and detection patterns requires further investigation.

Questions still open

  • Are the increasing cardiovascular events causally related to cannabis use or to changing user demographics and higher-potency products? How do hospitalization patterns differ between medical and recreational cannabis users? Should cardiovascular screening be recommended for heavy cannabis users?

Common questions

Does marijuana cause heart attacks?
This study found acute myocardial infarction in 1.2% of hospitalized marijuana users and that it was a strong predictor of in-hospital mortality (OR 4.59). However, this database study shows associations in hospitalized patients, not causation in the general cannabis-using population.
What was the most common reason marijuana users were hospitalized?
Mood disorders were the most common psychiatric diagnosis (20.6%), while diabetes with chronic complications (2.2%) and acute myocardial infarction (1.2%) were the top non-psychiatric diagnoses.

Read the original research

Primary Causes of Hospitalizations and Procedures, Predictors of In-hospital Mortality, and Trends in Cardiovascular and Cerebrovascular Events Among Recreational Marijuana Users: A Five-year Nationwide Inpatient Assessment in the United States.

Cureus, 10(8), e3195

Citation

Desai, Rupak; Shamim, Sofia; Patel, Krupa; Sadolikar, Ashish; Kaur, Vikram Preet; Bhivandkar, Siddhi; Patel, Smit; Savani, Sejal; Mansuri, Zeeshan; Mahuwala, Zabeen. (2018). Primary Causes of Hospitalizations and Procedures, Predictors of In-hospital Mortality, and Trends in Cardiovascular and Cerebrovascular Events Among Recreational Marijuana Users: A Five-year Nationwide Inpatient Assessment in the United States.. Cureus, 10(8), e3195. https://doi.org/10.7759/cureus.3195

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