Cannabis use disorder is defined as dependent use of cannabis despite having a psychological, physical and social functioning impairment. According to the American Heart Association, stroke rates are increasing in adults between ages 18 and 45, and each year young adults account for up to 15% of strokes in the United States.
"Since marijuana use is more common among younger people and is now legal in several U.S. states, we felt it was crucial to study the various risks it may impose," said Akhil Jain, M.D., lead author of the study and a resident physician at Mercy Fitzgerald Hospital in Darby, Pennsylvania. "First-time stroke risk among cannabis users is already established, so it intrigued us to investigate whether continued marijuana dependence also predisposes younger people to develop further strokes."
The researchers examined health information from the National Inpatient Sample, a large, publicly available database that compiles data on more than 7 million hospital stays annually across the U.S. For this study, the sample included 161,390 adults between 18-44 years of age who had been hospitalized for any reason between October 2015 and 2017, and whose health records indicated a previous stroke (either clot-caused or bleeding stroke) or TIA.
Using hospital diagnosis codes, researchers identified patients within the sample who met the criteria for cannabis use disorder, excluding those with charts indicating their cannabis dependence was in remission. This divided the sample into 4,690 patients who had been diagnosed with cannabis use disorder and 156,700 who had not. The median age for both groups was 37 years.
The study found that when compared with patients without cannabis use disorder, patients with the condition were:
- More likely to be male (55.2% vs. 40.9%), Black adults (44.6% vs. 37.2%), or to smoke tobacco (73.9% vs. 39.6%).
- More likely to be diagnosed with chronic obstructive pulmonary disease (21.5% vs. 19.0%), depression (20.4% vs. 16.1%) or psychosis (11.2% vs. 7.5%).
- Significantly more likely to abuse alcohol (16.5% vs. 3.6%).
- Less likely to have high blood pressure (53.1% vs. 55.6%), diabetes (16.3% vs. 22.7%), high cholesterol (21.6% vs. 24.1%) or obesity (12.0% vs. 19.6%).
Compared to current hospitalizations, the analysis found:
- Among adults with cannabis use disorder, 6.9% were hospitalized for a recurrent stroke, compared to only 5.4% hospitalized without the disorder.
- After adjusting for demographic factors and relevant pre-existing medical conditions (age at admission, sex, race, payer status, median household income, type of admission, hospital bed-size, region, location/teaching status and other medical conditions including traditional cardiovascular risk factors), patients with cannabis use disorder were 48% more likely to have been hospitalized for recurrent stroke than those without the disorder.
- Cannabis use disorder was most prominent among males, young Black or white adults and those who lived in low-income neighborhoods or in the northeast and southern regions of the U.S.
"Young marijuana users who have a history of stroke or TIA remain at significantly higher risk of future stroke. Therefore, it is essential to increase awareness among younger adults of the adverse impact of chronic, habitual use of marijuana, especially if they have established cardiovascular disease risk factors or previous stroke episodes," Jain said.
Possible mechanisms that have emerged from other research on cannabis use disorder include impairment of blood vessel function, changes in blood supply, an increased tendency towards blood-clotting, impaired energy production in brain cells, and an imbalance between molecules that harm healthy tissue and the antioxidant defenses that neutralize them.
Results from this study may not be generalizable to older adults (ages greater than 44), who are more likely to have a greater number of chronic health conditions and cardiovascular risk factors. The study is also limited in that all data was collected at a single point in time, rather than following participants over time. In addition, while the hospital coding identified cannabis use disorder, the data did not include information on the exact amount and duration of cannabis use or medications used.
"Our study is hypothesis-generating research for future prospective and randomized controlled studies. More research work is required to look deeply into this concerning clinical question. Most importantly, the impact of various doses, duration, forms of cannabis abuse, and the use of medicinal cannabis on the occurrence of recurrent strokes are critical questions that need to be answered," Jain said.
According to an August 2020 scientific statement from the American Heart Association, preliminary studies have found that cannabis use may negatively impact the heart and blood vessels. Although cannabis may be helpful for conditions such as spasticity associated with multiple sclerosis, among others, cannabis does not appear to have any well-documented benefits for the prevention or treatment of cardiovascular diseases.
Co-authors of the study include: Rupak Desai, M.B.B.S.; Terry Ricardo Went, M.B.B.S.; Waleed Sultan, M.B.B.Ch.; Dwayne Wiltshire, M.B.B.S.; Geethu Jnaneswaran, M.B.B.S.; Athul Raj Raju, M.B.B.S.; Roshna Asifali; Aamer Mohammad, M.B.B.S.; and Bisharah Rizvi, M.D.
As lawmakers in Illinois and across the nation consider reforms to the nation's juvenile-justice system, one country across the Atlantic could serve as a model.
Northern Ireland's Youth Justice Agency places an emphasis on early diversion, community involvement and restorative justice.
Kelvin Doherty, assistant director of the Agency, said the goal is to keep kids out of police custody and prevent them from building a criminal record.
"Let's address these concerns and these issues before the police are called, and before they get into a court setting," Doherty urged.
Doherty pointed out the restorative-justice process can take one of several paths: including a simple apology, community service or mental-health treatment. According to data from the Youth Justice Agency, more than 97% of victims said they are satisfied with the restorative-justice process.
The Youth Justice Agency was established in 2002, and was born out of the Good Friday Agreement. Doherty explained the program was part of a multipronged effort to modernize Northern Ireland's justice system.
"And the modernization process said, well, for a new justice system in Northern Ireland, it has to be not just about children and reducing reoffending," Doherty explained. "But it also has to be for victims and for communities as well."
From April 2020 to April 2021, Northern Ireland's Justice Department saw a nearly 17% decline in cases where kids came into contact with the criminal-justice system.
Doherty noted early diversion and support programs, typically used when the child is between 10 and 12 years old, can help prevent kids from coming into contact with the criminal-justice system down the line.
"Problems can be resolved in the child's life before they get worse," Doherty asserted. "And it has a better outcome for agencies and service providers, because it often involves less effort and more success, the earlier you are intervening or diverting children within the justice system."
According to the Children's Defense Fund, nearly 2,000 children are arrested in America every day. While the organization noted the overall number of kids in the juvenile-justice system was halved from 2007 to 2020, severe racial disparities persist, as children of color are nearly two times more likely to be arrested than white children.
"Howdy," was a common everyday word where I grew up. Raised on old Stidham, now known as Milo road in rural Appalachia, I spent a lot of time at my Grandpa and Grandma Hinkle’s store. People came and went buying gasoline, sandwich meat, snacks or groceries for the week. There were cane bottom chairs in the store. Often people would sit and chat for a while.
Regardless of how many times during the week I walked down the road to that store, the opening salutation was typically, "howdy."
People were in and out of the Hinkle store doing business. A family member was often coming or going because my grandparents had raised ten children and there were many grandchildren who frequented the Hinkle business. Often, family members were buying a soda pop or just stopping in to say “howdy.”
We grew up on Milo speaking to most everyone who came and went. When a car drove by, we usually waved even though we didn’t always know them. At family or church gatherings we typically talked to everyone for a minute or two and shook hands or hugged a few people.
The only time I can remember our family being speechless was when fifteen or twenty of us were sitting on the porch and a man from New York City pulled up in an older car.
My grandpa had received an advertisement in the mail about a great used car he could buy for $500. He ordered the car to surprise my grandma and we were all really surprised when this man pulled in front of the store in an old beat up looking car. He had driven the car from New York City, which was a long drive on those roads back then.
After being drop jaw stunned silent for a few minutes, everyone loosened up and eventually started talking to the man who was just doing a job but now had to get back to New York. By this time, some of us were chuckling just a little. A couple of the family members took the guy over to Kermit, West Virginia to catch a Greyhound bus to begin his long journey back home.
A part of American culture has been hand shaking and embracing those we know. A part of most American religious gatherings has been shaking hands. One church I attended insisted on everybody hugging each other.
Covid-19 has impacted our world with death, sickness and business failures. The distancing for many of us continues to be tough. We wear our masks and seldom know who else is in the grocery store.
We’re fearful of going to the funeral home to honor and respect the deceased. Shaking hands or embracing anyone anywhere is typically totally unwelcome. Many holiday parties of large gatherings were fewer over the past holidays. People don’t want to be sick and so the distancing continues.
We do have the telephone, social media and email which helps us at least stay connected.
However, please keep in mind, when you do recognize someone at the grocery or any public place you may not feel comfortable embracing or shaking hands, but you can still convey a greeting and kindness by at least saying, "howdy."
