The More Drugs You Take…(fill in the blank)

This was a retrospective longitudinal cohort study of adults aged 60 years and older.

An increase in polypharmacy severity was significantly associated with a higher likelihood of all-cause hospitalization within 1 year, but not a hospitalization related to IBD. Use of a PIM (potentially inappropriate medication) was also associated with a higher probability of all-cause hospitalization compared with patients without. Hospitalization Risk in Older Adults With IBD Associated With Severe Polypharmacyhttps://www.gastroenterologyadvisor.com/news/hospitalization-risk-in-older-adults-with-ibd-associated-with-severe-polypharmacy/

Photo by Anna Shvets on Pexels.com

Marijuana is Too Strong (THC turbocharged)

For some, it can be dangerous. In the past few years, reports have swelled of people, especially teens, experiencing short- and long-term “marijuana-induced psychosis,” with consequences including hospitalizations for chronic vomiting and auditory hallucinations of talking birds. Multiple studies have drawn a link between heavy use of high-potency marijuana, in particular, and the development of psychological disorders, including schizophrenia, although a causal connection hasn’t been proved. “It’s entirely possible that this new kind of cannabis—very strong, used in these very intensive patterns—could do permanent brain damage to teenagers because that’s when the brain is developing a lot,” Keith Humphreys, a Stanford psychiatry professor and a former drug-policy adviser to the Obama administration, told me. Humphreys stressed that the share of people who have isolated psychotic episodes on weed will be “much larger” than the number of people who end up permanently altered. But even a temporary bout of psychosis is pretty bad. Marijuana Is Too Strong Nowhttps://www.theatlantic.com/ideas/archive/2024/08/high-potency-marijuana-regulation/679639/

Cannabis Use and Psychosis Risk (Aussie Version)

Professor Emmerson says Queensland’s Metro North Health — Australia’s largest public health service, based in north Brisbane and the surrounding region — is seeing increased presentations of psychosis due to medicinal cannabis.”The Metro North early psychosis service reports 10 per cent of their new presentations — so these are kids aged 16 to 21 — are people who’ve ended up on medicinal cannabis and are becoming psychotic,” the Brisbane-based psychiatrist says.

Doctors warn of significant increase in people hospitalized with psychosis after being prescribed medicinal cannabishttps://www.abc.net.au/news/2024-07-21/medicinal-cannabis-psychosis-harm-risk-prescription-marijuana/104116952

Hallucinogenic Drugs at a Gas Station Near You!

Newly released testing data of Diamond Shruumz-brand gummies purchased in 2023 identified the presence of psilocin, a hallucinogenic drug closely related to the magic-mushroom drug psilocybin that is classified as a Schedule I drug, alongside psilocybin, heroin, and LSD. The finding comes as Diamond Shruumz’s current line of gummies, chocolates, and candy cones is being recalled and are under active investigation in connection to a nationwide rash of severe illnesses, which have involved seizures, intubation, and intensive care. As of the latest update on July 15, 69 people in 28 states have been sickened after eating a Diamond Shruumz product. Sixty of the 69 sought medical care, 36 were hospitalized, and there is one potentially associated death under investigation. Illegal drug found in Diamond Shruumz candies linked to severe illnesses — https://arstechnica.com/science/2024/07/illegal-drug-found-in-diamond-shruumz-candies-linked-to-severe-illnesses/

I’ll stick with my gas station beers, thanks.

Cannabis Use and Psychosis Risk

The investigators found that cannabis use was significantly associated with psychotic disorders during adolescence (adjusted hazard ratio [aHR], 11.2; 95% CI, 4.6 to 27.3), but not during young adulthood (aHR, 1.3; 95% CI, 0.6 to 2.6). Adolescents who used cannabis also had a substantially higher risk for hospitalizations and emergency department visits (aHR, 26.7; 95% CI, 7.7 to 92.8), while there was no substantial risk observed in young adulthood (aHR, 1.8; 95% CI, 0.6 to 5.4). Growing Evidence Supports the Link Between Cannabis Use and Psychosis Risk https://www.psychiatryadvisor.com/news/cannabis-use-and-psychosis-risk/

Have you read the book The Dangerous Truth About Today’s Marijuana by Laura Stack? https://johnnysambassadors.org/book/

If you have small children I highly recommend this book.

Cannabis and Kids

Epidemiologic research suggests that cannabis use may be a significant risk factor for psychotic disorders. A meta-analysis of longitudinal studies estimated that lifetime cannabis users had an odds ratio of 2.58 (95% CI 1.08–6.13) for psychotic disorders compared to non-users (Moore et al., Reference Moore, Zammit, Lingford-Hughes, Barnes, Jones, Burke and Lewis2007). Another meta-analysis found an odds ratio of 3.90 (95% CI 2.84–5.34) for psychotic disorders among the most frequent cannabis users compared to non-users, suggesting dose–response (Marconi, Di Forti, Lewis, Murray, & Vassos, Reference Marconi, Di Forti, Lewis, Murray and Vassos2016). Whether cannabis use is causally related to psychotic disorders continues to be debated, with recent genetic studies raising uncertainty about the directionality of the relationship and the magnitude of association (Ganesh & D’Souza, Reference Ganesh and D’Souza2022; Gillespie & Kendler, Reference Gillespie and Kendler2021).

This study provides new evidence of a strong but age-dependent association between cannabis use and risk of psychotic disorder, consistent with the neurodevelopmental theory that adolescence is a vulnerable time to use cannabis. The strength of association during adolescence was notably greater than in previous studies, possibly reflecting the recent rise in cannabis potency. Age-dependent association of cannabis use with risk of psychotic disorder Psychological Medicine , First View , pp. 1 – 11 https://doi.org/10.1017/S0033291724000990

Daily Marijuana Use Now Exceeds Daily Alcohol Use

Reported cannabis use declined to a nadir in 1992, with partial recovery through 2008, and substantial increases since then, particularly for measures of more intensive use. Between 2008 and 2022, the per capita rate of reporting past-year use increased by 120%, and days of use reported per capita increased by 218% (in absolute terms from the annual equivalent of 2.3 to 8.1 billion days per year). From 1992 to 2022, there was a 15-fold increase in the per capita rate of reporting daily or near daily use. Whereas the 1992 survey recorded 10 times as many daily or near daily alcohol as cannabis users (8.9 vs. 0.9 M), the 2022 survey, for the first time, recorded more daily and near daily users of cannabis than alcohol (17.7 vs. 14.7 M). Far more people drink, but high-frequency drinking is less common. In 2022, the median drinker reported drinking on 4–5 days in the past month, versus 15–16 days in the past month for cannabis. In 2022, past-month cannabis consumers were almost four times as likely to report daily or near daily use (42.3% vs. 10.9%) and 7.4 times more likely to report daily use (28.2% vs. 3.8%).

Long-term trends in cannabis use in the United States parallel corresponding changes in cannabis policy, with declines during periods of greater restriction and growth during periods of policy liberalization. A growing share of cannabis consumers report daily or near daily use, and their numbers now exceed the number of daily and near daily drinkers. Changes in self-reported cannabis use in the United States from 1979 to 2022https://doi.org/10.1111/add.16519

Cannabis Use Linked to Elevated Myocardial Infarction and Stroke Risk

Cannabis use may increase the risk of myocardial infarction and stroke independent of tobacco use, according to recent findings in the Journal of the American Heart Association. Compared with nonusers, daily cannabis consumers had 25% higher odds of myocardial infarction and 42% higher odds of stroke. More frequent use was associated with a greater possibility of adverse cardiovascular outcomes regardless of whether cannabis was smoked, eaten, or vaporized. AMA. 2024;331(14):1172. doi:10.1001/jama.2024.2075 — https://jamanetwork.com/journals/jama/fullarticle/2816618

Statins Raise Diabetes Risk (but CV Benefit Outweighs the Risk)

Statins raise the risks for increased glucose levels and the development of type 2 diabetes among people who don’t have it at baseline, but those risks are outweighed by the cardiovascular benefit, new data suggested.

The meta-analysis of trials in the CTT Collaboration included individual participant data from 19 double-blind randomized, controlled trials with a median follow-up of 4.3 years comparing statins with placebo in a total of 123,940 participants, including 18% who had known type 2 diabetes at randomization. Also analyzed were another four double-blind trials of lower- vs higher-intensity statins involving a total of 30,724 participants followed for a median of 4.9 years, with 15% having diabetes at baseline.

In the 19 trials of low- or moderate-intensity statins vs placebo, statins resulted in a significant 10% increase in new-onset diabetes compared with placebo (rate ratio, 1.10), while high-intensity statins raised the risk by an also significant 36% (1.36). This translated to a mean absolute excess of 0.12% per year of treatment.

Compared with less intensive statin therapy, more intensive statin therapy resulted in a significant 10% proportional increase in new-onset diabetes (1.10), giving an absolute annual excess of 0.22%

In an accompanying editorial, Hertzel C. Gerstein, MD, and Marie Pigeyre, MD, PhD, both of McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada, noted that the decreased absolute annual incidence of life-threatening cardiovascular outcomes with statins in people at high risk for type 2 diabetes “clearly exceeds the 0.1%-1.3% per year increased absolute incidence of type 2 diabetes.”

Statins Raise Diabetes Risk, but CV Benefit Outweighs It – Medscape – April 09, 2024. — https://www.medscape.com/viewarticle/statins-raise-diabetes-risk-cv-benefit-outweighs-it

Complications? What Complications? (just another GLP-1 receptor agonist post)

Adverse events are common in those using GLP-1 agonists, but the vast majority of these are minor. GI adverse effects are most common (20-70% of patients). Greater rate of GI effects with higher doses.

  • Most common problems: nausea (overall most common), vomiting, and diarrhea. Others included abdominal pain, dyspepsia, and constipation.
  • Symptoms are typically more severe within the first four weeks of therapy or with sudden escalation of therapy and tend to decrease over time.
  • Thought to be due to reduced gastric emptying and activation of centers involved in appetite regulation and nausea.
  • Severe diarrhea and vomiting may lead to volume loss, dehydration, and hypotension (not common).
  • There is an association with pancreatitis. GLP-1 agonists may stimulate pancreatic islet beta cells and exocrine duct cells leading to overgrowth and smaller duct size, which increase the pancreatic weight and risk of ductal occlusion.
    • Retrospective study published in 2022 of 81,752 adverse events associated with GLP-1 agonist therapy found an increased risk of pancreatitis, particularly with liraglutide (ROR 32.67; 95% CI 29.44-36.25). 2023 observational study found increased risk of pancreatitis (adjusted HR of 9.09, 95% CI 1.25-66).
  • Other GI issues include gallbladder and biliary tract disease (usually after 26 weeks of therapy and included cholelithiasis, cholecystitis, cholangitis), elevated LFTs, hepatitis, liver injury.
emDOCs Podcast – Episode 94: GLP-1 Agonist Complications — https://www.emdocs.net/?s=glp-1

But I Lost 25 pounds!

New Wonder Drug! Treat Diabetes, Obesity AND Addiction – (yup another GLP-1 receptor agonist post)

Why People Stop Using Drugs Like Ozempic – Wired (yet another GLP-1 receptor agonist post)

What the Scientists Who Pioneered Weight-Loss Drugs Want You to Know – Wired Magazine