Smoking cigarettes, marijuana common among CF young people

Up to almost 30% of teenagers, adults in US have smoked, a survey shows

Patricia Inácio, PhD avatar

by Patricia Inácio, PhD |

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A young boy covers his mouth to mouth as clouds of dust rise around him.

Up to almost 30% of teenagers and adults with cystic fibrosis (CF) in the U.S. have smoked marijuana and/or cannabidiol (CBD), one of the active components of cannabis, according to an online survey. Use of e-cigarettes and traditional cigarettes was just as common among them.

This increasing trend supports the need to “establish consistent guidelines, screening tools, and enhanced research efforts to understand potential health risks and benefits specific to this population,” the researchers wrote in “Time to be blunt: Substance use in cystic fibrosis,” which was published in Pediatric Pulmonology.

The researchers say people with CF may seek out complementary or alternative therapies to deal with the challenges of a chronic illness since recent, more effective treatments that have improved life expectancy have become available.

“Additionally, as health outcomes improve in the era of effective modulator therapy and respiratory symptoms become less prominent, [people with CF] may resort to inhalation of substances that could have significant impact on their lung health,” the scientists wrote.

The use of e-cigarettes and marijuana has risen among young people in the U.S. over the past decade, but substance use by teenagers and adults with CF hasn’t been known, leading researchers at the University of California San Francisco to develop an online survey that was available across multiple platforms, such as Facebook, and at CF centers. Studying smoking habits among CF patients in the U.S. who are older than 13 is a way to improve clinical care, they said.

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An illustration showing a line of cigarettes dimishing in size with ever more smoke.

E-cigarettes, marijuana of ‘growing popularity’ among younger patients

 Use of cigarettes, e-cigarettes, marijuana

In total, 226 CF patients completed the survey, answering questions about the use of cigarettes, e-cigarettes, marijuana, and CBD in the past 12 months. CBD is not psychoactive, meaning it doesn’t induce a “high.”

Marijuana was used by 29% of patients, followed by e-cigarettes (27%), and CBD and cigarettes (22% each). Only two participants (0.9%) reported using all four substances, while 6.2% used three and 22.6% used two.

Daily or near-daily use was highest for cigarettes (45%) and e-cigarettes (33%). Marijuana was more likely to be used on a daily or near-daily basis than CBD (23% vs. 16%). Overall, 39% of marijuana, 33% of CBD and 35% of e-cigarettes users smoked at least once a week compared to 22% of cigarette users.

Recent users were more likely to be college-educated, ages 26-39, and Black. Marijuana users were slightly more likely to identify as female and other gender identities, whereas users of CBD, e-cigarettes, and cigarettes were more likely male.

Marijuana users were mostly in states where it’s legal (73%), compared to participants in medically legal (22%) and illegal states (5%).

Use according to CF lung function, mental health

The researchers also assessed substance use according to lung function, as measured by the percent predicted forced expiratory volume in one second (FEV1), which measures how much air can be exhaled in a second after a deep inhaled breath.

Patients with a self-reported FEV1 between 60-80% were more likely to use e-cigarettes and cigarettes. No differences regarding marijuana or CBD were seen between both groups.

Mental health was significantly worse among recent users of CBD, e-cigarettes, and cigarettes compared to nonusers. This was assessed with the Patient Health Questionnaire-4, which measures anxiety and depression. No differences were seen with marijuana.

In a multivariate analysis, which is based on the relationship between several variables, usage of CFTR modulators was significantly higher among e-cigarette users (2.9 times higher) and marijuana users (2.45 times higher) over nonusers, after adjusting for potential confounding factors such as age, sex, and race.

Anxiety and influences from friends and family were among the more common reasons for substance use. Marijuana users reported sleep disturbances as the main reason (45.4%), and CBD users pain management (34.7%). Curiosity and flavor testing  (30%) were noted by e-cigarettes users, whereas stress relief and enjoyment were reported by cigarette users.

Concentration difficulties were reported by both marijuana and CBD users, as well as changes in appetite and energy levels. E-cigarette users reported frequent nausea and vomiting. Cough and shortness of breath were common in both cigarette and e-cigarette users.

Among substance users, those who smoked marijuana and CBD were more likely to quit than former users of e-cigarettes and cigarettes. Lack of enjoyment (58%) and avoiding getting high (50%) were the main reasons for quitting marijuana, while perceiving no effectiveness was the top reason CBD users quit. A high proportion of never-users of marijuana and CBD reported being curious about using.

The findings show that “substance use is more prevalent among [people with CF] than previously reported and needs to be addressed by healthcare providers,” said the investigators, who noted the limitations of their study included its reliance on self-reported rather than clinical data, which increase the possibility that associations of substance use with health outcomes and CFTR modulators aren’t accurate.