Marijuana Use Associated with Decreased Mortality in Trauma Patients

Abstract

Background The incidence of trauma patients with a positive marijuana screen (pMS) is increasing but the effects of marijuana on outcomes have varied in previous studies. A recent statewide analysis demonstrated decreased mortality for intensive care unit (ICU) trauma patients with pMS. Thus, we hypothesized a pMS to be associated with a decreased risk of mortality for all trauma patients. Methods The 2017 Trauma Quality Improvement Program (TQIP) database was queried for adult (≥18 years-old) pMS patients, who were compared to patients negative for all drugs and alcohol (nDS). Patients not drug tested or testing positive for drug(s)/alcohol other than marijuana were excluded. Multivariable logistic regression was used to evaluate risk of mortality after controlling for known predictors of mortality including age, sex, injury severity, vital signs, and comorbidities. Additional subgroup analyses were performed for ICU patients and younger adults (<40 years-old). Results From 141 737 tested patients, 23 310 (16.4%) had an isolated pMS. Patients with pMS were younger ( P < .001) but had a similar median injury severity score (ISS) (9, P = .42) compared to nDS patients. On multivariable analysis the associated risk of mortality was lower for pMS (OR .79, .71-.87, P < .001) compared to nDS patients. Subgroups analyses also demonstrated decreased associated risk of mortality for ICU and younger patients (both P < .05). Discussion Patients with a pMS had decreased associated risk of mortality compared to nDS patients, including subgroups of ICU and younger patients. These findings require corroboration with future prospective clinical study and basic science evaluation to ascertain the exact pathophysiologic basis and thereby target potential interventions.

Mechanisms of Injury in Adolescent Trauma Patients With a Positive Marijuana Screen

“…13 Moreover, multiple studies have demonstrated that adult pMS patients are more likely to be associated with penetrating traumas (stabbing, gunshot wounds). 3,7 Our study confirms these associations in adolescent patients as we found a positive association between pMS and gun or knife trauma. Healthcare providers may be in a unique position to counsel adolescents presenting with pMS to abstain from marijuana use, which may potentially mitigate trauma recidivism.…”

“…20 Lank et al 20 have previously reported that pMS trauma patients are admitted with more serious injuries. Bloom et al 3 also reported the prevalence of pMS patients admitted with severe thoracic injuries is significantly higher than nMS patients (3.8% vs 2.6%, P < .001). Our study confirms these previous reports with respect to thoracic injuries, in the adolescent population.…”

“…2 Its effects range from euphoria to anxiety and psychosis, 2 and its popularity has skyrocketed since the widespread legalization of medicinal and recreational marijuana use in the United States. 3 The effect of THC on users is through its interaction with endocannabinoid receptors throughout the body. 2 These receptors play a crucial role in regulating emotional behaviors.…”