CARDIOVASCULAR RISKS OF RECREATIONAL MARIJUANA USE



Jamshid Shirani, M.D., St. Luke’s University Health Network, PA, USA

Social acceptability, availability, and regional legalization of recreational marijuana (cannabis) have caused a dramatic increase in its use across the United States. In 2014, ~22.2 million individuals aged 12 years and older were considered current users of marijuana and 4.2 million met the diagnostic criteria for abuse of or dependence on cannabis in the United States. According to the 2014 National Survey on Drug Use and Health (NSDUH), marijuana remains the most commonly used illicit drug. The sharp rise in recreational marijuana use has paralleled increased reporting of serious cardiovascular adverse events related to this substance in younger individuals. Marijuana smoking is a recognized trigger for myocardial infarction (Figure). Other cardiovascular complications have included ischemic stroke, cardiac arrhythmias and stress cardiomyopathy. Marijuana-related complications appear to be pathophysiologically related to the absolute and relative contents of psychoactive [tetrahydrocannabinol (THC)] and non-psychoactive [cannabidiol (CBD)] cannabinoids and their interaction with endocannabinoid and autonomic nervous systems. National and local debates, among health professionals and policy makers, on the merits of legalization of marijuana continue and appear to be primarily centered on a perception of the safety of the drug. Awareness and acknowledgement of serious complications of unregulated marijuana use and their potential public health implications should be included in discussions of legalization and widespread availability of this “recreational” drug.