Tags: Cannabis; Cirrhosis; Decompensation; Hospital Utilization; Patient Outcomes

 

 

Thumbnail: This study analyses data from a state database to study the impact of cannabis use on healthcare utilization and hospital outcomes for patients with cirrhosis. The authors also compared cannabis use before and after cannabis legalization. For patients who used cannabis, they found mixed results regarding hospital admissions and hepatic decompensation. After legalization, there was a trend towards decreased hospital utilization and mortality among cannabis users.

 

The problem: The prevalence of cirrhosis is significantly increasing in the US, as is the prescription of medicinal cannabis. Cannabis has been noted as being effective in some digestive system diseases, including cirrhosis. Studies in animals suggest that cannabinoids, a primary compound in cannabis, can be effective in combating some aspects of cirrhosis, but there is not a lot of data on how this might translate to an effect in humans.

 

The study: The authors performed a retrospective analysis using data from the State Inpatient Database (SID) to evaluate patients from Colorado and Washington. They used data from 2011 (17,520 patients) to represent patient habits prior to cannabis legalization and data from 2015 (21,917 patients) to represent things after cannabis legalization.  It is unclear how information on cannabis use was collected. The authors studied the impact of cannabis on the rate of hospital admissions for hepatic decompensation, healthcare utilization and mortality in patients with cirrhosis.

 

Main Points:

• Cannabis use among patients with cirrhosis was detected in 2.1% of patients admitted to the hospital in 2011 and 5.3% of patients in 2015.

• After legalization, cirrhosis patients using cannabis had a lower rate of admission related to hepatorenal syndrome and ascites (specific features of hepatic decompensation).

• No significant difference was seen in admission rates for symptoms of hepatic encephalopathy and variceal bleeding between cirrhosis patients using cannabis after legalization and those not using it.

• After legalization, patients with cirrhosis who used cannabis had a decreased length of stay in the hospital, decreased total hospital charges, and a decrease in mortality while in the hospital, compared to cirrhosis patients not using cannabis or using cannabis prior to legalization.

• There was no significant difference in hospital length of stay, hospital charges or inpatient mortality between patients who did not did not use cannabis in 2011.

• For patients with cirrhosis due to reasons other than alcohol and hepatitis C, there was a higher risk of admission for hepatic encephalopathy if they used cannabis and a decreased risk if they did not.

• Patients with cirrhosis due to hepatitis C infection who used cannabis had a lower risk of mortality than patients with cirrhosis due to alcohol or other causes.

 

Conclusions: Medical cannabis use is associated with improved patient and hospital outcomes among patients with cirrhosis, but there were mixed results when looking at hospital admissions for hepatic decompensation. After legalization, the authors noted a trend towards decreased hospital utilization and mortality among patients who used cannabis, which may be a result of patients taking more consistent and regulated doses of cannabis. However, they recommend that these retrospective observations be confirmed by randomized longitudinal studies.

 

Why this is a good study:

• This study was done in a large population, more than 39,000 patients total, so these findings are more likely to accurately reflect outcomes in the wider population.

• This report considered different aspects of cirrhosis (different symptoms, different causes) independently to provide an informed breakdown of the effect of cannabis on different facets of the disease.

 

Why this isn’t a perfect study:

• This study does not shed any light on the long-term effects of cannabis use among cirrhosis patients, which could be particularly important for transplant candidates, as liver transplant is the only definitive treatment available for cirrhosis patients and cannabis use frequently disqualifies a candidate from receiving a transplant.

• This study only looks at generalized cannabis use among cirrhosis patients, it is unable to provide insights into the effects of cannabis use at specific stages of cirrhosis progression.

• The authors do not say how cannabis use was reported, so we do not know where that data came from or how reliable it is.

 

What this study adds:

• There have not been many studies looking at the effects of cannabis among cirrhosis patients and this study adds an in-depth analysis of the effects of cannabis use on healthcare utilization this patients population.

• The mixed outcomes of this study highlight the need for more studies in this area, particularly longitudinal, randomized studies.

 

What it doesn’t:

• This study is unable to provide any insights into the biological mechanism of how cannabis may be benefiting cirrhosis patients.

• This study does not provide a definitive conclusion on whether or not cannabis is an effective treatment for cirrhosis patients

 

Funder: None stated

 

Author conflicts: None declared