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Consequences

Title: 

Citation: Sara W. Kelly, Collins O. Odhiambo, Niranjan S. Karnik, Manu R. Sood; Cannabinoid Hyperemesis Syndrome: Unveiling the National Impact on Youth. Pediatrics Open Science March 2026; 2 (1): 1–9. https://doi.org/10.1542/pedsos.2025-000976

Background: Cannabis use (CU) among youth is an increasing public health concern, driven in part by evolving policies that expand access and shift social norms. An emerging consequence is the rise in cannabinoid hyperemesis syndrome (CHS), a condition associated with chronic Cannabis Use. CHS involves severe nausea and vomiting that may be mitigated by frequent showers see - https://my.clevelandclinic.org/health/diseases/21665-cannabis-hyperemesis-syndrome

Research Question: This study examined trends CHS-related acute health care encounters among youth across diverse sociodemographic groups using a nationally representative dataset called Epic COSMOS.

Methods: The study included individuals aged 6 to 18 years who were diagnosed with CHS from 2017 to 2024. We calculated CHS-related encounter rates per 100 000 using the number of unique pediatric patients with acute health care encounters as the denominator. Trends were assessed using join point regression to estimate the annual percent change (APC) and average annual percent change.

Results:
1. A total of 61 908 CHS-related acute health care encounters were identified among youth between 2017 and 2024.
2. CHS encounter rates were consistently higher among female youth and continued to increase at a faster pace than male youth, with an APC of 16.1, compared with 11.2.
3.  Black youth had an APC of 18.5 
4. Youth from other minority groups had the highest APC at 26.2, compared with other  racial groups.
 

Conclusions and Relevance: CHS-related encounters are rising rapidly, with disproportionately higher increases among female and minority youth. These findings highlight the need for CU prevention efforts tailored to high-risk youth and improved clinical awareness of CHS to support timely diagnosis and management.

Notes from Duane McBride: Marijuana legalization advocates argued that marijuana is relatively harmless but public health experience has shown at the current high THC levels it is not harmless. These data suggest that the greatest harm for CHS is occurring among females and minorities.

 

Title: 

Citation: Young-Wolff KC, Cortez CA, Alexeeff SE, et al. Adolescent Cannabis Use and Risk of Psychotic, Bipolar, Depressive, and Anxiety Disorders. JAMA Health Forum. 2026;7(2):e256839. doi:10.1001/jamahealthforum.2025.6839

Key Points
Question: Is adolescent cannabis use associated with an increased risk of developing psychiatric disorders by young adulthood? N=463,396.

Findings: In this cohort study of 463鈥�396 adolescents aged 13 to 17 years who were universally screened for cannabis use each year until the age of 26

Past-year cannabis use was associated with an increased risk of:
1. Incident psychotic episodes (adjusted hazard ratio [AHR], 2.19; 95% CI, 1.97-2.42),
2.    Bipolar diagnosis (AHR, 2.01; 95% CI, 1.82-2.22),
3. Depressive disorders (AHR, 1.34; 95% CI, 1.30-1.39), and
4. Anxiety disorders (AHR, 1.24; 95% CI, 1.21-1.28).
5. Controlling for past psychiatric disorders reduced the AHR for psychotic episodes to 1.92 and bipolar diagnosis to 1.73.
6. Thus, even controlling for past psychiatric disorder diagnosis, frequent marijuana use appears to be associated with a major increase of the odds for psychosis and bipolar episodes.

The strength of the associations between cannabis use and incident depressive and anxiety disorders decreased as adolescents aged.

Notes from Duane McBride: Daily marijuana use among adolescents about doubled the risk of psychosis and bipolar diagnosis by age 26. These data strongly support prevention efforts in public health education, policies restricting access to marijuana as well as the importance of prevention programs. As noted, marijuana use advocates sold the public on the relative safety of marijuana which has been shown to be very false!

 

Title: 

Citation: Hyatt AS, Overhage L, Cook BL. Use of Tobacco and Cannabis Following State-Level Cannabis Legalization. JAMA Netw Open. 2025;8(7):e2520093. doi:10.1001/jamanetworkopen.2025.20093

Key Points
Research Question: Is legalizing cannabis associated with use of cannabis, cigarettes, and electronic nicotine delivery systems (ENDS)?

Findings: In this cohort study using difference-in-differences methods to analyze 171,257 observations from 55,406 participants, legalization was associated with increased cannabis use and ENDS use. There was no association with cigarette use.

Notes from Duane McBride: Cannabis and ENDS use increased after cannabis legalization, but there was no evidence of a halt or reverse in the decline in cigarette use. (In other words, legalizing marijuana did not reduce cigarette use and was related to an increase in the use of marijuana and vaping cigarettes)
 

Title: 

Citation: Marshall AT, Adise S, Kan EC, Sowell ER. Prenatal Tobacco and Alcohol Exposure and Cortical Change Among Youths. JAMA Netw Open. 2025;8(6):e2516729. doi:10.1001/jamanetworkopen.2025.16729

Key Points
Research Question: How does prenatal tobacco and/or alcohol exposure affect brain structure and longitudinal development in early adolescence?

Findings:
1. In this cohort study of 5,417 youths aged 9 to 12 years, prenatal tobacco exposure was associated with faster rates of cortical thinning in the frontal lobe.
2. Prenatal alcohol exposure had no association with cortical structure and change.
3. Exploratory developmental-outcome analyses suggested that faster cortical thinning was associated with more externalizing behavior and sleep problems (eg, right pars orbitalis and externalizing behavior: |rp| = 0.04, P = .003), primarily in those with PTE.

Notes from Duane McBride: These findings suggest that prenatal substance (tobacco) exposure affects not only cortical structure but also how cortical development developed long after those exposures occurred. (Externalizing behavior means a loss of executive functioning where the individual acts our emotionally, has difficulty with self-control, and often acts aggressively. Thus, prenatal tobacco use was related to childhood to preadolescence behavioral problems and lack of sleep)
 

Title: 

Citation: Hsu M, Shah A, Jordan A, Gold MS, Hill KP. Therapeutic Use of Cannabis and Cannabinoids: A Review. JAMA. Published online November 26, 2025. doi:10.1001/jama.2025.19433

Abstract
Importance: Approximately 27% of adults in the US and Canada report having ever used cannabis for medical purposes. An estimated 10.5% of the US population reports using cannabidiol (CBD), a chemical compound extracted from cannabis that does not have psychoactive effects, for therapeutic purposes.

Observations: 
1. Conditions for which cannabinoids have approval from the US Food and Drug Administration include HIV/AIDS–related anorexia, chemotherapy-induced nausea and vomiting, and certain pediatric seizure disorders.
2. A meta-analysis of randomized clinical trials reported a small but significant reduction in nausea and vomiting from various causes (eg, chemotherapy, cancer) when comparing prescribed cannabinoids (eg, dronabinol, nabilone) with placebo or active comparators (eg, alizapride, chlorpromazine; standardized mean difference [SMD], −0.29 [95% CI, −0.39 to −0.18]).
3. A meta-analysis of randomized clinical trials among patients with HIV/AIDS reported that cannabinoids had a moderate effect on increasing body weight compared with placebo (SMD, 0.57 [95% CI, 0.22 to 0.92]).
4. Evidence-based guidelines do not recommend the use of inhaled or high-potency cannabis (≥10% or 10 mg Δ9-tetrahydrocannabinol [Δ9-THC]) for medical purposes.
5. High-potency cannabis compared with low-potency cannabis use is associated with increased risk of psychotic symptoms (12.4% vs 7.1%) and generalized anxiety disorder (19.1% vs 11.6%).
6. A meta-analysis of observational studies reported that 29% 0f individuals who used cannabis for medical purposes met criteria for cannabis use disorder.
7. Daily inhaled cannabis use compared with nondaily use was associated with an increased risk of coronary heart disease (2.0% vs 0.9%), myocardial infarction (1.7% vs 1.3%), and stroke (2.6% vs 1.0%).
8. Evidence from randomized clinical trials does not support the use of cannabis or cannabinoids for most conditions for which it is promoted, such as acute pain and insomnia. (in other words, medical marijuana is often misused and often not indicated for the health condition reported)

Conclusions and Relevance:  Evidence is insufficient for the use of cannabis or cannabinoids for most medical indications. Clear guidance from clinicians is essential to support safe, evidence-based decision-making. Clinicians should weigh benefits against risks when engaging patients in informed discussions about cannabis or cannabinoid use.
 

Title: 

Citation: Assoumou SA, Alexander RN, Miller SE. Viral Infections Associated With Injection Drug Use. JAMA. 2025;334(15):1386–1387. doi:10.1001/jama.2025.13287

Research Question: What is the relationship between injection drug use and viral infections.

Findings:
1. Data from 2017 to 2022 suggest that approximately 14.8 million individuals globally inject drugs, accounting for 0.29% of adults aged 15 to 64 years.
2. Persons who inject drugs (PWID) are at increased risk of viral infections, including HIV, hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C  
  virus (HCV), and hepatitis D virus (HDV)
3. Clinicians should be aware of this and discuss safter use and vaccinations against hepatitis.

Notes from Duane McBride: There is nothing new here, but it reminds us of the health risks of injecting drugs.