Tobacco Alcohol Cocaine Opioids Hallucinogens Amphetamine Marijuana No Marijuana 0 10% 20% 30% 40% 50% 60% 70% Recreational Marijuana Use & Acute Ischemic Stroke: A Population-Based Analysis of Hospitalized Patients in the United States Kavelin Rumalla 1, Adithi Y Reddy 1, Manoj K Mittal, MD 2 1 University of Missouri-Kansas City School of Medicine, Kansas City MO; 2 University of Kansas Medical Center, Department of Neurology, Kansas City, KS INTRODUCTION ➢ Recreational marijuana use is considered to have few adverse effects. 1,2,4-8 ➢ The association between marijuana, the most commonly used recreational drug in the United States, and stroke has been explored in several case reports. 1 ➢ An epidemiological relationship between recreational marijuana abuse and acute ischemic stroke has not previously been reported. METHODS ➢ The incidence of AIS was significantly greater among marijuana users compared to non-users (RR: 1.13, P<0.0001) and had the greatest difference in the 25–34 age group (RR: 2.26, P<0.0001). ➢ Marijuana users were more likely to use other illicit substances but had less overall medical comorbidity. ➢ Marijuana abuse was more prevalent among younger patients, males, African American patients, and Medicaid enrollees (P<0.0001). ➢ In multivariable analysis, adjusted for potential confounders, marijuana (OR: 1.17, 95% CI: 1.15–1.20), tobacco (OR: 1.76, 95% CI: 1.74–1.77), cocaine (OR: 1.32, 95% CI: 1.30–1.34), and amphetamine (OR: 2.21, 95% CI: 2.12–2.30) usage were found to increase the likelihood of AIS (all P<0.0001). ➢ Among younger adults aged 15-54, recreational marijuana use is independently associated with 17% increased likelihood of AIS hospitalization. ➢ Data Source: The Nationwide Inpatient Sample ( ) was used to create marijuana use (N=2,496,165) and non- marijuana use (N=116,163,454) cohorts. ➢ Inclusion Criteria: All patients aged with a primary diagnosis of acute ischemic stroke (ICD-9-CM code 430). Patients with a secondary diagnosis of current marijuana use were further identified. ➢ Exclusion criteria: Patients coded as “in remission” from drug abuse. ➢ Predictor variables: Demographics, pre-existing comorbidity, substance abuse. ➢ Outcome variables: Symptomatic cerebral vasospasm, discharge disposition, in-hospital mortality. ➢ Statistical analysis: Age stratification of the population into groups of 15-24, 25-34, 35-44, and was performed. We utilized bivariate analysis to compare demographics and comorbid risk factors of AIS. Multivariable logistic regression analyses were used to evaluate marijuana use as a risk factor of AIS and symptomatic cerebral vasospasm. P was set a priori at < for all analyses. RESULTS CONCLUSION LIMITATIONS RESULTS The Gateway Drug Effect: Comparing the Incidence of Substance Abuse in Marijuana vs. Non-Marijuana Cohorts ➢ We were unable to account for any dose-dependent mechanisms of marijuana use due to the limitations of the ICD-9-CM coding system. ➢ The high liposolubility of cannabis metabolites allows them to persist in fatty tissues and thereby be detected in urine for weeks after use. 3 ➢ There is no information available in the NIS regarding time from last drug use to AIS occurrence. ➢ The lack of data on preadmission functional status and severity in the NIS inhibits adjustment for the severity of AIS. 1.D.G. Hackam, Cannabis and stroke: systematic appraisal of case reports, Stroke J. Cereb. Circ. 46 (3) (2015) 852–856, D.Z. Rose, W.R. Guerrero, M.V. Mokin, et al., Hemorrhagic stroke following use of the synthetic marijuana “spice”, Neurology 85 (13) (2015) 1177–1179, org/ /WNL I. Mateo, A. Pinedo, M. Gomez-Beldarrain, J.M. Basterretxea, J.C. Garcia-Monco, Re- current stroke associated with cannabis use, J. Neurol. Neurosurg. Psychiatry 76 (3) (2005) 435–437, 4.P.A. Barber, H.M. Pridmore, V. Krishnamurthy, et al., Cannabis, ischemic stroke, and transient ischemic attack: a case–control study, Stroke J. Cereb. Circ. 44 (8) (2013) 2327–2329, 5.D. Renard, G. Taieb, G. Gras-Combe, P. Labauge, Cannabis-related myocardial infarc- tion and cardioembolic stroke, J. Stroke Cerebrovasc. Dis. Off. J. Natl. Stroke Assoc. 21 (1) (2012) 82–83, 6.K. Esse, M. Fossati-Bellani, A. Traylor, S. Martin-Schild, Epidemic of illicit drug use, mechanisms of action/addiction and stroke as a health hazard, Brain Behav. 1 (1) (2011) 44–54, 7. P. Cooles, R. Michaud, Stroke after heavy cannabis smoking, Postgrad. Med. J. 63 (740) (1987) T. Geller, L. Loftis, D.S. Brink, Cerebellar infarction in adolescent males associated with acute marijuana use, Pediatrics 113 (4) (2004) e365–e370. REFERENCES