Understanding the Metabolic Risks of Cannabis Use

The world has witnessed a significant increase in cannabis use, with estimates indicating 219 million users in 2021, representing 4.3% of the global adult population. However, the long-term metabolic effects of cannabis use remain unclear. While some studies suggest potential benefits of cannabis in combating inflammation or managing weight, concerns persist about its impact on glucose metabolism and insulin resistance, and the risk of developing diabetes among users is not well understood.

A New Study to Assess Cannabis Risks

In an effort to enhance the evidence base regarding cannabis use and its risks, Dr. Ibrahim Kamel and colleagues from Boston Medical Center in Massachusetts, USA, analyzed electronic health records from 54 healthcare organizations within the TriNetX research network, which includes centers from the United States and Europe. They identified 96,795 outpatients aged 18 to 50 (52.5% female) with diagnoses related to cannabis use between 2010 and 2018.

These patients were compared to 4,160,998 healthy individuals without illicit drug use or major chronic diseases, accounting for age, gender, and baseline conditions at the start of the study, and were followed for five years.

Results and Analysis

After controlling for factors such as good and bad cholesterol, uncontrolled hypertension, atherosclerotic cardiovascular disease, cocaine use, alcohol use, and various lifestyle factors, researchers found that new diabetes cases were significantly higher in the cannabis user group (1,937 cases; 2.2%) compared to the healthy group (518 cases; 0.6%). Statistical analyses showed that cannabis users were nearly four times more likely to develop diabetes compared to non-users.

Public Health Implications

Researchers indicate that more research is needed to fully understand the relationship between cannabis and diabetes, as it may be related to insulin resistance and unhealthy dietary behaviors. Nonetheless, the study’s findings have direct applications in metabolic monitoring practices and public health messaging.

According to Dr. Kamel, as cannabis becomes more socially and legally available in various regions, understanding its potential health risks is essential. Awareness of diabetes risks should be integrated into substance use disorder treatment and medical counseling, and healthcare professionals should routinely discuss cannabis use with patients to understand potential diabetes risks and the need for metabolic monitoring.

Research Challenges and Limitations

Despite the significant findings, this study is retrospective and cannot prove that cannabis use causes diabetes. Researchers cannot rule out the possibility that other unmeasured factors influenced the results, despite efforts to minimize bias using propensity score matching.

The study faces limitations due to the lack of detailed cannabis consumption data and potential classification errors. The authors acknowledge inherent limitations in real-world data resulting from variability in patient reporting in electronic medical records. They also note the risk of bias due to inaccurate measures of cannabis use and reliance on participants to accurately report any cannabis use, even when living in areas where the drug was illegal.

Conclusion

This study highlights the urgent need for further research into the metabolic health effects of cannabis, focusing on understanding the relationship between cannabis use and diabetes risk. Despite current limitations, the findings suggest the necessity of integrating education about diabetes risks into substance use disorder treatment programs and increasing awareness among healthcare providers and patients about these potential risks.