(323) It’s time to be blunt – a deeper investigation of attitudes and usage of marijuana, cannabidiol, and cigarettes in the Cystic Fibrosis community

Background: Life expectancy has increased in the era of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy; however, people with cystic fibrosis (CF) continue to be disproportionately affected by anxiety, depression, insomnia, and chronic pain. As the legal landscape and stigma surrounding marijuana and cannabidiol (CBD) continue to evolve, many with CF may use these products for relief. The prevalence, reasons for use and routes of administration of marijuana, CBD and other recreational drugs in people with CF is unknown. This study will begin to address these knowledge gaps to help CF care teams understand and appropriately educate their patients and families.

Methods: This was a cross-sectional study of the prevalence of marijuana, CBD, e-cigarette, and cigarette use in the CF population. Subjects with CF who were ≥13 years of age were recruited through CF support groups found on social media platforms and participating CF Centers recruited via the CF list serv. A REDCap survey assessed: frequency of use, routes of administration, reasons for use, demographics, PHQ4 screen for anxiety and depression, self-reported FEV₁ percent predicted (ppFEV1), and CFTR modulator use. STATA was used for analysis.

Results: Of the 217 subjects ages 13-58 years old (median 28 years), 29% (n=63) used marijuana, 21% (n=45) used CBD, 38% (n=82) vaped, and 45% (n=88) smoked cigarettes in the past year. Only 14% (n=30) subjects reported not using any of the substances. Of those using marijuana, 21% reported medical use, 45% for recreation and 17% for both. The most common substances vaped were nicotine (56%, n=46) and flavoring (38%, n=31). Marijuana use was not different in those with and without anxiety and depression but CBD users were more likely to have depression (p=0.03) and E-cigarette users were more likely to have anxiety (p=0.01). Cigarette smokers were more likely to have both anxiety (p=0.001) and depression (p< 0.001) (table 1).

Subjects with ppFEV₁ >80% and < 60% had lower marijuana use (p=0.02) and cigarette use (p< 0.001) than those with ppFEV₁ 60-80%. E-cigarette use was lowest in those with ppFEV₁ >80% (p< 0.004). CBD was used uniformly across all lung functions. Subjects on CFTR modulators were slightly more likely to use e-cigarettes (p=0.06) and less likely to use marijuana (p=0.047) than those not on modulators. There was no difference in cigarette or CBD use by CFTR modulators.

Substance users reported their healthcare team was aware of marijuana use in 70% (n=42/60) of users, CBD use in 78% (n=35/45) of users, e-cigarette use in 78% (n=56/72) of users, and cigarette use in 83% (n=73/88) of users. Most subjects were comfortable discussing their marijuana (63%, n=128) and CBD (66%, n=126) use and frequency of use with their healthcare team, while 27% (n=55) and 26% (n=54) stated that they would lie about frequency of marijuana and CBD respectively. If asked,10% (n=21) would not disclose marijuana use, 7% (n=15) would not disclose CBD use, 8% (n=16) would not disclose e-cigarette use, and 4% (n=9) would not disclose cigarette use.

Conclusions: Our results indicate that usage of these substances is frequent and occurring at a much higher proportion in individuals with CF than previously reported. Smoking and vaping are especially high among subjects with anxiety and depression. As most subjects feel comfortable disclosing substance use with their healthcare team, providers should ask about use and to help patients make informed decisions.

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