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Patterns of Marijuana Use Among Patients With Celiac Disease in the United States

A Population-based Analysis of the NHANES Survey

Knotts, Rita M. MD, MS*; Zylberberg, Haley M. MD; Jodorkovsky, Daniela MD; Green, Peter H.R. MD; Lebwohl, Benjamin MD, MS

Journal of Clinical Gastroenterology: May 03, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MCG.0000000000001220
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Background: Marijuana use has been assessed in patients with chronic gastrointestinal disorders and may contribute to either symptoms or palliation. Use in those with celiac disease (CD) has not been assessed. Our aim was to evaluate patterns of marijuana use in a large population-based survey among patients with CD, people who avoid gluten (PWAG), and controls.

Study: We analyzed data from the National Health and Nutrition Examination Survey from 2009 to 2014. χ2 tests and multivariable logistic regression were used to compare participants with CD and PWAG to controls regarding the use of marijuana.

Results: Among respondents who reported ever using marijuana (overall 59.1%), routine (at-least monthly) marijuana use was reported by 46% of controls versus 6% of participants with diagnosed CD (P=0.005) and 66% undiagnosed CD as identified on serology (P=0.098) and 51% of PWAG (P=0.536). Subjects with diagnosed CD had lower odds of routine marijuana use compared with controls (odds ratio, 0.08; 95% confidence interval, 0.01-0.73), whereas participants with undiagnosed CD had increased odds of routine use (odds ratio, 2.26; 95% confidence interval, 0.83-6.13), which remained elevated even after adjusting for age, sex, race/ethnicity, health insurance status, alcohol, tobacco use, educational level, and poverty/income ratio.

Conclusions: In all groups, marijuana use was high. Although there were no differences among subjects with CD, PWAG, and controls who ever used marijuana, subjects with diagnosed CD appear to have decreased routine use of marijuana when compared with controls and PWAG. Those with undiagnosed CD have significantly higher rates of regular use. Future research should focus on the utilization of marijuana as it may contribute to further understanding of symptoms and treatments.

*Department of Medicine, Division of Gastroenterology, New York University Langone Health

Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY

R.M.K.: study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript. H.M.Z and P.H.R.G.: critical revision of the manuscript for important intellectual content. D.J.: study concept and design; critical revision of the manuscript for important intellectual content. B.L.: study concept and design; analysis and interpretation of data; drafting of the manuscript.

Supported in part by a T32 award from the NIDDK (RMK, DK83256-9).

The authors declare that they have nothing to disclose.

Address correspondence to: Rita M. Knotts, MD, MS, Department of Medicine, Division of Gastroenterology, New York University Langone Health, 240 East 38th Street, 23rd Floor, New York, NY 10016 (e-mail: rita.knotts@nyumc.org).

Received November 12, 2018

Accepted April 1, 2019

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