5A-01 - Impact of Pre-Existing Cardiovascular Disease on Medical Cannabis Prescribing Patterns among Florida Medicaid Beneficiaries

Background

Medical cannabis use is increasing, and prior research suggests its use is associated with a broad range of adverse cardiovascular (CV) outcomes. In fact, some delta-9-tetrahydrocannabinoid (THC)-containing products are contraindicated outside the US in those with CV disease. As such, the American Heart Association has emphasized the need for observational research to better understand the epidemiology of medical cannabis and its usage among individuals with pre-existing CV disease. 

Objective

To analyze whether pre-existing CV disease is associated with differences in medical cannabis prescribing patterns and clinical characteristics among a population of Florida Medicaid beneficiaries 

Methods

For this study, we used data from the Medical Marijuana clinical Outcomes RepositorY (MEMORY), which contains Medical Marijuana Use Registry data linked to Florida Medicaid claims. We identified beneficiaries newly certified to use medical cannabis who were aged 19-65 with ≥ 365 days of continuous Medicaid enrollment. Next, we assessed for pre-existing CV disease during the 365-day baseline period prior to first medical cannabis dispensing, which was defined as a composite of acute myocardial infarction, unstable angina, ischemic heart disease, transient ischemic attack, stroke, peripheral vascular disease, atrial fibrillation, hypertension, or heart failure. We compared differences in dose/route of medical cannabis dispensing and demographic characteristics using Chi-squared tests or t-tests, where applicable.

Results

We identified 75,433 medical cannabis new users (63.19% female; 52.48% white; mean age 35.13) who met eligibility criteria for our study. Of those, 5,041 (6.68%) had pre-existing CV disease, with hypertension (5.74%), ischemic heart disease (1.23%) occurring most frequently. Medical cannabis new users with pre-existing CV disease were more likely to be older (mean age: 48.08 vs. 34.20, p<0.0001) and male (46.52 vs. 36.11, p<0.0001); and less likely to be non-Hispanic White (51.4% vs. 52.6%, p<0.0001) and to use a smokable product (66.34% vs. 75.40%, p<0.0001), compared to those without CV disease. We found no significant differences in daily dose of THC prescribed between the two groups (mean mg THC: 69.8 vs. 67.1, p=0.1369).

Conclusions

We found that over one out of every fifteen Florida Medicaid beneficiaries newly initiating medical cannabis had pre-existing CV disease. Despite the potential adverse CV risks associated with medical cannabis, our results suggest that the presence of pre-existing CV disease was not associated with significant differences in daily starting dose of THC. More research is needed to better understand medical cannabis epidemiology and associated risks among those with CV disease to optimize medication safety and improve outcomes.