Investigating the mechanisms involved in both alcohol and cannabis-mediated inflflammatory priming within the lung is important to better understand the pulmonary immune system and may reveal pathways susceptible to pharmacological intervention. In conclusion, although the experimental data are emerging, the increase in alcohol and cannabis sales during the time of pandemic should focus the attention of health and scientific professionals to this potential problem, for both health of both direct and indirect victims of COVID-19. Since the declaration of COVID-19 as a global pandemic by the World Health Organization on 11 March 2020, disparities in COVID-19-associated morbidity and mortality have emerged among older adults and individuals living with chronic health conditions . Within the United States, medicinal cannabis use is legal in certain states for individuals with certain health conditions, such as cancer .
Cancer survivors, including those who use medicinal cannabis, have been recommended to take additional precautions to reduce COVID-19 exposure due to increased risk for COVID-19 hospitalization and mortality among individuals with pre-existing chronic health conditions . Beyond the physical risks of COVID-19, individuals with chronic health conditions are reporting increased anxiety and depressive symptoms, as well as adverse economic outcomes including loss of employment and health insurance . Prior studies, including those conducted by the study team, have documented increased reports of physical and mental health symptoms during the pandemic period among cancer survivors compared to adults without a history of cancer . Legal qualifying medical conditions for cannabis use vary by state within the United States; cancer and HIV/AIDs are conditions consistently included across all legal states . Despite variation in the legality of cannabis, “conclusive or substantial evidence” in the effectiveness of cannabis to treat chronic pain, chemotherapy-induced nausea and vomiting, and patient-reported multiple sclerosis spasticity symptoms were identified in 2017 by the National Academies of Sciences, Engineering, and Medicine in a report on the Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research .
Cannabis contains phytocannabinoids that have been shown to engage with the endocannabinoid system, an endogenous system responsible for homeostasis. Receptors for the endocannabinoid system, CB1 and CB2, are located throughout the body and bind with phytocannabinoids depending on their affinity. CB2 receptors have been identified as opportunities for cannabis, CBD in particular, to impact the health of cancer patients due to its opportunity to effect pain and immune function, for example . Though clinical evidence on the indications of cannabis use for cancer has traditionally been limited due to federal legalization status, observational studies of cannabis consumers identify pain management, nausea, appetite, anxiety, depression, and sleep as most prevalent reasons for use . Further, medical cannabis use has been identified as a coping strategy to help manage physical and mental health symptoms among cancer survivors . However, the impacts of the COVID-19 pandemic on cannabis use behaviors and other coping strategies among cancer survivors remains underexplored. Cannabis as a coping strategy differs from other strategies largely due to its unique relationship with the human endocannabinoid system.
Cannabis has the opportunity to impact physical and mental health through cannabinoids that engage with the body based on the type of cannabis used and the method of delivery. The objective of the study is to identify changes to cannabis use, methods of cannabis delivery, and coping strategies among cancer survivors, and to describe differences in cannabis behaviors and coping strategies by cancer status among an age-matched sample of cannabis users from the COVID-19 cannabis health study.Cross-sectional data are from the COVID-19 cannabis health study, a multisite study designed to examine COVID-19 impacts on cannabis use patterns and related behaviors among adult medicinal and recreational cannabis users . The study includes domains regarding COVID-19 testing, diagnosis, and probable COVID-19 symptoms; measures of mental health symptoms reported since the COVID-19 pandemic; cannabis and other substance use behaviors before and during the pandemic period; and self-report of physician diagnosis of chronic health conditions. Study eligibility criteria included adults 18 yearsof age or older; participants included cannabis users and non-cannabis users.