Introduction
Over the past decade, there has been a notable change in the consumption
patterns of inhaled and ingested substances, driven in part by the
increased legalization of cannabis and the growing popularity of
electronic cigarettes (e-cigarettes)1. While cigarette
use is on the decline, the use of e-cigarettes and marijuana has
witnessed an upward trend, which is expected to continue with the
ongoing progress of cannabis legalization across states and diminishing
societal stigma2. Despite these changes, there remains
limited research on the frequency of use, effectiveness, and safety of
these substances for various medical conditions, particularly among
individuals with underlying lung disease.
Cystic fibrosis (CF), formerly considered a fatal condition, as many
individuals did not live past childhood, has experienced a remarkable
transformation, largely attributed to advances in precision medicine and
the introduction of modulator therapy3. As the CF
population continues to age, attention is shifting towards addressing
unique challenges teenagers and adults face, including mental health and
substance use. People with CF (pwCF) may seek complementary and
alternative treatments to address common issues associated with their
chronic illness, including treatment burden, anxiety, depression,
decreased appetite, pain, and sleep disturbances4,5.
Moreover, as health outcomes improve in the era of effective modulator
therapy and respiratory symptoms become less prominent, pwCF may resort
to inhalation of substances that could have significant impact on their
lung health.
Limited data currently exists on the prevalence, modalities,
perceptions, demographic, and health factors associated with using
marijuana, cannabidiol (CBD), e-cigarettes, and cigarettes in pwCF,
particularly in the era of effective modulator therapy. In the past
decade, there were only two studies on substance abuse in
CF6,7; both were conducted prior to the legalization
of marijuana and prior to the majority of pwCF qualifying for effective
modulator therapy. Given these evolving circumstances, it is essential
to reexamine substance use and its perception among pwCF. Gaining a
deeper understanding of substance usage patterns can enhance the quality
of clinical care and provide valuable insights into the underlying
reasons, empowering healthcare teams to provide informed guidance and
support.
In this study, we investigated the prevalence of marijuana, CBD,
e-cigarette, and cigarette usage within the CF community and the
characteristics of users. We sought to determine if pwCF using these
substances were on CFTR modulators as well. Lastly, we investigated
reasons for and attitudes regarding substance usage and self-reported
clinical outcomes with substance use.