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.