Cannabis disorders reported to the French monitoring system of abuse and dependence: increasing reporting of serious cardiovascular disorders

E Jouanjus1,2, M Lapeyre-Mestre1,2, J Micallef3. 1Université de Toulouse III, Inserm UMR 1027, Equipe de Pharmacoépidémiologie, Toulouse, F-31000, France, 2Centre Hospitalier Universitaire, Centre d\'Evaluation et d\'Information sur la Pharmacodépendance - Addictovigilance, Toulouse, F-31000, France, 3Centre Hospitalier Universitaire, Centre d\'Evaluation et d\'Information sur la Pharmacodépendance - Addictovigilance, Marseille, F-13000, France

This work was conducted by the French Association of Addictovigilance Centres (Association Française des Centres d’Évaluation et d’Information sur la Pharmacodépendance – Addictovigilance, AFCEIP-A).

Background: Cannabis is known to be associated with neuropsychiatric troubles, and less to complications affecting other specified body systems. Several outstanding cardiovascular complications following cannabis use were reported to the French Network of Addictovigilance Centres (CEIP-A) during the recent years.

Objectives: This study aimed to summarize and evaluate the cardiovascular complications of cannabis reported to the French monitoring system of abuse and dependence.

Methods: We identified all spontaneous reports (NotS) of cardiovascular complications related to cannabis use collected from 2006 to 2010 by the 13 French CEIP-A. Clinical characteristics of these cases and their evolutions were described.

Results: Among all NotS involving cannabis exposure, 2% were cardiovascular complications. Patients were mainly males (85.7%) with a mean age of 34.3 years old (SD 8.8). Cases were characterised by 3 cerebral, 10 peripheral and 22 cardiac complications including 20 cases of acute coronary syndromes. “Acute cerebral angiopathy”, “transient cortical blindness” and “spasm of cerebral artery” were reported as cerebral complications. Peripheral complications consisted in arteriopathies such as Buerger-like diseases. The follow-up of these reports identified 9 deaths in patients with cardiac complications whereas 19 patients were hospitalised for acute coronary syndrome. Management of hospitalised patients comprised non-invasive and invasive techniques (ie. cardiac repermeabilisation, limb amputation).

Conclusions: Cannabis derivatives were shown to lead to cardiovascular complications through mechanisms involving the autonomous nervous system. These complications represent about 2% of all adverse events related to cannabis use reported to the French system of drug abuse monitoring. Even though these complications are more likely observed among young adults who use stimulant drugs, practitioners should be aware that cannabis may work as other illicit psychoactive drug (cocaine or amphetamine) and may be a potential triggering factor for cardiovascular complications in young people.