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Rationale: Cannabis use is rapidly growing in the United States, but its health implications are poorly understood, particularly when compared with cigarette smoking. Previous research conducted on animal models or nonrepresentative populations with small sample sizes has yielded mixed results on the impact of marijuana use on hemoglobin concentrations, which might reflect subclinical hypoxemia and/or carbon monoxide exposure. Objectives: We evaluated the association between marijuana use and hemoglobin concentrations in a nationally representative sample of U.S. adults. Methods: This cross-sectional study included 16,038 individuals 18–59 years of age enrolled in National Health and Nutrition Examination Survey (NHANES) from 2009 to 2018. We related current and former marijuana use with measured hemoglobin concentrations, with adjustment for demographics, education, housing, and cigarette smoking status in multivariable analyses that incorporated complex survey weights. As candidate positive and negative control exposures, we used similar methods to relate cigarette smoking and benzodiazepine use, respectively, with hemoglobin concentrations. Results: Current marijuana use was associated with significantly higher hemoglobin concentrations. After multivariable adjustment, compared with never use, current marijuana use was associated with a 0.111 (95% confidence interval, 0.021 to 0.201) g/dl higher hemoglobin concentration, whereas former use was associated with a 0.047 (95% confidence interval, −0.018 to 0.113) g/dl higher concentration (linear trend P = 0.01). As hypothesized, cigarette smoking was also associated with higher hemoglobin concentrations, whereas benzodiazepine use was not. Conclusions: Among American adults, current marijuana use was associated with higher hemoglobin concentrations, as is cigarette smoking but not benzodiazepine use. These results suggest the possibility that marijuana smoking induces subclinical hypoxemia stimulating hemoglobin production. Further confirmation of this observational finding is needed in light of the increasing medical and recreational use of smoked marijuana products. [ABSTRACT FROM AUTHOR]

Background: Older adults are commonly prescribed long‐term benzodiazepines for anxiety and insomnia despite evidence of risks and limited evidence of long‐term benefits. Recent quality measures and guidelines have recommended benzodiazepine deprescribing, yet there is little real‐world data on clinic‐based deprescribing programs. Methods: We developed a benzodiazepine deprescribing quality improvement program for older adults at a large US academic medical center. The program targeted adults aged 65 years and older who were prescribed chronic benzodiazepines by their primary care physician (PCP). PCPs were contacted to opt‐out patients not suitable for deprescribing; then eligible patients were mailed a letter discussing patient‐specific risks and advising them to discuss deprescribing with their PCP or a pharmacist who was available to support tapering. The primary outcomes were the number of patients who discussed deprescribing and who initiated a taper within 90 days of outreach. Results: Of 504 older adults prescribed benzodiazepines, 133 (26%) were opted out by their PCPs leaving a cohort of 371 (median age 71 years [IQR 68–75], 58% female, 82% White). The median daily diazepam milligram equivalent was 5 mg (IQR 3–6 mg) and 30% were prescribed long‐acting benzodiazepines. Three months following patient outreach, 97 patients (26%) had a documented discussion of benzodiazepines with their PCP or clinic pharmacist. Of these patients, 35 (36%) had documentation of a deprescribing discussion and 25 (26%) initiated a taper. At 12 months, 16 patients (64%) were tapered successfully, with nine (36%) patients taking a lower benzodiazepine dose and seven (28%) discontinuing benzodiazepines completely. Conclusions: A low‐intensity benzodiazepine deprescribing outreach program led to deprescribing conversations for a minority of patients, but one‐quarter of older adults who engaged in a conversation chose to taper and nearly two‐thirds sustained reduced use. Incorporating benzodiazepine deprescribing into routine care may require more intensive population‐health efforts to engage patients and clinicians. [ABSTRACT FROM AUTHOR]