Cannabis use increases mortality risk in alcohol-associated hepatitis patients

People with alcohol-associated hepatitis are more likely to die from the disease if they use cannabis. A large multinational study just published in Alcohol: Clinical and Experimental Research is the first to identify active substance use, particularly cannabis use, by patients as an independent predictor of death in patients with alcohol-associated hepatitis. The study recommends integrating assessment and treatment of substance use into the clinical care of these patients to improve their prognoses.

Alcohol-associated hepatitis is a severe form of liver damage caused by alcohol use that can lead, often rapidly, to organ failure and death. Almost half of people with severe alcohol-associated hepatitis die within 90 days. In the U.S., mortality rates from the disease are on the rise, particularly among women and younger adults.

The sweeping study followed 800 patients hospitalized for alcohol-associated hepatitis at 40 different medical centers across 13 countries. Six percent, or 50 patients, reported active cannabis use; 45 reported cocaine use; and less than two percent used methamphetamine, opioids, or other drugs. At approximately 80 days from intake, one quarter of the patients had died.

Active cannabis and cocaine use were significantly more prevalent in people with severe hepatitis. Even after adjusting for liver disease severity, active substance use, especially cannabis use, independently predicted death. Active cannabis users had a two and a half times higher mortality rate.

The study authors recommend substance use as a primary target for intervention in patients with alcohol-associated liver disease and assessment of substance use as an important tool to inform clinical prognosis.