Paradox of protection: Re-examining cannabis use disorder in sepsis outcomes among cancer patients

Abstract

The intersection of cannabis use disorder (CUD) and critical illness outcomes in cancer patients represents a burgeoning area of research, particularly as cannabis legalization and therapeutic applications expand globally. Adjusted analyses of a retrospective cohort study by Sager et al revealed significantly lower odds of all-cause mortality (adjusted odds ratio (aOR) = 0.83) and respiratory failure (aOR = 0.8) in CUD-positive patients, alongside elevated hospitalization costs. These findings suggest the potential immunomodulatory and organ-protective effects of cannabinoids on sepsis. Future research must prioritize mechanistic studies, prospective clinical trials, and socioeconomic interventions to translate these findings into actionable clinical strategies, to align policy recommendations with guidelines, including those presented by the National Comprehensive Cancer Network.

Keywords: Cannabis/marijuana; Sepsis; Cannabis use disorder; Cardiovascular outcomes; Critical care; Cancer

Core Tip: This letter critiques a recent study revealing reduced sepsis mortality in cancer patients with cannabis use disorder. We highlight methodological limitations (e.g., coding bias and lack of dosage data) and propose future directions, including mechanistic studies on cannabinoid immunomodulation and policy reforms to address socioeconomic disparities. Key innovations include reconciling paradoxical findings through updated preclinical evidence, equitable policy frameworks to translate findings into clinical practice, and aligning policy recommendations with consensus and guidelines (e.g., National Comprehensive Cancer Network).