The association between smoking marijuana and the occurrence of lung cancer

It is still unclear if an association exists between the smoking of marijuana and the occurrence of lung cancer although one clearly exists between cigarette smoking and lung cancer. The objective of this study was to systematically review the literature in order to assess the impact of marijuana smoking, which is increasingly becoming a significant public health issue, on the occurrence of the number one killing cancer, lung cancer. ^ Method. Selected studies in the English language conducted on humans that assess the impact of marijuana smoking on lung cancer were identified from EBSCO MEDLINE, PUBMED, and GOOGLE databases. The search keywords were marijuana, cannabis, hashish, kif, and lung cancer with selection criteria including studies in the English language identified from 1950 to April 2008. Excluded were non-research studies such as editorials, letters, and reviews. Also excluded were studies that did not involve humans with direct intentional marijuana smoking or in vivo studies with mice. Case report studies or case series studies involving less than 10 patients were also excluded as well as studies that did not examine lung conditions related to premalignant or cancerous changes. ^ Results. Ten studies met the selection criteria and were analyzed. The ten studies in this review overall offer biological evidence of the potential association between marijuana smoking and premalignant lung findings but no overwhelming conclusive evidence for the association between marijuana smoking and the occurrence of lung cancer. Two of the observational studies [1, 2] failed to demonstrate an association between marijuana and lung cancer, but the remaining studies supported an association between marijuana smoking and premalignant or malignant lung findings. ^ Conclusion. It must, therefore, be concluded that no convincing evidence exists, based on the existing data, for an association between marijuana smoking and the occurrence of lung cancer even though the few observational studies failing to report such an association may be due to certain limitations particularly the relative young age of the participants precluding sufficient lag time for the identification of lung cancer outcome as explained in other sections of this paper. ^ Further research is, therefore, necessary to better evaluate this critical issue, while recommendations against smoking marijuana because of its potential harmful effects, including the potential for premalignant lung changes as noted in this review, should continue to be made. ^ In the future, large prospective studies with study participants representing a much wider spectrum of ages, and longer follow-up periods, with detailed assessment of marijuana exposure and definitive pathologic diagnosis of lung cancer are necessary^

Investigating the epidemic of heroin use in Dar es Salaam, Tanzania: Recognizing the issues of heroin smokers

Since heroin was introduced to East Africa during the 1980s, heroin use practices have changed rapidly in response to various internal and external pressures. The aim of this study was to identify and describe the population of heroin users and locations of heroin use in Dar es Salaam, Tanzania, in order to understand recent contexts of heroin use. The study took place between June 30 and August 19, 2011, in all three districts (Kinondoni, Ilala, and Temeke) of Dar es Salaam. We mapped sites using a Global Positioning System device, counted numbers of heroin users, and conducted informal interviews with heroin users. The mixed-methods analyses of the data included quantifying the basic demographic and aggregate information about the sites and heroin users, as well as qualitative analysis and coding of fieldnotes from observations and responses to interviews which was used to identify themes and characteristics of heroin users. ^ We identified a total of 150 sites and counted a total of 1046 male and 46 female non-injecting drug users and 78 male and 9 female injecting drug users (IDUs) of heroin. We found that social organization existed at some of the sites, with 31% (n=47) of sites reporting having a leader and 44% (n=66) of sites reporting mutual aid between users frequenting the site. We had difficulty locating IDUs and female drug users, and the majority of users we encountered were heroin smokers of kokteli, a mixture of heroin, cannabis, and/or tobacco which is smoked like a cigarette. ^ This research highlighted heroin smokers’ desire for access to drug treatment services. The current methadone-based medication assisted treatment (MAT) program is funded and operates as an HIV prevention program for IDUs to reduce HIV infection in this population and slow or stop the spread of a second wave of HIV infection in the general population. However, smokers perceived MAT to be primarily a drug use prevention or cessation program and felt unjustly neglected from the intervention, leading to a tense relationship with IDUs. From a public health standpoint, future interventions should include heroin smokers to prevent HIV transmission. ^