ABSTRACT
Background/Aim The prevalence of marijuana use has increased in the United States as many states have legalized its use. Cannabinoid hyperemesis syndrome (CHS) is an adverse effect that 17-30% of chronic users of marijuana will experience. The impact of the COVID- 19 pandemic on healthcare disruptions has been well established. The effect of the pandemic on vice-associated conditions has been described with increases in alcohol and substance related hospitalizations and mortality. Few studies have evaluated the effect of the COVID- 19 pandemic on CHS with regards to prevalence, admissions, readmissions, and healthcare burden. We sought to identify the impact of the COVID-19 pandemic on CHS using admissions and readmissions as metrics to evaluate healthcare burden. Methods Using Slicer-Dicer, an electronic medical record based self-service query tool, all cases of CHS requiring hospital admissions and those resulting in readmissions were recorded at the university's 3 hospital centers and stratified by gender, age, and location. Data was separated into pre-COVID (August 5, 2018 to April 5, 2020) and post-COVID (April 6, 2020 to October 5, 2021). Additionally, all positive cases of tetrahydrocannabinol (THC) tested were recorded and stratified by postal code. The primary outcome was identification of CHS cases requiring admission from the emergency department pre-COVID and post-COVID. The secondary outcome was identifying any differences in admission and readmission rates pre- COVID and post-COVID. Results A significant increase in total THC positive cases (p = <0.001) was seen with 2485 pre-COVID and 2936 post-COVID cases. 68 patients were diagnosed with CHS pre-COVID and 75 post-COVID. Cases requiring admission were 27.9% pre-COVID CHS and 30.7% post-COVID with a significant increase in admissions from one campus from 0% to 30.4% (p = 0.025). Pre-COVID CHS cases requiring readmission after an index admission was 31.6% and post-COVID was 26.1%. No significance was seen when stratifying the cohorts by gender and age. Discussion Our study shows a significant increase in CHS diagnoses and admissions with an associated significant increase in THC-positivity when comparing the pre-COVID and post-COVID cohorts. This is consistent with prior studies describing an increase in alcohol and substance use during the pandemic. Data from the Centers for Disease Control and Prevention also reveal a 30% increase in substance related deaths in 2020 when compared to 2019. Some suggest that factors related to the pandemic including social isolation stress, substance use in isolation, and decreased access to substance use treatment or programs are contributors. This study highlights the importance to identify this association to better understand and respond to pandemic-associated risk factors for substance use disorders to help alleviate its effect on healthcare burden.
ABSTRACT
The Coronavirus Disease 2019 (COVID-19) instigated a pandemic that impacted economies, employment, and shipping worldwide. This paper reviews how one international supply chain performed and identifies lessons that may be helpful to improve future resilience. Economic and employment data through November 2020 are used to review the effects of COVID-19 on operations of the bioenergy supply chain in the southeastern United States (SE United States) that utilizes wood fiber to fabricate pellets. Conditions associated with the production of pellets in the SE United States changed with the outbreak of COVID-19. Federal and state government programs and classification of workers in this sector as "essential" during the pandemic helped maintain the woody pellet supply chain and other industries during a period of general shut down in 2020. The availability of personal protective equipment, long-term supply contracts, and established safety cultures are among the factors that enhance supply chain resilience while limited availability of skilled workers, inadequate stakeholder engagement, and dependence on external policies are among factors that reduce resilience. The analysis concludes with recommendations for the SE pellet supply chain, and other biomass supply chains, to improve their resilience to future disturbances. When best practices are implemented, SE United States biomass offers opportunities to contribute to post-pandemic economic recovery while incentivizing better forest resource management.