Untreated symptoms
Mental health continues to be a major concern in pwCF16,17. In our study, many subjects had abnormal mental health screens; except for marijuana, poor mental health was associated with current substance use. Notably, current e-cigarette and cigarette users were associated with anxiety and depression, while current CBD users were associated with depressive symptoms. Many reported using substances to minimize the impact of their illness and improve their mental well-being, often to address anxiety, depression, and sleep issues. Current users frequently stated using CBD and marijuana as mood stabilizers; however, hyperawareness and anxiety were also reported as side effects. Approximately half of the subjects who quit marijuana reported wanting to avoid psychoactive effects. Although current users noted worsening mental health with e-cigarettes and cigarettes and a desire to stop using, quitting rates were lower when compared to marijuana and CBD, likely due to the highly addictive nature of nicotine18. While the causal relationship between substance use and mental health remains uncertain, it is crucial to recognize that some substances can exacerbate pre-existing mental health issues frequently observed in patients with chronic diseases19. It is also worth noting that some patients may experience neurocognitive, mood, and anxiety changes after initiating CFTR modulator therapy. Our study did not explore the relationship between modulator therapy initiation, substance use timing and mood which may be a confounding factor.