Multinational Cohort Links Cannabis Use to 2.5-Fold Mortality Rise in Alcohol-Associated Hepatitis

The Alcohol: Clinical and Experimental Research analysis identified active cannabis use in 6% of participants and cocaine use in 5.6%. Cannabis and cocaine were more common in severe cases; after multivariable adjustment cannabis remained a significant predictor of death while methamphetamine and opioid use were too rare for stable estimates. The observational design cannot exclude residual confounding by unmeasured psychiatric or socioeconomic factors. Prior single-center U.S. cohorts had reported similar point estimates but lacked power and geographic diversity; this study extends those signals to a global population and quantifies an absolute mortality difference of roughly 15-20 percentage points between users and non-users. It also highlights that current prognostic scores omit substance-use variables, potentially underestimating risk in polysubstance patients. Integration of substance-use assessment into hepatology pathways could mirror successful models already used in transplant evaluation, yet no randomized trial has tested whether cannabis cessation interventions alter survival. Next steps include linkage of electronic health records to toxicology confirmation and prospective cohorts that capture dose, route, and cannabinoid content. Guideline committees should evaluate adding routine cannabis screening to alcohol-associated hepatitis care bundles; if validated, this could shift 90-day mortality benchmarks used in trial design and transplant allocation.