Differences in total and differential white blood cell counts and in inflammatory parameters between psychiatric inpatients with and without recent consumption of cannabinoids, opioids, or cocaine: A retrospective single-center study

Abstract

Several drugs of abuse may exert their action by modulating the immune system. Despite this, individuals using substances of abuse are often excluded from immunopsychiatry studies. We conducted a retrospective, single-center study to examine differences in circulating immune/inflammatory parameters (i.e., total and differential white blood cell (WBC) counts, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte (MLR) ratio, platelet-to-lymphocyte ratio, and C-reactive protein) between psychiatric inpatients with a positive urine test to cannabinoids, opioids, or cocaine, and those with negative toxicology. A total of 927 inpatients were included. Patients with positive toxicology (n = 208) had significantly higher WBC counts (P < 0.001, η²p = 0.02), as well as increased neutrophils (P = 0.002, η²p = 0.01), monocytes (P < 0.001, η²p = 0.02), lymphocytes (P < 0.001, η²p = 0.02), and eosinophils (P = 0.01, η²p = 0.01) compared to those with negative toxicology (n = 719). The increase in neutrophil counts was particularly evident in patients who tested positive for cannabinoids (n = 168; P < 0.001, η²p = 0.02). In contrast, eosinophil counts were particularly increased in the cocaine-positive subgroup (n = 27; P = 0.004, η²p = 0.01). Patients with a positive urine test to opioids (n = 13) were characterized by a significantly lower MLR (P = 0.03, η²p = 0.005). The type of psychiatric diagnosis moderated the differences in neutrophil counts between patients with a positive and negative toxicology to cannabinoids. Notably, significantly higher neutrophil counts were found only in patients diagnosed with a psychotic disorder (P < 0.001, η²p = 0.03). Taken together, our findings suggest that drugs of abuse may differently impact the immune/inflammatory response system in individuals diagnosed with psychiatric conditions. Specifically, recent cannabinoids use may be associated with an acute activation of the inflammatory response system, particularly in individuals with a psychotic disorder, while cocaine and opioid use may be associated with eosinophilia and a decrease in the MLR, respectively, regardless of the primary psychiatric diagnosis.