Sociodemographic Characteristics Associated With and Prevalence and Frequency of Cannabis Use Among Adults in the US

Association of a Positive Drug Screening for Cannabis With Mortality and Hospital Visits Among Veterans Affairs Enrollees Prescribed Opioids

IMPORTANCE

Cannabis has been proposed as a therapeutic with potential opioid-sparing properties in chronic pain, and its use could theoretically be associated with decreased amounts of opioids used and decreased risk of mortality among individuals prescribed opioids.

OBJECTIVE

To examine the risks associated with cannabis use among adults prescribed opioid analgesic medications.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study was conducted among individuals aged 18 years and older who had urine drug screening in 2014 to 2019 and received any prescription opioid in the prior 90 days or long-term opioid therapy (LTOT), defined as more than 84 days of the prior 90 days, through the Veterans Affairs health system. Data were analyzed from November 2020 through March 2022.

EXPOSURES

Biologically verified cannabis use from a urine drug screen.

MAIN OUTCOMES AND MEASURES

The main outcomes were 90-day and 180-day all-cause mortality. A composite outcome of all-cause emergency department (ED) visits, all-cause hospitalization, or all-cause mortality was a secondary outcome. Weights based on the propensity score were used to reduce confounding, and hazard ratios [HRs] were estimated using Cox proportional hazards regression models. Analyses were conducted among the overall sample of patients who received any prescription opioid in the prior 90 days and were repeated among those who received LTOT. Analyses were repeated among adults aged 65 years and older.

RESULTS

Among 297 620 adults treated with opioids, 30 514 individuals used cannabis (mean [SE] age, 57.8 [10.5] years; 28 784 [94.3%] men) and 267 106 adults did not (mean [SE] age, 62.3 [12.3] years; P < .001; 247 684 [92.7%] men; P < .001). Among all patients, cannabis use was not associated with increased all-cause mortality at 90 days (HR, 1.07; 95% CI, 0.92-1.22) or 180 days (HR, 1.00; 95% CI, 0.90-1.10) but was associated with an increased hazard of the composite outcome at 90 days (HR, 1.05; 95% CI, 1.01-1.07) and 180 days (HR, 1.04; 95% CI, 1.01-1.06). Among 181 096 adults receiving LTOT, cannabis use was not associated with increased risk of all-cause mortality at 90 or 180 days but was associated with an increased hazard of the composite outcome at 90 days (HR, 1.05; 95% CI, 1.02-1.09) and 180 days (HR, 1.05; 95% CI, 1.02-1.09). Among 77 791 adults aged 65 years and older receiving LTOT, cannabis use was associated with increased 90-day mortality (HR, 1.55; 95% CI, 1.17-2.04).

CONCLUSIONS AND RELEVANCE

This study found that cannabis use among adults receiving opioid analgesic medications was not associated with any change in mortality risk but was associated with a small increased risk of adverse outcomes and that short-term risks were higher among older adults receiving LTOT.

Bidirectional associations between depressive symptoms and cigarette, e-cigarette, cannabis, and alcohol use: Cross-lagged panel analyses among young adults before and during COVID-19

BACKGROUND

The literature regarding bidirectional relationships of depressive symptoms to cigarette and alcohol use is mixed, and limited regarding e-cigarette and cannabis use. Moreover, COVID-19 has significantly impacted mental health and substance use, especially among young adults. Thus, this is a critical period for focused research on these relationships among young adults.

METHODS

We analyzed longitudinal data (assessments in Fall 2018, 2019, and 2020) from 3,006 young adults (Mage = 24.56 [SD = 4.72], 54.8% female, 31.6% sexual minority, 71.6% White, 5.3% Black, 12.2% Asian, 11.4% Hispanic) from 6 US metropolitan statistical areas. Cross-lagged panel models were conducted to examine bidirectional associations between depressive symptoms and past 30-day use of cigarettes, e-cigarettes, cannabis, and alcohol (respectively), controlling for sociodemographics.

RESULTS

During the study period, depressive symptoms decreased before the pandemic but increased during, cigarette and e-cigarette use decreased in both periods, alcohol use showed no change before but increases during the pandemic, and cannabis use increased in both periods. Additionally, each outcome demonstrated greater stability before versus during COVID-19. Finally, greater antecedent depressive symptoms correlated with more days of subsequent cigarette (β = 0.03, SE = 0.01, p =.011) and e-cigarette use (β = 0.03, SE = 0.01, p =.021), but fewer days of alcohol use (β = -0.02, SE = 0.01, p =.035). W2 cannabis use and alcohol use, respectively, were related to W3 depressive symptoms (cannabis: β = 0.09, SE = 0.02, p <.001; alcohol: β = 0.06, SE = 0.02, p =.002). No other cross-lagged associations were significant.

CONCLUSIONS

Intervention efforts targeting depression and substance use should explicitly address the potential for onset and escalation of substance use and depressive symptoms, respectively, especially during societal stressors.

Trends and Characteristics of Prenatal Cannabis Use in the U.S., 2002-2019

INTRODUCTION

The prevalence of prenatal cannabis use has nearly doubled in the U.S. from 2002 to 2017. As cannabis legalization continues to expand, this study aimed to estimate the recent trends in the prevalence of cannabis use, cannabis dependence, and cannabis risk perceptions among U.S. pregnant people.

METHODS

The National Survey on Drug Use and Health (2002-2019) was designed to be representative of the U.S. civilian non-institutionalized population. The study sample included pregnant participants (aged 12-44 years; n=15,109). Cannabis consumption was defined as using cannabis at least once in the 30 days before assessment. Past 12‒month cannabis dependence was defined on the basis of the DSM-IV. Joinpoint regression was used to test for significant changes in the trends while controlling for age, race/ethnicity, and family income. Analyses were conducted between August 2021 and April 2022.

RESULTS

No evidence of change in the prevalence of prenatal cannabis use was detected between 2016-2017 (5.8%) and 2018-2019 (4.7%) (prevalence difference= -1.1; 95% CI= -2.9, 0.7). The prevalence of cannabis dependence did not change significantly among pregnant people from 2002 to 2019. The percentage of pregnant people perceiving regular cannabis use (1-2 times/week) as a great risk remained stable from 2002 to 2007 (∼53%) and declined sharply after (27%).

CONCLUSIONS

Three of 4 pregnant people in the U.S. do not characterize regular cannabis use as a great risk. As cannabis legalization increases, public health efforts are needed to raise awareness of the possible harms associated with cannabis use.