Young adult sequelae of adolescent cannabis use: an integrative analysis

Parental Cannabis Use Is Associated with Cannabis Initiation and Use in Offspring

OBJECTIVES

To assess, before legalization in Canada, whether parental cannabis use is associated with initiation of use in adolescent offspring or with use in young-adult offspring.

STUDY DESIGN

Data were available in 2 longitudinal studies in Montréal, Canada. In AdoQuest, 1048 parents with children in grade 6 reported past-year cannabis use. Cannabis initiation among offspring was measured in grade 7, 9, and/or 11. In the Nicotine Dependence in Teens study, cannabis use data were available for 584 participants (mean age 24 years) and their parents (ie, 542 offspring-mother pairs, 438 offspring-father pairs). The association between parental and offspring cannabis use was estimated using multivariable logistic regression in both studies.

RESULTS

In AdoQuest, grade 6 never-users were 1.8 times more likely to initiate cannabis during high school if their parents reported past-year use. In the Nicotine Dependence in Teens study, the aORs (95% CI) for past-year cannabis use among adult offspring were not different for "mother uses cannabis" (2.8 [1.4-5.8]) or "father uses cannabis" (2.1 [1.2-3.8]). Participants with 1 or 2 cannabis-using parents were 1.7 and 7.1 times more likely to use cannabis, respectively, than participants with non-using parents.

CONCLUSIONS

To enable informed decision-making about their own cannabis use, parents need to be aware that children of cannabis users are more likely to use cannabis in adolescence and young adulthood.

Relationship Between Recency and Frequency of Youth Cannabis Use on Other Substance Use

PURPOSE

To assess the relationship between lifetime, past-year, and frequent past-year cannabis use on use of other substances among youth in order to inform prevention initiatives.

METHODS

Data are from 27,900 youth aged 12-17 participating in the 2015-2016 National Surveys on Drug Use and Health. Multivariable multinomial logistic regression assessed the relationship between levels of youth cannabis use and past-year use of other substances compared to youth with no lifetime cannabis use.

RESULTS

Prevalence of lifetime cannabis use among youth was 15.4%; 3.0% reported lifetime but not past-year use, 10.3% reported past-year use <200 days, and 2.1% reported past-year use ≥200 days. Past-year tobacco and alcohol use, and past-year misuse of prescription sedatives or tranquilizers, stimulants, and opioids were associated with increased adjusted relative risk ratios across all levels of cannabis use compared to youth reporting no lifetime cannabis use. Increased adjusted relative risk ratios across all levels of cannabis use were seen among youth aged 14-15 and 16-17 compared to 12-17 and among non-Hispanic blacks and Hispanics compared to non-Hispanic whites.

CONCLUSIONS

Cannabis use is prevalent among youth and associated with other substance use. Efforts to scale up prevention programming and science-based messaging on risks of substance use are needed.

Household Gun Ownership and Youth Suicide Rates at the State Level, 2005-2015

INTRODUCTION

Determining whether the prevalence of gun ownership is associated with youth suicide is critical to inform policy to address this problem. The objective of this study is to investigate the relationship between the prevalence of household gun ownership in a state and that state's rate of youth suicide.

METHODS

This study, conducted in 2018, involved a secondary analysis of state-level data for the U.S. using multivariable linear regression. The relationship between the prevalence of household gun ownership and youth (aged 10-19 years) suicide rates was examined in a time-lagged analysis of state-level household gun ownership in 2004 and youth suicide rates in the subsequent decade (2005-2015), while controlling for the prevalence of youth suicide attempts and other risk factors.

RESULTS

Household gun ownership was positively associated with the overall youth suicide rate. For each 10 percentage-point increase in household gun ownership, the youth suicide rate increased by 26.9% (95% CI=14.0%, 39.8%).

CONCLUSIONS

Because states with high levels of household gun ownership are likely to experience higher youth suicide rates, these states should be especially concerned about implementing programs and policies to ameliorate this risk.

A Review of Cannabis in Chronic Kidney Disease Symptom Management

PURPOSE OF REVIEW

Physical and psychological symptom burden in patients with advanced chronic kidney disease (CKD) is significantly debilitating; yet, it is often inadequately treated. Legalization of cannabis in Canada may attract increasing interest from patients for its medical use in refractory symptom management, but its indications and long-term adverse health impacts are poorly established, creating a challenge for clinicians to support its use. In this review, we summarize key clinical studies and the level of evidence for nonsynthetic cannabinoids in the treatment of common symptoms encountered in advanced stages of CKD, including chronic pain, nausea and vomiting, anorexia, pruritus, and insomnia.

SOURCES OF INFORMATION

Medline and Embase.

METHODS

A search was conducted in MEDLINE and EMBASE (inception to March 1, 2018) on cannabis and CKD symptoms of interest, complemented with a manual review of bibliographies. Studies that examined synthetic cannabinoids that are manufactured to mimic the effects of ∆9-tetrahydrocannabinol such as dronabinol, levonantradol, nabilone, and ajulemic acid were excluded. We focused on studies with higher level of evidence where available, and quality of studies was graded based on the Oxford Centre for Evidence-based Medicine Levels of Evidence (1a to 5).

FINDINGS

Based on studies conducted in patients without renal impairment, those treated with nonsynthetic cannabinoids were 43% to 300% more likely to report a ≥30% reduction in chronic neuropathic pain compared with placebo. However, there is currently insufficient evidence to recommend nonsynthetic cannabinoids for other medical indications, although preliminary investigation into topical endocannabinoids for uremia-induced pruritus in end-stage renal disease is promising. Finally, any benefits of cannabis may be offset by potential harms in the form of cognitive impairment, increased risk of mortality post-myocardial infarction, orthostatic hypotension, respiratory irritation, and malignancies (with smoked cannabis).

LIMITATIONS

Nonsynthetic cannabinoid preparations were highly variable between studies, sample sizes were small, and study durations were short. Due to an absence of studies conducted in CKD, recommendations were primarily extrapolated from the general population.

IMPLICATIONS

Until further studies are conducted, the role of nonsynthetic cannabinoids for symptom management in patients with CKD should be limited to the treatment of chronic neuropathic pain. Clinicians need to be cognizant that nonsynthetic cannabinoid preparations, particularly smoked cannabis, can pose significant health risks and these must be cautiously weighed against the limited substantiated therapeutic benefits of cannabis in patients with CKD.

Pharmacotherapies for cannabis dependence

BACKGROUND

Globally, cannabis use is prevalent and widespread. There are currently no pharmacotherapies approved for treatment of cannabis use disorders.This is an update of a Cochrane Review first published in the Cochrane Library in Issue 12, 2014.

OBJECTIVES

To assess the effectiveness and safety of pharmacotherapies as compared with each other, placebo or no pharmacotherapy (supportive care) for reducing symptoms of cannabis withdrawal and promoting cessation or reduction of cannabis use.

SEARCH METHODS

We updated our searches of the following databases to March 2018: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO and Web of Science.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and quasi-RCTs involving the use of medications to treat cannabis withdrawal or to promote cessation or reduction of cannabis use, or both, in comparison with other medications, placebo or no medication (supportive care) in people diagnosed as cannabis dependent or who were likely to be dependent.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included 21 RCTs involving 1755 participants: 18 studies recruited adults (mean age 22 to 41 years); three studies targeted young people (mean age 20 years). Most (75%) participants were male. The studies were at low risk of performance, detection and selective outcome reporting bias. One study was at risk of selection bias, and three studies were at risk of attrition bias.All studies involved comparison of active medication and placebo. The medications were diverse, as were the outcomes reported, which limited the extent of analysis.Abstinence at end of treatment was no more likely with Δ⁹-tetrahydrocannabinol (THC) preparations than with placebo (risk ratio (RR) 0.98, 95% confidence interval (CI) 0.64 to 1.52; 305 participants; 3 studies; moderate-quality evidence). For selective serotonin reuptake inhibitor (SSRI) antidepressants, mixed action antidepressants, anticonvulsants and mood stabilisers, buspirone and N-acetylcysteine, there was no difference in the likelihood of abstinence at end of treatment compared to placebo (low- to very low-quality evidence).There was qualitative evidence of reduced intensity of withdrawal symptoms with THC preparations compared to placebo. For other pharmacotherapies, this outcome was either not examined, or no significant differences was reported.Adverse effects were no more likely with THC preparations (RR 1.02, 95% CI 0.89 to 1.17; 318 participants; 3 studies) or N-acetylcysteine (RR 0.94, 95% CI 0.71 to 1.23; 418 participants; 2 studies) compared to placebo (moderate-quality evidence). For SSRI antidepressants, mixed action antidepressants, buspirone and N-acetylcysteine, there was no difference in adverse effects compared to placebo (low- to very low-quality evidence).There was no difference in the likelihood of withdrawal from treatment due to adverse effects with THC preparations, SSRIs antidepressants, mixed action antidepressants, anticonvulsants and mood stabilisers, buspirone and N-acetylcysteine compared to placebo (low- to very low-quality evidence).There was no difference in the likelihood of treatment completion with THC preparations, SSRI antidepressants, mixed action antidepressants and buspirone compared to placebo (low- to very low-quality evidence) or with N-acetylcysteine compared to placebo (RR 1.06, 95% CI 0.93 to 1.21; 418 participants; 2 studies; moderate-quality evidence). Anticonvulsants and mood stabilisers appeared to reduce the likelihood of treatment completion (RR 0.66, 95% CI 0.47 to 0.92; 141 participants; 3 studies; low-quality evidence).Available evidence on gabapentin (anticonvulsant), oxytocin (neuropeptide) and atomoxetine was insufficient for estimates of effectiveness.

AUTHORS' CONCLUSIONS

There is incomplete evidence for all of the pharmacotherapies investigated, and for many outcomes the quality of the evidence was low or very low. Findings indicate that SSRI antidepressants, mixed action antidepressants, bupropion, buspirone and atomoxetine are probably of little value in the treatment of cannabis dependence. Given the limited evidence of efficacy, THC preparations should be considered still experimental, with some positive effects on withdrawal symptoms and craving. The evidence base for the anticonvulsant gabapentin, oxytocin, and N-acetylcysteine is weak, but these medications are also worth further investigation.

Age of First Marijuana Use and Its Impact on Education Attainment and Employment Status

With the increased prevalence of marijuana use among youth, the increase in state legalization, and changing social norms in the United States, it is important to understand the long-term impact of marijuana use initiation. This study examined whether age of first marijuana use is associated with educational attainment and employment status. Data from 5,988 adults aged 26 to 49 years who participated in the 2015 National Survey on Drug Use and Health were used in the current study. Logistic regression analyses were used to examine the odds of graduating from high school and being employed. Controlling for demographics, persons with late-early first use had significantly higher odds of graduating from high school and being employed compared with persons with early first use. Results underscore the importance of early prevention for youth aged 15 and younger and have implications for intervention and policy development.

Trends in cannabis use over time among Canadian youth: 2004-2014

Cannabis is the most commonly used illicit substance among Canadian youth. The current study examined national trends in cannabis use among Canadian youth from 2004/05 to 2014/15 using nationally representative data from the Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS). Data were collected from students in Grades 7 to 12 as part of the Canadian Student Tobacco, Alcohol and Drugs Survey (formerly the Youth Smoking Survey) using a repeat-cross sectional survey across 6 biennial survey waves between 2004 and 2014 (N = 243,057). Regression models examined factors associated with cannabis use in the past 12 months, perceived ease of access, and a multilinear regression examined age of initiation across survey cycles. The findings indicate that use of cannabis in the past 12-months significantly decreased among Canadian youth. Past-year use peaked in 2008/09 at 27.3%; compared to 16.5%, in 2014/15. Mean age of initiation did not vary over time, while youth in recent cycles reported that cannabis was more difficult to access: in 2006/07, 77.1% reported that it would be easy to access cannabis compared to 49.0% in 2014/15. Overall, cannabis use among Canadian youth appears to have peaked around 2008/09, with substantial declines over the past decade. It will be critically important to examine any changes in patterns of use following legalization of non-medical cannabis in Canada.

Graduate degree completion: Associations with alcohol and marijuana use before and after enrollment

Research has shown that alcohol and marijuana use are associated with academic performance difficulties, but the relationship to completion of a graduate degree has not been explored. Undergraduate students (n = 1253) were assessed during their first year of college and annually thereafter until age 29. Among the subset of the original sample who enrolled in graduate school (n = 520), measures of alcohol and marijuana use were averaged separately for the time periods before and after graduate school enrollment. Logistic regression models were developed to examine the associations between these variables and graduate degree completion, adjusting for other factors. In general, a minority of the sample were excessive drinkers or frequent marijuana users. The majority of drinkers (70%) drank an average of twice a week or less each year, and 62% of marijuana users used marijuana once a month or less each year. After adjusting for demographic and program characteristics, marijuana use frequency after graduate school enrollment was negatively associated with odds of graduate degree completion. Alcohol use frequency before graduate school enrollment was positively associated with odds of graduate degree completion. Results add to the growing body of literature on marijuana use and decreased academic achievement, but results should be interpreted with caution given the small, but significant, effect sizes found. The positive association between alcohol use frequency and degree completion might be attributed to engagement in the academic environment. Future studies should examine the potential mechanisms through which alcohol and marijuana use are related to the academic achievement of graduate students.

The Implications of Cannabis Policy Changes in Washington on Adolescent Perception of Risk, Norms, Attitudes, and Substance Use

There is increasing interest in the effect of legalization (particularly recreational legalization) of cannabis on prevalence of use and related problems. However, there is no consensus about the impact of policy change on cannabis use, particularly among adolescents. Legalization may increase adolescent use through mediating factors such as perceived risk and normative beliefs regarding the use of cannabis. Washington State enacted Initiative 502 on December 2012, which legalized and taxed recreational cannabis for adults aged ⩾21 years. This paper used data from a randomized, controlled intervention trial for cannabis-using adolescents that was recruiting participants in Seattle before and after the policy change to evaluate the following goals: assess differences in substance use, problems, and symptomatology pre- and post-policy change; evaluate several proposed risk factors that may be associated with such differences; and describe participants’ understanding of the law and how this understanding may relate to rates of use. Analyses revealed no significant differences pre- to post-policy in rate of substance use. However, there were significant post-policy increases in problems and use disorder symptoms. Despite these differences, there were no significant increases in norms, attitudes, or perceptions of risk. Participants were able to answer most questions regarding policy changes correctly, indicating a good understanding of the policy. Results provided no evidence that policy change influenced heavy-using adolescents’ rates of use nor the proposed risk factors associated with problematic use patterns.

Age moderates the association between frequent cannabis use and negative schizotypy over time

The current study examined whether age and frequent cannabis use interact to influence the trajectories of positive and negative schizotypy over time. Participants were 155 cannabis users, aged 15-24 years old, assessed over a 12-month period at 6-monthly intervals. The analyses examined the influence of age, frequent use, and time on positive and negative schizotypy. The current study found that among frequent cannabis users, younger age was associated with increased negative schizotypy over time, while among occasional cannabis users, younger age was associated with decreasing negative schizotypy over time. The current findings have implications for understanding how cannabis use may influence psychosis risk differently depending on age and frequency of use, as well as bring together past mixed findings on the relationship between negative schizotypy and cannabis use.

Marijuana Use and Depressive Symptoms; Gender Differences in African American Adolescents

Introduction: This study aimed to examine gender differences in the bidirectional associations between marijuana use and depressive symptoms among African American adolescents. The study also tested gender differences in the effects of socioeconomic status, maternal support, and friends' drug use on adolescents' depressive symptoms and marijuana use. Methods: This is a secondary analysis of the Flint Adolescent Study (FAS). Six hundred and eighty one African American adolescents (335 males and 346 females) were followed for 3 years, from 1995 (mean age 16) to 1997 (mean age 19). Depressive symptoms (Brief Symptom Inventory) and marijuana use were measured annually during the follow up. We used multi-group latent growth curve modeling to explore the reciprocal associations between depressive symptoms and marijuana use over time based on gender. Results: Baseline marijuana use was predictive of an increase in depressive symptoms over time among male but not female African American adolescents. Baseline depressive symptoms were not predictive of an increase in marijuana use among male or female adolescents. Conclusion: Study findings suggest that male African American adolescents who use marijuana are at an increased risk of subsequent depressive symptoms. Interventions that combine screening and treatment for marijuana use and depression may be indicated for African American male adolescents.

Clinical issues in cannabis use

Cannabis is the most commonly used illicit substance worldwide and the prevalence of users continues to increase. Over the last 2 decades, the world has seen significant changes regarding cannabis for recreational use as well as application in its use as a therapeutic medicine. This is likely to have influenced the decreasing perception of risks associated with the use of cannabis. Cannabis, however, is not benign and, depending on the pattern of its use, can incur a range of harmful effects, which have implications when prescribing medicinal cannabinoids for individuals. Based on research evidence from recreational use of cannabis as well as the emerging data from trials of medicinal cannabis, we propose some clinical domains that will need specific considerations when prescribing medicinal cannabis.

Recovery schools for improving behavioral and academic outcomes among students in recovery from substance use disorders: a systematic review

This Campbell systematic review examines the effects of recovery schools on student behavioral and academic outcomes, compared to the effects of non-recovery schools. The review summarizes evidence from one quasi-experimental study (with a total of 194 participants) that had potential serious risk of bias due to confounding. Sizable portions of youth are in recovery from substance use disorders, and many youth will return to use after receiving substance use treatment. Youth spend most of their waking hours at school, and thus schools are important social environments for youth in recovery from substance use disorders. Recovery schools have been identified as educational programs that may help support youth in recovery from substance use disorders. This review focused on two types of recovery schools: RHSs, which are schools that award secondary school diplomas and offer a range of therapeutic services in addition to standard educational curricula; and CRCs, which offer therapeutic and sober support services on college campuses. This review looked at whether recovery schools (RHSs or CRCs) affect academic success and substance use outcomes among students, compared to similar students who are not enrolled in recovery schools.

Plain language summary

There is insufficient evidence to know whether recovery high schools and collegiate recovery communities are effective: Evidence that recovery high schools (RHSs) may improve academic and substance use outcomes is based on the findings from a single study with a serious risk of bias.The review in brief: Very limited evidence addresses the effectiveness of recovery high schools (RHSs). There is no rigorous evidence on the effectiveness of collegiate recovery communities (CRCs).It is unclear whether CRCs are effective in promoting academic success and reducing substance use among college students.What is the aim of this review?: This Campbell systematic review examines the effects of recovery schools on student behavioral and academic outcomes, compared to the effects of non-recovery schools. The review summarizes evidence from one quasi-experimental study (with a total of 194 participants) that had potential serious risk of bias due to confounding.What are the main findings of this review?: Sizable portions of youth are in recovery from substance use disorders, and many youth will return to use after receiving substance use treatment. Youth spend most of their waking hours at school, and thus schools are important social environments for youth in recovery from substance use disorders. Recovery schools have been identified as educational programs that may help support youth in recovery from substance use disorders.This review focused on two types of recovery schools: RHSs, which are schools that award secondary school diplomas and offer a range of therapeutic services in addition to standard educational curricula; and CRCs, which offer therapeutic and sober support services on college campuses.This review looked at whether recovery schools (RHSs or CRCs) affect academic success and substance use outcomes among students, compared to similar students who are not enrolled in recovery schools.What studies are included?: The included study of recovery high schools used a controlled quasi-experimental pretest-posttest design and reported on the following outcomes: grade point average, truancy, school absenteeism, alcohol use, marijuana use, other drug use, and abstinence from alcohol/drugs. The included study focused on a sample of U.S. high school students. There were no eligible studies of CRCs.What do the findings of this review mean?: Findings from this review indicate insufficient evidence on the effects of recovery schools on student well-being. Although there is some indication RHSs may improve academic and substance use outcomes, this is based on the findings from a single study. There is no available evidence on the effects of CRCs.No strong conclusions can be drawn at this time, given the lack of available evidence on RHSs and CRCs, and the serious risk of bias in the one RHS study included in the review. The evidence from this review suggests there is a clear need for additional rigorous evaluations of recovery school effects prior to widespread implementation.How up-to-date is this review?: The review authors searched for studies until September 2018. This Campbell systematic review was published in 2018.

Executive Summary/Abstract

BACKGROUND: Substance use disorders (SUDs) among youth are a major public health problem. In the United States, for example, the incidence of SUDs increases steadily after age 12 and peaks among youth ages 18-23 (White, Evans, Ali, Achara-Abrahams, & King, 2009). Although not every youth who experiments with alcohol or illicit drugs is diagnosed with an SUD, approximately 7-9% of 12-24 year olds in the United States were admitted for public SUD treatment in 2013 (Substance Abuse and Mental Health Services Administration [SAMHSA], 2016). Recovery from an SUD involves reduction or complete abstinence of use, defined broadly as "voluntarily sustained control over substance use, which maximises health and wellbeing and participation in the rights, roles and responsibilities of society" (UK Drug Policy Commission, 2008). However, SUDs are often experienced as chronic conditions; among youth who successfully complete substance use treatment, approximately 45-70% return to substance use within months of treatment discharge (Anderson, Ramo, Schulte, Cummins, & Brown, 2007; Brown, D'Amico, McCarthy, & Tapert, 2001; Ramo, Prince, Roesch, & Brown, 2012; White et al., 2004). Thus, multiple treatment episodes and ongoing recovery supports after treatment are often necessary to assist with the recovery process (Brown et al., 2001; Ramo et al., 2012; White et al., 2004).Success and engagement at school and in postsecondary education are critical to healthy youth development. For youth in recovery from SUDs, school attendance, engagement, and achievement build human capital by motivating personal growth, creating new opportunities and social networks, and increasing life satisfaction and meaning (Keane, 2011; Terrion, 2012; 2014). Upon discharge from formal substance use treatment settings, schools become one of the most important social environments in the lives of youth with SUDs. Healthy school peer environments can enable youth to replace substance use behaviors and norms with healthy activities and prosocial, sober peers. Conversely, many school environments may be risky for youth in recovery from SUDs due to perceived substance use among peers, availability of drugs or alcohol, and substance-approving norms on campus (Centers for Disease Control [CDC], 2011; Spear & Skala, 1995; Wambeam, Canen, Linkenbach, & Otto, 2014).Given the many social and environmental challenges faced by youth in recovery from substance use, recovery-specific institutional supports are increasingly being linked to educational settings. The two primary types of education-based continuing care supports for youth in recovery, defined under the umbrella term of "recovery schools" for this review, are recovery high schools (RHSs) and collegiate recovery communities (CRCs). RHSs are secondary schools that provide standard high school education and award secondary school diplomas, but also include therapeutic programming aimed at promoting recovery (e.g., group check-ins, community service, counseling sessions). CRCs also provide recovery oriented support services (e.g., self-help groups, counseling sessions, sober dorms) for students, but are embedded within larger college or university settings. The primary aims of RHSs and CRCs are to promote abstinence and prevent relapse among students, and thus ultimately improve students' academic success.OBJECTIVES: This review summarized and synthesized the available research evidence on the effects of recovery schools for improving academic success and behavioural outcomes among high school and college students who are in recovery from substance use. The specific research questions that guided the review are as follows: 1. What effect does recovery school attendance (versus attending a non-recovery or traditional school setting) have on academic outcomes for students in recovery from substance use? Specifically (by program type): a. For recovery high schools: what are the effects on measures of academic achievement, high school completion, and college enrolment?b. For collegiate recovery communities: what are the effects on measures of academic achievement and college completion?2. What effect does recovery school attendance have on substance use outcomes for students in recovery from substance use? Specifically, what are the effects on alcohol, marijuana, cocaine, or other substance use?3. Do the effects of recovery schools on students' outcomes vary according to the race/ethnicity, gender, or socioeconomic status of the students?4. Do the effects of recovery schools on students' outcomes vary according to existing mental health comorbidity status or juvenile justice involvement of the students? SEARCH METHODS: We aimed to identify all published and unpublished literature on recovery schools by using a comprehensive and systematic literature search. We searched multiple electronic databases, research registers, grey literature sources, and reference lists from prior reviews; and contacted experts in the field.SELECTION CRITERIA: Studies were included in the review if they met the following criteria:Types of studies: Randomized controlled trial (RCT), quasi-randomized controlled trial (QRCT), or controlled quasi-experimental design (QED).Types of participants: Students in recovery from substance use who were enrolled part-time or full-time in secondary (high school) or postsecondary (college or university) educational institutions.Types of interventions: Recovery schools broadly defined as educational institutions, or programs at educational institutions, developed specifically for students in recovery and that address recovery needs in addition to academic development.Types of comparisons: Traditional educational programs or services that did not explicitly have a substance use recovery focus.Types of outcome measures: The review focused on primary outcomes in the following two domains: academic performance (e.g., achievement test scores, grade-point average, high school completion, school attendance, college enrolment, college completion) and substance use (alcohol, marijuana, cocaine, heroin, stimulant, mixed drug use, or other illicit drug use). Studies that met all other eligibility criteria were considered eligible for the narrative review portion of this review even if they did not report outcomes in one of the primary outcome domains.Other criteria: Studies must have been reported between 1978 and 2016. The search was not restricted by geography, language, publication status, or any other study characteristic.DATA COLLECTION AND ANALYSIS: Two reviewers independently screened all titles and abstracts of records identified in the systematic search. Records that were clearly ineligible or irrelevant were excluded at the title/abstract phase; all other records were retrieved in full-text and screened for eligibility by two independent reviewers. Any discrepancies in eligibility assessments were discussed and resolved via consensus. Studies that met the inclusion criteria were coded by two independent reviewers using a structured data extraction form; any disagreements in coding were resolved via discussion and consensus. If members of the review team had conducted any of the primary studies eligible for the review, external and independent data collectors extracted data from those studies. Risk of bias was assessed using the ROBINS-I tool for non-randomized study designs (Sterne, Higgins, & Reeves, 2016).Inverse variance weighted random effects meta-analyses were planned to synthesize effect sizes across studies, as well as heterogeneity analysis, subgroup analysis, sensitivity analysis, and publication bias analysis. However, these synthesis methods were not used given that only one study met the inclusion criteria for the review. Instead, effect sizes (and their corresponding 95% confidence intervals) were reported for all eligible outcomes reported in the study.RESULTS: Only one study met criteria for inclusion in the review. This study used a QED to examine the effects of RHSs on high school students' academic and substance use outcomes. No eligible studies examining CRCs were identified in the search.The results from the one eligible RHS study indicated that after adjusting for pretest values, students in the RHS condition reported levels of grade point averages (= 0.26, 95% CI [-0.04, 0.56]), truancy (= 0.01, 95% CI [-0.29, 0.31]), and alcohol use (= 0.23, 95% CI [-0.07, 0.53]) similar to participants in the comparison condition. However, students in the RHS condition reported improvements in absenteeism (= 0.56, 95% CI [0.25, 0.87]), abstinence from alcohol/drugs (OR = 4.36, 95% CI [1.19, 15.98]), marijuana use (= 0.51, 95% CI [0.20, 0.82]), and other drug use (= 0.45, 95% CI [0.14, 0.76]).Overall, there was a serious risk of bias in the one included study. The study had a serious risk of bias due to confounding, low risk of bias due to selection of participants into the study, moderate risk of bias due to classification of interventions, inconclusive risk of bias due to deviations from intended interventions, inconclusive risk of bias due to missing data, moderate risk of bias in measurement of outcomes, and low risk of bias in selection of reported results.AUTHORS' CONCLUSIONS: There is insufficient evidence regarding the effectiveness of RHSs and CRCs for improving academic and substance use outcomes among students in recovery from SUDs. Only one identified study examined the effectiveness of RHSs. Although the study reported some beneficial effects, the results must be interpreted with caution given the study's potential risk of bias due to confounding and limited external validity. No identified studies examined the effectiveness of CRCs across the outcomes of interest in this review, so it is unclear what effects these programs may have on students' academic and behavioral outcomes.The paucity of evidence on the effectiveness of recovery schools, as documented in this review, thus suggest the need for caution in the widespread adoption of recovery schools for students in recovery from SUDs. Given the lack of empirical support for these recovery schools, additional rigorous evaluation studies are needed to replicate the findings from the one study included in the review. Furthermore, additional research examining the costs of recovery schools may be needed, to help school administrators determine the potential cost-benefits associated with recovery schools.

Developmental sensitivity to cannabis use patterns and risk for major depressive disorder in mid-life: findings from 40 years of follow-up

BACKGROUND

Evidence regarding the association between cannabis use and depression remain conflicting, especially as studies have not typically adopted a longitudinal design with a follow-up period that was long enough to adequately cover the risk period for onset of depression.

METHOD

Males from the Cambridge Study in Delinquent Development (CSDD) (N = 285) were assessed seven times from age 8 to 48 years to prospectively investigate the association between cannabis use and risk of major depressive disorder (MDD). A combination of multiple analyses (logistic regression, Cox regression, fixed-effects analysis) was employed to explore the strength and direction of effect within different developmental stages.

RESULTS

Multiple regression analyses revealed that early-onset cannabis use (before age 18) but not late-onset cannabis use (after age 27) was associated with a higher risk and shorter time until a subsequent MDD diagnosis. This effect was present in high-frequency [(odds ratio (OR) 8.83, 95% confidence interval (CI) 1.29-70.79]; [hazard ratio (HR) 8.69, 95% CI 2.07-36.52)] and low-frequency early-onset users (OR 2.41, 95% CI 1.22-4.76; HR 2.09, 95% CI 1.16-3.74). Effect of increased frequency of cannabis use on increased risk of subsequent MDD was observed only for use during adolescence (age 14-18) but not at later life stages, while controlling for observed and non-unobserved time-invariant factors. Conversely, MDD in adulthood (age 18-32) was linked to a reduction in subsequent cannabis use (age 32-48).

CONCLUSIONS

The present findings provide evidence implicating frequent cannabis use during adolescence as a risk factor for later life depression. Future studies should further examine causality of effects in larger samples.

Changes in cannabis potency and first-time admissions to drug treatment: a 16-year study in the Netherlands

BACKGROUND

The number of people entering specialist drug treatment for cannabis problems has increased considerably in recent years. The reasons for this are unclear, but rising cannabis potency could be a contributing factor.

METHODS

Cannabis potency data were obtained from an ongoing monitoring programme in the Netherlands. We analysed concentrations of δ-9-tetrahydrocannabinol (THC) from the most popular variety of domestic herbal cannabis sold in each retail outlet (2000-2015). Mixed effects linear regression models examined time-dependent associations between THC and first-time cannabis admissions to specialist drug treatment. Candidate time lags were 0-10 years, based on normative European drug treatment data.

RESULTS

THC increased from a mean (95% CI) of 8.62 (7.97-9.27) to 20.38 (19.09-21.67) from 2000 to 2004 and then decreased to 15.31 (14.24-16.38) in 2015. First-time cannabis admissions (per 100 000 inhabitants) rose from 7.08 to 26.36 from 2000 to 2010, and then decreased to 19.82 in 2015. THC was positively associated with treatment entry at lags of 0-9 years, with the strongest association at 5 years, b = 0.370 (0.317-0.424), p < 0.0001. After adjusting for age, sex and non-cannabis drug treatment admissions, these positive associations were attenuated but remained statistically significant at lags of 5-7 years and were again strongest at 5 years, b = 0.082 (0.052-0.111), p < 0.0001.

CONCLUSIONS

In this 16-year observational study, we found positive time-dependent associations between changes in cannabis potency and first-time cannabis admissions to drug treatment. These associations are biologically plausible, but their strength after adjustment suggests that other factors are also important.

Trends in cannabis use disorder by cigarette smoking status in the United States, 2002-2016

BACKGROUND

Cannabis use is on the rise in the United States (US) and is disproportionately common among cigarette smokers. Cannabis use disorder (CUD) occurs among a small subset of cannabis users and may impact cigarette use. The objective of this study was to estimate trends in the prevalence of CUD among daily, non-daily, former, and never cigarette smokers from 2002 to 2016.

METHODS

Data were drawn from cross-sectional, nationally representative samples of individuals ages 12 and older in the US that were collected annually. The prevalence of past 12-month CUD was estimated each year from 2002 to 2016 among daily, non-daily, former, and never cigarette smokers (total analytic N = 837,326).

RESULTS

Overall, the prevalence of CUD decreased from 2002 to 2016. Yet, trends differed by cigarette smoking status. Adjusting for demographics, the prevalence of CUD increased significantly among non-daily smokers (aOR = 1.02; 95% CI = 1.01-1.03) from 2002 to 2016 and did not change among daily, former, or never smokers. CUD was significantly more common among non-daily (4.32%) and daily cigarette smokers (2.92%) compared with former (0.99%) and never smokers (1.11%) in 2016. Approximately one in five (18.11%-22.87%) youth ages 12-17 who smoke cigarettes met criteria for CUD in 2016, compared with approximately 2% of non-smoking youth.

CONCLUSIONS

Despite downward trends in CUD observed at the general population level, the prevalence of CUD significantly increased among non-daily cigarette smokers from 2002 to 2016. In the US, CUD remains significantly higher among cigarette smokers relative to non-cigarette smokers.

Is cannabis a risk factor for suicide attempts in men and women with psychotic illness?

OBJECTIVE

To investigate whether recent cannabis use by men and women with psychotic disorders was associated with increased risk of suicide attempt, and to determine associated factors, stratified by sex.

METHODS

Data from 1065 men and 725 women interviewed in the Australian national survey of psychosis were analysed to model separately, for each sex, the impact of daily, casual or no past-year cannabis use and other risk factors including age, on a past-year suicide attempt.

RESULTS

In the past year, 168 (9.4%) participants attempted suicide. Unadjusted analyses showed daily cannabis users of both sexes had significantly increased odds of attempting suicide compared to non-users. After adjusting for confounding factors, this relationship was no longer significant. Depression had the strongest association with attempting suicide for both sexes. Sex differences in other risk factors were observed. In post hoc analysis, daily cannabis use was associated with higher odds of attempting suicide in older men compared to non-users; this was not found in younger men or women.

CONCLUSIONS

Associations between past-year cannabis use and suicide attempts were confounded by other factors (depression, loneliness, homelessness and hallucinations). The possibility of greater risk of suicidal behaviour with regular cannabis use for older men should be considered.

Association of Cannabis With Cognitive Functioning in Adolescents and Young Adults: A Systematic Review and Meta-analysis

IMPORTANCE

Substantial shifts in perception and policy regarding cannabis have recently occurred, with use of cannabis increasing while its perceived harm decreases. One possible risk of increased cannabis use is poorer cognitive functioning, especially in youth.

OBJECTIVE

To provide the first quantitative synthesis of the literature examining cannabis and cognitive functioning in adolescents and young adults (with a mean age of 26 years and younger).

DATA SOURCES

PubMed, PsycInfo, Academic Search Premier, Scopus, and bibliographies of relevant reviews were searched for peer-reviewed, English-language studies from the date the databases began through May 2017.

STUDY SELECTION

Consensus criteria were used to determine study inclusion through abstract and manuscript review.

DATA EXTRACTION AND SYNTHESIS

This study followed Meta-analysis of Observational Studies in Epidemiology guidelines. Effect size estimates were calculated using multivariate mixed-effects models for cognitive functioning outcomes classified into 10 domains.

MAIN OUTCOMES AND MEASURES

Results from neurocognitive tests administered in cross-sectional studies were primary outcomes, and we examined the influence of a priori explanatory variables on variability in effect size.

RESULTS

Sixty-nine studies of 2152 cannabis users (mean [SD] age, 20.6 [2.8] years; 1472 [68.4%] male) and 6575 comparison participants with minimal cannabis exposure were included (mean [SD] age, 20.8 [3.4]; 3669 [55.8%] male). Results indicated a small overall effect size (presented as mean d) for reduced cognitive functioning associated with frequent or heavy cannabis use (d, -0.25; 95% CI, -0.32 to -0.17; P < .001). The magnitude of effect sizes did not vary by sample age or age at cannabis use onset. However, studies requiring an abstinence period longer than 72 hours (15 studies; n = 928) had an overall effect size (d, -0.08; 95% CI, -0.22 to 0.07) that was not significantly different from 0 and smaller than studies with less stringent abstinence criteria (54 studies; n = 7799; d, -0.30; 95% CI, -0.37 to -0.22; P = .01).

CONCLUSIONS AND RELEVANCE

Associations between cannabis use and cognitive functioning in cross-sectional studies of adolescents and young adults are small and may be of questionable clinical importance for most individuals. Furthermore, abstinence of longer than 72 hours diminishes cognitive deficits associated with cannabis use. Although other outcomes (eg, psychosis) were not examined in the included studies, results indicate that previous studies of cannabis in youth may have overstated the magnitude and persistence of cognitive deficits associated with use. Reported deficits may reflect residual effects from acute use or withdrawal. Future studies should examine individual differences in susceptibility to cannabis-associated cognitive dysfunction.

Advancing the Study of Adolescent Substance Use Through the Use of Integrative Data Analysis

A wealth of information is currently known about the epidemiology, etiology, and evaluation of drug and alcohol use across the life span. Despite this corpus of knowledge, much has yet to be learned. Many factors conspire to slow the pace of future advances in the field of substance use including the need for long-term longitudinal studies of often hard-to-reach subjects who are reporting rare and episodic behaviors. One promising option that might help move the field forward is integrative data analysis (IDA). IDA is a principled set of methodologies and statistical techniques that allow for the fitting of statistical models to data that have been pooled across multiple, independent samples. IDA offers a myriad of potential advantages including increased power, greater coverage of rare behaviors, more rigorous psychometric assessment of theoretical constructs, accelerated developmental time period under study, and enhanced reproducibility. However, IDA is not without limitations and may not be useful in a given application for a variety of reasons. The goal of this article is to describe the advantages and limitations of IDA in the study of individual development over time, particularly as it relates to trajectories of substance use. An empirical example of the measurement of polysubstance use is presented and this article concludes with recommendations for practice.

The prevalence of substance use among Russian, Somali and Kurdish migrants in Finland: a population-based study

Background

Substance use is a well-known public health problem, but population-based research on migrants’ substance use in Europe is limited. Factors related to the cultural background and current life situation might influence substance use among migrants. Here, the prevalence of substance use in Russian, Somali and Kurdish migrants in Finland is reported in comparison with the general population, and the associations between substance use and socio-economic and migration-related background factors among migrants are analysed.

Methods

Cross-sectional data from the Finnish Migrant Health and Wellbeing Study (Maamu) and comparison group data of the general Finnish population (n = 1165) from the Health 2011 Survey were used. The survey participants were of Russian (n = 702), Somali (n = 512), and Kurdish (n = 632) origin. Substance use included self-reported alcohol use within previous 12 months (AUDIT-C questionnaire), current and lifetime daily smoking and lifetime use of cannabis and intravenous drugs.

Results

Binge drinking was less prevalent among all migrant groups than in the general Finnish population (Russian men 65%, p < 0.01; Russian women 30%, p < 0.01, Somali men 2%, p < 0.01, Kurdish men 27%, p < 0.01, Kurdish women 6%, p < 0.01, general population men 87% and women 72%). Current daily smoking was more prevalent among Russian (28%, p = 0.04) and Kurdish (29%, p < 0.01) migrant men compared with the reference group (20%). Younger age and employment were associated with binge drinking among migrants. Socio-economic disadvantage increased the odds for daily smoking in Russian, Somali and Kurdish migrant men. Several migration-related factors, such as age at migration and language proficiency, were associated with substance use.

Conclusions

Binge drinking is less common among migrants than in the Finnish general population. However, current daily smoking was more prevalent among Russian and Kurdish migrant men compared with the general population. Younger age, level of education, employment, duration of residence in Finland and language proficiency were associated with binge drinking and daily smoking with varying patterns of association depending on the migrant group and gender. These findings draw attention to the variation in substance use habits among migrant populations.

Cannabis use, other substance use, and co-occurring mental health concerns among youth presenting for substance use treatment services: Sex and age differences

Cannabis use among youth is of significant concern given the potential negative health impacts on young people. This study describes the mental health characteristics, cannabis use, and substance use profiles of youth aged 14 to 24 years seen at the Youth Addiction and Concurrent Disorders Service at the Centre for Addiction and Mental Health, through an age and gender lens. Almost all participating youth indicated lifetime cannabis use. Substance use and mental health profiles among those indicating a history of cannabis use differed along sex and age. Male youth were more likely to use cannabis more frequently, while female youth were more likely to use greater variety of substances and display more co-occurring mental health problems. Adolescent problematic substance use tended to co-occur with externalizing problems whereas problematic young adult substance use tended to co-occur with internalizing problems. Implications for the integrated, coordinated care of substance use and mental health concerns, with attention to the unique needs of subgroups of youth, are discussed.

Trends in and correlates of medical marijuana use among adults in the United States

BACKGROUND

Trends in and correlates of medical marijuana use are important to inform ongoing clinical, research, policy, and programmatic efforts. This study assessed trends in and correlates of medical marijuana use among U.S. adults.

METHODS

We analyzed data from approximately 147,200 U.S. civilians aged 18 or older who participated in the 2013-2015 National Surveys on Drug Use and Health. Descriptive analyses, multivariable logistic regressions, and zero-truncated native binomial regressions were applied.

RESULTS

Among U.S. adults, the prevalence of medical marijuana use increased from 1.2% in 2013 to 1.6% in 2015 (p = 0.0007). After adjusting for covariates, adults residing in medical marijuana states (states with legalized medical marijuana use) were 1.3 times more likely to use marijuana medically in 2015 than in 2013 (adjusted odds ratio (AOR) = 1.3, 95% confidence interval (CI) = 1.03-1.61), and adults in nonmedical marijuana states were 1.4 times more likely to report medical marijuana use in 2015 than in 2013 (AOR = 1.4, 95% CI = 1.05-1.90). Among adults who used marijuana exclusively for medical purposes in the past 12 months, trends in 12-month cannabis use disorders, daily or near daily use, and the number of days of marijuana use remained unchanged during 2013-2015. We identified how correlates of medical marijuana use among adults in medical marijuana states differed from their counterparts in nonmedical marijuana states.

CONCLUSIONS

Adults were more likely to use marijuana medically in 2015 than in 2013 in both medical and nonmedical marijuana states. Clinicians need to learn about and address evolving patterns of medical marijuana use in patients.

Testing associations between cannabis use and subcortical volumes in two large population-based samples

BACKGROUND AND AIMS

Disentangling the putative impact of cannabis on brain morphology from other comorbid substance use is critical. After controlling for the effects of nicotine, alcohol and multi-substance use, this study aimed to determine whether frequent cannabis use is associated with significantly smaller subcortical grey matter volumes.

DESIGN

Exploratory analyses using mixed linear models, one per region of interest (ROI), were performed whereby individual differences in volume (outcome) at seven subcortical ROIs were regressed onto cannabis and comorbid substance use (predictors).

SETTING

Two large population-based twin samples from the United States and Australia.

PARTICIPANTS

A total of 622 young Australian adults [66% female; μage  = 25.9, standard deviation SD) = 3.6] and 474 middle-aged US males (μage  = 56.1SD = 2.6 ) of predominately Anglo-Saxon ancestry with complete substance use and imaging data. Subjects with a history of stroke or traumatic brain injury were excluded.

MEASUREMENTS

Magnetic resonance imaging (MRI) and volumetric segmentation methods were used to estimate volume in seven subcortical ROIs: thalamus, caudate nucleus, putamen, pallidum, hippocampus, amygdala and nucleus accumbens. Substance use measurements included maximum nicotine and alcohol use, total life-time multi-substance use, maximum cannabis use in the young adults and regular cannabis use in the middle-aged males.

FINDINGS

After correcting for multiple testing (P = 0.007), cannabis use was unrelated to any subcortical ROI. However, maximum nicotine use was associated with significantly smaller thalamus volumes in middle-aged males.

CONCLUSIONS

In exploratory analyses based on young adult and middle-aged samples, normal variation in cannabis use is unrelated statistically to individual differences in brain morphology as measured by subcortical volume.

Frequency of Cannabis Use and Medical Cannabis Use Among Persons Living With HIV in the United States: Findings From a Nationally Representative Sample

Little is known about cannabis use frequency, medical cannabis use, or correlates of use among persons living with HIV (PLWH) in United States nationally representative samples. Data came from 626 PLWH from the 2005-2015 National Survey on Drug Use and Health. Logistic regression identified characteristics associated with frequency of cannabis use. Chi-squares identified characteristics associated with medial cannabis use. Non-daily and daily cannabis use was reported by 26.9% and 8.0%. Greater perceived risk of cannabis use was negatively associated with daily and non-daily use. Younger age, substance use, and binge drinking were positively associated with non-daily cannabis use. Smoking and depression were associated with non-daily and daily use. One-quarter reported medical cannabis use. Medical users were more likely to be White, married, and nondrinkers. Cannabis use was common among PLWH. Findings help to differentiate between cannabis users based on frequency of use and medical versus recreational use.

Individual and school-class correlates of youth cannabis use in Sweden: A multilevel study

Background and aims:

The school-class context is a crucial social environment for young people but substance use researchers have largely overlooked potential influences operating at this level. This study explores associations between school-class and individual-level factors and cannabis use in Swedish youth.

Data and methods:

Data comprised four waves (2012–2015) of the Swedish Council for Information on Alcohol and Other Drugs’ (CAN) nationally representative school surveys among individuals in 9th and 11th grade. For the present analyses, we had data on totally 28,729 individuals from 2377 unique school classes. Multilevel logistic regressions predicted lifetime and 10+ times use of cannabis from both individual-level predictors and school-class-level measures derived from the individual-level variables.

Results:

There were individual-level associations between most predictor variables and cannabis use. An early debut of tobacco use and binge drinking as well as low cannabis related risk perceptions had strong associations with cannabis use. Conversely, several school-class-level variables had aggregate relationships with cannabis use, most notably the overall level of risk perceptions in the school class. Some of the school-class factors predicted cannabis use over and above the individual-level covariates, suggesting the presence of contextual effects. Surprisingly, while female gender was negatively related with cannabis use at the individual level, a higher proportion of females in the classroom increased the odds for lifetime cannabis use even after controlling for individual and other contextual-level covariates.

Conclusions:

Youth cannabis use is related to various factors at both the individual and school-class level in Sweden. Truancy and perceived risk related to cannabis use had contextual associations with cannabis use. The positive contextual association between a higher proportion of females in the classroom and lifetime use should be explored further.

Psychometric assessment of the marijuana adolescent problem inventory

Cannabis is one of the most commonly used psychoactive substances among adolescents in the United States. Adolescent cannabis use has multiple consequences including academic, health, and psychiatric problems. The Marijuana Adolescent Problem Inventory (MAPI) is a 23-item scale adapted from the Rutgers Alcohol Problem Index and used in the current literature to assess cannabis use problem severity. Psychometric testing for the MAPI has yet to be reported. The current investigation assessed the psychometric characteristics of the MAPI with cannabis-using adolescents (n=727) from school and outpatient settings who enrolled in five separate randomized clinical trials focused on treatment of substance use. Findings suggested that the MAPI is internally consistent and reliable. Factor structure analyses suggested that the MAPI measures one latent construct, with no differences in factor structure between the outpatient and school settings, supporting a one-factor model. External validity of the MAPI was also demonstrated as evidenced by significant relations with concurrent diagnosis of cannabis dependence and abuse, longitudinal frequency of cannabis use, and mean times used per day. Overall, this initial test of the psychometric characteristics of the MAPI suggests that it can be considered a reliable and valid measure of problems associated with cannabis use among adolescents. Future work is now needed to replicate these findings by testing the psychometric properties of the MAPI in more diverse samples and developing a short version to be used as a brief assessment tool.

Identity as a cannabis user is related to problematic patterns of consumption among emerging adults

INTRODUCTION

Cannabis use has become a more normative, socially-acceptable behavior in the United States, despite research indicating that frequent use may become problematic for some individuals. Emerging adulthood, a time of identity development, is the most common time for cannabis use. Cannabis self-concept, or one's identification with cannabis as part of their personality or identity, is one factor that may influence use behavior. This study extends previous research that reported a link between self-concept, motivational factors, and normative beliefs by evaluating relationships between cannabis self-concept, motives for use, motivation to change, perceived descriptive norms, as well as cannabis-related outcomes (use, using alone, and cannabis-related problems).

METHODS

Emerging adults who used cannabis in the previous month (n=345, 53.9% male, mean age 21.0, 67.5% Non-Latino White) were recruited from a community sample for a health behaviors study. Participants were assessed for explicit cannabis self-concept, frequency of use, problems associated with use, motives for use, motivation to change, and normative beliefs about others' use.

RESULTS

Participants reported using cannabis on an average of 17.9 (SD=11.1) days of the previous month. Correlational analyses revealed that cannabis self-concept was positively associated with frequency of use, use-related problems, several motives for use, descriptive norms, and with using cannabis alone. Multivariate analyses revealed that rates of use, problems, and social and enhancement motives were independently and positively associated (p<0.05) with cannabis self-concept, while self-concept was negatively associated with desire to reduce cannabis use.

CONCLUSIONS

Cannabis self-concept may be a marker for more problematic patterns of use.

The lows of getting high: sentinel surveillance of injuries associated with cannabis and other substance use

OBJECTIVES

Cannabis is a widely used illicit substance that has been associated with acute injuries. This study seeks to provide near real-time injury estimates related to cannabis and other substance use from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database.

METHODS

Data from the eCHIRPP database, years 2011 to 2016, were analyzed via data mining, descriptive, logistic regression, and sensitivity analyses. Drug use trends over time for cannabis and/or other substances (alcohol, illicit drugs, and medications) were assessed. Descriptive statistics (intent, external cause, and nature of injury) and proportionate injury ratios (PIR) associated with cannabis use are presented.

RESULTS

Cannabis use was observed in 184 cases/100,000 eCHIRPP cases, and related injuries were mostly identified as unintentional (66.8%). Poisoning (68.5%) and intoxication (69.4%) were the external cause and nature of injury most associated with these events, and hospitalization was recorded for 14.3% of cases. Per 100,000 eCHIRPP cases, cannabis was used alone in 72.4 cases, and in combination with alcohol, illicit drugs, or medications in 74.6 cases, 11.3 cases, and 7.9 cases, respectively. Relative to non-use, the PIR of hospitalization was not significant for cannabis-only users of either sex (males: PIR 1.0, 95% CI 0.6-1.7, females: PIR 0.9, 95% CI: 0.5-1.7).

CONCLUSION

Cannabis use injuries are rare, but can occur when cannabis is used with or without other substances. As Canada considers legislative changes, our finding of cases related to unintentional injury, poisoning, and intoxication suggests areas that might benefit from health literacy efforts.

Adolescent mental health and behavioural predictors of being NEET: a prospective study of young adults not in employment, education, or training

BACKGROUND

Young adults who are not in employment, education, or training (NEET) are at risk of long-term economic disadvantage and social exclusion. Knowledge about risk factors for being NEET largely comes from cross-sectional studies of vulnerable individuals. Using data collected over a 10-year period, we examined adolescent predictors of being NEET in young adulthood.

METHODS

We used data on 1938 participants from the Victorian Adolescent Health Cohort Study, a community-based longitudinal study of adolescents in Victoria, Australia. Associations between common mental disorders, disruptive behaviour, cannabis use and drinking behaviour in adolescence, and NEET status at two waves of follow-up in young adulthood (mean ages of 20.7 and 24.1 years) were investigated using logistic regression, with generalised estimating equations used to account for the repeated outcome measure.

RESULTS

Overall, 8.5% of the participants were NEET at age 20.7 years and 8.2% at 24.1 years. After adjusting for potential confounders, we found evidence of increased risk of being NEET among frequent adolescent cannabis users [adjusted odds ratio (ORadj) = 1.74; 95% confidence interval (CI) 1.10-2.75] and those who reported repeated disruptive behaviours (ORadj = 1.71; 95% CI 1.15-2.55) or persistent common mental disorders in adolescence (ORadj = 1.60; 95% CI 1.07-2.40). Similar associations were present when participants with children were included in the same category as those in employment, education, or training.

CONCLUSIONS

Young people with an early onset of mental health and behavioural problems are at risk of failing to make the transition from school to employment. This finding reinforces the importance of integrated employment and mental health support programmes.

Mood Fluctuation and Psychobiological Instability: The Same Core Functions Are Disrupted by Novel Psychoactive Substances and Established Recreational Drugs

Many novel psychoactive substances (NPS) have entered the recreational drug scene in recent years, yet the problems they cause are similar to those found with established drugs. This article will debate the psychobiological effects of these newer and more traditional substances. It will show how they disrupt the same core psychobiological functions, so damaging well-being in similar ways. Every psychoactive drug causes mood states to fluctuate. Users feel better on-drug, then feel worse off-drug. The strength of these mood fluctuations is closely related to their addiction potential. Cyclical changes can occur with many other core psychobiological functions, such as information processing and psychomotor speed. Hence the list of drug-related impairments can include: homeostatic imbalance, HPA axis disruption, increased stress, altered sleep patterns, neurohormonal changes, modified brain rhythms, neurocognitive impairments, and greater psychiatric vulnerability. Similar patterns of deficit are found with older drugs such as cocaine, nicotine and cannabis, and newer substances such as 3,4-methylenedioxymethamphetamine (MDMA), mephedrone and spice. All psychoactive drugs damage human well-being through similar basic neuropsychobiological mechanisms.

Prevalence of Cannabis Use Disorder and Associated Factors among Cannabis Young Adult Users at Shashemene Town, Oromia Region, Ethiopia, 2016

Introduction

Cannabis users are at high risk of developing cannabis use disorder which is a problematic pattern of cannabis use leading to clinically significant impairment or distress.

Objective

To assess the magnitude of cannabis use disorder and associated factors among young adults using cannabis at Shashemene Town, Oromia Region, Ethiopia.

Methods

A cross-sectional study was conducted at Shashemene Town, from May to June 2016. Young adults aged 18–25 who use cannabis and are permanent residents of Shashemene were included in the study. Using single proportion formula, 423 participants were selected using exponential discriminative snow ball sampling.

Result

This study revealed that the magnitude of cannabis use disorder was 42.2%. The most contributing factors that remained to be statistically significant with cannabis use disorder were common mental disorder (AOR = 2.125, 95% CI: 1.218, 3.708), current cigarette smoking (AOR = 6.118, 95% CI: 2.13, 17.575), and current use of shisha (AOR = 4.313, 95% CI: 2.427, 7.664).

Conclusion

The magnitude of cannabis use disorder among young adults using cannabis was high.

The intergenerational transmission of cannabis use: Associations between parental history of cannabis use and cannabis use disorder, low positive parenting, and offspring cannabis use

Parental cannabis use disorder (CUD) and low positive parenting (monitoring, support, and consistency) are risk factors for adolescent cannabis use. However, it is unclear whether parental cannabis use without CUD is sufficient to increase risk for low positive parenting and adolescent cannabis use. Additionally, parents may not treat each of their adolescents the same, and risk for adolescent cannabis use may increase as a result of low levels of positive parenting in families or low positive parenting unique to each adolescent. The current study prospectively tested low positive parenting as a mediator of the relation between parental cannabis use history (with parental cannabis use and CUD considered separately) and adolescent cannabis use at the family level and individual level. Participants were 363 adolescents from a multigenerational longitudinal study who reported on positive parenting when they were ages 9-16 (M = 11.6, SD = 1.40) and on cannabis use when they were ages 13-19 (M = 16.3, SD = 1.84). Parents reported on their own cannabis use and CUD. Results showed that parental CUD was associated with adolescent cannabis use (OR = 3.62, p = .047) but parental cannabis use without CUD was not, and only parental CUD predicted low positive parenting (B = -0.28, p < .05). Average levels of low positive parenting within a family partially mediated the association between parental CUD and offspring cannabis use. These findings suggest parental cannabis use alone may not impair parenting, but parental use that meets criteria for CUD does impair parenting. Additionally, average levels of positive parenting in families may be a mechanism underlying the intergenerational transmission of cannabis use. (PsycINFO Database Record

Cannabis use among middle and high school students in Ontario: a school-based cross-sectional study

BACKGROUND

Cannabis use can have serious detrimental effects in children and adolescents. It is therefore important to continually assess the use of cannabis among young people in order to inform prevention efforts. We assessed the prevalence of cannabis use among middle and high school students in Ontario and examined its association with demographic and behavioural factors.

METHODS

Data were obtained from the 2015 Ontario Student Drug Use and Health Survey, a province-wide school-based survey of students in grades 7 through 12. Analyses included a representative sample of 9920 middle and high school students. Bivariate cross-tabulations and logistic regression analyses were used to investigate the factors associated with cannabis use.

RESULTS

Overall, 21.5% and 13.9% of students reported using cannabis in the previous year and previous month, respectively. The conditional probability that an adolescent who reported cannabis use in the previous year would report daily use was 12.5%. There was a significant dose-response gradient with age, with older students being more likely to use cannabis than younger students. In multivariable analyses, being in grades 10 through 12 (odds ratios [ORs] ranged from 3.71 to 3.85), being black (OR 2.67 [95% confidence interval (CI) 1.76-4.05]), using tobacco cigarettes (OR 10.10 [95% CI 8.68-13.92]) and being an occasional (OR 5.35 [95% CI 4.01-7.13]) or regular (OR 14.6 [95% CI 10.8-19.89]) alcohol user were associated with greater odds of cannabis use. Being an immigrant was associated with lower odds of cannabis use (OR 0.55 [95% CI 0.39-0.78]).

INTERPRETATION

The findings suggest that cannabis use is prevalent among middle and high school students in Ontario and is strongly associated with tobacco cigarette smoking and alcohol consumption. Future research should document trends in cannabis use over time, including its risks, especially when the legalization of recreational cannabis comes into effect.

Sociodemographic, clinical, and functional long-term outcomes in adolescents and young adults with mental disorders

OBJECTIVE

To examine unfavorable sociodemographic, clinical, and functional long-term outcomes for a range of adolescent mental disorders.

METHODS

A total number of 2210 adolescents and young adults (14-24 years at baseline, T0) from a representative community sample were prospectively followed up (T1-T3) over 10 years. DSM-IV mental disorders, sociodemographic, clinical, and functional outcomes were assessed using the DIA-X/M-CIDI and its embedded assessment modules.

RESULTS

In (multinomial) logistic regressions adjusted for sex, age, other baseline disorders and sociodemographics, baseline anxiety, affective, substance use, somatoform and eating disorders (lifetime) predicted various unfavorable sociodemographic, clinical, and functional outcomes at T3. Particularly, strong associations were found between baseline disorders and adverse clinical outcomes at T3 (12-month diagnosis of the same/other disorder(s), drug use, suicide attempts, and help-seeking due to psychological problems). While substance use disorders were primarily associated with unfavorable sociodemographic and educational outcomes, anxiety and eating disorders were associated with unfavorable interpersonal outcomes, affective disorders with pregnancy-/childbirth-related complications and financial issues, and somatoform disorders with unfavorable educational/occupational and interpersonal outcomes. The risk of unfavorable outcomes increased with clinical severity, especially a higher number of baseline diagnoses.

CONCLUSIONS

Our findings emphasize the importance of effective treatment of mental disorders to prevent unfavorable long-term outcomes in various life domains.

Non-medical Cannabis Self-Exposure as a Dimensional Predictor of Opioid Dependence Diagnosis: A Propensity Score Matched Analysis

Background: The impact of increasing non-medical cannabis use on vulnerability to develop opioid use disorders has received considerable attention, with contrasting findings. A dimensional analysis of self-exposure to cannabis and other drugs, in individuals with and without opioid dependence (OD) diagnoses, may clarify this issue. Objective: To examine the age of onset of maximal self-exposure to cannabis, alcohol, cocaine, and heroin, in volunteers diagnosed with OD, using a rapidly administered instrument (the KMSK scales). To then determine whether maximal self-exposure to cannabis, alcohol, and cocaine is a dimensional predictor of odds of OD diagnoses. Methods: This outpatient observational study examined maximal self-exposure to these drugs, in volunteers diagnosed with DSM-IV OD or other drug diagnoses, and normal volunteers. In order to focus more directly on opioid dependence diagnosis as the outcome, volunteers who had cocaine dependence diagnoses were excluded. Male and female adults of diverse ethnicity were consecutively ascertained from the community, and from local drug treatment programs, in 2002-2013 (n = 574, of whom n = 94 had OD diagnoses). The age of onset of maximal self-exposure of these drugs was examined. After propensity score matching for age at ascertainment, gender, and ethnicity, a multiple logistic regression examined how increasing self-exposure to non-medical cannabis, alcohol and cocaine affected odds of OD diagnoses. Results: Volunteers with OD diagnoses had the onset of heaviest use of cannabis in the approximate transition between adolescence and adulthood (mean age = 18.9 years), and onset of heaviest use of alcohol soon thereafter (mean age = 20.1 years). Onset of heaviest use of heroin and cocaine was detected later in the lifespan (mean ages = 24.7 and 25.3 years, respectively). After propensity score matching for demographic variables, we found that the maximal self-exposure to cannabis and cocaine, but not to alcohol, was greater in volunteers with OD diagnoses, than in those without this diagnosis. Also, a multiple logistic regression detected that increasing self-exposure to cannabis and cocaine, but not alcohol, was a positive predictor of OD diagnosis. Conclusions/Importance: Increasing self-exposure to non-medical cannabis, as measured with a rapid dimensional instrument, was a predictor of greater odds of opioid dependence diagnosis, in propensity score-matched samples.

Psychosocial factors associated with adolescent substance use: a longitudinal investigation

Purpose

Alcohol and cannabis are the two most commonly used substances by young people in many developed nations. The purpose of this paper is to explore the longitudinal relationships between risky substance use (binge drinking and cannabis use) and psychological distress, emotional and behavioural difficulties, and truancy among Australian adolescents.

Design/methodology/approach

A total of 527 students (Mage=13.4 years, SD=0.43; 67 per cent female) from seven Australian schools completed an online self-report survey on four occasions over two years (baseline, 6, 12 and 24 months). The survey assessed binge drinking (5+ standard drinks on one occasion), cannabis use in the past six months, psychological distress, emotional and behavioural difficulties (Strength and Difficulties Questionnaire), and truancy. Generalised estimating equations (GEEs) were conducted to examine the longitudinal relationship between the substance use outcomes and each predictor variable.

Findings

At baseline, 3 per cent of students reported binge drinking and 6 per cent had used cannabis in the past six months. Rates of binge drinking significantly increased over time (21.1 per cent at 24 months) however, rates of cannabis use remained relatively stable (8.8 per cent at 24 months). Multivariate GEE analyses indicated that higher levels of hyperactivity/inattention, more days of truancy and being female were independently and consistently associated with binge drinking over time. Conduct problems was the only factor to be independently associated with cannabis use over time.

Originality/value

These findings provide valuable information about psychosocial risk factors for harmful alcohol and cannabis use. A better understanding of these associations is critical for informing substance use prevention efforts in the future.

Legalization of cannabis: Considerations for intervening with adolescent consumers

Eight states and the District of Columbia have legalized the recreational use of cannabis for adults and more are expected to follow suit. After alcohol, cannabis is the most commonly used drug by adolescents. Consumption of this drug during this developmental period poses unique risks. Therefore, attention must be paid both to how legalization affects adolescents and how tailored interventions can effectively address their needs for assistance. This commentary offers considerations for how legalization might be crafted so as to benefit adolescents. It additionally focuses on how services might be designed to reach and intervene with teens who are questioning their use or are experiencing a cannabis use disorder and desire assistance in quitting.

Ready, willing, and able: the role of cannabis use opportunities in understanding adolescent cannabis use

AIMS

To examine adolescent cannabis use-both at national and individual levels-by deconstructing it into its necessary conditions of realistic use opportunities and willingness to use the drug given such opportunities.

DESIGN

Nationally representative, repeated cross-sectional survey.

SETTING

Norway.

PARTICIPANTS

A total of 8818 16-year-olds who participated in the European School Survey Project on Alcohol and Other Drugs (ESPAD) in 2007, 2011, and 2015.

MEASUREMENTS

Adolescent reports concerning their life-time 'cannabis use' and 'possibilities to use cannabis' were used to assess: (a) overall cannabis use, (b) exposure to realistic cannabis use opportunities, and (c) cannabis use among those exposed to use opportunities. Logistic regression models were used to estimate national trends since 2007 in these indicators, and to identify individual-level factors associated with cannabis use versus non-use among youth exposed to concrete use opportunities.

FINDINGS

Prevalence of life-time cannabis use remained stably low, averaging 6.4% across the three surveys. Life-time exposure to cannabis use opportunities decreased [odds ratio (OR)_{ESPAD assessment}  = 0.90, 95% confidence interval (CI) = 0.84-0.97, P = 0.006], yet cannabis use among adolescents with such opportunities increased significantly (OR_{ESPAD assessment}  = 1.17, 95% CI = 1.03-1.34, P = 0.02) since 2007. After controlling for a range of other risk factors, abstinence from alcohol intoxication and cigarette use, as well as the perceptions of even minimal cannabis use as risky remained the factors most robustly associated with lower likelihood of cannabis use among youth with realistic use opportunities.

CONCLUSIONS

Approaches accounting for realistic use opportunities proved critical in our understanding of underage cannabis use, both at the national and individual level, and may be informative for development of prevention strategies in the era of cannabis liberalization. In addition, delineation of realistic opportunities from behaviours conditioned upon such opportunities is generalizable to a range of public health issues.

Health considerations in regulating marijuana in Vermont

This article delineates the current efforts of the Vermont Department of Health (VDH) to address the potential health impact of legalization and regulation of recreational marijuana for use by adults at least 21years of age. To this end, VDH and key stakeholders developed and published a Health Impact Assessment with specific recommendations should legislation that legalized and regulated marijuana be passed into law. Although the legalization legislation failed in 2016 and was vetoed by the Governor in 2017, it is unclear what will happen in the future.

Developmental Pathways from Child Maltreatment to Adolescent Substance Use: The Roles of Posttraumatic Stress Symptoms and Mother-Child Relationships

While many studies have identified a significant relation between child maltreatment and adolescent substance use, the developmental pathways linking this relation remain sparsely explored. The current study examines posttraumatic stress (PTS) symptoms, mother-child relationships, and internalizing and externalizing problems as potential longitudinal pathways through which child maltreatment influences adolescent substance use. Structural equation modeling was conducted on 883 adolescents drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). The pathways of PTS symptoms linked physical and sexual abuse to substance use, and the pathways of mother-child relationships linked emotional abuse and neglect to substance use. None of the four types of maltreatment affected substance use via internalizing or externalizing problems. The findings suggest that intervention efforts aimed at addressing posttraumatic stress symptoms and improving mother-child relationship quality may be beneficial in reducing substance use among adolescents with child maltreatment histories.

Evidence for Sex Convergence in Prevalence of Cannabis Use: A Systematic Review and Meta-Regression

OBJECTIVE

Generally, cannabis use has been more prevalent in men than in women. However, emerging evidence suggests that the prevalence of cannabis use is converging among males and females from recent cohorts. This study aimed to systematically summarize published literature on birth cohort changes in male-to-female ratios in prevalence of cannabis use.

METHOD

Twenty-two studies with a median sample size of 85,052 were identified for inclusion. Data were collected between 1979 and 2010, representing birth cohorts from 1936 to 1999. For quantitative synthesis, male-to-female ratios in prevalence of any cannabis use were calculated for all 5-year birth cohorts available, generating 348 separate ratios among birth cohorts from 1941 to 1995 in 30 countries. Random-effects meta-analyses generated pooled sex ratios, stratified by 5-year birth cohorts.

RESULTS

Of the 22 included studies, 10 reported some evidence of sex convergence in cannabis use among more recent cohorts. Quantitative synthesis found that the ratio of cannabis use prevalence in males and females decreased significantly from 2.0 among cohorts born in 1941 to 1.3 among those born in 1995.

CONCLUSIONS

Findings support the narrowing sex gap in the prevalence of cannabis use. Results are concordant with a broader literature demonstrating sex convergence in prevalence of other substance use, particularly alcohol use and related harms. Both young women and men should be the target of prevention and early intervention efforts. Future research in more diverse global settings, especially in low- and middle-income countries, would enhance the international scope of the findings.

Adolescent cannabis use, change in neurocognitive function, and high-school graduation: A longitudinal study from early adolescence to young adulthood

The main objective of this prospective longitudinal study was to investigate bidirectional associations between adolescent cannabis use (CU) and neurocognitive performance in a community sample of 294 young men from ages 13 to 20 years. The results showed that in early adolescence, and prior to initiation to CU, poor short-term and working memory, but high verbal IQ, were associated with earlier age of onset of CU. In turn, age of CU onset and CU frequency across adolescence were associated with (a) specific neurocognitive decline in verbal IQ and executive function tasks tapping trial and error learning and reward processing by early adulthood and (b) lower rates of high-school graduation. The association between CU onset and change in neurocognitive function, however, was found to be accounted for by CU frequency. Whereas the link between CU frequency across adolescence and change in verbal IQ was explained (mediated) by high school graduation, the link between CU frequency and tasks tapping trial and error learning were independent from high school graduation, concurrent cannabis and other substance use, adolescent alcohol use, and externalizing behaviors. Findings support prevention efforts aimed at delaying onset and reducing frequency of CU.