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Kayser RR, Senter MS, Tobet R, Raskin M, Patel S, Simpson HB. Patterns of Cannabis Use Among Individuals with Obsessive-Compulsive Disorder: Results from an Internet Survey. J Obsessive Compuls Relat Disord 2021; 30:100664. [PMID: 34336561 PMCID: PMC8323783 DOI: 10.1016/j.jocrd.2021.100664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Americans increasingly use cannabis, including those with psychiatric disorders. Yet little is known about cannabis use among individuals with obsessive-compulsive disorder (OCD). Thus, we conducted the first survey of cannabis users with OCD. METHODS Adults with OCD (i.e., prior professional diagnosis and/or score above the cutoff on a validated scale) who reported using cannabis were recruited from internet sources to complete a survey querying demographic information, medical/psychiatric history, cannabis use patterns, and perceived cannabis effects. RESULTS Of 1096 survey completers, 601 met inclusion criteria. Inhalation/cannabis flower were the most common method/formulation participants endorsed; most identified using high-potency cannabis products; 42% met criteria for cannabis use disorder. Nearly 90% self-reported using cannabis medicinally, 33.8% had a physician's recommendation, and 29% used specifically to manage OCD symptoms. Most participants reported cannabis improved obsessions/compulsions; those with increased obsession severity perceived less benefit. Finally, most participants were not receiving evidence-based OCD treatment, and the odds of receiving treatment decreased with increased cannabis use. CONCLUSIONS In this survey, participants with OCD reported both subjective benefits and harms from cannabis use. Future research should clarify the risks and benefits of cannabis use to those with OCD and develop treatment models to better support this population.
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Affiliation(s)
- Reilly R Kayser
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
- Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York, NY
| | - Meredith S Senter
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Rebecca Tobet
- University of Connecticut School of Medicine, Farmington, CT
| | - Marissa Raskin
- Institute for Neuroscience, University of Texas at Austin, Austin, TX
| | - Sapana Patel
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
- Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York, NY
| | - H Blair Simpson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
- Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York, NY
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202
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Weinberger AH, Platt J, Zhu J, Levin J, Ganz O, Goodwin RD. Cigarette Use and Cannabis Use Disorder Onset, Persistence, and Relapse: Longitudinal Data From a Representative Sample of US Adults. J Clin Psychiatry 2021; 82:20m13713. [PMID: 34232581 PMCID: PMC9059255 DOI: 10.4088/jcp.20m13713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: The current study prospectively investigated the relationship between cigarette use and the onset of, persistence of, and relapse to cannabis use disorder (CUD) 3 years later among adults in the United States. Methods: Analyses included respondents who completed Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002 and 2004-2005, respectively) and responded to questions about cigarette use, cannabis use, and CUD (n = 34,653). CUDs were defined by DSM-IV criteria using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-Diagnostic Version IV. Multivariable logistic regression models were used to calculate the odds of CUD onset, persistence, and relapse at Wave 2 by Wave 1 cigarette use status. Analyses were adjusted for sociodemographics, psychiatric disorders, nicotine dependence, and alcohol and other substance use disorders. Results: Cigarette use at Wave 1 was associated with onset of CUD at Wave 2 among those without Wave 1 cannabis use (adjusted odds ratio [AOR] = 1.62; 95% CI, 1.35-1.94) but not among those with Wave 1 cannabis use (AOR = 1.00; 95% CI, 0.83-1.19). Cigarette use at Wave 1 was also associated with persistence of CUD at Wave 2 among those with CUD at Wave 1 (AOR = 1.63; 95% CI, 1.30-2.00) and relapse to CUD at Wave 2 among those with remitted CUD at Wave 1 (AOR = 1.23; 95% CI, 1.09-1.45). Conclusions: Among adults, cigarette use is associated with increased onset and persistence of and relapse to CUD 3 years later. Additional attention to cigarette use in community prevention and clinical treatment efforts aimed at reducing CUD may be warranted.
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Affiliation(s)
- Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York,Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jonathan Platt
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Jiaqi Zhu
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, New York
| | - Jacob Levin
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - Ollie Ganz
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey,Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Renee D. Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York,Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, New York,Corresponding author: Renee D. Goodwin, PhD, MPH, Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, 55 West 125th Street, New York, NY 10027 ()
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203
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Abstract
OBJECTIVE Beliefs about marijuana use and prevalence of use may be associated with the legalization status of the state of residence. We examined differences in views and rates of use of marijuana among residents in recreationally legal, medically legal, and nonlegal states. METHODS We surveyed a nationally representative online panel of US adults (N = 16,280) and stratified results by marijuana legalization status of states. We compared views of residents of recreational states on benefits and risks of marijuana use to residents in other states. RESULTS The response rate was 56.3% (n = 9003). Residents in recreationally legal states were more likely to believe marijuana could be beneficial for pain management (73% in recreationally legal states, 67% in medically legal states, 63% in nonlegal states; P value: <0.0001), provide relief from stress, anxiety or depression (52% in recreationally legal states, 47% in medically legal states, 46% in nonlegal states; P value: 0.01), and improve appetite (39% in recreationally legal states, 36% in medically legal states, 33% in nonlegal states; P value: <0.009). In addition, residents in recreational states were significantly more likely to believe that smoking 1 marijuana joint a day is somewhat or much safer than smoking 1 cigarette a day (40.8% in recreationally legal states, 39.1% in medically legal states, and 36.1% in nonlegal states; P value: <0.0001). Residents of recreationally and medically legal states were more likely to believe second-hand marijuana smoke was somewhat or much safer than second-hand tobacco smoke (38.3% in recreationally legal states, 38.3% in medically legal states, and 35.7% in nonlegal states; P value: 0.003). Past-year marijuana use in any form (20% in recreational, 14.1% in medical, 12% in nonlegal) and past-year marijuana use of multiple forms (11.1% in recreational, 6.1% in medical, 4.9% in nonlegal) were highest among residents of recreationally legal states. Overall, prevalence of past-year use of any form of marijuana use was more common among residents of recreationally legal states compared with other states (20.3%, confidence interval [CI] 19.5, 21.1 in recreationally legal states; 15.4%, CI 14.7, 16.2 in medically legal states; 11.9%, CI 11.2, 12.6 in nonlegal states). CONCLUSIONS Residents in recreationally legal states were most likely to believe marijuana has benefits, marijuana smoke is safer than tobacco smoke, and have the highest rate of marijuana use. This is cause for concern, given the tide of commercialization, growing number of high-potency cannabis products, and favorable media coverage promoting use for health problems.
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204
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Associations of Current and Remitted Cannabis Use Disorder With Health-related Quality of Life and Employment Among US Adults. J Addict Med 2021; 16:286-294. [PMID: 34145190 DOI: 10.1097/adm.0000000000000889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The associations of current and remitted cannabis use disorder (CUD) with health-related quality of life (HRQOL) and employment have not been studied, and we aim to address these gaps. METHODS The 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions III (NESARC III) surveyed a nationally representative sample of non-institutionalized civilian US adults (≥18 years) (n = 36,309 unweighted). Using DSM-5 criteria, adults with current CUD were compared with those with CUD in remission and no history of CUD on standard measures of the mental and physical component scores of HRQOL and of quality-adjusted life years (QALYs) along with employment in the past 12 months. Multivariable-adjusted regression analyses were used to adjust for and examine the role of covariates. RESULTS Overall, 2.5% of the study sample, representing 6.0 million adults nationwide, met criteria for current CUD, and 3.7%, representing 8.8 million adults, met the criteria for CUD in remission. Adults with current or past CUD had lower mental HRQOL and QALYs, as compared to adults who never had CUD. However, these differences were no longer significant when adjusted for behavioral co-morbidities and personal histories. Current CUD was associated with lower odds of being employed (Adjusted odds ratio AOR = 0.76; 95% confidence intervals [CI], 0.60-0.96), but CUD in remission with a greater likelihood of employment (Adjusted odds ratio = 1.53; 95% CI, 1.23-1.91), both as compared to those never experiencing CUD. CONCLUSIONS Both current CUD and past CUD are adversely associated with HRQOL and current CUD with not being employed; Since CUD associations are not independent of comorbidities, treatment must take a wide-ranging approach.
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205
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Jugl S, Okpeku A, Costales B, Morris EJ, Alipour-Haris G, Hincapie-Castillo JM, Stetten NE, Sajdeya R, Keshwani S, Joseph V, Zhang Y, Shen Y, Adkins L, Winterstein AG, Goodin A. A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019. Med Cannabis Cannabinoids 2021; 4:21-42. [PMID: 34676348 PMCID: PMC8525213 DOI: 10.1159/000515069] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/03/2021] [Indexed: 12/15/2022] Open
Abstract
In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016-2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn's disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson's disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.
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Affiliation(s)
- Sebastian Jugl
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Aimalohi Okpeku
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Brianna Costales
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Earl J. Morris
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Golnoosh Alipour-Haris
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Juan M. Hincapie-Castillo
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | | | - Ruba Sajdeya
- Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Shailina Keshwani
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Verlin Joseph
- Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Yahan Zhang
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Yun Shen
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Lauren Adkins
- Health Sciences Center Libraries, University of Florida, Gainesville, Florida, USA
| | - Almut G. Winterstein
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Amie Goodin
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
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206
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Schattner A, Glick Y. Hemoptysis in a cannabis user. Am J Emerg Med 2021; 49:442.e1-442.e2. [PMID: 34001429 DOI: 10.1016/j.ajem.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 04/20/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022] Open
Abstract
A healthy young man presented to the emergency department with mild hemoptysis associated with cannabis abuse. He was on no medications and cocaine abuse was ruled out by both history and negative toxicology screens. There were neither signs of an infection, nor of a systemic or cardiac disease. Imaging studies were consistent with diffuse alveolar hemorrhage, a reported, albeit rare adverse drug reaction of tetrahydrocannabinol (Naranjo score 6). The patient improved spontaneously within a few days, hemoptysis stopped and repeat imaging was entirely normal. With the increase in cannabis abuse and enhanced cannabis potency worldwide clinicians may increasingly encounter even unusual cannabis-associated adverse drug reactions, including associated diffuse alveolar hemorrhage.
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Affiliation(s)
- Ami Schattner
- The Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel.
| | - Yair Glick
- Department of Imaging, Sanz Medical Center, Netanya, Israel
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207
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Hoffman AF, Hwang EK, Lupica CR. Impairment of Synaptic Plasticity by Cannabis, Δ 9-THC, and Synthetic Cannabinoids. Cold Spring Harb Perspect Med 2021; 11:cshperspect.a039743. [PMID: 32341064 PMCID: PMC8091957 DOI: 10.1101/cshperspect.a039743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The ability of neurons to dynamically and flexibly encode synaptic inputs via short- and long-term plasticity is critical to an organism's ability to learn and adapt to the environment. Whereas synaptic plasticity may be encoded by pre- or postsynaptic mechanisms, current evidence suggests that optimization of learning requires both forms of plasticity. Endogenous cannabinoids (eCBs) play critical roles in modulating synaptic transmission via activation of cannabinoid CB1 receptors (CB1Rs) in many central nervous system (CNS) regions, and the eCB system has been implicated, either directly or indirectly, in several forms of synaptic plasticity. Because of this, perturbations within the eCB signaling system can lead to impairments in a variety of learned behaviors. One agent of altered eCB signaling is exposure to "exogenous cannabinoids" such as the primary psychoactive constituent of cannabis, Δ9-THC, or illicit synthetic cannabinoids that in many cases have higher potency and efficacy than Δ9-THC. Thus, by targeting the eCB system, these agonists can produce widespread impairment of synaptic plasticity by disrupting ongoing eCB function. Here, we review studies in which Δ9-THC and synthetic cannabinoids impair synaptic plasticity in a variety of neuronal circuits and examine evidence that this contributes to their well-documented ability to disrupt cognition and behavior.
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Affiliation(s)
- Alexander F Hoffman
- Electrophysiology Research Section, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, Maryland 21224, USA
| | - Eun-Kyung Hwang
- Electrophysiology Research Section, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, Maryland 21224, USA
| | - Carl R Lupica
- Electrophysiology Research Section, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, Maryland 21224, USA
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208
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Matson TE, Carrell DS, Bobb JF, Cronkite DJ, Oliver MM, Luce C, Ghitza UE, Hsu CW, Campbell CI, Browne KC, Binswanger IA, Saxon AJ, Bradley KA, Lapham GT. Prevalence of Medical Cannabis Use and Associated Health Conditions Documented in Electronic Health Records Among Primary Care Patients in Washington State. JAMA Netw Open 2021; 4:e219375. [PMID: 33956129 PMCID: PMC8103224 DOI: 10.1001/jamanetworkopen.2021.9375] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/18/2021] [Indexed: 12/11/2022] Open
Abstract
Importance Many people use cannabis for medical reasons despite limited evidence of therapeutic benefit and potential risks. Little is known about medical practitioners' documentation of medical cannabis use or clinical characteristics of patients with documented medical cannabis use. Objectives To estimate the prevalence of past-year medical cannabis use documented in electronic health records (EHRs) and to describe patients with EHR-documented medical cannabis use, EHR-documented cannabis use without evidence of medical use (other cannabis use), and no EHR-documented cannabis use. Design, Setting, and Participants This cross-sectional study assessed adult primary care patients who completed a cannabis screen during a visit between November 1, 2017, and October 31, 2018, at a large health system that conducts routine cannabis screening in a US state with legal medical and recreational cannabis use. Exposures Three mutually exclusive categories of EHR-documented cannabis use (medical, other, and no use) based on practitioner documentation of medical cannabis use in the EHR and patient report of past-year cannabis use at screening. Main Outcomes and Measures Health conditions for which cannabis use has potential benefits or risks were defined based on National Academies of Sciences, Engineering, and Medicine's review. The adjusted prevalence of conditions diagnosed in the prior year were estimated across 3 categories of EHR-documented cannabis use with logistic regression. Results A total of 185 565 patients (mean [SD] age, 52.0 [18.1] years; 59% female, 73% White, 94% non-Hispanic, and 61% commercially insured) were screened for cannabis use in a primary care visit during the study period. Among these patients, 3551 (2%) had EHR-documented medical cannabis use, 36 599 (20%) had EHR-documented other cannabis use, and 145 415 (78%) had no documented cannabis use. Patients with medical cannabis use had a higher prevalence of health conditions for which cannabis has potential benefits (49.8%; 95% CI, 48.3%-51.3%) compared with patients with other cannabis use (39.9%; 95% CI, 39.4%-40.3%) or no cannabis use (40.0%; 95% CI, 39.8%-40.2%). In addition, patients with medical cannabis use had a higher prevalence of health conditions for which cannabis has potential risks (60.7%; 95% CI, 59.0%-62.3%) compared with patients with other cannabis use (50.5%; 95% CI, 50.0%-51.0%) or no cannabis use (42.7%; 95% CI, 42.4%-42.9%). Conclusions and Relevance In this cross-sectional study, primary care patients with documented medical cannabis use had a high prevalence of health conditions for which cannabis use has potential benefits, yet a higher prevalence of conditions with potential risks from cannabis use. These findings suggest that practitioners should be prepared to discuss potential risks and benefits of cannabis use with patients.
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Affiliation(s)
- Theresa E. Matson
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Services, University of Washington, Seattle
| | | | | | | | - Malia M. Oliver
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Casey Luce
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Udi E. Ghitza
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Clarissa W. Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Cynthia I. Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Kendall C. Browne
- Center of Excellence in Substance Addiction Treatment and Education, Veteran Affairs Puget Sound Health Care System, Seattle, Washington
| | - Ingrid A. Binswanger
- Kaiser Permanente Colorado Institute for Health Research and Colorado Permanente Medical Group, Denver
| | - Andrew J. Saxon
- Center of Excellence in Substance Addiction Treatment and Education, Veteran Affairs Puget Sound Health Care System, Seattle, Washington
| | - Katharine A. Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Services, University of Washington, Seattle
| | - Gwen T. Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Services, University of Washington, Seattle
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209
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Salas-Wright CP, Hai AH, Oh S, Alsolami A, Vaughn MG. Trends in cannabis views and use among American adults: Intersections with alcohol consumption, 2002-2018. Addict Behav 2021; 116:106818. [PMID: 33453586 DOI: 10.1016/j.addbeh.2021.106818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/10/2020] [Accepted: 01/04/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE The present study aims to examine trends in cannabis views and use among US adults who are alcohol abstainers, non-binge drinkers, and binge drinkers. METHODS We used data from the 2002-2018 National Survey on Drug Use and Health (US adults ages 18 and older, n = 664,152). Consistent with the Centers for Disease Control and Prevention guidelines, we conducted survey-adjusted logistic regression analyses to examine the significance of survey year in relation to cannabis views/use while controlling for demographic factors. RESULTS Between 2002 and 2018, the proportion of adults reporting strong disapproval of cannabis use initiation decreased significantly (AOR = 0.947, CI = 0.945-948). While the prevalence of cannabis use increased significantly for non-binge (AOR = 1.070, CI = 1.065-1.076) and binge drinkers (AOR = 1.039, CI = 1.035-1.042), the trend increase was greatest among abstainers (OR = 1.099, CI = 1.088-1.111). The association between disapproval and cannabis use did not change between 2003 and 2018 among alcohol abstainers, but weakened among both non-binge (2003-2006: AOR = 0.154, CI = 0.135-0.176; 2014-2018: AOR = 0.221, CI = 0.200-0.246) and binge drinkers (2003-2006: AOR = 0.297, CI = 0.275-0.321; 2014-2018: AOR = 0.361, CI = 0.333-0.391). CONCLUSION Cannabis disapproval has decreased and cannabis use increased among alcohol abstainers, non-binge drinkers, and binge drinkers between 2002 and 2018. The impact of cannabis disapproval on use attenuated during the study period among drinkers but not among abstainers, suggesting that the effect of anti-cannabis attitudes may be weakening among those most likely to use cannabis.
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210
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Enkema MC, Hallgren KA, Bowen S, Lee CM, Larimer ME. Craving management: Exploring factors that influence momentary craving-related risk of cannabis use among young adults. Addict Behav 2021; 115:106750. [PMID: 33383565 DOI: 10.1016/j.addbeh.2020.106750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/19/2020] [Accepted: 11/22/2020] [Indexed: 01/13/2023]
Abstract
Young adult frequent cannabis use has increased in prevalence and some frequent users have problems reducing their use. A strong link between momentary craving and subsequent use behaviors among individuals with problematic cannabis use has been reported in the literature, including young adults. In treatment contexts, interventions based on associative learning and reinforcement aim to reduce the prevalence of problematic substance use by altering the association between craving and use by increasing craving management skills such as mindfulness and reducing unhelpful responding such as avoidance or suppression. However, this model has not been tested among young adult cannabis users. The current study examined the influence of trait and state craving management strategies (mindfulness, coping style, experiential avoidance, and craving beliefs) on the link between momentary craving and use, using ecological momentary assessment in a sample of young adults with problematic use interested in reducing their use. Results demonstrated that two craving management constructs were associated with use: non-reactivity (p = 0.02) and non-judgment (p < 0.01). Interactions with momentary craving were observed for two constructs: non-judgmentalness (p = 0.02) and craving beliefs (p < 0.01). Findings suggest that treatments that increase non-reactivity and non-judgmentalness may reduce the occurrence of cannabis use for young adults contemplating reduction during an important period of biopsychosocial development by mitigating the impact of craving or directly reducing use. Additionally, negative beliefs about craving may serve a protective function during acute periods of elevation in momentary craving, an unexpected finding deserving further investigation.
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211
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Swiggett SJ, Vakharia AM, Ehiorobo JO, Vakharia RM, Roche MW, Mont MA, Choueka J. Impact of depressive disorders on primary total shoulder arthroplasties: a matched control analysis of 113,648 Medicare patients. Shoulder Elbow 2021; 13:181-187. [PMID: 33897849 PMCID: PMC8039756 DOI: 10.1177/1758573220916846] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/09/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate whether patients with depressive disorders undergoing primary total shoulder arthroplasty have higher rates of (1) in-hospital lengths of stay, (2) readmission rates, (3) medical complications, and (4) implant-related complications. METHODS A retrospective query was performed using a national claims database. Study group patients were matched to controls in a 1:5 ratio according to age, sex, and medical comorbidities. The query yielded 113,648 patients who were with (n = 18,953) and without (n = 94,695) depressive disorders. Pearson's χ2 analyses were used to compare patient demographics. Logistic regression analyses were used to calculate odds-ratios of complications and readmission rates. Welch's t-tests were used to test for significance for in-hospital lengths of stay. A p-value less than 0.003 was considered statistically significant. RESULTS Study group patients had significantly longer in-hospital lengths of stay (2.7 days versus 2.3 days; p < 0.0001). Patients who have depressive disorders had higher incidences and odds of readmissions (9.4 versus 6.15%; odds-ratio: 1.6, p < 0.0001), medical complications (2.7 versus 0.9%; odds-ratio: 3.0, p < 0.0001), and implant-related complications (6.1 versus 2.4%; odds-ratio: 2.59, p < 0.0001) compared to controls. CONCLUSION Depressive disorder patients have longer in-hospital lengths of stay and increased odds of readmissions and complications following primary total shoulder arthroplasty.
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Affiliation(s)
- Samuel J Swiggett
- Department of Orthopedic Surgery,
Maimonides Medical Center, Brooklyn, USA,Samuel J Swiggett, Maimonides Medical
Center, 4802, 10th Avenue Brooklyn, NY 11219, USA.
| | - Ajit M Vakharia
- Department of Orthopedic Surgery, Case
Western Reserve University Hospital, Cleveland, USA
| | - Joseph O Ehiorobo
- Department of Orthopedic Surgery,
Northwell Health, Lenox Hill Hospital, New York, USA
| | | | - Martin W Roche
- Holy Cross Hospital, Orthopedic Research
Institute, Ft Lauderdale, USA
| | - Michael A Mont
- Department of Orthopedic Surgery,
Northwell Health, Lenox Hill Hospital, New York, USA,Department of Orthopaedic Surgery,
Cleveland Clinic Hospital, Cleveland, USA
| | - Jack Choueka
- Department of Orthopedic Surgery,
Maimonides Medical Center, Brooklyn, USA
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212
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Doran N, Strong D, Myers MG, Correa JB, Tully L. Post-legalization changes in marijuana use in a sample of young California adults. Addict Behav 2021; 115:106782. [PMID: 33388479 DOI: 10.1016/j.addbeh.2020.106782] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/04/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Increasing marijuana use among young adults is a concern due to substantial acute and chronic health risks. More widespread use of marijuana may also lead to increased use of nicotine and tobacco products. California legalized commercial sales of marijuana for recreational use as of January 2018. To our knowledge no studies to date have examined subsequent changes in marijuana use. The goal of this study was to test the hypothesis that marijuana use frequency increased following legalization of recreational sales. We also hypothesized that increased marijuana frequency would predict greater frequency of nicotine/tobacco consumption. METHODS The study was a secondary analysis of a longitudinal study of tobacco use among non-daily cigarette smokers. Participants were 563 young adults (aged 18-24) enrolled in 2015-16 and followed quarterly for 3 years. RESULTS A piecewise multilevel regression model indicated that marijuana use frequency did not change over time, including following legalization. More frequent use was associated with younger age and identifying as white (ps < 0.001, which did not change after legalization. Marijuana frequency was moderated by sex (p < .001), with women reporting increasing and men decreasing use over time. It was also associated with tobacco use, and particularly with e-cigarette use following legalization (ps < 0.05). CONCLUSIONS Findings suggest legalization of recreational marijuana sales had a negligible overall impact on days of use among young adults, but may have prompted increased interest in marijuana among some, particularly women and e-cigarette users. The continuously evolving landscape around these products indicates that ongoing surveillance is critical.
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Affiliation(s)
- Neal Doran
- Department of Psychiatry, University of California, San Diego, United States; VA San Diego Healthcare System, San Diego, United States.
| | - David Strong
- School of Public Health, University of California, San Diego, United States.
| | - Mark G Myers
- Department of Psychiatry, University of California, San Diego, United States; VA San Diego Healthcare System, San Diego, United States.
| | - John B Correa
- Department of Psychiatry, University of California, San Diego, United States; VA San Diego Healthcare System, San Diego, United States.
| | - Lyric Tully
- Department of Psychiatry, University of California, San Diego, United States.
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213
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Sperandio KR, Gutierrez D, Hilert A, Fan S. The Lived Experiences of Addiction Counselors After Marijuana Legalization. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2021. [DOI: 10.1002/jaoc.12088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Katharine R. Sperandio
- School of Education College of William & Mary
- Now at Department of Counseling and Behavioral Health Thomas Jefferson University
| | | | - Alex Hilert
- School of Education College of William & Mary
| | - Shuhui Fan
- School of Education College of William & Mary
- Now at School of Education Northern State University
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214
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Moore JR, Chen Q, Choi NG. Cannabis use, use frequency, and use disorder in large metropolitan, small metropolitan, and nonmetropolitan areas. Drug Alcohol Depend 2021; 221:108631. [PMID: 33647587 DOI: 10.1016/j.drugalcdep.2021.108631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite significant geographical heterogeneity of sociodemographic and clinical characteristics, little is known about potential differences in cannabis use behaviors in U.S. geographic areas. In this study, we examined cannabis use behaviors in large metropolitan, small metropolitan, and nonmetropolitan areas. We focused on interactions between geographic areas and health insurance status and medical cannabis laws (MCL). METHODS Data came from the 2015-2018 National Survey on Drug Use and Health (NSDUH; N = 171,766 adults; N = 36,175 cannabis users). Weighted chi-squares tests of independence and multivariable Poisson regression models were used to examine study questions. RESULTS Past-year use was highest in large metropolitan areas (16.08 %). Frequent use was highest among nonmetropolitan area users (48.67 %). Uninsured adults had a higher likelihood of past-year use (RRR = 1.21, 95 % CI = 1.14, 1.29) and frequent use (RRR = 1.27, 95 % CI = 1.14, 1.41), but a lower likelihood of cannabis use disorder (RRR = 0.77, 95 % CI = 0.66, 0.89). Uninsured adults in nonmetropolitan areas had a higher likelihood (RRR = 1.62, 95 % CI = 1.39, 1.88) of past-year use than insured nonmetropolitan area adults. MCL state residency was associated with a higher likelihood of frequent use among nonmetropolitan (RRR = 1.39, 95 % CI = 1.11, 1.74) and small metropolitan users (RRR = 1.30, 95 % CI = 1.15, 1.47). Cannabis use disorder likelihood did not vary by geographic area. CONCLUSIONS Lack of health insurance and MCL state residency are significant variables affecting cannabis use behaviors in small metropolitan and/or nonmetropolitan areas.
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Affiliation(s)
- John R Moore
- The University of Texas at Austin, Steve Hicks School of Social Work, 1925 San Jacinto Blvd, Austin, TX 78712, United States.
| | - Qi Chen
- The University of Texas at Austin, Steve Hicks School of Social Work, 1925 San Jacinto Blvd, Austin, TX 78712, United States
| | - Namkee G Choi
- The University of Texas at Austin, Steve Hicks School of Social Work, 1925 San Jacinto Blvd, Austin, TX 78712, United States
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215
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Hasin D, Walsh C. Trends over time in adult cannabis use: A review of recent findings. Curr Opin Psychol 2021; 38:80-85. [PMID: 33873044 PMCID: PMC8905582 DOI: 10.1016/j.copsyc.2021.03.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 01/06/2023]
Abstract
In the United States, policies regarding the medical and nonmedical use of cannabis are changing rapidly. In 2021, a total of 34 US states have legalized cannabis for adult medical use, and 15 of these states have legalized adult non-medical use. These changing policies have raised questions about increasing prevalences of cannabis use, changing perceptions regarding frequent use, and potentially related outcomes such as comorbid psychiatric illness or driving under the influence of cannabis. Research regarding the correlates of any and frequent cannabis use is also developing quickly. This article reviews recent empirical studies concerning (1) adult trends in cannabis use, (2) state cannabis laws and related outcomes, and (3) emerging evidence regarding how the global coronavirus 19 pandemic may impact cannabis use patterns. We summarize recent findings and conclude with suggestions to address unanticipated effects of rapidly changing cannabis laws and policies.
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Affiliation(s)
- Deborah Hasin
- New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Claire Walsh
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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216
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Cyrus E, Coudray MS, Kiplagat S, Mariano Y, Noel I, Galea JT, Hadley D, Dévieux JG, Wagner E. A review investigating the relationship between cannabis use and adolescent cognitive functioning. Curr Opin Psychol 2021; 38:38-48. [PMID: 32818908 PMCID: PMC7365113 DOI: 10.1016/j.copsyc.2020.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022]
Abstract
Given varying state-level laws regarding cannabis use, the objective of the review was to summarize contemporary literature on the relationship between adolescent cognitive function and academic performance with cannabis use. Frequency and quantity of cannabis use were associated with decreased functional connectivity of the brain. Earlier age at cannabis initiation and more frequent use was associated with poorer executive control and academic performance. Social determinants such as minimal parental monitoring, peer use and low social cohesion were associated with more frequent adolescent use. Race/ethnicity and residence were other factors influencing cannabis use. To prevent cannabis use disorders among adolescents, interventions should aim to prevent early initiation that can lead to chronic use in youth who may be more at risk.
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Affiliation(s)
- Elena Cyrus
- Department of Population Health Sciences, College of Medicine, University of Central Florida (UCF), 6850 Lake Nona Boulevard, Orlando, FL, 32827, USA.
| | - Makella S Coudray
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University (FIU), 11200 SW 8thStreet, Miami, FL, 33199, USA
| | - Sandra Kiplagat
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University (FIU), 11200 SW 8thStreet, Miami, FL, 33199, USA
| | - Yandra Mariano
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University (FIU), 11200 SW 8thStreet, Miami, FL, 33199, USA
| | - Ines Noel
- Department of Psychological Sciences, College of Arts and Sciences, 5998 Alcala Park, University of San Diego, San Diego, CA, 92110, USA
| | - Jerome T Galea
- School of Social Work & College of Public Health, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL, 33620, USA
| | - Dexter Hadley
- Department of Clinical Sciences, College of Medicine, UCF, 6850 Lake Nona Boulevard, Orlando, FL, 32827, USA
| | - Jessy G Dévieux
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, 11200 SW 8thStreet, Miami, FL, 33199, USA
| | - Eric Wagner
- Community-Based Research Institute, FIU, 11200 SW 8thStreet, Miami, FL, 33199, USA
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217
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McFadden BR, Malone T. Homegrown perceptions about the medical use and potential abuse of CBD and THC. Addict Behav 2021; 115:106799. [PMID: 33387977 DOI: 10.1016/j.addbeh.2020.106799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/05/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Despite heightened consumer interest in cannabinoids such as cannabidiol (CBD) and tetrahydrocannabinol (THC), little is known about public perceptions regarding their medical use and potential for abuse, particularly relative to commonly used medications. Using data from 1,050 U.S. adult respondents from a national survey conducted in 2019, this study found that more than half of respondents perceived CBD, THC, hemp, and marijuana as having medical use. They also perceived the potential for abuse of CBD, THC, hemp, and marijuana as significantly less than potential for abuse of commonly prescribed anti-anxiety and pain medications. At the nexus of medical use and potential abuse, public perceptions classified CBD and hemp as similar to over-the-counter pain relief medications such as Advil and Tylenol and did not classify marijuana as a Schedule I substance. Slightly more than 20% of respondents reported having consumed CBD and/or THC. CBD was consumed more than THC to reduce pain while THC was consumed more than CBD for recreation. There were no differences in the types of medications they were replacing with CBD and THC.
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218
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Thompson K, Holley M, Sturgess C, Leadbeater B. Co-Use of Alcohol and Cannabis: Longitudinal Associations with Mental Health Outcomes in Young Adulthood. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073652. [PMID: 33807491 PMCID: PMC8037602 DOI: 10.3390/ijerph18073652] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022]
Abstract
Increases in cannabis use among young people has heightened concern about the potential interactive health effects of cannabis with other drugs. We examined the longitudinal association between concurrent and simultaneous (SAM) co-use of alcohol and cannabis in young adulthood on mental health symptoms, substance use behaviors, and substance-related harms two years later. Data were drawn from Time 5 (T5; n = 464; 46% male) and 6 (T6; n = 478; 45% male) of the Victoria Healthy Youth Survey. At T5, 42% of participants used alcohol-only, 13% used concurrently, 41% used SAM, 1% were cannabis only users, and 3% abstained from cannabis and alcohol. Boys were more likely to use SAM. Higher T5 SAM use frequency was associated with heavier use of substances, more substance-related harms, and symptoms of psychosis and externalizing problems at T6. T5 Concurrent use was associated with conduct symptoms, illicit drug use, and alcohol use disorders at T6 relative to alcohol-only use. Cannabis is commonly used with alcohol and the findings suggest that any co-use (concurrent or simultaneous) may be problematic in young adulthood. Public health messages need to explicitly inform consumers about the possible consequences of using both alcohol and marijuana and the addictive pharmacological impact of using them together.
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Affiliation(s)
- Kara Thompson
- Department of Psychology, St. Francis Xavier University, 103 Annex, 2323 Notre Dame Ave., Antigonish, NS B2G 2W5, Canada;
- Correspondence:
| | - Maria Holley
- Department of Psychology, St. Francis Xavier University, 103 Annex, 2323 Notre Dame Ave., Antigonish, NS B2G 2W5, Canada;
| | - Clea Sturgess
- Department of Psychology, University of Victoria, Greater Victoria, BC V8W 2Y2, Canada; (C.S.); (B.L.)
| | - Bonnie Leadbeater
- Department of Psychology, University of Victoria, Greater Victoria, BC V8W 2Y2, Canada; (C.S.); (B.L.)
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219
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Johnson JK, Johnson RM, Hodgkin D, Jones AA, Kritikos A, Doonan SM, Harris SK. Medical marijuana laws (MMLs) and dispensary provisions not associated with higher odds of adolescent marijuana or heavy marijuana use: A 46 State Analysis, 1991-2015. Subst Abus 2021; 42:471-475. [PMID: 33750275 DOI: 10.1080/08897077.2021.1900986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: States are rapidly moving to reverse marijuana prohibition, most frequently through legalization of medical marijuana laws (MMLs), and there is concern that marijuana legalization may affect adolescent marijuana use. Methods: This natural-experimental study used state Youth Risk Behavior Survey (YRBS) data collected from participants in grades 9-12 from 1991 to 2015 in 46 states (N = 1,091,723). Taking advantage of heterogeneity across states in MML status and MML dispensary design, difference-in-difference estimates compared states with enacted MMLs/dispensaries to non-MML/dispensaries states. Multivariable logistic regression modeling was used to adjust for state and year effects, and student demographics. The main outcome assessed was past 30-day adolescent marijuana use ["any" and "heavy" (≥20)]. Results: In the overall sample, the adjusted odds of adolescents reporting any past 30-day marijuana use was lower in states that enacted MMLs at any time during the study period (OR 0.94, 95% CI 0.89 to 0.99; p < .05), and in states with operational dispensaries in 2015 (OR 0.93, 95% CI 0.88 to 0.99; p < .05). Among grade cohorts, only 9th graders showed a significant effect, with lower odds of use with MML enactment. We found no effects on heavy marijuana use. Conclusions: This study found no evidence between 1991 and 2015 of increases in adolescents reporting past 30-day marijuana use or heavy marijuana use associated with state MML enactment or operational MML dispensaries. In a constantly evolving marijuana policy landscape, continued monitoring of adolescent marijuana use is important for assessing policy effects.
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Affiliation(s)
- Julie K Johnson
- Cannabis Control Commission, Commonwealth of Massachusetts, Worcester, Massachusetts, USA
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dominic Hodgkin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abenaa A Jones
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Alexandra Kritikos
- Institute for Behavioral Health, Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Samantha M Doonan
- Cannabis Control Commission, Commonwealth of Massachusetts, Worcester, Massachusetts, USA
| | - Sion K Harris
- The Center for Adolescent Substance use and Addiction Research (CeASAR), Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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220
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Rice J, Hildebrand A, Waslo CS, Cameron MH, Jones KD. Cannabis for medical purposes: A cross-sectional analysis of health care professionals' knowledge. J Am Assoc Nurse Pract 2021; 34:100-106. [PMID: 33767121 DOI: 10.1097/jxx.0000000000000590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/25/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Legalization of cannabis use and the evidence base supporting both risks and benefits of cannabinoids are expanding, but our understanding of health care professionals' (HCPs) knowledge about cannabis for medical purposes is limited. Understanding of the knowledge base and knowledge gaps about medical cannabis use is critical to advanced practice registered nurses (APRNs) because they are increasingly called on to manage patients taking multiple drugs, including prescribed and unprescribed cannabis and prescription cannabinoids. PURPOSE The purpose of this study was to examine HCPs' knowledge of clinical cannabis, including laws and regulations; risks and harms; pharmacology; and effects on pain, multiple sclerosis spasticity, and seizures as assessed with written tests before an in-person, continuing medical education program. METHODS Total scores and differences among professions and topics were compared. RESULTS A total of 178 of the 226 program attendees completed the test (79%) (107 [47%] physicians, 30 [13%] APRNs, and 18 [8%] registered nurses). The mean test score was 63.2% (SD = 12.7%) without significant differences among professions (F(3, 174) = 1.53; p = .21) but with significant differences among topics (χ2(7, 1068) = 201.13; p < .001). The score was lowest for effects on seizures (43.8%) and with scores below 70% for all other areas except laws and regulations (85.7%). IMPLICATIONS FOR PRACTICE There are substantial gaps in HCPs' knowledge about the clinical effects of cannabis, especially about risks and harms, pharmacology, and the effects on pain, multiple sclerosis spasticity, and seizures. Further education may help HCPs to understand the risks and benefits of cannabis and cannabinoids across conditions.
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Affiliation(s)
- Jessica Rice
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
- Portland VA Health Care System, Portland, Oregon
| | - Andrea Hildebrand
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
- Portland VA Health Care System, Portland, Oregon
| | - Carin S Waslo
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
- Portland VA Health Care System, Portland, Oregon
| | - Michelle H Cameron
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
- Portland VA Health Care System, Portland, Oregon
| | - Kim Dupree Jones
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
- Portland VA Health Care System, Portland, Oregon
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221
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Rinehart L, Spencer S. Which came first: Cannabis use or deficits in impulse control? Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110066. [PMID: 32795592 PMCID: PMC7750254 DOI: 10.1016/j.pnpbp.2020.110066] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/12/2020] [Accepted: 08/05/2020] [Indexed: 12/16/2022]
Abstract
Impulse control deficits are often found to co-occur with substance use disorders (SUDs). On the one hand, it is well known that chronic intake of drugs of abuse remodels the brain with significant consequences for a range of cognitive behaviors. On the other hand, individual variation in impulse control may contribute to differences in susceptibility to SUDs. Both of these relationships have been described, thus leading to a "chicken or the egg" debate which remains to be fully resolved. Does impulsivity precede drug use or does it manifest as a function of problematic drug usage? The link between impulsivity and SUDs has been most strongly established for cocaine and alcohol use disorders using both preclinical models and clinical data. Much less is known about the potential link between impulsivity and cannabis use disorder (CUD) or the directionality of this relationship. The initiation of cannabis use occurs most often during adolescence prior to the brain's maturation, which is recognized as a critical period of development. The long-term effects of chronic cannabis use on the brain and behavior have started to be explored. In this review we will summarize these observations, especially as they pertain to the relationship between impulsivity and CUD, from both a psychological and biological perspective. We will discuss impulsivity as a multi-dimensional construct and attempt to reconcile the results obtained across modalities. Finally, we will discuss possible avenues for future research with emerging longitudinal data.
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Affiliation(s)
- Linda Rinehart
- University of Minnesota, Department of Psychiatry and Behavioral Sciences
| | - Sade Spencer
- University of Minnesota, Department of Pharmacology, Minneapolis, MN, USA.
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222
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Jordan Walter T, Pocuca N, Young JW, Geyer MA, Minassian A, Perry W. The relationship between cannabis use and cognition in people with bipolar disorder: A systematic scoping review. Psychiatry Res 2021; 297:113695. [PMID: 33545431 PMCID: PMC7914198 DOI: 10.1016/j.psychres.2020.113695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
Bipolar disorder (BD) and cannabis use are highly comorbid and are each associated with cognitive impairment. Given the prevalence of cannabis use in people with BD, it is important to understand whether the two interact to impact cognitive function. We performed a systematic scoping review to determine what is currently known in this field. We systematically searched PubMed, Embase, CINAHL, Web of Science, and PsycINFO for studies on the relationship between cannabis use and cognition in people with BD or relevant animal models. Six observational human studies and no animal studies met inclusion criteria. Two studies found cannabis use in BD was associated with better performance in some cognitive domains, while three studies found no association. One study found cannabis use in BD was associated with worse overall cognition. Overall, most identified studies suggest cannabis use is not associated with significant cognitive impairment in BD; however, the scope of knowledge in this field is limited, and more systematic studies are clearly required. Future studies should focus on longitudinal and experimental trials, and well-controlled observational studies with rigorous quantification of the onset, frequency, quantity, duration, and type of cannabis use, as well as BD illness features.
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Affiliation(s)
- T Jordan Walter
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Nina Pocuca
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Research Services, Veterans Administration San Diego HealthCare System, 3350 La Jolla Village Drive, San Diego CA, 92161, USA
| | - Mark A Geyer
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Research Services, Veterans Administration San Diego HealthCare System, 3350 La Jolla Village Drive, San Diego CA, 92161, USA
| | - Arpi Minassian
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; VA Center of Excellence for Stress and Mental Health, Veterans Administration San Diego HealthCare System, 3350 La Jolla Village Drive, San Diego CA, 92161, USA
| | - William Perry
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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223
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Matthay EC, Kiang MV, Elser H, Schmidt L, Humphreys K. Evaluation of State Cannabis Laws and Rates of Self-harm and Assault. JAMA Netw Open 2021; 4:e211955. [PMID: 33734416 PMCID: PMC7974641 DOI: 10.1001/jamanetworkopen.2021.1955] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/25/2021] [Indexed: 12/13/2022] Open
Abstract
Importance State cannabis laws are changing rapidly. Research is inconclusive about their association with rates of self-harm and assault. Existing studies have not considered variations in cannabis commercialization across states over time. Objective To evaluate the association of state medical and recreational cannabis laws with self-harm and assault, overall and by age and sex, while considering varying degrees of commercialization. Design, Setting, and Participants Using a cohort design with panel fixed-effects analysis, within-state changes in claims for self-harm and assault injuries before and after changes in cannabis laws were quantified in all 50 US states and the District of Columbia. Comprehensive claims data on commercial and Medicare Advantage health plan beneficiaries from January 1, 2003, to December 31, 2017, grouped by state and month, were evaluated. Data analysis was conducted from January 31, 2020, to January 21, 2021. Exposures Categorical variable that indexed the degree of cannabis legalization in each state and month based on law type (medical or recreational) and operational status of dispensaries (commercialization). Main Outcomes and Measures Claims for self-harm and assault injuries based on International Classification of Diseases codes. Results The analysis included 75 395 344 beneficiaries (mean [SD] age, 47 [22] years; 50% female; and median follow-up, 17 months [interquartile range, 8-36 months]). During the study period, 29 states permitted use of medical cannabis and 11 permitted recreational cannabis. Point estimates for populationwide rates of self-harm and assault injuries were higher in states legalizing recreational cannabis compared with states with no cannabis laws, but these results were not statistically significant (adjusted rate ratio [aRR] assault, recreational dispensaries: 1.27; 95% CI, 0.79-2.03;self-harm, recreational dispensaries aRR: 1.15; 95% CI, 0.89-1.50). Results varied by age and sex with no associations found except for states with recreational policies and self-harm among males younger than 40 years (aRR <21 years, recreational without dispensaries: 1.70; 95% CI, 1.11-2.61; aRR aged 21-39 years, recreational dispensaries: 1.46; 95% CI, 1.01-2.12). Medical cannabis was generally not associated with self-harm or assault injuries populationwide or among age and sex subgroups. Conclusions and Relevance Recreational cannabis legalization appears to be associated with relative increases in rates of claims for self-harm among male health plan beneficiaries younger than 40 years. There was no association between cannabis legalization and self-harm or assault, for any other age and sex group or for medical cannabis. States that legalize but still constrain commercialization may be better positioned to protect younger male populations from unintended harms.
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Affiliation(s)
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California
| | - Holly Elser
- Medical student, Stanford University School of Medicine, Palo Alto, California
| | - Laura Schmidt
- Philip R. Lee Institute for Health Policy Studies and Department of Humanities and Social Sciences, University of California, San Francisco
| | - Keith Humphreys
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
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224
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Duncan C, Butler K, Loa L. Cannabis use disorder: Implications and best practices. Nurse Pract 2021; 46:12-15. [PMID: 33606454 DOI: 10.1097/01.npr.0000733712.67456.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cannabinoid-Induced Conditioned Place Preference, Intravenous Self-Administration, and Behavioral Stimulation Influenced by Ghrelin Receptor Antagonism in Rats. Int J Mol Sci 2021; 22:ijms22052397. [PMID: 33673659 PMCID: PMC7957642 DOI: 10.3390/ijms22052397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/13/2021] [Accepted: 02/21/2021] [Indexed: 11/24/2022] Open
Abstract
Cannabis/cannabinoids are widely used for recreational and therapy purposes, but their risks are largely disregarded. However, cannabinoid-associated use disorders and dependence are alarmingly increasing and an effective treatment is lacking. Recently, the growth hormone secretagogue receptor (GHSR1A) antagonism was proposed as a promising mechanism for drug addiction therapy. However, the role of GHS-R1A and its endogenous ligand ghrelin in cannabinoid abuse remains unclear. Therefore, the aim of our study was to investigate whether the GHS-R1A antagonist JMV2959 could reduce the tetrahydrocannabinol (THC)-induced conditioned place preference (CPP) and behavioral stimulation, the WIN55,212-2 intravenous self-administration (IVSA), and the tendency to relapse. Following an ongoing WIN55,212-2 self-administration, JMV2959 3 mg/kg was administered intraperitoneally 20 min before three consequent daily 120-min IVSA sessions under a fixed ratio FR1, which significantly reduced the number of the active lever-pressing, the number of infusions, and the cannabinoid intake. Pretreatment with JMV2959 suggested reduction of the WIN55,212-2-seeking/relapse-like behavior tested in rats on the twelfth day of the forced abstinence period. On the contrary, pretreatment with ghrelin significantly increased the cannabinoid IVSA as well as enhanced the relapse-like behavior. Co-administration of ghrelin with JMV2959 abolished/reduced the significant efficacy of the GHS-R1A antagonist in the cannabinoid IVSA. Pretreatment with JMV2959 significantly and dose-dependently reduced the manifestation of THC-induced CPP. The THC-CPP development was reduced after the simultaneous administration of JMV2959 with THC during conditioning. JMV2959 also significantly reduced the THC-induced behavioral stimulation in the LABORAS cage. Our findings suggest that GHS-R1A importantly participates in the rewarding/reinforcing effects of cannabinoids.
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Abstract
Cannabis use disorder (CUD) is an underappreciated risk of using cannabis that affects ~10% of the 193 million cannabis users worldwide. The individual and public health burdens are less than those of other forms of drug use, but CUD accounts for a substantial proportion of persons seeking treatment for drug use disorders owing to the high global prevalence of cannabis use. Cognitive behavioural therapy, motivational enhancement therapy and contingency management can substantially reduce cannabis use and cannabis-related problems, but enduring abstinence is not a common outcome. No pharmacotherapies have been approved for cannabis use or CUD, although a number of drug classes (such as cannabinoid agonists) have shown promise and require more rigorous evaluation. Treatment of cannabis use and CUD is often complicated by comorbid mental health and other substance use disorders. The legalization of non-medical cannabis use in some high-income countries may increase the prevalence of CUD by making more potent cannabis products more readily available at a lower price. States that legalize medical and non-medical cannabis use should inform users about the risks of CUD and provide information on how to obtain assistance if they develop cannabis-related mental and/or physical health problems.
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Kayser RR, Haney M, Simpson HB. Human Laboratory Models of Cannabis Use: Applications for Clinical and Translational Psychiatry Research. Front Psychiatry 2021; 12:626150. [PMID: 33716825 PMCID: PMC7947318 DOI: 10.3389/fpsyt.2021.626150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/03/2021] [Indexed: 11/13/2022] Open
Abstract
Cannabis is increasingly used by individuals with mental health diagnoses and often purported to treat anxiety and various other psychiatric symptoms. Yet support for using cannabis as a psychiatric treatment is currently limited by a lack of evidence from rigorous placebo-controlled studies. While regulatory hurdles and other barriers make clinical trials of cannabis challenging to conduct, addiction researchers have decades of experience studying cannabis use in human laboratory models. These include methods to control cannabis administration, to delineate clinical and mechanistic aspects of cannabis use, and to evaluate potential treatment applications for cannabis and its constituents. In this paper, we review these human laboratory procedures and describe how each can be applied to study cannabis use in patients with psychiatric disorders. Because anxiety disorders are among the most common psychiatric illnesses affecting American adults, and anxiety relief is also the most commonly-reported reason for medicinal cannabis use, we focus particularly on applying human laboratory models to study cannabis effects in individuals with anxiety and related disorders. Finally, we discuss how these methods can be integrated to study cannabis effects in other psychiatric conditions and guide future research in this area.
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Affiliation(s)
- Reilly R. Kayser
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York, NY, United States
| | - Margaret Haney
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York, NY, United States
| | - Helen Blair Simpson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York, NY, United States
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Andersson HW, Lilleeng SE, Ose SO. Comparison of social and sociodemographic characteristics and treatment goals of persons with alcohol versus drug use disorders: Result from a national census of inpatients in specialized treatment for substance use. Addict Behav Rep 2021; 13:100340. [PMID: 33614886 PMCID: PMC7878974 DOI: 10.1016/j.abrep.2021.100340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 01/19/2023] Open
Abstract
A national census of patients in residential substance use treatment. We compared inpatients with primary alcohol use disorders vs. drug use disorders. Patients with drug use disorders were more likely sociodemographic disadvantaged. Patients with drug use disorders more likely had poor friend relationships. Treatment goal differences disappeared when adjusted for sociodemographic variables.
Introduction We examined differences in social and sociodemographic characteristics and treatment goals between people with primary alcohol use disorder (AUD) versus those with a primary drug use disorder receiving inpatient treatment for a substance use disorder (SUD). Methods A national census utilizing a cross sectional design included 56 of 60 specialized inpatient SUD treatment clinics in Norway and all patients receiving treatment on a specific date (responserate = 70%). Data on substance use, social and sociodemographic characteristics, and patient-reported treatment goals were collected. Patients were classified as having primary AUD or a drug use disorder based on the main SUD diagnosis relevant to the treatment episode. Results The analytic sample included 1093 patients. Patients with primary AUD (n = 362) were more often older, had a higher educational level and income from work, and lived in permanent housing compared with patients with a drug use disorder (n = 731). Patients with AUD were more likely to have good relationships with friends. The higher frequency of reported reduced substance use (versus quitting substance use) as the treatment goal among AUD patients disappeared when controlled for sociodemographic factors. Conclusions Knowledge about the different characteristics of inpatients with AUD versus a drug use disorder is relevant when conducting research involving the SUD treatment population and for facilitating treatment. The lower frequency of perceived support from friends among patients with a drug use disorder suggests a need for targeted efforts in (re)building supportive social relationships for inpatients being treated for SUD.
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Affiliation(s)
- Helle Wessel Andersson
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, PB 3250 Sluppen, 7006 Trondheim, Norway
| | - Solfrid E Lilleeng
- The Norwegian Directorate of Health, Department of Analysis and Performance Assessment, Holtermanns vei 70, Trondheim 7031, Norway
| | - Solveig Osborg Ose
- SINTEF Technology and Society, Department of Health, Klæbuveien 153, Trondheim 7049, Norway
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Abstract
Lung cancer is the leading cause of global cancer incidence and mortality, accounting for an estimated 2 million diagnoses and 1.8 million deaths. Neoplasms of the lungs are the second most common cancer diagnosis in men and women (after prostate and breast cancer, respectively). With increasing access to tobacco and industrialization in developing nations, lung cancer incidence is rising globally. The average age of diagnosis is 70 years old. Men are twice as likely to be diagnosed with lung cancer, which largely reflects differences in tobacco consumption, although women may be more susceptible due to higher proportions of epidermal growth factor receptor mutations and the effects of oestrogen. African American men in the US are at the highest risk of lung cancer. Family history increases risk by 1.7-fold, with a greater risk among first-degree relatives. Tobacco smoking is the greatest preventable cause of death worldwide, accounting for up to 90% of lung cancer cases, and continued consumption is projected to increase global cancer incidence, particularly in developing nations such as China, Russia, and India. Second-hand smoke among children and spouses has likewise been implicated. Radon from natural underground uranium decay is the second leading cause of lung cancer in the developed world. Occupational hazards such as asbestos and environmental exposures such as air pollution, arsenic, and HIV and Tb infection have all been implicated in lung carcinogenesis, while cannabis smoking, electronic cigarettes, heated tobacco products, and COVID-19 have been hypothesized to increase risk.
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Traccis F, Serra V, Sagheddu C, Congiu M, Saba P, Giua G, Devoto P, Frau R, Cheer JF, Melis M. Prenatal THC Does Not Affect Female Mesolimbic Dopaminergic System in Preadolescent Rats. Int J Mol Sci 2021; 22:ijms22041666. [PMID: 33562259 PMCID: PMC7914408 DOI: 10.3390/ijms22041666] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/30/2022] Open
Abstract
Cannabis use among pregnant women is increasing worldwide along with permissive sociocultural attitudes toward it. Prenatal cannabis exposure (PCE), however, is associated with adverse outcome among offspring, ranging from reduced birth weight to child psychopathology. We have previously shown that male rat offspring prenatally exposed to Δ9-tetrahydrocannabinol (THC), a rat model of PCE, exhibit extensive molecular, cellular, and synaptic changes in dopamine neurons of the ventral tegmental area (VTA), resulting in a susceptible mesolimbic dopamine system associated with a psychotic-like endophenotype. This phenotype only reveals itself upon a single exposure to THC in males but not females. Here, we characterized the impact of PCE on female behaviors and mesolimbic dopamine system function by combining in vivo single-unit extracellular recordings in anesthetized animals and ex vivo patch clamp recordings, along with neurochemical and behavioral analyses. We find that PCE female offspring do not show any spontaneous or THC-induced behavioral disease-relevant phenotypes. The THC-induced increase in dopamine levels in nucleus accumbens was reduced in PCE female offspring, even when VTA dopamine activity in vivo and ex vivo did not differ compared to control. These findings indicate that PCE impacts mesolimbic dopamine function and its related behavioral domains in a sex-dependent manner and warrant further investigations to decipher the mechanisms determining this sex-related protective effect from intrauterine THC exposure.
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Affiliation(s)
- Francesco Traccis
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.T.); (V.S.); (C.S.); (M.C.); (P.S.); (G.G.); (P.D.); (R.F.)
| | - Valeria Serra
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.T.); (V.S.); (C.S.); (M.C.); (P.S.); (G.G.); (P.D.); (R.F.)
| | - Claudia Sagheddu
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.T.); (V.S.); (C.S.); (M.C.); (P.S.); (G.G.); (P.D.); (R.F.)
| | - Mauro Congiu
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.T.); (V.S.); (C.S.); (M.C.); (P.S.); (G.G.); (P.D.); (R.F.)
| | - Pierluigi Saba
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.T.); (V.S.); (C.S.); (M.C.); (P.S.); (G.G.); (P.D.); (R.F.)
| | - Gabriele Giua
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.T.); (V.S.); (C.S.); (M.C.); (P.S.); (G.G.); (P.D.); (R.F.)
| | - Paola Devoto
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.T.); (V.S.); (C.S.); (M.C.); (P.S.); (G.G.); (P.D.); (R.F.)
| | - Roberto Frau
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.T.); (V.S.); (C.S.); (M.C.); (P.S.); (G.G.); (P.D.); (R.F.)
| | - Joseph Francois Cheer
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Miriam Melis
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.T.); (V.S.); (C.S.); (M.C.); (P.S.); (G.G.); (P.D.); (R.F.)
- Correspondence: ; Tel.: +39-070-675-4322
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Dean D, Passalacqua KD, Oh SM, Aaron C, Van Harn MG, King A. Pediatric Cannabis Single-Substance Exposures Reported to the Michigan Poison Center From 2008-2019 After Medical Marijuana Legalization. J Emerg Med 2021; 60:701-708. [PMID: 33541760 DOI: 10.1016/j.jemermed.2020.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/09/2020] [Accepted: 12/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Legalization of medical and recreational cannabis is a major contributor to pediatric cannabis exposures. The trends and magnitude of pediatric cannabis exposures in Michigan after medical cannabis legalization in 2008 have not been assessed. OBJECTIVE To describe the temporal trends of pediatric cannabis exposures reported to the Michigan Poison Center (MiPC) after medical cannabis was legalized in 2008 and 1 year after legalization of recreational cannabis in 2018. METHODS Retrospective electronic chart review of pediatric (<18 years old) single-substance cannabis exposures reported to the MiPC from January 1, 2008 to December 31, 2019. Routes of cannabis exposure were reported as ingestion, inhalation, and unknown. Types of ingested cannabis products were also documented. RESULTS Between 2008 and 2019, 426 pediatric cannabis single exposures were reported. The median patient age was 6.0 years (interquartile range 2-15 years). Age distribution was bimodal. A total of 327 (76.8%) exposures were from cannabis ingestion, 79 (18.5%) from inhalation, 2 (0.5%) from both ingestion and inhalation, and 18 (4.2%) from unknown route. The doubling time for number of cases was 2.1 years, and the total number of annual reported cases increased after 2016. Teenagers (13-17 years) had the highest number of inhalational exposures, whereas young children (0-5 years) had the highest number of ingestions. CONCLUSION Single-substance pediatric cannabis exposures reported to the Michigan Poison Center increased after medical cannabis was legalized in 2008 through recreational legalization in 2018.
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Affiliation(s)
- Diana Dean
- Michigan Poison Center at Wayne State University School of Medicine, Detroit, Michigan; Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan
| | | | - Su Min Oh
- Michigan Department of Health and Human Services, Lansing, Michigan
| | - Cynthia Aaron
- Michigan Poison Center at Wayne State University School of Medicine, Detroit, Michigan
| | - Meredith G Van Harn
- Public Health Science Division of Biostatistics, Henry Ford Hospital, Detroit, Michigan
| | - Andrew King
- Michigan Poison Center at Wayne State University School of Medicine, Detroit, Michigan; Department of Emergency Medicine, Detroit Medical Center, Detroit, Michigan
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Lees R, Hines LA, D'Souza DC, Stothart G, Di Forti M, Hoch E, Freeman TP. Psychosocial and pharmacological treatments for cannabis use disorder and mental health comorbidities: a narrative review. Psychol Med 2021; 51:353-364. [PMID: 33536109 DOI: 10.1017/s0033291720005449] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cannabis is the most widely used illicit drug worldwide, and it is estimated that up to 30% of people who use cannabis will develop a cannabis use disorder (CUD). Demand for treatment of CUD is increasing in almost every region of the world and cannabis use is highly comorbid with mental disorders, where sustained use can reduce treatment compliance and increase risk of relapse. In this narrative review, we outline evidence for psychosocial and pharmacological treatment strategies for CUD, both alone and when comorbid with psychosis, anxiety or depression. Psychosocial treatments such as cognitive behavioural therapy, motivational enhancement therapy and contingency management are currently the most effective strategy for treating CUD but are of limited benefit when comorbid with psychosis. Pharmacological treatments targeting the endocannabinoid system have the potential to reduce cannabis withdrawal and cannabis use in CUD. Mental health comorbidities including anxiety, depression and psychosis hinder effective treatment and should be addressed in treatment provision and clinical decision making to reduce the global burden of CUDs. Antipsychotic medication may decrease cannabis use and cannabis craving as well as psychotic symptoms in patients with CUD and psychosis. Targeted treatments for anxiety and depression when comorbid with CUD are feasible.
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Affiliation(s)
- Rachel Lees
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Lindsey A Hines
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Deepak Cyril D'Souza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - Marta Di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eva Hoch
- Cannabinoid Research and Treatment Group, Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry, Ludwig Maximilian University of Munich, Munich, Germany
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
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Wilkins C, Rychert M. Assessing New Zealand's Cannabis Legalization and Control Bill: prospects and challenges. Addiction 2021; 116:222-230. [PMID: 32621400 DOI: 10.1111/add.15144] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/23/2020] [Accepted: 06/03/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Few countries have developed detailed legislative proposals for legalizing cannabis. New Zealand recently released the Cannabis Legalization and Control Bill (CLCB) that will be the subject of a referendum in September 2020. AIMS To assess the CLCB, drawing on emerging evidence from cannabis legalization overseas, public health research on alcohol and tobacco and the attempt to establish a regulated market for 'legal highs' in New Zealand. DISCUSSION The CLCB proposes a strictly regulated commercial cannabis market that resembles the Canadian approach, but notably without on-line sales or regional heterogeneity in retail distribution. The objective of the CLCB of lowering cannabis use over time appears at odds with the largely commercial cannabis sector that will focus on expanding sales. The CLCB includes provision for home cultivation and social benefit operators, but it is not clear what priority these operators will receive. A potency cap of 15% tetrahydrocannabinol (THC) for cannabis plants is included, and this is at the high end of black-market cannabis. The proposed progressive product tax based on THC will be challenging to implement. There is no formal minimum price, but rather discretionary powers to raise the excise if the price drops too much. The CLCB includes a comprehensive ban on advertising, but non-conventional on-line promotion will be difficult to suppress. The central government cannabis authority is tasked with developing local retail outlet policies. We caution against the temptation to employ an interim regulatory regime following a positive referendum result, because a partially regulated market will expose users to health risks and undermine public support. CONCLUSIONS New Zealand's Cannabis Legalization and Control Bill's objective of reducing cannabis use via a commercial market will be challenging to achieve. The bill could be strengthened with formal minimum pricing, lower potency cap and greater clarity concerning social benefit operators and the role of local government.
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Affiliation(s)
- Chris Wilkins
- SHORE & Whariki Research Centre, Massey University, P.O. Box 6137, Victoria Street West, Auckland, 1142, New Zealand
| | - Marta Rychert
- SHORE & Whariki Research Centre, Massey University, P.O. Box 6137, Victoria Street West, Auckland, 1142, New Zealand
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Cannabis use and posttraumatic stress disorder comorbidity: Epidemiology, biology and the potential for novel treatment approaches. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 157:143-193. [PMID: 33648669 DOI: 10.1016/bs.irn.2020.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cannabis use is increasing among some demographics in the United States and is tightly linked to anxiety, trauma, and stress reactivity at the epidemiological and biological level. Stress-coping motives are highly cited reasons for cannabis use. However, with increased cannabis use comes the increased susceptibility for cannabis use disorder (CUD). Indeed, CUD is highly comorbid with posttraumatic stress disorder (PTSD). Importantly, endogenous cannabinoid signaling systems play a key role in the regulation of stress reactivity and anxiety regulation, and preclinical data suggest deficiencies in this signaling system could contribute to the development of stress-related psychopathology. Furthermore, endocannabinoid deficiency states, either pre-existing or induced by trauma exposure, could provide explanatory insights into the high rates of comorbid cannabis use in patients with PTSD. Here we review clinical and preclinical literature related to the cannabis use-PTSD comorbidity, the role of endocannabinoids in the regulation of stress reactivity, and potential therapeutic implications of recent work in this area.
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235
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Portugalov A, Akirav I. Do Adolescent Exposure to Cannabinoids and Early Adverse Experience Interact to Increase the Risk of Psychiatric Disorders: Evidence from Rodent Models. Int J Mol Sci 2021; 22:ijms22020730. [PMID: 33450928 PMCID: PMC7828431 DOI: 10.3390/ijms22020730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/30/2022] Open
Abstract
There have been growing concerns about the protracted effects of cannabis use in adolescents on emotion and cognition outcomes, motivated by evidence of growing cannabis use in adolescents, evidence linking cannabis use to various psychiatric disorders, and the increasingly perceived notion that cannabis is harmless. At the same time, studies suggest that cannabinoids may have therapeutic potential against the impacts of stress on the brain and behavior, and that young people sometimes use cannabinoids to alleviate feelings of depression and anxiety (i.e., “self-medication”). Exposure to early adverse life events may predispose individuals to developing psychopathology in adulthood, leading researchers to study the causality between early life factors and cognitive and emotional outcomes in rodent models and to probe the underlying mechanisms. In this review, we aim to better understand the long-term effects of cannabinoids administered in sensitive developmental periods (mainly adolescence) in rodent models of early life stress. We suggest that the effects of cannabinoids on emotional and cognitive function may vary between different sensitive developmental periods. This could potentially affect decisions regarding the use of cannabinoids in clinical settings during the early stages of development and could raise questions regarding educating the public as to potential risks associated with cannabis use.
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Affiliation(s)
- Anna Portugalov
- Department of Psychology, School of Psychological Sciences, University of Haifa, 3498838 Haifa, Israel;
- The Integrated Brain and Behavior Research Center (IBBR), University of Haifa, 3498838 Haifa, Israel
| | - Irit Akirav
- Department of Psychology, School of Psychological Sciences, University of Haifa, 3498838 Haifa, Israel;
- The Integrated Brain and Behavior Research Center (IBBR), University of Haifa, 3498838 Haifa, Israel
- Correspondence:
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Drake VE, Fakhry C, Windon MJ, Stewart CM, Akst L, Hillel A, Chien W, Ha P, Miles B, Gourin CG, Mandal R, Mydlarz WK, Rooper L, Troy T, Yavvari S, Waterboer T, Brenner N, Eisele DW, D'Souza G. Timing, number, and type of sexual partners associated with risk of oropharyngeal cancer. Cancer 2021; 127:1029-1038. [PMID: 33426652 DOI: 10.1002/cncr.33346] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/27/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Case-control studies from the early 2000s demonstrated that human papillomavirus-related oropharyngeal cancer (HPV-OPC) is a distinct entity associated with number of oral sex partners. Using contemporary data, we investigated novel risk factors (sexual debut behaviors, exposure intensity, and relationship dynamics) and serological markers on odds of HPV-OPC. METHODS HPV-OPC patients and frequency-matched controls were enrolled in a multicenter study from 2013 to 2018. Participants completed a behavioral survey. Characteristics were compared using a chi-square test for categorical variables and a t test for continuous variables. Adjusted odds ratios (aOR) were calculated using logistic regression. RESULTS A total of 163 HPV-OPC patients and 345 controls were included. Lifetime number of oral sex partners was associated with significantly increased odds of HPV-OPC (>10 partners: odds ratio [OR], 4.3 [95% CI, 2.8-6.7]). After adjustment for number of oral sex partners and smoking, younger age at first oral sex (<18 vs >20 years: aOR, 1.8 [95% CI, 1.1-3.2]) and oral sex intensity (>5 sex-years: aOR, 2.8 [95% CI, 1.1-7.5]) remained associated with significantly increased odds of HPV-OPC. Type of sexual partner such as older partners when a case was younger (OR, 1.7 [95% CI, 1.1-2.6]) or having a partner who had extramarital sex (OR, 1.6 [95% CI, 1.1-2.4]) was associated with HPV-OPC. Seropositivity for antibodies to HPV16 E6 (OR, 286 [95% CI, 122-670]) and any HPV16 E protein (E1, E2, E6, E7; OR, 163 [95% CI, 70-378]) was associated with increased odds of HPV-OPC. CONCLUSION Number of oral sex partners remains a strong risk factor for HPV-OPC; however, timing and intensity of oral sex are novel independent risk factors. These behaviors suggest additional nuances of how and why some individuals develop HPV-OPC.
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Affiliation(s)
- Virginia E Drake
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Melina J Windon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - C Matthew Stewart
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Lee Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Alexander Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Wade Chien
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Patrick Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Brett Miles
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Health System, New York City, New York
| | - Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Rajarsi Mandal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Wojciech K Mydlarz
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Lisa Rooper
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Tanya Troy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Siddhartha Yavvari
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tim Waterboer
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center, Heidelberg, Germany
| | - Nicole Brenner
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center, Heidelberg, Germany
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Paul SE, Hatoum AS, Fine JD, Johnson EC, Hansen I, Karcher NR, Moreau AL, Bondy E, Qu Y, Carter EB, Rogers CE, Agrawal A, Barch DM, Bogdan R. Associations Between Prenatal Cannabis Exposure and Childhood Outcomes: Results From the ABCD Study. JAMA Psychiatry 2021; 78:64-76. [PMID: 32965490 PMCID: PMC7512132 DOI: 10.1001/jamapsychiatry.2020.2902] [Citation(s) in RCA: 148] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE In light of increasing cannabis use among pregnant women, the US Surgeon General recently issued an advisory against the use of marijuana during pregnancy. OBJECTIVE To evaluate whether cannabis use during pregnancy is associated with adverse outcomes among offspring. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, data were obtained from the baseline session of the ongoing longitudinal Adolescent Brain and Cognitive Development Study, which recruited 11 875 children aged 9 to 11 years, as well as a parent or caregiver, from 22 sites across the United States between June 1, 2016, and October 15, 2018. EXPOSURE Prenatal cannabis exposure prior to and after maternal knowledge of pregnancy. MAIN OUTCOMES AND MEASURES Symptoms of psychopathology in children (ie, psychotic-like experiences [PLEs] and internalizing, externalizing, attention, thought, and social problems), cognition, sleep, birth weight, gestational age at birth, body mass index, and brain structure (ie, total intracranial volume, white matter volume, and gray matter volume). Covariates included familial (eg, income and familial psychopathology), pregnancy (eg, prenatal exposure to alcohol and tobacco), and child (eg, substance use) variables. RESULTS Among 11 489 children (5997 boys [52.2%]; mean [SD] age, 9.9 [0.6] years) with nonmissing prenatal cannabis exposure data, 655 (5.7%) were exposed to cannabis prenatally. Relative to no exposure, cannabis exposure only before (413 [3.6%]) and after (242 [2.1%]) maternal knowledge of pregnancy were associated with greater offspring psychopathology characteristics (ie, PLEs and internalizing, externalizing, attention, thought and, social problems), sleep problems, and body mass index, as well as lower cognition and gray matter volume (all |β| > 0.02; all false discovery rate [FDR]-corrected P < .03). Only exposure after knowledge of pregnancy was associated with lower birth weight as well as total intracranial volume and white matter volumes relative to no exposure and exposure only before knowledge (all |β| > 0.02; all FDR-corrected P < .04). When including potentially confounding covariates, exposure after maternal knowledge of pregnancy remained associated with greater PLEs and externalizing, attention, thought, and social problems (all β > 0.02; FDR-corrected P < .02). Exposure only prior to maternal knowledge of pregnancy did not differ from no exposure on any outcomes when considering potentially confounding variables (all |β| < 0.02; FDR-corrected P > .70). CONCLUSIONS AND RELEVANCE This study suggests that prenatal cannabis exposure and its correlated factors are associated with greater risk for psychopathology during middle childhood. Cannabis use during pregnancy should be discouraged.
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Affiliation(s)
- Sarah E. Paul
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
| | - Alexander S. Hatoum
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Jeremy D. Fine
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
| | - Emma C. Johnson
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Isabella Hansen
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
| | - Nicole R. Karcher
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
| | - Allison L. Moreau
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
| | - Erin Bondy
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
| | - Yueyue Qu
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
| | - Ebony B. Carter
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Cynthia E. Rogers
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Arpana Agrawal
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Deanna M. Barch
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri,Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Ryan Bogdan
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
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238
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Hill ML, Nichter BM, Norman SB, Loflin M, Pietrzak RH. Burden of cannabis use and disorder in the U.S. veteran population: Psychiatric comorbidity, suicidality, and service utilization. J Affect Disord 2021; 278:528-535. [PMID: 33017681 DOI: 10.1016/j.jad.2020.09.099] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/17/2020] [Accepted: 09/26/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cannabis use is associated with psychiatric illness and suicidality, which are prevalent among U.S. military veterans. However, the psychiatric burden of cannabis use and cannabis use disorder (CUD) among veterans is unclear. Using data from a nationally representative sample of veterans, we evaluated associations of lifetime cannabis use and CUD with psychiatric problems, suicidality, and treatment utilization. METHODS Participants were 3,157 veterans aged 21 to 96 years from the National Health and Resilience in Veterans Study (NHRVS). Cannabis use and CUD were assessed using the Mini International Neuropsychiatric Interview. Psychiatric morbidities, suicidal ideation and attempts, and treatment utilization were assessed and compared between three cannabis groups: [1] no lifetime cannabis use (never-use); [2] lifetime cannabis use but never met criteria for CUD (non-CUD cannabis use); [3] lifetime CUD (CUD). RESULTS Relative to the never-use group, veterans who used cannabis had elevated odds of current and lifetime posttraumatic stress disorder (PTSD), mood, anxiety, and substance use disorders, current suicidal ideation, lifetime suicide attempts, and current and lifetime mental health treatment utilization [odds ratios (ORs)=1.5-8.3]. Veterans with CUD had higher odds of current and lifetime PTSD, mood, and anxiety disorders, lifetime nicotine and alcohol dependence, and current suicidal ideation, relative to veterans who used cannabis but never met criteria for CUD (ORs=1.6-2.7). LIMITATIONS The cross-sectional design of this study precludes causal inference. CONCLUSIONS Cannabis use and CUD are associated with substantial psychiatric and suicide-related burden among veterans, highlighting the need for screening, education, and treatment to mitigate potential cannabis-related harm.
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Affiliation(s)
- Melanie L Hill
- Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA.
| | - Brandon M Nichter
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; National Center for PTSD, White River Junction, VT, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Mallory Loflin
- Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; National Center for PTSD, White River Junction, VT, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Robert H Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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239
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Bar-Or RL, Kor A, Jaljuli I, Lev-Ran S. The Epidemiology of Substance Use Disorders among the Adult Jewish Population in Israel. Eur Addict Res 2021; 27:362-370. [PMID: 33730716 DOI: 10.1159/000513776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 12/11/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Substance use disorders (SUDs) are a leading cause of morbidity and mortality worldwide, having a profound and global impact on health, well-being, safety, and productivity. Although traditionally the prevalence of SUDs in Israel has been estimated to be lower than those in high-income countries, estimates and characteristics of individuals with SUDs in the past decade are lacking. In this work, we explored the prevalence of SUDs among the adult Jewish population in Israel, per different classes of substances across sex, age group, and other sociodemographic factors. METHODS Data from an online representative sample of 4,025 respondents were collected, including the alcohol, smoking, and substance involvement screening test (ASSIST) metric and sociodemographic data. RESULTS We found that the most common SUDs were alcohol (10.5% [9.5-11.4]), cannabis (9.0% [8.2-9.9]), and sedative (3.6% [3.0-4.2]) use disorders. Alcohol-cannabis (3.2% [2.7-3.7]) and alcohol-sedative (1.04% [0.7-1.35]) were the most prevalent co-occurring SUDs. Among those with cannabis use disorder, the prevalence of alcohol use disorder was found to be 35.3% [30.4-40.2]. The estimated risk for alcohol use disorder was found to be inversely proportional to age, cannabis use disorder increased, peaked, and decreased with age, and that of sedative use disorder increased with age, particularly among women. While older individuals (in the 51-60 years of age group) were at lower risk (OR = 0.5 [0.3, 0.8]) compared to those <20 years of age for alcohol use disorder, they were at increased risk for sedative use disorder (OR = 3.1 [1.2, 9.7]). CONCLUSIONS These findings represent substantially higher rates of SUDs in Israel than those previously reported and should affect resources allocated to addiction prevention and treatment. Further research on the role of gender, age, culture, and ethnicity in the propensity to develop SUDs is necessary for the development of more focused preventive and intervention measures. Focusing on non-Jewish populations in Israel and broadening the scope to include behavioral addictions should be addressed in future studies.
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Affiliation(s)
- Ruth Lev Bar-Or
- Israel Center on Addiction (ICA), Netanya, Israel, .,Hadassah School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel,
| | - Ariel Kor
- Israel Center on Addiction (ICA), Netanya, Israel.,Interdisciplinary Center (IDC), Herzliya, Israel.,Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Iman Jaljuli
- Department of Statistics and Operations Research, Tel-Aviv University, Tel-Aviv, Israel
| | - Shaul Lev-Ran
- Israel Center on Addiction (ICA), Netanya, Israel.,Lev-Hasharon Medical Center, Netanya, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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240
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Rogers SM, Loukas A, Harrell MB, Chen B, Springer A, Perry CL. Multidirectional Pathways of Tobacco and Marijuana Use, Including Comorbid Use, Among Young Adults (Aged 18-25 Years) in Texas: A Six-Wave Cross-Lagged Model. J Adolesc Health 2021; 68:116-122. [PMID: 32631731 PMCID: PMC7755747 DOI: 10.1016/j.jadohealth.2020.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/01/2020] [Accepted: 05/07/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Prevalence of past 30-day tobacco and marijuana use are highest among young adults in the U.S., and comorbid use of these products is common. However, it is unclear whether the use of one product precedes the other-an important consideration, given the new climate surrounding marijuana legalization and the popularity of e-cigarette products. METHODS Six-panel cross-lagged regression models, with 6 months between each panel/wave, were used to model bidirectional paths between past 30-day use and comorbid use of marijuana and tobacco products from 2014 to 2017 among young adults (N = 5,221 college students, aged 18-25 years). RESULTS Combustible tobacco use and e-cigarette use were prospectively associated with greater risk of future marijuana use while controlling for the stability of use over time, age, race/ethnicity, and sex. Marijuana use was prospectively associated with greater risk of future combustible tobacco and e-cigarette use. Comorbid use was common, but while the odds of comorbid use decreased with increasing age, odds of tobacco use increased. CONCLUSIONS More young adults may be consolidating their use than are successfully ceasing their tobacco or marijuana use as they mature through young adulthood. Although we observed decreases in comorbid use of combustible tobacco with marijuana and e-cigarettes with marijuana, we simultaneously observed strong stability in single use of these products over time. Taken together, these results should help structure interventions specific to young adults that target use and comorbid use in early young adulthood to discourage initiation, encourage cessation, and curb subsequent escalation in later young adulthood.
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Affiliation(s)
- Shannon M Rogers
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas
| | - Alexandra Loukas
- Health Behavior and Health Education, Department of Kinesiology & Health Education, The University of Texas at Austin, Austin, Texas.
| | - Melissa B Harrell
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas
| | - Baojiang Chen
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas
| | - Andrew Springer
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas
| | - Cheryl L Perry
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas
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241
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Gabrhelík R, Mahic M, Lund IO, Bramness J, Selmer R, Skovlund E, Handal M, Skurtveit S. Cannabis Use during Pregnancy and Risk of Adverse Birth Outcomes: A Longitudinal Cohort Study. Eur Addict Res 2021; 27:131-141. [PMID: 33040062 PMCID: PMC8006586 DOI: 10.1159/000510821] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/25/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND With recent changes in legislation regulating recreational and medical cannabis use around the globe, increased use in pregnancy is to be expected. OBJECTIVES To investigate the association between cannabis use during pregnancy and birth outcomes. METHOD Data from the Norwegian Mother and Child Cohort Study (MoBa), a prospective pregnancy cohort, were used. Participants were recruited from all over Norway between 1999 and 2008: 9,312 women with 10,373 pregnancies who reported use of cannabis before or in pregnancy. Women reported on their illegal drug use before pregnancy and at pregnancy weeks 17/18 and 30 and at 6 months postpartum. Linear regression was used to estimate crude and adjusted effects of prenatal cannabis exposure on birth outcomes. RESULTS In 10,101 pregnancies, women had used cannabis before pregnancy but not during pregnancy. In 272 pregnancies, women had used cannabis during pregnancy, and among these, in 63 pregnancies, women had used cannabis in at least 2 periods. In adjusted analyses for potential confounders, only cannabis use during at least 2 periods of pregnancy showed statistically significant effects on birth weight. The effect was observed in the complete cohort (B = -228 g, 95% CI = -354 to -102, p < 0.001) and for the subgroup where information about the child's father was available (B = -225 g, 95% CI = -387 to -63, p = 0.01). Our results may indicate that prolonged use causes more harm, whereas short-term use did not indicate adverse effects on birth outcomes. CONCLUSIONS There was a statistically significant and clinically relevant association between the use of cannabis during pregnancy and reduced birth weight. Clinicians should screen not only for cannabis use but also for the length and intensity of use as part of a comprehensive substance use screening.
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Affiliation(s)
- Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czechia,*Roman Gabrhelík, Department of Addictology, Charles University, First Faculty of Medicine, Apolinářská 4, 120 00 Prague 2 (Czech Republic),
| | - Milada Mahic
- Norwegian Institute of Public Health, Oslo, Norway
| | | | | | - Randi Selmer
- Norwegian Institute of Public Health, Oslo, Norway
| | - Eva Skovlund
- Norwegian Institute of Public Health, Oslo, Norway,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marte Handal
- Norwegian Institute of Public Health, Oslo, Norway
| | - Svetlana Skurtveit
- Norwegian Institute of Public Health, Oslo, Norway,Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
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242
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Hasin D, Walsh C. Cannabis Use, Cannabis Use Disorder, and Comorbid Psychiatric Illness: A Narrative Review. J Clin Med 2020; 10:E15. [PMID: 33374666 PMCID: PMC7793504 DOI: 10.3390/jcm10010015] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/10/2020] [Accepted: 12/19/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The landscape of attitudes, legal status and patterns of use of cannabis is rapidly changing in the United States and elsewhere. Therefore, the primary aim of this narrative review is to provide a concise overview of the literature on the comorbidity of cannabis use and cannabis use disorder (CUD) with other substance use and psychiatric disorders, and to use this information to accurately guide future directions for the field. METHODS A literature review of PubMed was conducted for studies relating to cannabis use, CUD, and a co-occurring psychiatric disorder. To provide an overview of representative data, the literature review focused on national-level, population-based work from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and National Survey on Drug Use and Health (NSDUH) surveys. Considering rapidly changing cannabis laws, recent (past five-year) studies were addressed. RESULTS A strong body of literature shows associations between cannabis use and CUD with other drug use, psychosis, mood disorders, anxiety disorders, and personality disorders. The strongest evidence of a potential causal relationship exists between cannabis use and psychotic disorders. While some evidence shows potential directionality between cannabis use and mood and anxiety disorders, results are inconsistent. Studies have established higher rates of CUD among those with personality disorders, but little about the specifics of this relationship is understood. CONCLUSIONS Although the general population in the United States increasingly perceives cannabis to be a harmless substance, empirical evidence shows that cannabis use is associated both with CUD and comorbid psychiatric illness. However, there is mixed evidence regarding the role of cannabis in the etiology, course, and prognosis of a co-occurring disorder across all categories of psychiatric disorders. Future research should expand on the existing body of literature with representative, longitudinal data, in order to better understand the acute and long-term effects of cannabis on comorbid psychiatric illness.
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Affiliation(s)
- Deborah Hasin
- New York State Psychiatric Institute, New York, NY 10032, USA;
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY 10032, USA
| | - Claire Walsh
- New York State Psychiatric Institute, New York, NY 10032, USA;
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243
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Beiersdorf J, Hevesi Z, Calvigioni D, Pyszkowski J, Romanov R, Szodorai E, Lubec G, Shirran S, Botting CH, Kasper S, Guy GW, Gray R, Di Marzo V, Harkany T, Keimpema E. Adverse effects of Δ9-tetrahydrocannabinol on neuronal bioenergetics during postnatal development. JCI Insight 2020; 5:135418. [PMID: 33141759 PMCID: PMC7714410 DOI: 10.1172/jci.insight.135418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 10/28/2020] [Indexed: 11/22/2022] Open
Abstract
Ongoing societal changes in views on the medical and recreational roles of cannabis increased the use of concentrated plant extracts with a Δ9-tetrahydrocannabinol (THC) content of more than 90%. Even though prenatal THC exposure is widely considered adverse for neuronal development, equivalent experimental data for young age cohorts are largely lacking. Here, we administered plant-derived THC (1 or 5 mg/kg) to mice daily during P5–P16 and P5–P35 and monitored its effects on hippocampal neuronal survival and specification by high-resolution imaging and iTRAQ proteomics, respectively. We found that THC indiscriminately affects pyramidal cells and both cannabinoid receptor 1+ (CB1R)+ and CB1R– interneurons by P16. THC particularly disrupted the expression of mitochondrial proteins (complexes I–IV), a change that had persisted even 4 months after the end of drug exposure. This was reflected by a THC-induced loss of membrane integrity occluding mitochondrial respiration and could be partially or completely rescued by pH stabilization, antioxidants, bypassed glycolysis, and targeting either mitochondrial soluble adenylyl cyclase or the mitochondrial voltage-dependent anion channel. Overall, THC exposure during infancy induces significant and long-lasting reorganization of neuronal circuits through mechanisms that, in large part, render cellular bioenergetics insufficient to sustain key developmental processes in otherwise healthy neurons. Repeated THC exposure in juvenile mice compromises the limbic circuitry, with life-long impairment to the respiration of neurons.
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Affiliation(s)
- Johannes Beiersdorf
- Department of Molecular Neurosciences, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Zsofia Hevesi
- Department of Molecular Neurosciences, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Daniela Calvigioni
- Department of Molecular Neurosciences, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | | | - Roman Romanov
- Department of Molecular Neurosciences, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Edit Szodorai
- Department of Molecular Neurosciences, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Gert Lubec
- Paracelsus Private Medical University, Salzburg, Austria
| | - Sally Shirran
- School of Chemistry, University of St. Andrews, St. Andrews, United Kingdom
| | | | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Roy Gray
- GW Phamaceuticals, Salisbury, Wiltshire, United Kingdom
| | - Vincenzo Di Marzo
- Endocannabinoid Research Group, Institute of Biomolecular Chemistry, Consiglio Nazionale delle Ricerche, Pozzuoli, Italy.,Canada Excellence Research Chair, Institut Universitaire de Cardiologie et de Pneumologie de Québec and Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Québec, Québec, Canada
| | - Tibor Harkany
- Department of Molecular Neurosciences, Center for Brain Research, Medical University of Vienna, Vienna, Austria.,Department of Neuroscience, Biomedikum D7, Karolinska Institutet, Solna, Sweden
| | - Erik Keimpema
- Department of Molecular Neurosciences, Center for Brain Research, Medical University of Vienna, Vienna, Austria
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244
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Cubillos Sánchez PA. Cannabis for medical and scientific purposes: the Colombian landscape. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.5554/22562087.e954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The Colombian government, through Law 1787 of 2016, has created a regulatory framework that allows its citizens to have a safe and informed access to cannabis and its derivatives for medical and scientific purposes. Our country joins others in their efforts to legalize cannabis-derived substances for therapeutic purposes, as many jurisdictions have recognized the potential these products have in the treatment of certain medical conditions. This paper describes the current medical cannabis outlook in Colombia, compares the different medical cannabis supply systems in other parts of the world, summarizes the evidence related to the potential therapeutic benefits and potential risks of using cannabis for medical purposes.
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245
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Evans EA, Goldwater E, Stanek EJ, Brierley-Bowers P, Buchanan D, Whitehill JM. Prevalence and Correlates of Cannabis Use in Massachusetts after Cannabis Legalization and before Retail Sales. J Psychoactive Drugs 2020; 53:158-167. [PMID: 33242292 DOI: 10.1080/02791072.2020.1850945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We determined the prevalence and correlates of cannabis use in Massachusetts after recreational use was passed, but before recreational cannabis stores opened. A cross-sectional, population-based survey of Massachusetts adults, age 18 years or older, (n = 3,022) was conducted in November-December, 2017. We estimated population-level prevalence and correlates of past 30-day cannabis use. 21.1% [95% CI: 18.6, 23.6] of Massachusetts adults reported past 30-day cannabis use. Among cannabis users, 56.0% [CI 49.1, 62.9] reported non-medical cannabis use, 15.5% [12.1, 18.9] reported medical cannabis use, and 28.5% [CI 22.3, 34.8] reported both types of use. Men were more likely than women to use cannabis (Risk Ratio: 1.3 [CI 1.1, 1.6]), as were young adults (18-25 years old), those with lower socioeconomic status, non-parenting individuals, those who used alcohol (1.9 [CI 1.4, 2.6]) or other substances (1.7 [CI 1.3, 2.4]), and residents of Western Massachusetts (2.0 [1.3, 3.0]; ref: Boston area), the Northeast (1.8 [CI 1.2, 2.7]), and the Southeast (1.8 [CI 1.1, 2.7]). Cannabis is widely used in Massachusetts, with varying prevalence rates by gender, age, socioeconomic status, poly-substance use, and region. Findings may inform public health efforts and serve as a baseline for measuring health and social impacts of opening retail cannabis stores.
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Affiliation(s)
- Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Eva Goldwater
- Department of Epidemiology and Biostatistics, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Edward J Stanek
- Department of Epidemiology and Biostatistics, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | | | - David Buchanan
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Jennifer M Whitehill
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
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246
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Amroussia N, Watanabe M, Pearson JL. Seeking safety: a focus group study of young adults' cannabis-related attitudes, and behavior in a state with legalized recreational cannabis. Harm Reduct J 2020; 17:92. [PMID: 33243280 PMCID: PMC7689992 DOI: 10.1186/s12954-020-00442-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Only July 1, 2017, Nevada became the fifth US state to allow the legal sale of recreational cannabis products for adults ages of 21 and over. This study investigates young adults' cannabis-related attitudes, perceptions, and behaviors in a state where recreational and medical cannabis use was recently legalized. METHODS We conducted 8 focus groups stratified by cannabis use (regular users, occasional users, and nonusers) with 32 college students ages 18 to 24. Data were analyzed using the inductive qualitative thematic analysis method. RESULTS Four themes emerged during analyses: "sort of legal," "mitigating harm through legalization," "Increasing acceptance," and "seeking safety when purchasing cannabis." Despite their limited knowledge of cannabis regulation, the majority of the participants supported recreational cannabis legalization from a harm reduction perspective. Most participants did not believe that cannabis legalization had affected their use behavior. However, participants, especially cannabis users, perceived that recreational cannabis legalization created a context where cannabis use was legally, socially, and behaviorally "safer" than in an illegal context, even for those below the legal age of sale. CONCLUSIONS Most studies focus on the role of perceived health risk on cannabis use. If there are population-level long-term effects of recreational cannabis legalization on use behavior, findings suggest that they will be mediated by the perceived legal, social, and behavioral risk of using cannabis.
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Affiliation(s)
- Nada Amroussia
- Faculty of Health and Society, Malmö University, Malmö, Sweden
- Division of Social and Behavioral Health, University of Nevada, Reno, USA
| | - Mika Watanabe
- Division of Health Administration and Policy, University of Nevada, Reno, USA
| | - Jennifer L. Pearson
- Division of Social and Behavioral Health/Health Administration and Policy, University of Nevada, Reno, USA
- Department of Health, Johns Hopkins Bloomberg School of Public Health, Behavior, and Society, Baltimore, MD USA
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247
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Hatoum AS, Morrison CL, Winiger EA, Johnson EC, Agrawal A, Bogdan R. Genetic Liability to Cannabis Use Disorder and COVID-19 Hospitalization. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.11.15.20229971. [PMID: 33236033 PMCID: PMC7685351 DOI: 10.1101/2020.11.15.20229971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Behavioral and life style factors plausibly play a role in likelihood of being hospitalized for COVID-19. Genetic vulnerability to hospitalization after SARS-CoV2 infection may partially relate to comorbid behavioral risk factors, especially the use of combustible psychoactive substances. Paralleling the COVID-19 crisis has been increasingly permissive laws for recreational cannabis use. Cannabis Use Disorder (CUD) is a psychiatric disorder that is heritable and genetically correlated with respiratory disease, independent of tobacco smoking. By leveraging genome-wide association summary statistics of CUD and COVID-19, we find that at least 1/3 rd of the genetic vulnerability to COVID-19 overlaps with genomic liability to CUD (rg=.34, p=0.0003). Genetic causality as a potential mechanism of risk could not be excluded. The association between CUD and COVID-19 remained when accounting for genetics of trying marijuana, tobacco smoking (ever smoking regularly, cigarettes per day, smoking cessation, age of smoking initiation), BMI, fasting glucose, forced expiration volume, education attainment, and Townsend deprivation index. Heavy problematic cannabis use may increase chances of hospitalization due to COVID-19 respiratory complications. Curbing excessive cannabis use may be an essential strategy in COVID-19 mitigation.
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Affiliation(s)
| | | | - Evan A Winiger
- Institute for Behavioral Genetics, University of Colorado Boulder
| | - Emma C Johnson
- Washington University School of Medicine, Department of Psychiatry
| | - Arpana Agrawal
- Washington University School of Medicine, Department of Psychiatry
| | - Ryan Bogdan
- Washington University in St. Louis, Department of Psychological & Brain Sciences
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Howard J, Osborne J. Cannabis and work: Need for more research. Am J Ind Med 2020; 63:963-972. [PMID: 32797692 DOI: 10.1002/ajim.23170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/12/2022]
Abstract
Cannabis sativa is one of the oldest and most widely used plants in the world with a variety of industrial, medical, and nonmedical applications. Despite its long history, cannabis-derived products remain a source of controversy across the fields of medicine, law, and occupational safety and health. More favorable public attitudes about cannabis in the US have resulted in greater access to cannabis through legalization by states, leading to more consumption by workers. As more states adopt cannabis access laws, and as more workers choose to consume cannabis products, the implications for existing workplace policies, programs, and practices become more salient. Past workplace practices were grounded in a time when cannabis consumption was always viewed as problematic, considered a moral failing, and was universally illegal. Shifting cultural views and the changing legal status of cannabis indicate a need for research into the implications and challenges relating to cannabis and work. This commentary suggests research needs in the following areas: (a) data about industries and occupations where cannabis consumption among workers is most prevalent; (b) adverse health consequences of cannabis consumption among workers; (c) workplace supported recovery programs; (d) hazards to workers in the emerging cannabis industry; (e) relationship between cannabis consumption and occupational injuries; (f) ways to assess performance deficits and impairment from cannabis consumption; (g) consumption of synthetic cannabinoids to evade detection by drug testing; (h) cannabis consumption and its effect on occupational driving; and (i) ways to craft workplace policies and practices that take into consideration conflicting state and federal laws pertaining to cannabis.
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Affiliation(s)
- John Howard
- Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention US Department of Health and Human Services Washington DC
| | - Jamie Osborne
- Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention US Department of Health and Human Services Atlanta Georgia
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Hasin D, Shmulewitz D, Stohl M, Greenstein E, Roncone S, Aharonovich E, Wall M. Test-retest reliability of DSM-5 substance disorder measures as assessed with the PRISM-5, a clinician-administered diagnostic interview. Drug Alcohol Depend 2020; 216:108294. [PMID: 33007702 PMCID: PMC7663179 DOI: 10.1016/j.drugalcdep.2020.108294] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/24/2022]
Abstract
AIM In DSM-5, the definitions of substance use disorders (SUD) were changed considerably, yet little is known about the reliability of DSM-5 SUD and its new features. METHODS The test-retest reliability of DSM-5 SUD and DSM-IV substance dependence (SD) was evaluated in 565 adult substance users, each interviewed twice by different clinician interviewers using the semi-structured Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 version (PRISM-5). DSM-5 SUD and DSM-IV SD criteria were assessed for past year and lifetime, yielding diagnoses and severity levels for alcohol, tobacco, cannabis, cocaine, heroin, opioids, sedatives, hallucinogen, and stimulant use disorders. Cohen's and intraclass correlation coefficients (ICC) assessed reliability for categorical and graded outcomes, respectively. Factors potentially influencing reliability were explored, including inpatient vs. community participant, days between interviews gender, age, race/ethnicity, and SUD severity. RESULTS DSM-5 SUD diagnoses had substantial to excellent reliability for most substances (κ = 0.63-0.94), and moderate for others (hallucinogens, stimulants, sedatives; κ = 0.50-0.59). For graded outcomes (DSM-5 SUD mild, moderate, severe; criteria count 0-11), reliability was substantial to excellent (ICC = 0.74-0.99). Comparisons of DSM-5 SUD and DSM-IV SD reliability showed few significant differences. Reliability of the DSM-5 craving criterion was excellent for heroin (κ = 0.84-0.95) and moderate to substantial for other substances (κ = 0.49-0.76). The only factor influencing reliability of SUD was severity, with milder disorders significantly more likely to be discordant between the interviews. CONCLUSION Reproducibility is crucial to good measurement. In a large sample using rigorous methodology, diagnoses and dimensional measures from clinician-administered interviews for DSM-5 SUD were generally highly reliable.
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Affiliation(s)
- Deborah Hasin
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA; Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Dr, New York, NY, 10032, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA.
| | - Dvora Shmulewitz
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA,Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Malka Stohl
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - Eliana Greenstein
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - Stephanie Roncone
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - Efrat Aharonovich
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA,Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Melanie Wall
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA,Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Dr, New York, NY, 10032, USA
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Self-reported driving after marijuana use in association with medical and recreational marijuana policies. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 92:102944. [PMID: 33268196 DOI: 10.1016/j.drugpo.2020.102944] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND A common concern surrounding increasingly permissive marijuana policies in the US is that they will lead to more dangerous behavior, including driving after marijuana use. Although there is considerable research on the effects of marijuana policies on behaviours, few studies have examined self-reported driving after marijuana use. In this study, we use data from the Traffic Safety Culture Index (TSCI) to model self-reported past-year driving after marijuana use in association with medical and recreational marijuana policies. METHODS We analysed individual responses to annual administrations of TSCI from years 2013-2017 using a multiple logistic regression model. Our outcome variable was self-reported past-year driving after marijuana use (at least once vs. never), and our primary explanatory variable was the respondents' state medical marijuana (MM) and recreational marijuana (RM) policy. Additional explanatory variables include policies that specify thresholds for marijuana-intoxicated driving, year, and demographic factors. RESULTS Drivers in states that legalized MM but not RM had marginally higher odds of self-reporting driving after marijuana use compared to drivers in states where both RM and MM were illegal (adjusted OR 1.29; 95% CI 0.98, 1.70; p = 0.075). However, we found little evidence that drivers in states that legalized both RM and MM had higher odds of driving after marijuana use compared to drivers in states where both RM and MM were illegal (adjusted OR 1.06; 95% CI 0.71, 1.56; p = 0.784). Per-se or THC threshold laws were associated with lower self-reported driving after marijuana use (adjusted OR 0.74; 95% CI 0.57, 0.95; p = 0.018). CONCLUSION Although we found some evidence of an association between MM legalization and self-reported driving after marijuana use, our results provide only mixed support for the hypothesis that permissive marijuana policies are associated with higher odds of self-reported driving after marijuana use.
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