Association of Depression With Past-Month Cannabis Use Among US Adults Aged 20 to 59 Years, 2005 to 2016

Correlates of cannabis use and cannabis use disorder among adolescents with major depressive disorder and bipolar disorder in the National Comorbidity Survey-Adolescent Supplement (NCS-A)

BACKGROUND

Despite evidence regarding prevalence and correlates of cannabis use (CU) and cannabis use disorder (CUD) in major depressive disorder (MDD) and bipolar disorder (BD) in adults, little is known about this topic among adolescents.

METHODS

Data is from the 2001-2004 National Comorbidity Survey-Adolescent Supplement, an in-person, cross-sectional epidemiologic survey of mental disorders. Participants included adolescents, ages 13-18 years, with MDD (n = 354 with CU, n = 70 with CUD, n = 688 with no CU), BD (n = 79 with CU, n = 32 with CUD, n = 184 with no CU), or adolescents without mood disorders (n = 1413 with CU, n = 333 with CUD, n = 6970 with no CU). Analyses examined prevalence and correlates of CU and CUD within MDD and BD groups.

RESULTS

CU was most prevalent in adolescents with MDD followed by adolescents with BD then controls. CUD was most prevalent in adolescents with BD followed by adolescents with MDD then controls. In covariate-adjusted ordinal logistic regression models, within MDD and BD, CU and CUD groups had significantly higher odds of lifetime suicidal ideation/attempts, as well as other significant indicators of clinical severity.

LIMITATIONS

Based on changes in cannabis acceptance, potency, and availability in the two decades since this study was conducted, present findings may underestimate adverse cannabis associations.

CONCLUSION

CU and CUD are both associated with adverse clinical characteristics in a community-based sample of adolescents with MDD and BD. Evidence that risks of cannabis use extend across the spectrum of use is important for adolescents with MDD and BD, in whom cannabis-related consequences tend to be more severe.

Trends in the co-occurrence of substance use and mental health symptomatology in a national sample of US post-secondary students from 2009 to 2019

Objective: This study examined joint trends over time in associations between substance use (heavy drinking, cannabis, and cigarette smoking) and mental health concerns (depression, anxiety, and suicidal ideation) among US post-secondary students. Participants: Data came from 323,896 students participating in the Healthy Minds Study from 2009 to 2019, a national cross-sectional survey of US post-secondary students. Weighted two-level logistic regression models with a time by substance interaction term were used to predict mental health status. Results: Use of each substance was associated with a greater odds of students endorsing depression, anxiety, and suicidal ideation. Over time, the association with mental health concerns strengthened substantially for cannabis, modestly for heavy drinking, and remained stable for smoking. Conclusion: Given co-occurrence is common and increasing among post-secondary students, college and university health systems should prioritize early identification, psychoeducation, harm-reduction, and brief interventions to support students at risk.

Adolescent-onset cannabis use and parenting young children: an investigation of differential effectiveness of a digital parenting intervention

Introduction

There is scant empirical work on associations between current and past cannabis use and parenting skills in parents of young children. As recreational cannabis use is now legal in nearly half of states in the U.S., cannabis use is becoming more ubiquitous.

Methods

In the current study, parents of toddler and pre-school age children were randomly assigned to participate in an app-based parenting skills program that included telehealth coaching (Family Check-Up Online; FCU-O), with a focus on parenting in the context of substance use. We aimed to test associations between adolescent-onset and current cannabis use and parent mental health and parenting skills, as well as whether effects of the FCU-O on parent mental health outcomes varied as a function of past cannabis use. Participants were 356 parents of children ages 1.5-5 participating in a randomized controlled trial of the FCU-O. Parents screened into the study if they reported current or past substance misuse or current depressive symptoms. After completing a baseline assessment, parents were randomly assigned to the FCU-O or control group and completed a follow-up assessment 3 months later. Parents retrospectively reported on the age when they initially used substances, as well as their current use.

Results

After accounting for current cannabis use, adolescent-onset cannabis use was significantly associated with higher symptoms of anxiety and depression, but not with parenting skills. Adolescent-onset cannabis use was found to significantly moderate the effect of the FCU-O on parents' anxiety symptoms. Specifically, the FCU-O was particularly effective in reducing anxiety symptoms for parents with adolescent-onset regular cannabis use, after accounting for current cannabis use.

Discussion

Adolescent-onset regular cannabis use may be a risk factor for later mental health challenges in parents of children under 5. An app-based parenting intervention may be particularly helpful in reducing symptoms of anxiety for parents who used cannabis regularly as adolescents. The findings have significant implications for the prevention of multigenerational risk for substance use and mental health challenges.

Cannabis use and its association with psychopathological symptoms in a Swiss adult population: a cross-sectional analysis

Background

As the most commonly used illicit substance, cannabis is gaining global acceptance through increasing legalization efforts. This shift intensifies the need for research to guide policymakers and healthcare providers in harm reduction and treatment strategies. Nonetheless, the relationship between psychopathological symptoms and cannabis use remains inadequately understood.

Methods

A sample of regular cannabis consumers completed self-reported assessments for depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), Attention-Deficit/Hyperactivity Disorder (ADHD; Adult ADHD Self-Report Scale V1.1), and psychosis (Early Recognition Inventory based on IRAOS) as well as previous black-market cannabis use patterns. Cannabis Use Disorder Identification Test Revised (CUDIT-R) was used to identify cannabis use disorder (CUD). To understand psychopathological symptom load related to cannabis consumption as well as cannabis use motives, multiple regression models were performed to identify psychopathological variables predicting cannabis use frequency and quantity. Linear regression and correlation analyses were conducted, adjusting for relevant covariates (age, gender, education, alcohol, other substance use).

Results

Three-hundred-sixty regular cannabis users interested in a study on regulated cannabis access in Basel, Switzerland were examined. In bivariate analysis, cannabis use frequency correlated with depressive (r(358) = 0.16, p = 0.003) and anxiety symptom load (r(358) = 0.11, p = 0.034). Cannabis quantity correlated with depressive (r(358) = 0.15, p = 0.005), ADHD (r(358) = 0.14, p = 0.008), and psychosis symptom load (r(358) = 0.16, p = 0.002). However, in the adjusted regression models only depressive and ADHD symptom loads were significantly associated with cannabis use frequency (p = 0.006 and p = 0.034, respectively) and quantity (p = 0.037 and p = 0.019, respectively). No significant correlations between cannabis consumption and anxiety or psychosis remained after adjustment.

Conclusion

ADHD and depressive symptoms correlate with increased cannabis use in a cohort of regular users, suggesting potential self-medication in nonclinical populations. With the rising availability of cannabis worldwide, these results highlight the necessity for longitudinal studies to disentangle the complex dynamics between cannabis consumption and mental health symptoms.

Cannabis use and mood disorders: a systematic review

Background

Problematic cannabis use is highly prevalent among people with mood disorders. This underscores the need to understand the effects of cannabis and cannabinoids in this population, especially considering legalization of recreational cannabis use.

Objectives

We aimed to (1) systematically evaluate cross-sectional and longitudinal studies investigating the interplay between cannabis use, cannabis use disorder (CUD), and the occurrence of mood disorders and symptoms, with a focus on major depressive disorder (MDD) and bipolar disorder (BD) and; (2) examine the effects of cannabis on the prognosis and treatment outcomes of MDD and BD.

Methods

Following PRISMA guidelines, we conducted an extensive search for English-language studies investigating the potential impact of cannabis on the development and prognosis of mood disorders published from inception through November 2023, using EMBASE, PsycINFO, PubMed, and MEDLINE databases.

Results

Our literature search identified 3,262 studies, with 78 meeting inclusion criteria. We found that cannabis use is associated with increased depressive and manic symptoms in the general population in addition to an elevated likelihood of developing MDD and BD. Furthermore, we observed that cannabis use is linked to an unfavorable prognosis in both MDD or BD.

Discussion

Our findings suggest that cannabis use may negatively influence the development, course, and prognosis of MDD and BD. Future well-designed studies, considering type, amount, and frequency of cannabis use while addressing confounding factors, are imperative for a comprehensive understanding of this relationship.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023481634.

Associations Between Cannabis Use and Mental Distress in Young People: A Longitudinal Study

PURPOSE

Despite a large number of studies on the relation between cannabis use and mental distress in adolescence, results are inconclusive regarding the nature of this association. The aim of the present study is to expand this body of research by analyzing the within-person association between changes in cannabis use and changes in mental distress among young people.

METHODS

We used longitudinal data from a national sample of young people in Norway. The cohort was assessed in 1992 (T1), 1994 (T2), 1999 (T3), and 2005 (T4). The cumulative response rate was 60%. Respondents who participated in all four waves, aged 11-18 years at T1 (N = 1,988) were analyzed. Within-person association between changes in cannabis use and changes in mental distress in terms of symptoms of depression, anxiety, suicidal ideation, and deliberate self-harm were estimated by applying fixed-effects modeling.

RESULTS

For males, an increase in cannabis use from no use to more than 10 times/year was significantly associated with increased risk for anxiety (relative risk [RR]: 1.72, p = .009), depressed mood (RR: 1.49, p < .001), and suicidal ideation (RR: 3.43, p = .012). For females, the corresponding increase in cannabis use yielded an increased risk for anxiety (RR: 1.38, p = .023) and suicidal ideation (RR: 2.47, p = .002).

DISCUSSION

Increased cannabis use during adolescence and young adulthood seem to increase the risk for symptoms of mental distress. Although the associations appear to be more pronounced among males, it was only for depression that there was a statistically significant gender difference in the association.

Young Adult Depression and Cannabis Use: Associations Before and After Recreational Legalization

INTRODUCTION

The co-occurrence of depression with cannabis use worsens both mood and substance use disorder outcomes, with young adults particularly at risk of co-occurrence. This research investigates whether the association of state-level prevalence rates of young adult (age 18-25) depression and cannabis use in the U.S. changed following enactment of recreational (adult use) cannabis legalization between 2008 and 2019.

METHODS

Annual, state prevalence data on past-year major depressive episode (hereafter, depression) and past-month cannabis use were extracted from the National Survey on Drug Use and Health (N=600 state-year observations). Moderated regression models tested whether the association of depression with cannabis use differed before versus after recreational legalization by comparing prevalence rates of depression and cannabis use in states that enacted recreational legalization to those that did not, while fixing state, year, and medical legalization effects. Data were accessed and analyzed in 2023.

RESULTS

Prevalence rates of both depression and cannabis use increased throughout the study period. The positive statistical effect of depression on cannabis use more than doubled in magnitude after legalization (β=0.564, 95% CI=0.291, 0.838) as compared to before (β=0.229, 95% CI=0.049, 0.409), representing a significant change (β=0.335, 95% CI=0.093, 0.577).

CONCLUSIONS

These results suggest that the association between prevalence rates of young adult depression and cannabis use strengthened following recreational legalization in the U.S. This is potentially due to increases in cannabis accessibility and the acceptance of the health benefits of cannabis, which may enhance the use of cannabis as a coping mechanism among young adults with depression.

Trends in Prevalence of Cannabis Use Disorder Among U.S. Veterans With and Without Psychiatric Disorders Between 2005 and 2019

OBJECTIVE

Cannabis use disorder diagnoses are increasing among U.S. adults and are more prevalent among people with comorbid psychiatric disorders. Recent changes in cannabis laws, increasing cannabis availability, and higher-potency cannabis may have placed people with cannabis use and psychiatric disorders at disproportionately increasing risk for cannabis use disorder. The authors used Veterans Health Administration (VHA) data to examine whether trends in cannabis use disorder prevalence among VHA patients differ by whether they have psychiatric disorders.

METHODS

VHA electronic health records from 2005 to 2019 (N range, 4,332,165-5,657,277) were used to identify overall and age-group-specific (<35, 35-64, and ≥65 years) trends in prevalence of cannabis use disorder diagnoses among patients with depressive, anxiety, posttraumatic stress, bipolar, or psychotic spectrum disorders and to compare these to corresponding trends among patients without any of these disorders. Given transitions in ICD coding, differences in trends were tested within two periods: 2005-2014 (ICD-9-CM) and 2016-2019 (ICD-10-CM).

RESULTS

Greater increases in prevalence of cannabis use disorder diagnoses were observed among patients with psychiatric disorders compared to those without (difference in prevalence change, 2005-2014: 1.91%, 95% CI=1.87-1.96; 2016-2019: 0.34%, 95% CI=0.29-0.38). Disproportionate increases in cannabis use disorder prevalence among patients with psychiatric disorders were greatest among those under age 35 between 2005 and 2014, and among those age 65 or older between 2016 and 2019. Among patients with psychiatric disorders, the greatest increases in cannabis use disorder prevalences were observed among those with bipolar and psychotic spectrum disorders.

CONCLUSIONS

The findings highlight disproportionately increasing disparities in risk of cannabis use disorder among VHA patients with common psychiatric disorders. Greater public health and clinical efforts are needed to monitor, prevent, and treat cannabis use disorder in this population.

Unhealthy behaviors associated with mental health disorders: a systematic comparative review of diet quality, sedentary behavior, and cannabis and tobacco use

Background

There are well-established literatures documenting the associations between mental disorders and unhealthy behaviors such as poor diet quality, sedentary behavior, and cannabis and tobacco use. Few studies have attempted to understand the respective findings in light of each other, however.

Objective

The purpose of this review was to assemble comparable data for each behavior-disorder association and assess the associations in terms of their overall strength. The review aimed to include a representative, but not exhaustive, range of studies that would allow for explorative comparisons.

Methods

Eligible studies were identified via Pubmed searches and citation searching, restricted to publications no older than 2015 written in English. To obtain comparable data, only studies that reported findings as odds ratios were included, and risk of bias related to study samples, behavioral measurement disparities, and control variables was assessed via sensitivity analyses. Findings for each disorder were compared on the basis of different measures of central tendency.

Results

From 3,682 records, 294 studies were included. The review found evidence of associations between each of the four unhealthy behaviors and psychosis, depression, anxiety, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), while personality disorder was only investigated in relation to cannabis and tobacco use. In overall comparison, the associations were generally of similar strength, and only the association between cannabis use and personality disorder was exceptional in terms of being significantly stronger than its counterparts across disorders and across behaviors. Analyses of bias risk identified some influence from behavioral measurement disparities and lack of adequate statistical control, but findings were generally robust across a range of sensitivity analyses.

Conclusion

This explorative and comparative review found that poor diet quality, sedentary behavior, and cannabis and tobacco use are about equally strongly associated with a range of different mental disorders. Given the general nature of these associations, we should probably understand them to reflect a general and shared etiology. However, the findings in this review should be regarded as tentative until confirmed by more comprehensive investigations.

Sex-Dependent Synergism of an Edible THC: CBD Formulation in Reducing Anxiety and Depressive-like Symptoms Following Chronic Stress

Cannabis has shown therapeutic potential in mood and anxiety-related pathologies. However, the two primary constituents of cannabis, cannabidiol (CBD) and Δ-9-tetrahydrocannabinol (THC) produce distinct effects on molecular pathways in neural circuits associated with affective disorders. Moreover, it has been proposed that the combination of THC: and CBD may have unique synergistic properties. In the present study, the effects of a 1:100 THC: CBD ratio edible formulation were tested in behavioural, neuronal and molecular assays for anxiety and depressive-like endophenotypes. Adult male and female Sprague-Dawley rats were stressed for 14 days. Then, for three weeks, open field, elevated plus maze, light/dark box, social interaction, sucrose preference, and the forced swim test were performed 90 minutes after acute consumption of CBD (30 mg/kg), THC (0.3 mg/kg), or 1:100 combination of THC:CBD. After behavioural tests, in vivo, neuronal electrophysiological analyses were performed in the ventral tegmental area and prefrontal cortex (PFC). Furthermore, western-blot experiments examined the expression of biomarkers associated with mood and anxiety disorders, including protein kinase B (Akt), glycogen synthase kinase-3 (GSK-3), BDNF, mTOR, D1, and D2 receptor in nucleus accumbens (NAc) and PFC.Edible THC:CBD produces significant anxiolytic and antidepressant effects only in stressed male rats. In most cases, the combination of THC and CBD had stronger effects than either phytochemical alone. These synergistic effects are associated with alterations in Akt/GSK3 and D2-R expression in NAc and BDNF expression in PFC. Furthermore, THC:CBD reverses chronic stress-induced alterations in PFC neuronal activity. These findings demonstrate a novel synergistic potential for THC:CBD edible formulations in stress-related pathologies.

Trends in past-month cannabis use among US adults across a range of disabilities and health conditions, 2015-2019

INTRODUCTION

While there is increasing interest in the use of cannabis to manage a range of health-related symptoms, little is known about trends in recent cannabis use with respect to various health conditions.

METHODS

We examined data from a US representative sample of noninstitutionalized adults age ≥ 18 from the 2015-2019 National Survey on Drug Use and Health (N = 214,505). We estimated the pooled prevalences followed by linear time trends, overall, and by disability (i.e., difficulty hearing, seeing, thinking, walking, dressing, doing errands) and lifetime (i.e., bronchitis, cancer, diabetes, hepatitis, kidney disease) and current (i.e., asthma, depression, heart disease, hypertension) health condition status using logistic regression. Models with year-by-condition status interaction terms were used to assess differential time trends, adjusting for demographic characteristics.

RESULTS

From 2015 to 2019, cannabis use increased significantly among adults with and without each disability and health condition examined. However, the increase was more rapid among those with (versus without) difficulty hearing (89.8% increase [4.9% to 9.3%] vs. 37.9% increase [8.7% to 12.0%], p = 0.015), difficulty walking (84.1% increase [6.3% to 11.6%] vs. 36.8% increase [8.7% to 11.9%], p < 0.001), 2-3 impairments (75.3% increase [9.3% to 16.3%] vs. 36.6% increase [8.2% to 11.2%], p = 0.041), and kidney disease (135.3% increase [3.4% to 8.0%] vs. 38.4% increase [8.6% to 11.9%], p = 0.045).

CONCLUSION

Given the potential adverse effects of cannabis, prevention and harm reduction efforts should focus on groups at increasingly higher risk for use, including those with disabilities and kidney disease.

Disparities in cannabis-related emergency department visits across depressed and non-depressed individuals and the impact of recreational cannabis policy in Ontario, Canada

BACKGROUND

Recreational cannabis policies are being considered in many jurisdictions internationally. Given that cannabis use is more prevalent among people with depression, legalisation may lead to more adverse events in this population. Cannabis legalisation in Canada included the legalisation of flower and herbs (phase 1) in October 2018, and the deregulation of cannabis edibles one year later (phase 2). This study investigated disparities in cannabis-related emergency department (ED) visits in depressed and non-depressed individuals in each phase.

METHODS

Using administrative data, we identified all adults diagnosed with depression 60 months prior to legalisation (n = 929 844). A non-depressed comparison group was identified using propensity score matching. We compared the pre-post policy differences in cannabis-related ED-visits in depressed individuals v. matched (and unmatched) non-depressed individuals.

RESULTS

In the matched sample (i.e. comparison with non-depressed people similar to the depressed group), people with depression had approximately four times higher risk of cannabis-related ED-visits relative to the non-depressed over the entire period. Phases 1 and 2 were not associated with any changes in the matched depressed and non-depressed groups. In the unmatched sample (i.e. comparison with the non-depressed general population), the disparity between individuals with and without depression is greater. While phase 1 was associated with an immediate increase in ED-visits among the general population, phase 2 was not associated with any changes in the unmatched depressed and non-depressed groups.

CONCLUSIONS

Depression is a risk factor for cannabis-related ED-visits. Cannabis legalisation did not further elevate the risk among individuals diagnosed with depression.

Depressive symptoms predict trajectories of electronic delivery nicotine systems, cigarette, and cannabis use across 4.5 years among college students

BACKGROUND

This study examined the role of depressive symptoms on trajectories of electronic nicotine delivery systems (ENDS), cigarette, and cannabis use across 4.5 years in a sample of college students aged 18-19 at the initial study wave.

METHODS

Participants were 2,264 students enrolled in one of 24 Texas colleges that participated in a multi-wave study between 2014 and 2019. Latent growth mixture models were fit to identify longitudinal trajectories for past 30-day ENDS, cigarette, and cannabis use over a 4.5-year period. Class membership was regressed on baseline depressive symptoms in multinomial regression models.

RESULTS

Four trajectory classes were identified for each product: abstainer/minimal, decreasing, increasing, and high. Depressive symptoms were associated with a greater likelihood of belonging to the decreasing, increasing, and high trajectory classes relative to the abstainer/minimal class for all products, with the exception of the increasing ENDS class and the decreasing cannabis class.

DISCUSSION

The findings demonstrate that there is considerable similarity across trajectories of ENDS, cigarette, and cannabis use during traditional collegiate years. Furthermore, depressive symptoms increased the likelihood of belonging to substance using trajectory classes for all products.

Association of cannabis use with depression among cancer patients

The rate of cannabis use by cancer patients is climbing. However, as the risk of mental illness caused by cannabis use in cancer patients has not been effectively evaluated, this study will analyze the association between cannabis use and depression in cancer patients. This study collected data from respondents to the National Health and Nutrition Examination Survey from 2005 to 2018. A total of 22,181 respondents self-reported information about cannabis use in questionnaire, of which 893 were diagnosed with cancer. We found that the rate of cannabis use among cancer patients increased each year from 2005 to 2018. We analyzed the association between cannabis use and depression in cancer patients by multivariable logistic regression. Results found that the current cannabis use had a significant positive correlation with increased risk of depression in cancer patients (OR = 2.135, 95% CI = 1.21-3.777, p = 0.009). In our stratified analysis, current cannabis use was associated with an increased risk of depression in cancer patients who were female, had a history of cocaine use, and initiated cannabis use after age 17. (OR = 1.981, 95% CI = 1.024-3.85, P = 0.043; OR = 3.19, 95% CI = 1.61-6.41, P < 0.001; OR = 2.236, 95% CI = 1.018-4.967, P = 0.045). In conclusion, the use of cannabis by cancer patients has an associated risk of depression and the cancer patients who currently use cannabis are more likely to have depression.

Associations between tobacco and cannabis use and anxiety and depression among adults in the United States: Findings from the COVID-19 citizen science study

BACKGROUND

Little is known about whether people who use both tobacco and cannabis (co-use) are more or less likely to have mental health disorders than single substance users or non-users. We aimed to examine associations between use of tobacco and/or cannabis with anxiety and depression.

METHODS

We analyzed data from the COVID-19 Citizen Science Study, a digital cohort study, collected via online surveys during 2020-2022 from a convenience sample of 53,843 US adults (≥ 18 years old) nationwide. Past 30-day use of tobacco and cannabis was self-reported at baseline and categorized into four exclusive patterns: tobacco-only use, cannabis-only use, co-use of both substances, and non-use. Anxiety and depression were repeatedly measured in monthly surveys. To account for multiple assessments of mental health outcomes within a participant, we used Generalized Estimating Equations to examine associations between the patterns of tobacco and cannabis use with each outcome.

RESULTS

In the total sample (mean age 51.0 years old, 67.9% female), 4.9% reported tobacco-only use, 6.9% cannabis-only use, 1.6% co-use, and 86.6% non-use. Proportions of reporting anxiety and depression were highest for the co-use group (26.5% and 28.3%, respectively) and lowest for the non-use group (10.6% and 11.2%, respectively). Compared to non-use, the adjusted odds of mental health disorders were highest for co-use (Anxiety: OR = 1.89, 95%CI = 1.64-2.18; Depression: OR = 1.77, 95%CI = 1.46-2.16), followed by cannabis-only use, and tobacco-only use. Compared to tobacco-only use, co-use (OR = 1.35, 95%CI = 1.08-1.69) and cannabis-only use (OR = 1.17, 95%CI = 1.00-1.37) were associated with higher adjusted odds for anxiety, but not for depression. Daily use (vs. non-daily use) of cigarettes, e-cigarettes, and cannabis were associated with higher adjusted odds for anxiety and depression.

CONCLUSIONS

Use of tobacco and/or cannabis, particularly co-use of both substances, were associated with poor mental health. Integrating mental health support with tobacco and cannabis cessation may address this co-morbidity.

Should Marijuana Be Legalized: A Scoping Review of Associations of Marijuana and Depression

People with addiction to marijuana and those who have ever consumed marijuana at any time during their life suffer from depression at some point in their life. Depression has been associated with substance use as both a trigger and repercussion. A total of 3663 articles were analyzed, and 26 articles were collectively selected for this study. Consuming marijuana was linked to the development of depression in the majority of individuals. Marijuana consumption and its repercussions have both been connected to negative effects on the body, such as respiratory disorders and even psychological disorders, including stress and depressive disorders. Studies potentially point to a complicated causal relationship between marijuana consumption and depressive disorder, stating that early depressive symptoms enable marijuana usage, which then reduces depression. A research article clearly states that consuming marijuana can be helpful in elevating mood and anxiolytic initially, but it is subsequently followed by a rise in depressive symptoms, which manifest as mental distress and frustration. Discussions with patients about the extent of their marijuana consumption, techniques for reducing the use, and the impact of marijuana on depression may be beneficial in medical facilities where depressive disorder is treated. This research paper highlights the importance of understanding depression and the use of marijuana for temporary relief from depressive symptoms and its long-term consequences on mental health.

US-Mexico Border Stress and Daily Substance Use among Latino Youth: a Cross-Sectional Study

Background

Historically marginalized youth are at risk for daily substance use. Daily use may be associated with social and environmental factors.

Methods

In March 2018, we surveyed primarily Latino adolescents ages 14-18 who lived on the US-Mexico border and assessed associations between daily substance use, neighborhood stress, border community and immigration stress, and family support.

Results

Of 443 surveyed adolescents, 41 (9%) reported daily use. Those who used daily were more likely to be older, identify as male, and reported lower social support and higher neighborhood and border community stress compared to those who did not use daily. Perceived neighborhood stress (OR = 1.95, 95% CI 1.37-2.80) and border community and immigration stress (OR = 1.55, 95% CI 1.12-2.02) were associated with increased odds of daily substance use.

Discussion

Latino adolescents who live near the US-Mexico border experience unique socioenvironmental stress which is associated with daily substance use.

Cannabis use in repeated representative cross-sectional studies on Italian adults after the COVID-19 pandemic

Lockdown measures in response to the COVID-19 pandemic in 2020 yielded dramatic changes in drug consumption. A cross-sectional study was conducted on a representative sample of 6003 Italian adults (18-74 years) in April-May 2020 - reporting information before lockdown and at the time of interview - and two years later (i.e., in February-March 2022). Italian adults using cannabis decreased from 7.0% in pre-pandemic to 5.9% during lockdown (percent change -15.7%) and to 6.7% in 2022 (-4.3%). The reduction was particularly evident among adults aged 55-74 years, whereas cannabis use strongly increased among those aged 18-34 years. In the last period considered (2022), cannabis use was significantly more frequent in men (adjusted odds ratio, OR = 1.43), adults aged 18-34 years (p-trend <0.001), individuals with a low or high level of education (OR = 1.42 and 1.46, respectively), those from Central or Southern Italy/islands (OR = 1.50 and 1.38, respectively), and those with an economic status above the average (OR = 3.07). In 2022, cannabis use was also more frequently reported in current smokers (OR = 3.52), current e-cigarette and heated tobacco product users (OR = 6.09 and 2.94, respectively), individuals with a risky alcohol consumption (OR = 4.60), gamblers (OR = 3.76), those with anxiety and depression (OR = 2.50 and 2.80, respectively), those using psychotropic drugs (OR = 8.96), those with a low quality of life (OR = 1.91), and those sleeping less (OR = 1.42). After the COVID-19 pandemic, cannabis use was more frequent in individuals with other addictive behaviours, and with anxiety and depressive symptoms.

Medicinal cannabis for psychiatry-related conditions: an overview of current Australian prescribing

Objective: Evidence is accumulating that components of the Cannabis sativa plant may have therapeutic potential in treating psychiatric disorders. Medicinal cannabis (MC) products are legally available for prescription in Australia, primarily through the Therapeutic Goods Administration (TGA) Special Access Scheme B (SAS-B). Here we investigated recent prescribing practices for psychiatric indications under SAS-B by Australian doctors. Methods: The dataset, obtained from the TGA, included information on MC applications made by doctors through the SAS-B process between 1st November 2016 and 30th September 2022 inclusive. Details included the primary conditions treated, patient demographics, prescriber location, product type (e.g., oil, flower or capsule) and the general cannabinoid content of products. The conditions treated were categorized according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR). Trends in prescribing for conditions over time were analyzed via polynomial regression, and relationships between categorical variables determined via correspondence analyses. Results: Approximately 300,000 SAS-B approvals to prescribe MC had been issued in the time period under investigation. This included approvals for 38 different DSM-5-TR defined psychiatric conditions (33.9% of total approvals). The majority of approvals were for anxiety disorders (66.7% of psychiatry-related prescribing), sleep-wake disorders (18.2%), trauma- and stressor-related disorders (5.8%), and neurodevelopmental disorders (4.4%). Oil products were most prescribed (53.0%), followed by flower (31.2%) and other inhaled products (12.4%). CBD-dominant products comprised around 20% of total prescribing and were particularly prevalent in the treatment of autism spectrum disorder. The largest proportion of approvals was for patients aged 25-39 years (46.2% of approvals). Recent dramatic increases in prescribing for attention deficit hyperactivity disorder were identified. Conclusion: A significant proportion of MC prescribing in Australia is for psychiatry-related indications. This prescribing often appears somewhat "experimental", given it involves conditions (e.g., ADHD, depression) for which definitive clinical evidence of MC efficacy is lacking. The high prevalence of THC-containing products being prescribed is of possible concern given the psychiatric problems associated with this drug. Evidence-based clinical guidance around the use of MC products in psychiatry is lacking and would clearly be of benefit to prescribers.

Prevalence of depressive symptoms and cannabis use among adult cigarette smokers in Canada: cross-sectional findings from the 2020 International Tobacco Control Policy Evaluation Project Canada Smoking and Vaping Survey

BACKGROUND

Tobacco smoking and cannabis use are independently associated with depression, and evidence suggests that people who use both tobacco and cannabis (co-consumers) are more likely to report mental health problems, greater nicotine dependence and alcohol misuse than those who use either product exclusively. We examined prevalence of cannabis use and depressive symptoms among Canadian adults who smoke cigarettes and tested whether co-consumers of cannabis and tobacco were more likely to report depressive symptoms than cigarette-only smokers; we also tested whether cigarette-only smokers and co-consumers differed on cigarette dependence measures, motivation to quit smoking and risky alcohol use by the presence or absence of depressive symptoms.

METHODS

We analyzed cross-sectional data from adult (age ≥ 18 yr) current (≥ monthly) cigarette smokers from the Canadian arm of the 2020 International Tobacco Control Policy Evaluation Project Four Country Smoking and Vaping Survey. Canadian respondents were recruited from Leger's online probability panel across all 10 provinces. We estimated weighted percentages for depressive symptoms and cannabis use among all respondents and tested whether co-consumers (≥ monthly use of cannabis and cigarettes) were more likely to report depressive symptoms than cigarette-only smokers. Weighted multivariable regression models were used to identify differences between co-consumers and cigarette-only smokers with and without depressive symptoms.

RESULTS

A total of 2843 current smokers were included in the study. The prevalence of past-year, past-30-day and daily cannabis use was 44.0%, 33.2% and 16.1%, respectively (30.4% reported using cannabis at least monthly). Among all respondents, 30.0% screened positive for depressive symptoms, with co-consumers being more likely to report depressive symptoms (36.5%) than those who did not report current cannabis use (27.4%, p < 0.001). Depressive symptoms were associated with planning to quit smoking (p = 0.01), having made multiple attempts to quit smoking (p < 0.001), the perception of being very addicted to cigarettes (p < 0.001) and strong urges to smoke (p = 0.001), whereas cannabis use was not (all p ≥ 0.05). Cannabis use was associated with high-risk alcohol consumption (p < 0.001), whereas depressive symptoms were not (p = 0.1).

INTERPRETATION

Co-consumers were more likely to report depressive symptoms and high-risk alcohol consumption; however, only depression, and not cannabis use, was associated with greater motivation to quit smoking and greater perceived dependence on cigarettes. A deeper understanding of how cannabis, alcohol use and depression interact among people who smoke cigarettes is needed, as well as how these factors affect cessation activity over time.

Nondisordered Cannabis Use Among US Adolescents

Importance

Cannabis use is increasingly viewed by adolescents as not harmful. Youths with cannabis use disorder (CUD) are recognized by clinicians as being at risk for adverse outcomes, yet little is known about the associations between subclinical cannabis use (ie, nondisordered cannabis use [NDCU]) and adverse psychosocial events.

Objective

To describe the prevalence and demographics of NDCU and to compare associations of cannabis use with adverse psychosocial events among adolescents with no cannabis use, NDCU, and CUD.

Design, Setting, and Participants

This cross-sectional study used a nationally representative sample derived from the 2015 to 2019 National Survey on Drug Use and Health. Participants were adolescents aged 12 to 17 years, separated into 3 distinct groups: nonuse (no recent cannabis use), NDCU (recent cannabis use below diagnostic threshold), and CUD. Analysis was conducted from January to May 2022.

Exposures

CUD, NDCU, or cannabis nonuse. NDCU was defined as endorsing recent cannabis use but not meeting the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) CUD criteria. CUD was defined using DSM-5 criteria.

Main Outcomes and Measures

The main outcomes were prevalence of adolescents meeting criteria for NDCU and associations between adverse psychosocial events and NDCU, adjusted for sociodemographic characteristics.

Results

The 68 263 respondents (mean [SD] age, 14.5 [1.7] years; 34 773 [50.9%] males) included in the analysis represented an estimated yearly mean of 25 million US adolescents during 2015 to 2019. Among respondents, 1675 adolescents (2.5%) had CUD, 6971 adolescents (10.2%) had NDCU, and 59 617 adolescents (87.3%) reported nonuse. Compared with nonusers, individuals with NDCU had approximately 2 to 4 times greater odds of all adverse psychosocial events examined, including major depression (adjusted odds ratio [aOR], 1.86; 95% CI, 1.67-2.08), suicidal ideation (aOR, 2.08; 95% CI, 1.88-2.29), slower thoughts (aOR, 1.76; 95% CI, 1.58-1.96), difficulty concentrating (aOR, 1.81; 95% CI, 1.65-2.00), truancy (aOR, 1.90; 95% CI, 1.67-2.16), low grade point average (aOR, 1.80; 95% CI, 1.62-2.00), arrest (aOR, 4.15; 95% CI, 3.17-5.43), fighting (aOR, 2.04; 95% CI, 1.80-2.31), and aggression (aOR, 2.16; 95% CI, 1.79-2.62). Prevalence of adverse psychosocial events was greatest for adolescents with CUD (range, 12.6% to 41.9%), followed by NDCU (range, 5.2% to 30.4%), then nonuse (range, 0.8% to 17.3%).

Conclusions and Relevance

In this cross-sectional study of US adolescents, past-year NDCU was approximately 4 times as prevalent as past-year CUD. A stepwise gradient association was observed for odds of adverse psychosocial events between adolescent NDCU and CUD. In the context of US normalization of cannabis use, prospective research into NDCU is necessary.

Access to mental health support, unmet need and preferences among adolescents during the first year of the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic has had widespread effects on adolescent mental health. However, little is known about support-seeking, unmet need and preferences for mental health care among adolescents.

METHODS

The Youth Development Instrument (YDI) is a school-administered survey of adolescents (N = 1928, mean age = 17.1, SD = 0.3) across British Columbia, Canada. In this cohort, we assessed the characteristics of accessed mental health supports, prevalence of unmet need and preferences for in-person versus internet-based services.

RESULTS

Overall, 40% of adolescents obtained support for mental health, while 41% experienced unmet need. The most commonly accessed supports were family doctors or pediatricians (23.1%) and adults at school (20.6%). The most preferred mode of mental health care was in-person counselling (72.4%), followed by chat-based services (15.0%), phone call (8.1%) and video call (4.4%). The adjusted prevalence of accessing support was elevated among adolescents with anxiety (adjusted prevalence ratio [aPR] = 1.29, 95% CI: 1.10-1.51), those who used alcohol (1.14, 1.01-1.29), gender minorities (1.28, 1.03-1.58) and sexual minorities (1.28, 1.03-1.45). The adjusted prevalence of unmet need was elevated among adolescents with depression (1.90, 1.67-2.18), those with anxiety (1.78, 1.56-2.03), females (1.43, 1.31-1.58), gender minorities (1.45, 1.23-1.70) and sexual minorities (1.15, 1.07-1.23).

CONCLUSION

Adolescents of gender or sexual minority status and those with anxiety were more likely than others to have discussed mental health concerns and also to have reported unmet need. The most common sources of support were primary health care providers and adults at school, while the most and least preferred modes of support were in-person and video call services, respectively.

Sex differences in Cannabis use disorder and associated psychosocial problems among US adults, 2012-2013

While men show greater prevalence of cannabis use disorder (CUD) than women, whether cannabis use frequency drives this difference is unknown, and little is known about sex differences in problems associated with CUD. We therefore assessed the association of CUD with sex, adjusted for frequency of use, and compared the association of psychosocial and health-related problems with CUD between men and women. We included US adults age ≥ 18 who reported past-year cannabis use in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 3701). Cannabis use frequency, DSM-5 CUD and problems (interpersonal, financial, legal, health-related) were assessed. Associations between psychosocial problems, sex and DSM-5 CUD were assessed using prevalence differences (PD) and 95% confidence intervals (CI) from logistic regression models, controlling for demographics and cannabis use frequency, and effect modification by sex was assessed. We found that the prevalence of CUD among men versus women was not significantly greater after adjusting for use frequency. Women had significantly higher prevalence of interpersonal, financial and health-related problems than men, adjusting for frequency of use. Women showed significantly greater association of CUD with interpersonal problems with a boss or co-workers (p < 0.05) and a neighbor, relative or friend (p < 0.05) compared to men. Lack of sex differences in CUD after adjusting for frequency of use suggests use frequency may be an important target of CUD prevention efforts. CUD showed stronger associations for interpersonal problems among women than men, suggesting the need for particular emphasis on treating interpersonal problems related to cannabis use among women.

Smoking Mostly Alone as a Risk Factor for Cannabis Use Disorders and Depressive Symptoms

The empirically grounded etiological models of cannabis use already include a vast range of psychological factors (within an individual), paving the ground for individualized prevention and intervention programs. However, the interpersonal (among individuals) and relational variables influencing the emergence of excessive cannabis use are less understood. Particularly, the impact of consumption context (i.e., smoking alone or with others) on cannabis use intensity in youth remains to be clarified. We evaluated how smoking mostly alone modulates cannabis use disorders (CUD) and depressive symptoms in college students. A sample of 854 individuals from France (568 women, 286 men) who used cannabis in the last 6 months completed self-report questionnaires evaluating cannabis consumption, CUD symptoms, and depressive symptoms. Mostly alone users presented higher current use frequency as well as increased CUD and depressive symptoms compared to mostly social users. Smoking mostly alone remained positively correlated with CUD and depressive symptoms, even when controlling for current use frequency. The association between smoking mostly alone and depressive symptoms was significant before adjustment for symptoms of CUD. The loss of significance of this association after control reflected the mediating effects of symptoms of CUD on the relationship between smoking mostly alone and depressive symptoms. These results suggest that smoking mostly alone constitutes a risk factor for uncontrolled cannabis use and promote the relationship between cannabis use and depressive disorders, potentially through loneliness and social isolation. Longitudinal studies are required to identify the causal mechanisms underlying the links between smoking mostly alone, cannabis use and psychopathological disorders.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Barriers for recruitment to treatment of youths with co-occurring substance use disorders and depression

BACKGROUND AND OBJECTIVES

Recruitment challenges for treatment trials of adolescents with substance use disorder (SUD) and co-occurring depression (COD) have not been reported. The objective is to examine whether recruitment and engagement during the pretreatment assessment phase differ between adolescents in a SUD-COD versus SUD-only treatment study.

METHODS

A similar recruitment approach compared five-stage progressions in the pretreatment phase between a SUD-only (n = 252) and SUD-COD (n = 212) study. We examined the "gradient" of recruitment and retention along four stages after referral/inquiries; (a) screening for eligibility by phone, (b) meeting eligibility in an interview, (c) completion of baseline assessment, and (d) participation in the first psychotherapy session of each study.

RESULTS

Compared to SUD-only, the retention of adolescents with SUD-COD was significantly poorer from referral/inquiry to all subsequent stages. In particular, the odds ratio and 95% confidence interval from referral/inquiry to screening for eligibility by phone, meeting eligibility in an interview, completion of baseline assessment, and participation in the first psychotherapy session were all less than one. Male attrition rates were slightly higher than females but were not statistically significant.

DISCUSSION AND CONCLUSIONS

A high proportion of referred adolescents did not meet the study criteria. This indicates a need to examine (1) potential strategies for overcoming recruitment challenges in adolescents and their engagement in the pretreatment phase for studies of COD and (2) baseline variables for predictors and moderators for adequately powered studies.

SCIENTIFIC SIGNIFICANCE

This is the first study to assess recruitment challenges for adolescents with COD.

Examining Risk Factors in the Cannabis–Suicide Link: Considering Trauma and Impulsivity among University Students

Cannabis is a commonly used substance among university students that may have several negative health repercussions, including suicidal ideation (SI) and suicide attempts (SA). The factors that contribute to or help explain this relation remain uncertain. Earlier negative experiences, especially trauma encountered during early life, have been associated with the development of psychopathology upon later stressor encounters. In the current study, we examined the associations between SI and SA with problematic cannabis use among young adults and the role of earlier trauma experiences and trait impulsiveness in understanding this link. Among university students (N = 539), problematic cannabis use was moderately related to lifetime and past-12-months suicidal ideation and attempts. Impulsiveness mediated the relationship between problematic cannabis use and lifetime SI and SA. Moreover, previous life trauma moderated the relationship between problematic cannabis use and SA, such that the association between problematic cannabis use and SA was stronger among those who experienced high levels of trauma. These findings highlight behavioral and environmental factors that could predict suicide ideation and attempts among young cannabis users. Accordingly, trait impulsiveness and early trauma experiences should be considered, alongside problematic cannabis use, in suicide-risk detection and prevention strategies among young adults.

Perceived Normalization of Drug Trafficking and Adolescent Substance Use on the US-Mexico Border

BACKGROUND

Historically marginalized youth are at risk for daily substance use. Daily use may be associated with social and environmental factors.

METHODS

In March 2018, we surveyed primarily Latino adolescents ages 14-18 who lived on the US-Mexico border and assessed associations between daily substance use, neighborhood stress, border community and immigration stress, and family support.

RESULTS

Of 443 surveyed adolescents, 41 (9%) reported daily use. Those who used daily were more likely to be older, identify as male, and reported lower social support and higher neighborhood and border community stress compared to those who did not use daily. Perceived neighborhood stress (OR = 1.95, 95% CI 1.37-2.80) and border community and immigration stress (OR = 1.55, 95% CI 1.12-2.02) were associated with increased odds of daily substance use.

DISCUSSION

Latino adolescents who live near the US-Mexico border experience unique socioenvironmental stress which is associated with daily substance use.

Associations between cannabis use, cannabis use disorder, and mood disorders: longitudinal, genetic, and neurocognitive evidence

RATIONALE

Cannabis use among people with mood disorders increased in recent years. While comorbidity between cannabis use, cannabis use disorder (CUD), and mood disorders is high, the underlying mechanisms remain unclear.

OBJECTIVES

We aimed to evaluate (1) the epidemiological evidence for an association between cannabis use, CUD, and mood disorders; (2) prospective longitudinal, genetic, and neurocognitive evidence of underlying mechanisms; and (3) prognosis and treatment options for individuals with CUD and mood disorders.

METHODS

Narrative review of existing literature is identified through PubMed searches, reviews, and meta-analyses. Evidence was reviewed separately for depression, bipolar disorder, and suicide.

RESULTS

Current evidence is limited and mixed but suggestive of a bidirectional relationship between cannabis use, CUD, and the onset of depression. The evidence more consistently points to cannabis use preceding onset of bipolar disorder. Shared neurocognitive mechanisms and underlying genetic and environmental risk factors appear to explain part of the association. However, cannabis use itself may also influence the development of mood disorders, while others may initiate cannabis use to self-medicate symptoms. Comorbid cannabis use and CUD are associated with worse prognosis for depression and bipolar disorder including increased suicidal behaviors. Evidence for targeted treatments is limited.

CONCLUSIONS

The current evidence base is limited by the lack of well-controlled prospective longitudinal studies and clinical studies including comorbid individuals. Future studies in humans examining the causal pathways and potential mechanisms of the association between cannabis use, CUD, and mood disorder comorbidity are crucial for optimizing harm reduction and treatment strategies.

The Association between Recent Cannabis Use and Suicidal Ideation in Adults: A Population-based Analysis of the NHANES from 2005 to 2018

OBJECTIVE

With the increasing prevalence of cannabis use, there is a growing concern about its association with depression and suicidality. The aim of this study was to examine the relationship between recent cannabis use and suicidal ideation using a nationally representative data set.

METHODS

A cross-sectional analysis of adults was undertaken using National Health and Nutrition Examination Survey data from 2005 to 2018. Participants were dichotomized by whether or not they had used cannabis in the past 30 days. The primary outcome was suicidal ideation, and secondary outcomes were depression and having recently seen a mental health professional. Multiple logistic regression was used to adjust for potential confounders, and survey sample weights were considered in the model.

RESULTS

Compared to those with no recent use (n = 18,599), recent users (n = 3,127) were more likely to have experienced suicidal ideation in the past 2 weeks (adjusted odds ratio [aOR] 1.54, 95% CI, 1.19 to 2.00, P = 0.001), be depressed (aOR 1.53, 95% CI, 1.29 to 1.82, P < 0.001), and to have seen a mental health professional in the past 12 months (aOR 1.28, 95% CI, 1.04 to 1.59, P = 0.023).

CONCLUSIONS

Cannabis use in the past 30 days was associated with suicidal thinking and depression in adults. This relationship is likely multifactorial but highlights the need for specific guidelines and policies for the prescription of medical cannabis for psychiatric therapy. Future research should continue to characterize the health effects of cannabis use in the general population.

Prevalence of Cannabis Use and Cannabis Route of Administration among Massachusetts Adults in Buprenorphine Treatment for Opioid Use Disorder

BACKGROUND

Recent prevalence estimates of cannabis use among individuals receiving medication treatment for OUD (MOUD) are lacking, and no study has characterized cannabis route of administration (cROA) in this population. These knowledge gaps are relevant because cannabis' effects and health outcomes vary by cROA and the availability and perceptions of cROA (e.g., vaping devices) are changing.

METHODS

The Vaping In Buprenorphine-treated patients Evaluation (VIBE) cross-sectional survey assessed the prevalence and correlates of cannabis use and cROA among adults receiving buprenorphine MOUD from 02/20 to 07/20 at five community health centers in Massachusetts, a state with legal recreational and medical cannabis use.

RESULTS

Among the 92/222 (41%) respondents reporting past 30-day cannabis use, smoking was the most common cROA (75%), followed by vaping (38%), and eating (26%). Smoking was more often used as a single cROA vs. in combination others (p = 0.01), whereas vaping, eating, and dabbing were more often used in combination with another cROA (all p < 0.05). Of the 39% of participants reporting multiple cROA, smoking and vaping (61%), and smoking and eating (50%), were the most prevalent combinations. Nonwhite race (vs. white) and current cigarette smoking (vs. no nicotine use) were associated with past 30-day cannabis use in multiple logistic regression.

CONCLUSIONS

Prevalence of past 30-day cannabis use among individuals receiving buprenorphine MOUD in Massachusetts in 2020 was nearly double the prevalence of cannabis use in Massachusetts' adult general population in 2019 (21%). Our data are consistent with state and national data showing smoking as the most common cROA.

Early Age of Cannabis Initiation and Its Association With Suicidal Behaviors

Background:

Suicide rates in the U.S. have continued to rise over the last 2 decades. The increased availability and broader legalization of cannabis is a public health concern, particularly among adolescents. The objective of this study was to examine the association between the age of cannabis initiation and lifetime suicidal ideations and attempts in a sample of adults aged 18 or older.

Methods:

Data are from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001 to 2003 (N = 15 238). The primary objective of the CPES was to collect data about the prevalence of mental disorders, impairments associated with these disorders, and their treatment patterns from representative samples of majority and minority adult populations in the U.S. Logistic regression analyses were conducted to test the association between cannabis initiation age (early ⩽14 years old; later >14 years old) and outcomes of lifetime suicide ideation and attempts. Cigarette use, cannabis use, gender, income, race, education, and age were controlled for the analyses.

Results:

Overall, 12.5% of participants reported suicide ideation, while 4.2% reported attempt. Early cannabis use was associated with a higher risk of suicide ideation (AOR = 3.32, 95% CI [2.75, 3.80]) than later cannabis use (AOR = 2.15, 95% CI [1.92, 2.39]). Early cannabis use was associated with a higher risk of suicide attempt (AOR = 4.38, 95% CI [3.48, 5.52]) than later cannabis use (AOR = 2.56, 95% CI [2.14, 3.06]). Wald chi-squared tests revealed significant differences between the early and late initiation for both ideation (χ2 = 26.99; P < .001) and attempts (χ2 = 26.02; P < .001).

Conclusions:

Significant associations were found between early initiation of cannabis and suicide behaviors. As suicide rates continue to rise, it is recommended that clinicians, treatment providers, and other professionals consider the use of cannabis at an early age as a risk for subsequent suicide behaviors.

Cannabis and binge alcohol use among older individuals with major depressive episode

BACKGROUND

Research shows significant associations of major depression with cannabis and binge alcohol use. However, despite increasing cannabis and binge alcohol use rates among the 50+ age group, research on this age group is scant. Methods: We used the 2015-2019 National Survey on Drug Use and Health data (n = 44,007 age 50+) and multinomial logistic regression models to examine associations of a major depressive episode (MDE) with cannabis and binge alcohol use and co-use and associations of binge alcohol use with nonmedical and medical cannabis use. Results: Of individuals age 50+, 89.6% had no history of MDE, 5.7% had prior-to-past-year MDE, and 4.7% had past-year MDE. The rates of past-month cannabis use were 4.3%, 7.7%, and 11.6% and binge alcohol use were 17.3%, 18.7%, and 19.9% among those with no MDE history, prior-to-past-year MDE, and past-year MDE, respectively. Compared to no MDE history, prior-to-past-year MDE (RRR = 1.70, 95% CI = 1.30-2.23) and past-year MDE (RRR = 1.80, 95% CI = 1.27-2.55) were significantly associated with past-month cannabis use (with or without binge alcohol use). However, MDE status was not associated with past-month binge alcohol use. Among cannabis users, binge alcohol use was significantly associated with nonmedical cannabis use only (RRR = 2.50, 95% CI = 1.95-3.21). Users of cannabis and/or binge alcohol also had a higher likelihood of using tobacco products and illicit drugs. Conclusions: Healthcare professionals treating individuals age 50+ with depression should screen for substance use, provide education on the potential adverse effects of polysubstance use, and help them access treatment for co-occurring depression and substance use problems.

Risk and benefit of cannabis prescription for chronic non-cancer pain

OBJECTIVES

We investigated whether cannabis usage was associated with reduced opioid usage, and the rates of opioid and cannabis use disorders among chronic pain patients who had been prescribed medical cannabis.

METHODS

A random sample of chronic pain patients who had license for cannabis use were interviewed by telephone about their lifetime opioid and cannabis usage. Cannabis and opioid use disorders were assessed with Portenoy's criteria.

RESULTS

Of the 100 participants aged 18-70 years (compliance 67% (aged >40) and 33% (aged ≤ 40y)), 76 ever used opioids. Of them, 93% decreased or stopped opioids following cannabis initiation. Ten patients (10%), 17.4% of the ≤40 y age group, met the criteria for cannabis use disorder. Compared to those who did not meet the criteria, their lifetime depression was higher (80% vs. 43.2%, respectively, P=.042), and they were less educated (12.2 ± 0.6y vs. 13.5 ± 2.1y, p = 0.05).

CONCLUSIONS

Cannabis usage was associated with reduced opioid usage. The prevalence of cannabis use disorder was high among the younger participants who also had a lower study compliance rate, suggesting the higher actual prevalence of cannabis use disorder. While medical cannabis may help reduce opioid use in chronic non-cancer pain patients, younger age, depression, and other risk factors should be carefully evaluated before cannabis is prescribed.

Building risk prediction models for daily use of marijuana using machine learning techniques

Identifying the characteristics of adults with recent marijuana use is limited by standard statistical methods and requires a unique approach. The objective of this study is to evaluate the efficiency of machine learning models in predicting daily marijuana use and identify factors associated with daily use among adults. The study analyzed pooled data from the 2016-2019 Behavioral Risk Factor Surveillance System (BRFSS) Survey in 2020. Prediction models were developed using four machine learning algorithms, including Logistic Regression, Decision Tree, and Random Forest with Gini function, and Naïve Bayes. Respondents were randomly divided into training and testing samples. The performance of all the models was compared using accuracy, AUC, precision, and recall. The study included 253,569 respondents, of whom 10,182 (5.9 %) reported daily marijuana use in the last 30 days. Of daily marijuana use, 53.4 % were young adults (age 18-34 years), 34.3 % female, 56.1 % non-Hispanic White, 15.2 % were college graduates, and 67.3 % were employed. Random Forest was the best performing model with AUC 0.97, followed by a Decision tree (AUC 0.95). The most important factors for daily marijuana use were the current use of e-cigarette and combustible cigarette use, male gender, unmarried, poor mental health, depression, cognitive decline, abnormal sleep pattern, and high-risk behavior. Data mining methods were useful in the discovery of behavior health-risk knowledge and to visualize the significance of predicting modeling from a multidimensional behavioral health survey.

Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status

IMPORTANCE

During the past decade, cannabis use among US adults has increased markedly, with a parallel increase in suicidality (ideation, plan, attempt, and death). However, associations between cannabis use and suicidality among young adults are poorly understood.

OBJECTIVE

To determine whether cannabis use and cannabis use disorder (CUD) are associated with a higher prevalence of suicidality among young adults with or without depression and to assess whether these associations vary by sex.

DESIGN, SETTING, AND PARTICIPANTS

This survey study examined data from 281 650 adults aged 18 to 34 years who participated in the National Surveys on Drug Use and Health. Data were collected from January 1, 2008, to December 31, 2019.

EXPOSURES

Prevalence of past-year daily or near-daily cannabis use (≥300 days in the past year), CUD, and major depressive episode (MDE). Past-year CUD and MDE were based on DSM-IV diagnostic criteria.

MAIN OUTCOMES AND MEASURES

Past-year suicidal ideation, plan, and attempt.

RESULTS

Among the 281 650 adults aged 18 to 34 (men, 49.9% [95% CI, 49.6%-50.2%]; women, 50.1% [95% CI, 49.8%-50.4%]) included in the analysis, past-year suicidal ideation and plan along with daily cannabis use increased among all examined sociodemographic subgroups (except daily cannabis use among current high-school students), and past-year suicide attempt increased among most subgroups. National trends in adjusted prevalence of past-year suicidal ideation, plan, and attempt varied by daily and nondaily cannabis use and CUD among adults with or without MDE. After controlling for MDE, CUD, cannabis use status, and potential confounding factors, the adjusted prevalence of suicidal ideation, plan, and attempt increased 1.4 to 1.6 times from the 2008-2009 to 2018-2019 periods (adjusted risk ratio [ARR] for suicidal ideation, 1.4 [95% CI, 1.3-1.5]; ARR for suicide plan, 1.6 [95% CI, 1.5-1.9]; ARR for suicide attempt, 1.4 [95% CI, 1.2-1.7]), with 2008 to 2009 as the reference period. Past-year CUD, daily cannabis use, and nondaily cannabis use were associated with a higher prevalence of past-year suicidal ideation, plan, and attempt in both sexes (eg, among individuals without MDE, prevalence of suicidal ideation for those with vs without CUD was 13.9% vs 3.5% among women and 9.9% vs 3.0% among men; P < .001), but significantly more so in women than men (eg, suicide plan among those with CUD and MDE was 52% higher for women [23.7%] than men [15.6%]; P < .001).

CONCLUSIONS AND RELEVANCE

From 2008 to 2019, suicidal ideation, plan, and attempt increased 40% to 60% over increases ascribed to cannabis use and MDE. Future research is needed to examine this increase in suicidality and to determine whether it is due to cannabis use or overlapping risk factors.

Cannabis Use, Cannabis Use Disorder, and Comorbid Psychiatric Illness: A Narrative Review

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.

Considerations for Cannabis Use to Treat Pain in Sickle Cell Disease

Pain in Sickle Cell Disease (SCD) is a major comorbidity and unique with acute pain due to recurrent and episodic vaso-occlusive crises as well as chronic pain, which can span an individual's entire life. Opioids are the mainstay treatment for pain in SCD. Due to recent health crises raised by adverse effects including deaths from opioid use, pain management in SCD is adversely affected. Cannabis and its products are most widely used for pain in multiple conditions and also by patients with SCD on their own. With the availability of "Medical Cannabis" and approval to use cannabis as medicine across majority of States in the United States as well as over-the-counter preparations, cannabis products are being used increasingly for SCD. The reliability of many of these products remains questionable, which poses a major health risk to the vulnerable individuals seeking pain relief. Therefore, this review provides up to date insights into available categories of cannabis-based treatment strategies, their mechanism of action and pre-clinical and clinical outcomes in SCD. It provides evidence for the benefits and risks of cannabis use in SCD and cautions about the unreliable and unvalidated products that may be adulterated with life-threatening non-cannabis compounds.