A Scoping Review of Associations Between Cannabis Use and Anxiety in Adolescents and Young Adults

Fatty Acid Amide Hydrolase and Cannabinoid Receptor Type 1 Genes Regulation is Modulated by Social Isolation in Rats

Social isolation is a state of lack of social connections, involving the modulation of different molecular signalling cascades and associated with high risk of mental health issues. To investigate if and how gene expression is modulated by social experience at the central level, we analyzed the effects of 5 weeks of social isolation in rats focusing on endocannabinoid system genes transcription in key brain regions involved in emotional control. We observed selective reduction in mRNA levels for fatty acid amide hydrolase (Faah) and cannabinoid receptor type 1 (Cnr1) genes in the amygdala complex and of Cnr1 in the prefrontal cortex of socially isolated rats when compared to controls, and these changes appear to be partially driven by trimethylation of Lysine 27 and acetylation of Lysine 9 at Histone 3. The alterations of Cnr1 transcriptional regulation result also directly correlated with those of oxytocin receptor gene. We here suggest that to counteract the effects of SI, it is of relevance to restore the endocannabinoid system homeostasis via the use of environmental triggers able to revert those epigenetic mechanisms accounting for the alterations observed.

Adverse Childhood Experiences and Problematic Cannabis Use: The Role of Emotion Dysregulation and Affective Impulsivity

Problematic cannabis use is highly prevalent among postsecondary students. Consequently, there is a need to examine risk factors associated with problematic cannabis use in this population. The present study investigated whether emotion dysregulation mediates the relationship between adverse childhood experiences (ACEs) and problematic cannabis use, and whether affective impulsivity (negative and positive urgency) uniquely moderates this relationship. Participants consisted of current cannabis users (N = 586) recruited from five universities across Canada. Participants completed an online survey containing self-report measures of ACEs, emotion dysregulation, negative and positive urgency, and problematic cannabis use. Among the sample of postsecondary students, 36% (n = 213) met the threshold for problematic cannabis use. Moderated-mediation analyses revealed that ACEs were positively associated with emotion dysregulation and problematic cannabis use. There was also a significant indirect effect of emotion dysregulation on the association between ACEs and problematic cannabis use at moderate and high (but not low) levels of negative urgency, and at moderate and high (but not low) levels of positive urgency. The moderated-mediation models remained significant when controlling for other facets of impulsivity. Results suggest that elevated levels of emotion dysregulation and urgency are important proximal risk factors for problematic cannabis use among postsecondary students with a history of ACEs. While ACEs cannot be modified given their occurrence in the past, interventions that aim to build mindfulness and adaptive emotion regulation skills may be beneficial for reducing the likelihood that these students will engage in impulsive behaviors, such as cannabis use, when experiencing emotional distress.

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.

Mental and Physical Health Conditions Among U.S. Veterans with Cannabis Use and Cannabis Use Disorders

Purpose of Review

Veterans are a large population that is disproportionately affected by various physical and mental health conditions. The primary aim of this review is to provide a concise overview of recent literature on the prevalence of cannabis use and cannabis use disorder (CUD) among US Veterans, and associations with mental and physical health conditions. We also addressed gaps in the literature by investigating associations between CUD and mental and physical health conditions in 2019 data from the Veterans Health Administration (VHA; N=5,657,277).

Recent Findings

In total, 25 studies were reviewed. In 2019, the prevalence of Veteran cannabis use ranged from 11.9%-18.7%. Cannabis use and CUD were associated with bipolar disorders, psychotic disorders, suicidality, pain conditions, and other substance use, but less consistently associated with depressive disorders, anxiety disorders, and posttraumatic stress disorder. Analyses of 2019 VHA data indicated that CUD was strongly associated with a broad array of physical and mental health conditions and mortality.

Summary

Cannabis use and CUD are prevalent and highly comorbid with other conditions among US Veterans. Harm reduction methods tailored to these populations are needed.

Cannabis-Induced Anxiety Disorder in the Emergency Department

BACKGROUND

In December 2018, Michigan became the 10th state to legalize marijuana for adults. Since this law took effect, increased availability and use of cannabis in Michigan have led to increased emergency department (ED) visits associated with the drug's psychiatric effects.

OBJECTIVES

To describe cannabis-induced anxiety disorder's prevalence, clinical features, and disposition in a community-based study.

METHODS

This was a retrospective cohort analysis of consecutive patients diagnosed with acute toxicity related to cannabis use (ICD-10 code F12). Patients were seen at seven EDs over a 24-month study period. Data collected included demographics, clinical features, and treatment outcomes in ED patients who met the criteria for cannabis-induced anxiety disorder. This group was compared to a cohort experiencing other forms of acute cannabis toxicity. Chi-squared and t-tests were used to compare these two groups across key demographic and outcome variables.

RESULTS

During the study period, 1135 patients were evaluated for acute cannabis toxicity. A total of 196 patients (17.3%) had a chief complaint of anxiety, and 939 (82.7%) experienced other forms of acute cannabis toxicity, predominantly symptoms of intoxication or cannabis hyperemesis syndrome. Patients with anxiety symptoms had panic attacks (11.7%), aggression or manic behavior (9.2%), and hallucinations (6.1%). Compared to patients presenting with other forms of cannabis toxicity, those with anxiety were likelier to be younger, ingested edible cannabis, had psychiatric comorbidities, or had a history of polysubstance abuse.

CONCLUSIONS

Cannabis-induced anxiety occurred in 17.3% of ED patients in this community-based study. Clinicians must be adept in recognizing, evaluating, managing, and counseling these patients following cannabis exposure.

Cannabis use and social anxiety in young adulthood: A meta-analysis

Young adulthood (ages 18 to 30 years old), a developmental age of exploration, is marked by new experiences and transitions. Cannabis use frequency is highest in young adulthood compared to other age periods. Social anxiety (characterized by fear, shyness, and inhibition in social situations where scrutiny and judgment is possible) is also prevalent during young adulthood. Social anxiety may be a complex predictor of cannabis use frequency and problems (e.g., any negative physical, emotional, or social outcome from use). Social anxiety may act as a risk factor as individuals may use cannabis frequently to manage their fear of negative evaluation and associated unpleasant affective states. The purpose of this meta-analysis was to quantify the magnitude of the associations between social anxiety and two cannabis variables (frequency of use and problems) in young adulthood. A comprehensive literature review was conducted to identify studies that included measures of social anxiety and at least one cannabis-related variable of interest among young adults. Eighteen studies were included in the meta-analysis. Results revealed a small, statistically significant positive association between social anxiety and cannabis problems (r = 0.197, k = 16, p = <0.001), and a nonsignificant association between social anxiety and cannabis use frequency (r = 0.002, k = 16, p = 0.929). The association between social anxiety and cannabis use frequency was moderated by the mean age such that samples with older mean ages exhibited a stronger correlation. Additionally, the association between social anxiety and cannabis problems was moderated by clinically significant levels of social anxiety, such that samples with fewer participants who met clinical levels of social anxiety exhibit a stronger correlation. This meta-analysis supports the idea that there is a complex relation between social anxiety and cannabis outcomes during young adulthood.