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Subbaraman MS, Mahoney E, Mericle A, Polcin D. Cannabis use and alcohol and drug outcomes in a longitudinal sample of sober living house residents in California. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 165:209454. [PMID: 39067771 PMCID: PMC11347081 DOI: 10.1016/j.josat.2024.209454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 06/10/2024] [Accepted: 07/11/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Some evidence suggests that cannabis may be a safer substitute for other drugs. Historically, sober living houses (SLHs) have been abstinence-based environments designed for individuals in recovery to live with others in recovery. However, the evolving legal landscape around cannabis use has left SLH operators and managers in a difficult position regarding policies related to cannabis use among residents. The primary aim of this study was to examine how cannabis use relates to alcohol use, other drug use, and related problems among SLH residents. METHODS Baseline (N = 557), 6-month (n = 462), and 12-month (n = 457) data came from SLH residents living in 48 houses in Los Angeles, CA from 2018 to 2021. Longitudinal generalized estimating equation models tested associations between any past six-month cannabis use and alcohol and non-cannabis drug outcomes: any use, number of days of use, and any alcohol- or drug-related problems. Final models adjusted for baseline age, sex, race-and-ethnicity, inpatient substance use treatment, and alcohol/drug use days, and time-varying 12-step attendance and percent of social network using drugs/alcohol heavily. RESULTS At baseline, 107 (19.2 %) residents reported cannabis use in the past six months. At 12 months, 80 (17.5 %) residents reported cannabis use in the past six months. Across all timepoints, any vs. no past six-month cannabis use was related to significantly (P < 0.05) higher odds of past-month alcohol use (OR = 3.85, 95 % CI: 2.65, 5.59); more drinking days in the past six months (IRR = 1.76, 95 % CI: 1.40, 2.21); higher odds of alcohol problems (OR = 2.74, 95 % CI: 1.99, 3.76); higher odds of past-month drug use (OR = 10.41, 95 % CI: 6.37, 17.00); more drug use days in the past six months (IRR = 1.86, 95 % CI: 1.40, 2.49); and higher odds of drug problems (OR = 14.99, 95 % CI: 9.91, 22.68). CONCLUSIONS During each assessment period, almost one-fifth of individuals residing in sample of California sober living houses report using cannabis in the past six months. Cannabis does not appear to work as a substitute for alcohol or other drugs in this population because cannabis use is related to increased risk of alcohol and other drug use and problems. SLH managers and operators should consider potential harm that could result from house policies that fail to address cannabis use.
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Affiliation(s)
- Meenakshi S Subbaraman
- Behavioral Health and Recovery Studies, Public Health Institute, 555 12th St, Oakland, CA 94607, USA.
| | - Elizabeth Mahoney
- Behavioral Health and Recovery Studies, Public Health Institute, 555 12th St, Oakland, CA 94607, USA.
| | - Amy Mericle
- Behavioral Health and Recovery Studies, Public Health Institute, 555 12th St, Oakland, CA 94607, USA; Alcohol Research Group, Public Health Institute, 6001 Shellmound St #450, Emeryville, CA 94608, USA.
| | - Douglas Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, 555 12th St, Oakland, CA 94607, USA.
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Choi NG, Moore J, Choi BY. Cannabis use disorder and substance use treatment among U.S. adults. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 167:209486. [PMID: 39151799 DOI: 10.1016/j.josat.2024.209486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/24/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Recent expansion of cannabis legalization in multiple states calls for reexamination of the prevalence of cannabis use, cannabis use disorder (CUD), and the associations between CUD severity and substance use treatment. We used Andersen's behavioral model of healthcare use as the conceptual/analytic framework for examining treatment use. METHODS We used data from the 2022 National Survey on Drug Use and Health (NSDUH; N = 47,100, age 18+) to describe the prevalence of past-year cannabis use, CUD and CUD severity, other substance use disorders, and substance use treatment. We compared sociodemographic, mental health, healthcare use, and cannabis and other substance use characteristics by CUD severity. Finally, we used logistic regression models to examine the associations between CUD severity and substance use treatment. RESULTS Of the U.S. adult population, 23.0 % used cannabis in the past year; 7.0 % had a CUD (3.9 % mild, 1.9 % moderate, and 1.2 % severe CUD); and 4.7 % received substance use treatment. Of past-year cannabis users, 30.3 % had CUD (16.9 % mild, 8.4 % moderate, and 5.0 % severe CUD), and 9.6 % received substance use treatment. Cannabis users had 3-4 times higher rates of other substance use disorders than nonusers. Of those with CUD, 38.4 % had moderate/severe mental illness, 52.4 % had other substance use disorders, and 16.5 % received substance use treatment. Among all cannabis users, moderate (aOR [adjusted odds ratios] = 1.48, 95 % CI = 1.03-2.13) and severe (aOR = 2.57, 95 % CI = 1.60-4.11) CUDs were associated with greater odds of substance use treatment. Among cannabis users without nicotine dependence and alcohol, opioid, tranquilizer/sedative, and stimulant use disorders, only severe CUD (aOR = 6.03, 95 % CI = 3.37-10.78) was associated with greater odds of substance use treatment. CONCLUSIONS This study shows increased prevalence of cannabis use and CUD among U.S. adults, and with or without other substance use disorders, CUD was associated with greater odds of substance use treatment. However, the overall low rate of treatment use among those with CUD is concerning. Healthcare providers need to provide education for both medical and recreational users on the development of tolerance and dependence. Harm reduction strategies to minimize the negative consequences of CUD are also needed.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA.
| | - John Moore
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, USA
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Lapham GT, Matson TE, Carrell DS, Bobb JF, Luce C, Oliver MM, Ghitza UE, Hsu C, Browne KC, Binswanger IA, Campbell CI, Saxon AJ, Vandrey R, Schauer GL, Pacula RL, Horberg MA, Bailey SR, McClure EA, Bradley KA. Comparison of Medical Cannabis Use Reported on a Confidential Survey vs Documented in the Electronic Health Record Among Primary Care Patients. JAMA Netw Open 2022; 5:e2211677. [PMID: 35604691 PMCID: PMC9127557 DOI: 10.1001/jamanetworkopen.2022.11677] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/23/2022] [Indexed: 12/18/2022] Open
Abstract
Importance Patients who use cannabis for medical reasons may benefit from discussions with clinicians about health risks of cannabis and evidence-based treatment alternatives. However, little is known about the prevalence of medical cannabis use in primary care and how often it is documented in patient electronic health records (EHR). Objective To estimate the primary care prevalence of medical cannabis use according to confidential patient survey and to compare the prevalence of medical cannabis use documented in the EHR with patient report. Design, Setting, and Participants This study is a cross-sectional survey performed in a large health system that conducts routine cannabis screening in Washington state where medical and nonmedical cannabis use are legal. Among 108 950 patients who completed routine cannabis screening (between March 28, 2019, and September 12, 2019), 5000 were randomly selected for a confidential survey about cannabis use, using stratified random sampling for frequency of past-year use and patient race and ethnicity. Data were analyzed from November 2020 to December 2021. Exposures Survey measures of patient-reported past-year cannabis use, medical cannabis use (ie, explicit medical use), and any health reason(s) for use (ie, implicit medical use). Main Outcomes and Measures Survey data were linked to EHR data in the year before screening. EHR measures included documentation of explicit and/or implicit medical cannabis use. Analyses estimated the primary care prevalence of cannabis use and compared EHR-documented with patient-reported medical cannabis use, accounting for stratified sampling and nonresponse. Results Overall, 1688 patients responded to the survey (34% response rate; mean [SD] age, 50.7 [17.5] years; 861 female [56%], 1184 White [74%], 1514 non-Hispanic [97%], and 1059 commercially insured [65%]). The primary care prevalence of any past-year patient-reported cannabis use on the survey was 38.8% (95% CI, 31.9%-46.1%), whereas the prevalence of explicit and implicit medical use were 26.5% (95% CI, 21.6%-31.3%) and 35.1% (95% CI, 29.3%-40.8%), respectively. The prevalence of EHR-documented medical cannabis use was 4.8% (95% CI, 3.45%-6.2%). Compared with patient-reported explicit medical use, the sensitivity and specificity of EHR-documented medical cannabis use were 10.0% (95% CI, 4.4%-15.6%) and 97.1% (95% CI, 94.4%-99.8%), respectively. Conclusions and Relevance These findings suggest that medical cannabis use is common among primary care patients in a state with legal use, and most use is not documented in the EHR. Patient report of health reasons for cannabis use identifies more medical use compared with explicit questions about medical use.
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Affiliation(s)
- Gwen T. Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Theresa E. Matson
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, University of Washington, Seattle
| | | | | | - Casey Luce
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Malia M. Oliver
- 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 Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - 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, Denver
- 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
| | - Ryan Vandrey
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Rosalie Liccardo Pacula
- Price School of Public Policy, University of Southern California, Los Angeles
- Leonard D Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
| | - Michael A. Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, North Bethesda, Maryland
| | - Steffani R. Bailey
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Erin A. McClure
- Medical University of South Carolina College of Medicine, Charleston
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Exploring the Psychometric Properties of the Current Opioid Misuse Measure Among Adults With Chronic Pain and Opioid Use. Clin J Pain 2021; 36:578-583. [PMID: 32433073 DOI: 10.1097/ajp.0000000000000846] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The opioid epidemic is a significant public health problem that is associated with overdose and death. The increase in opioid-related problems can largely be attributed to increases in opioid prescriptions for the treatment of chronic pain. Unfortunately, there is not a consensus on a definition of opioid misuse in the context of chronic pain, making measurement a challenge. One commonly used measure to assess opioid misuse in the context of chronic pain is the Current Opioid Misuse Measure (COMM). The COMM was designed to assess opioid misuse generally, as captured by psychiatric symptoms and aberrant drug use behaviors. Although studies have examined cross-validation using correlations, little psychometric work has been conducted, and therefore it is currently unknown what domains the measure is assessing. MATERIALS AND METHODS The current study examined the factor structure of the COMM using confirmatory and exploratory factor analysis among 445 opioid-using adults with chronic pain. RESULTS The results did not support the widely accepted 1-factor opioid misuse solution; rather they supported a 2-factor, psychiatric problems and aberrant-drug-use-problems factor structure. Convergent and divergent validity were also examined at the bivariate level. DISCUSSION Given the importance and relevance for opioid misuse in the context of chronic pain, it is important for researchers to continue assessing and providing psychometric evidence for the COMM.
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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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Association between marijuana use and nonmedical prescription opioid use in the United States: are we shifting from one epidemic to another? J Public Health Policy 2021; 42:310-321. [PMID: 33879832 DOI: 10.1057/s41271-021-00282-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 11/21/2022]
Abstract
The United States (US) is grappling with a severe opioid epidemic. Marijuana is emerging as a therapy for pain management and an alternative to opioids, but little evidence supports its long-term benefits. This study aims to examine the association of marijuana use among patients on prescription pain relievers in a retrospective cross-sectional study using zero-inflated negative binomial regression. The recipients of prescription pain medicines were identified using National Survey on Drug Use and Health (2015-2017). Irrespective of the state marijuana laws, marijuana use days were 34% higher and odds of having zero days of marijuana use were 73% lower in those using nonmedical prescription opioids vs. not (IRR = 1.34, p < 0.0001; OR = 0.27, p < 0.0001, respectively). In the absence of consequential evidence supporting marijuana for pain management and more states venturing into legalizing it, there needs to be more caution as the country struggles to recover from one epidemic.
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7
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Wildberger J, Katz EC. Attitudes toward medical marijuana among substance use clinicians. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1638458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Naseh M, Wagner EF, Abtahi Z, Potocky M, Zahedi L. Prevalence of and risk factors for substance use among Afghan refugees in Iran: An exploratory study. J Ethn Subst Abuse 2019; 20:34-59. [PMID: 30806180 DOI: 10.1080/15332640.2019.1571976] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Afghan refugees may be a high-risk group for substance use problems. However, research is scarce in this area, specifically among Afghan refugees in one of their main host countries, Iran. This study aimed to estimate the prevalence of substance use among this population and explore the associated risk factors using a mixed-methods design. Findings suggest that 4.2% of the surveyed households had at least one adult member using illicit drugs. Moreover, results show that substance use among Afghans had statistically significant associations with illiteracy, lack of documentation, living in slum areas, and multidimensional poverty. Policy implications are discussed and recommendations provided.
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Affiliation(s)
- Mitra Naseh
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University, Miami, Florida
| | - Eric F Wagner
- Community-Based Research Institute, Florida International University, Miami, Florida
| | - Zahra Abtahi
- Department of Anthropology, University of Tehran, Tehran, Iran
| | - Miriam Potocky
- Department of Anthropology, University of Tehran, Tehran, Iran
| | - Leila Zahedi
- Department of Computing and Information Science, Florida International University, Miami, Florida
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Manning K, Rogers AH, Bakhshaie J, Hogan JBD, Buckner JD, Ditre JW, Zvolensky MJ. The association between perceived distress tolerance and cannabis use problems, cannabis withdrawal symptoms, and self-efficacy for quitting cannabis: The explanatory role of pain-related affective distress. Addict Behav 2018; 85:1-7. [PMID: 29787925 DOI: 10.1016/j.addbeh.2018.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 01/25/2023]
Abstract
Rates of cannabis use and related problems continue to rise, ranking as the third most common substance use disorder in the United States, behind tobacco and alcohol use. Past work suggests that perceived distress tolerance is related to several clinically significant features of cannabis use (e.g., coping-oriented use). However, there has been little exploration of the mechanisms that may underlie relations between perceived distress tolerance and cannabis use problems, withdrawal severity, and self-efficacy for quitting. The current study sought to examine the experience of pain, which frequently co-occurs with cannabis use (Ashrafioun, Bohnert, Jannausch, & Ilgen, 2015), as an underlying factor in the relation between perceived distress tolerance and cannabis related problems among 203 current cannabis-using adults (29.2% female, M = 37.7 years, SD = 10.2, 63% African American). Results indicated that perceived distress tolerance via pain related affective distress significantly predicted the severity of cannabis use problems (Pm = 0.60), degree of cannabis withdrawal (Pm = 0.39), and lower self-efficacy for quitting cannabis (Pm = 0.36). Future work may usefully explore the role of pain-related affective distress as a mechanistic factor in the context of perceived distress tolerance-cannabis relations.
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Affiliation(s)
- Kara Manning
- University of Houston, Department of Psychology, Houston, TX, United States
| | - Andrew H Rogers
- University of Houston, Department of Psychology, Houston, TX, United States
| | - Jafar Bakhshaie
- University of Houston, Department of Psychology, Houston, TX, United States
| | | | - Julia D Buckner
- Louisiana State University, Department of Psychology, Baton Rouge, LA, United States
| | - Joseph W Ditre
- Syracuse University, Department of Psychology, Syracuse, NY, United States
| | - Michael J Zvolensky
- University of Houston, Department of Psychology, Houston, TX, United States; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX, United States.
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Vadivelu N, Kai AM, Kodumudi G, Haddad D, Kodumudi V, Kuruvilla N, Kaye AD, Urman RD. Recommendations for Substance Abuse and Pain Control in Patients with Chronic Pain. Curr Pain Headache Rep 2018; 22:25. [DOI: 10.1007/s11916-018-0679-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Metrik J, Bassett SS, Aston ER, Jackson KM, Borsari B. Medicinal versus Recreational Cannabis Use among Returning Veterans. TRANSLATIONAL ISSUES IN PSYCHOLOGICAL SCIENCE 2018; 4:6-20. [PMID: 30003119 PMCID: PMC6037171 DOI: 10.1037/tps0000133] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although increasing rates of cannabis use and cannabis use disorder (CUD) are well-documented among veterans, little is known about their use of cannabis specifically for medicinal purposes. The present study characterizes such use and compares veterans reporting cannabis use for medicinal (n = 66) versus recreational (n = 77) purposes on (a) sociodemographic factors, (b) psychiatric disorders (posttraumatic stress disorder [PTSD], major depressive disorder [MDD], and CUD), (c) other substance use, (d) reasons for cannabis use and cannabis-related problems, and (e) physical and mental health. METHODS Participants were veterans deployed post 9/11/2001 recruited from a Veterans Health Administration (VHA) facility (N = 143; mean [SD] age = 30.0 [6.6]; mean [SD] deployments = 1.7 [1.1]) who reported past-year cannabis use. RESULTS The most frequently endorsed conditions for medicinal cannabis (MC) use were anxiety/stress, PTSD, pain, depression, and insomnia. In logistic regression analyses adjusted for frequency of cannabis use, MC users were significantly more likely (OR = 3.16) to meet criteria for PTSD than recreational cannabis (RC) users. Relative to RC users, MC users reported significantly greater motivation for using cannabis to cope with sleep disturbance as well as significantly poorer sleep quality and worse physical health. CONCLUSIONS Veterans who use cannabis for medicinal purposes differ significantly in sleep, physical and mental health functioning than veterans who use cannabis for recreational purposes. PTSD and sleep problems may be especially relevant issues to address in screening and providing clinical care to returning veterans who are using cannabis for medicinal purposes.
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Affiliation(s)
- Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
- Providence VA Medical Center, Providence, RI, 02908, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02912, USA
| | - Shayna S. Bassett
- Department of Psychology, Social Sciences Research Center, University of Rhode Island, Kingston, RI, 02881, USA
| | - Elizabeth R. Aston
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Brian Borsari
- San Francisco VA Medical Center, San Francisco, CA, 94121, USA
- Department of Psychiatry, University of California – San Francisco, San Francisco, CA, 94103, USA
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Nugent SM, Yarborough BJ, Smith NX, Dobscha SK, Deyo RA, Green CA, Morasco BJ. Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. Gen Hosp Psychiatry 2018; 50:104-110. [PMID: 29153783 PMCID: PMC5788035 DOI: 10.1016/j.genhosppsych.2017.11.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/03/2017] [Accepted: 11/04/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Little is known about co-occurring long-term opioid therapy (LTOT) and medical cannabis use. We compared characteristics of patients prescribed LTOT who endorsed using medical cannabis for pain to patients who did not report cannabis use. METHOD Participants (n=371) prescribed LTOT completed self-report measures about pain, substance use, and mental health. RESULTS Eighteen percent of participants endorsed using medical cannabis for pain. No significant differences were detected on pain-related variables, depression, or anxiety between those who endorsed medical cannabis use and those who did not. Medical cannabis users had higher scores of risk for prescription opioid misuse (median=17.0 vs. 11.5, p<0.001), rates of hazardous alcohol use (25% vs. 16%, p<0.05), and rates of nicotine use (42% vs. 26%, p=0.01). Multivariable analyses indicated that medical cannabis use was significantly associated with risk of prescription opioid misuse (β=0.17, p=0.001), but not hazardous alcohol use (aOR=1.96, 95% CI=0.96-4.00, p=0.06) or nicotine use (aOR=1.61, 95% CI=0.90-2.88, p=0.11). CONCLUSION There are potential risks associated with co-occurring LTOT and medical cannabis for pain. Study findings highlight the need for further clinical evaluation in this population. Future research is needed to examine the longitudinal impact of medical cannabis use on pain-related and substance use outcomes.
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Affiliation(s)
- Shannon M. Nugent
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System,Mental Health and Clinical Neurosciences Division, VA Portland Health Care System,Department of Psychiatry, Oregon Health & Science University
| | | | - Ning X. Smith
- Kaiser Permanente Northwest Center for Health Research
| | - Steven K. Dobscha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System,Mental Health and Clinical Neurosciences Division, VA Portland Health Care System,Department of Psychiatry, Oregon Health & Science University
| | - Richard A. Deyo
- Kaiser Permanente Northwest Center for Health Research,Departments of Family Medicine, Internal Medicine, and the Oregon Institute for Occupational Health Sciences, Oregon Health & Science University,Public Health and Preventive Medicine, Oregon Health & Science University
| | - Carla A. Green
- Kaiser Permanente Northwest Center for Health Research,Public Health and Preventive Medicine, Oregon Health & Science University
| | - Benjamin J. Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System,Mental Health and Clinical Neurosciences Division, VA Portland Health Care System,Department of Psychiatry, Oregon Health & Science University
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Park JY, Wu LT. Prevalence, reasons, perceived effects, and correlates of medical marijuana use: A review. Drug Alcohol Depend 2017; 177:1-13. [PMID: 28549263 PMCID: PMC5542049 DOI: 10.1016/j.drugalcdep.2017.03.009] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/10/2017] [Accepted: 03/12/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND The use of marijuana for medical purposes is now legal in some U.S. states and other jurisdictions, such as Canada, and Israel. Despite the widespread legalization of medical marijuana globally, there is limited information on patterns and correlates of medical marijuana use (MMU). We conducted a literature review to assess prevalence, reasons, perceived effects, and correlates of MMU among adolescents and adults. METHODS We searched peer-reviewed articles in English between January 1996 and August 2016 from several databases (PubMed, Google Scholar, Embase, CINAHL, and PsycINFO) using different combinations of keywords. RESULTS A total of 25 articles met the inclusion criteria. In the U.S., national survey estimates of prescribed MMU was 1.1% among 12th graders and 17% among adults who reported past-year marijuana use. The reported prevalence of prescribed MMU ranged from <1.7% in Israeli cancer patients to 17.4% in American health care patients. The reported prevalence of self-medication with marijuana ranged from 15% in Canadian patients with chronic pain to 30% in British patients with multiple sclerosis. Pain was the most frequently endorsed reason for use. MMU appeared to provide symptom relief for a range of pain conditions, sleep disturbance, and anxiety symptoms, but it did not appear to provide sufficient relief of cluster headache symptoms. Non-medical marijuana use was a common factor associated with MMU across studies. CONCLUSION Either MMU or self-medication with marijuana was common, mainly due to pain management. Additional research is needed to evaluate temporal and causal associations of non-medical marijuana use with MMU.
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Affiliation(s)
- Ji-Yeun Park
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, BOX 3903, Durham, NC, USA.
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, BOX 3903, Durham, NC, USA; Department of Medicine, School of Medicine, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham NC, USA.
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Miller NS, Oberbarnschiedt T. Current Medical and Legal Status for Smoked “Medical Marijuana” and Addiction. Psychiatr Ann 2017. [DOI: 10.3928/00485713-20170424-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Walsh Z, Gonzalez R, Crosby K, S. Thiessen M, Carroll C, Bonn-Miller MO. Medical cannabis and mental health: A guided systematic review. Clin Psychol Rev 2017; 51:15-29. [DOI: 10.1016/j.cpr.2016.10.002] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 10/06/2016] [Accepted: 10/10/2016] [Indexed: 12/28/2022]
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Davis AK, Bonar EE, Ilgen MA, Walton MA, Perron BE, Chermack ST. Factors associated with having a medical marijuana card among Veterans with recent substance use in VA outpatient treatment. Addict Behav 2016; 63:132-6. [PMID: 27475408 DOI: 10.1016/j.addbeh.2016.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 05/24/2016] [Accepted: 07/07/2016] [Indexed: 01/06/2023]
Abstract
Psychiatric symptoms, somatic problems, and co-occurring substance use have been associated with medical marijuana consumption among civilian patients with substance use disorders. It is possible that these factors may impact Veterans' ability to engage in or adhere to mental health and substance use disorder treatment. Therefore, we examined whether psychiatric functioning, substance use, and somatic problems were associated with medical marijuana use among Veterans receiving substance use disorder and/or mental health treatment. Participants (n=841) completed screening measures for a randomized controlled trial and 67 (8%) reported that they had a current medical marijuana card. Most of these participants (78%) reported using marijuana to treat severe/chronic pain. Significant bivariate differences revealed that, compared to participants without a medical marijuana card, those with a card were more likely to be in a middle income bracket, unemployed, and they had a significantly higher number of recent days of marijuana use, synthetic marijuana use, and using sedatives prescribed to them. Additionally, a significantly higher proportion of participants with a medical marijuana card scored above the clinical cutoff for posttraumatic stress disorder (PTSD) symptoms, had significantly higher severity of sleep-related problems, and reported a higher level of pain. These findings highlight the co-occurrence of substance use, PTSD symptoms, sleep-related problems, and chronic pain among Veterans who use medical marijuana. Future research should investigate the inter-relationships among medical marijuana use and other clinical issues (e.g., PTSD symptoms, sleep, pain) over time, and potential implications of medical marijuana use on treatment engagement and response.
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Sterniczuk R, Whelan J. Cannabis use among Canadian Armed Forces Veterans. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2016. [DOI: 10.3138/jmvfh.3836] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Despite rapidly changing cannabis use regulations in Canada, including health care support for Canadian Armed Forces (CAF) Veterans, the prevalence of and reasons for cannabis use in this population have not been studied. Methods: An online 28-item anonymous survey was used to examine the prevalence of cannabis use among CAF Veterans who reported undergoing treatment of PTSD ( N=120). We aimed to estimate the prevalence of cannabis use among CAF Veterans, as well as to explore the reasons for cannabis use in this population. We also examined the relationships between cannabis use and other aspects of health in CAF Veterans, namely other substance use, PTSD symptom severity, and chronic pain severity. Results: Approximately half of the respondents reported a history of cannabis use. Of these, approximately 35.5% reported beginning cannabis use before a military-related trauma, 23% reported beginning after a traumatic event, and 42% reported beginning after release. Participants stated that they used cannabis primarily for relaxation and emotional calm, and for pain management. Only 10% reported its use specifically for PTSD-related symptoms and anxiety. Chronic cannabis users (i.e., one or more years) endorsed a greater number of cannabis abuse symptoms than acute users (i.e., one time to less than three months). Cannabis users were also more likely to use both prescription and non-prescription drugs. No relationships were found between cannabis use and military-related PTSD symptom severity or pain severity. Discussion: Cannabis use, along with other substance use, is common among CAF Veterans, and the reasons for cannabis use vary greatly. Cannabis use does not appear to have an impact on PTSD- and pain-related symptom expression; however, further study is recommended.
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Affiliation(s)
- Roxanne Sterniczuk
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John Whelan
- Whelan Psychological Services Incorporated, Halifax, Nova Scotia, Canada
- Family Studies and Gerontology, Mount St. Vincent University, Halifax, Nova Scotia, Canada
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