Prevalence and correlates of treatment utilization among adults with cannabis use disorder in the United States

Social Determinants Associated with Substance Use and Treatment Seeking in Females of Reproductive Age in the United States

Introduction: Females of reproductive age (FoRA; 15-49 years) are the demographic most likely to be diagnosed with a substance use disorder. Preventative treatment prior to or during pregnancy is critical. Stigma and social inequities can delay access to care. There is limited research examining social determinants of health (SDoH) and how they are related to substance use and treatment seeking in this demographic. Methods: We analyzed the 2016-2019 data from the United States National Survey on Drug Use and Health using multivariable logistic regression models. Statistically significant variables were conceptually linked to the Office of Disease Prevention and Health Promotion's (ODPHP's) SDoH framework's five domains. Results: From a total sample of 1,477,336 (weighted) pregnant people and 39,600,523 (weighted) FoRA, substance use was reported by 879,209 (2.14% [95% confidence interval = 2.13-2.15]). Pregnancy status was not associated with substance use or treatment seeking. Past-month substance use was associated with high educational attainment, an annual income <$20,000, a history of criminality, low religiosity, and having health insurance. Past-month treatment-seeking behavior was associated with older age, an annual income >$20,000, a history of criminality, and greater religiosity. Behavioral health support seeking in the past month was associated with some college education. Higher depression severity was associated with all the three models. Conclusions: Using the ODPHP's SDoH framework, we begin to elicit critical connections that can describe substance use and treatment-seeking practices in FoRA. We encourage additional research to inform public health, health care, behavioral health, and other support service programming.

Results of a randomized controlled trial of the cannabis eCHECKUP TO GO personalized normative feedback intervention on reducing cannabis use, cannabis consequences, and descriptive norms

BACKGROUND

The prevalence of cannabis use disorder and its negative consequences among young adults has highlighted the need for prevention and early intervention programs. However, low treatment prevalence persists due to factors such as lack of perceived need, concerns about stigma, and limited access to treatment. To address these barriers, web-based cannabis interventions have been developed, but their efficacy remain limited. This study aims to evaluate the cross-site efficacy of the Cannabis eCHECKUP TO GO program, a web-based Personalized Normative Feedback and Protective Behavioral Strategies intervention for reducing cannabis use frequency and consequences in college students with willingness to change.

METHODS

Participants were 781 students from three universities (two in Canada, one in the US) who reported using cannabis in the past month and expressed interest in reducing or engaging in safer cannabis use. The study randomly assigned them to either an experimental group that received personalized normative feedback or a control group that received information on healthy stress management. The study collected follow-up data 4 weeks after the initial intervention and measured participants' frequency of cannabis use, number of cannabis consequences, descriptive and injunctive norms at both time points.

RESULTS

The results showed no significant reductions in cannabis use or negative consequences of use. However, students who received personalized normative feedback experienced a significant reduction in descriptive norms related to cannabis use, to be more in line with actual use.

CONCLUSION

This study suggests that more targeted interventions may be necessary for university students who are already using and seeking help to reduce their use.

Associations between cannabis policies and state-level specialty cannabis use disorder treatment in the United States, 2004-2019

BACKGROUND

Cannabis use disorder (CUD) treatment prevalence decreased in the US between 2002 and 2019, yet structural mechanisms for this decrease are poorly understood. We tested associations between cannabis laws becoming effective and self-reported CUD treatment.

METHODS

Restricted-use 2004-2019 National Surveys on Drug Use and Health included people ages 12+ classified as needing CUD treatment (i.e., past-year DSM-5-proxy CUD or last/current specialty treatment for cannabis). Time-varying indicators of medical cannabis laws (MCL) with/without cannabis dispensary provisions differentiated state-years before/after laws using effective dates. Multi-level logistic regressions with random state intercepts estimated individual- and state-adjusted CUD treatment odds by MCLs and model-based changes in specialty CUD treatment state-level prevalence. Secondary analyses tested associations between CUD treatment and MCL or recreational cannabis laws (RCL).

RESULTS

Using a broad treatment need sample definition in 2004-2014, specialty CUD treatment prevalence decreased by 1.35 (95 % CI = -2.51, -0.18) points after MCL without dispensaries and by 2.15 points (95 % CI = -3.29, -1.00) after MCL with dispensaries provisions became effective, compared to before MCL. Among people with CUD in 2004-2014, specialty treatment decreased only in MCL states with dispensary provisions (aPD = -0.91, 95 % CI = -1.68, -0.13). MCL were not associated with CUD treatment use in 2015-2019. RCL were associated with lower CUD treatment among people classified as needing CUD treatment, but not among people with past-year CUD.

CONCLUSIONS

Policy-related reductions in specialty CUD treatment were concentrated in states with cannabis dispensary provisions in 2004-2014, but not 2015-2019, and partly driven by reductions among people without past-year CUD. Other mechanisms (e.g., CUD symptom identification, criminal-legal referrals) could contribute to decreasing treatment trends.

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.

Screening for cannabis use disorder among young adults: Sensitivity, specificity, and item-level performance of the Cannabis Use Disorders Identification Test - Revised

The Cannabis Use Disorders Identification Test Revised (CUDIT-R) is a widely used screening tool. However, its utility in screening for cannabis use disorder (CUD) among young adults requires further investigation. The current study evaluated the accuracy of the CUDIT-R in distinguishing between young adults with and without CUD. We also examined the individual item properties of the CUDIT-R in this sample. A community sample of young adults (N = 153, ages 19-26 years) who reported at least one lifetime period of regular cannabis use (i.e., twice or more per month for at least six months) completed the CUDIT-R and the Structured Clinical Interview for DSM-5 (SCID-5) Substance Use Module. The CUDIT-R showed good accuracy in distinguishing between young adults with and without CUD as determined by the SCID-5 (area under the receiver operating characteristic curve = 0.84). A cut-point of nine yielded 87.80 % sensitivity and 70.42 % specificity, with positive and negative predictive values of 77.42 % and 83.33 %, respectively. Item response theory analyses revealed that CUDIT-R items assessing impaired control, failure to meet expectations, time devoted to use, and memory and concentration problems displayed high discrimination and were relatively difficult, whereas items assessing frequency of use and attempts to reduce use showed moderate discrimination and relatively low difficulty. Items assessing hours high and use with potential for physical hazard displayed poor discrimination. The CUDIT-R appears to validly distinguish between young adults with and without CUD and may be useful in screening for CUD in this high-risk population. Further research considering individual item properties is needed to refine the CUDIT-R for use among young adults.

Neurophysiological error processing and addiction self-awareness correlates of reduced insight in cannabis use disorder

BACKGROUND AND AIMS

Cannabis use disorder (CUD) prevalence has increased, while perceived risks of cannabis use and CUD treatment need have decreased. Chronic cannabis use may also impair the neural and behavioral mechanisms of insight, further hampering treatment-seeking. This study aimed to measure whether CUD is characterized by reduced self-monitoring in drug-related contexts (objectively-assessed insight), subserved by functional neural abnormalities in error-processing and manifested clinically as decreased awareness of the need to change.

DESIGN

Case-control laboratory study was used.

SETTING

University setting was in Alabama, USA.

PARTICIPANTS

There were 42 CUD participants and 47 age-, sex-, and nicotine use-matched controls.

MEASUREMENTS

Participants completed a probabilistic choice task, adapted for the first time for CUD, in which they selected pleasant, unpleasant, neutral, and cannabis-related images according to their preference. Reduced versus accurate insight was operationalized as the correspondence between self-reported and actual most chosen image type. Neurophysiological error-processing during an inhibitory control task was recorded using electroencephalography. Participants with CUD completed measures of cannabis problem recognition and motivation to change.

FINDINGS

Compared with controls, the CUD group made significantly more cannabis selections on the choice task (mean difference [MD] = 8.11, 95% confidence interval [CI] [4.88 11.35], p < 0.001) and had significantly reduced insight into cannabis choice (odds ratio [OR] = 9.69, 95% CI [1.06 88.65], p = 0.04). CUD participants with reduced insight on the choice task had significantly decreased neurophysiological reactivity to errors on the inhibitory control task (error-related negativity) compared with CUD participants with accurate insight (MD = 2.64 μV, 95% CI [0.74 μV 4.54 μV], p = 0.008) and controls (MD = 4.05 μV, 95% CI [1.29 μV 6.80 μV], p = 0.005). Compared with CUD participants with accurate insight on the choice task, CUD participants with reduced insight reported significantly less agreement that they had a cannabis problem (MD = -5.06, 95% CI [-8.49-1.62], p = 0.003).

CONCLUSIONS

People with CUD who show reduced insight on a drug-related choice task may also have decreased early neural error-processing and less cannabis problem recognition.

Cannabis Use Among U.S. Military Veterans Following Residential Substance Use Disorder Treatment

INTRODUCTION

Use rates of cannabis, a substance associated with a host of comorbid physical and mental health concerns, continue to rise for military veterans. Despite this prevalence, descriptive patterns of use among veterans and research on treatment factors that predict cannabis outcomes are lacking. This study aimed to conduct a descriptive profile of veterans who endorse cannabis use, compare veterans endorsing cannabis use to those who do not endorse use, and investigate what factors (other substance use, psychiatric symptoms, and treatment outcomes) predicted return to cannabis use following residential treatment.

MATERIALS AND METHODS

The study was a secondary data analysis of a longitudinal sample of U.S. military veterans (N = 200, 193 males, Mage = 50.14, SD = 9) participating in residential substance use disorder treatment through a Veterans Affairs medical center. Interview, survey, and electronic health data were collected over 12 months. Analyses included descriptive and frequency statistics to identify patterns in cannabis use behaviors and motives, independent t-tests to examine differences between the cannabis-using group and non-using group, and a series of univariate logistic regressions to examine potential predictors for cannabis use after treatment discharge.

RESULTS

Lifetime cannabis use was common among veterans (77.5%), and 29.5% reported use during the study. On average, veterans had made one quit attempt before treatment entry. Veterans who endorsed cannabis use consumed more alcohol in the past 30 days at baseline and reported less impulse control and less confidence in maintaining abstinence at discharge. Length of stay in the residential program and no diagnosis of Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV cannabis use disorder criteria predicted post-treatment cannabis use such that veterans who remained in the program longer were more likely to abstain from cannabis use following treatment, and those who did not meet DSM-IV cannabis use disorder criteria were more likely to use following treatment.

CONCLUSIONS

Identification of relevant risk factors and treatment processes, such as impulse control, confidence in treatment, and length of stay in treatment, provides practical recommendations for future intervention efforts. This study calls for further examination of cannabis use outcomes among veterans, particularly those participating in substance use treatment.

Cannabis use disorder, suicide attempts, and self-harm among adolescents: A national inpatient study across the United States

BACKGROUND

Suicide is among the top three causes of adolescent mortality. There is a scarcity of research examining cannabis use and suicidal behavior in adolescents.

OBJECTIVES

To determine the association between cannabis use disorder (CUD) and suicide attempt/self-harm in a hospitalized sample of adolescents.

METHODS

We conducted a cross-sectional observation study using data from the Nationwide Inpatient Sample collected over four years from January 1, 2016, through December 31, 2019. We included adolescents aged 10-19 hospitalized during the above period (N = 807,105). The primary outcome was suicide attempt/self-harm and the main predictor was CUD. The International Classification of Diseases Tenth Revision (ICD 10) diagnostic codes was used to identify a diagnosis of CUD, suicide attempt/self-harm, and other diagnoses included in the analyses. Adolescents diagnosed with CUD (n = 53,751) were compared to adolescents without CUD (n = 753,354). Univariate and multivariate logistic regressions were conducted to determine the association between CUD and suicide attempts/self-harm.

RESULTS

807,105 adolescent hospitalizations were analyzed, of which 6.9% had CUD. Adolescents with CUD were more likely to be older (17 years vs. 15 years), female (52% vs. 48%), have depression (44% vs. 17%), anxiety (32% vs. 13%), an eating disorder (1.9% vs. 1.2%), ADHD (16.3% vs. 9.1%), Conduct Disorder (4.1% vs. 1.3%), Alcohol Use Disorder (11.9% vs. 0.8%), Nicotine Use Disorder (31.1% vs. 4.1%), Cocaine Use Disorder (5.4% vs. 0.2%), Stimulant Use Disorder (0.8% vs. 0.4%) and report suicide attempts/self-harm (2.8% vs. 0.9%) [all ps<0.001]. After adjusting for potential confounders, CUD was associated with a higher risk of suicide attempts/self-harm (OR = 1.4, 95% CI 1.3-1.6, p <0.001). Post-hoc analyses showed the presence of depression moderated the association between CUD and suicide attempts/self-harm in that adolescents with CUD and depression had 2.4 times the odds of suicide attempt/self-harm compared to those with CUD but no depression after controlling for potential confounders (p<0.001).

CONCLUSIONS

Our study provides evidence for the association between CUD and suicide risk among hospitalized adolescents and underscores the importance of recognizing and addressing co-occurring mental and substance use disorders along with CUD to mitigate suicide risk. Identifying high-risk adolescents in inpatient settings provides an opportunity for intervention.

A randomized controlled trial of brief intervention for patients with cannabis use disorder

Objectives

Effective interventions for cannabis use disorders are fairly limited. The present randomized controlled trial (RCT) aimed to compare the reduction in cannabis use (number of days cannabis used) with brief intervention and simple advice in patients with cannabis use disorder.

Materials and Methods

This non-blinded and parallel two-group RCT included 100 male patients with cannabis use disorder. A semi-structured pro forma and severity of dependence scale (SDS) were used. Participants were then randomized to either of the two arms (brief intervention and simple advice) in a 1:1 ratio. Cannabis use patterns and SDS scores were assessed over the phone at week 4, week 8, and week 12.

Results

The two groups were comparable in sociodemographics and cannabis use characteristics. Participants in both groups were using cannabis for 30 days in the past month before enrolment. The brief intervention group had a lesser number of days of cannabis use vis-a-vis the simple advice group at 4, 8, and 12 weeks. There was a significant time effect for change in SDS scores (F = 30.629, P < 0.001), but the group effect was not significant (F = 0.379, P = 0.541).

Conclusion

In this population of regular cannabis users, brief intervention may be useful in reducing cannabis usage. It can be integrated into routine assessments and management of those with regular use of cannabis.

Recreational cannabis legalization alters associations among cannabis use, perception of risk, and cannabis use disorder treatment for adolescents and young adults

OBJECTIVE

Understanding how recreational cannabis legalization may impact cannabis use disorder (CUD) among adolescents and young adults is key to developing an appropriate public health response. This research investigates whether associations among adolescent and young adult perception of risk of harm from cannabis use, prevalence of past-month cannabis use, and rate of CUD treatment admissions changed following recreational cannabis legalization in the US, 2008-2019.

METHODS

Data from the NSDUH and TEDS-A datasets are employed in difference-in-differences models of the effect of recreational legalization on perception of risk, cannabis use prevalence, and CUD treatment admissions. Moderated models test whether associations among variables changed following recreational legalization.

RESULTS

Following recreational legalization: 1) adolescent and young adult past-month cannabis use prevalence increased; 2) among both adolescents and young adults, the association of lower perception of risk of harm with higher cannabis use prevalence was strengthened; 3) among adolescents, the association of higher cannabis use prevalence with higher CUD treatment admissions was suppressed; and 4) among young adults, an association of higher cannabis use prevalence with lower CUD treatment admissions emerged.

CONCLUSIONS

Recreational legalization is likely to increase cannabis use among adolescents and young adults who perceive cannabis as less harmful, while at the same time reduce rates of CUD treatment utilization. These trends portend an increase in unmet need for CUD treatment for age groups particularly vulnerable to the development and negative consequences of CUD.

Cannabis use disorder in relation to socioeconomic factors and psychiatric comorbidity: A cluster analysis of three million individuals born in 1970-2000

BACKGROUND

Cannabis use disorder (CUD) is one of the main reasons for seeking substance use treatment. It is thus important to monitor and increase knowledge of individuals with CUD utilizing healthcare. We aimed to examine the number of CUD diagnoses over time, compare individuals with CUD with those without and identify subgroups based on CUD diagnosis, sex, birth year, socioeconomic factors and psychiatric comorbidity.

METHODS

A Swedish, population-based study with 3,307,759 individuals, born in 1970-2000, with register data extending to 2016. K-mode cluster analysis was used to identify potential subgroups.

RESULTS

The number of individuals with a CUD diagnosis was 14,046 (0.42%). CUD diagnoses increased over time (born 1990-1994: 61 per 100,000, born 1995-2000: 107 per 100,000, by 2016). A majority of those with a CUD had another psychiatric diagnosis (80%, compared with 19% for those without CUD). Four clusters were identified. Cluster 1 comprised mainly men with low income and substance use disorders, clusters 2, 3 and 4 comprised mainly women with higher proportions of mood-related, neurotic and stress-related and behavioural disorders.

CONCLUSIONS

There was an increase in CUD diagnoses in Sweden over time, especially among younger birth cohorts. Individuals with CUD were more often male, from younger birth cohorts, with lower education and income than those without CUD. Men and women with CUD exhibited differences in education, income and psychiatric comorbidity. Our results demonstrate the importance of monitoring the impact of socioeconomic factors and psychiatric comorbidity in relation to CUD.

SEXUALITY OF MEN EXPERIENCING INTESTINAL OSTOMIES: STORIES ABOUT FEELINGS AND MEANINGS

Objective: To apprehend the feelings and meanings about the sexuality of adult men with intestinal ostomies. Method: Thirty adult men with stomas participated of a qualitative, historical-analytical and comprehensive exploratory study. Data were obtained from interviews, followed by analysis anchored in thematic oral history, and data interpretation based on Ágnes Heller’s theory of feelings. Results: It has been shown that adult men with intestinal ostomies experience multiple feelings related to their sexuality, including impulsive, emotional, affective, and orienting feelings. Conclusion: The relevance of specialized and multidisciplinary care is highlighted to better meet the demands of sexual health, which is intertwined with psychic-social health, of men with stomas.

SEXUALIDADE DE HOMENS EM VIVÊNCIA DE ESTOMIAS INTESTINAIS: HISTÓRIAS SOBRE SENTIMENTOS E SIGNIFICADOS

Objetivo:Apreender os sentimentos e significados acerca da sexualidade de homens adultos com estomias intestinais. Método: Estudo qualitativo, histórico-analítico e compreensivo-exploratório no qual participaram 30 homens adultos estomizados. Os dados foram obtidos de entrevistas, seguidas de análise ancorada na história oral temática e interpretação dos dados com base na teoría de los sentimientos, de Ágnes Heller. Resultados: Demonstrou-se que homens adultos com estomias intestinais vivenciam múltiplos sentimentos vinculados à sua sexualidade, entre eles sentimentos impulsivos, emocionais, afetivos e orientativos. Conclusão: Salienta-se a relevância de uma assistência especializada e multidisciplinar para melhor atender às demandas de saúde sexual, que se entrelaça com a saúde psíquico-social, dos homens com estomia

Classifying risky cannabis involvement in young adults using the Marijuana Consequences Questionnaire (MACQ)

BACKGROUND

Despite the growing prevalence of cannabis use and associated consequences among U.S. young adults, relatively little is known about precisely what level of marijuana involvement may be problematic.

METHOD

With this study we sought to identify empirically-derived cut-scores for the Marijuana Consequences Questionnaire (MACQ) that would distinguish among levels of cannabis risk in a sample of young adult college students (N = 496). We also examined how these levels of cannabis risk corresponded to a variety of indicators of cannabis involvement, including frequency of use, intoxication, other measures of cannabis consequences, and indicators of more severe cannabis involvement (e.g., physiological dependence, loss of control over use, cannabis use disorder).

RESULTS

Receiver operating characteristic analyses yielded cutoffs that distinguished among three distinct levels of risk, "Low", "Moderate", and "High". These empirically derived cut scores showed strong overall differentiation among classifications, with good sensitivity and specificity. MACQ-based risk levels were validated across several indices of cannabis involvement. Cutoffs differed across genders.

CONCLUSIONS

Findings offer a new application for the MACQ, allowing for the identification of those at greatest risk. As such, this measure may be used to facilitate appropriately targeted intervention.

Disparities in functioning from alcohol and cannabis use among a racially/ethnically diverse sample of emerging adults

BACKGROUND

Trajectory studies have consistently shown that alcohol and cannabis (AC) use during emerging adulthood (EA) affect functioning; however, few studies examine whether racial/ethnic disparities may occur at similar levels of use.

METHODS

We conducted web-based surveys across five waves from mean age 18.3 through 22.6. The sample (N = 2945) is 55% female, 46% Hispanic, 23% Asian, 23% White, 6% multi-racial (MR)/other, and 2% Black.

MEASUREMENTS

Past month substance use was defined as number of days used. Outcomes at age 22.6 included negative consequences, delinquency, physical ailments and health, depression and anxiety, peer relationship functioning, life satisfaction, employment, and education.

RESULTS

Compared to White EAs, Hispanic, Asian, and MR/other EAs reported less initial alcohol use; Hispanic and Asian EAs reported less initial cannabis use, whereas Black EAs reported more cannabis use. Greater initial frequency and increased frequency of AC use were associated with poorer outcomes (e.g., worse mental health). In terms of disparities, compared to White EAs, Hispanic EAs reported poorer physical health at the same levels of AC use; Hispanic, Asian, and MR/other EAs reported greater alcohol consequences and delinquency; Black, Hispanic, Asian and MR/other EAs reported lower life satisfaction; and Hispanic and MR/other EAs were less likely to pursue education beyond high school (although Asian EAs were more likely).

CONCLUSIONS

Findings emphasize that trajectories of AC use during EA are associated with a range of functional outcomes. Disparities in functioning at similar levels of AC use highlight the importance of reaching racially/ethnically diverse EAs with prevention and intervention programming.

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.

Cannabis Use Disorder in the Setting of Primary Total Hip Arthroplasty: Understanding the Epidemiology, Demographic Characteristics, and Inpatient Postoperative Outcomes

INTRODUCTION

Cannabis use is expected to increase in the context of its decriminalization and legalization in several states. The purpose of this study was to report on the epidemiologic and demographic characteristics and inpatient postoperative outcomes of patients with cannabis use disorder (CUD) undergoing primary total hip arthroplasty (THA).

METHODS

The National Inpatient Sample registry was used to identify patients undergoing THA between 2006 and 2015. Patients were stratified into groups with and without CUD. Epidemiology, comorbidity, and outcomes data were comparatively analyzed between these two groups.

RESULTS

A total of 2,838,742 THAs were performed during the study period. The prevalence of CUD significantly increased from 0.10% in 2006 to 0.39% in 2015 (P < 0.0001). Patients with CUD were significantly younger, more likely to be male, had higher rates of Medicaid insurance and were more likely to be non-Hispanic Black and less likely to be non-Hispanic White when compared with the control group. When comparing patients with and without CUD, there was no significant difference in the composite any complication variable and no significant difference in seven of eight individual in-hospital complications assessed, with the exception being higher genitourinary complications in the CUD group. There were no significant differences in discharge disposition or length of stay.

DISCUSSION

Although CUD is significantly associated with various demographic, comorbidity, and hospital characteristics, it is not significantly associated with in-hospital complications, discharge disposition, and length of stay outcomes in the immediate in-hospital, postoperative period. It is critical for clinicians and public health professionals to understand the characteristics and expected inpatient outcomes of this evolving population of patients with CUD undergoing THA, particularly in the context of widespread legalization.

LEVEL OF EVIDENCE

Level III.

Predictors of no, low and frequent emergency department use for any medical reason among patients with cannabis-related disorders attending Quebec (Canada) addiction treatment centres

INTRODUCTION

Patients with substance-related disorders and mental disorders (MD) contribute substantially to emergency department (ED) overcrowding. Few studies have identified predictors of ED use integrating service use correlates, particularly among patients with cannabis-related disorders (CRD). This study compared predictors of low (1-2 visits/year) or frequent (3+ visits/year) ED use with no ED use for a cohort of 9836 patients with CRD registered at Quebec (Canada) addiction treatment centres in 2012-2013.

METHODS

This longitudinal study used multinomial logistic regression to evaluate clinical, sociodemographic and service use variables from various databases as predictors of the frequency of ED use for any medical reason in 2015-2016 among patients with CRD.

RESULTS

Compared to non-ED users with CRD, frequent ED users included more women, rural residents, patients with serious MD and chronic CRD, dropouts from programs in addiction treatment centres and with less continuity of physician care. Compared with non-users, low ED users had more common MD and there more workers than students.

DISCUSSION AND CONCLUSIONS

Multimorbidity, including MD, chronic physical illnesses and other substance-related disorders than CRD, predicted more ED use and explained frequent use of outpatient services and prior specialised acute care, as did being 12-29 years, after controlling for all other covariates. Better continuity of physician care and reinforcement of programs like assertive community or integrated treatment, and chronic primary care models may protect against frequent ED use. Strategies like screening, brief intervention and treatment referral, including motivational therapy for preventing treatment dropout may also be expanded to decrease ED use.

College students' receptiveness to intervention approaches for alcohol and cannabis use

OBJECTIVE

Addressing high-risk alcohol and cannabis use represent major challenges to institutions of higher education. A range of evidence-based treatment approaches are available, but little is known concerning students' receptiveness to such approaches. Prior work identified that students were most open to individual therapy and self-help options for reducing alcohol use, but less open to medication. The current study examines student receptiveness to intervention approaches across a wider range of intervention approaches (e.g., remote/telehealth), and extends to evaluate cannabis intervention receptiveness.

METHOD

Undergraduate students reported on alcohol and cannabis use, motives for and reasons against use, and openness to an array of interventions for reducing alcohol and cannabis use.

RESULTS

Informal options (self-help, talking with family/friends), individual therapy, and appointments with a primary care provider (PCP) were endorsed most frequently. Group therapy and medication were less commonly endorsed, though medication was endorsed at a higher prevalence than in prior studies. Women generally expressed higher receptiveness than men. Lower alcohol consumption was associated with increased receptiveness to some approaches. Students at high risk for alcohol and/or cannabis dependence were less receptive to many treatment options.

CONCLUSIONS

College students were open to a wide variety of approaches for reducing their alcohol and cannabis use. These results can inform selection, implementation, and availability of campus-wide services, especially as low-cost technological-based approaches are expanding. Further attention to existing services (e.g., PCP) for addressing alcohol and cannabis use may be considered, given students' receptiveness to such approaches. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Racial and Ethnic Differences in Cannabis Use and Cannabis Use Disorder: Implications for Researchers

PURPOSE

Heavy and prolonged use of cannabis is associated with several adverse health, legal and social consequences. Although cannabis use impacts all U.S. racial/ethnic groups, studies have revealed racial/ethnic disparities in the initiation, prevalence, prevention and treatment of cannabis use and Cannabis Use Disorder (CUD). This review provides an overview of recent studies on cannabis and CUD by race/ethnicity and a discussion of implications for cannabis researchers.

FINDINGS

The majority of studies focused on cannabis use and CUD among African American/Black individuals, with the smallest number of studies found among Native Hawaiians/Pacific Islanders. The limited number of studies highlight unique risk and protective factors for each racial/ethnic group, such as gender, mental health status, polysubstance use and cultural identity.

SUMMARY

Future cannabis studies should aim to provide a deeper foundational understanding of factors that promote the initiation, maintenance, prevention and treatment of cannabis use and CUD among racial/ethnic groups. Cannabis studies should be unique to each racial/ethnic group and move beyond racial comparisons.

Profiles of individuals with cannabis-related disorders

Background: Profiles of individuals with cannabis-related disorders (CRD) in specialized addiction treatment centers serving high-need patients have not been identified. This longitudinal study developed a typology for 9,836 individuals with CRD attending Quebec (Canada) addiction treatment centers in 2012-2013. Methods: Data on sociodemographic, clinical and service use variables were extracted from several databases for the years 1996-1997 to 2014-2015. Individual profiles were produced using Latent Class Analysis and compared predicting health outcomes on emergency department (ED) use, hospitalizations and suicidal behaviors for 2015-2016. Results: Six profiles were identified: 1-Older individuals, many living in couples and working, with moderate health problems, receiving intensive general practitioner (GP) care and high continuity of physician care; 2-Older individuals with chronic CRD, multiple social and health problems, and low health service use (chronic CRD referred to experiencing CRD for several years; social problems related to homelessness, unemployment, having criminal records or living alone); 3-Students with few social and health problems, and low health service use; 4-Young adults, many working, with few health problems, least health service use and continuity of physician care; 5-Youth, many working but some criminal offenders, with 1 or 2 years of CRD, few health problems and high addiction treatment center use; and 6-Older individuals with chronic CRD and multiple social and health problems, high health service use and continuity of physician care. Profiles 6 and 2 had the worst health outcomes. Conclusions: For Profiles 2 to 5, outreach and motivational services should be prioritized, integrated health and criminal justice services for profile 5 and, for Profiles 2 and 6, assertive community treatments. Screening, brief intervention and referrals to addiction treatment centers may also be encouraged for individuals with CRD, particularly those in Profile 2. This cohort had high social and health needs relative to services received, suggesting continued need for care.

Comparing Cannabis Use Disorder in the General Population with Cannabis Treatment Seekers Using Multi-Source National Datasets: Who Receives Treatment?

INTRODUCTION

Given the increased prevalence of cannabis use in Ireland and increase in cannabis potency, this study aimed to estimate the size of the potential population in Ireland that may be in need of cannabis treatment and the percentage of people with cannabis use disorder (CUD) who actually access treatment. We also compared the profile of those with CUD in the general population to those who receive treatment for their cannabis use to explore whether certain subgroups are more or less likely to enter treatment.

METHOD

This was a retrospective, multi-source database study. Data were obtained from (1) Ireland's 2014/2015 national general population survey (GPS) on drug use and (2) treatment data from the Irish National Drug Treatment Reporting System (NDTRS) for 2015. The profiles of GPS cases with CUD and NDTRS cases were compared using 2-sided t tests designed for independent samples.

RESULTS

The prevalence of last year cannabis use among adults aged 15 and older was 6.5% and the prevalence of CUD was 2.6%, representing 94,515 of the Irish population. A total of 4,761 cases entered treatment for problem cannabis use. NDTRS treatment cases were significantly more likely than GPS cases to be unemployed (63.7% vs. 26.6%) and have no or primary level only educational attainment (56.3% vs. 21.2%). Over half (53.3%) of NDTRS cases first used cannabis before the age of 15 years, compared to 14.7% of CUD cases in the population.

DISCUSSION/CONCLUSION

Our findings suggest that earlier users and those with more complex or disadvantaged lives are more likely to seek treatment. A broad population health approach that engages multiple sectors such as health, social welfare, and education is recommended to ensure that there is increased opportunity for people with CUD to be identified and signposted towards treatment.

Frequencies of emergency department use and hospitalization comparing patients with different types of substance or polysubstance-related disorders

Background

This study measured emergency department (ED) use and hospitalization for medical reasons among patients with substance-related disorders (SRD), comparing four subgroups: cannabis-related disorders, drug-related disorders other than cannabis, alcohol-related disorders and polysubstance-related disorders, controlling for various clinical, sociodemographic and service use variables.

Methods

Clinical administrative data for a cohort of 22,484 patients registered in Quebec (Canada) addiction treatment centers in 2012-13 were extracted for the years 2009-10 to 2015-16. Using negative binomial models, risks of frequent ED use and hospitalization were calculated for a 12-month period (2015-16).

Results

Patients with polysubstance-related disorders used ED more frequently than other groups with SRD. They were hospitalized more frequently than patients with cannabis or other drug-related disorders, but less frequently than those with alcohol-related disorders. Patients with alcohol-related disorders used ED more frequently than those with cannabis-related disorders and underwent more hospitalizations than both patients with cannabis-related and other drug-related disorders. Co-occurring SRD-mental disorders or SRD-chronic physical illnesses, more years with SRD, being women, living in rural territories, more frequent consultations with usual general practitioner or outpatient psychiatrist, and receiving more interventions in community healthcare centers increased frequency of ED use and hospitalization, whereas both adverse outcomes decreased with high continuity of physician care. Behavioral addiction, age less than 45 years, living in more materially deprived areas, and receiving 1-3 interventions in addiction treatment centers increased risk of frequent ED use, whereas living in semi-urban areas decreased ED use. Patients 25-44 years old receiving 4+ interventions in addiction treatment centers experienced less frequent hospitalization.

Conclusion

Findings showed higher risk of ED use among patients with polysubstance-related disorders, and higher hospitalization risk among patients with alcohol-related disorders, compared with patients affected by cannabis and other drug-related disorders. However, other variables contributed substantially more to the frequency of ED use and hospitalization, particularly clinical variables regarding complexity and severity of health conditions, followed by service use variables. Another important finding was that high continuity of physician care helped decrease the use of acute care services. Strategies like integrated care and outreach interventions may enhance SRD services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13011-021-00421-7.

Drug and alcohol treatment utilization and barriers among Black, American Indian/Alaskan Native, Latine, Asian/Pacific Islander/Native Hawaiian, and White adults: Findings from NESARC-III

BACKGROUND

Existing epidemiological data suggest differences across racial/ethnic groups in drug and alcohol treatment utilization and barriers to treatment and typically include only Black, Latine, and White adults. The objective of this study was to examine whether disparities remain for DSM-5 lifetime alcohol use disorder (AUD) and drug use disorder (DUD) treatment utilization and barriers across Black, American Indian/Alaska Native (AI/AN), Latine, Asian/Pacific Islander/Native Hawaiian (Asian/PI/NH), and White adults.

METHODS

The current study conducted secondary analyses on data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III). Regression analyses, followed by pairwise comparisons, investigated differences across racial/ethnic groups.

RESULTS

Analyses indicated differences across racial/ethnic groups in AUD treatment utilization. White and AI/AN adults were more likely to utilize a health care professional than were Black adults. Asian/PI/NH and Latine adults were more likely to endorse language as a barrier to AUD treatment than were White adults. Black adults were more likely to use 12-step programs for DUD treatment utilization than were White and Latine adults, and Black and White adults were more likely to use outpatient programs than were Latine adults. Further, Black adults were more likely than Asian/PI/NH and Latine adults to use specialty DUD treatment. AI/AN, Asian/PI/NH, and White adults were more likely to endorse fear of what others would think as a barrier to DUD treatment relative to Black adults. AI/AN adults were more likely to endorse fear of being hospitalized relative to Black, Latine, and White adults. Asian/PI/NH and Latine adults were more likely to indicate that the hours were inconvenient relative to Black and White adults. White adults were more likely to endorse a family member objected relative to Black adults. AI/AN and White adults were more likely to endorse they stopped on their own relative to Black, Asian/PI/NH, and Latine adults. Further, AI/AN and White adults reported the greatest number of barriers to DUD treatment.

CONCLUSIONS

Differences remain across racial/ethnic group in drug and alcohol treatment utilization and barriers to treatment. Future research aimed at increasing treatment utilization across racial/ethnic groups should focus on social determinants of health.

Sensitivity and specificity of the CRAFFT to identify heavy cannabis use: Evidence from a large statewide adolescent sample

BACKGROUND AND AIM

Screening adolescents at risk for cannabis use disorders is critical. The CRAFFT is a screening tool designed to address both alcohol and drug use among youth. Current study tests the psychometric properties of the CRAFFT and attempts to modify one of the screening items to compare the efficiency.

DESIGN

We examined the ideal cut-off point of the CRAFFT for identifying persons with heavy cannabis use and compared the utility of the original and revised CRAFFT.

PARTICIPANTS

Sample (N = 132,555) averaged 16.19 (±1.21) years of age; 51.0% were female, 59.7% were White, 15.2% were Latino/Latina, and 6.7% were African-American. Majority resided in non-rural area and 34.5% were receiving free or reduced lunch at school.

MEASUREMENTS

Heavy cannabis use was defined as using cannabis 10 or more times in the past 30 days. Sensitivity, specificity, the area under the receiver operating characteristic curve, and Youden value were analyzed to determine the ideal cut-off point.

FINDINGS

Maximum overall predictive accuracy was at a cutoff score of 2 or higher when using the original CRAFFT questions. At a cutoff score of 2, sensitivity was 82.0%, specificity was 83.7%, with an AUC of 0.880. On the contrary, when an alternative CAR question was used, maximum predictive accuracy was at a cutoff score of 1 or higher when predicting heavy cannabis use. At a cutoff score of 1, sensitivity was 92.7%, specificity was 75.5%, with an AUC of 0.900.

CONCLUSIONS

The results provide evidence that the CRAFFT is a promising brief diagnostic instrument for heavy cannabis use among youth. Modification to Car item may have potential in reducing disparities in sensitivity among different racial ethnic groups, as well as those who with low socioeconomic status.

Cannabis-induced oceanic boundlessness

BACKGROUND

Despite tetrahydrocannabinol (THC)'s reputation for creating dramatic effects at high doses, empirical work rarely addresses cannabis's impact on subjective responses common to the tryptamine psychedelics. We focused on these effects because they have preceded and covaried with the therapeutic impact of psilocybin in previous work.

AIMS

The current study examined if self-reported responses to cannabis products might parallel those found in clinical trials of psilocybin administration. We also investigated if measures of demographics and cannabis use might correlate with these responses.

METHODS

Participants reported the subjective effect of their highest THC experience using 27 items that assess oceanic boundlessness, a correlate of mystical experiences. They also answered infrequency items and questions on demographics and cannabis consumption.

RESULTS

In an effort to address concerns about replication, we divided respondents who passed infrequency items into two random samples. Self-reported "breakthrough" experiences were significantly greater than zero but significantly lower than those reported in randomized clinical trials of psilocybin (17-19% vs. 59%). Total scores covaried with perceived dosages of THC, but only in one sample. Heavier users of cannabis reported lower scores.

CONCLUSIONS

Self-report data suggest that high doses of cannabis can create subjective effects comparable to those identified in trials of psilocybin that precede relief from cancer-related distress, treatment-resistant depression, alcohol problems, and cigarette dependence. Given the disparate mechanisms of action, comparing THC-induced to psilocybin-induced effects might improve our understanding of the mechanisms underlying subjective experiences. This work might also support the development of a cannabis-assisted psychotherapy comparable to psilocybin-assisted psychotherapy.

Precision Mental Health Care for Cannabis Use Disorder: Utility of a bioSocial Cognitive Theory to Inform Treatment

Globally, cannabis is the most frequently used controlled substance after alcohol and tobacco. Rates of cannabis use are steadily increasing in many countries and there is emerging evidence that there is likely to be greater risk due to increased concentrations of delta-9-tetrahydrocannabinol (THC). Cannabis use and Cannabis Use Disorder (CUD) has been linked to a wide range of adverse health outcomes. Several biological, psychological, and social risk factors are potential targets for effective evidence-based treatments for CUD. There are no effective medications for CUD and psychological interventions are the main form of treatment. Psychological treatments based on Social Cognitive Theory (SCT) emphasize the importance of targeting 2 keys psychological mechanisms: drug outcome expectancies and low drug refusal self-efficacy. This mini-review summarizes the evidence on the role of these mechanisms in the initiation, maintenance, and cessation of cannabis use. It also reviews recent evidence showing how these psychological mechanisms are affected by social and biologically-based risk factors. A new bioSocial Cognitive Theory (bSCT) is outlined that integrates these findings and implications for psychological cannabis interventions are discussed. Preliminary evidence supports the application of bSCT to improve intervention outcomes through better targeted treatment.

Associations of cannabis use frequency and cannabis use disorder with receiving a substance use screen and healthcare professional discussion of substance use

BACKGROUND AND OBJECTIVES

Screening, brief intervention, and referral to treatment (SBIRT) can reduce substance use, but receipt of these services by those who use cannabis frequently and have cannabis use disorder (CUD) remains unexplored. We examined cannabis use frequency and CUD's associations with the odds of receiving a substance use screening and a healthcare professional discussion among those who used healthcare services.

METHODS

Data came from the 2015-2019 National Survey on Drug Use and Health (N = 214,505 aged 18+). Among adults who used cannabis and attended healthcare settings in the past year (N = 36,374), multivariable logistic regression analysis was used to examine associations of cannabis use frequency and CUD with receiving a substance use screen and substance use discussion by a healthcare professional.

RESULTS

Cannabis use frequency was associated with higher odds of receiving a screen (adjusted odds ratio [AOR] = 1.27, 95% confidence interval [CI] = 1.14-1.41 for 300+ days of use) and a discussion among those screened (AOR = 1.83, 95% CI = 1.60-2.09 for 300+ days of use). CUD was not associated with receiving a screen, but it was positively associated with receiving a discussion among those screened (AOR = 1.22, 95% CI = 1.08-1.39). Nonmedical users were less likely to have a discussion among those screened and not screened.

DISCUSSION AND CONCLUSIONS

Findings indicate disparities in screening and discussion of substance use with patients, especially between medical and nonmedical users.

SCIENTIFIC SIGNIFICANCE

Study findings provide novel insight into differences in the reach of SBIRT services among adult cannabis users.

Reaching nontreatment-seeking cannabis users: Testing an extended marijuana check-up intervention

Some adult cannabis users report negative consequences of use but do not seek treatment. Nonjudgmental, brief interventions incorporating motivational interviewing techniques may be able to reach users who otherwise would not seek treatment and increase their motivation to change use. Previous studies have shown brief interventions with this population are efficacious in reducing use, but the absolute amount of change has not clearly translated into meaningful reductions in associated negative consequences. The current study used a marijuana check-up (MCU) model to attract nontreatment-seeking adults who used cannabis at levels that may have caused negative consequences. The study randomly assigned participants to 2-session (n = 93) and 6-session (n = 93) versions of the intervention and followed them for 12 months. The study designed the extended 6-session condition to build on the efficacy of the previously tested 2-session intervention. The study hypothesized that the opportunity to continue to consider the consequences of cannabis use would have the greatest impact on those who were in earlier stages of readiness for change. We used cognitive behavioral techniques to assist with change efforts when indicated. Results showed significant reductions in the frequency and daily duration of cannabis use at all follow-ups in both intervention conditions. The extended 6-session condition produced greater change only on a measure of the number of periods of the day in which cannabis was used. Reductions in dependence symptoms and problems related to cannabis use occurred in both conditions, but there was no effect of intervention condition. Participants who were less ready to make changes at the outset decreased use and negative consequences the least. Results suggested that some benefit of the extended session format of the check-up in reducing daily use, but the lack of a corresponding reduction in consequences suggested that the original 2-session MCU may be more cost effective.

Untapped endocannabinoid pharmacological targets: Pipe dream or pipeline?

It has been established that the endogenous cannabinoid (endocannabinoid) system plays key modulatory roles in a wide variety of pathological conditions. The endocannabinoid system comprises both cannabinoid receptors, their endogenous ligands including 2-arachidonoylglycerol (2-AG), N-arachidonylethanolamine (anandamide, AEA), and enzymes that regulate the synthesis and degradation of endogenous ligands which include diacylglycerol lipase alpha (DAGL-α), diacylglycerol lipase beta (DAGL-β), fatty acid amide hydrolase (FAAH), monoacylglycerol lipase (MAGL), α/β hydrolase domain 6 (ABHD6). As the endocannabinoid system exerts considerable involvement in the regulation of homeostasis and disease, much effort has been made towards understanding endocannabinoid-related mechanisms of action at cellular, physiological, and pathological levels as well as harnessing the various components of the endocannabinoid system to produce novel therapeutics. However, drug discovery efforts within the cannabinoid field have been slower than anticipated to reach satisfactory clinical endpoints and raises an important question into the validity of developing novel ligands that therapeutically target the endocannabinoid system. To answer this, we will first examine evidence that supports the existence of an endocannabinoid system role within inflammatory diseases, neurodegeneration, pain, substance use disorders, mood disorders, as well as metabolic diseases. Next, this review will discuss recent clinical studies, within the last 5 years, of cannabinoid compounds in context to these diseases. We will also address some of the challenges and considerations within the cannabinoid field that may be important in the advancement of therapeutics into the clinic.

Cannabis use, use frequency, and use disorder in large metropolitan, small metropolitan, and nonmetropolitan areas

BACKGROUND

Despite significant geographical heterogeneity of sociodemographic and clinical characteristics, little is known about potential differences in cannabis use behaviors in U.S. geographic areas. In this study, we examined cannabis use behaviors in large metropolitan, small metropolitan, and nonmetropolitan areas. We focused on interactions between geographic areas and health insurance status and medical cannabis laws (MCL).

METHODS

Data came from the 2015-2018 National Survey on Drug Use and Health (NSDUH; N = 171,766 adults; N = 36,175 cannabis users). Weighted chi-squares tests of independence and multivariable Poisson regression models were used to examine study questions.

RESULTS

Past-year use was highest in large metropolitan areas (16.08 %). Frequent use was highest among nonmetropolitan area users (48.67 %). Uninsured adults had a higher likelihood of past-year use (RRR = 1.21, 95 % CI = 1.14, 1.29) and frequent use (RRR = 1.27, 95 % CI = 1.14, 1.41), but a lower likelihood of cannabis use disorder (RRR = 0.77, 95 % CI = 0.66, 0.89). Uninsured adults in nonmetropolitan areas had a higher likelihood (RRR = 1.62, 95 % CI = 1.39, 1.88) of past-year use than insured nonmetropolitan area adults. MCL state residency was associated with a higher likelihood of frequent use among nonmetropolitan (RRR = 1.39, 95 % CI = 1.11, 1.74) and small metropolitan users (RRR = 1.30, 95 % CI = 1.15, 1.47). Cannabis use disorder likelihood did not vary by geographic area.

CONCLUSIONS

Lack of health insurance and MCL state residency are significant variables affecting cannabis use behaviors in small metropolitan and/or nonmetropolitan areas.

Psychosocial and pharmacological treatments for cannabis use disorder and mental health comorbidities: a narrative review

Cannabis is the most widely used illicit drug worldwide, and it is estimated that up to 30% of people who use cannabis will develop a cannabis use disorder (CUD). Demand for treatment of CUD is increasing in almost every region of the world and cannabis use is highly comorbid with mental disorders, where sustained use can reduce treatment compliance and increase risk of relapse. In this narrative review, we outline evidence for psychosocial and pharmacological treatment strategies for CUD, both alone and when comorbid with psychosis, anxiety or depression. Psychosocial treatments such as cognitive behavioural therapy, motivational enhancement therapy and contingency management are currently the most effective strategy for treating CUD but are of limited benefit when comorbid with psychosis. Pharmacological treatments targeting the endocannabinoid system have the potential to reduce cannabis withdrawal and cannabis use in CUD. Mental health comorbidities including anxiety, depression and psychosis hinder effective treatment and should be addressed in treatment provision and clinical decision making to reduce the global burden of CUDs. Antipsychotic medication may decrease cannabis use and cannabis craving as well as psychotic symptoms in patients with CUD and psychosis. Targeted treatments for anxiety and depression when comorbid with CUD are feasible.

Racial/Ethnic Differences in 30-Year Trajectories of Cannabis Use among Males

Background: Given that cannabis is the most commonly used illicit substance in the US, continuous research on patterns of cannabis use over the life course can help to ensure progress towards improving public health and reducing health inequalities across race/ethnicity. Thus, we examine racial/ethnic differences in cannabis use trajectories among males across two overlapping stages of the life course. Methods: We use data from two companion studies, the Rochester Youth Development Study (RYDS - a longitudinal cohort study that followed participants from adolescence into adulthood), and its intergenerational extension - the Rochester Intergenerational Study. For Life Stage 1, we consider cannabis use during the transition from adolescence to adulthood (spanning ages 13 to 33; 439 Black, 128 White, and 125 Hispanic males). Among these males who became fathers, we consider cannabis use during fatherhood (Life Stage 2 -spanning the period of time when their firstborn child was between the ages of 7 and 17-217 Black, 55 White, and 56 Hispanic males). Ordinal generalized estimating equations were specified to examine cannabis use trajectories during both stages of the males' lives. Results: No significant differences in cannabis use as a function of racial/ethnic group were found during the transition from adolescence to adulthood (Life Stage 1). All groups had a peak of cannabis use in the early to mid-20's followed by a decline in use. During fatherhood (Life Stage 2), cannabis use was stable for all groups, but Black fathers reported more frequent cannabis use on average than Hispanic fathers. Conclusions: The increase in cannabis use well past adolescence for all groups suggests the potential importance of intervention initiatives during the transition to adulthood. The more frequent use of cannabis by Black fathers warrants further study given the impact parental cannabis use can have on offspring.

Examining Associations Between Licensed and Unlicensed Outlet Density and Cannabis Outcomes From Preopening to Postopening of Recreational Cannabis Outlets

BACKGROUND AND OBJECTIVES

To expand on epidemiologic studies examining associations between the legalization of recreational cannabis and use among young adults, we examined the associations between licensed and unlicensed cannabis outlet density and cannabis outcomes.

METHODS

A total of 1097 young adults aged 21 and older living in Los Angeles County were surveyed before licensed recreational cannabis outlets opened (Time 1: July to December 2017) and after (Time 2: July 2018 to June 2019). Using a database of open licensed and unlicensed cannabis retailers to calculate individual-level cannabis outlet density measures, we examined associations between outlet density within a 4-mile radius of participants' residences with Time 2 outcomes of any past-month use, daily use, intentions to use, quantity used, consequences, and cannabis use disorder (CUD) symptoms.

RESULTS

After controlling for demographic factors and cannabis outcomes at a time point prior to their opening (Time 1), licensed cannabis outlets were associated with young adults' cannabis use, heavy use, and intentions, and unlicensed outlets were associated with young adults' heavy cannabis use and CUD symptoms.

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

This study expands beyond studies of outlet prevalence to find that, after controlling for outcomes 1 year prior, licensed and unlicensed outlets were associated with young adults' cannabis outcomes. The current study is among the first to find associations between cannabis use outcomes and density of cannabis outlets among young adults using data from two time points: preopening and postopening of recreational cannabis retailers. Findings can inform policies around the density and placement of cannabis outlets. (Am J Addict 2020;00:00-00).

An investigation of the relationship between glutamate and resting state connectivity in chronic cannabis users

Human and animal studies have shown that heavy cannabis (CB) use interacts with glutamatergic signaling. Additionally, recent studies have suggested that glutamate (Glu) may drive resting state functional connectivity (RSfc). The aims of the current preliminary study were to: 1) determine whether dorsal anterior cingulate cortex (dACC) Glu is related to RSfc between the dACC and two nodes of the reward network, the nucleus accumbens (NAc) and hippocampus (Hp); and 2) determine whether CB use interacts with the relationship between dACC Glu and RSfc. A group of 23 chronic CB users and 23 healthy controls participated in this multimodal MRI study. Glu levels were assessed in the dACC using magnetic resonance spectroscopy (MRS). Linear regression models were used to determine whether dACC Glu and CB use predicts RSfc between the dACC and the NAc and Hp. While the effect size is small, the results showed that the connectivity between the dACC and right NAc was predicted by the interaction between dACC Glu levels and monthly CB use. Additionally, while there is some suggestion that dACC Glu is correlated with dACC-hippocampal connectivity, unlike for dACC/NAc connectivity the relationship between them does not appear to be affected by CB use. These preliminary findings are significant in that they demonstrate the need for future studies with larger sample sizes to better characterize the relationship between resting state connectivity and neurochemistry as well as to characterize how CB use interacts with that relationship.

Trends and Related Factors of Cannabis-Associated Emergency Department Visits in the United States: 2006-2014

OBJECTIVES

To examine national trends and contributing factors of cannabis-associated emergency department visits in the United States.

METHODS

This pooled serial cross-sectional study used a hierarchical multivariable analysis on emergency department visit adjusting for year, patient and hospital characteristics. We analyzed 2006 to 2014 National Emergency Department Sample data that identified cannabis-associated emergency department visits among patients aged 12 years or older (n = 265,128).

RESULTS

Cannabis-associated emergency department visits per 100,000 emergency department discharges increased monotonically (annually by 7%). As compared with privately insured patients, Medicare, and Medicaid, uninsured patients were over 40% more likely to visit emergency department. The age group 12 to 17 had the highest risk of emergency department visits and the risk monotonically declined as the age increased. Hospitals in the South region showed the highest cannabis-associated emergency department utilization, yet trends of cannabis-associated emergency department visits increased in the West region from 15.4% to 26% over time.

CONCLUSIONS

Cannabis-associated emergency department visits increase monotonically over time. Although vulnerable persons were identified, additional policy or regional factors should explore risks of emergency department visits associated with cannabis use.

Multiple drug use disorder diagnoses among drug-involved hospitalizations in the United States: Results from the 2016 National Inpatient Sample

BACKGROUND

Having more than one drug use disorders (DUDs) is an increasing public health concern, but it has been understudied. The goal of this study is to investigate the prevalence and patterns of coexisting DUD diagnoses among inpatient hospitalizations due to DUD in the United States.

METHODS

Data were from the 2016 National Inpatient Sample and included hospitalizations with a principal DUD diagnosis for patients aged ≥18 years (i.e., drug-involved hospitalizations, unweighted n = 31,707). The DUD diagnosis profile was categorized into three groups: single, two, and three or more DUD diagnoses. Generalized ordered logit models were used to examine correlates of DUD diagnosis groups.

RESULTS

Among drug-involved hospitalizations, approximately 50.1 % had multiple coexisting DUD diagnoses (2 DUD diagnoses, 32.1 %; ≥3 DUD diagnoses, 18.0 %). Particularly, opioid use disorder accounted for 58.6 % of drug-involved hospitalizations. Among specific opioid-involved hospitalizations, about 51.2 % had multiple DUD diagnoses. The most common secondary DUD diagnoses among opioid-involved hospitalizations included cocaine (21.7 %), cannabis (18.5 %), and sedatives (18.1 %). Adjusted analyses showed that being aged 18-25 years (vs. ≥ 26), living in areas with the lowest quartile of household income (vs. highest), and having a secondary diagnosis of mental disorders or tobacco/alcohol use disorder were associated with increased odds of having multiple DUD diagnoses in the total sample and in the opioid subsample.

CONCLUSIONS

Findings suggest that healthcare providers should increase the awareness of multiple DUDs while treating patients with DUD, especially those with opioid use disorder. More research is needed to better characterize treatment needs for patients with multiple DUDs.

Does Self-Change Occur Among Severely Dependent Substance Users?

The aims of the current study were to examine differences between self-changers (SC) and treatment-changers (TC) in sociodemographic, personal characteristics, severity of substance use disorders (SUDs), and psychiatric problems, and to predict the severity of SUDs, psychiatric problems, and belonging to the SC group. The sample included 229 Israeli respondents (134 SC and 95 TC). Significant differences between the two groups were found. The SC were younger, had a higher sense of coherence, and reported more cannabis use. The TC were involved more in crime and had experienced more child abuse and severe psychiatric problems compared with the SC. No significant group differences were found in the severity of substance dependence. The findings suggested that severity of SUDs did not differentiate between the groups, but the severity of psychiatric problems and history of child abuse did. This indicates a need for treatment interventions targeting all three issues of childhood trauma, SUDs, and psychiatric problems.

Depressive symptoms moderate cannabis use for young adults in a Text-Delivered randomized clinical trial for cannabis use disorder

BACKGROUND

The importance and complexity of addressing both substance use and mood disorders such as depression within traditional treatment settings is well established. However, little is known about this issue within the context of mHealth treatment. Research is needed to determine if depression interacts with mHealth delivered cannabis use disorder treatment similarly compared traditional treatments.

OBJECTIVE

We examined the moderating effect of depressive symptoms on cannabis use with 96 young adults (ages 18 to 25) enrolled in a text-delivered randomized clinical trial for cannabis use disorder. Participants were followed for three months.

METHOD

We used a repeated measures general linear model to test if depressive symptoms moderated the treatment's effect on cannabis use. Self-report of past 30-day use and urinalysis of THC metabolites were the outcome measures. Depressive symptoms were measured using the PHQ-2, with scores >3 serving as the clinical cut-point, indicating likely depression disorder.

RESULTS

Participants with sub-threshold depression scores significantly reduced the number of days they used cannabis across all three months of the study. For participants with scores above the clinical cut-point, treatment had no effect on cannabis use. Similarly, participants with sub-threshold depression scores reduced the number of positive urinalysis results at three months. Effect sizes ranged from small to medium.

CONCLUSION

Results support the importance of simultaneously addressing depressive symptoms and cannabis use when treating young adults using text-delivered counseling. As mHealth interventions continue to demonstrate efficacy in addressing substance use disorders, the integration of mood disorder treatments appears warranted.

Depressive symptoms and cannabis use in a placebo-controlled trial of N-Acetylcysteine for adult cannabis use disorder

RATIONALE

Depression is common among individuals with cannabis use disorder (CUD), particularly individuals who present to CUD treatment. Treatments that consider this comorbidity are essential.

OBJECTIVES

The goal of this secondary analysis was to examine whether N-acetylcysteine (NAC) reduced depressive symptoms among adults (age 18-50) with CUD (N = 302) and whether the effect of NAC on cannabis cessation varied as a result of baseline levels of depression. Bidirectional associations between cannabis use amount and depression were also examined.

METHODS

Data for this secondary analysis were from a National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) multi-site clinical trial for CUD. Adults with CUD (N = 302) were randomized to receive 2400 mg of NAC daily or matched placebo for 12 weeks. All participants received abstinence-based contingency management. Cannabis quantity was measured by self-report, and weekly urinary cannabinoid levels (11-nor-9-carboxy-Δ9-tetrahydrocannabinol) confirmed abstinence. Depressive symptoms were measured by the Hospital Anxiety and Depression Scale.

RESULTS

Depressive symptoms did not differ between the NAC and placebo groups during treatment. There was no significant interaction between treatment and baseline depression predicting cannabis abstinence during treatment. Higher baseline depression was associated with decreased abstinence throughout treatment and a significant gender interaction suggested that this may be particularly true for females. Cross-lagged panel models suggested that depressive symptoms preceded increased cannabis use amounts (in grams) during the subsequent month. The reverse pathway was not significant (i.e., greater cannabis use preceding depressive symptoms).

CONCLUSIONS

Results from this study suggest that depression may be a risk factor for poor CUD treatment outcome and therefore should be addressed in the context of treatment. However, results do not support the use of NAC to concurrently treat co-occurring depressive symptoms and CUD in adults.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT01675661.

Clinical Workflow and Substance Use Screening, Brief Intervention, and Referral to Treatment Data in the Electronic Health Records: A National Drug Abuse Treatment Clinical Trials Network Study

Introduction:

The use of electronic health records (EHR) data in research to inform recruitment and outcomes is considered a critical element for pragmatic studies. However, there is a lack of research on the availability of substance use disorder (SUD) treatment data in the EHR to inform research.

Methods:

This study recruited providers who used an EHR for patient care and whose facilities were affiliated with the National Institute on Drug Abuse’s National Drug Abuse Treatment Clinical Trials Network (NIDA CTN). Data about providers’ use of an EHR and other methods to support and document clinical tasks for Substance use screening, Brief Intervention, and Referral to Treatment (SBIRT) were collected.

Results:

Participants (n = 26) were from facilities across the country (South 46.2%, West 23.1%, Midwest 19.2 percent, Northeast 11.5 percent), representing 26 different health systems/facilities at various settings: primary care (30.8 percent), ambulatory other/specialty (26.9 percent), mixed setting (11.5 percent), hospital outpatient (11.5 percent), emergency department (7.7 percent), inpatient (3.8 percent), and other (7.7 percent). Validated tools were rarely used for substance use screen and SUD assessment. Structured and unstructured EHR fields were commonly used to document SBIRT. The following tasks had high proportions of using unstructured EHR fields: substance use screen, treatment exploration, brief intervention, referral, and follow-up.

Conclusion:

This study is the first of its kind to investigate the documentation of SBIRT in the EHR outside of unique settings (e.g., Veterans Health Administration). While results are descriptive, they emphasize the importance of developing EHR features to collect structured data for SBIRT to improve health care quality evaluation and SUD research.

Cannabis and Tramadol are Prevalent among the First Episode Drug-Induced Psychosis in the Egyptian Population: Single Center Experience

(1) Background: Cannabis and tramadol are featuring prominently in Egypt; however, their prevalence in first episode psychosis is still uncertain. We aimed at determining the prevalence of cannabis and tramadol among the first-psychotic episode in Egyptian inpatients and to compare the demographic and psychopathological profiles of substance abusers versus patients with the comorbid diagnosis. (2) Methods: Patients presented with psychotic episode and admitted to Mansoura Psychiatric Department were recruited. Diagnosis of psychiatric illness and drug/substance use was carried out using the Diagnostic and Statistical Manual- Fourth Edition (DSM-IV) criteria. Standard urine tests and thin layer chromatography were performed to detect cannabis and tramadol. (3) Results: Of the 100 subjects in the study, the majority (55.6%) of patients were cannabis-only positive. Overall, cannabis-alone showed the highest frequency of substance used among the currently diagnosed psychotic disorders. According to urine tests, cannabis demonstrates the higher frequency of intake in both studied groups. 66.7% of the studied population had 1–5 years self-reported histories of substance abuse predating the first psychotic episode. (4) Conclusions: The percentage of cannabis and tramadol among the first episode psychotic patients has been unexpectedly high and the standard urine testing should be considered in emergency and mental health facilities.

Cannabis and the Current State of Treatment for Cannabis Use Disorder

Although the opioid epidemic may command more national headlines, the past two decades have seen a revolution in cannabis policy driven largely by the public and by business interests. As a result, the population of cannabis users nationwide-especially of heavy users-has grown yearly. Although less visible than patients admitted to the emergency department for opioid-related overdose or to treatment for opioid use disorder, an estimated 4.5-7 million individuals in the United States are thought to meet criteria for cannabis use disorder in a given year. This article focuses on the developmental pathways of cannabis use disorder, the epidemiology of cannabis use among adolescents and adults in the context of rapidly changing state laws, and evidence-based treatment for the general psychiatrist. The authors provide an overview of pharmacological and psychosocial behavioral treatments for patients with the disorder while emphasizing aspects of clinical management unique to this patient population.

An update on cannabis use disorder with comment on the impact of policy related to therapeutic and recreational cannabis use

Confusion and controversy related to the potential for cannabis use to cause harm, or alternatively to provide benefit, continues globally. This issue has grown in intensity and importance with the increased recognition of the public health implications related to the escalation of the legalization of cannabis and cannabinoid products. This selective overview and commentary attempt to succinctly convey what is known about one potential consequence of cannabis use, the development of cannabis use disorder (CUD). Such knowledge may help guide a reasonable and objective public health perspective on the potential impact of cannabis use and CUD. Current scientific data and clinical observation strongly support the contention that cannabis use, like the use of other substances such as alcohol, opioids, stimulants, and tobacco, can develop into a use disorder (addiction) with important clinical consequences. Epidemiological data indicate that the majority of those who use cannabis do not have problems related to their use, but a substantial subset (10-30%) do report experiencing symptoms and consequences consistent with a CUD. Treatment seeking for CUD comprises a substantial proportion of all substance use treatment admissions, yet treatment response rates show much room for improvement. Changing cannabis policies related to its therapeutic and recreational use are likely to impact the development of CUD and its course; however, definitive data on such effects are not yet available. Clearly, the development of more effective prevention and treatment strategies is needed for those vulnerable to developing a CUD and for those with a CUD.

Key Considerations in Planning for Substance Use Treatment: Estimating Treatment Need and Demand

OBJECTIVE

Estimates of the extent of treatment need (defined by the presence of a diagnosis for which there is an effective treatment available) and treatment demand (defined as treatment seeking) are essential parts of effective treatment planning, service provision, and treatment funding. This article reviews the existing literature on approaches to estimating need and demand and the use of models to inform such estimation, and then considers the implications for health planners.

METHOD

A thematic review of the literature was undertaken, with a focus on covering the key concepts and research methods that have been used to date.

RESULTS

Both need and demand are important estimates in planning for services but contain many difficulties in moving from the theory of measurement to the practicalities of establishing these figures. Furthermore, the simple quantum of need or demand is limited in its usefulness unless it is matched with consideration of different treatment types and their relative intensity, and/or explored as a function of geography and subpopulation. Modeling can assist with establishing more fine-tuned planning estimates, and is able to take into account both client severity and the various treatment types that might be available.

CONCLUSIONS

Moving from relatively simplistic estimates of need and demand for treatment, this review has shown that although such estimation can inform national or subnational treatment planning, more sophisticated models are required for alcohol and other drug treatment planning. These can help health planners to determine the appropriate amount and mix of treatments for substance use disorders.

Prevalence and predictors of no lifetime utilization of mental health treatment among people with mental disorders in France: findings from the 'Mental Health in General Population' (MHGP) survey

PURPOSE

No lifetime utilization of mental health treatment (NUMT) is an indicator of the treatment gap among people in need of treatment. Until now, the overall prevalence and predictors of NUMT have never been explored in France.

METHODS

In a 39,617-respondent survey, participants were assessed for NUMT, i.e., no lifetime psychotherapy, psychopharmacotherapy, or psychiatric hospitalization. Mental disorders were investigated using the Mini International Neuropsychiatric Interview (MINI 5.0.0). MINI diagnoses were grouped into five categories: mood disorders (MDs); anxiety disorders (ADs); alcohol use disorders (AUDs); substance use disorders (SUDs); and psychotic disorders (PDs). Using multivariable logistic regression models, we explored the factors associated with NUMT among the MINI-positive respondents. The odds ratio and 95% confidence interval were calculated for each factor.

RESULTS

In total, 12,818 (32.4%) respondents were MINI-positive, 46.5% of them reported NUMT (35.6% for MDs, 39.7% for PDs, 42.8% for ADs, 56.0% for AUDs, and 56.7% for SUDs). NUMT was positively associated with being male [OR 1.75 (1.59-1.91)] and practising religion [OR 1.13 (1.02-1.25)] and negatively associated with ageing [per 10-year increase: OR 0.88 (0.85-0.91)], being single [OR 0.74 (0.66-0.84)], being a French native [OR 0.67 (0.60-0.75)], and experiencing MDs [OR 0.39 (0.36-0.43)], ADs [OR 0.47 (0.43-0.52)], AUDs [OR 0.83 (0.73-0.96)], SUDs [OR 0.77 (0.65-0.91)], or PDs [OR 0.50 (0.43-0.59)].

CONCLUSIONS

In France, NUMT rates were the highest for AUDs and SUDs. Additionally, suffering from MDs or ADs increased the lifetime treatment utilization for people having any other mental disorder. This finding emphasizes the need to better screen AUDs and SUDs among people treated for MDs or ADs.

US Epidemiology of Cannabis Use and Associated Problems

This review provides an overview of the changing US epidemiology of cannabis use and associated problems. Adults and adolescents increasingly view cannabis as harmless, and some can use cannabis without harm. However, potential problems include harms from prenatal exposure and unintentional childhood exposure; decline in educational or occupational functioning after early adolescent use, and in adulthood, impaired driving and vehicle crashes; cannabis use disorders (CUD), cannabis withdrawal, and psychiatric comorbidity. Evidence suggests national increases in cannabis potency, prenatal and unintentional childhood exposure; and in adults, increased use, CUD, cannabis-related emergency room visits, and fatal vehicle crashes. Twenty-nine states have medical marijuana laws (MMLs) and of these, 8 have recreational marijuana laws (RMLs). Many studies indicate that MMLs or their specific provisions did not increase adolescent cannabis use. However, the more limited literature suggests that MMLs have led to increased cannabis potency, unintentional childhood exposures, adult cannabis use, and adult CUD. Ecological-level studies suggest that MMLs have led to substitution of cannabis for opioids, and also possibly for psychiatric medications. Much remains to be determined about cannabis trends and the role of MMLs and RMLs in these trends. The public, health professionals, and policy makers would benefit from education about the risks of cannabis use, the increases in such risks, and the role of marijuana laws in these increases.