Trends in cannabis use among U.S. adults amid the COVID-19 pandemic

Prevalence and Correlates of Cannabis Use among U.S. Veterans during the Second Wave of the COVID-19 Pandemic

INTRODUCTION

Military veterans are at increased risk of substance use disorders. Limited research is available about veterans' cannabis use (CU) during the coronavirus disease 2019 (COVID-19) pandemic. This study estimated the prevalence of past 30-day CU, investigated individual-level correlates of past 30-day CU, and evaluated the reasons (medical, recreational, or both) of past 30-day CU among U.S. Veterans during the second wave of the COVID-19 pandemic.

MATERIALS AND METHODS

We used population-based, cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System Survey Marijuana Use model. The sample included nationally representative military veterans aged 18+ years (n = 11,167). The outcome was past 30-day CU. Individual-level demographic, socioeconomic, behavioral, and clinical correlates were examined. Analyses were weighted to account for the survey's complex design with results generalizable to nearly 2.9 million veterans. We conducted weighted descriptive statistics, prevalence estimates, and multivariable logistic regression analyses.

RESULTS

Out of 2.9 million veterans, 11.1% self-reported as non-Hispanic Black, 3.7% Hispanic, and 79.1% non-Hispanic White; 88.5% were men, and 72.8% were aged 50+ years. About 14.6% were current tobacco smokers, 4.7% were current e-cigarette users, 12.5% were binge alcohol drinkers, and 43.4% had three or more comorbid conditions. Overall, 8.5% reported CU in the past 30 days, of which 30.4% used it for medical reasons and 25.8% used it for nonmedical reasons. The prevalence of past 30-day CU decreased with age, education, and income level. Compared to their counterparts, the odds of past 30-day CU were greater among men, those living in urban areas, those with frequent mental distress, infrequent physical distress, and those who had at least one comorbid condition. Non-Hispanic Black veterans had 89% increased odds of past 30-day CU (adjusted odds ratio [AOR] =1.89, 95% confidence interval [CI], 1.19-3.0) compared with non-Hispanic White veterans. Current tobacco smokers had 3.54 (95% CI, 2.40-5.24) and former smokers had 1.78 (95% CI, 1.28-2.47) times higher odds of reporting past 30-day CU than never smokers. Current e-cigarette use (AOR = 3.37, 95% CI, 2.20-5.16) and binge drinking (AOR = 3.18, 95% CI, 2.29-4.41) were also statistically significantly associated with increased odds of past 30-day CU compared to no e-cigarette use and no binge drinking.

CONCLUSIONS

CU is prevalent among veterans, and certain subgroups are at higher risk of CU. Thus, identifying high-risk subgroups of veterans and adequately educating them about CU's benefits, risks, and safety is crucial.

Cannabis And College Students: Self-Perceived Mental Health Prior to, During, and After the Pandemic

Introduction

College students demonstrated changes in levels of mental wellbeing as they and the world experienced new levels of stress and anxiety due to the COVID-19 pandemic. As access to healthcare became limited, students turned to alternative methods of coping, which included cannabis use.

Objective

To determine if an association between cannabis use and self-perceived mental wellbeing during the pandemic among college students exists.

Method

A paired samples t-Test was used to compare self-reported mental wellbeing at different times during the pandemic, a one-way ANOVA to compare self-reported mental health between respondents' cannabis use status, and a Tukey-Kramer post-hoc analysis was used to determine between group significance. All data collected were from participants at a single time point (retrospective self-report during April 2022).

Results

Of 103 self-reported college students, the most significant differences in mental wellbeing were reported prior to and during the pandemic. Consistent significant differences were observed between each of the college student groups derived from those students who entirely avoided cannabis use or cessation of use (highest rating), p = .018, as compared to those who initiated cannabis use prior to and during the pandemic (lowest rating) p = .045. Post pandemic mental wellbeing demonstrated a higher level of mental wellbeing among those who had some exposure to cannabis compared to those who avoided cannabis entirely.

Conclusions

It cannot be concluded that mental wellbeing was lower due to cannabis use. However, it is possible those with lower self-perceived mental wellbeing turned to cannabis use.

Tobacco and marijuana use during the COVID-19 pandemic lockdown among American Indians residing in California and Oklahoma

INTRODUCTION

American Indian (AI) people experience a disproportionate tobacco and marijuana burden which may have been exacerbated by the COVID-19 pandemic. Little is known about the tobacco and marijuana habits of American Indian individuals during the COVID-19 pandemic. The objective of this study is to examine tobacco and marijuana use as well as change in use during the COVID-19 pandemic among the American Indian community.

METHODS

This cross-sectional study analyzes survey data from a convenience sample of American Indian individuals residing in California and Oklahoma and included adults with and without cancer that resided in both rural and urban areas (n=1068).

RESULTS

During October 2020 - January 2021, 36.0% of participants reported current use of tobacco products, 9.9% reported current use of marijuana products, and 23.7% reported increased use of tobacco and/or marijuana in the past 30 days, with no difference between those with cancer and those without cancer. Tobacco use was associated with marital status, age, employment status, COVID-19 exposure, COVID-19 beliefs, and alcohol consumption. Marijuana use was associated with COVID-19 beliefs, alcohol consumption, and income level. Increased tobacco and/or marijuana use was associated with baseline use of those products. Nearly a quarter of participants reported increased use of tobacco and/or marijuana products during the COVID-19 pandemic.

CONCLUSIONS

We observed high rates of tobacco use during the COVID-19 pandemic, consistent with other studies. Research is needed to examine whether tobacco and marijuana use will decrease to pre-pandemic levels post-pandemic or if these behaviors will persist post-pandemic. Given these findings, there is a pressing need to increase access to evidence-based tobacco and marijuana treatment services in the AI population post COVID-19 pandemic.

Cannabis-Impaired driving: ethical considerations for the primary care practitioner

Background: Widespread cannabis consumption and recreational cannabis legalization is thought to have led to an increase in motor vehicle accidents, although there currently lacks ethical guidance for primary care practitioners on cannabis-impaired driving.Objective: The aim was to develop an ethical framework for primary care providers on cannabis-impaired driving.Methods: An ethical analysis in the form of a critical interpretive review was undertaken, using a systematic approach to determine the appropriate action to a given situation with evidence to substantiate its claims. The search strategy was designed to answer the research question: What are some ethical concerns for primary care providers to consider when cannabis-impaired driving is suspected? Four databases were searched in December 2021 using keywords related to cannabis, impaired driving, ethics, and primary care. The resulting evidence was synthesized as recommendations for primary care practice.Results: The ethical approach for primary care practitioners in addressing cannabis-impaired driving can be summarized as the duty to always inform, provide care through prevention and harm reduction strategies, and report when necessary. The prevention of cannabis-impaired driving should not fall on the sole responsibility of primary care practitioners. As this review offers a high-level discussion of the ethical considerations in cannabis-impaired driving, specific recommendations will depend upon the legal and policy designations of individual jurisdictions.Conclusion: Ultimately, the practitioner should manage cannabis-impaired driving in a way that fosters the therapeutic relationship in patient-centered care, through motivational discussions, collaboration with specialists, skills for self-management, patient empowerment, and support. KEY MESSAGES  Take-Home Points for Primary Care Practitioners in Cannabis-Impaired Driving  •  For patients who report driving frequently and using cannabis, the frequency of use, dosage, form of cannabis, tolerance levels, and withdrawal symptoms should be discussed, while informing the patient of the risks, harms, and legal consequences associated with cannabis-impaired driving.  •  The practitioner's primary responsibility in the cannabis-impaired driving context is to provide care to patients who drive and consume cannabis, which may include referring patients to mental health care to manage addictive or problematic behaviors associated with cannabis use.  •  Practitioners may have a duty to report cannabis-impaired driving to legal authorities (such as law enforcement) when the user engages in harmful behavior to themselves or others.

COVID-19 Concerns, Coping and Perceived Peer Norms: Correlates of Increased Alcohol and Marijuana Use Among Sexual Minority Women

This study explored the impact of COVID-related concerns and other characteristics on alcohol and marijuana use among sexual minority women (SMW). Survey data from a racially/ethnically diverse sample of 338 SMW participants in the Chicago Health and Life Experiences of Women (CHLEW) study were used to examine correlates of three substance use outcomes: frequent intoxication (once a month or more), perceived increase in alcohol use, and perceived increase in marijuana use. Coping motives for alcohol use was positively associated with each of the substance use outcomes. Belief that peers (in terms of age, sexual identity, and gender) used alcohol often to cope was associated with higher odds of frequent intoxication. COVID-19 related financial concerns were positively associated with both frequent intoxication and increased marijuana use. Health and mental health concerns were associated with lower odds of frequent intoxication. Findings underscore the importance of enhancing coping skills, addressing perceived peer coping norms, and providing both economic and social support in intervention efforts.

"What was the vibe you were going for?" SAM Behaviors and Socialization During the COVID-19 Pandemic, a Qualitative Approach

Introduction

Marijuana use is at historic highs amongst college-aged adults, who are more likely to engage in simultaneous alcohol and marijuana use (SAM) than other age cohorts. For college students, the COVID-19 pandemic is a unique transitory phenomenon that led to isolation, as well as changes in socialization, academic environments, and substance use. This exploratory qualitative study aims to understand SAM socialization and motivation behaviors among college students.

Methods

Semi-structured qualitative interviews (N=32) were conducted across the United States from January 2021-April 2021via Zoom. Interviews were then transcribed, then a thematic analysis was conducted in Atlas.ti.

Results

The sample was primarily college juniors (mage=21). Since the pandemic, half of the participants increased SAM, whereas the other half decreased SAM. SAM was reported in different categories including primarily with friends, but, much less with partners and with roommates. More than half of the sample indicated that they used SAM alone. Motivations to engage in SAM included relaxing, socializing, offsetting stressors specific to the COVID-19 pandemic, and relieving general stress, anxiety and boredom.

Conclusion

The COVID-19 pandemic impacted college students' substance use in interesting ways. Understanding the behaviors of SAM in the context of the COVID-19 pandemic is crucial due to the legalization of marijuana in many states. This understanding has significant implications for prevention strategies and potential policy interventions. Our study yielded findings regarding the impact of socialization on SAM. We discovered that not only does socialization affect SAM, but the specific contexts and motivations behind these behaviors also play a crucial role, which adds to our developing understanding of SAM behavior.

Changes in self-reported cannabis use during the COVID-19 pandemic: a scoping review

BACKGROUND

The COVID-19 pandemic is affecting mental health and substance use (MHSU) issues worldwide. The purpose of this study was to characterize the literature on changes in cannabis use during the pandemic and the factors associated with such changes.

METHODS

We conducted a scoping review by searching peer-reviewed databases and grey literature from January 2020 to May 2022 using the Arksey and O'Malley Framework. Two independent reviewers screened a total of 4235 documents. We extracted data from 129 documents onto a data extraction form and collated results using content analytical techniques.

RESULTS

Nearly half (48%) of the studies reported an increase/initiation of cannabis use, while 36% studies reported no change, and 16% reported a decrease/cessation of cannabis use during the pandemic. Factors associated with increased cannabis use included socio-demographic factors (e.g., younger age), health related factors (e.g., increased symptom burden), MHSU factors (e.g., anxiety, depression), pandemic-specific reactions (e.g., stress, boredom, social isolation), cannabis-related factors (e.g., dependence), and policy-related factors (e.g., legalization of medical/recreational cannabis).

CONCLUSION

Public health emergencies like the COVID-19 pandemic have the potential to significantly impact cannabis use. The pandemic has placed urgency on improving coping mechanisms and supports that help populations adapt to major and sudden life changes. To better prepare health care systems for future pandemics, wide-reaching education on how pandemic-related change impacts cannabis use is needed.

Trends in Young Adult Alcohol and Cannabis Use Through the First 1.5 Years of the COVID-19 Pandemic From a Community Cohort Sample

OBJECTIVE

There has been concern regarding increased substance use during the COVID-19 pandemic, particularly among young adults, but much of this concern stemmed from cross-sectional or short-term data collected early in the pandemic. This study followed a young adult community cohort throughout the first 1.5 years of the pandemic to examine longer-term trends/trajectories in alcohol and cannabis use behaviors.

METHOD

Beginning before the COVID-19 pandemic (January 2020), 656 young adults completed up to eight surveys on substance use and other behaviors, which extended through August 2021. Multilevel spline growth models estimated changes in alcohol/cannabis use in three segments: (a) from pre-pandemic to April 2020, (b) from April 2020 to September/October 2020, and (c) from September/October 2020 to July/August 2021. Abstainers were removed from the analyses, yielding subsamples for alcohol models (n = 545; M age = 25.6 years; 59.8% female) and cannabis models (n = 303; M age = 25.6; 61.4% female).

RESULTS

Drinking frequency initially increased (3% per month), decreased in the second segment (4% per month), and plateaued in the final segment. Drinking quantity significantly decreased in all three segments: 4% per month in segment one, 3% per month in segment two, and 1% per month in the final segment. Cannabis frequency and quantity showed no significant changes across the first two segments, then significantly decreased in the final segment (3% and 6% per month, respectively). The significant changes for cannabis frequency/quantity were moderated by age, such that older participants had steeper decreases in the final segment.

CONCLUSIONS

Findings highlight that young adult alcohol and cannabis use generally declined across the first 1.5 years of the COVID-19 pandemic, contrary to widespread concerns.

Externalizing traits: Shared causalities for COVID-19 and Alzheimer's dementia using Mendelian randomization analysis

Externalizing traits have been related with the outcomes of coronavirus disease 2019 (COVID-19) and Alzheimer's dementia (AD); however, whether these associations are causal remains unknown. We used the two-sample Mendelian randomization (MR) approach with more than 200 single-nucleotide polymorphisms (SNPs) for externalizing traits to explore the causal associations of externalizing traits with the risk of COVID-19 (infected COVID-19, hospitalized COVID-19, and severe COVID-19) or AD based on the summary data. The inverse variance-weighted method (IVW) was used to estimate the main effect, followed by several sensitivity analyses. IVW analysis showed significant associations of externalizing traits with COVID-19 infection (odds ratio [OR] = 1.456, 95% confidence interval [95% CI] = 1.224-1.731), hospitalized COVID-19 (OR = 1.970, 95% CI = 1.374-2.826), and AD (OR = 1.077, 95% CI = 1.037-1.119). The results were consistent using weighted median (WM), penalized weighted median (PWM), MR-robust adjusted profile score (MR-RAPS), and leave-one-out sensitivity analyses. Our findings assist in exploring the causal effect of externalizing traits on the pathophysiology of infection and severe infection of COVID-19 and AD. Furthermore, our study provides evidence that shared externalizing traits underpin the two diseases.

Regular Cannabis Use During the First Year of the Pandemic: Studying Trajectories Rather Than Prevalence

INTRODUCTION

Cannabis use in the U.S. rose early in the COVID-19 pandemic, but it is unclear whether that rise was temporary or permanent. This study estimated the nature and sociodemographic correlates of U.S. adult subpopulations regularly using cannabis by examining weekly trajectories of use during the first year of the pandemic.

METHODS

Data came from the Understanding America Study, a nationally representative panel of U.S. adults (N=8,397; March 10, 2020-March 29, 2021). A growth mixture model was deployed to identify subgroups with similar regular cannabis use. Sociodemographic correlates of subgroups were examined using multinomial logistic regression.

RESULTS

Four cannabis-use groups were identified. Most participants did not regularly use cannabis (no regular use; 81.7%). The other groups increased regular use until April 2020 but then diverged. Some (7.1%) decreased thereafter, whereas others (3.4%) maintained their elevated use until October 26, 2020 before decreasing. The last group (7.7%) sustained their elevated use throughout. Individuals aged between 18 and 39 years, unmarried, living in poverty, without a college degree, and with longer unemployment or underemployment spells had higher odds of being in the other groups with more weekly use than in the no-regular-use group.

CONCLUSIONS

The analyses revealed population subgroups with prolonged regular cannabis use and a disproportionate concentration of socioeconomically vulnerable members of society in these subgroups. These findings elucidate important heterogeneity in the subpopulations using cannabis, highlighting the urgent need to tailor public health programs for subgroups that may have unique service needs.

Puff, Puff, Don't Pass: harm reduction for cannabis use during a viral respiratory pandemic

BACKGROUND

Prior to the COVID-19 pandemic, cannabis use social practices often involved sharing prepared cannabis (joints/blunts/cigarettes) and cannabis-related paraphernalia. Previous studies have demonstrated that sharing paraphernalia for cannabis, tobacco, and crack cocaine is a risk factor for respiratory viral and bacterial infections. Although COVID-19 is a respiratory viral infection that spreads through droplets and airborne transmission, it is unclear if many individuals adopted harm reduction practices around sharing cannabis. This study: quantifies the prevalence of sharing prepared non-medical cannabis and cannabis-related paraphernalia reported before and during the pandemic; assesses changes in sharing of non-medical cannabis from before to during the pandemic; assess the association between frequency of non-medical cannabis use and sharing of cannabis during the pandemic; and describes how respondents obtained their cannabis and the reasons for changing their cannabis use during the pandemic to explain differences in sharing patterns.

METHODS

This cross-sectional study used data collected from an anonymous, US-based web survey on cannabis-related behaviors from August to September 2020 (n = 1833). Participants were included if they reported using a mode of inhalation for non-medical cannabis consumption. We calculated proportional changes in sharing cannabis before/during the COVID-19 pandemic. Associations between frequency of cannabis use and cannabis sharing during the COVID-19 pandemic were assessed using logistic regression analysis.

RESULTS

Overall, 1,112 participants reported non-medical cannabis use; 925 (83.2%) reported a mode of cannabis inhalation. More respondents reported no sharing during (24.9%) than before the pandemic (12.4%; p < 0.01); less respondents shared most of the time (19.5% before; 11.2% during; p < 0.01) and always during the pandemic (5.2% before; 3.1% during; p < 0.01). After adjusting for covariates, the odds of any sharing during the pandemic for those who reported ≥ weekly cannabis use was 0.53 (95% CI 0.38, 0.75) compared to those who reported ≤ monthly.

CONCLUSIONS

Sharing of prepared cannabis and cannabis-related paraphernalia decreased during the COVID-19 pandemic compared to before the pandemic. This finding suggests potential risk mitigation strategies taken by participants for COVID-19 prevention either directly through behavior change or indirectly through adherence to COVID-19 prevention recommendations. Harm reduction messaging around sharing of cannabis during surges of COVID-19 or other respiratory infections may provide benefit in reducing infection among those who use cannabis, especially as cannabis use in the USA continues to increase.

Substance Use From Social Distancing and Isolation by US Nativity During the Time of COVID-19: Cross-sectional Study

BACKGROUND

The COVID-19 pandemic had many unprecedented secondary outcomes resulting in various mental health issues leading to substance use as a coping behavior. The extent of changes in substance use in a US sample by nativity has not been previously described.

OBJECTIVE

This study aimed to design a web-based survey to assess the social distancing and isolation issues exacerbated by the COVID-19 pandemic to describe substance use as a coping behavior by comparing substance use changes before and during the pandemic.

METHODS

A comprehensive 116-item survey was designed to understand the impact of COVID-19 and social distancing on physical and psychosocial mental health and chronic diseases. Approximately 10,000 web-based surveys were distributed by Qualtrics LLC between May 13, 2021, and January 09, 2022, across the United States (ie, continental United States, Hawaii, Alaska, and territories) to adults aged ≥18 years. We oversampled low-income and rural adults among non-Hispanic White, non-Hispanic Black, Hispanic or Latino, and foreign-born participants. Of the 5938 surveys returned, 5413 (91.16%) surveys were used after proprietary expert review fraud detection (Qualtrics) and detailed assessments of the completion rate and the timing to complete the survey. Participant demographics, substance use coping behaviors, and substance use before and during the pandemic are described by the overall US resident sample, followed by US-born and foreign-born self-reports. Substance use included the use of tobacco, e-cigarettes or nicotine vapes, alcohol, marijuana, and other illicit substances. Marginal homogeneity based on the Stuart-Maxwell test was used to assess changes in self-reported substance use before and during the pandemic.

RESULTS

The sample mostly included White (2182/5413, 40.31%) and women participants (3369/5406, 62.32%) who identified as straight or heterosexual (4805/5406, 88.88%), reported making ≥US $75,000 (1405/5355, 26.23%), and had vocational or technical training (1746/5404, 32.31%). Similarities were observed between the US-born and the foreign-born participants on increased alcohol consumption: from no alcohol consumption before the pandemic to consuming alcohol once to several times a month and from once to several times per week to every day to several times per day. Although significant changes were observed from no prior alcohol use to some level of increased use, the opposite was also observed and was more pronounced among foreign-born participants. That is, there was a 5.1% overall change in some level of alcohol use before the pandemic to no alcohol use during the pandemic among foreign-born individuals, compared with a 4.3% change among US-born individuals.

CONCLUSIONS

To better prepare for the inadvertent effects of public health policies meant to protect individuals, we must understand the mental health burdens that can precipitate into substance use coping mechanisms that not only have a deleterious effect on physical and mental health but also exacerbate morbidity and mortality in a disease like COVID-19.

Pregnant individual's lived experience of cannabis use during the COVID-19 pandemic: a qualitative study

Introduction

Quantitative studies indicate that the COVID-19 pandemic has contributed to increased rates of prenatal cannabis use. However, little is known about how the pandemic has impacted cannabis use from the perspective of pregnant individuals themselves. Our objective was to characterize COVID-19-related changes in cannabis use among pregnant individuals who used cannabis during the pandemic.

Methods

We conducted 18 focus groups (from 11/17/2021 to 12/17/2021) with Black and White pregnant individuals aged 18+ who self-reported prenatal cannabis use during universal screening at entrance to prenatal care (at ~8 weeks gestation) in Kaiser Permanente Northern California. Virtual focus groups were transcribed and analyzed using thematic analysis.

Results

The sample of 53 pregnant individuals (23 Black, 30 White) was 30.3  years old (SD = 5.2) on average, and most (70%) self-reported daily versus weekly or monthly prenatal cannabis use. Major themes regarding the impact of the pandemic on cannabis use included increases in use (resulting from depression, anxiety, stress, boredom), and changes in social use (less sharing of smoked cannabis products), modes of use (from smoking to other modes due to respiratory concerns) and source (from storefront retailers to delivery).

Conclusion

Coping with mental health symptoms and stress were identified drivers of perceived pandemic-related increases in prenatal cannabis use in 2021. Pregnant individuals adapted their use in ways consistent with public health recommendations to decrease social contact and reduce or quit smoking to mitigate COVID-19 transmission and harms. Proactive, mental health outreach for pregnant individuals during future pandemic waves may reduce prenatal cannabis use.

Differences between adults who smoke cigarettes daily and do and do not co-use cannabis: Findings from the 2020 ITC four country smoking and vaping survey

BACKGROUND

Little is known about population-level differences between adults who exclusively smoke cigarettes and those who smoke cigarettes and also use cannabis (co-consumers). Thus, this study describes differences on sociodemographic, cigarette-dependence, health and behavioral variables, and risk perceptions associated with smoking cannabis.

METHODS

This cross-sectional study included 6941 respondents from the 2020 ITC Four Country Smoking and Vaping Survey (US, Canada, Australia, England). Adult daily cigarette smokers were included and categorized as: cigarette-only smokers (never used cannabis/previously used cannabis, but not in the past 12 months, n = 4857); occasional co-consumers (cannabis use in the past 12 months, but < weekly use, n = 739); or regular co-consumers (use cannabis ≥ weekly, n = 1345). All outcomes were self-reported. Regression models were conducted on weighted data.

RESULTS

Overall, 19.9 % of respondents reported regular cannabis co-use and 10.1 % reported occasional co-use. Regular co-use was highest in Canada (27.2 %), followed by the US (24.4 %), England (12.7 %) and Australia (12.3 %). Compared to cigarette-only smokers, regular co-consumers were more likely to be male and report chest/breathing problems (p < 0.001). All co-consumers were more likely to be younger, have lower income, be experiencing financial stress, reside in Canada, have depressive symptoms, use alcohol more frequently and binge drink, use other tobacco/nicotine products, and perceive smoking cannabis as low health risk and less harmful than smoking cigarettes (all p < 0.001). Cigarette dependence measures were similar between co-consumers and cigarette-only smokers (all p ≥ 0.05).

CONCLUSIONS

Although there were no differences on cigarette dependence measures between daily cigarette smokers who do and do not use cannabis, there are several other risk factors that may affect tobacco use and abstinence among co-consumers (e.g., greater depression, high-risk alcohol consumption). Thus, tobacco cessation treatment may require multi-pronged strategies to address other health behaviors. Continued surveillance is needed to determine the nature and health implications of co-use considering changing policies, markets, and products.

Factors affecting tobacco, nicotine, and cannabis product use among California young adults during the COVID-19 pandemic: A qualitative study

The effects of COVID-19 on tobacco use and cannabis has been variable, and it is unclear the extent to which factors affecting changes in tobacco and cannabis use differ. The purpose of this study was to identify the COVID-19-related factors that affect changes in tobacco and cannabis use during the pandemic. Focus groups with 114 young adults in California in April 2021 were held to discuss tobacco and cannabis use patterns, adverse events, and the effect of COVID-19 on tobacco and cannabis product use. Factors affecting changes in use were largely similar between tobacco products and cannabis products. Drivers of increased cannabis use distinct from tobacco or nicotine product use included feeling greater freedom to disengage and perceptions of less harm. Increases in product use were a result of changing social environment, coping with emotional and psychological distress, and product related factors. Decreases in product use were a result of social isolation, COVID-19-related health concerns, disruptions in daily patterns of living, and reduced access. Improved understanding of how the pandemic has affected tobacco and cannabis use can inform tailored interventions to both support those who have decreases or quit and assist those who have increased use during the pandemic to reduce or cease their consumption.

Drug use trajectories among U.S. adults during the first year of the COVID-19 pandemic

This study characterized the prevalence, sociodemographic characteristics, and behavioral health of U.S. adult subpopulations with distinct drug use trajectories during the first year of the COVID-19 pandemic. Adult respondents (n = 8306) in a nationally-representative longitudinal study completed 13 monthly web surveys (March 2020-March 2021). Frequency of past-week drug use, cannabis use, and alcohol use (range:0-7), as well as anxiety and depressive symptoms, were assessed at each survey. Growth mixture models were used to parse out distinct subpopulations with homogenous drug use trajectories based on mean drug use days over time. Four drug use trajectories were identified: Stable Abstinence (85.7% [95%CI = 85.0-86.5] of the sample) with &lt;1 mean past-week drug use days; Escalating Infrequent Use (7.1% [95%CI = 6.6-7.7]) with 0.2 March mean past-week drug use days and increases from April to October; Use Cessation (4.3% [95%CI = 3.8-4.7]) with 1.1 March mean past-week drug use days that initially increased, then sharply decreased to near zero; and Stable Frequent Use (2.9% [95%CI = 2.5-3.3]) with between 2.4 and 3.5 past-week drug use days across the study period. Compared to the stable abstinence group, the other subgroups were more likely to be Hispanic or Black, younger in age, unemployed, below the federal poverty line, and less likely to have a college degree or be married. They also reported higher levels of alcohol and cannabis use, as well as higher anxiety and depressive symptoms. These results provide opportunities to optimize the targeted delivery of preventive interventions for substance use during the COVID-19 pandemic and future public health emergencies.

Predicting Self-Medication with Cannabis in Young Adults with Hazardous Cannabis Use

Using cannabis to reduce psychological and physical distress, referred to as self-medication, is a significant risk factor for cannabis use disorder. To better understand this high-risk behavior, a sample of 290 young adults (ages 18–25; 45.6% female) were recruited from two U.S. universities in January and February of 2020 to complete a survey about their cannabis use and self-medication. Results: seventy-six percent endorsed using cannabis to reduce problems such as anxiety, sleep, depression, pain, loneliness, social discomfort, and concentration. When predicting reasons for self-medication with cannabis, logistic regression models showed that lower CUDIT-R scores, experiencing withdrawal, living in a state where cannabis was illegal, and being female were all associated with higher rates of self-medication. Withdrawal symptoms were tested to predict self-medication with cannabis, and only insomnia and loss of appetite were significant predictors. To further explore why young adults self-medicate, each of the original predictors were regressed on seven specified reasons for self-medication. Young adults experiencing withdrawal were more likely to self-medicate for pain. Participants living where cannabis is legal were less likely to self-medicate for anxiety and depression. Living where cannabis is illegal also significantly predicted self-medicating for social discomfort—though the overall model predicting social discomfort was statistically non-significant. Finally, female participants were more likely to self-medicate for anxiety. These results suggest widespread self-medication among young adults with likely CUD and underscore the complexity of their cannabis use. The findings have implications for understanding why young adults use cannabis in relation to psychological and physical distress and for accurately treating young adults with cannabis use disorder.