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Feingold D, Gliksberg O, Brill S, Amit BH, Lev-Ran S, Kushnir T, Sznitman SR. Conceptualizing problematic use of medicinal Cannabis: Development and preliminary validation of a brief screening questionnaire. Addict Behav 2024; 158:108122. [PMID: 39128420 DOI: 10.1016/j.addbeh.2024.108122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 07/23/2024] [Accepted: 07/28/2024] [Indexed: 08/13/2024]
Abstract
The use of Medicinal Cannabis (MC) for treating chronic pain is increasing, globally, yet the definition of problematic MC use remains unclear. Defining problematic use of cannabis in medical and non-medical contexts may be fundamentally different since individuals prescribed MC often experience physical dependence, which do not necessarily imply pathology. We aimed to conceptualize problematic use of MC and develop a brief questionnaire for identifying and quantifying problematic MC use. Content validation used a broad definition of problematic substance use, adapting and compiling an initial list of 36 items from various sources: (a) screening tools for assessing problematic prescription opioid medication use; (b) screening tools for problematic recreational cannabis use and (c) qualitative interviews with MC patients. 390 American self-identified chronic pain patients holding a MC card rated each item from the initial list on a 5-point frequency scale and filled out questionnaires assessing various clinical outcomes. Following initial item titration, a multi-group measurement invariance comparison strategy, using two external indicators: alcohol-related problems and depression, resulted a final eight-item list that met fit quality in a baseline model, presented excellent internal consistency reliability (α = 0.929), and significantly correlated with anxiety and low quality of life. Items in the final list related predominantly to negative consequences of MC use. Problematic use of MC is characterized by negative physiological, social, emotional and functional consequences. The final eight-item list was named the Medicinal Cannabis Negative Consequences Scale (MCNCS), emerging as a brief measure for problematic MC use and demonstrating preliminary reliability and validity, which could aid clinicians and researchers.
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Affiliation(s)
| | - Or Gliksberg
- Department of Psychology, Ariel University, Ariel, Israel.
| | - Silviu Brill
- Pain Institute, Sourasky Medical Center, Tel Aviv, Israel.
| | - Ben H Amit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sourasky Medical Center, Tel Aviv, Israel.
| | - Shaul Lev-Ran
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Israel Center on Addiction, Netanya, Israel; Lev Hasharon Medical Center, Netanya, Israel.
| | - Talma Kushnir
- Department of Psychology, Ariel University, Ariel, Israel; Adelson School of Medicine, Ariel University, Israel.
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Patel B, Khadke S, Mahajan K, Dhingra A, Trivedi R, Brar SS, Dixit S, Periwal V, Chauhan S, Desai R. Association of cannabis use disorder with atrial fibrillation in young men without concomitant tobacco use: Insights from nationwide propensity matched analysis. World J Exp Med 2024; 14:93742. [DOI: 10.5493/wjem.v14.i3.93742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/23/2024] [Accepted: 07/04/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Recent data are inconclusive regarding the risk of arrhythmias among young cannabis users. Furthermore, many young adults use both cannabis and tobacco, which could add a residual confounding effect on outcomes. So, we studied young men who have cannabis use disorder (CUD) excluding tobacco use disorder (TUD) to understand their independent association with atrial fibrillation (AF) and related outcomes.
AIM To study the association of CUD with AF and related outcomes.
METHODS We used weighted discharge records from National Inpatient Sample (2019) to assess the baseline characteristics and mortality rates for AF-related hospitalizations in young (18-44 years) men in 1:1 propensity-matched CUD + vs CUD- cohorts without TUD.
RESULTS Propensity matched CUD + and CUD- cohorts consisted of 108495 young men in each arm. Our analysis showed an increased incidence of AF in black population with CUD. In addition, the CUD + cohort had lower rates of hyperlipidemia (6.4% vs 6.9%), hypertension (5.3% vs 6.3%), obesity (9.1% vs 10.9%), alcohol abuse (15.5% vs 16.9%), but had higher rates of anxiety (24.3% vs 18.4%) and chronic obstructive pulmonary disease (COPD) (9.8% vs 9.4%) compared to CUD-cohort. After adjustment with covariates including other substance abuse, a non-significant association was found between CUD + cohort and AF related hospitalizations (odd ratio: 1.27, 95% confidence interval: 0.91-1.78, P = 0.15).
CONCLUSION Among hospitalized young men, the CUD + cohort had a higher prevalence of anxiety and COPD, and slightly higher proportion of black patients. Although there were higher odds of AF hospitalizations in CUD + cohort without TUD, the association was statistically non-significant. The subgroup analysis showed higher rates of AF in black patients. Large-scale prospective studies are required to evaluate long-term effects of CUD on AF risk and prognosis without TUD and concomitant substance abuse.
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Affiliation(s)
- Bhavin Patel
- Department of Internal Medicine, Trinity Health Oakland Hospital, Pontiac, MI 48341, United States
| | - Sumanth Khadke
- Lahey Hospital and Medical Center, Division of Cardiovascular Medicine, Department of Medicine, Burlington, MA 01805, United States
| | - Kshitij Mahajan
- Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, United States
| | - Avleen Dhingra
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
| | - Rishika Trivedi
- Department of Internal Medicine, DHR Health, Edinburg, TX 78539, United States
| | - Samrath Singh Brar
- Department of Medicine, Government Medical College, Patiala 147001, Punjab, India
| | - Sakshi Dixit
- Department of Medicine, Government Medical College, Patiala 147001, Punjab, India
| | - Vaibhav Periwal
- Department of Medicine, Government Medical College, Patiala 147001, Punjab, India
| | - Shaylika Chauhan
- Department of Internal Medicine, Geisinger Health System, Wikes-Barre, PA 18702, United States
| | - Rupak Desai
- Independent Researcher, Outcomes Research, Atlanta, GA 30079, United States
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Mattingly DT, Richardson MK, Hart JL. Prevalence of and trends in current cannabis use among US youth and adults, 2013-2022. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 12:100253. [PMID: 39040476 PMCID: PMC11262189 DOI: 10.1016/j.dadr.2024.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 06/13/2024] [Accepted: 06/27/2024] [Indexed: 07/24/2024]
Abstract
Introduction Cannabis use is increasing due to several factors including the adoption of laws legalizing its use across the United States (US). We examined changes in current cannabis use among US youth and adults and by key sociodemographic groups. Methods Using data from the 2013-2022 National Survey on Drug Use and Health (n=543,195), we estimated the prevalence of (2013-2019, 2020, 2021-2022) and trends in (2013-2019, 2021-2022) current (i.e., past 30-day) cannabis use among US youth (aged 12-17) and adults (aged 18+) overall and by age, gender, race and ethnicity, educational attainment, and total annual family income. We also examined sociodemographic factors associated with use from 2013 to 2019, in 2020, and from 2021 to 2022. Results Cannabis use increased from 7.59 % to 11.48 % in 2013-2019, was 11.54 % in 2020, and increased again from 13.13 % to 15.11 % in 2021-2022. Among youth, cannabis use remained constant from 2013 to 2019 and 2021-2022. In 2022, use was highest among aged 18-34, male, non-Hispanic multiracial, and generally lower SES adults. From 2021-2022, cannabis use increased among several groups such as adults who were aged 35-49 (14.25-17.23 %), female (11.21-13.00 %), and Hispanic (10.42-13.50 %). Adults who were aged 18-25, male, non-Hispanic multiracial, some college educated, and of lower annual family income had consistently higher odds of current cannabis use from 2013 to 2019, in 2020, and from 2021 to 2022. Conclusions Cannabis use is increasing overall and among certain sociodemographic groups. Our findings inform prevention and harm reduction efforts aimed at mitigating the prevalence of cannabis use in the US.
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Affiliation(s)
- Delvon T. Mattingly
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
- Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Maggie K. Richardson
- Department of Educational, School, & Counseling Psychology, College of Education, University of Kentucky, Lexington, KY 40506, USA
| | - Joy L. Hart
- Department of Communication, College of Arts and Sciences, University of Louisville, Louisville, KY 40292, USA
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY 40202, USA
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX 75231, USA
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Shankar DS, DeClouette B, Vasavada KD, Avila A, Strauss EJ, Alaia MJ, Gonzalez-Lomas G. Cannabis Use Disorder Not Associated With Opioid Analgesic Use or Patient-Reported Outcomes After ACL Reconstruction: A Retrospective Matched-Cohort Analysis. Sports Health 2024; 16:687-694. [PMID: 37632361 PMCID: PMC11346227 DOI: 10.1177/19417381231190391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare opioid analgesic use and patient-reported outcomes (PROs) after anterior cruciate ligament reconstruction (ACLR) between patients with and without cannabis use disorder (CUD). HYPOTHESIS We hypothesized that patients with CUD would have greater postoperative opioid usage with comparable improvement in PROs. STUDY DESIGN Retrospective matched-cohort study. LEVEL OF EVIDENCE Level 3. METHODS We identified patients with CUD who underwent primary ACLR at a single center and had minimum 3-month follow-up. Patients with CUD were propensity score matched 1:1 to non-CUD controls with respect to age, sex, and follow-up time. Total refills, days supply, and morphine milligram equivalents (MMEs) of opioid analgesics prescribed were calculated for up to 1 year postoperatively. Patient-Reported Outcome Information System (PROMIS) instruments were used to assess PROs. Opioid use and outcomes were compared between CUD and control groups using Mann-Whitney U test and Fisher's exact test. P values <0.05 were considered significant. RESULTS A total of 104 patients with CUD were matched to 104 controls. Both groups were majority male (65.4% male, 34.6% female). The CUD group had a mean age of 29.9 years and mean follow-up time of 16.1 months. There was no significant intergroup difference in opioid prescription rates (CUD 82.7% vs control 83.7%, P ≥ 0.99). Among patients prescribed opioids, there were no significant intergroup differences in total days supply (P = 0.67), total MMEs (P = 0.71), or MMEs per day (P = 0.65). There were no significant differences in pre- to postoperative improvement in PROMIS Pain Intensity (P = 0.51), Pain Interference (P = 0.81), Mobility (P = 0.90), Mental Health (P = 0.74), or Physical Health (P = 0.94). CONCLUSION There were no significant differences detected in opioid usage or PRO improvement after ACLR between patients with CUD and those without. However, because a sample size was not determined a priori, a larger sample may show a difference. CLINICAL RELEVANCE CUD does not appear to correlate with inferior outcomes after ACLR.
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Affiliation(s)
- Dhruv S. Shankar
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Brittany DeClouette
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Kinjal D. Vasavada
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Amanda Avila
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Eric J. Strauss
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Michael J. Alaia
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Guillem Gonzalez-Lomas
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York
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Sharma P, Nelson RJ. Disrupted Circadian Rhythms and Substance Use Disorders: A Narrative Review. Clocks Sleep 2024; 6:446-467. [PMID: 39189197 PMCID: PMC11348162 DOI: 10.3390/clockssleep6030030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/12/2024] [Accepted: 08/15/2024] [Indexed: 08/28/2024] Open
Abstract
Substance use disorder is a major global health concern, with a high prevalence among adolescents and young adults. The most common substances of abuse include alcohol, marijuana, cocaine, nicotine, and opiates. Evidence suggests that a mismatch between contemporary lifestyle and environmental demands leads to disrupted circadian rhythms that impair optimal physiological and behavioral function, which can increase the vulnerability to develop substance use disorder and related problems. The circadian system plays an important role in regulating the sleep-wake cycle and reward processing, both of which directly affect substance abuse. Distorted substance use can have a reciprocal effect on the circadian system by influencing circadian clock gene expression. Considering the detrimental health consequences and profound societal impact of substance use disorder, it is crucial to comprehend its complex association with circadian rhythms, which can pave the way for the generation of novel chronotherapeutic treatment approaches. In this narrative review, we have explored the potential contributions of disrupted circadian rhythms and sleep on use and relapse of different substances of abuse. The involvement of circadian clock genes with drug reward pathways is discussed, along with the potential research areas that can be explored to minimize disordered substance use by improving circadian hygiene.
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Affiliation(s)
- Pallavi Sharma
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA;
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Yang KH, Mueller L, El-Shahawy O, Palamar JJ. Cannabis Use, Use Disorder, and Workplace Absenteeism in the U.S., 2021-2022. Am J Prev Med 2024:S0749-3797(24)00258-7. [PMID: 39186019 DOI: 10.1016/j.amepre.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/27/2024]
Abstract
INTRODUCTION Cannabis use and cannabis use disorder (CUD) are associated with adverse psychosocial outcomes, but their impact on workplace absenteeism remains poorly understood. Moreover, few studies have examined the role of CUD severity. This study aims to address these gaps by examining the associations between cannabis use recency, frequency, CUD severity, and workplace absenteeism. METHODS Cross-sectional data from a U.S. representative sample of full-time employed adults aged ≥18 from the 2021 to 2022 National Survey on Drug Use and Health (N=46,499) were analyzed. The associations between cannabis use recency, past-month cannabis use frequency, CUD severity, and workplace absenteeism (measured by self-reported number of missed days due to illness/injury and skipped work in the last 30 days) were evaluated using negative binomial regression, adjusting for sociodemographic characteristics and other substance use. Data were analyzed in 2023-2024. RESULTS An estimated 15.9% of full-time employed adults used cannabis in the past month, with 6.5% meeting CUD criteria. Past-month cannabis use (compared to no lifetime use), more frequent past-month cannabis use (compared to no use in the past month), and each level of CUD (compared to no CUD) were associated with increased incidence of both missing work due to illness/injury and skipping work, with a dose-response relationship observed between CUD severity and skipping work (mild: adjusted incident rate ratio [aIRR]=1.60 [95% confidence interval [CI]=1.24, 2.08]; moderate: aIRR=1.98 [95% CI=1.50, 2.61]); severe (aIRR=2.87 [95% CI=2.12, 3.88]). CONCLUSIONS Individuals with recent and frequent cannabis use and CUD are disproportionately prone to workplace absenteeism. Results support the enforcement of workplace drug prevention and treatment policies.
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Affiliation(s)
- Kevin H Yang
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, California.
| | - Letitia Mueller
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, California
| | - Omar El-Shahawy
- Department of Public Health, NYU Grossman School of Medicine, New York, New York
| | - Joseph J Palamar
- Department of Public Health, NYU Grossman School of Medicine, New York, New York
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Choi NG, Moore J, Choi BY. Cannabis use disorder and substance use treatment among U.S. adults. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 167:209486. [PMID: 39151799 DOI: 10.1016/j.josat.2024.209486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/24/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Recent expansion of cannabis legalization in multiple states calls for reexamination of the prevalence of cannabis use, cannabis use disorder (CUD), and the associations between CUD severity and substance use treatment. We used Andersen's behavioral model of healthcare use as the conceptual/analytic framework for examining treatment use. METHODS We used data from the 2022 National Survey on Drug Use and Health (NSDUH; N = 47,100, age 18+) to describe the prevalence of past-year cannabis use, CUD and CUD severity, other substance use disorders, and substance use treatment. We compared sociodemographic, mental health, healthcare use, and cannabis and other substance use characteristics by CUD severity. Finally, we used logistic regression models to examine the associations between CUD severity and substance use treatment. RESULTS Of the U.S. adult population, 23.0 % used cannabis in the past year; 7.0 % had a CUD (3.9 % mild, 1.9 % moderate, and 1.2 % severe CUD); and 4.7 % received substance use treatment. Of past-year cannabis users, 30.3 % had CUD (16.9 % mild, 8.4 % moderate, and 5.0 % severe CUD), and 9.6 % received substance use treatment. Cannabis users had 3-4 times higher rates of other substance use disorders than nonusers. Of those with CUD, 38.4 % had moderate/severe mental illness, 52.4 % had other substance use disorders, and 16.5 % received substance use treatment. Among all cannabis users, moderate (aOR [adjusted odds ratios] = 1.48, 95 % CI = 1.03-2.13) and severe (aOR = 2.57, 95 % CI = 1.60-4.11) CUDs were associated with greater odds of substance use treatment. Among cannabis users without nicotine dependence and alcohol, opioid, tranquilizer/sedative, and stimulant use disorders, only severe CUD (aOR = 6.03, 95 % CI = 3.37-10.78) was associated with greater odds of substance use treatment. CONCLUSIONS This study shows increased prevalence of cannabis use and CUD among U.S. adults, and with or without other substance use disorders, CUD was associated with greater odds of substance use treatment. However, the overall low rate of treatment use among those with CUD is concerning. Healthcare providers need to provide education for both medical and recreational users on the development of tolerance and dependence. Harm reduction strategies to minimize the negative consequences of CUD are also needed.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA.
| | - John Moore
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, USA
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Piland R, Jenkins RJ, Darwish D, Kram B, Karamchandani K. Substance-Use Disorders in Critically Ill Patients: A Narrative Review. Anesth Analg 2024:00000539-990000000-00898. [PMID: 39116017 DOI: 10.1213/ane.0000000000007078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Substance-use disorders (SUDs) represent a major public health concern. The increased prevalence of SUDs within the general population has led to more patients with SUD being admitted to intensive care units (ICUs) for an SUD-related condition or with SUD as a relevant comorbidity. Multiprofessional providers of critical care should be familiar with these disorders and their impact on critical illness. Management of critically ill patients with SUDs is complicated by both acute exposures leading to intoxication, the associated withdrawal syndrome(s), and the physiologic changes associated with chronic use that can cause, predispose patients to, and worsen the severity of other medical conditions. This article reviews the epidemiology of substance use in critically ill patients, discusses the identification and treatment of common intoxication and withdrawal syndromes, and provides evidence-based recommendations for the management of patients exposed to chronic use.
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Affiliation(s)
- Rebecca Piland
- From the Division of Critical Care, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Russell Jack Jenkins
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Dana Darwish
- From the Division of Critical Care, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bridgette Kram
- Department of Pharmacy, Duke University Hospital, Durham, North Carolina
| | - Kunal Karamchandani
- From the Division of Critical Care, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
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Gallagher TJ, Chung RS, Lin ME, Kim I, Kokot NC. Cannabis Use and Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2024:2822269. [PMID: 39115834 PMCID: PMC11310842 DOI: 10.1001/jamaoto.2024.2419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/17/2024] [Indexed: 08/11/2024]
Abstract
Importance Cannabis is the most commonly used illicit substance worldwide. Whether cannabis use is associated with head and neck cancer (HNC) is unclear. Objective To assess the clinical association between cannabis use and HNC. Design, Setting, and Participants This large multicenter cohort study used clinical records from a database that included 20 years of data (through April 2024) from 64 health care organizations. A database was searched for medical records for US adults with and without cannabis-related disorder who had recorded outpatient hospital clinic visits and no prior history of HNC. Propensity score matching was performed for demographic characteristics, alcohol-related disorders, and tobacco use. Subsequently, relative risks (RRs) were calculated to explore risk of HNC, including HNC subsites. This analysis was repeated among those younger than 60 years and 60 years or older. Exposure Cannabis-related disorder. Main Outcomes and Measures Diagnosis of HNC and any HNC subsite. Results The cannabis-related disorder cohort included 116 076 individuals (51 646 women [44.5%]) with a mean (SD) age of 46.4 (16.8) years. The non-cannabis-related disorder cohort included 3 985 286 individuals (2 173 684 women [54.5%]) with a mean (SD) age of 60.8 (20.6) years. The rate of new HNC diagnosis in all sites was higher in the cannabis-related disorder cohort. After matching (n = 115 865 per group), patients with cannabis-related disorder had a higher risk of any HNC (RR, 3.49; 95% CI, 2.78-4.39) than those without HNC. A site-specific analysis yielded that those with cannabis-related disorder had a higher risk of oral (RR, 2.51; 95% CI, 1.81-3.47), oropharyngeal (RR, 4.90; 95% CI, 2.99-8.02), and laryngeal (RR, 8.39; 95% CI, 4.72-14.90) cancer. Results were consistent when stratifying by older and younger age group. Conclusions and Relevance This cohort study highlights an association between cannabis-related disorder and the development of HNC in adult patients. Given the limitations of the database, future research should examine the mechanism of this association and analyze dose response with strong controls to further support evidence of cannabis use as a risk factor for HNCs.
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Affiliation(s)
- Tyler J. Gallagher
- Keck School of Medicine of the University of Southern California, Los Angeles
| | - Ryan S. Chung
- Keck School of Medicine of the University of Southern California, Los Angeles
| | - Matthew E. Lin
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Ian Kim
- Department of Pediatrics and Department of Disease Prevention, Stanford University, Palo Alto, California
| | - Niels C. Kokot
- Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles
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Suchert V, Isensee B, Goecke M, Hanewinkel R. [School-based cannabis prevention: Results of a cluster-randomised trial]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2024. [PMID: 39102842 DOI: 10.1055/a-2364-3055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Acluster-randomised trial was conducted in five German federal states to evaluate the results of a school-based cannabis prevention unit. A total of 55 schools were randomly assigned to the intervention group, i.e. participation in a two-hour cannabis prevention workshop conducted by drug prevention specialists in grades 8 and 9, or to a control group with a waiting list. The knowledge, attitudes, intentions and behaviour of the young people in relation to cannabis were measured at the start of the study and six months later. 2,669 pupils(50.8% girls, average age=14.12 years) made up the sample. Effects of the intervention on the students' knowledge (adjusted regression coefficient=0.26 [0.15-0.38], p<0.001) and on the expected negative consequences of cannabis use in adolescents (adjusted regression coefficient=0.15 [0.04-0.25], p=0.006) were found. Both increased significantly more in the intervention group compared to the control group. There were no effects on other attitude-related variables, intentions or behaviour. A very short school-based workshop for grade 8 and 9 students improved their knowledge of and critical attitudes towards cannabis use, but had no effect on their future intentions and cannabis use.
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Affiliation(s)
- Vivien Suchert
- Institut für Therapie- und Gesundheitsforschung, Kiel, Germany
| | - Barbara Isensee
- Institut für Therapie- und Gesundheitsforschung, Kiel, Germany
| | - Michaela Goecke
- Bundeszentrale fur gesundheitliche Aufklärung, Köln, Germany
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Romeo B, Kervadec E, Fauvel B, Strika-Bruneau L, Amirouche A, Verroust V, Piolino P, Benyamina A. Significant Psychedelic Experiences Evaluated for Mystical Characteristics Associated with Cannabis Use Reduction and Psychological Flexibility Improvement: A Naturalistic Cross-Sectional Retrospective Survey. J Psychoactive Drugs 2024:1-12. [PMID: 38961652 DOI: 10.1080/02791072.2024.2375720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 05/13/2024] [Indexed: 07/05/2024]
Abstract
Treating cannabis use disorder remains a significant challenge in the field of addiction medicine. Some recent studies point to psychedelic-assisted psychotherapy as a potential treatment option for substance use disorders. The objective of this study was therefore to explore the impact of naturalistic psychedelic experiences on cannabis use and psychological flexibility. An online retrospective survey was carried out on 152 cannabis users who also reported a significant experience induced by psychedelics in the past. Following a psychedelic experience, there was a significant and sustained reduction of average CUDIT score (p < .001), frequency of cannabis use (p < .001), and acute duration of daily intoxication (p < .001). Cannabis use reduction during the first month post-experience was significantly associated with the intensity of the mystical experience (p = .01). Participants reported a concomitant increased lasting improvement of psychological flexibility following the experience (p < .001), which was correlated to the intensity of the mystical experience during the first month post-experience (p = .04). This study demonstrates that naturalistic psychedelic experiences may be followed by a decrease in cannabis use. Positive health outcomes appear potentially connected to the intensity of the mystical experience, as well as an improvement in psychological flexibility.
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Affiliation(s)
- B Romeo
- Department of Psychiatry and Addictology, APHP, Paul Brousse Hospital, Villejuif, France
- Unité de Recherche Psychiatrie-Comorbidités-Addictions, PSYCOMADD - Paris Saclay University Île-de-France, Villejuif, France
| | - E Kervadec
- Department of Psychiatry and Addictology, APHP, Paul Brousse Hospital, Villejuif, France
| | - B Fauvel
- Laboratoire Mémoire, Cerveau et Cognition (UR 7536), Institut de Psychologie, Université Paris Cité, Paris, France
| | - L Strika-Bruneau
- Department of Psychiatry and Addictology, APHP, Paul Brousse Hospital, Villejuif, France
- Unité de Recherche Psychiatrie-Comorbidités-Addictions, PSYCOMADD - Paris Saclay University Île-de-France, Villejuif, France
| | - A Amirouche
- Department of Psychiatry and Addictology, APHP, Paul Brousse Hospital, Villejuif, France
- Unité de Recherche Psychiatrie-Comorbidités-Addictions, PSYCOMADD - Paris Saclay University Île-de-France, Villejuif, France
| | - V Verroust
- Unité de Recherche Psychiatrie-Comorbidités-Addictions, PSYCOMADD - Paris Saclay University Île-de-France, Villejuif, France
- Université Picardie-Jules Vernes, Amiens, France
| | - P Piolino
- Laboratoire Mémoire, Cerveau et Cognition (UR 7536), Institut de Psychologie, Université Paris Cité, Paris, France
| | - A Benyamina
- Department of Psychiatry and Addictology, APHP, Paul Brousse Hospital, Villejuif, France
- Unité de Recherche Psychiatrie-Comorbidités-Addictions, PSYCOMADD - Paris Saclay University Île-de-France, Villejuif, France
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12
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Tilhou AS, Burns M, Chachlani P, Chen Y, Dague L. How Does Telehealth Expansion Change Access to Healthcare for Patients With Different Types of Substance Use Disorders? SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:473-485. [PMID: 38494728 PMCID: PMC11179974 DOI: 10.1177/29767342241236028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Patients with substance use disorders (SUDs) exhibit low healthcare utilization despite high medical need. Telehealth could boost utilization, but variation in uptake across SUDs is unknown. METHODS Using Wisconsin Medicaid enrollment and claims data from December 1, 2018, to December 31, 2020, we conducted a cohort study of telemedicine uptake in the all-ambulatory and the primary care setting during telehealth expansion following the COVID-19 public health emergency (PHE) onset (March 14, 2020). The sample included continuously enrolled (19 months), nonpregnant, nondisabled adults aged 19 to 64 years with opioid (OUD), alcohol (AUD), stimulant (StimUD), or cannabis (CannUD) use disorder or polysubstance use (PSU). Outcomes: total and telehealth visits in the week, and fraction of visits in the week completed by telehealth. Linear and fractional regression estimated changes in in-person and telemedicine utilization. We used regression coefficients to calculate the change in telemedicine utilization, the proportion of in-person decline offset by telemedicine uptake ("offset"), and the share of visits completed by telemedicine ("share"). RESULTS The cohort (n = 16 756) included individuals with OUD (34.8%), AUD (30.1%), StimUD (9.5%), CannUD (9.5%), and PSU (19.7%). Total and telemedicine utilization varied by group post-PHE. All-ambulatory: total visits dropped for all, then rose above baseline for OUD, PSU, and AUD. Telehealth expansion was associated with visit increases: OUD: 0.489, P < .001; PSU: 0.341, P < .001; StimUD: 0.160, P < .001; AUD: 0.132, P < .001; CannUD: 0.115, P < .001. StimUD exhibited the greatest telemedicine share. Primary care: total visits dropped for all, then recovered for OUD and CannUD. Telemedicine visits rose most for PSU: 0.021, P < .001; OUD: 0.019, P < .001; CannUD: 0.011, P < .001; AUD: 0.010, P < .001; StimUD: 0.009, P < .001. PSU and OUD exhibited the greatest telemedicine share, while StimUD exhibited the lowest. Telemedicine fully offset declines for OUD only. CONCLUSIONS Telehealth expansion helped maintain utilization for OUD and PSU; StimUD and CannUD showed less responsiveness. Telehealth expansion could widen gaps in utilization by SUD type.
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Affiliation(s)
- Alyssa Shell Tilhou
- Department of Family Medicine, Boston University Medical Center, Boston, MA, USA
| | - Marguerite Burns
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Preeti Chachlani
- Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI, USA
| | - Ying Chen
- Department of Risk and Insurance, Wisconsin School of Business, University of Wisconsin-Madison, Madison, WI, USA
| | - Laura Dague
- The Bush School of Government and Public Service, Texas A&M University, College Station, TX, USA
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13
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Stampf A, Schwarzkopf L, Batalla A, Feingold D, Fischer B, Hoch E. Cannabis-related treatment demand at the eve of German cannabis legalization - a 20-years trend analysis. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01832-w. [PMID: 38951248 DOI: 10.1007/s00406-024-01832-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/27/2024] [Indexed: 07/03/2024]
Abstract
Post-2000, the prevalence of cannabis consumption has been rising internationally. This paper investigates whether cannabis-related treatment demand in German outpatient addiction care facilities (OACFs) has been following this trend. Treatment demand related to cannabis use disorder (CUD) for the period 2001 to 2021 was investigated using data from the nation-wide standardized German Addiction Care Statistical Service. Analyses covered all and first-time treatment admissions, demographics, and treatment outcomes. We identified years with significant changes in slope or direction of trends through joinpoint regression. Trends within the CUD client population were contrasted with trends among the entire OACF client population. CUD is the second-most common cause for OACF admissions in Germany. Between 2001 and 2021, the share of CUD-related cases among total OACF caseload increased from 7.1 to 19.9%, whereby the share of first-time treatment admissions declined from 79.6 to 55.6%. The share of CUD client population > 35 years almost tripled from 6.0 to 17.4%, that of female client population rose from 15.6 to 18.1%. From 2001 to 2007, the share of CUD-related treatments completed with improved symptomatology increased from 54.7 to 65.6%, followed by a marginal decline. CUD-related treatment demand is growing in Germany's OACFs, involving a client population that is increasingly older and more experienced with the addiction care system. As current intervention programmes mainly target adolescents and young adults who have been consuming cannabis only for a short time, adapting service offers to the changing client profiles appears paramount to improve treatment effectiveness.
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Affiliation(s)
- Alisa Stampf
- IFT Institut Für Therapieforschung, Centre for Mental Health and Addiction Research, Leopoldstrasse 175, 80804, Munich, Germany
| | - Larissa Schwarzkopf
- IFT Institut Für Therapieforschung, Centre for Mental Health and Addiction Research, Leopoldstrasse 175, 80804, Munich, Germany.
- Department of Psychiatry and Psychotherapy, University Clinic of the Ludwig Maximilians University Munich, Nussbaumstraße 7, 80336, Munich, Germany.
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Marchioninistrasse 17, 80336, Munich, Germany.
| | - Albert Batalla
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Daniel Feingold
- Psychology Department, Achva Academic College, 1 Achva, MP. Shikmim, 7980400, Arugot, Israel
| | - Benedikt Fischer
- Research & Graduate Studies, University of the Fraser Valley, 33844 King Road, Abbotsford, BC, Canada
- Department of Psychiatry, University of Toronto, 250 College St, Toronto, Canada
- Department of Psychiatry, Federal University of Sao Paulo, R. Sena Madureira, São Paulo, 1500, Brazil
- School of Population Health, University of Auckland, 85 Park Road, Auckland, New Zealand
| | - Eva Hoch
- IFT Institut Für Therapieforschung, Centre for Mental Health and Addiction Research, Leopoldstrasse 175, 80804, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Clinic of the Ludwig Maximilians University Munich, Nussbaumstraße 7, 80336, Munich, Germany
- School of Population Health, University of Auckland, 85 Park Road, Auckland, New Zealand
- Department Psychologie, Professur Für Klinische Psychologie Und Psychotherapie, Charlotte-Fresenius-Universität, Infanteriestrasse 11a, 80797, Munich, Germany
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Sridharan P, Romm KF, Berg CJ. Use of Cannabis for Medical or Recreational Purposes Among US Young Adults: Correlates and Implications for Problematic Use and Interest in Quitting. CANNABIS (ALBUQUERQUE, N.M.) 2024; 7:51-64. [PMID: 38975600 PMCID: PMC11225981 DOI: 10.26828/cannabis/2024/000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Objective Recreational and medical cannabis use has increased, particularly among young adults, but little is known regarding who uses for these purposes or how purpose of use is associated with problematic use. Methods We analyzed Fall 2019 survey data among 1,083 US young adults (ages 18-34) reporting past 6-month cannabis use. Multivariable regression analyses examined: 1) characteristics of those using for only/primarily medical purposes, primarily recreationally, and only recreationally vs. equally for medical and recreational purposes (referent; multinomial logistic); and 2) reasons for use in relation to cannabis use disorder symptoms (linear) and driving under the influence of cannabis (DUIC; binary logistic). Results 37.1% used only recreationally, 23.5% primarily recreationally, 21.5% equally for both, and 17.8% medically. Compared to those using equally for medical and recreational purposes, those using only/primarily medically had fewer friends who used cannabis; those using primarily recreationally were younger, more educated, less likely used tobacco, and reported fewer ACEs. Those using only recreationally were younger, more likely male, less likely to report an ADHD diagnosis or past-month alcohol or tobacco use, and reported fewer friends who used cannabis, ACEs, and depressive symptoms. Using equally for medical and recreational purposes (vs. all other cannabis use subgroups) correlated with greater use disorder symptoms and DUIC. Conclusions Using cannabis equally for medical and recreational purposes may pose particularly high-risk, given the association with greater mental health concerns and problematic use. Understanding use profiles and how young adults interpret and distinguish medical and recreational use is critical.
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Affiliation(s)
- Priyanka Sridharan
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University
| | - Katelyn F Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University
- George Washington Cancer Center, George Washington University
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15
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Powlowski P, Matheson J, Le Foll B, Andreazza AC, Ross RA. Acute Cannabis Administration Transiently Reduces Mitochondrial DNA in Young Adults: Findings from a Secondary Analysis of a Double-Blind, Placebo-Controlled, Randomized Clinical Trial. Cannabis Cannabinoid Res 2024. [PMID: 38923954 DOI: 10.1089/can.2023.0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
Background: Cannabis is one of the world's most commonly used substances; however, many questions remain unanswered as to how cannabis impacts the body. Recently, there has been a resurgence of research into the effects of plant-derived cannabinoids on mitochondrial health. In particular, a number of studies implicate mitochondrial-Δ9-tetrahydrocannabinol (Δ9-THC) interactions with altered memory, metabolism, and catalepsy in mice. Although the research in this field is expanding rapidly, there is little known about the effects of cannabis on mitochondria health in human subjects either in acute or chronic term use. Methods: Blood samples were obtained from a double-blind, placebo-controlled, parallel-group randomized clinical trial in which adults who regularly use cannabis (1-4 days/week) aged 19-25 years were randomized 2:1 to receive either an active (12.5% Δ9-THC) cigarette or placebo (<0.01% Δ9-THC) cigarette containing 750 mg of cannabis before driving simulator testing. DNA was extracted from whole blood using commercial spin columns, followed by measurement of mt-ND1, mt-ND4, and β2M using quantitative polymerase chain reaction. One-way repeated measures analysis of variance (ANOVA) followed by Dunnett's multiple comparisons test was used to observe changes in mitochondrial DNA (mtDNA) copy number over time. A two-tailed Pearsons R test was used to assess correlations between mtDNA copy number and cannabinoid levels (Δ9-THC and metabolites) in blood. Results: We found that exposure to active cannabis containing Δ9-THC, as opposed to placebo, was associated with an acute reduction in mitochondrial DNA copy number in whole blood at 15 min and 1 h after smoking. The observed decrease in mtDNA copy number negatively correlated with blood concentrations of 11-hydroxy-Δ9-tetrahydrocannabinol (11-OH-THC) and 11-Nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH), the two primary metabolites of Δ9-THC, but not Δ9-THC itself. Further, the negative correlation between 11-OH THC and THC-COOH concentrations and mtDNA copy number was found in only a subgroup of participants who use cannabis infrequently, suggesting a tolerance effect. Conclusions: These results illuminate mitochondrial alterations attributed to Δ9-THC consumption, which may be mediated by metabolites. These results appear to suggest stronger effects in individuals who consume cannabis less frequently, suggesting some form of tolerance to the effects of Δ9-THC and its metabolites on mtDNA content in whole blood. Keywords: Mitochondria; mtDNA; cannabis; THC; THC metabolites; blood; THC-COOH; 11-OH-THC.
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Affiliation(s)
- Pavel Powlowski
- Department of Pharmacology & Toxicology, Medical Sciences Building, University of Toronto, Toronto, Canada
| | - Justin Matheson
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Acute Care Program, Centre for Addiction and Mental Health, Toronto, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Canada
| | - Ana C Andreazza
- Department of Pharmacology & Toxicology, Medical Sciences Building, University of Toronto, Toronto, Canada
| | - Ruth A Ross
- Department of Pharmacology & Toxicology, Medical Sciences Building, University of Toronto, Toronto, Canada
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16
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Manthey J. Treatment demand for cannabis use problems: analyses of routine data from 30 European countries. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01840-w. [PMID: 38867084 DOI: 10.1007/s00406-024-01840-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
Cannabis use and treatment demand has risen in the past decade. Previous analyses of treatment demand are limited by methodological constraints or are outdated. Cross-country differences and trends in cannabis treatment demand are described using data from the European Monitoring Centre for Drugs and Drug Addiction. Two novel indicators are employed: firstly, the cannabis-attributable treatment fraction (CATF) is obtained by dividing the number of treatment entrants for cannabis use problems by the number of treatment entrants for any substance use problem, accounting for possible changes in the reporting system. Secondly, comparing the number of treatment entrants for cannabis use problems to the number of people who use cannabis (near) daily yields the treated-user-ratio (TUR), which considers a proxy for treatment need (frequent use). Across 30 countries with available data, the importance of cannabis in European treatment facilities varies greatly (CATF: min = 3%; max = 65%), with lower estimates in Eastern European countries. Across 20 countries with complete data, the CATF has risen from 29.4% in 2013 to 37.1% in 2020. The TUR calculated on 26 countries suggests that about 3 in 100 frequent users have sought treatment for their cannabis use problems. Over time, treatment demand has increased at a slower pace than treatment need in most countries. One in three treatment entrants for substance use problems in Europe are due to cannabis, with large variations between countries. There are indications for a widening treatment gap for cannabis use problems. In countries liberalising cannabis laws, monitoring changes in treatment access and demand is warranted.
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Affiliation(s)
- Jakob Manthey
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
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17
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Wąsik J, Likońska A, Kurowski M. IgE-Mediated Allergy and Asymptomatic Sensitization to Cannabis Allergens-Review of Current Knowledge and Presentation of Six Cases. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:954. [PMID: 38929571 PMCID: PMC11205784 DOI: 10.3390/medicina60060954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
Cannabis allergy is a relatively new phenomenon described in the 1970s. Its increased frequency has been observed over the last years due to the increasing therapeutic and recreational use of cannabis-based products. Sensitization possibly leading to allergy symptoms can occur not only through the smoking of cannabis, but also through ingestion, the inhalation of pollen, or direct contact. The severity of symptoms varies from benign pruritus to anaphylaxis. There is scant information available to support clinicians throughout the entire therapeutic process, starting from diagnosis and ending in treatment. In this review, we present six cases of patients in whom molecular in vitro testing revealed sensitization to cannabis extract and/or cannabis-derived nsLTP molecules (Can s 3). Based on these cases, we raise important questions regarding this topic. The article discusses current proposals and highlights the importance of further research not only on cannabis allergy but also on asymptomatic sensitization to cannabis allergens, which may be ascertained in some percentage of the population.
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Affiliation(s)
- Jakub Wąsik
- Department of Immunology and Allergy, Medical University of Lodz, 90-419 Lodz, Poland; (J.W.); (A.L.)
- Student Scientific Association, Department of Immunology and Allergy, Medical University of Lodz, 90-419 Lodz, Poland
| | - Aleksandra Likońska
- Department of Immunology and Allergy, Medical University of Lodz, 90-419 Lodz, Poland; (J.W.); (A.L.)
| | - Marcin Kurowski
- Department of Immunology and Allergy, Medical University of Lodz, 90-419 Lodz, Poland; (J.W.); (A.L.)
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18
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Brodeur M, Jutras-Aswad D, Légaré AA, Morvannou A, Monson E, Cotton JC, Hakansson A, Parent V, Hudon C. Cannabis use, mental health, and problematic Internet use in Quebec: A study protocol. PLoS One 2024; 19:e0304697. [PMID: 38829870 PMCID: PMC11146692 DOI: 10.1371/journal.pone.0304697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 05/15/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Problematic Internet use is characterized by excessive use of online platforms that can result in social isolation, family problems, psychological distress, and even suicide. Problematic Internet use has been associated with cannabis use disorder, however knowledge on the adult population remains limited. In Quebec, cannabis use has significatively increased since 2018, and it is associated with various risks in public safety, public health, and mental health. This study aims to identify factors associated with problematic Internet use among adult cannabis users and to better understand their experiences. METHOD This project is a mixed explanatory sequential study consisting of two phases. Phase 1 (n = 1500) will be a cross-sectional correlational study using probability sampling to examine variables that predispose individuals to problematic Internet use, characteristics associated with cannabis use, Internet use, and the mental health profile of adult cannabis users in Quebec. Descriptive analyses and regression models will be used to determine the relationship between cannabis use and Internet use. Phase 2 (n = 45) will be a descriptive qualitative study in the form of semi-structured interviews aimed at better understanding the experience and background of cannabis users with probable problematic Internet use. DISCUSSION The results of this study will support the development of public policies and interventions for the targeted population, by formulating courses of action that contribute to the prevention and reduction of harms associated with cannabis use and problematic Internet use. Furthermore, an integrated knowledge mobilization plan will aid in the large-scale dissemination of information that can result useful to decision-makers, practitioners, members of the scientific community, and the general population regarding the use of cannabis and the Internet.
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Affiliation(s)
- Magaly Brodeur
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, Quebec, Canada
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Andrée-Anne Légaré
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Adèle Morvannou
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Eva Monson
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Julie-Christine Cotton
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Anders Hakansson
- Faculty of Medicine, Clinical Addiction Research Unit, Lund University, Lund, Sweden
| | - Virginie Parent
- Centre Integré Universitaire de Santé et de Services Sociaux de l’Estrie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Campbell JE, Chen S, Bailey A, Blair A, Comiford AL. Investigating Cannabis-Use Among Students Attending High Schools Within the Cherokee Nation Reservation 2017 and 2019. J Community Health 2024; 49:402-414. [PMID: 38066219 PMCID: PMC10981585 DOI: 10.1007/s10900-023-01304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 02/18/2024]
Abstract
Oklahoma's medical cannabis is some of the least restrictive in the US. Previous research suggests that American Indian/Alaska Native (AIAN) have higher rates of cannabis use than other racial or ethnic groups. The goals of this paper are, first, to look at cannabis use among high school students living on the Cherokee Nation Reservation before (2017) and after (2019) medical cannabis because legal in Oklahoma (2018) utilizing the Cherokee Nation Youth Risk Behavior Survey (CNYRBS). Second, to describe the socio-demographic characteristics of youth using cannabis in the Cherokee Nation Reservation. Data were retrieved from the 2017 and 2019 CNYRBS. The data for this study included 1,216 high school students who completed the 2017 and 1,476 who completed the 2019 CNYRBS. After removal of incomplete records, there were 2,602 students whose data was analyzed in this study. Data were weighted to be representative of public-school students attending grades 9-12 within Cherokee Nation Reservation. Despite the legalization of medical cannabis in Oklahoma in 2018, there was no change in cannabis use among youth between 2017 and 2019. There were variations in cannabis use based on demographic factors and other substance uses. AIAN individuals had higher odds of current cannabis use compared to non-Hispanic White students, but there were no differences based on ethnicity. Additionally, the use of cigarettes, e-cigarettes, alcohol, and illegal drugs were associated with increased odds of cannabis use among both current and former users compared to those who had never used it. There was no spike in use among youth at least immediately after the legalization of cannabis in the Cherokee Nation Reservation. There were socio-demographic as well as substance use disparities in the use of cannabis.
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Affiliation(s)
- Janis E Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Anna Bailey
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Andrea Blair
- Cherokee Nation Public Health, 1325 East Boone Street, Tahlequah, OK, 74464, USA
| | - Ashley L Comiford
- Cherokee Nation Health Services, 19600 East Ross Road, Tahlequah, OK, 74464, USA
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20
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Munir MM, Woldesenbet S, Endo Y, Dillhoff M, Pawlik TM. Cannabis use disorder and perioperative outcomes following complex cancer surgery. J Surg Oncol 2024; 129:1430-1441. [PMID: 38606521 DOI: 10.1002/jso.27644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Cannabis usage is increasing in the United States, especially among patients with cancer. We sought to evaluate whether cannabis use disorder (CUD) was associated with higher morbidity and mortality among patients undergoing complex cancer surgery. METHODS Patients who underwent complex cancer surgery between January 2016 and December 2019 were identified in the National Inpatient Sample database. CUD was defined according to ICD-10 codes. Propensity score matching was performed to create a 1:1 matched cohort that was well balanced with respect to covariates, which included patient comorbidities, sociodemographic factors, and procedure type. The primary composite outcome was in-hospital mortality and seven major perioperative complications (myocardial ischemia, acute kidney injury, stroke, respiratory failure, venous thromboembolism, hospital-acquired infection, and surgical procedure-related complications). RESULTS Among 15 014 patients who underwent a high-risk surgical procedure, a cohort of 7507 patients with CUD (median age; 43 years [IQR: 30-56 years]; n = 3078 [41.0%] female) were matched with 7507 patients who were not cannabis users (median age; 44 years [IQR: 30-58 years); n = 2997 [39.9%] female). CUD was associated with slight increased risk relative to postoperative kidney injury (CUD, 7.8% vs. no CUD, 6.1%); however, in-hospital mortality was slightly lower (CUD, 0.9% vs. no CUD, 1.6%) (both p < 0.001). On multivariable analysis, after controlling for other risk factors, CUD was not associated with higher morbidity and mortality (adjusted odds ratio: 1.06, 95% CI: 0.98-1.15; p = 0.158). CONCLUSION CUD was not associated with a higher risk of postoperative morbidity and mortality following complex cancer surgery.
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Affiliation(s)
- Muhammad M Munir
- Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Selamawit Woldesenbet
- Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Yutaka Endo
- Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Mary Dillhoff
- Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
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21
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Connor JP, Manthey J, Hall W, Stjepanović D. Effectiveness of cannabis use and cannabis use disorder interventions: a European and international data synthesis. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01829-5. [PMID: 38780801 DOI: 10.1007/s00406-024-01829-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
This data synthesis examined the effectiveness of behavioural and pharmacological approaches for cannabis treatment. We integrated findings from high level evidence studies and prioritised data from Europe when available. The synthesis found that only a relatively small number of published behavioural and pharmacological studies on cannabis interventions have been conducted in Europe. Applying both European and non-European data, it was found that Cognitive Behavioural Therapy (CBT) and/or Motivational Enhancement Therapy (MET) improved short-term outcomes in the frequency of cannabis use and dependency severity, although abstinence outcomes were less consistent. These improvements were typically not maintained nine months after treatment. CBT and MET (or combined CBT + MET) treatments that extend beyond four sessions were more effective than fewer sessions over a shorter duration. Combining CBT or MET (or combined CBT + MET) with adjunctive Contingency Management (CM) improved therapeutic outcomes. No pharmacotherapies have been approved for the management of cannabis use, cannabis use disorders or cannabis withdrawal. Despite only weak evidence to support the use of pharmacological agents, some are used 'off-label' to manage withdrawal symptoms outside clinical trials.
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Affiliation(s)
- Jason P Connor
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
- Discipline of Psychiatry, School of Medicine, The University of Queensland, Herston, Australia
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Wayne Hall
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Woolloongabba, Australia
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Daniel Stjepanović
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia.
- School of Psychology, The University of Queensland, St Lucia, Australia.
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22
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Mosandl CF, Baltes-Flückiger L, Kronschnabel J, Meyer M, Guessoum A, Herrmann O, Vogel M, Walter M, Pichler EM. Cannabis use and its association with psychopathological symptoms in a Swiss adult population: a cross-sectional analysis. Front Public Health 2024; 12:1356988. [PMID: 38841675 PMCID: PMC11151851 DOI: 10.3389/fpubh.2024.1356988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/10/2024] [Indexed: 06/07/2024] Open
Abstract
Background As the most commonly used illicit substance, cannabis is gaining global acceptance through increasing legalization efforts. This shift intensifies the need for research to guide policymakers and healthcare providers in harm reduction and treatment strategies. Nonetheless, the relationship between psychopathological symptoms and cannabis use remains inadequately understood. Methods A sample of regular cannabis consumers completed self-reported assessments for depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), Attention-Deficit/Hyperactivity Disorder (ADHD; Adult ADHD Self-Report Scale V1.1), and psychosis (Early Recognition Inventory based on IRAOS) as well as previous black-market cannabis use patterns. Cannabis Use Disorder Identification Test Revised (CUDIT-R) was used to identify cannabis use disorder (CUD). To understand psychopathological symptom load related to cannabis consumption as well as cannabis use motives, multiple regression models were performed to identify psychopathological variables predicting cannabis use frequency and quantity. Linear regression and correlation analyses were conducted, adjusting for relevant covariates (age, gender, education, alcohol, other substance use). Results Three-hundred-sixty regular cannabis users interested in a study on regulated cannabis access in Basel, Switzerland were examined. In bivariate analysis, cannabis use frequency correlated with depressive (r(358) = 0.16, p = 0.003) and anxiety symptom load (r(358) = 0.11, p = 0.034). Cannabis quantity correlated with depressive (r(358) = 0.15, p = 0.005), ADHD (r(358) = 0.14, p = 0.008), and psychosis symptom load (r(358) = 0.16, p = 0.002). However, in the adjusted regression models only depressive and ADHD symptom loads were significantly associated with cannabis use frequency (p = 0.006 and p = 0.034, respectively) and quantity (p = 0.037 and p = 0.019, respectively). No significant correlations between cannabis consumption and anxiety or psychosis remained after adjustment. Conclusion ADHD and depressive symptoms correlate with increased cannabis use in a cohort of regular users, suggesting potential self-medication in nonclinical populations. With the rising availability of cannabis worldwide, these results highlight the necessity for longitudinal studies to disentangle the complex dynamics between cannabis consumption and mental health symptoms.
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Affiliation(s)
- Christoph Felix Mosandl
- Clinic of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | | | - Jens Kronschnabel
- Clinic of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
| | - Maximilian Meyer
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Adrian Guessoum
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Oliver Herrmann
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Marc Vogel
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Marc Walter
- Clinic of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
| | - Eva-Maria Pichler
- Clinic of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
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23
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Yang G, Li F, Wang Q, Liu Y, Guo J, Yue C. Association between history of cannabis use and outcomes after total hip or knee arthroplasty: a systematic review and meta-analysis. Front Public Health 2024; 12:1377688. [PMID: 38827608 PMCID: PMC11140086 DOI: 10.3389/fpubh.2024.1377688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/25/2024] [Indexed: 06/04/2024] Open
Abstract
Background Cannabis use may be increasing as countries legalize it and it becomes socially acceptable. A history of cannabis use may increase risk of complications after various kinds of surgery and compromise functional recovery. Here we systematically reviewed and meta-analyzed available evidence on how history of cannabis use affects recovery after hip or knee arthroplasty (THA/TKA). Methods The PubMed, EMBASE, and Web of Science databases were comprehensively searched and studies were selected and analyzed in accordance with the PRISMA guidelines. The methodological quality of included studies was assessed based on the Newcastle-Ottawa Scale, while quality of evidence was evaluated according to the "Grading of recommendations assessment, development, and evaluation" system. Data on various outcomes were pooled when appropriate and meta-analyzed. Results The systematic review included 16 cohort studies involving 5.91 million patients. Meta-analysis linked history of cannabis use to higher risk of the following outcomes: revision (RR 1.68, 95% CI 1.31-2.16), mechanical loosening (RR 1.77, 95% CI 1.52-2.07), periprosthetic fracture (RR 1.85, 95% CI 1.38-2.48), dislocation (RR 2.10, 95% CI 1.18-3.73), cardiovascular events (RR 2.49, 95% CI 1.22-5.08), cerebrovascular events (RR 3.15, 95% CI 2.54-3.91), pneumonia (RR 3.97, 95% CI 3.49-4.51), respiratory failure (RR 4.10, 95% CI 3.38-4.97), urinary tract infection (RR 2.46, 95% CI 1.84-3.28), acute kidney injury (RR 3.25, 95% CI 2.94-3.60), venous thromboembolism (RR 1.48, 95% CI 1.34-1.63), and deep vein thrombosis (RR 1.42, 95% CI 1.19-1.70). In addition, cannabis use was associated with significantly greater risk of postoperative transfusion (RR 2.23, 95% CI 1.83-2.71) as well as higher hospitalization costs. Conclusion History of cannabis use significantly increases the risk of numerous complications and transfusion after THA or TKA, leading to greater healthcare costs. Clinicians should consider these factors when treating cannabis users, and pre-surgical protocols should give special consideration to patients with history of cannbis use.
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Affiliation(s)
| | | | | | | | - Jiayi Guo
- Luoyang Orthopedic Traumatological Hospital, Luoyang, China
| | - Chen Yue
- Luoyang Orthopedic Traumatological Hospital, Luoyang, China
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24
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Karst M. Overview: Chronic Pain and Cannabis-Based Medicines. PHARMACOPSYCHIATRY 2024; 57:152-159. [PMID: 38198809 PMCID: PMC11076105 DOI: 10.1055/a-2231-6630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024]
Abstract
Chronic pain is primarily conceptualized as a disease in its own right when it is associated with emotional distress and functional impairment. Pathophysiologically, dysfunction of the cortico-mesolimbic connectome is of major importance, with overlapping signals in the nociceptive and stress systems. The endocannabinoid system plays an important role in the central processing of nociceptive signals and regulates the central stress response. Clinically, there is moderate evidence that cannabis-based medicines (CBM) can contribute to a significant reduction in pain, especially the associated pain affect, and improvement in physical function and sleep quality in a proportion of patients with chronic pain. The analgesic effect appears to be largely independent of the cause of pain. In this context, CBM preferentially regulates stress-associated pain processing.
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Affiliation(s)
- Matthias Karst
- Anesthesiology, Pain Clinic, Hannover Medical School, Hannover,
Germany
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25
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Das A, Hendershot CS, Husain MI, Knyahnytska Y, Elsaid S, Le Foll B, Kloiber S. Perceptions, Experiences, and Patterns of Cannabis Use in Individuals with Mood and Anxiety Disorders in the Context of Cannabis Legalization and Medical Cannabis Program in Canada - A Qualitative Study. PHARMACOPSYCHIATRY 2024; 57:141-151. [PMID: 38467156 DOI: 10.1055/a-2264-1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Perceptions of cannabis as a potential medical treatment for mood and anxiety disorders have been increasing in the context of legalizations, availability, and medical cannabis programs, though current evidence predominately indicates risks and negative effects of cannabis use (CU) on mental health outcomes. This study aims to understand motivations, perceptions, effects, and patterns of CU in individuals with mood and anxiety disorders. METHODS Thirty-six adult patients diagnosed with mood or anxiety disorders, obsessive-compulsive disorder, or posttraumatic stress disorder who were currently using cannabis completed an in-depth qualitative interview on individual motivations, perceptions, experiences, effects, and patterns of their CU. The thematic analysis focused on phases of CU and sources of cannabis products and information. RESULTS Reported motivations for initiation of CU included curiosity, peer pressure, and dissatisfaction with conventional treatments. Factors such as psychotropic effects and coping with mental health symptoms and insomnia contributed to the continuation of CU. More negative effects, including cognitive dysfunction, worsening of mood, and anxiety symptoms, were acknowledged with ongoing CU. Concerning findings included common initiation of CU before age 18, combined medical and recreational CU, rare consultation of medical professionals on CU, and potential effects and harms. DISCUSSION Findings indicate individual complexity of motivations, perceptions, and patterns of CU in the study population. The reported potential beneficial effects of specific cannabis products should be further investigated. Findings emphasize patient-provider dialogue on both CU and conventional treatments. Information from this study can contribute to and inform the development of education, prevention, and intervention strategies.
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Affiliation(s)
- Ankita Das
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Christian S Hendershot
- Department of Psychiatry and Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, NC, USA
| | - M Ishrat Husain
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yuliya Knyahnytska
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Sonja Elsaid
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Bernard Le Foll
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Canada
| | - Stefan Kloiber
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
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26
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Grigsby TJ, Lopez A, Guo Y. Development and preliminary validation of the positive consequences of cannabis (PCOC) scale. Addict Behav 2024; 152:107977. [PMID: 38295608 DOI: 10.1016/j.addbeh.2024.107977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION While extensive research exists on the negative consequences of cannabis use, there is a noticeable gap in the literature regarding positive consequences on patterns of cannabis use. The goal of the present study was to develop and test the psychometric properties of a novel scale, the Positive Consequences of Cannabis scale (PCOC) to assess positive outcomes of cannabis use among current adult cannabis users. METHODS Participants (n = 768) were recruited through online platforms. The sample was predominantly non-Hispanic (92.3 %) male (62.92 %) with an average age of 29.08 years (SD = 6.10). A split half validation method was used to assess the factor structure of the PCOC scale. Data analysis also included Exploratory factor analysis (EFA) to identify underlying factor structures of the PCOC, confirmatory factor analysis (CFA) to validate the factor structure, and the assessments of internal consistency and validity. RESULTS The EFA identified a two-factor solution for the PCOC: Social and Psychological Consequences and Cognitive and Motivational Consequences. The CFA confirmed the validity of this factor structure with good model fit (χ2 = 321.33, p < 0.001; CFI = 0.95; TLI = 0.95; RMSEA = 0.038; SRMR = 0.048). Internal consistency coefficients for the PCOC subscales and total scale exceeded acceptable thresholds. A hierarchical regression model showed that both PCOC subscales were significantly associated with cannabis use frequency and quantity. DISCUSSION The development and validation of the PCOC represent a significant advancement in assessing positive consequences in understanding cannabis use patterns, indicating that individuals who experience a range of positive effects are more likely to engage in more frequent and intense cannabis use.
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Affiliation(s)
- Timothy J Grigsby
- Department of Social and Behavioral Health, University of Nevada, Las Vegas, USA.
| | - Andrea Lopez
- Department of Epidemiology and Biostatistics, University of Nevada, Las Vegas, USA
| | - Ying Guo
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas, USA
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Braun IM, Bohlke K, Abrams DI, Anderson H, Balneaves LG, Bar-Sela G, Bowles DW, Chai PR, Damani A, Gupta A, Hallmeyer S, Subbiah IM, Twelves C, Wallace MS, Roeland EJ. Cannabis and Cannabinoids in Adults With Cancer: ASCO Guideline. J Clin Oncol 2024; 42:1575-1593. [PMID: 38478773 DOI: 10.1200/jco.23.02596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 04/28/2024] Open
Abstract
PURPOSE To guide clinicians, adults with cancer, caregivers, researchers, and oncology institutions on the medical use of cannabis and cannabinoids, including synthetic cannabinoids and herbal cannabis derivatives; single, purified cannabinoids; combinations of cannabis ingredients; and full-spectrum cannabis. METHODS A systematic literature review identified systematic reviews, randomized controlled trials (RCTs), and cohort studies on the efficacy and safety of cannabis and cannabinoids when used by adults with cancer. Outcomes of interest included antineoplastic effects, cancer treatment toxicity, symptoms, and quality of life. PubMed and the Cochrane Library were searched from database inception to January 27, 2023. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS The evidence base consisted of 13 systematic reviews and five additional primary studies (four RCTs and one cohort study). The certainty of evidence for most outcomes was low or very low. RECOMMENDATIONS Cannabis and/or cannabinoid access and use by adults with cancer has outpaced the science supporting their clinical use. This guideline provides strategies for open, nonjudgmental communication between clinicians and adults with cancer about the use of cannabis and/or cannabinoids. Clinicians should recommend against using cannabis or cannabinoids as a cancer-directed treatment unless within the context of a clinical trial. Cannabis and/or cannabinoids may improve refractory, chemotherapy-induced nausea and vomiting when added to guideline-concordant antiemetic regimens. Whether cannabis and/or cannabinoids can improve other supportive care outcomes remains uncertain. This guideline also highlights the critical need for more cannabis and/or cannabinoid research.Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
- Ilana M Braun
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | - Donald I Abrams
- University of California San Francisco Osher Center for Integrative Health, San Francisco, CA
| | | | | | | | | | | | - Anuja Damani
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | | | | | | | - Chris Twelves
- University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Eric J Roeland
- Oregon Health and Science University, Knight Cancer Institute, Portland, OR
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28
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Wichaidit W, Chapakiya I, Waeuseng A, Chumchuen K, Assanangkornchai S. Density of cannabis outlets vs. cannabis use behaviors and prevalent cannabis use disorder: findings from a nationally-representative survey. PeerJ 2024; 12:e17317. [PMID: 38699183 PMCID: PMC11064851 DOI: 10.7717/peerj.17317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/09/2024] [Indexed: 05/05/2024] Open
Abstract
Background Thailand recently decriminalized (de facto legalized) cannabis use and sales. However, nationally representative data are scarce with regard to cannabis use behaviors and its association with cannabis outlet density. The objectives of this study are: (1) to describe the prevalence of cannabis use behaviors and cannabis use disorder among the general adult population of Thailand; (2) to describe the extent that the density of cannabis outlets is associated with cannabis use behaviors, cannabis use disorder, and the amount of cannabis smoked per day. Methods We conducted a community-based cross-sectional study in 11 provinces and the Bangkok Metropolitan Area. Participants were residents of sampled communities aged 20 years or older. We requested literate participants to self-administer the questionnaire and interviewed participants who could not read. We analyzed data using descriptive statistics with sampling weight adjustments and multivariate logistic regression analyses. Results The prevalence of current cannabis use was 15 percent. At a 400-m radius, participants who reported three cannabis outlets had 4.2 times higher odds of being current users than participants who reported no outlet (Adjusted OR = 4.82; 95% CI [3.04-7.63]). We found no association between outlet density and hazardous cannabis use or cannabis use disorder, nor association with the amount of cannabis use among cannabis smokers. Discussion and Conclusion The patterns of association between outlet density and cannabis use behaviors were inconsistent. Furthermore, limitations regarding outlet density measurement and lack of temporality should be considered as caveats in the interpretation of the study findings.
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Affiliation(s)
- Wit Wichaidit
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla Province, Thailand
- Centre for Alcohol Studies, Hat Yai, Songkhla Province, Thailand
| | - Ilham Chapakiya
- Division of Computational Science (Statistics), Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla Province, Thailand
| | - Aneesah Waeuseng
- Division of Computational Science (Statistics), Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla Province, Thailand
| | - Kemmapon Chumchuen
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla Province, Thailand
| | - Sawitri Assanangkornchai
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla Province, Thailand
- Centre for Alcohol Studies, Hat Yai, Songkhla Province, Thailand
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29
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Rubin-Kahana DS, Butler K, Hassan AN, Sanches M, Le Foll B. Cannabis Use Characteristics Associated with Self-Reported Cognitive Function in a Nationally Representative U.S. sample. Subst Use Misuse 2024; 59:1303-1312. [PMID: 38664196 DOI: 10.1080/10826084.2024.2340975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND With increases in cannabis use and potency, there is a need to improve our understanding of the impact of use on cognitive function. Previous research indicates long-term cannabis use may have a negative effect on executive function. Few studies have examined persistence of it in protracted abstinence, and there is limited evidence of predictors of worse cognitive function in current and former users. In this study, we aim to evaluate the associations between cannabis use status (current, former, and never use) and self-report cognition. Further, we investigate if cannabis use characteristics predict self-report cognitive function. METHODS Cross-sectional cannabis use data from the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III), a national survey (N = 36,309) conducted in the USA between 2012 and 2013 were used alongside the Executive Function Index scales. The data were analyzed by using Ordinary Least Squares regression. RESULTS Current (N = 3,681, Female = 37.7%) and former users (N = 7,448, Female = 45.4%) reported poorer cognition than never users (N = 24,956, Female = 56.6%). Self-reported cognition of former users was in-between that of current and never users. Several cannabis use characteristics were associated with self-reported cognition in current and former users. CONCLUSION While prospective studies are required to confirm, findings suggest cannabis use is linked to worse cognition. There may be some limited recovery of cognition in former users and some cannabis use characteristics predict impairment. These findings add to our understanding of the cognitive impact of cannabis use. As worse cognitive function may impact relapse, findings have implications for personalization of cannabis use disorder treatment.
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Affiliation(s)
- Dafna Sara Rubin-Kahana
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Butler
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- School of Psychology, College of Health and Science, University of Lincoln, Lincoln, UK
| | - Ahmed Nabeel Hassan
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, King Abdul-Aziz University, Jeddah, Saudi Arabia
- Department of Psychiatry, Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Marcos Sanches
- Biostatistics Core, Centre for Addiction and Mental Health, Centre for Addiction and Health, Toronto, Ontario, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Departments of Family and Community Medicine, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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30
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Galimberti M, Levey DF, Deak JD, Zhou H, Stein MB, Gelernter J. Genetic influences and causal pathways shared between cannabis use disorder and other substance use traits. Mol Psychiatry 2024:10.1038/s41380-024-02548-y. [PMID: 38580809 DOI: 10.1038/s41380-024-02548-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/07/2024]
Abstract
Cannabis use disorder (CanUD) has increased with the legalization of the use of cannabis. Around 20% of individuals using cannabis develop CanUD, and the number of users has grown with increasing ease of access. CanUD and other substance use disorders (SUDs) are associated phenotypically and genetically. We leveraged new CanUD genomics data to undertake genetically-informed analyses with unprecedented power, to investigate the genetic architecture and causal relationships between CanUD and lifetime cannabis use with risk for developing SUDs and substance use traits. Analyses included calculating local and global genetic correlations, genomic structural equation modeling (genomicSEM), and Mendelian Randomization (MR). Results from the genetic correlation and genomicSEM analyses demonstrated that CanUD and cannabis use differ in their relationships with SUDs and substance use traits. We found significant causal effects of CanUD influencing all the analyzed traits: opioid use disorder (OUD) (Inverse variant weighted, IVW β = 0.925 ± 0.082), problematic alcohol use (PAU) (IVW β = 0.443 ± 0.030), drinks per week (DPW) (IVW β = 0.182 ± 0.025), Fagerström Test for Nicotine Dependence (FTND) (IVW β = 0.183 ± 0.052), cigarettes per day (IVW β = 0.150 ± 0.045), current versus former smokers (IVW β = 0.178 ± 0.052), and smoking initiation (IVW β = 0.405 ± 0.042). We also found evidence of bidirectionality showing that OUD, PAU, smoking initiation, smoking cessation, and DPW all increase risk of developing CanUD. For cannabis use, bidirectional relationships were inferred with PAU, smoking initiation, and DPW; cannabis use was also associated with a higher risk of developing OUD (IVW β = 0.785 ± 0.266). GenomicSEM confirmed that CanUD and cannabis use load onto different genetic factors. We conclude that CanUD and cannabis use can increase the risk of developing other SUDs. This has substantial public health implications; the move towards legalization of cannabis use may be expected to increase other kinds of problematic substance use. These harmful outcomes are in addition to the medical harms associated directly with CanUD.
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Affiliation(s)
- Marco Galimberti
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Daniel F Levey
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Joseph D Deak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Hang Zhou
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Murray B Stein
- Department of Psychiatry and School of Public Health, University of California San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
- Departments of Genetics and Neuroscience, Yale University School of Medicine, New Haven, CT, USA.
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31
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Troyer J, Tanco K. Review of the Use of Medicinal Cannabis Products in Palliative Care. Cancers (Basel) 2024; 16:1412. [PMID: 38611090 PMCID: PMC11011126 DOI: 10.3390/cancers16071412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
In this review, we discuss the potential role of cannabis and cannabinoids in the management of cancer-related symptoms. There is limited evidence demonstrating the effectiveness of cannabis-based products in treating cancer-related pain and gastrointestinal symptoms such as nausea, vomiting, and loss of appetite. Regarding the role of cannabis-based products in the treatment of insomnia and mood disorders, most studies looked at these symptoms as secondary outcomes with mixed results. Cannabis-based products have adverse effects, ranging from neuropsychiatric to systemic effects to potential drug interactions.
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Affiliation(s)
| | - Kimberson Tanco
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
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32
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Ngoy A, Tang VM, Xiao K, Blumberger DM, George TP, Gowin JL, Le Foll B, Sloan ME. Neuromodulation for Cannabis Use: A Scoping Review. Brain Sci 2024; 14:356. [PMID: 38672008 PMCID: PMC11048669 DOI: 10.3390/brainsci14040356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
This scoping review explores the use of neuromodulation techniques in individuals with cannabis use. Our goal was to determine whether cannabis use alters cortical excitation and inhibition in the context of neuromodulation and to determine whether neuromodulation affects craving and cannabis use patterns. A systematic search was conducted using PubMed, OVID Medline, and PsycINFO from inception to 20 December 2022. Our review identified ten relevant studies, eight of which used Transcranial Magnetic Stimulation (TMS), while two employed Transcranial Direct Current Stimulation (tDCS). Findings from TMS studies suggest that cannabis users exhibit altered cortical inhibition, with decreased short interval intracortical inhibition (SICI) compared to non-users. Single sessions of rTMS did not have any impact on cannabis craving. By contrast, two studies found that multiple sessions of rTMS reduced cannabis use, but these changes did not meet the threshold for statistical significance and both studies were limited by small sample sizes. The two included tDCS studies found contradictory results, with one showing reduced cannabis craving with active treatment and another showing no effect of active treatment on craving compared to sham. Future studies should further explore the effects of multiple treatment sessions and different neuromodulation modalities.
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Affiliation(s)
- Anthony Ngoy
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5G 2C8, Canada
| | - Victor M. Tang
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (V.M.T.); (D.M.B.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
| | - Kebin Xiao
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5G 2C8, Canada
| | - Daniel M. Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (V.M.T.); (D.M.B.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Tony P. George
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Joshua L. Gowin
- Departments of Radiology and Psychiatry, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5G 2C8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON L9M 1G3, Canada
| | - Matthew E. Sloan
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5G 2C8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
- Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, ON M1C 1A4, Canada
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Isensee B, Neumann C, Goecke M, Hanewinkel R. [Effectiveness of a cannabis prevention program in school: results of a randomized prospective study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:446-455. [PMID: 38172374 DOI: 10.1007/s00103-023-03816-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND In the current debate about legalized access to cannabis for adults in Germany, there is widespread agreement about the need for increased prevention among children and young people. The aim of this work is to examine the effectiveness of a school-based cannabis prevention program on knowledge, attitudes, and behavior. METHOD Cluster-randomized waiting list control group study with two study arms: "participation in the 'Der grüne Koffer' prevention program", a collection of methods for cannabis prevention, vs. "no participation" and two measurement time points before and four months after the intervention in four German states. RESULTS The mean age of the sample of 3976 adolescents from 280 school classes in grades 8 and 9 was 14.02 years (standard deviation = 0.89). The sex ratio was balanced (49.5% female). Cannabis-related knowledge increased significantly more in the intervention group compared to the control group from the first to the second measurement time point (adjusted beta = 0.25 [95% confidence interval: 0.14-0.37]). Attitudes toward cannabis use did not change significantly in either group. In the 8th grades of the intervention group, significantly fewer adolescents (2.9%) started experimenting with cannabis use for the first time during the observation period than in the control group (5.3%), whereas no group difference was detectable in the 9th grades (interaction grade level x group: odds ratio = 2.17 [1.13-4.15], p = 0.019). DISCUSSION The evidence of an effect of participation in the "Der grüne Koffer" prevention program on knowledge and first-time use of cannabis in the 8th grade can be considered promising against the background of previous national and international studies, which could not provide evidence of effects of school-based cannabis prevention in middle and late adolescence.
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Affiliation(s)
- Barbara Isensee
- Institut für Therapie- und Gesundheitsforschung, IFT-Nord gGmbH, Kiel, Deutschland.
| | - Clemens Neumann
- Institut für Therapie- und Gesundheitsforschung, IFT-Nord gGmbH, Kiel, Deutschland
| | - Michaela Goecke
- Bundeszentrale für gesundheitliche Aufklärung (BZgA), Köln, Deutschland
| | - Reiner Hanewinkel
- Institut für Therapie- und Gesundheitsforschung, IFT-Nord gGmbH, Kiel, Deutschland
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Murta JCD, Easpaig BNG, Hazell-Raine K, Byrne MK, Lertwatthanawilat W, Kritkitrat P, Bressington D. Recreational cannabis policy reform-What mental health nurses need to know about minimising harm and contributing to the reform debate. J Psychiatr Ment Health Nurs 2024; 31:270-282. [PMID: 37767750 DOI: 10.1111/jpm.12984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
The recently rapidly evolving legal status of recreational cannabis in various countries has triggered international debate, particularly around measures required to minimise resulting harms. The present article argues that mental health nurses should have a key role in promoting safe and appropriate use of recreational cannabis, and minimising harm based on the extant evidence. The article summarises the factors driving legalisation, outlines the evident medicinal benefits of cannabis, and appraises the evidence on the negative mental health impacts associated with use. We go on to discuss research findings on the potentially deleterious mental health effects resulting from legalising recreational cannabis and strategies to minimise these harms, including directions for future research and evaluation. Further, we consider the importance of the implementation of harm minimisation measures that are context-specific, using Thailand as an example. Finally, we present the key health promotion messages that mental health nurses should aim to convey to people who use or consider using recreational cannabis. Ultimately, we aim to provide a summary of the existing evidence that mental health nurses can draw upon to promote mental health and engage with the policy reform debate.
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Affiliation(s)
| | | | - Karen Hazell-Raine
- Faculty of Health, Charles Darwin University, Darwin, Northern Territory, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Mitchell K Byrne
- Faculty of Health, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | | | - Daniel Bressington
- Faculty of Health, Charles Darwin University, Darwin, Northern Territory, Australia
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
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Shamabadi A, Arabzadeh Bahri R, Karimi H, Heidari E, Akhondzadeh S. Emerging pharmacotherapy for the treatment of cannabis use disorder. Expert Opin Pharmacother 2024; 25:695-703. [PMID: 38717605 DOI: 10.1080/14656566.2024.2353638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION About one-fifth of cannabis users, the most commonly used illicit substance, have cannabis use disorder (CUD). Psychiatric disorders and suicide are more common in these patients, and the disability-adjusted life years were reported to be 0.69 million. Pharmacotherapy for CUD is an unmet public health need, as current evidence-based therapies have limited efficacy. AREAS COVERED After explaining the pathophysiology of CUD, the effects of emerging pharmacological interventions in its treatment obtained from randomized controlled trials were reviewed in light of mechanisms of action. Superiority over control of cannabidiol, gabapentin, galantamine, nabilone plus zolpidem, nabiximols, naltrexone, PF-04457845, quetiapine, varenicline, and topiramate were observed through the cannabinoid, glutamatergic, γ-aminobutyric acidergic, serotonergic, noradrenergic, dopaminergic, opioidergic, and cholinergic systems. All medications were reported to be safe and tolerable. EXPERT OPINION Adding pharmacotherapy to psychotherapy is the optimal treatment for CUD on a case-by-case basis. Drug development to add to psychotherapy is the main path, but time and cost suggest repurposing and repositioning existing drugs. Considering sample size, follow-up, and effect size, further studies using objective tools are necessary. The future of CUD treatment is promising.
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Affiliation(s)
- Ahmad Shamabadi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Razman Arabzadeh Bahri
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanie Karimi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Heidari
- Department of Pharmacy, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Dawson D, Stjepanović D, Lorenzetti V, Cheung C, Hall W, Leung J. The prevalence of cannabis use disorders in people who use medicinal cannabis: A systematic review and meta-analysis. Drug Alcohol Depend 2024; 257:111263. [PMID: 38493566 DOI: 10.1016/j.drugalcdep.2024.111263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND The prevalence of cannabis use disorders (CUDs) in people who use cannabis recreationally has been estimated at 22%, yet there is a dearth of literature exploring CUDs among people who use medicinal cannabis. We aimed to systematically review the prevalence of CUDs in people who use medicinal cannabis. METHODS In our systematic review and meta-analysis, we followed PRISMA guidelines and searched three databases (PsychInfo, Embase and PubMed) to identify studies examining the prevalence of CUDs in people who use medicinal cannabis. Meta-analyses were calculated on the prevalence of CUDs. Prevalence estimates were pooled across different prevalence periods using the DSM-IV and DSM-5. RESULTS We conducted a systematic review of 14 eligible publications, assessing the prevalence of CUDs, providing data for 3681 participants from five different countries. The systematic review demonstrated that demographic factors, mental health disorders and the management of chronic pain with medicinal cannabis were associated with an elevated risk of CUDs. Meta-analyses were conducted on the prevalence of CUDs. For individuals using medicinal cannabis in the past 6-12 months, the prevalence of CUDs was 29% (95% CI: 21-38%) as per DSM-5 criteria. Similar prevalence was observed using DSM-IV (24%, CI: 14-38%) for the same period. When including all prevalence periods and using the DSM-5, the prevalence of CUDs in people who use medicinal cannabis was estimated at 25% (CI: 18-33%). CONCLUSIONS The prevalence of CUDs in people who use medicinal cannabis is substantial and comparable to people who use cannabis for recreational reasons, emphasizing the need for ongoing research to monitor the prevalence of CUDs in people who use medicinal cannabis.
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Affiliation(s)
- Danielle Dawson
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia; National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, St Lucia, QLD 4067, Australia.
| | - Daniel Stjepanović
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia; National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, St Lucia, QLD 4067, Australia
| | - Valentina Lorenzetti
- Healthy Brain and Mind Research Centre, School of Behavioural & Health Sciences, Faculty of Health Science, Australian Catholic University, Daniel Mannix Building, Fitzroy, VIC 3065, Australia
| | - Christy Cheung
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia; National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, St Lucia, QLD 4067, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, St Lucia, QLD 4067, Australia
| | - Janni Leung
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia; National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, St Lucia, QLD 4067, Australia
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Lorenzetti V, Gaillard A, McTavish E, Grace S, Rossetti MG, Batalla A, Bellani M, Brambilla P, Chye Y, Conrod P, Cousijn J, Labuschagne I, Clemente A, Mackey S, Rendell P, Solowij N, Suo C, Li CSR, Terrett G, Thompson PM, Yücel M, Garavan H, Roberts CA. Cannabis Dependence is Associated with Reduced Hippocampal Subregion Volumes Independently of Sex: Findings from an ENIGMA Addiction Working Group Multi-Country Study. Cannabis Cannabinoid Res 2024. [PMID: 38498015 DOI: 10.1089/can.2023.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Background: Males and females who consume cannabis can experience different mental health and cognitive problems. Neuroscientific theories of addiction postulate that dependence is underscored by neuroadaptations, but do not account for the contribution of distinct sexes. Further, there is little evidence for sex differences in the neurobiology of cannabis dependence as most neuroimaging studies have been conducted in largely male samples in which cannabis dependence, as opposed to use, is often not ascertained. Methods: We examined subregional hippocampus and amygdala volumetry in a sample of 206 people recruited from the ENIGMA Addiction Working Group. They included 59 people with cannabis dependence (17 females), 49 cannabis users without cannabis dependence (20 females), and 98 controls (33 females). Results: We found no group-by-sex effect on subregional volumetry. The left hippocampal cornu ammonis subfield 1 (CA1) volumes were lower in dependent cannabis users compared with non-dependent cannabis users (p<0.001, d=0.32) and with controls (p=0.022, d=0.18). Further, the left cornu ammonis subfield 3 (CA3) and left dentate gyrus volumes were lower in dependent versus non-dependent cannabis users but not versus controls (p=0.002, d=0.37, and p=0.002, d=0.31, respectively). All models controlled for age, intelligence quotient (IQ), alcohol and tobacco use, and intracranial volume. Amygdala volumetry was not affected by group or group-by-sex, but was smaller in females than males. Conclusions: Our findings suggest that the relationship between cannabis dependence and subregional volumetry was not moderated by sex. Specifically, dependent (rather than non-dependent) cannabis use may be associated with alterations in selected hippocampus subfields high in cannabinoid type 1 (CB1) receptors and implicated in addictive behavior. As these data are cross-sectional, it is plausible that differences predate cannabis dependence onset and contribute to the initiation of cannabis dependence. Longitudinal neuroimaging work is required to examine the time-course of the onset of subregional hippocampal alterations in cannabis dependence, and their progression as cannabis dependence exacerbates or recovers over time.
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Affiliation(s)
- Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Alexandra Gaillard
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
- Centre for Mental Health and Department of Health Sciences and Biostatistics, Swinburne University, Hawthorn, Australia
| | - Eugene McTavish
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Sally Grace
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Maria Gloria Rossetti
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Albert Batalla
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Marcella Bellani
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Paolo Brambilla
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Yann Chye
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Patricia Conrod
- Department of Psychiatry, Université de Montreal, CHU Ste Justine Hospital, Montreal, Canada
| | - Janna Cousijn
- Neuroscience of Addiction Lab, Center for Substance Use and Addiction Research (CESAR), Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Izelle Labuschagne
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Australia
| | - Adam Clemente
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Scott Mackey
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
| | - Peter Rendell
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Australia
| | - Nadia Solowij
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Chao Suo
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gill Terrett
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Paul M Thompson
- Department of Neurology, Imaging Genetics Center, Stevens Institute for Neuroimaging & Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, California, USA
| | - Murat Yücel
- QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Hugh Garavan
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Australia
| | - Carl A Roberts
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
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Feingold D, Tzur Bitan D, Ferri M, Hoch E. Predictors of effective therapy among individuals with Cannabis Use Disorder: a review of the literature. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01781-4. [PMID: 38493284 DOI: 10.1007/s00406-024-01781-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/16/2024] [Indexed: 03/18/2024]
Abstract
Treatment demand for Cannabis Use Disorder (CUD) has increased in the past decade in almost all European countries, and CUD is currently the most common reason for first-time drug-related treatment admission in the European Union. Even though several therapeutic approaches have been shown to benefit individuals with CUD, there is a lack of knowledge regarding factors associated with effective therapy and the underlying mechanisms of change among individuals with CUD presenting for treatment. The aim of the present paper was to review current knowledge on factors that have been shown to contribute to positive outcomes in CUD treatment. A scoping methodology was used, focusing on empirically evaluated studies that used defined, cannabis-related outcome measures. In eligible studies, factors of investigation were categorized as either 'mediators', i.e., treatment-related factors associated with the processes or mechanisms through which patients benefit from therapy, or 'moderators' which are patient-related characteristics that predict his/her odds to benefit from treatment or patient-related (i.e., moderators). Factors categorized as mediators were then classified 'specific factors' if they were related to a certain technique or treatment modality or 'common factors' if they were assessed beyond treatment modalities. Findings suggest that in CUD treatment, specific mediators include treatment duration, addressing motivation to change, acquiring coping skills, enhancing self-efficacy, and integrating several therapeutic components. Common mediators include therapeutic alliance, empathy, expectations and cultural adaptation. Moderators in CUD treatment include sex, ethnicity, age-related factors and comorbid disorders.
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Affiliation(s)
- Daniel Feingold
- Psychology Department, Achva Academic College, Achva, Israel.
| | - Dana Tzur Bitan
- Department of Community Mental Health, University of Haifa, Haifa, Israel
- Shalvata Mental Health Center, Hod Hasharon, Israel
| | | | - Eva Hoch
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
- IFT Institut für Therapieforschung, Centre of Health and Addiction Research, Munich, Germany
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Hall W, Manthey J, Stjepanović D. Cannabis use and cannabis use disorders and their treatment in the Europe. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01776-1. [PMID: 38489067 DOI: 10.1007/s00406-024-01776-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/02/2024] [Indexed: 03/17/2024]
Abstract
This paper introduces the special issue on cannabis use in Europe. It describes data on the prevalence of cannabis use in Europe and the more limited data on the prevalence of cannabis use disorders, one of the most common forms of drug problem treated in many countries in Europe. It summarises what research has indicated about the adverse effects of acute and chronic cannabis use and discusses potential health system responses that may reduce some of these harms. These include public education about the risks of cannabis use; screening and brief interventions in primary medical settings; and specialist treatment for cannabis use disorders. It briefly indicates the special issues that may need to be addressed in dealing with the high rates of comorbidity between cannabis use disorders, other types of drug use disorders, and common mental disorders.
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Affiliation(s)
- Wayne Hall
- The National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia.
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany
| | - Daniel Stjepanović
- The National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
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Livne O, Budney A, Borodovsky J, Shmulewitz D, Walsh C, Struble CA, Habib M, Aharonovich E, Hasin DS. Age differences in patterns of cannabis use among an online US sample of adults who consume cannabis frequently. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:242-251. [PMID: 38640463 DOI: 10.1080/00952990.2024.2309340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 01/19/2024] [Indexed: 04/21/2024]
Abstract
Background: Cannabis use is increasing among middle-aged and older US adults, populations that are particularly vulnerable to the adverse effects of cannabis. Risks for adverse effects differ by cannabis use patterns, which have become increasingly heterogeneous. Nevertheless, little is known about age differences in such patterns.Objective: To investigate age differences in cannabis use patterns, comparing younger (age 18-49), middle-aged (age 50-64), and older adults (age ≥65).Methods: A total of 4,151 US adults with past 7-day cannabis consumption completed an online survey (35.1% male; 60.1% female; 4.8% identified as "other"). Regression models examined age differences in cannabis use patterns.Results: Compared to younger adults, middle-aged and older adults were more likely to consume cannabis during evening hours (50-64: adjusted odds ratio [aOR] = 2.98, 95% CI 2.24-3.96; ≥65: aOR = 4.23, 95 CI 2.82-6.35); by only one method (50-64: aOR = 1.67, 95% CI 1.34-2.09; ≥65: aOR = 3.38, 95 CI 2.24-5.09); primarily by smoking as the only method (50-64: aOR = 1.52, 95% CI 1.29-1.78; ≥65: aOR = 2.12, 95 CI 1.64-2.74); but less likely to consume concentrated cannabis products (concentrates) with extremely high %THC (50-64: aOR = 0.71, 95% CI 0.54-0.93; ≥65: aOR = 0.30, 95 CI 0.16-0.55). Age differences in cannabis use patterns were also observed between middle-aged and older adults.Conclusion: Findings suggest that middle-aged and older adults may engage in less risky cannabis use patterns compared to younger groups (e.g. lower likelihood of consuming highly potent concentrates). However, findings also underscore the importance of recognizing risks unique to these older demographics, such as smoking-related health events. Consequently, prevention strategies targeting such use patterns are needed.
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Affiliation(s)
- Ofir Livne
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Alan Budney
- Departments of Psychiatry and Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Hanover, NH, Lebanon
| | - Jacob Borodovsky
- Departments of Psychiatry and Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Hanover, NH, Lebanon
| | - Dvora Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Claire Walsh
- New York State Psychiatric Institute, New York, NY, USA
| | - Cara A Struble
- Departments of Psychiatry and Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Hanover, NH, Lebanon
| | - Mohammad Habib
- Departments of Psychiatry and Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Hanover, NH, Lebanon
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Deborah S Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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Hill ML, Kline AC, Saraiya TC, Gette J, Ruglass LM, Norman SB, Back SE, Saavedra LM, Hien DA, Morgan-López AA. Cannabis use and trauma-focused treatment for co-occurring posttraumatic stress disorder and substance use disorders: A meta-analysis of individual patient data. J Anxiety Disord 2024; 102:102827. [PMID: 38266511 PMCID: PMC11138203 DOI: 10.1016/j.janxdis.2024.102827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/22/2023] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
High rates of cannabis use among people with posttraumatic stress disorder (PTSD) have raised questions about the efficacy of evidence-based PTSD treatments for individuals reporting cannabis use, particularly those with co-occurring alcohol or other substance use disorders (SUDs). Using a subset of four randomized clinical trials (RCTs) included in Project Harmony, an individual patient meta-analysis of 36 RCTs (total N = 4046) of treatments for co-occurring PTSD+SUD, we examined differences in trauma-focused (TF) and non-trauma-focused (non-TF) treatment outcomes for individuals who did and did not endorse baseline cannabis use (N = 410; 70% male; 33.2% endorsed cannabis use). Propensity score-weighted mixed effects modeling evaluated main and interactive effects of treatment assignment (TF versus non-TF) and baseline cannabis use (yes/no) on attendance rates and within-treatment changes in PTSD, alcohol, and non-cannabis drug use severity. Results revealed significant improvements across outcomes among participants in all conditions, with larger PTSD symptom reductions but lower attendance among individuals receiving TF versus non-TF treatment in both cannabis groups. Participants achieved similar reductions in alcohol and drug use across all conditions. TF outperformed non-TF treatments regardless of recent cannabis use, underscoring the importance of reducing barriers to accessing TF treatments for individuals reporting cannabis use.
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Affiliation(s)
- Melanie L Hill
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
| | | | - Tanya C Saraiya
- Center of Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jordan Gette
- Center of Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA
| | - Lesia M Ruglass
- Center of Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA; Department of Psychology, The City College of New York, New York, NY, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; National Center for PTSD, Executive Division, White River Junction, VT, USA
| | - Sudie E Back
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Healthcare System, Charleston, SC, USA
| | | | - Denise A Hien
- Center of Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA
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Magno LAV, Tameirão DR, Alves LF, Guimarães NS. Effect of recreational cannabis use on bone mineral density: a systematic review. Osteoporos Int 2024; 35:391-399. [PMID: 38141142 DOI: 10.1007/s00198-023-06992-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Abstract
The recreational use of cannabis products has risen considerably worldwide over the past decade. As the cannabis legal market grows, a critical challenge has been to make substantiated claims about the benefits and adverse health problems triggered by cannabis exposure. Despite accumulating evidence from animal studies demonstrating the role of cannabinoids on bone metabolism, there are conflicting results in clinical literature regarding their effects on bone health outcomes.We undertook a systematic review to assess the evidence for the safety of cannabis use on bone health. We searched the databases MEDLINE, EMBASE, Cochrane Library, and Web of Science up to March 2023 for studies evaluating the effect of the recreational use of cannabis on the bone mineral density (BMD) of adults.Among the 2620 studies reviewed, three cross-sectional studies and one randomized controlled trial comprised 4032 participants from 18 to 60 years who met the inclusion criteria. Two studies showed that cannabis exposure decreased BMD, while the other 2 indicated no alteration. Despite the different study designs, the included studies showed a low risk of bias according to the Joanna Briggs Institute tool.Eligible studies present differences in cannabis products, administration routes, and exposure determination. Further longitudinal research is needed to establish multiple clinical predictors associated with potentially negative consequences of cannabis exposure, especially in vulnerable populations such as elderly individuals.
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Affiliation(s)
- Luiz Alexandre Viana Magno
- Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Faculdade Ciências Médicas de Minas Gerais (FCMMG), Alameda Ezequiel Dias, 275, Belo Horizonte, 30130-110, Brazil
| | - Diego Ribeiro Tameirão
- Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Faculdade Ciências Médicas de Minas Gerais (FCMMG), Alameda Ezequiel Dias, 275, Belo Horizonte, 30130-110, Brazil
- Observatório de Pesquisas E Extensão Em Nutrição E Saúde (OPeNS), Belo Horizonte, Brazil
| | - Lucas Ferreira Alves
- Curso de Medicina, Faculdade Ciências Médicas de Minas Gerais (FCMMG), Belo Horizonte, Brazil
| | - Nathalia Sernizon Guimarães
- Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Faculdade Ciências Médicas de Minas Gerais (FCMMG), Alameda Ezequiel Dias, 275, Belo Horizonte, 30130-110, Brazil.
- Observatório de Pesquisas E Extensão Em Nutrição E Saúde (OPeNS), Belo Horizonte, Brazil.
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Benoy R, Ramirez C, Hitchcock M, Reardon C. Cannabis Use in Adolescent and Young Adult Athletes: A Clinical Review. Sports Health 2024; 16:279-284. [PMID: 37950433 PMCID: PMC10916776 DOI: 10.1177/19417381231208661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
CONTEXT Cannabis use among the general population has increased over time, in part due to decriminalization of use and greater social acceptance of cannabis use. These changes have contributed to increased availability of cannabis products, thus raising the likelihood that a subset of adolescent and young adult athletes will use cannabis. Therefore, it is imperative that clinicians and other providers working with young athletes have a thorough understanding of the impact cannabis can have on the athletic performance and overall health of a young athlete. EVIDENCE ACQUISITION PubMed (Medline), CINAHL, PsycINFO, and SportDiscus databases were used to perform a literature search of articles published between January 1, 2010 and December 31, 2022. Additional articles were reviewed based on references obtained from initial articles. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Survey studies suggest that up to 1 in 4 athletes have used cannabis at least once in the last year. Age, sex, race, sexual orientation, level of competition, and country of residence of an athlete all contribute to differing rates of cannabis use among athletes. The scientific literature does not support using cannabis for athletic performance, and multiple studies have demonstrated notable impairments in objective athletic performance measures. Cannabis use can also negatively impact an athlete's overall health via cardiovascular, gastrointestinal, and mental health symptoms and disorders. CONCLUSION Cannabis use among adolescent and young adult athletes is common, and rates of use are influenced by many different factors. Current evidence suggests that cannabis use can worsen sport performance, negatively impact an athlete's general health, and contribute to negative mental health outcomes.
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Affiliation(s)
- Ryan Benoy
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Cesar Ramirez
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mary Hitchcock
- University of Wisconsin-Madison, Ebling Library for the Health Sciences, 2339 Health Sciences Learning Center, Madison, Wisconsin
| | - Claudia Reardon
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Shah K, Farwa UE, Vanaparti A, Patel S, Kanumuri M, Vashishth O, Hossain N, Dahiya R, Banala M, Enamorado FRP, Patel AS, Nadeem H, Kanani R, Desai HD, Sharma KH, Tripathi S. Global epidemiology of cannabis use disorders and its trend from 1990 to 2019: Benchmarking analysis of the global burden of disease study. J Family Med Prim Care 2024; 13:881-889. [PMID: 38736814 PMCID: PMC11086777 DOI: 10.4103/jfmpc.jfmpc_824_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/16/2023] [Accepted: 08/01/2023] [Indexed: 05/14/2024] Open
Abstract
Introduction Cannabis is one of the most widely used psychoactive substances globally, with an increasing trend in its legalization for both medical and recreational purposes in various countries. While cannabis offers potential therapeutic benefits, its regular use can lead to the development of Cannabis Use Disorders (CUDs). Understanding the epidemiology of CUDs is crucial in assessing the public health burden associated with cannabis use. Methods Epidemiological parameters of CUDs were assessed using the Global Burden of Disease (GBD) methodology across different age-groups, years, sexes, and locations worldwide from 1990-2019. Results Globally, for both sexes combined, prevalent cases of CUDs increased steadily from 17.1 million(95%UI=12.7-22.8million) in 1990 to 23.8-million(95%UI=17.8-30.9 million) in 2019. All age-adjusted highest number of incidence observed in High-Income-North-America(HINA)(121/100,000), followed by Australasia(100/100,000), Oceania(83.97/100,000), Tropical Latin America(69.59/100,000). Globally, age-standardized disability-adjusted life years rate(ASDR) observed higher in HINA, followed by Australasia, and Western-Europe. In male, all-age incidence counts increased from 1.7 million(95%UI=1.3-2.4million) in 1990 to 2.4 million(95%UI=1.8-3.2 million) in 2019. The highest annual percentage of change in age-standardized incidence rate(ASIR) was found in East-Asia (22%) followed by Middle-East and North-Africa(MENA)(15%). The age group of 15-24 years exhibited the highest burden of CUDs. Conclusion The widespread occurrence of CUDs on a global scale poses a substantial challenge to public health. Understanding the impact of CUDs and implementing evidence-based interventions is crucial in mitigating the associated individual, societal, and economic burdens. Continued research, collaboration, and knowledge dissemination are essential to inform policies, prevention efforts, and treatment strategies aimed at addressing CUDs on a global-scale.
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Affiliation(s)
- Kinjal Shah
- Department of Public Health Administration, Rutgers University, Edward J. Bloustein School of Planning and Public Policy, New Jersey, United States of America
| | - Umm E. Farwa
- Department of Internal Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Ankitha Vanaparti
- Department of Internal Medicine, Kakatiya Medical College, Hyderabad, Telangana, India
| | - Savan Patel
- Department of Internal Medicine, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Manisha Kanumuri
- Department of Psychiatry, Mediciti Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Oshin Vashishth
- Department of Internal Medicine, St. Martinus University, Willemstad, Curaçao
| | - Nadia Hossain
- Department of Internal Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - Roopali Dahiya
- Department of Internal Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, Delhi, India
| | - Mallareddy Banala
- Department of Internal Medicine, Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India
| | | | - Abhiraj S. Patel
- Department of Internal Medicine, Our Lady of Fatima University College of Medicine, Valenzuela, Philippines
| | - Huzaifa Nadeem
- Department of Psychiatry, CMH Lahore Medical College, Combined Military Hospital, Lahore, Pakistan
| | - Ravi Kanani
- Department of Research Wing, Gujarat Adani Institute of Medical Sciences, Bhuj, Gujarat, India
| | - Hardik D. Desai
- Department of Research Wing, Gujarat Adani Institute of Medical Sciences, Affiliated to K.S.K.V University, Bhuj, Gujarat, India
| | - Kamal H. Sharma
- Department of Cardiology, U N Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Sharanya Tripathi
- Department of Internal Medicine, G.M.E.R.S Medical College, M.S. University, Gotri, Vadodara, Gujarat, India
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Leung J, Yimer TM, Chiu V, Hall WD, Connor JP, Chan GCK. Participation in Australian drug treatment programs for individuals engaging in high-risk substance use: Data from a nationally representative sample. Drug Alcohol Rev 2024; 43:688-693. [PMID: 38087847 DOI: 10.1111/dar.13792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Substance use, including drugs, alcohol and smoking have a significant health, social and economic impact. We aim to assess the rate and factors associated with treatment access among individuals with high-risk substance use. METHOD This study is a cross-sectional analysis of the 2019 Australian National Drug Strategy Household Survey (N = 22,015). Participants were persons with high-risk substance use based on the Alcohol, Smoking and Substance Involvement Screening Test-Lite (ASSIST-Lite) and current smokers. We measured self-reports of past 12-month engagement in a tobacco, alcohol or other drugs treatment program. RESULTS Overall, 0.4% had high-risk drug use (0.3% cannabis, 0.1% meth/amphetamine or 0.1% opioids), 7.4% had high-risk alcohol use, and 14.0% currently smoked. Among high-risk users, past 12-month treatment access rates were 50.6% [22.3-78.9%] for opioids, 27.1% [8.1-46.1%] for meth/amphetamine, 14.5% [4.3-24.7%] for cannabis, 9.6% [8.1-11.0%] for alcohol and 11.7% [10.6-12.9%] for current smoking. The primary source of treatment support was information and education (12.7% drugs, 4.6% alcohol, 4.0% smoking), followed by counselling (6.7% drugs, 4.5% alcohol, 3.0% smoking). Online or internet support was accessed by 5.9% (drug) and 1.6% (alcohol) people with high-risk use. Psychological distress was associated with treatment access (drugs: odds ratio 3.03 [0.77-11.95], p = 0.111; alcohol: odds ratio 3.16 [2.20-4.56], p ≤ 0.001; smoking: odds ratio 1.95 [1.52-2.49], p ≤ 0.001). DISCUSSION AND CONCLUSIONS The proportion of people engaging in risky substance use who had used treatment programs remains low, especially for alcohol. Public health strategies to scale up treatment access are warranted.
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Affiliation(s)
- Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Tesfa Mekonen Yimer
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
- Psychiatry Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Vivian Chiu
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Wayne D Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Jason P Connor
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Gary Chung Kai Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
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Guo Y, Dai CL, Ward RM, Mason WA. The Interaction of Cannabis Consumption with Heavy Episodic Drinking and Alcohol-induced Blackouts in Relation to Cannabis Use Consequences Among Recent Undergraduate College Cannabis Users. CANNABIS (ALBUQUERQUE, N.M.) 2024; 6:23-32. [PMID: 38883276 PMCID: PMC11178058 DOI: 10.26828/cannabis/2023/000193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Introduction Risky alcohol use patterns, characterized by heavy episodic drinking (HED) and alcohol-induced blackout, are prevalent in college students. However, it is not clear if experiencing HED and blackout among college-attending cannabis users heightens risk for adverse cannabis use consequences. The purpose of this study was to examine whether heavy episodic drinking and blackout episodes moderate the relationship between cannabis consumption and cannabis use consequences among college students. Methods Undergraduate college students (n = 4331) were recruited from a Midwest University in 2021. This analysis used a subset of data from past 6-month cannabis users (n= 772; 17.8% of the full sample). Among cannabis users, 64.5% identified as female and 87.8% were White with an average age of 19.99 (SD=2.88). A linear regression was conducted with two two-way interactions of cannabis consumption and HED frequency as well as cannabis consumption and alcohol-induced blackout episodes. Results Results showed a statistically significant positive association between cannabis consumption and cannabis use consequences (B=0.73, p<.001), adjusting for the other variables in the model. Blackout, but not HED, was a significant moderator (B=0.19, p=.003). Discussion The findings of this study indicate that blackout experiences amplify the relationship between cannabis use and cannabis-related consequences among college students. This underscores that blackouts not only signal a risk of problematic drinking but also exacerbate the association between cannabis use and its negative consequences. Conclusion Findings may inform college campus interventions targeting cannabis and alcohol concurrent-users who experience alcohol-induced blackouts to reduce their additional risk for cannabis-related consequences.
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Vieira JL, Snaychuk LA, Milicevic J, Hodgins DC, Shead NW, Keough MT, Kim HS. Adverse Childhood Experiences and Problematic Cannabis Use: The Role of Emotion Dysregulation and Affective Impulsivity. CANNABIS (ALBUQUERQUE, N.M.) 2024; 6:111-126. [PMID: 38883277 PMCID: PMC11178067 DOI: 10.26828/cannabis/2023/000190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Problematic cannabis use is highly prevalent among postsecondary students. Consequently, there is a need to examine risk factors associated with problematic cannabis use in this population. The present study investigated whether emotion dysregulation mediates the relationship between adverse childhood experiences (ACEs) and problematic cannabis use, and whether affective impulsivity (negative and positive urgency) uniquely moderates this relationship. Participants consisted of current cannabis users (N = 586) recruited from five universities across Canada. Participants completed an online survey containing self-report measures of ACEs, emotion dysregulation, negative and positive urgency, and problematic cannabis use. Among the sample of postsecondary students, 36% (n = 213) met the threshold for problematic cannabis use. Moderated-mediation analyses revealed that ACEs were positively associated with emotion dysregulation and problematic cannabis use. There was also a significant indirect effect of emotion dysregulation on the association between ACEs and problematic cannabis use at moderate and high (but not low) levels of negative urgency, and at moderate and high (but not low) levels of positive urgency. The moderated-mediation models remained significant when controlling for other facets of impulsivity. Results suggest that elevated levels of emotion dysregulation and urgency are important proximal risk factors for problematic cannabis use among postsecondary students with a history of ACEs. While ACEs cannot be modified given their occurrence in the past, interventions that aim to build mindfulness and adaptive emotion regulation skills may be beneficial for reducing the likelihood that these students will engage in impulsive behaviors, such as cannabis use, when experiencing emotional distress.
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Affiliation(s)
- Jenna L Vieira
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Lindsey A Snaychuk
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Jana Milicevic
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - David C Hodgins
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - N Will Shead
- Department of Psychology, Mount Saint Vincent University, Halifax, NS, Canada
| | | | - Hyoun S Kim
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, Ontario, Canada
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Hanewinkel R, Hansen J. [Cannabis use in teenage years: Results of the prevention radar from 2016 to 2023]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2024. [PMID: 38387481 DOI: 10.1055/a-2256-5062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
ZusammenfassungTrends des Cannabiskonsums in der Adoleszenz sollen von 2016 bis 2023 abgebildet
werden. Basierend auf sieben Wellen des Präventionsradars, einer schulbasierten
epidemiologischen Studie in der Sekundarstufe I, wurden die Lebenszeit- und
Monatsprävalenzen des Cannabiskonsums von 12-bis 17-Jährigen für den Zeitraum
von 2016 bis 2023 ermittelt. Der Auswertung lagen 54.242 Fragebögen mit Angaben
zum Konsum von Cannabis zugrunde. Das Geschlechterverhältnis war ausgeglichen
(50% weiblich). Das durchschnittliche Alter betrug 13,9 Jahre (SD=1,3). Von 2016
bis zum Ausbruch der COVID-19-Pandemie stieg die Lebenszeitprävalenz des
Cannabiskonsums statistisch bedeutsam an, im ersten Jahr der Pandemie sank sie
signifikant. Post-pandemisch hatten 12,3% (95 % KI: 11,6-13,1) der
Heranwachsenden mindestens einmal in ihrem Leben Cannabis konsumiert. Dieser
Wert liegt auf dem Niveau von 2016. Die Monatsprävalenz des Cannabiskonsums lag
2022/2023 bei 3,8% (95% KI: 3,4-4,3). Sowohl die Lebenszeit- als auch die
Monatsprävalenz des Cannabiskonsums von Jungen liegen signifikant über den
Werten der Mädchen. Angesichts der bekannten Risiken, die mit dem Cannabiskonsum
im Jugendalter einhergehen können, ist es besorgniserregend, dass 2022/2023 etwa
jeder achte Jugendliche bereits mit Cannabis experimentiert hatte. Konsequente
verhältnis- und verhaltenspräventive Maßnahmen sind erforderlich, um den
Cannabiskonsums im Teenageralter einzudämmen.
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Affiliation(s)
| | - Julia Hansen
- Institut für Therapie- und Gesundheitsforschung, Kiel, Deutschland
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Dietz N, Alkin V, Agarwal N, Sharma M, Oxford BG, Wang D, Ugiliweneza B, Mettille J, Boakye M, Drazin D. Cannabis Use Disorder Trends and Health Care Utilization After Cervical and Lumbar Spine Fusions. Spine (Phila Pa 1976) 2024; 49:E28-E45. [PMID: 37962203 DOI: 10.1097/brs.0000000000004874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To identify differences in complication rates after cervical and lumbar fusion over the first postoperative year between those with and without cannabis use disorder (CUD) and to assess how CUD affects opioid prescription patterns. SUMMARY OF BACKGROUND DATA Cannabis is legal for medical purposes in 36 states and for recreational use in 18 states. Cannabis has multisystem effects and may contribute to transient vasoconstrictive, prothrombotic, and inflammatory effects. METHODS The IBM MarketScan Database (2009-2019) was used to identify patients who underwent cervical or lumbar fusions, with or without CUD. Exact match hospitalization and postdischarge outcomes were analyzed at index, six, and 12 months. RESULTS Of 72,024 cervical fusion (2.0% with CUD) and 105,612 lumbar fusion patients (1.5% with CUD), individuals with CUD were more likely to be young males with higher Elixhauser index. The cervical CUD group had increased neurological complications (3% vs. 2%) and sepsis (1% vs. 0%) during the index hospitalization and neurological (7% vs. 5%) and wound complications (5% vs. 3%) at 12 months. The lumbar CUD group had increased wound (8% vs. 5%) and myocardial infarction (MI) (2% vs. 1%) complications at six months and at 12 months. For those with cervical myelopathy, increased risk of pulmonary complications was observed with CUD at index hospitalization and 12-month follow-up. For those with lumbar stenosis, cardiac complications and MI were associated with CUD at index hospitalization and 12 months. CUD was associated with opiate use disorder, decreasing postoperatively. CONCLUSIONS No differences in reoperation rates were observed for CUD groups undergoing cervical or lumbar fusion. CUD was associated with an increased risk of stroke for the cervical fusion cohort and cardiac (including MI) and pulmonary complications for lumbar fusion at index hospitalization and six and 12 months postoperatively. Opiate use disorder and decreased opiate dependence after surgery also correlated with CUD.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | | | - Nitin Agarwal
- Washington University, Barnes Jewish Hospital Plaza, St. Louis, MO
| | - Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | | | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, Louisville, KY
- Department of Health Management and Systems Science, School of Public Health and Information Science, University of Louisville, Louisville, KY
| | | | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | - Doniel Drazin
- Providence Regional Medical Center Everett, Everett, WA
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Beyer E, Poudel G, Antonopoulos S, Thomson H, Lorenzetti V. Brain reward function in people who use cannabis: a systematic review. Front Behav Neurosci 2024; 17:1323609. [PMID: 38379938 PMCID: PMC10877725 DOI: 10.3389/fnbeh.2023.1323609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/18/2023] [Indexed: 02/22/2024] Open
Abstract
Rationale Cannabis is one of the most widely used psychoactive substances globally. Cannabis use can be associated with alterations of reward processing, including affective flattening, apathy, anhedonia, and lower sensitivity to natural rewards in conjunction with higher sensitivity to cannabis-related rewards. Such alterations have been posited to be driven by changes in underlying brain reward pathways, as per prominent neuroscientific theories of addiction. Functional neuroimaging (fMRI) studies have examined brain reward function in cannabis users via the monetary incentive delay (MID) fMRI task; however, this evidence is yet to be systematically synthesised. Objectives We aimed to systematically integrate the evidence on brain reward function in cannabis users examined by the MID fMRI task; and in relation to metrics of cannabis exposure (e.g., dosage, frequency) and other behavioural variables. Method We pre-registered the review in PROSPERO and reported it using PRISMA guidelines. Literature searches were conducted in PsycINFO, PubMed, Medline, CINAHL, and Scopus. Results Nine studies were included, comprising 534 people with mean ages 16-to-28 years, of which 255 were people who use cannabis daily or almost daily, and 279 were controls. The fMRI literature to date led to largely non-significant group differences. A few studies reported group differences in the ventral striatum while participants anticipated rewards and losses; and in the caudate while participants received neutral outcomes. A few studies examined correlations between brain function and withdrawal, dosage, and age of onset; and reported inconsistent findings. Conclusions There is emerging but inconsistent evidence of altered brain reward function in cannabis users examined with the MID fMRI task. Future fMRI studies are required to confirm if the brain reward system is altered in vulnerable cannabis users who experience a Cannabis Use Disorder, as postulated by prominent neuroscientific theories of addiction.
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Affiliation(s)
- Emillie Beyer
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Govinda Poudel
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
- Braincast Neurotechnologies, Melbourne, VIC, Australia
| | - Stephanie Antonopoulos
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Hannah Thomson
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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