1
|
Manzo LL, Sarkar S, Nicholson NR, Sanft T, Poghosyan H. Prevalence and Correlates of Cannabis Use among U.S. Veterans during the Second Wave of the COVID-19 Pandemic. Mil Med 2024; 189:e1230-e1239. [PMID: 37715685 DOI: 10.1093/milmed/usad360] [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: 05/12/2023] [Revised: 08/09/2023] [Accepted: 08/31/2023] [Indexed: 09/18/2023] Open
Abstract
INTRODUCTION Military veterans are at increased risk of substance use disorders. Limited research is available about veterans' cannabis use (CU) during the coronavirus disease 2019 (COVID-19) pandemic. This study estimated the prevalence of past 30-day CU, investigated individual-level correlates of past 30-day CU, and evaluated the reasons (medical, recreational, or both) of past 30-day CU among U.S. Veterans during the second wave of the COVID-19 pandemic. MATERIALS AND METHODS We used population-based, cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System Survey Marijuana Use model. The sample included nationally representative military veterans aged 18+ years (n = 11,167). The outcome was past 30-day CU. Individual-level demographic, socioeconomic, behavioral, and clinical correlates were examined. Analyses were weighted to account for the survey's complex design with results generalizable to nearly 2.9 million veterans. We conducted weighted descriptive statistics, prevalence estimates, and multivariable logistic regression analyses. RESULTS Out of 2.9 million veterans, 11.1% self-reported as non-Hispanic Black, 3.7% Hispanic, and 79.1% non-Hispanic White; 88.5% were men, and 72.8% were aged 50+ years. About 14.6% were current tobacco smokers, 4.7% were current e-cigarette users, 12.5% were binge alcohol drinkers, and 43.4% had three or more comorbid conditions. Overall, 8.5% reported CU in the past 30 days, of which 30.4% used it for medical reasons and 25.8% used it for nonmedical reasons. The prevalence of past 30-day CU decreased with age, education, and income level. Compared to their counterparts, the odds of past 30-day CU were greater among men, those living in urban areas, those with frequent mental distress, infrequent physical distress, and those who had at least one comorbid condition. Non-Hispanic Black veterans had 89% increased odds of past 30-day CU (adjusted odds ratio [AOR] =1.89, 95% confidence interval [CI], 1.19-3.0) compared with non-Hispanic White veterans. Current tobacco smokers had 3.54 (95% CI, 2.40-5.24) and former smokers had 1.78 (95% CI, 1.28-2.47) times higher odds of reporting past 30-day CU than never smokers. Current e-cigarette use (AOR = 3.37, 95% CI, 2.20-5.16) and binge drinking (AOR = 3.18, 95% CI, 2.29-4.41) were also statistically significantly associated with increased odds of past 30-day CU compared to no e-cigarette use and no binge drinking. CONCLUSIONS CU is prevalent among veterans, and certain subgroups are at higher risk of CU. Thus, identifying high-risk subgroups of veterans and adequately educating them about CU's benefits, risks, and safety is crucial.
Collapse
Affiliation(s)
- Laura L Manzo
- US Army, AMEDD Student Detachment, 187th Medical Battalion, Joint Base San Antonio, TX 78234, USA
- Yale School of Nursing, Orange, CT 06477, USA
| | | | | | - Tara Sanft
- Yale School of Medicine, New Haven, CT 06520, USA
| | - Hermine Poghosyan
- Yale School of Nursing, Orange, CT 06477, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER), Yale School of Medicine, New Haven, CT 06520, USA
| |
Collapse
|
2
|
Gething K, Erku D, Scuffham P. Stakeholders' Decisions and Preferences for the Provision and Use of Medicinal Cannabis: A Scoping Review. Cannabis Cannabinoid Res 2023; 8:986-998. [PMID: 36888538 DOI: 10.1089/can.2022.0115] [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: 03/09/2023] Open
Abstract
Background: The aim of this scoping review was to examine the extent that stakeholder's decisions about and preferences for the provision and use of medicinal cannabis (MC) had been investigated. We sought to identify which populations were examined, the methods used for eliciting preferences and exploring decisions, and the reported outcomes of studies. Methods: Electronic databases (PubMed, CINAHL, Embase, BSC and PsycINFO) and the reference lists of relevant articles were searched for studies published up to March 2022. Studies were included if stakeholder preferences for MC were (1) the primary focus of the research, or (2) an aspect of a larger preference focus. Studies that (3) described the decisions to use MC were also included. Results: Thirteen studies were reviewed. The population focus of these was primarily patient, with seven studies focused on general patient populations and five studies targeting specific patient populations such as cancer survivors, and people experiencing depression. Methods included health economics preference methods, qualitative interviews, and a single multicriteria decision-making study. Four categories of outcomes were defined and included comparisons of MC with a therapeutic alternative (n=5), preferences for MC attributes (n=5), administration preferences (n=4), and the decision process of users (n=2). Motivation differences in preference were found. Purely medicinal users and novice users place more importance on cannabidiol (CBD) than tetrahydrocannabinol. Overall, inhalation methods of administration were preferred due to quick onset of symptom relief. Price was the greatest influence on choice for recreational/medicinal users, whereas purely medicinal users were less price sensitive for products with higher CBD content. Conclusion: Studies examining public preferences for the provision and use of MC were absent. Revealed preference methods are a useful technique for understanding preferences for characteristics that are difficult to visibly assess such as cannabinoid or strain. The outcomes of symptom-specific multicriteria decision method studies that compare the benefit-safety profiles of commonly used treatments and MC may be a useful decision support tool for health practitioners. Studies with representative samples are needed to understand the impact of age, gender, and race on preferences for MC.
Collapse
Affiliation(s)
- Katrina Gething
- Center for Applied Health Economics, School of Medicine, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Daniel Erku
- Center for Applied Health Economics, School of Medicine, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Paul Scuffham
- Center for Applied Health Economics, School of Medicine, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| |
Collapse
|
3
|
Valikhanova G, Kato Y, Fitzcharles MA, Ware M, Da Costa D, Lowensteyn I, Cheung HS, Grover S. Medical Cannabis Use Among Canadian Veterans and Non-Veterans: A National Survey. INTEGRATIVE MEDICINE REPORTS 2023; 2:120-128. [PMID: 37920683 PMCID: PMC10619467 DOI: 10.1089/imr.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 11/04/2023]
Abstract
Background Medical cannabis (MC) is used by Canadian Veterans to manage a wide range of health issues. However, there is little information comparing the reasons for MC use and its perceived effectiveness between Veterans and non-Veterans. Objects We compared MC use among a convenience sample of Canadian Veterans and with non-Veteran controls, including demographics, reasons and patterns of use, and perceived effectiveness. Methods Between November and December 2021, Canadian Veterans using cannabis were invited to participate in a survey using a national press release, social media, and announcements on online platform dedicated to promoting health among Canadian Veterans and non-Veterans during the pandemic (www.MissionVav.com). The survey was also mentioned in a monthly newsletter from Veteran Affairs Canada. Self-reported effectiveness was evaluated using a 0 to 10 visual analogue scale (0 being not all effective, 10 being the most effective). Results The survey was completed by 157 people, including 108 (69%) males and 49 (31%) females. The mean age was 57 years (range 19 to 84). Among responders, 90 (63%) identified as Veterans. The most common reasons for MC use among Veterans included: insomnia (80%), anxiety (73%), and depression (52%). Veterans reported medical conditions such as chronic pain (88%) and arthritis (51%). Compared with non-Veterans, Veterans were significantly more likely to be male (83% vs. 49%), have a higher BMI (35.2 vs. 30.9), to report problems with sleep, anxiety, depression, and PTSD, and to use cannabis in edible form (51% vs. 22%). Self-reported mean effectiveness scores for MC were highest for PTSD (8.4), insomnia (8.2), anxiety (8.1), depression (8.0), and chronic pain (7.6). Conclusions We found important differences in user characteristics and cannabis use patterns between Canadian Veterans and non-Veterans. Further controlled studies are required to validate these findings, but these data suggest that orally administered cannabis products may be worth further study.
Collapse
Affiliation(s)
| | - Yuka Kato
- Department of Mathematics & Statistics, Concordia University, Montreal, Canada
| | - Mary-Ann Fitzcharles
- Department of Rheumatology, McGill University, Montreal, Canada
- Alan Edwards Pain Management Unit, McGill University, Montreal, Canada
| | - Mark Ware
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Deborah Da Costa
- Division of Clinical Epidemiology, McGill University, Montreal, Canada
| | - Ilka Lowensteyn
- McGill Comprehensive Health Improvement Program, Faculty of Medicine, McGill University, Montréal, Canada
| | - Ho Sum Cheung
- McGill Comprehensive Health Improvement Program, Faculty of Medicine, McGill University, Montréal, Canada
| | - Steven Grover
- Department of Medicine, McGill University, Montreal, Canada
| |
Collapse
|
4
|
McNabb M, Durante KA, Trocchio S, Ritter DJ, MacCaffrie R, Brum A, Mandile S, White S. Self-reported Medicinal Cannabis Use as an Alternative to Prescription and Over-the-counter Medication Use Among US Military Veterans. Clin Ther 2023; 45:562-577. [PMID: 37414507 DOI: 10.1016/j.clinthera.2023.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Mental and other physical health concerns and substance use disorder are common and co-occurring events experienced by US veterans. Treatment with medicinal cannabis is a potential alternative to unwanted medication use for veterans, but more clinical and epidemiologic research is needed to understand the risks and benefits. METHODS Data were collected from a cross-sectional, self-reported, anonymous survey asking US veterans about their health conditions, medical treatments, demographics, and medicinal cannabis use along with its self-reported effectiveness. In addition to descriptive statistics, logistic regression models were run to examine correlates of the use of cannabis as a substitution for prescription or over-the-counter medications. FINDINGS A total of 510 veterans of US military service participated in the survey, which was administered between March 3 and December 31, 2019. The participants reported experiencing a variety of mental and other physical health conditions. Primary health conditions reported included chronic pain (196; 38%), PTSD (131; 26%), anxiety (47; 9%), and depression (26; 5%). Most participants (343; 67%) reported using cannabis daily. Many reported using cannabis to reduce the use of over-the-counter medications (151; 30%) including antidepressants (130; 25%), anti-inflammatories (89; 17%), and other prescription medications. Additionally, 463 veterans (91% of respondents) reported that medical cannabis helped them to experience a greater quality of life and 105 (21%) reported using fewer opioids as a result of their medical cannabis use. Veterans who were Black, who were female, who served in active combat, and who were living with chronic pain were more likely to report a desire to reduce the number of prescription medications they were taking (odds ratios = 2.92, 2.29, 1.79, and 2.30, respectively). Women and individuals who used cannabis daily were more likely to report active use of cannabis to reduce prescription medication use (odds ratios = 3.05 and 2.26). IMPLICATIONS Medicinal cannabis use was reported to improve quality of life and reduce unwanted medication use by many of the study participants. The present findings indicate that medicinal cannabis can potentially play a harm-reduction role, helping veterans to use fewer pharmaceutical medications and other substances. Clinicians should be mindful of the potential associations between race, sex, and combat experience and the intentions for and frequency of medicinal cannabis use.
Collapse
Affiliation(s)
- Marion McNabb
- Cannabis Center of Excellence Inc, Boston, Massachusetts.
| | | | - Sarah Trocchio
- Cannabis Center of Excellence Inc, Boston, Massachusetts; Department of Sociology and Criminology, Rider University, Lawrenceville, New Jersey
| | - David J Ritter
- Cannabis Center of Excellence Inc, Boston, Massachusetts
| | | | - Ann Brum
- Joint Venture & Co, Mansfield, Massachusetts
| | | | - Steven White
- Charlton College of Business, University of Massachusetts, North Dartmouth, Massachusetts
| |
Collapse
|
5
|
Sznitman SR, Meiri D, Amit BH, Rosenberg D, Greene T. Posttraumatic stress disorder, sleep and medical cannabis treatment: A daily diary study. J Anxiety Disord 2022; 92:102632. [PMID: 36182689 DOI: 10.1016/j.janxdis.2022.102632] [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: 10/18/2021] [Revised: 06/19/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
Despite increasing use of Medical Cannabis (MC) among posttraumatic stress disorder (PTSD) patients, research is lacking on how MC treatment relates to PTSD symptomatology, in particular sleep disturbances. This study examines the time gap between MC use and sleep onset and its association with (1) number of awakenings throughout the night, (2) early awakenings, (3) nightmares. Each morning over a two week period, 77 licensed MC patients suffering from PTSD reported on the timing of previous night MC use and sleep disturbances. Within-person analyses found that shorter time gaps between previous night MC use and sleep start time was associated with lower likelihood of experiencing nightmares throughout the night, but it was not associated with nightly awakenings or waking up too early. Between-person analyses showed that individuals who used MC products with higher CBD concentrations reported fewer early awakenings. These preliminary results indicate that future research should test causal relations between MC use and sleep problems in PTSD patients. Future research is warranted in order to explore causal relationships between MC use, nightmares and insomnia in PTSD patients.
Collapse
Affiliation(s)
| | - David Meiri
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ben H Amit
- Reuth Rehabilitation Center, Faculty of Medicine, Tel Aviv University, Israel
| | | | - Talya Greene
- Department of Community Mental Health, University of Haifa, Israel
| |
Collapse
|
6
|
Pillai M, Erridge S, Bapir L, Nicholas M, Dalavaye N, Holvey C, Coomber R, Barros D, Bhoskar U, Mwimba G, Praveen K, Symeon C, Sachdeva-Mohan S, Rucker JJ, Sodergren MH. Assessment of clinical outcomes in patients with post-traumatic stress disorder: analysis from the UK Medical Cannabis Registry. Expert Rev Neurother 2022; 22:1009-1018. [PMID: 36503404 DOI: 10.1080/14737175.2022.2155139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The current paucity of clinical evidence limits the use of cannabis-based medicinal products (CBMPs) in post-traumatic stress disorder (PTSD). This study investigates health-related quality of life (HRQoL) changes and adverse events in patients prescribed CBMPs for PTSD. METHODS A case-series of patients from the UK Medical Cannabis Registry was analyzed. HRQoL was assessed at 1-, 3-, and 6-months using validated patient reported outcome measures (PROMs). Adverse events were analyzed according to the Common Terminology Criteria for Adverse Events version 4.0. Statistical significance was defined as p < 0.050. RESULTS Of 162 included patients, 88.89% (n = 144) were current/previous cannabis users. Median daily CBMP dosages were 5.00 (IQR: 0.00-70.00) mg of cannabidiol and 145.00 (IQR: 100.00-200.00) mg of Δ9-tetrahydrocannabinol. Significant improvements were observed in PTSD symptoms, sleep, and anxiety across all follow-up periods (p < 0.050). There were 220 (135.8%) adverse events reported by 33 patients (20.37%), with the majority graded mild or moderate in severity (n = 190, 117.28%). Insomnia and fatigue had the greatest incidence (n = 20, 12.35%). CONCLUSIONS Associated improvements in HRQoL were observed in patients who initiated CBMP therapy. Adverse events analysis suggests acceptability and safety up to 6 months. This study may inform randomized placebo-controlled trials, required to confirm causality and determine optimal dosing.
Collapse
Affiliation(s)
- Manaswini Pillai
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Simon Erridge
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Lara Bapir
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Martha Nicholas
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nishaanth Dalavaye
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Carl Holvey
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Ross Coomber
- Department of Medicine, Sapphire Medical Clinics, London, UK.,Department of Trauma & Orthopaedics, St. George's Hospital NHS Trust, London, UK
| | - Daniela Barros
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Urmila Bhoskar
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Gracia Mwimba
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Kavita Praveen
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Chris Symeon
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | | | - James J Rucker
- Department of Medicine, Sapphire Medical Clinics, London, UK.,Department of Psychological Medicine, Kings College London, London, UK.,Centre for Affective Disorders, South London & Maudsley NHS Foundation Trust, London, UK
| | - Mikael H Sodergren
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Medicine, Sapphire Medical Clinics, London, UK
| |
Collapse
|
7
|
Hill ML, Loflin M, Nichter B, Na PJ, Herzog S, Norman SB, Pietrzak RH. Cannabis use among U.S. military veterans with subthreshold or threshold posttraumatic stress disorder: Psychiatric comorbidities, functioning, and strategies for coping with posttraumatic stress symptoms. J Trauma Stress 2022; 35:1154-1166. [PMID: 35275431 DOI: 10.1002/jts.22823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/27/2021] [Accepted: 01/19/2022] [Indexed: 11/07/2022]
Abstract
Cannabis use is common among individuals with posttraumatic stress disorder (PTSD) symptoms, but its impact on psychiatric symptoms and functioning in this population is unclear. To clarify the clinical and functional correlates of cannabis use in individuals with PTSD symptoms, we analyzed data from the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative survey of U.S. military veterans. Participants with current subthreshold or full PTSD (N = 608) reported on their past-6-month cannabis use and current psychiatric symptoms, functioning, treatment utilization, and PTSD symptom management strategies. Veterans with subthreshold/full PTSD who used cannabis more than weekly were more likely to screen positive for co-occurring depression, anxiety, and suicidal ideation than those who did not use cannabis, ORs = 3.4-3.8, or used cannabis less than weekly, ORs = 2.7-3.7. Veterans who used cannabis more than weekly also scored lower in cognitive functioning than veterans with no use, d = 0.25, or infrequent use, d = 0.71, and were substantially more likely to endorse avoidance coping strategies, ORs = 8.2-12.2, including substance use, OR = 4.4, and behavioral disengagement, ORs = 2.7-9.1, to manage PTSD symptoms. Despite more psychiatric and functional problems, veterans with frequent cannabis use were not more likely to engage in mental health treatment, ORs = 0.87-0.99. The results suggest enhanced cannabis use screening, interventions targeting risky use, and strategies promoting treatment engagement may help ameliorate more severe clinical presentations associated with frequent cannabis use among veterans with subthreshold/full PTSD.
Collapse
Affiliation(s)
- Melanie L Hill
- Department of Psychiatry, University of California, San Diego, California, USA.,VA San Diego Healthcare System, San Diego, California, USA
| | - Mallory Loflin
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Brandon Nichter
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Sarah Herzog
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, New York, USA.,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California, San Diego, California, USA.,VA San Diego Healthcare System, San Diego, California, USA.,National Center for PTSD, White River Junction, Vermont, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
8
|
Clary KL, Kang H, Quintero Silva L, Bobitt J. Weeding Out the Stigma: Older Veterans in Illinois Share Their Experiences Using Medical Cannabis. J Psychoactive Drugs 2022:1-8. [PMID: 35640046 DOI: 10.1080/02791072.2022.2082901] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Many U.S. Veterans are using cannabis for medical purposes. Modern research findings continue to point to medical cannabis as a potentially effective alternative to prescription medications for treating a range of medical conditions. While research exists on the use levels of cannabis, limited research can be found on the perceived stigma of using cannabis, especially among older Veterans. We surveyed 121 older U.S. Veterans who were enrolled in the Illinois Medical Cannabis Patient Program during Fall 2020. We then used maximum variation sampling to select a subset of 32 Veterans to partake in a phone interview. Two researchers conducted and qualitatively coded 30-minute audiotaped semi-structured interviews. Interview topics included (1) the use of cannabis, opioids, and benzodiazepines; (2) interactions with medical providers; (3) stigma regarding cannabis use; and (4) educational materials. We share findings from stigma. We identified three themes: (1) stereotypes regarding people who use cannabis, (2) media portrayal of cannabis users, and (3) hesitation in disclosing cannabis use. Stigma creates situations in which older Veterans may be hesitant to disclose their use of cannabis with physicians and friends/family, which can be dangerous and socially isolating. Additional research is needed to expand upon our findings with more generalizable methods.
Collapse
Affiliation(s)
- Kelly Lynn Clary
- School of Social Work, Texas State University, San Marcos, TX, USA
| | - Hyojung Kang
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Laura Quintero Silva
- Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Julie Bobitt
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
9
|
Scherer M, Nochajski TH, Romano E, Romosz A, Evans K, Taylor E, Voas R. Examining the role of trauma in alcohol interlock performance: A structural pathway analysis. TRAFFIC INJURY PREVENTION 2022; 23:153-158. [PMID: 35263239 DOI: 10.1080/15389588.2022.2046270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Self-medication using alcohol is a common coping response among individuals dealing with trauma as is driving under the influence of alcohol (DUI). A common intervention for drivers convicted of DUI, is an alcohol ignition interlock device (IID)-which requires breath samples before starting the car. If the sample is above a predetermined limit (.025), the car will not start, thus preventing impaired driving. IIDs are an effective intervention to reduce rates of drinking and driving among high risk populations; however, limited research has examined how traumatic experiences may impact performance on IIDs. METHODS This study is an archival analysis of the Managing Heavy Drinking (MHD) study of drivers in New York state. The MHD is a comprehensive study of drivers convicted of a DUI from 2015-2020. Participants (N = 121) completed questionnaires and provided consent to retrieve information from interlock providers. Outcome variable included high BAC lockout ratios (number of high BAC lockouts [BAC>.08]/number of clean blows [BAC ≤ .025]). Other variables included demographic variables, alcohol treatment history, trauma experiences, and prior DUI history. Variables were entered into a structural equation model. RESULTS In the final structural model, pathways that demonstrated a p-value of greater than .10 were dropped from the model. This produced acceptable overall model fit statistics (χ2 = 27.059(10), p=.003; CFI = .900; NFI = .898; RMSEA = .063). A significant pathway was found from the trauma measure to alcohol use (β = .132), and from alcohol use to interlock performance (β = .636). However, no significant relationship was found between trauma and interlock performance other than through alcohol use. CONCLUSIONS The current study provides a useful framework upon which to understand the role traumatic experiences have on alcohol IID performance. Traumatic experiences are in of themselves insufficient to impact IID performance directly, but it may indirectly impact IID performance through increasing alcohol use.
Collapse
Affiliation(s)
- Michael Scherer
- Pacific Institute for Research and Evaluation, Beltsville, Maryland
- The Chicago School of Professional Psychology, Washington, District of Columbia
| | - Thomas H Nochajski
- University at Buffalo, The State University of New York, Buffalo, New York
| | - Eduardo Romano
- Pacific Institute for Research and Evaluation, Beltsville, Maryland
| | - Ann Romosz
- Pacific Institute for Research and Evaluation, Beltsville, Maryland
- The Chicago School of Professional Psychology, Washington, District of Columbia
| | - Kierra Evans
- The Chicago School of Professional Psychology, Washington, District of Columbia
| | - Eileen Taylor
- Pacific Institute for Research and Evaluation, Beltsville, Maryland
| | - Robert Voas
- Pacific Institute for Research and Evaluation, Beltsville, Maryland
| |
Collapse
|
10
|
Striley CW, Hoeflich CC. Intricacies of Researching Cannabis Use and Use Disorders Among Veterans in the United States. Am J Psychiatry 2022; 179:5-7. [PMID: 34974758 DOI: 10.1176/appi.ajp.2021.21111125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Catherine W Striley
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville
| | - Carolin C Hoeflich
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville
| |
Collapse
|
11
|
Gibson M, Williamson L, Henwood G, Chalmers D, Dell CA. Perceptions and Use of Alcohol and Medical Cannabis among Canadian Military Veterans Living with PTSD. JOURNAL OF VETERANS STUDIES 2021. [DOI: 10.21061/jvs.v7i1.200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
|
12
|
Bonn-Miller MO, Sisley S, Riggs P, Yazar-Klosinski B, Wang JB, Loflin MJE, Shechet B, Hennigan C, Matthews R, Emerson A, Doblin R. The short-term impact of 3 smoked cannabis preparations versus placebo on PTSD symptoms: A randomized cross-over clinical trial. PLoS One 2021; 16:e0246990. [PMID: 33730032 PMCID: PMC7968689 DOI: 10.1371/journal.pone.0246990] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 01/26/2021] [Indexed: 12/01/2022] Open
Abstract
IMPORTANCE There is a pressing need for development of novel pharmacology for the treatment of Posttraumatic Stress Disorder (PTSD). Given increasing use of medical cannabis among US military veterans to self-treat PTSD, there is strong public interest in whether cannabis may be a safe and effective treatment for PTSD. OBJECTIVE The aim of the present study was to collect preliminary data on the safety and potential efficacy of three active concentrations of smoked cannabis (i.e., High THC = approximately 12% THC and < 0.05% CBD; High CBD = 11% CBD and 0.50% THC; THC+CBD = approximately 7.9% THC and 8.1% CBD, and placebo = < 0.03% THC and < 0.01% CBD) compared to placebo in the treatment of PTSD among military veterans. METHODS The study used a double-blind, cross-over design, where participants were randomly assigned to receive three weeks of either active treatment or placebo in Stage 1 (N = 80), and then were re-randomized after a 2-week washout period to receive one of the other three active treatments in Stage 2 (N = 74). The primary outcome measure was change in PTSD symptom severity from baseline to end of treatment in Stage 1. RESULTS The study did not find a significant difference in change in PTSD symptom severity between the active cannabis concentrations and placebo by the end of Stage 1. All three active concentrations of smoked cannabis were generally well tolerated. CONCLUSIONS AND RELEVANCE The present study is the first randomized placebo-controlled trial of smoked cannabis for PTSD. All treatment groups, including placebo, showed good tolerability and significant improvements in PTSD symptoms during three weeks of treatment, but no active treatment statistically outperformed placebo in this brief, preliminary trial. Additional well-controlled and adequately powered studies with cannabis suitable for FDA drug development are needed to determine whether smoked cannabis improves symptoms of PTSD. TRIAL REGISTRATION Identifier: NCT02759185; ClinicalTrials.gov.
Collapse
Affiliation(s)
- Marcel O. Bonn-Miller
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Sue Sisley
- Scottsdale Research Institute, Scottsdale, Arizona, United States of America
| | - Paula Riggs
- School of Medicine, University of Colorado, Aurora, Colorado, United States of America
| | - Berra Yazar-Klosinski
- Multidisciplinary Association for Psychedelic Studies, Santa Cruz, California, United States of America
| | - Julie B. Wang
- Multidisciplinary Association for Psychedelic Studies, Santa Cruz, California, United States of America
| | - Mallory J. E. Loflin
- Center of Excellence for Stress and Mental Health & National Center for PTSD, VA San Diego Healthcare System, San Diego, California, United States of America
- San Diego School of Medicine, Department of Psychiatry, University of California, San Diego, California, United States of America
| | - Benjamin Shechet
- Scottsdale Research Institute, Scottsdale, Arizona, United States of America
- Multidisciplinary Association for Psychedelic Studies, Santa Cruz, California, United States of America
| | - Colin Hennigan
- Multidisciplinary Association for Psychedelic Studies, Santa Cruz, California, United States of America
| | - Rebecca Matthews
- Multidisciplinary Association for Psychedelic Studies, Santa Cruz, California, United States of America
| | - Amy Emerson
- Multidisciplinary Association for Psychedelic Studies, Santa Cruz, California, United States of America
| | - Rick Doblin
- Multidisciplinary Association for Psychedelic Studies, Santa Cruz, California, United States of America
| |
Collapse
|
13
|
Hill ML, Nichter BM, Norman SB, Loflin M, Pietrzak RH. Burden of cannabis use and disorder in the U.S. veteran population: Psychiatric comorbidity, suicidality, and service utilization. J Affect Disord 2021; 278:528-535. [PMID: 33017681 DOI: 10.1016/j.jad.2020.09.099] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/17/2020] [Accepted: 09/26/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cannabis use is associated with psychiatric illness and suicidality, which are prevalent among U.S. military veterans. However, the psychiatric burden of cannabis use and cannabis use disorder (CUD) among veterans is unclear. Using data from a nationally representative sample of veterans, we evaluated associations of lifetime cannabis use and CUD with psychiatric problems, suicidality, and treatment utilization. METHODS Participants were 3,157 veterans aged 21 to 96 years from the National Health and Resilience in Veterans Study (NHRVS). Cannabis use and CUD were assessed using the Mini International Neuropsychiatric Interview. Psychiatric morbidities, suicidal ideation and attempts, and treatment utilization were assessed and compared between three cannabis groups: [1] no lifetime cannabis use (never-use); [2] lifetime cannabis use but never met criteria for CUD (non-CUD cannabis use); [3] lifetime CUD (CUD). RESULTS Relative to the never-use group, veterans who used cannabis had elevated odds of current and lifetime posttraumatic stress disorder (PTSD), mood, anxiety, and substance use disorders, current suicidal ideation, lifetime suicide attempts, and current and lifetime mental health treatment utilization [odds ratios (ORs)=1.5-8.3]. Veterans with CUD had higher odds of current and lifetime PTSD, mood, and anxiety disorders, lifetime nicotine and alcohol dependence, and current suicidal ideation, relative to veterans who used cannabis but never met criteria for CUD (ORs=1.6-2.7). LIMITATIONS The cross-sectional design of this study precludes causal inference. CONCLUSIONS Cannabis use and CUD are associated with substantial psychiatric and suicide-related burden among veterans, highlighting the need for screening, education, and treatment to mitigate potential cannabis-related harm.
Collapse
Affiliation(s)
- Melanie L Hill
- Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA.
| | - Brandon M Nichter
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; National Center for PTSD, White River Junction, VT, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Mallory Loflin
- Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; National Center for PTSD, White River Junction, VT, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Robert H Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
14
|
Bonn-Miller MO, Brunstetter M, Simonian A, Loflin MJ, Vandrey R, Babson KA, Wortzel H. The Long-Term, Prospective, Therapeutic Impact of Cannabis on Post-Traumatic Stress Disorder. Cannabis Cannabinoid Res 2020; 7:214-223. [PMID: 33998874 PMCID: PMC9070744 DOI: 10.1089/can.2020.0056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Introduction: Given the increasing availability and use of cannabis among individuals with post-traumatic stress disorder (PTSD) and the addition of PTSD as an eligible diagnosis in several U.S. medical cannabis programs, the efficacy of dispensary-obtained cannabis needs to be thoroughly examined. Materials and Methods: This prospective study assessed PTSD symptoms and functioning every 3 months over the course of a year in two samples of participants diagnosed with PTSD: (1) those with PTSD using dispensary-obtained cannabis (cannabis users) and (2) those with PTSD, who do not use cannabis (controls). Linear mixed-effects models and generalized estimating equations tested whether trajectories of symptoms differed between the two subsamples. Results: A total of 150 participants (mean [standard deviation] age, 50.67 [15.26] years; 73% male) were enrolled in the study. Over the course of 1 year, the cannabis users reported a greater decrease in PTSD symptom severity over time compared to controls [group×time interaction=-0.32 (95% confidence interval [CI]=-0.59 to -0.05, R2=0.13; t=-2.35, p=0.02). Participants who used cannabis were 2.57 times more likely to no longer meet DSM-5 criteria for PTSD at the end of the study observation period compared to participants who did not use cannabis (95% CI=1.12-6.07; p=0.03). Conclusions: This study provides evidence that the types of cannabis available in recreational and medical cannabis dispensaries might hold promise as an alternative treatment for PTSD. Randomized placebo-controlled trials are needed to assess safety and determine how different preparations of cannabis impact PTSD and functioning.
Collapse
Affiliation(s)
- Marcel O Bonn-Miller
- Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Mallory J Loflin
- VA San Diego Health Care System, Center of Excellence for Stress and Mental Health and National Center for PTSD, San Diego, California, USA.,University of California San Diego School of Medicine, La Jolla, California, USA
| | - Ryan Vandrey
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Hal Wortzel
- Rocky Mountain MIRECC Rocky, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA.,University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
15
|
Sbarski B, Akirav I. Cannabinoids as therapeutics for PTSD. Pharmacol Ther 2020; 211:107551. [PMID: 32311373 DOI: 10.1016/j.pharmthera.2020.107551] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 03/08/2020] [Indexed: 02/09/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a complex disorder that involves dysregulation of multiple neurobiological systems. The traumatic stressor plays a causal role in producing psychological dysfunction and the pattern of findings suggests that the hypothalamic-pituitary-adrenal (HPA) axis, which is instrumental for stress adaptation, is critically dysfunctional in PTSD. Given the lack of understanding of the basic mechanisms and underlying pathways that cause the disorder and its heterogeneity, PTSD poses challenges for treatment. Targeting the endocannabinoid (ECB) system to treat mental disorders, and PTSD in particular, has been the focus of research and interest in recent years. The ECB system modulates multiple functions, and drugs enhancing ECB signaling have shown promise as potential therapeutic agents in stress effects and other psychiatric and medical conditions. In this review, we focus on the interaction between the ECB-HPA systems in animal models for PTSD and in patients with PTSD. We summarize evidence supporting the use of cannabinoids in preventing and treating PTSD in preclinical and clinical studies. As the HPA system plays a key role in the mediation of the stress response and the pathophysiology of PTSD, we describe preclinical studies suggesting that enhancing ECB signaling is consistent with decreasing PTSD symptoms and dysfunction of the HPA axis. Overall, we suggest that a pharmacological treatment targeted at one system (e.g., HPA) may not be very effective because of the heterogeneity of the disorder. There are abnormalities across different neurotransmitter systems in the pathophysiology of PTSD and none of these systems function uniformly among all patients with PTSD. Hence, conceptually, enhancing ECB signaling may be a more effective avenue for pharmacological treatment.
Collapse
Affiliation(s)
- Brenda Sbarski
- School of Psychological Sciences, Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel
| | - Irit Akirav
- School of Psychological Sciences, Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel.
| |
Collapse
|