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Fischer B, Hall W, Fidalgo TM, Hoch E, Foll BL, Medina-Mora ME, Reimer J, Tibbo PG, Jutras-Aswad D. Recommendations for Reducing the Risk of Cannabis Use-Related Adverse Psychosis Outcomes: A Public Mental Health-Oriented Evidence Review. J Dual Diagn 2023; 19:71-96. [PMID: 37450645 DOI: 10.1080/15504263.2023.2226588] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Objective: Cannabis use is increasingly normalized; psychosis is a major adverse health outcome. We reviewed evidence on cannabis use-related risk factors for psychosis outcomes at different stages toward recommendations for risk reduction by individuals involved in cannabis use. Methods: We searched primary databases for pertinent literature/data 2016 onward, principally relying on reviews and high-quality studies which were narratively summarized and quality-graded; recommendations were developed by international expert consensus. Results: Genetic risks, and mental health/substance use problem histories elevate the risks for cannabis-related psychosis. Early age-of-use-onset, frequency-of-use, product composition (i.e., THC potency), use mode and other substance co-use all influence psychosis risks; the protective effects of CBD are uncertain. Continuous cannabis use may adversely affect psychosis-related treatment and medication effects. Risk factor combinations further amplify the odds of adverse psychosis outcomes. Conclusions: Reductions in the identified cannabis-related risks factors-short of abstinence-may decrease risks of related adverse psychosis outcomes, and thereby protect cannabis users' health.
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Affiliation(s)
- Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Research and Graduate Studies Division, University of the Fraser Valley, Abbotsford, Canada
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Wayne Hall
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Australia
| | - Thiago M Fidalgo
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Eva Hoch
- Department of Psychiatry, Ludwig-Maximilian-University, Munich, Germany
- Institut für Therapieforschung (IFT), Munich, Germany
| | - Bernard Le Foll
- Translational Addiction Research Laboratory and Campbell Family Mental Health Research Institute and Acute Care Program, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology and Toxicology and Dalla Lana School of Public Health and Department of Psychiatry and Institute of Medical Science, University of Toronto, Toronto, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Canada
| | - Maria-Elena Medina-Mora
- Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
- Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Jens Reimer
- Departments of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
- Center for Psychosocial Medicine, Academic Teaching Hospital Itzehoe, Itzehoe, Germany
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- Nova Scotia Health, Halifax, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Édouard Montpetit Boulevard, Montreal, Canada
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Reddon H, Milloy MJ, Wood E, Nosova E, Kerr T, DeBeck K. High-intensity cannabis use and hospitalization: a prospective cohort study of street-involved youth in Vancouver, Canada. Harm Reduct J 2021; 18:53. [PMID: 34001159 PMCID: PMC8130127 DOI: 10.1186/s12954-021-00501-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is concern that cannabis use negatively affects vulnerable groups such as youth; however, the relationship between cannabis use and health care utilization has not been well characterized in this population. We longitudinally evaluated the association between daily cannabis use and hospitalization among a prospective cohort of street-involved youth. METHODS Data were collected from the At-Risk Youth Study (ARYS) in Vancouver, Canada, from September 2005 to May 2015. Participants were interviewed semi-annually and multivariable generalized estimating equation (GEE) logistic regression was used to examine the relationship between daily cannabis use and hospitalization. RESULTS A total of 1216 participants (31.2% female) were included in this analysis, and 373 (30.7%) individuals reported hospitalization at some point during the study period. In a multivariable GEE analysis, daily cannabis use was not significantly associated with hospitalization (Adjusted Odds Ratio [AOR] = 1.17, 95% Confidence interval [CI] = 0.84, 1.65). We did observe a significant interaction between daily cannabis use and sex (AOR = 0.51, 95% CI = 0.34, 0.77), whereby cannabis use was associated with a decreased odds of hospitalization among males (AOR = 0.60, 95% CI = 0.47, 0.78), yet was not significantly associated with hospitalization among females (AOR = 1.19, 95% CI = 0.84, 1.67). CONCLUSIONS The finding that daily cannabis use was not associated with hospitalization among street-involved youth is encouraging given the high rates of cannabis use in this population and the expansion of cannabis legalization and regulation. Future studies, however, are warranted to monitor possible changes in the consequences of cannabis use as cannabis legalization and regulation increase internationally.
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Affiliation(s)
- Hudson Reddon
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- CIHR Canadian HIV Trials Network, 588-1081 Burrard Street, Vancouver, BC, V6B 3E6, Canada
| | - M-J Milloy
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, ,Vancouver, BC, V6Z 1Y6, Canada
| | - Evan Wood
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, ,Vancouver, BC, V6Z 1Y6, Canada
| | - Ekaterina Nosova
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
| | - Thomas Kerr
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, ,Vancouver, BC, V6Z 1Y6, Canada
| | - Kora DeBeck
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada.
- School of Public Policy, SFU Harbour Centre, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.
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Are we any closer to identifying a causal relationship between cannabis and psychosis? Curr Opin Psychol 2021; 38:56-60. [DOI: 10.1016/j.copsyc.2020.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/20/2020] [Accepted: 07/26/2020] [Indexed: 12/31/2022]
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Abrahamyan Empson L, Baumann PS, Söderström O, Codeluppi Z, Söderström D, Conus P. Urbanicity: The need for new avenues to explore the link between urban living and psychosis. Early Interv Psychiatry 2020; 14:398-409. [PMID: 31389169 DOI: 10.1111/eip.12861] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 11/25/2018] [Accepted: 07/14/2019] [Indexed: 12/26/2022]
Abstract
AIM A growing body of evidence suggests that urban living contributes to the development of psychosis. However, the mechanisms underlying this phenomenon remain unclear. This paper aims to explore the best available knowledge on the matter, identify research gaps and outline future prospects for research strategies. METHOD A comprehensive literature survey on the main computerized medical research databases, with a time limit up to August 2017 on the issue of urbanicity and psychosis has been conducted. RESULTS The impact of urbanicity may result from a wide range of factors (from urban material features to stressful impact of social life) leading to "urban stress." The latter may link urban upbringing to the development of psychosis through overlapping neuro- and socio-developmental pathways, possibly unified by dopaminergic hyperactivity in mesocorticolimbic system. However, "urban stress" is poorly defined and research based on patients' experience of the urban environment is scarce. CONCLUSIONS Despite accumulated data, the majority of studies conducted so far failed to explain how specific factors of urban environment combine in patients' daily life to create protective or disruptive milieus. This undermines the translation of a vast epidemiological knowledge into effective therapeutic and urbanistic developments. New studies on urbanicity should therefore be more interdisciplinary, bridging knowledge from different disciplines (psychiatry, epidemiology, human geography, urbanism, etc.) in order to enrich research methods, ensure the development of effective treatment and preventive strategies as well as create urban environments that will contribute to mental well-being.
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Affiliation(s)
- Lilith Abrahamyan Empson
- Treatment and early Intervention in Psychosis Program, Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Philipp S Baumann
- Treatment and early Intervention in Psychosis Program, Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland.,Center for Psychiatric Neurosciences, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Ola Söderström
- Institute of Geography, University of Neuchâtel, Neuchâtel, Switzerland
| | - Zoé Codeluppi
- Institute of Geography, University of Neuchâtel, Neuchâtel, Switzerland
| | | | - Philippe Conus
- Treatment and early Intervention in Psychosis Program, Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland
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Fischer B, Daldegan‐Bueno D, Boden JM. Facing the option for the legalisation of cannabis use and supply in New Zealand: An overview of relevant evidence, concepts and considerations. Drug Alcohol Rev 2020; 39:555-567. [PMID: 32436274 PMCID: PMC7383663 DOI: 10.1111/dar.13087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 12/18/2022]
Abstract
ISSUES Non-medical cannabis policies are changing, including towards legalisation-with-regulation frameworks. New Zealand will hold a public referendum on cannabis legalisation in 2020. We reviewed data on cannabis use and health/social harms; policy reform options; experiences with and outcomes of reforms elsewhere; and other relevant considerations towards informing policy choices in the upcoming referendum. APPROACH Relevant epidemiological, health, social, criminal justice and policy studies and data were identified and comprehensively reviewed. KEY FINDINGS Cannabis use is common (including in New Zealand) and associated with risks for health and social harms, mainly concentrated in young users; key harms are attributable to criminalisation. 'Decriminalisation' reforms have produced ambivalent results. Existing cannabis legalisation frameworks vary considerably in main parameters. Legalisation offers some distinct advantages, for example regulated use, products and user education, yet outcomes depend on essential regulation parameters, including commercialisation, and policy ecologies. While major changes in use are not observed, legalisation experiences are inconclusive to date, including mixed health and social outcomes, with select harms increasing and resilient illegal markets. It is unclear whether legalisation reduces cannabis exposure or social harms (e.g. from enforcement) for youth. IMPLICATIONS/CONCLUSIONS No conclusive overall evidence on the outcomes of legalisation elsewhere exists, nor is evidence easily transferable to other settings. Legalisation offers direct social justice benefits for adults, yet overall public health impacts are uncertain. Legalisation may not categorically improve health or social outcomes for youth. Legalisation remains a well-intended, while experimental policy option towards more measured and sensible cannabis control and overall greater policy coherence, requiring close monitoring and possible adjustments depending on setting-specific outcomes.
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Affiliation(s)
- Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
- Department of PsychiatryUniversity of TorontoTorontoCanada
- Centre for Applied Research in Mental Health and AddictionSimon Fraser UniversityVancouverCanada
- Department of PsychiatryFederal University of Sao PauloSao Paulo, Brazil
| | - Dimitri Daldegan‐Bueno
- Schools of Population Health and Pharmacy, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Joseph M. Boden
- Department of Psychological MedicineUniversity of OtagoChristchurchNew Zealand
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Banducci AN, Felton JW, Bonn-Miller MO, Lejuez C. An Examination of the Impact of Childhood Emotional Abuse and Gender on Cannabis Use Trajectories among Community Youth. TRANSLATIONAL ISSUES IN PSYCHOLOGICAL SCIENCE 2018; 4:85-98. [PMID: 29930974 PMCID: PMC6005668 DOI: 10.1037/tps0000142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cannabis is the most frequently used illicit substance among youth, with rates of cannabis use escalating across adolescence. One potential factor predicting cannabis use among youth is childhood emotional abuse (CEA), which has been associated with substance use behaviors more broadly. Although CEA may be associated with increased cannabis use in general, it is likely that sex may have an impact on these relations, given that girls are more likely to use substances following abuse experiences than boys. The purpose of the current study as to examine longitudinal relations between CEA and gender on cannabis use during adolescence. The current study included a sample of 206 9th grade community youth (120 boys; Mage = 14.10, 55% European-American) followed annually through the 12th grade. CEA was assessed with the Childhood Trauma Questionnaire and cannabis use was assessed with the Youth Risk Behavior Survey. A latent growth model was utilized to examine cannabis use trajectories from grades 9-12. Within our initial model, elevated baseline use was associated with male gender and more severe CEA. Significant predictors of increases in cannabis use over time included elevated baseline alcohol use and the interaction between gender and CEA, such that girls with the most severe CEA had the greatest increases in cannabis use over time. These results suggest the importance of addressing CEA among adolescent girls. Given that cannabis use during adolescence is associated with a host of negative outcomes, targeted efforts to reduce use, through prevention and intervention efforts, is critical.
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Affiliation(s)
- Anne N. Banducci
- VA Boston Healthcare System, 251 Causeway St. Boston, MA 02114
- The National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (NCPTSD 324), Menlo Park, CA 94025
- Department of Psychology, University of Maryland College Park. 1147 Biology Psychology Building, College Park, MD 20742
| | - Julia W. Felton
- Department of Psychology, University of Maryland College Park. 1147 Biology Psychology Building, College Park, MD 20742
- Michigan State University, Division of Public Health, 200 East 1 St. Flint, MI 48502
| | - Marcel O. Bonn-Miller
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3440 Market St, Suite 370, Philadelphia, PA 19104
| | - C.W. Lejuez
- College of Liberal Arts and Sciences, University of Kansas, 1450 Jayhawk Blvd. Lawrence, KS, 66045
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Fischer B, Russell C, Sabioni P, van den Brink W, Le Foll B, Hall W, Rehm J, Room R. Lower-Risk Cannabis Use Guidelines: A Comprehensive Update of Evidence and Recommendations. Am J Public Health 2017. [PMID: 28644037 DOI: 10.2105/ajph.2017.303818] [Citation(s) in RCA: 253] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cannabis use is common in North America, especially among young people, and is associated with a risk of various acute and chronic adverse health outcomes. Cannabis control regimes are evolving, for example toward a national legalization policy in Canada, with the aim to improve public health, and thus require evidence-based interventions. As cannabis-related health outcomes may be influenced by behaviors that are modifiable by the user, evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG)-akin to similar guidelines in other health fields-offer a valuable, targeted prevention tool to improve public health outcomes. OBJECTIVES To systematically review, update, and quality-grade evidence on behavioral factors determining adverse health outcomes from cannabis that may be modifiable by the user, and translate this evidence into revised LRCUG as a public health intervention tool based on an expert consensus process. SEARCH METHODS We used pertinent medical search terms and structured search strategies, to search MEDLINE, EMBASE, PsycINFO, Cochrane Library databases, and reference lists primarily for systematic reviews and meta-analyses, and additional evidence on modifiable risk factors for adverse health outcomes from cannabis use. SELECTION CRITERIA We included studies if they focused on potentially modifiable behavior-based factors for risks or harms for health from cannabis use, and excluded studies if cannabis use was assessed for therapeutic purposes. DATA COLLECTION AND ANALYSIS We screened the titles and abstracts of all studies identified by the search strategy and assessed the full texts of all potentially eligible studies for inclusion; 2 of the authors independently extracted the data of all studies included in this review. We created Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow-charts for each of the topical searches. Subsequently, we summarized the evidence by behavioral factor topic, quality-graded it by following standard (Grading of Recommendations Assessment, Development, and Evaluation; GRADE) criteria, and translated it into the LRCUG recommendations by the author expert collective on the basis of an iterative consensus process. MAIN RESULTS For most recommendations, there was at least "substantial" (i.e., good-quality) evidence. We developed 10 major recommendations for lower-risk use: (1) the most effective way to avoid cannabis use-related health risks is abstinence, (2) avoid early age initiation of cannabis use (i.e., definitively before the age of 16 years), (3) choose low-potency tetrahydrocannabinol (THC) or balanced THC-to-cannabidiol (CBD)-ratio cannabis products, (4) abstain from using synthetic cannabinoids, (5) avoid combusted cannabis inhalation and give preference to nonsmoking use methods, (6) avoid deep or other risky inhalation practices, (7) avoid high-frequency (e.g., daily or near-daily) cannabis use, (8) abstain from cannabis-impaired driving, (9) populations at higher risk for cannabis use-related health problems should avoid use altogether, and (10) avoid combining previously mentioned risk behaviors (e.g., early initiation and high-frequency use). AUTHORS' CONCLUSIONS Evidence indicates that a substantial extent of the risk of adverse health outcomes from cannabis use may be reduced by informed behavioral choices among users. The evidence-based LRCUG serve as a population-level education and intervention tool to inform such user choices toward improved public health outcomes. However, the LRCUG ought to be systematically communicated and supported by key regulation measures (e.g., cannabis product labeling, content regulation) to be effective. All of these measures are concretely possible under emerging legalization regimes, and should be actively implemented by regulatory authorities. The population-level impact of the LRCUG toward reducing cannabis use-related health risks should be evaluated. Public health implications. Cannabis control regimes are evolving, including legalization in North America, with uncertain impacts on public health. Evidence-based LRCUG offer a potentially valuable population-level tool to reduce the risk of adverse health outcomes from cannabis use among (especially young) users in legalization contexts, and hence to contribute to improved public health outcomes.
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Affiliation(s)
- Benedikt Fischer
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Cayley Russell
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Pamela Sabioni
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Wim van den Brink
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Bernard Le Foll
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Wayne Hall
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Jürgen Rehm
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Robin Room
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Hall W. Alcohol and cannabis: Comparing their adverse health effects and regulatory regimes. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 42:57-62. [PMID: 27908654 DOI: 10.1016/j.drugpo.2016.10.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/04/2016] [Accepted: 10/28/2016] [Indexed: 01/13/2023]
Abstract
The claim that the adverse health effects of cannabis are much less serious than those of alcohol has been central to the case for cannabis legalisation. Regulators in US states that have legalised cannabis have adopted regulatory models based on alcohol. This paper critically examines the claim about adverse health effects and the wisdom of regulating cannabis like alcohol. First, it compares what we know about the adverse health effects of alcohol and cannabis. Second, it discusses the uncertainties about the long term health effects of sustained daily cannabis use. Third, it speculates about how the adverse health effects of cannabis may change after legalisation. Fourth, it questions the assumption that alcohol provides the best regulatory model for a legal cannabis market. Fifth, it outlines the major challenges in regulating cannabis under the liberal alcohol-like regulatory regimes now being introduced.
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Affiliation(s)
- Wayne Hall
- National Addiction Centre, Kings College London and Centre for Youth Substance Abuse Research, University of Queensland, Australia.
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Kedzior KK, Wehmann E, Martin-Iverson M. Habituation of the startle reflex depends on attention in cannabis users. BMC Psychol 2016; 4:50. [PMID: 27782849 PMCID: PMC5080700 DOI: 10.1186/s40359-016-0158-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/17/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cannabis use is associated with an attention-dependent deficit in prepulse inhibition of the startle reflex (PPI). The aim of the current study was to investigate startle habituation in cannabis users and healthy controls during two attentional tasks. METHODS Auditory startle reflex was recorded from orbicularis oculi muscle while participants (12 controls and 16 regular cannabis users) were either attending to or ignoring 100 dB startling pulses. Startle habituation was measured as the absolute reduction in startle magnitude on block 2 (last nine trials) vs. block 1 (first nine trials). RESULTS Startle habituation with moderate effect sizes was observed in controls and cannabis users only while they were ignoring the startling pulses but not while they were attending to them. Similar results were also observed in controls (lifetime non-users of cannabis) and cannabis users with lifetime cannabis use disorders (CUD). CONCLUSION Startle habituation appears to depend on selective attention but not on cannabis use. Startle habituation was present when attention was directed away from auditory startling pulses in healthy controls and cannabis users. Such a similar pattern of results in both groups suggests that at least a trend exists towards presence of startle habituation regardless of cannabis use or CUD in otherwise healthy members of the general population.
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Affiliation(s)
- Karina K Kedzior
- Institute of Psychology and Transfer, University of Bremen, (FB 11), Grazer Str. 2c, 28359, Bremen, Germany. .,School of Engineering and Science, Jacobs University Bremen, Bremen, Germany. .,Clinical Neurophysiology Unit, Graylands Hospital and Pharmacology & Anaesthesiology Unit, School of Medicine & Pharmacology, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, Australia.
| | - Eileen Wehmann
- School of Engineering and Science, Jacobs University Bremen, Bremen, Germany
| | - Mathew Martin-Iverson
- Clinical Neurophysiology Unit, Graylands Hospital and Pharmacology & Anaesthesiology Unit, School of Medicine & Pharmacology, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, Australia
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Fischer B, Rehm J, Crépault JF. Realistically furthering the goals of public health by cannabis legalization with strict regulation: Response to Kalant. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 34:11-6. [PMID: 27424176 DOI: 10.1016/j.drugpo.2016.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/08/2016] [Accepted: 06/14/2016] [Indexed: 12/26/2022]
Abstract
Cannabis Policy Framework respond to select issues from Kalant's Commentary (in this issue).
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Affiliation(s)
- Benedikt Fischer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, ON M5S 2S1, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON M5S 1A8, Canada; Institute of Medical Science (IMS), University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada; Centre for Criminology & Sociolegal Studies, University of Toronto, 14 Queen's Park Crescent West, Toronto, ON M5S 3K9, Canada.
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, ON M5S 2S1, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON M5S 1A8, Canada; Institute of Medical Science (IMS), University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Jean-François Crépault
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, ON M5S 2S1, Canada
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11
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McGrath JJ, Alati R, Clavarino A, Williams GM, Bor W, Najman JM, Connell M, Scott JG. Age at first tobacco use and risk of subsequent psychosis-related outcomes: A birth cohort study. Aust N Z J Psychiatry 2016; 50:577-83. [PMID: 25991762 DOI: 10.1177/0004867415587341] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Compared to the substantial body of research examining links between cannabis use and psychosis, there has been relatively little attention to the role of tobacco as a potential risk factor for psychosis. This study explored the association between age at first tobacco use and psychosis-related outcomes in a birth cohort. METHOD This study is based on a large birth cohort (the Mater-University Study of Pregnancy). At approximately 21 years of age, cohort members (N = 3752) were assessed for three psychosis-related outcomes (International Classification of Diseases non-affective psychosis, the presence of any hallucination and total count of delusional-like experiences) with the Composite International Diagnostic Interview and the Peters Delusional Inventory. Associations between age at first tobacco use and psychosis-related outcomes were examined using logistic regression in a model (a) adjusted for sex and age and (b) in a second model excluding all respondents who had a history of past problematic and current cannabis use. RESULTS When adjusted for age and sex, those who commenced tobacco at 15 years of age or younger were significantly more likely to (a) have non-affective psychosis, (b) be in the highest quartile of total score of the Peters Delusional Inventory and (c) report hallucinations. After excluding all those with a history of a cannabis use disorder, or who were current (last month) cannabis users, a significant association between age at first tobacco use and the presence of hallucinations persisted. CONCLUSION There is an association between age at first tobacco use and subsequent psychosis-related outcomes in young adults. While the findings cannot be used to deduce causality, it adds weight to the hypothesis that early tobacco use may contribute to the risk of developing psychosis-related outcomes.
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Affiliation(s)
- John J McGrath
- Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia Discipline of Psychiatry, University of Queensland, Herston, QLD, Australia
| | - Rosa Alati
- School of Population Health and School of Social Science, University of Queensland, Herston, QLD, Australia
| | - Alexandra Clavarino
- School of Pharmacy, University of Queensland, Pharmacy Australia Centre of Excellence, Woolloongabba, QLD, Australia
| | | | - William Bor
- Mater Children's Hospital, South Brisbane, QLD, Australia
| | - Jake M Najman
- School of Population Health and School of Social Science, University of Queensland, Herston, QLD, Australia
| | - Melissa Connell
- Discipline of Psychiatry, University of Queensland, Herston, QLD, Australia The University of Queensland Centre for Clinical Research, Herston, QLD, Australia
| | - James G Scott
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia Discipline of Psychiatry, University of Queensland, Herston, QLD, Australia The University of Queensland Centre for Clinical Research, Herston, QLD, Australia Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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12
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Copeland J, Pokorski I. Progress toward pharmacotherapies for cannabis-use disorder: an evidence-based review. Subst Abuse Rehabil 2016; 7:41-53. [PMID: 27217809 PMCID: PMC4862355 DOI: 10.2147/sar.s89857] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cannabis is the most widely used and variably regulated drug in the world, with increasing trends of use being reported in the US, Australia, Asia, and Africa. Evidence has shown a decrease in the age of commencement of cannabis use in some developed countries and a prolongation of risk of initiation to cannabis use beyond adolescence among more recent users. Cannabis use is associated with numerous health risks and long-term morbidity, as well as risk of developing cannabis-use disorders. Cannabis users infrequently seek professional treatment, and normally do so after a decade of use. Cannabis-use disorders are currently treated using a selection of psychosocial interventions. Severity of withdrawal is a factor that increases the risk of relapse, and is the target of pharmacotherapy studies. Currently, there is no approved pharmacotherapy for cannabis-use disorders. A number of approaches have been examined, and trials are continuing to find a safe and effective medication with little abuse liability.
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Affiliation(s)
- Jan Copeland
- UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Izabella Pokorski
- UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
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13
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Imtiaz S, Shield KD, Roerecke M, Cheng J, Popova S, Kurdyak P, Fischer B, Rehm J. The burden of disease attributable to cannabis use in Canada in 2012. Addiction 2016; 111:653-62. [PMID: 26598973 DOI: 10.1111/add.13237] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/07/2015] [Accepted: 11/13/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Cannabis use is associated with several adverse health effects. However, little is known about the cannabis-attributable burden of disease. This study quantified the age-, sex- and adverse health effect-specific cannabis-attributable (1) mortality, (2) years of life lost due to premature mortality (YLLs), (3) years of life lost due to disability (YLDs) and (4) disability-adjusted life years (DALYs) in Canada in 2012. DESIGN Epidemiological modeling. SETTING Canada. PARTICIPANTS Canadians aged ≥ 15 years in 2012. MEASUREMENTS Using comparative risk assessment methodology, cannabis-attributable fractions were computed using Canadian exposure data and risk relations from large studies or meta-analyses. Outcome data were obtained from Canadian databases and the World Health Organization. The 95% confidence intervals (CIs) were computed using Monte Carlo methodology. FINDINGS Cannabis use was estimated to have caused 287 deaths (95% CI = 108, 609), 10,533 YLLs (95% CI = 4760, 20,833), 55,813 YLDs (95% CI = 38,175, 74,094) and 66,346 DALYs (95% CI = 47,785, 87,207), based on causal impacts on cannabis use disorders, schizophrenia, lung cancer and road traffic injuries. Cannabis-attributable burden of disease was highest among young people, and males accounted for twice the burden than females. Cannabis use disorders were the most important single cause of the cannabis-attributable burden of disease. CONCLUSIONS The cannabis-attributable burden of disease in Canada in 2012 included 55,813 years of life lost due to disability, caused mainly by cannabis use disorders. Although the cannabis-attributable burden of disease was substantial, it was much lower compared with other commonly used legal and illegal substances. Moreover, the evidence base for cannabis-attributable harms was smaller.
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Affiliation(s)
- Sameer Imtiaz
- Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Kevin D Shield
- Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Michael Roerecke
- Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Joyce Cheng
- Centre for Addiction and Mental Health, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Svetlana Popova
- Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Benedikt Fischer
- Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, Canada
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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14
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Fischer B, Imtiaz S, Rudzinski K, Rehm J. Crude estimates of cannabis-attributable mortality and morbidity in Canada-implications for public health focused intervention priorities. J Public Health (Oxf) 2016; 38:183-8. [PMID: 25630540 PMCID: PMC4750519 DOI: 10.1093/pubmed/fdv005] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cannabis is the most commonly used drug in Canada; while its use is currently controlled by criminal prohibition, debates about potential control reforms are intensifying. There is substantive evidence about cannabis-related risks to health in various key outcome domains; however, little is known about the actual extent of these harms specifically in Canada. METHODS Based on epidemiological data (e.g. prevalence of relevant cannabis use rates and relevant risk behaviors; risk ratios; and annual numbers of morbidity/mortality cases in relevant domains), and applying the methodology of comparative risk assessment, we estimated attributable fractions for cannabis-related morbidity and mortality, specifically for: (i) motor-vehicle accidents (MVAs); (ii) use disorders; (iii) mental health (psychosis) and (iv) lung cancer. RESULTS MVAs and lung cancer are the only domains where cannabis-attributable mortality is estimated to occur. While cannabis use results in morbidity in all domains, MVAs and use disorders by far outweigh the other domains in the number of cases; the popularly debated mental health consequences (e.g., psychosis) translate into relatively small case numbers. CONCLUSIONS The present crude estimates should guide and help prioritize public health-oriented interventions for the cannabis-related health burden in the population in Canada; formal burden of disease calculations should be conducted.
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Affiliation(s)
- Benedikt Fischer
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada M5S 2S1
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada V6B 5K3
- Department of Psychiatry, University of Toronto, Toronto, CanadaM5T 1R8
| | - Sameer Imtiaz
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada M5S 2S1
- Institute of Medical Science, University of Toronto, Toronto, CanadaM5S 1A8
| | - Katherine Rudzinski
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada M5S 2S1
- Dalla Lana School of Public Health, University of Toronto, Toronto, CanadaM5T 3M7
| | - Jürgen Rehm
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada M5S 2S1
- Department of Psychiatry, University of Toronto, Toronto, CanadaM5T 1R8
- Institute of Medical Science, University of Toronto, Toronto, CanadaM5S 1A8
- Dalla Lana School of Public Health, University of Toronto, Toronto, CanadaM5T 3M7
- WHO/PAHO Collaborating Centre for Mental Health and Addiction, Toronto, CanadaM5S 2S1
- Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden 01069, Germany
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15
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Degenhardt L, Coffey C, Hearps S, Kinner SA, Borschmann R, Moran P, Patton G. Associations between psychotic symptoms and substance use in young offenders. Drug Alcohol Rev 2015; 34:673-82. [PMID: 26084677 DOI: 10.1111/dar.12280] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 04/01/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Substance use and psychotic symptoms/disorders are associated. There has been little examination of this issue in young offenders, despite elevated substance use in this group. DESIGN AND METHODS Semistructured interviews were conducted by trained researchers with 514 young offenders. Psychotic symptoms were assessed using a previously validated screening measure, with scores ≥3 indicative of possible psychotic disorder. Associations between this indicator and patterns of offending, common symptoms of mental disorders and health risk behaviours, including substance use were examined. The extent to which substance use and psychotic symptoms remained associated after adjustment for possible confounding was evaluated. RESULTS Thirteen percent screened positive for psychosis. Participants who screened positive for psychosis were more likely than those who did not to have: unstable housing; been expelled from school; a family history of substance use/mental health problems, and depressive symptoms. Amphetamine, sedative and cannabis dependence were all strongly associated with screening positive for psychosis. Screening positive remained significantly associated with amphetamine and sedative dependence, and daily cannabis and sedative use, in multivariable regressions. DISCUSSION AND CONCLUSIONS One in eight young offenders reported symptoms consistent with psychosis. Symptomatology was strongly associated with heavy use of a range of illicit drugs. Given the frequency of these symptoms and the potential for them to be related to or exacerbated by drug use, this study highlights the importance of co-ordinated alcohol and other drugs and mental health treatment for young offenders, both due to co-occurrence and given the possibility that treating SUDs may impact on mental health symptoms.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Australia, Sydney, Australia.,School of Population and Global Health, University of Melbourne, Parkville, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Australia.,Department of Global Health, School of Public Health, University of Washington, Seattle, USA
| | - Carolyn Coffey
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Australia
| | - Stephen Hearps
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Australia
| | - Stuart A Kinner
- School of Population and Global Health, University of Melbourne, Parkville, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Australia.,School of Medicine, University of Queensland, St Lucia, Australia.,School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Rohan Borschmann
- School of Population and Global Health, University of Melbourne, Parkville, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Australia
| | - Paul Moran
- King's College London (Institute of Psychiatry), King's College London, London, UK
| | - George Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
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16
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Onyeka IN, Beynon CM, Ronkainen K, Tiihonen J, Föhr J, Kuikanmäki O, Paasolainen M, Kauhanen J. Hospitalization in a Cohort Seeking Treatment for Illicit Drug Use in Finland. J Subst Abuse Treat 2015; 53:64-70. [DOI: 10.1016/j.jsat.2014.12.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 11/28/2022]
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17
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Charlson FJ, Baxter AJ, Dua T, Degenhardt L, Whiteford HA, Vos T. Excess mortality from mental, neurological and substance use disorders in the Global Burden of Disease Study 2010. Epidemiol Psychiatr Sci 2015; 24:121-40. [PMID: 25497332 PMCID: PMC6998140 DOI: 10.1017/s2045796014000687] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 10/02/2014] [Accepted: 10/04/2014] [Indexed: 01/08/2023] Open
Abstract
AIMS Mortality-associated burden of disease estimates from the Global Burden of Disease 2010 (GBD 2010) may erroneously lead to the interpretation that premature death in people with mental, neurological and substance use disorders (MNSDs) is inconsequential when evidence shows that people with MNSDs experience a significant reduction in life expectancy. We explore differences between cause-specific and excess mortality of MNSDs estimated by GBD 2010. METHODS GBD 2010 cause-specific death estimates were produced using the International Classification of Diseases death-coding system. Excess mortality (all-cause) was estimated using natural history models. Additional mortality attributed to MNSDs as underlying causes but not captured through GBD 2010 methodology is quantified in the comparative risk assessments. RESULTS In GBD 2010, MNSDs were estimated to be directly responsible for 840 000 deaths compared with more than 13 million excess deaths using natural history models. CONCLUSIONS Numbers of excess deaths and attributable deaths clearly demonstrate the high degree of mortality associated with these disorders. There is substantial evidence pointing to potential causal pathways for this premature mortality with evidence-based interventions available to address this mortality. The life expectancy gap between persons with MNSDs and the general population is high and should be a focus for health systems reform.
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Affiliation(s)
- F. J. Charlson
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
- University of Queensland, School of Population Health, Herston, Queensland, Australia
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - A. J. Baxter
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
- University of Queensland, School of Population Health, Herston, Queensland, Australia
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - T. Dua
- World Health Organization, Department of Mental Health and Substance Abuse, Geneva
| | - L. Degenhardt
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- University of New South Wales, National Drug and Alcohol Research Centre, New South Wales, Australia
- University of Melbourne, Melbourne School of Population and Global Health, Victoria, Australia
| | - H. A. Whiteford
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
- University of Queensland, School of Population Health, Herston, Queensland, Australia
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - T. Vos
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
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18
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Wiedermann W, von Eye A. Direction of Effects in Multiple Linear Regression Models. MULTIVARIATE BEHAVIORAL RESEARCH 2015; 50:23-40. [PMID: 26609741 DOI: 10.1080/00273171.2014.958429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Previous studies analyzed asymmetric properties of the Pearson correlation coefficient using higher than second order moments. These asymmetric properties can be used to determine the direction of dependence in a linear regression setting (i.e., establish which of two variables is more likely to be on the outcome side) within the framework of cross-sectional observational data. Extant approaches are restricted to the bivariate regression case. The present contribution extends the direction of dependence methodology to a multiple linear regression setting by analyzing distributional properties of residuals of competing multiple regression models. It is shown that, under certain conditions, the third central moments of estimated regression residuals can be used to decide upon direction of effects. In addition, three different approaches for statistical inference are discussed: a combined D'Agostino normality test, a skewness difference test, and a bootstrap difference test. Type I error and power of the procedures are assessed using Monte Carlo simulations, and an empirical example is provided for illustrative purposes. In the discussion, issues concerning the quality of psychological data, possible extensions of the proposed methods to the fourth central moment of regression residuals, and potential applications are addressed.
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19
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Spence N, Wells S, George J, Graham K. An Examination of Marijuana Use Among a Vulnerable Population in Canada. J Racial Ethn Health Disparities 2014; 1:247-256. [PMID: 27134815 DOI: 10.1007/s40615-014-0031-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Although the perceived risk of cannabis has decreased over the last few years, the contribution of marijuana use to the burden of disease on society is significant. Globally, Indigenous peoples have rates of marijuana use that are significantly higher than that of the general population. Understanding patterns of use is fundamental to developing appropriate policy and programming strategies to improve health and well-being. METHODS This study examined the characteristics of respondents who had ever been frequent marijuana users (used more than once a week), among a cross-sectional sample of 340 people, aged 18 and over, from Kettle and Stony Point First Nation in Ontario, Canada. The research incorporated Aboriginal-specific measures, examining issues related to colonialism and racism. Logistic regression models were used to assess the extent that sociodemographic variables, body mass index, mental health (depression, anxiety), licit substance use (alcohol and tobacco), Historical Loss Scale, Childhood Trauma Scale, and Measure of Indigenous Racism Experience (MIRE) Interpersonal Racism Scale predicted ever having been a frequent marijuana user. RESULTS Aboriginal-specific issues were not associated with marijuana use nor was marijuana use related to depression or anxiety. However, ever engaging in frequent marijuana use was reported by more than half of the sample and associated with being younger, male, and a smoker. CONCLUSIONS The high prevalence of frequent marijuana use (53.2 %) suggests normalization of the substance that may indicate a potentially large public health problem.
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Affiliation(s)
- Nicholas Spence
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH) The University of Western Ontario, 200-100 Collip Circle London, Ontario N6G4X8, Canada
| | - Samantha Wells
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 200-100 Collip Circle London, Ontario N6G4X8, Canada
| | - Julie George
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 200-100 Collip Circle London, Ontario N6G4X8, Canada
| | - Kathryn Graham
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 200-100 Collip Circle London, Ontario N6G4X8, Canada
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20
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Yip SW, DeVito EE, Kober H, Worhunsky PD, Carroll KM, Potenza MN. Pretreatment measures of brain structure and reward-processing brain function in cannabis dependence: an exploratory study of relationships with abstinence during behavioral treatment. Drug Alcohol Depend 2014; 140:33-41. [PMID: 24793365 PMCID: PMC4057888 DOI: 10.1016/j.drugalcdep.2014.03.031] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/25/2014] [Accepted: 03/28/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cannabis is widely abused, and efficacies of therapeutics for cannabis dependence remain suboptimal. Magnetic resonance imaging (MRI) may aid in the identification of biological markers for successful treatment outcomes (i.e., abstinence). METHODS Twenty men with cannabis dependence and twenty non-substance-using healthy comparison (HC) men underwent MRI scanning. Cannabis-dependent individuals then participated in a 12-week randomized clinical trial of behavioral treatments (contingency management (CM), cognitive behavioral therapy (CBT) or both). Pretreatment functional and structural data were compared between the cannabis-dependent and HC participants. In addition, individuals with cannabis dependence were subdivided based on the successful achievement of 21 days of consecutive abstinence during treatment to assess whether abstinent versus non-abstinent cannabis-dependent participants displayed different pretreatment functional and structural characteristics when compared to HC participants. RESULTS In comparison to HC participants, cannabis-dependent participants demonstrated greater ventral striatal activation during the receipt of losing outcomes and smaller putamenal volumes. Cannabis-dependent participants who did not subsequently achieve 21 days of consecutive abstinence had increased activity within the striatum during the receipt of losing outcomes, relative to HC participants. Cannabis-dependent participants who did not achieve 21 days of abstinence had decreased bilateral putamen volumes prior to treatment, relative to HC participants. CONCLUSIONS Individual differences in pretreatment striatal function and structure may relate to individual differences in treatment responses for cannabis dependence. While mechanisms underlying these associations require further exploration, the striatum might mediate treatment responses via its role in associative reward-learning (e.g., through skills training in CBT or reinforcement of abstinence in CM).
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Affiliation(s)
- Sarah W. Yip
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Elise E. DeVito
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Hedy Kober
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Patrick D. Worhunsky
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Kathleen M. Carroll
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Marc N. Potenza
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
,Department of Neurobiology, Yale University School of Medicine, New Haven, CT, USA
,Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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21
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Kedzior KK, Laeber LT. A positive association between anxiety disorders and cannabis use or cannabis use disorders in the general population--a meta-analysis of 31 studies. BMC Psychiatry 2014; 14:136. [PMID: 24884989 PMCID: PMC4032500 DOI: 10.1186/1471-244x-14-136] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 03/31/2014] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND The aim of the current study was to investigate the association between anxiety and cannabis use/cannabis use disorders in the general population. METHODS A total of N = 267 studies were identified from a systematic literature search (any time- March 2013) of Medline and PsycInfo databases, and a hand search. The results of 31 studies (with prospective cohort or cross-sectional designs using non-institutionalised cases) were analysed using a random-effects meta-analysis with the inverse variance weights. Lifetime or past 12-month cannabis use, anxiety symptoms, and cannabis use disorders (CUD; dependence and/or abuse/harmful use) were classified according to DSM/ICD criteria or scores on standardised scales. RESULTS There was a small positive association between anxiety and either cannabis use (OR = 1.24, 95% CI: 1.06-1.45, p = .006; N = 15 studies) or CUD (OR = 1.68, 95% CI: 1.23-2.31, p = .001; N = 13 studies), and between comorbid anxiety + depression and cannabis use (OR = 1.68, 95% CI: 1.17-2.40, p = .004; N = 5 studies). The positive associations between anxiety and cannabis use (or CUD) were present in subgroups of studies with ORs adjusted for possible confounders (substance use, psychiatric illness, demographics) and in studies with clinical diagnoses of anxiety. Cannabis use at baseline was significantly associated with anxiety at follow-up in N = 5 studies adjusted for confounders (OR = 1.28, 95% CI: 1.06-1.54, p = .01). The opposite relationship was investigated in only one study. There was little evidence for publication bias. CONCLUSION Anxiety is positively associated with cannabis use or CUD in cohorts drawn from some 112,000 non-institutionalised members of the general population of 10 countries.
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Affiliation(s)
- Karina Karolina Kedzior
- School of Humanities and Social Sciences, Jacobs University Bremen, Campus Ring 1, 28759 Bremen, Germany.
| | - Lisa Tabata Laeber
- School of Humanities and Social Sciences, Jacobs University Bremen, Campus Ring 1, 28759 Bremen, Germany
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22
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Copeland J, Clement N, Swift W. Cannabis use, harms and the management of cannabis use disorder. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/npy.13.90] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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23
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Affiliation(s)
- Michael T Lynskey
- National Addiction Centre, King's College London, London SE5 8BB, UK.
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Degenhardt L, Ferrari AJ, Calabria B, Hall WD, Norman RE, McGrath J, Flaxman AD, Engell RE, Freedman GD, Whiteford HA, Vos T. The global epidemiology and contribution of cannabis use and dependence to the global burden of disease: results from the GBD 2010 study. PLoS One 2013; 8:e76635. [PMID: 24204649 PMCID: PMC3811989 DOI: 10.1371/journal.pone.0076635] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/26/2013] [Indexed: 01/17/2023] Open
Abstract
AIMS Estimate the prevalence of cannabis dependence and its contribution to the global burden of disease. METHODS Systematic reviews of epidemiological data on cannabis dependence (1990-2008) were conducted in line with PRISMA and meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Culling and data extraction followed protocols, with cross-checking and consistency checks. DisMod-MR, the latest version of generic disease modelling system, redesigned as a Bayesian meta-regression tool, imputed prevalence by age, year and sex for 187 countries and 21 regions. The disability weight associated with cannabis dependence was estimated through population surveys and multiplied by prevalence data to calculate the years of life lived with disability (YLDs) and disability-adjusted life years (DALYs). YLDs and DALYs attributed to regular cannabis use as a risk factor for schizophrenia were also estimated. RESULTS There were an estimated 13.1 million cannabis dependent people globally in 2010 (point prevalence0.19% (95% uncertainty: 0.17-0.21%)). Prevalence peaked between 20-24 yrs, was higher in males (0.23% (0.2-0.27%)) than females (0.14% (0.12-0.16%)) and in high income regions. Cannabis dependence accounted for 2 million DALYs globally (0.08%; 0.05-0.12%) in 2010; a 22% increase in crude DALYs since 1990 largely due to population growth. Countries with statistically higher age-standardised DALY rates included the United States, Canada, Australia, New Zealand and Western European countries such as the United Kingdom; those with lower DALY rates were from Sub-Saharan Africa-West and Latin America. Regular cannabis use as a risk factor for schizophrenia accounted for an estimated 7,000 DALYs globally. CONCLUSION Cannabis dependence is a disorder primarily experienced by young adults, especially in higher income countries. It has not been shown to increase mortality as opioid and other forms of illicit drug dependence do. Our estimates suggest that cannabis use as a risk factor for schizophrenia is not a major contributor to population-level disease burden.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | - Alize J. Ferrari
- Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | - Bianca Calabria
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Wayne D. Hall
- University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
- National Addiction Centre, Kings College London, London, United Kingdom
| | - Rosana E. Norman
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
- Queensland Children’s Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - John McGrath
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Abraham D. Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Rebecca E. Engell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Greg D. Freedman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Harvey A. Whiteford
- Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
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Vilain J, Galliot AM, Durand-Roger J, Leboyer M, Llorca PM, Schürhoff F, Szöke A. [Environmental risk factors for schizophrenia: a review]. Encephale 2012. [PMID: 23177330 DOI: 10.1016/j.encep.2011.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence of variations in schizophrenia incidence rates has been found in genetically homogenous populations, depending on changes within time or space of certain environmental characteristics. The consideration of the impact of environmental risk factors in etiopathogenic studies has put the environment in the forefront of research regarding psychotic illnesses. Various environmental factors such as urbanicity, migration, cannabis, childhood traumas, infectious agents, obstetrical complications and psychosocial factors have been associated with the risk of developing schizophrenia. These risk factors can be biological, physical, psychological as well as social and may operate at different times in an individual's life (fetal period, childhood, adolescence and early adulthood). Whilst some of these factors act on an individual level, others act on a populational level, modulating the individual risk. These factors can have a direct action on the development of schizophrenia, or on the other hand act as markers for directly implicated factors that have not yet been identified. LITERATURE FINDINGS This article summarizes the current knowledge on this subject. An extensive literature search was conducted via the search engine Pubmed. Eight risk factors were selected and developed in the following paper: urbanicity (or living in an urban area), cannabis, migration (and ethnic density), obstetrical complications, seasonality of birth, infectious agents (and inflammatory responses), socio-demographic factors and childhood traumas. For each of these factors, we provide information on the importance of the risk, the vulnerability period, hypotheses made on the possible mechanisms behind the factors and the level of proof the current research offers (good, medium, or insufficient) according to the amount, type, quality and concordance of the studies at hand. Some factors, such as cannabis, are "unique" in their influence on the development of schizophrenia since it labels only one risk factor. Others, such as obstetrical complications, are grouped (or "composed") in that they include various sub-factors that can influence the development of schizophrenia. DISCUSSION The data reviewed clearly demonstrates that environmental factors have an influence on the risk of developing schizophrenia. For certain factors - cannabis, migration, urbanicity, obstetrical complications, seasonality - there is enough evidence to establish an association with the risk of schizophrenia. This association, however, remains weak (especially for seasonality). With the exception of cannabis, no direct link can yet be established. Concerning the three remaining factors - childhood traumas, infectious agents, socio-demographic factors - the available proof is insufficient. One main limitation concerning all environmental factors is the generalization of results due to the fact that the studies were conducted on geographically limited populations. The current state of knowledge does not allow us to determine the mechanisms by which these factors may act. CONCLUSION Further research is needed to fill the gaps in our understanding of the subject. In response to this need, a collaborative European project (European Study of Gene-Environment Interactions [EU GEI]) was set-up. This study proposes the analysis of those environmental factors that influence the incidence of schizophrenia in various European countries, in both rural and urban settings, migrant and native populations, as well as their interaction with genetic factors.
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Affiliation(s)
- J Vilain
- Inserm U 955, équipe de psychiatrie génétique, département de génomique médicale, institut Mondor de recherches biomédicales (IMRB), 94000 Créteil, France.
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Rössler W, Hengartner MP, Angst J, Ajdacic-Gross V. Linking substance use with symptoms of subclinical psychosis in a community cohort over 30 years. Addiction 2012; 107:1174-84. [PMID: 22151745 DOI: 10.1111/j.1360-0443.2011.03760.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS The aim of the study was to examine the temporal associations between substance use and subclinical psychosis symptoms. DESIGN Data from a prospective community study sampled within a single cohort over 30 years (1978-2008) were analysed with discrete-time hazard models. SETTING General population-based sample. PARTICIPANTS At initial sampling in 1978 males (n = 292) were 19 and females (n = 299) were 20 years old. MEASUREMENTS Two psychosis syndromes representing 'schizotypal signs' and 'schizophrenia nuclear symptoms' and various substance use variables including cannabis, alcohol, tobacco and multiple-drug use (i.e. cannabis combined with other drugs). FINDINGS In bivariate analyses, schizotypal signs were predominantly associated with regular cannabis use in adolescence (OR = 2.29, 95% CI 1.32-3.97). Schizophrenia nuclear symptoms were mainly related to alcohol (OR = 1.84, 95% CI 1.00-3.38) and multiple-drug use (OR = 2.35, 95% CI 1.38-4.02) during adolescence. Multivariate analyses showed that, in particular, regular cannabis use during adolescence was associated with the occurrence of subsequent schizotypal symptoms over a 30-year period (OR = 2.60, 95% CI; 1.59-4.23), whereas multiple-drug use in adolescence was associated predominantly with schizophrenia nuclear symptoms (OR = 1.75, 95% CI 1.01-3.03). Alcohol misuse was only slightly associated with the onset of such symptoms. CONCLUSIONS A significant portion of the occurrence of subclinical psychosis symptoms in adulthood can be attributed to excessive cannabis and multiple-drug use during adolescence. This is in line with the hypothesis that long-term sensitization of dopaminergic brain receptors plays a role in developing psychotic symptoms.
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Affiliation(s)
- Wulf Rössler
- Department of General and Social Psychiatry, Psychiatric University Hospital Zurich, Zurich, Switzerland.
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van Amsterdam JG, van Laar M, Brunt TM, van den Brink W. Risk assessment of gamma-hydroxybutyric acid (GHB) in the Netherlands. Regul Toxicol Pharmacol 2012; 63:55-63. [DOI: 10.1016/j.yrtph.2012.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 02/22/2012] [Accepted: 03/07/2012] [Indexed: 11/26/2022]
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Abstract
This paper summarises data for the prevalence, correlates, and probable adverse health consequences of problem use of amphetamines, cannabis, cocaine, and opioids. We discuss findings from systematic reviews of the prevalence of illicit drug use and dependence, remission from dependence, and mortality in illicit drug users, and evidence for acute and chronic effects of illicit drug use. We outline the regional and global distribution of use and estimated health burden from illicit drugs. These distributions are likely to be underestimates because they have not included all adverse outcomes of drug use and exclude those of cannabis--the mostly widely used illicit drug. In high-income countries, illicit drug use contributes less to the burden of disease than does tobacco but a substantial proportion of that due to alcohol. The major adverse health effects of cannabis use are dependence and probably psychotic disorders and other mental disorders. The health-related harms of cannabis use differ from those of amphetamine, cocaine, and opioid use, in that cannabis contributes little to mortality. Intelligent policy responses to drug problems need better data for the prevalence of different types of illicit drug use and the harms that their use causes globally. This need is especially urgent in high-income countries with substantial rates of illicit drug use and in low-income and middle-income countries close to illicit drug production areas.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
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Saha S, Scott JG, Varghese D, Degenhardt L, Slade T, McGrath JJ. The association between delusional-like experiences, and tobacco, alcohol or cannabis use: a nationwide population-based survey. BMC Psychiatry 2011; 11:202. [PMID: 22204498 PMCID: PMC3313864 DOI: 10.1186/1471-244x-11-202] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 12/28/2011] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Previous population-based studies have found that delusional-like experiences (DLE) are prevalent in the community, and are associated with a wide range of mental health disorders including substance use. The aim of the study was to explore the association between DLE and three commonly used substances--tobacco, alcohol and cannabis. METHODS Subjects were drawn from the Australian National Survey of Mental Health and Wellbeing 2007. The Composite International Diagnostic Interview was used to identify DLE, common psychiatric disorders, and substance use. We examined the relationship between the variables of interest using logistic regression, adjusting for potential confounding factors. RESULTS Of 8,773 participants, 8.4% (n=776) subjects endorsed one or more DLE. With respect to tobacco use, compared to nonusers, DLE were more common in those who (a) had daily use, (b) commenced usage aged 15 years or less, and (c) those who smoked heavily (23 or more cigarettes per day). Participants with cannabis use disorders were more likely to endorse DLE; this association was most prominent in those with an onset of 16 years or younger. In contrast, the pattern of association between DLE versus alcohol use or dependence was less consistent, however those with early onset alcohol use disorders were more likely to endorse DLE probe items. CONCLUSIONS While cannabis use disorders have been previously linked with DLE, our findings linking alcohol and tobacco use and DLE suggest that the influence of these substances on psychosis-related outcomes warrants closer scrutiny in longitudinal prospective studies.
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Affiliation(s)
- Sukanta Saha
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD 4076, Australia
| | - James G Scott
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD 4076, Australia,Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia,The University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia,Department of Psychiatry, University of Queensland, St Lucia QLD, Australia
| | - Daniel Varghese
- Princess Alexandra Hospital, Woolloongabba, QLD 4102 Australia
| | - Louisa Degenhardt
- National Drug & Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Tim Slade
- National Drug & Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - John J McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD 4076, Australia,Department of Psychiatry, University of Queensland, St Lucia QLD, Australia,Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
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Affiliation(s)
- Alan S Brown
- College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, New York, NY 10032, USA.
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Lynskey MT, Agrawal A, Heath AC. Genetically informative research on adolescent substance use: methods, findings, and challenges. J Am Acad Child Adolesc Psychiatry 2010; 49:1202-14. [PMID: 21093770 PMCID: PMC2991153 DOI: 10.1016/j.jaac.2010.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 08/31/2010] [Accepted: 09/03/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To provide an overview of the genetic epidemiology of substance use and misuse in adolescents. METHOD A selective review of genetically informative research strategies, their limitations, and key findings examining issues related to the heritability of substance use and substance use disorders in children and adolescents is presented. RESULTS Adoption, twin, and extended-family designs have established there is a strong heritable component to liability to nicotine, alcohol, and illicit drug dependence in adults. However, shared environmental influences are relatively stronger in youth samples and at earlier stages of substance involvement (e.g., use). There is considerable overlap in the genetic influences associated with the abuse/dependence across drug classes, and shared genetic influences contribute to the commonly observed associations between substance-use disorders and externalizing and, to a lesser extent, internalizing psychopathology. Rapid technologic advances have made the identification of specific gene variants that influence risks for substance-use disorders feasible, and linkage and association (including genomewide association studies) have identified promising candidate genes implicated in the development of substance-use disorders. CONCLUSIONS Studies using genetically informative research designs, including those that examine aggregate genetic factors and those examining specific gene variants, individually and in interaction with environmental influences, offer promising avenues not only for delineating genetic effects on substance-use disorders but also for understanding the unfolding of risk across development and the interaction between environmental and genetic factors in the etiology of these disorders.
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32
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Affiliation(s)
- Nadia Solowij
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia.
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Werb D, Fischer B, Wood E. Cannabis policy: time to move beyond the psychosis debate. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:261-4. [PMID: 20381329 DOI: 10.1016/j.drugpo.2010.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 02/26/2010] [Accepted: 03/11/2010] [Indexed: 10/19/2022]
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