Very long-term users of marijuana in the United States: a pilot study

Cannabis use in repeated representative cross-sectional studies on Italian adults after the COVID-19 pandemic

Lockdown measures in response to the COVID-19 pandemic in 2020 yielded dramatic changes in drug consumption. A cross-sectional study was conducted on a representative sample of 6003 Italian adults (18-74 years) in April-May 2020 - reporting information before lockdown and at the time of interview - and two years later (i.e., in February-March 2022). Italian adults using cannabis decreased from 7.0% in pre-pandemic to 5.9% during lockdown (percent change -15.7%) and to 6.7% in 2022 (-4.3%). The reduction was particularly evident among adults aged 55-74 years, whereas cannabis use strongly increased among those aged 18-34 years. In the last period considered (2022), cannabis use was significantly more frequent in men (adjusted odds ratio, OR = 1.43), adults aged 18-34 years (p-trend <0.001), individuals with a low or high level of education (OR = 1.42 and 1.46, respectively), those from Central or Southern Italy/islands (OR = 1.50 and 1.38, respectively), and those with an economic status above the average (OR = 3.07). In 2022, cannabis use was also more frequently reported in current smokers (OR = 3.52), current e-cigarette and heated tobacco product users (OR = 6.09 and 2.94, respectively), individuals with a risky alcohol consumption (OR = 4.60), gamblers (OR = 3.76), those with anxiety and depression (OR = 2.50 and 2.80, respectively), those using psychotropic drugs (OR = 8.96), those with a low quality of life (OR = 1.91), and those sleeping less (OR = 1.42). After the COVID-19 pandemic, cannabis use was more frequent in individuals with other addictive behaviours, and with anxiety and depressive symptoms.

Kratom use for depression/anxiety self-management: challenges during the COVID-19 pandemic - A case report

Background

Kratom is a psychoactive plant preparation originating from Southeast Asia. It has been used as a recreational and performance drug in Southeast Asia, and is now increasingly used in Europe and the U.S.

Case report

We describe the case of a 63-year-old man who presented for treatment after his long-term Kratom use failed as a self-management for persistent major depression (ICD 10: F33.2) and a generalized anxiety disorder (ICD-10: F41.1). The failure coincided with emerging stress at the beginning of the COVID-19 pandemic. The patient suffered from childhood on from ruminative thinking and depressive mood, which was treated in several settings during his life. He started to use alcohol to control his depression, but developed an alcohol addiction. This was successfully treated and the patient remained abstinent for more than 25 years afterwards. About 7 years ago, he started to use Kratom 3–4 times daily on a regular, but constant rate. Kratom use worked efficiently as a self-management of his depression with no escalation of dosing. It was also very effective in reducing Morbus Menière symptoms of tinnitus and sudden hearing loss, which eventually allowed regular performance as a caregiver in a demanding job on shift-work. During recently increased stress load in the work environment and the COVID-19 pandemic, the established Kratom doses failed to control hyperarousal and mental nervousness. The patient was treatment seeking and subsequently detoxified from Kratom. Anxiety- and depression management was shifted to treatment attempts with Lorazepam, Venlafaxine, Opipramol, Mirtazapine and psychotherapy.

Conclusion

Kratom instrumentalization for self-management of depression and anxiety may effectively work without causing escalation of drug use and addiction, but may be limited by a temporary increase in psychological stress load and a relapse into major depression and generalized anxiety disorder.

Cannabis and Depression

There is a growing body of evidence pointing to the co-occurrence of cannabis use and depression. There is also some evidence that the use of cannabis may lead to the onset of depression; however, strong evidence points to the inverse association; i.e. that depression may lead to the onset or increase in cannabis use frequency. Observational and epidemiological studies have not indicated a positive long-term effect of cannabis use on the course and outcome of depression. The association between cannabis use and depression may be stronger among men during adolescence and emerging adulthood and stronger in women during midlife. There is an indication for potential genetic correlation contributing to the comorbidity of cannabis dependence and major depression, namely that serotonin (5-HT) may mediate such association and there is also evidence for specific risk alleles for cannabis addiction. There is preclinical evidence that alteration in the endocannabinoid system could potentially benefit patients suffering from depression. However, the issue of using cannabis as an anti-depressant is at an early stage of examination and there is little evidence to support it. Finally, there has been little support to the notion that selective serotonin reuptake inhibitors (SSRIs) may be effective in decreasing depressive symptoms or rates of substance use in adolescents treated for depression and a co-occurring substance use disorder. In conclusion, despite methodological limitations, research in the past decades has broadened our knowledge on the association between cannabis use and depression from epidemiological, neurological, genetic, and pharmacological perspectives.

Cognitive Function Impairments Linked to Alcohol and Cannabis Use During Adolescence: A Study of Gender Differences

Major neurocognitive changes occur during adolescence, making this phase one of the most critical developmental periods of life. Furthermore, this phase in life is also the time in which youth substance use begins. Several studies have demonstrated the differential associations of alcohol and cannabis use concerning the neurocognitive functioning of both males and females. Past and contemporary literature on gender-specific effects in neuroscience of addiction is predominantly based on cross-sectional datasets and data that is limited in terms of measurement variability. Given the importance of gender-specific effects in addiction studies, and in order to address the two above-mentioned gaps in the literature, the present study aimed to compare neurocognitive functioning of male and female adolescents in the context of cannabis and alcohol use, while employing a longitudinal design with multiple repeated measurements. Participants were 3,826 high school students (47% female; mean age, 12.7), who were recruited from 31 high schools in the greater Montreal area. Participants were requested to complete annual surveys for five consecutive years, from 7th to 11th grade, assessing their alcohol/cannabis use and neurocognitive functioning (working memory, delayed recall memory, perceptual reasoning, and inhibition control). The analytical strategy focused on the longitudinal association between each predictor (female, male) and each of the outcomes (domains of neurocognitive functioning). Multilevel linear models assessed the association of alcohol and cannabis consumption and the four domains of neurocognitive functioning. Results revealed a gender by within-subject interaction, suggesting a weaker effect of yearly fluctuation of cannabis use on working memory among males compared to females. Our findings suggest a different pattern of neurocognitive impairment of female and male working memory after using cannabis over the course of adolescence. Early initiation of cannabis use potentially results in more spatial working memory deficits in female adolescents. This may negatively influence young females' capacity in academic settings and lead to significant impairment in adulthood, which critically decreases the individual's quality of life.

Cannabis Careers Reconsidered: Transitions and Trajectories of Committed Long-Term Users

Despite the cross-culturally persistent high prevalence of cannabis use in general adult populations, in-depth analyses of extended use careers are uncommon in the scientific literature. This paper reports on in-depth interviews conducted with 104 users living in Toronto, Canada. A pretested questionnaire developed for use in a larger, cross-national study guided data collection on use levels and frequency from the first year to most recent month of use. The data support a controlled drug use model, with aggregate intake eventually decreasing and becoming stable or more moderate over time. Four main career patterns are identified and compared on measures of dependence and levels of consumption in the year prior to the study. In comparison with those whose long-term use has varied, stable users report fewer cannabis-related problems, despite using more heavily and frequently. While dependency problems are highly subjective, transitions in use patterns more generally reflect personal contingencies of lifestyle.

The association between cannabis use and mood disorders: A longitudinal study

BACKGROUND

The association between cannabis use and mood disorders is well documented, yet evidence regarding causality is conflicting. This study explored the association between cannabis use, major depressive disorder (MDD) and bipolar disorder (BPD) in a 3-year prospective study.

METHODS

Data was drawn from waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). MDD and BPD were controlled at baseline and defined as meeting full criteria in the 12 months prior to the follow-up. Initiation of cannabis use was defined as any cannabis used by former lifetime abstainers in the time period between baseline and follow-up.

RESULTS

Cannabis use was not significantly associated with increased incidence of MDD (Adjusted Odds Ratio (AOR) for daily use=0.58(0.22-1.51)). Weekly to almost daily cannabis use was associated with increased incidence of BPD ((AOR for weekly to daily use=2.47(1.03-5.92)); daily use was not (AOR=0.52(0.17-1.55)). Baseline MDD was associated with initiation of cannabis use (AOR=1.72(1.1-2.69)). A crude association between baseline BPD and incidence of cannabis use was not maintained in adjusted models (AOR=0.61(0.36-1.04)).

LIMITATIONS

Lack of information regarding frequency of cannabis use at follow-up and limitations regarding generalization of the results.

CONCLUSIONS

Our findings do not support a longitudinal association between cannabis use and incidence of MDD. Results regarding the association between cannabis use and incidence of BPD are conflicting and require further investigation. Baseline MDD, but not BPD, may be associated with future initiation of cannabis use. This may have implications for clinical, social and legislative aspects of cannabis use.

Disruptive Behavior Disorders and Marijuana Use: The Role of Depressive Symptoms

OBJECTIVE

The present study sought to examine the relations among disruptive behavior disorders (DBDs; ie, attention-deficit/hyperactivity disorder [ADHD], conduct disorder [CD], oppositional defiant disorder [ODD]), depressive symptoms, and marijuana use among a sample of late adolescents and emerging adults.

METHOD

A total of 900 students (75.8% female, 80.3% Caucasian, M_age = 20) from a large public university completed an online survey.

RESULTS

Findings indicated that depressive symptoms mediated the relation between the marijuana use and past symptoms of ADHD, past diagnosis of ADHD, CD symptoms, CD diagnosis, and ODD diagnosis.

CONCLUSION

Depressive symptoms represent a link between DBDs and marijuana use that is suggested, but not well documented in the existing literature. The current findings add to this evidence and suggest a need to assess individuals presenting with symptoms of DBDs for depressive symptoms, as this symptom pattern may result in a greater likelihood of marijuana use.

A placebo-controlled trial of buspirone for the treatment of marijuana dependence

The present study investigated the potential efficacy of buspirone for treating marijuana dependence. Participants received either buspirone (maximum 60mg/day) (n=23) or matching placebo (n=27) for 12 weeks, each in conjunction with motivational interviewing. In the modified intention-to-treat analysis, the percentage of negative UDS results in the buspirone-treatment group was 18 percentage points higher than the placebo-treatment group (95% CI: -2% to 37%, p=0.071). On self-report, participants receiving buspirone reported not using marijuana 45.2% of days and participants receiving placebo reported not using 51.4% of days (p=0.55). An analysis of participants that completed the 12-week trial showed a significant difference in the percentage negative UDS (95% CI: 7-63%, p=0.014) and a trend for participants randomized to the buspirone-treatment group who completed treatment to achieve the first negative UDS result sooner than those participants treated with placebo (p=0.054). Further study with buspirone in this population may be warranted; however, strategies to enhance study retention and improve outcome measurement should be considered in future trials.

Cannabis dependence as a primary drug use-related problem: the case for harm reduction-oriented treatment options

Few studies have focused on cannabis dependence as compared to other drugs more commonly acknowledged as presenting a substantial need for treatment. This paper presents findings from a 2004-2005 study of drug user treatment clients in Southern Ontario, Canada. Clients with cannabis (n = 128) or cocaine (n = 300) as their primary drug problem were compared on psychosocial and demographic characteristics, drug effects, and clinical impairment. There are more similarities than differences between groups, with DAST and DSM scores showing high rates of "dependence" and reported symptoms of "abuse." However, cannabis consistently scored lower on these items, supporting the idea of a continuum of risk on which its rank compared with other potentially misused drugs holds across a wide range of symptoms of impairment. The less disruptive nature of cannabis use-related problems poses greater challenges for drug user treatment providers guided by strict abstinence agendas. The authors call for the expansion of harm reduction treatment options and educational initiatives beyond primary prevention that acknowledge benefits of moderate controlled use when addressing cannabis misuse.

Lifetime associations between cannabis, use, abuse, and dependence and panic attacks in a representative sample

BACKGROUND

The present investigation evaluated lifetime associations between cannabis use, abuse, and dependence and panic attacks after controlling for alcohol abuse, polysubstance use, and demographic variables.

METHODS

Data for this study were obtained as part of a large statewide survey, the Colorado Social Health Survey (CSHS). Participants were contacted using randomly sampled household addresses (72% response rate) and interviews took place in participants' homes. Participants consisted of a representative sample from the Colorado general adult population (n=4745; 52% female). The Diagnostic Interview Schedule was administered to obtain diagnoses.

RESULTS

After controlling for polysubstance use, alcohol abuse, and demographic variables, lifetime history of cannabis dependence, but not use or abuse, was significantly related to an increased risk of panic attacks. Additionally, among participants reporting a lifetime history of both panic attacks and cannabis use, the age of onset of panic attacks (M=19.0 years of age) was significantly earlier than for individuals with a lifetime panic attack history but no cannabis use (M=27.6 years of age).

CONCLUSIONS

Structured interview data suggest lifetime cannabis dependence is significantly associated with an increased risk of panic attacks.

Adverse effects of cannabis on health: an update of the literature since 1996

Recent research has clarified a number of important questions concerning adverse effects of cannabis on health. A causal role of acute cannabis intoxication in motor vehicle and other accidents has now been shown by the presence of measurable levels of Delta(9)-tetrahydrocannabinol (THC) in the blood of injured drivers in the absence of alcohol or other drugs, by surveys of driving under the influence of cannabis, and by significantly higher accident culpability risk of drivers using cannabis. Chronic inflammatory and precancerous changes in the airways have been demonstrated in cannabis smokers, and the most recent case-control study shows an increased risk of airways cancer that is proportional to the amount of cannabis use. Several different studies indicate that the epidemiological link between cannabis use and schizophrenia probably represents a causal role of cannabis in precipitating the onset or relapse of schizophrenia. A weaker but significant link between cannabis and depression has been found in various cohort studies, but the nature of the link is not yet clear. A large body of evidence now demonstrates that cannabis dependence, both behavioral and physical, does occur in about 7-10% of regular users, and that early onset of use, and especially of weekly or daily use, is a strong predictor of future dependence. Cognitive impairments of various types are readily demonstrable during acute cannabis intoxication, but there is no suitable evidence yet available to permit a decision as to whether long-lasting or permanent functional losses can result from chronic heavy use in adults. However, a small but growing body of evidence indicates subtle but apparently permanent effects on memory, information processing, and executive functions, in the offspring of women who used cannabis during pregnancy. In total, the evidence indicates that regular heavy use of cannabis carries significant risks for the individual user and for the health care system.

Being stoned: a review of self-reported cannabis effects

Although there has been considerable research into the adverse effects of cannabis, less attention has been directed toward subjective effects that may be associated with ongoing cannabis use. Examination of self-reported cannabis effects is an important issue in understanding the widespread use of cannabis. While reviews have identified euphoria as a primary factor in maintaining cannabis use, relaxation is the effect reported most commonly in naturalistic studies of cannabis users, irrespective of the method used. Self-reported effects in 12 naturalistic and 18 laboratory studies were compared. Regardless of methodology there was considerable variation in the effects experienced. Variation has been reported in terms of opposite effects being experienced by different individuals, variation of effects by individuals within a single occasion and between occasions of use. Factors that might explain this variation are outlined. Limitations of the available literature and suggested directions for future research are discussed. [Green B, Kavanagh D, Young R. Being stoned: a review of self-reported cannabis effects.

Exploring the association between cannabis use and depression

AIM

To examine the evidence on the association between cannabis and depression and evaluate competing explanations of the association.

METHODS

A search of Medline, Psychinfo and EMBASE databases was conducted. All references in which the terms 'cannabis', 'marijuana' or 'cannabinoid', and in which the words 'depression/depressive disorder/depressed', 'mood', 'mood disorder' or 'dysthymia' were collected. Only research studies were reviewed. Case reports are not discussed.

RESULTS

There was a modest association between heavy or problematic cannabis use and depression in cohort studies and well-designed cross-sectional studies in the general population. Little evidence was found for an association between depression and infrequent cannabis use. A number of studies found a modest association between early-onset, regular cannabis use and later depression, which persisted after controlling for potential confounding variables. There was little evidence of an increased risk of later cannabis use among people with depression and hence little support for the self-medication hypothesis. There have been a limited number of studies that have controlled for potential confounding variables in the association between heavy cannabis use and depression. These have found that the risk is much reduced by statistical control but a modest relationship remains.

CONCLUSIONS

Heavy cannabis use and depression are associated and evidence from longitudinal studies suggests that heavy cannabis use may increase depressive symptoms among some users. It is still too early, however, to rule out the hypothesis that the association is due to common social, family and contextual factors that increase risks of both heavy cannabis use and depression. Longitudinal studies and studies of twins discordant for heavy cannabis use and depression are needed to rule out common causes. If the relationship is causal, then on current patterns of cannabis use in the most developed societies cannabis use makes, at most, a modest contribution to the population prevalence of depression.

A Marijuana Screening Inventory (Experimental Version): Description and Preliminary Psychometric Properties

OBJECTIVE

Marijuana use prevalence, culturally confusing messages about marijuana risks, assessment dilemmas, and current screening inadequacies justify developing a marijuana specific screening inventory for assessment purposes. This article describes the Marijuana Screening Inventory (MSI-X) and its preliminary psychometric reliability, factor analyses, and factor structure.

METHOD

The MSI-X was administered to a community sample of 420 Army reservists participating in substance abuse educational classes. Participants responded anonymously to the 39-item MSI-X. SPSS analyses were performed with 408 returned MSI-Xs from a sample of 49% males and 40% females.

RESULTS

Analyses revealed 61% smoked marijuana during their lifetime. Reliability of the MSI-X was .89. Exploratory factor analyses of 31 scored items by principal components and varimax rotation supported a nine-factor structure, explaining 65.8% of the variance, with all items loading > or = .30. Within the sample, 7.84% scored > or = 7 suggesting "at risk" with marijuana; 6.12% scored 4 to 6 "suggestive of risk"; 20.83% scored 1 to 3 reflecting "normal or experimental" use; and 65.4% scored 0 suggesting "no problem."

CONCLUSIONS

The reliability, variance explained, factor-loading matrix of the nine-factor MSI-X structure and clinically predetermined scoring ranges appear useful for screening marijuana use patterns. Factor-based subscales were derived from the factor-loading matrix and described as a base for future confirmatory factor analysis. Although the MSI-X version needs psychometric strengthening, it shows potential as a marijuana-specific screening inventory for use in general mental health and primary care settings.

Does marijuana use have residual adverse effects on self-reported health measures, socio-demographics and quality of life? A monozygotic co-twin control study in men

AIMS

To assess the effects of former heavy marijuana use on selected aspects of health.

DESIGN

A monozygotic co-twin control design was used to compare the health of former heavy marijuana using male monozygotic twins to that of their co-twins who never used marijuana significantly.

SETTING

In-person survey and questionnaires.

PARTICIPANTS

Fifty-six marijuana use discordant monozygotic twin pair members of the Vietnam Era Twin (VET) Registry.

MEASUREMENTS

Current socio-demographic characteristics; current nicotine and alcohol use; life-time nicotine and alcohol abuse/dependence; past 5-year physical and mental health services utilization; and health-related quality of life.

FINDINGS

The mean number of days on which the marijuana user twin used marijuana in his life-time was 1085, while the non-marijuana user used marijuana a maximum of 5 days. Marijuana was last used a mean of 20 years previously. No significant differences were found between the former marijuana user twins and their siblings for current socio-demographic characteristics; current nicotine or alcohol use; life-time nicotine or alcohol abuse/dependence; past 5-year out-patient or emergency room visits, hospitalizations or medication use for medical problems; past 5-year mental health out-patient use or hospitalizations; or health-related quality of life.

CONCLUSIONS

Previous heavy marijuana use a mean of 20 years earlier by a group of men who reported no other significant illicit drug use does not appear to be associated with adverse socio-demographic, physical or mental health adverse effects. The conclusions of the study are limited by possible participation and recall biases, relatively small sample size and the absence of a physical health examination.