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Satre DD, Sarovar V, Levine T, Leibowitz AS, Lea AN, Ridout KK, Hare CB, Luu MN, Flamm J, Dilley JW, Davy-Mendez T, Sterling SA, Silverberg MJ. Factors associated with suicidal ideation among people with HIV engaged in care. J Affect Disord 2024; 358:369-376. [PMID: 38723683 DOI: 10.1016/j.jad.2024.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND People with HIV (PWH) are at elevated risk for suicidal ideation (SI), yet few studies have examined how substance use, clinical and sociodemographic factors are associated with SI among PWH. METHOD We used substance use (Tobacco, Alcohol, Prescription Medication, and Other Substance Use [TAPS]) and depression (PHQ-9) data from computerized screening of adult PWH in primary care clinics in Northern California, combined with health record data on psychiatric diagnoses, HIV diagnosis, treatment, and control (HIV RNA, CD4), insurance, and neighborhood deprivation index (NDI) to examine factors associated with SI (PHQ-9 item 9 score > 0). Adjusted odds ratios (aOR) for SI were obtained from logistic regression models. RESULTS Among 2829 PWH screened (92 % male; 56 % white; mean (SD) age of 54 (13) years; 220 (8 %) reported SI. Compared with no problematic use, SI was higher among those reporting one (aOR = 1.65, 95 % CI = 1.17, 2.33), two (aOR = 2.23, 95 % CI = 1.42, 3.49), or ≥ 3 substances (aOR = 4.49, 95 % CI = 2.41, 8.39). SI risk was higher for those with stimulant use (aOR = 3.55, 95 % CI = 2.25, 5.59), depression (aOR = 4.18, 95 % CI = 3.04, 5.74), and anxiety diagnoses (aOR = 1.67, 95 % CI = 1.19, 2.34), or Medicaid (aOR = 2.11, 95%CI = 1.24, 3.60) compared with commercial/other insurance. SI was not associated with HIV-related measures or NDI. LIMITATIONS SI was assessed with a single PHQ-9 item. Simultaneous SI and exposure data collection restricts the ability to establish substance use as a risk factor. CONCLUSIONS HIV care providers should consider multiple substance use, stimulant use, depression or anxiety, and public insurance as risk factors for SI and provide interventions when needed.
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Affiliation(s)
- Derek D Satre
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, San Francisco, CA 94107, United States of America; Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America.
| | - Varada Sarovar
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Tory Levine
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Amy S Leibowitz
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Alexandra N Lea
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Kathryn K Ridout
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America; The Permanente Medical Group, Oakland, CA 94612, United States of America
| | - C Bradley Hare
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Mitchell N Luu
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Jason Flamm
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - James W Dilley
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, San Francisco, CA 94107, United States of America
| | - Thibaut Davy-Mendez
- University of North Carolina at Chapel Hill, Department of Medicine, Division of Infectious Diseases, Chapel Hill, NC 27599, United States of America
| | - Stacy A Sterling
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, San Francisco, CA 94107, United States of America; Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Michael J Silverberg
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
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Warnock CA, Ondrusek AR, Edelman EJ, Kershaw T, Muilenburg JL. Perspectives regarding cannabis use: Results from a qualitative study of individuals engaged in substance use treatment in Georgia and Connecticut. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 11:100228. [PMID: 38585142 PMCID: PMC10997993 DOI: 10.1016/j.dadr.2024.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/08/2024] [Accepted: 03/14/2024] [Indexed: 04/09/2024]
Abstract
Objective Cannabis use is increasingly pervasive throughout the U.S. People in treatment for substance use disorders (SUD) may be especially at-risk of harm due to this changing context of cannabis in the U.S. This study's objective was to qualitatively describe experiences and beliefs around cannabis among people who had entered treatment for any SUD in the past 12-months. Methods From May to November of 2022, we conducted 27 semi-structured interviews (n=16 in Georgia, n=11 in Connecticut) with individuals in treatment for SUD in Georgia and Connecticut. Interviews were recorded, transcribed, and thematically analyzed using an emergent approach. Results All participants had used cannabis in the past. Four themes emerged from the interviews. Participants: (1) perceived cannabis as an important contributor to non-cannabis substance use initiation in adolescence; (2) viewed cannabis as a substance with the potential to improve health with fewer side effects than prescription medications; (3) expressed conflicting opinions regarding cannabis as a trigger or tool to manage cravings for other non-cannabis substances currently; and 4) described concerns related to negative legal, social service, and treatment-related consequences as well as negative peer perception relating to the use of cannabis. Conclusion Although participants described cannabis's important role as an initiatory drug in adolescence and young adulthood, many felt that cannabis was a medicinal substance for a range of health challenges. These findings suggest SUD treatment clinicians should address medicinal beliefs related to cannabis among their clients and emphasizes the need for research on cannabis use and SUD treatment outcomes.
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Affiliation(s)
- Charles A. Warnock
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Ashlin R. Ondrusek
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - E. Jennifer Edelman
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, USA
| | - Trace Kershaw
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Jessica L. Muilenburg
- Department of Health Promotion and Behavior, University of Georgia College of Public Health, Athens, GA, USA
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3
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Sorkhou M, Dent EL, George TP. Cannabis use and mood disorders: a systematic review. Front Public Health 2024; 12:1346207. [PMID: 38655516 PMCID: PMC11035759 DOI: 10.3389/fpubh.2024.1346207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Background Problematic cannabis use is highly prevalent among people with mood disorders. This underscores the need to understand the effects of cannabis and cannabinoids in this population, especially considering legalization of recreational cannabis use. Objectives We aimed to (1) systematically evaluate cross-sectional and longitudinal studies investigating the interplay between cannabis use, cannabis use disorder (CUD), and the occurrence of mood disorders and symptoms, with a focus on major depressive disorder (MDD) and bipolar disorder (BD) and; (2) examine the effects of cannabis on the prognosis and treatment outcomes of MDD and BD. Methods Following PRISMA guidelines, we conducted an extensive search for English-language studies investigating the potential impact of cannabis on the development and prognosis of mood disorders published from inception through November 2023, using EMBASE, PsycINFO, PubMed, and MEDLINE databases. Results Our literature search identified 3,262 studies, with 78 meeting inclusion criteria. We found that cannabis use is associated with increased depressive and manic symptoms in the general population in addition to an elevated likelihood of developing MDD and BD. Furthermore, we observed that cannabis use is linked to an unfavorable prognosis in both MDD or BD. Discussion Our findings suggest that cannabis use may negatively influence the development, course, and prognosis of MDD and BD. Future well-designed studies, considering type, amount, and frequency of cannabis use while addressing confounding factors, are imperative for a comprehensive understanding of this relationship. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023481634.
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Affiliation(s)
- Maryam Sorkhou
- Institute for Mental Health Policy and Research at CAMH, Toronto, ON, Canada
- Department of Psychiatry, Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Eliza L. Dent
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Tony P. George
- Institute for Mental Health Policy and Research at CAMH, Toronto, ON, Canada
- Department of Psychiatry, Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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De Genna NM, Jacobsen E, Ganguli M. Marijuana use among community-dwelling older adults: A population-based study. Int J Geriatr Psychiatry 2024; 39:e6086. [PMID: 38613138 PMCID: PMC11112682 DOI: 10.1002/gps.6086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/01/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES There is a paucity of population-level data on marijuana use and mental health and functioning in older adults. METHODS We analyzed cross-sectional data (n = 910) from a well-characterized cohort, the Monongahela-Youghiogheny Healthy Aging Team (MYHAT) study. MYHAT is an age-stratified random sample of the population age 65 years and older from a small-town in the USA. Half the sample was female and half were over 75 (Mean age = 77). Most participants were non-Hispanic White. Marijuana use was assessed by self-report and symptoms of mood disorders were screened using the modified Centers for Epidemiological Studies-Depression Scale and the Generalized Anxiety Disorder screener. Cognition was assessed by the Mini-Mental State Examination and a neuropsychological test battery; functioning using the OARS Activities of Daily Living and Instrumental Activities of Daily Living; and overall assessment using the Clinical Dementia Rating (CDR®). RESULTS One in five MYHAT participants had a history of marijuana use and 5% reported recent use, primarily for pain (41%) and recreation/relaxation (37%). Recent use was associated with cigarette and alcohol use, symptoms of depression or anxiety, and impairments in attention. CONCLUSIONS Twenty-percent of community-dwelling older adults living in a US state where recreational marijuana use is illegal had a history of marijuana use. Recent marijuana use was less common but, consistent with prior research, associated with other substance use and poorer mental health.
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Affiliation(s)
- Natacha M. De Genna
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Erin Jacobsen
- Department of Psychiatry, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - Mary Ganguli
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Departments of Psychiatry and Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Salinas KZ, Saran S, Saulnier K, Hoglen B, Houser KR, Krebs NM, Kaynak Ö, Bordner CR, Yingst JM, Foulds J, Allen SI, Hobkirk AL. A Comparison of Mental Health Symptoms among Adults Who Vape Nicotine, Cannabis, or Both. Subst Use Misuse 2024; 59:601-607. [PMID: 38115560 DOI: 10.1080/10826084.2023.2294956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Dual use of combustible cannabis and nicotine is related to worse mental health symptoms (MHS); however, little is known about MHS among those who vape cannabis and nicotine. The current study aimed to determine if dual use of cannabis and nicotine vapes is associated with worse MHS compared to single use and to identify correlates of MHS for dual users. METHODS We used Amazon Mechanical Turk to survey adults (N = 492) who used nicotine or cannabis vapes in the past 30 days on stress, anxiety, depression, vape use behaviors and sociodemographic information. We conducted hierarchical linear regressions to compare MHS between dual vs. single substance vape use and to identify correlates of MHS, including sociodemographic variables and vape use characteristics. RESULTS The final sample was 37.6% female, 87.6% White, and 11% Hispanic/Latinx with a mean age of 34.15 years. After controlling for sociodemographic characteristics and combustible product use, dual users had significantly higher mean MHS severity than single users. For dual users, younger age and being married were associated with higher symptoms of depression and stress. Holding a medical cannabis card was associated with higher anxiety symptoms. CONCLUSION The findings suggest that dual use of cannabis and nicotine vapes is associated with worse MHS severity compared to single substance use.
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Affiliation(s)
- Kalin Z Salinas
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Savreen Saran
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Kevin Saulnier
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Brianna Hoglen
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Kenneth R Houser
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Nicolle M Krebs
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Övgϋ Kaynak
- School of Behavioral Sciences & Education, Penn State Harrisburg, Middletown, Pennsylvania, USA
| | - Candace R Bordner
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jessica M Yingst
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jonathan Foulds
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Sophia I Allen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Andrea L Hobkirk
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
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6
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Llewelyn-Williams J, Mykota D. Predictors of Cannabis Use Among Canadian University Students. CANNABIS (ALBUQUERQUE, N.M.) 2023; 6:87-104. [PMID: 38035164 PMCID: PMC10683746 DOI: 10.26828/cannabis/2023/000160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Objective To examine the correlates between cannabis use, motives to use, related psychosocial outcomes and academic behaviours among a sample of Canadian university students. Methods A random sample of 6,000 students who were enrolled in at least one class and were 18 years or over were asked to complete a cross-sectional online survey. Of the 920 students that responded, 478 (ages 18-55; mean age = 25.02, SD = 5.95) identified as having used cannabis within the past six months and thus were included as participants in the current study. Participants completed a battery of measures designed to examine cannabis use and associated constructs (i.e., substance use risk, personal well-being, non-specific psychological distress, academic behaviours, and motivations for use). Results Among the participants, 31% (n = 148) were found to be frequent (i.e., hazardous) users. Using cannabis for enhancement, coping, expansion, sleep difficulties, and conformity purposes, as well as impulsive personality traits were found to be predictors of cannabis use severity, with the enhancement motive identified as the strongest predictor for the total sample, males, and hazardous users. The coping motive was the strongest predictor for females, and impulsivity was the strongest predictor for non-hazardous users. Conclusion Findings will help inform the development of campus guidelines for lower risk cannabis use. Information gleaned from this study will also provide important information for those that use cannabis, policymakers, and health care providers in considering optimal personal use, prevention, and intervention plans.
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Affiliation(s)
| | - David Mykota
- Department of Educational Psychology and Special Education, University of Saskatchewan
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Reece AS, Hulse GK. Perturbation of 3D nuclear architecture, epigenomic aging and dysregulation, and cannabinoid synaptopathy reconfigures conceptualization of cannabinoid pathophysiology: part 2-Metabolome, immunome, synaptome. Front Psychiatry 2023; 14:1182536. [PMID: 37854446 PMCID: PMC10579598 DOI: 10.3389/fpsyt.2023.1182536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023] Open
Abstract
The second part of this paper builds upon and expands the epigenomic-aging perspective presented in Part 1 to describe the metabolomic and immunomic bases of the epigenomic-aging changes and then considers in some detail the application of these insights to neurotoxicity, neuronal epigenotoxicity, and synaptopathy. Cannabinoids are well-known to have bidirectional immunomodulatory activities on numerous parts of the immune system. Immune perturbations are well-known to impact the aging process, the epigenome, and intermediate metabolism. Cannabinoids also impact metabolism via many pathways. Metabolism directly impacts immune, genetic, and epigenetic processes. Synaptic activity, synaptic pruning, and, thus, the sculpting of neural circuits are based upon metabolic, immune, and epigenomic networks at the synapse, around the synapse, and in the cell body. Many neuropsychiatric disorders including depression, anxiety, schizophrenia, bipolar affective disorder, and autistic spectrum disorder have been linked with cannabis. Therefore, it is important to consider these features and their complex interrelationships in reaching a comprehensive understanding of cannabinoid dependence. Together these findings indicate that cannabinoid perturbations of the immunome and metabolome are important to consider alongside the well-recognized genomic and epigenomic perturbations and it is important to understand their interdependence and interconnectedness in reaching a comprehensive appreciation of the true nature of cannabinoid pathophysiology. For these reasons, a comprehensive appreciation of cannabinoid pathophysiology necessitates a coordinated multiomics investigation of cannabinoid genome-epigenome-transcriptome-metabolome-immunome, chromatin conformation, and 3D nuclear architecture which therefore form the proper mechanistic underpinning for major new and concerning epidemiological findings relating to cannabis exposure.
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Affiliation(s)
- Albert Stuart Reece
- Division of Psychiatry, University of Western Australia, Crawley, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Gary Kenneth Hulse
- Division of Psychiatry, University of Western Australia, Crawley, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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Cairns EA, Benson MJ, Bedoya-Pérez MA, Macphail SL, Mohan A, Cohen R, Sachdev PS, McGregor IS. Medicinal cannabis for psychiatry-related conditions: an overview of current Australian prescribing. Front Pharmacol 2023; 14:1142680. [PMID: 37346297 PMCID: PMC10279775 DOI: 10.3389/fphar.2023.1142680] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
Objective: Evidence is accumulating that components of the Cannabis sativa plant may have therapeutic potential in treating psychiatric disorders. Medicinal cannabis (MC) products are legally available for prescription in Australia, primarily through the Therapeutic Goods Administration (TGA) Special Access Scheme B (SAS-B). Here we investigated recent prescribing practices for psychiatric indications under SAS-B by Australian doctors. Methods: The dataset, obtained from the TGA, included information on MC applications made by doctors through the SAS-B process between 1st November 2016 and 30th September 2022 inclusive. Details included the primary conditions treated, patient demographics, prescriber location, product type (e.g., oil, flower or capsule) and the general cannabinoid content of products. The conditions treated were categorized according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR). Trends in prescribing for conditions over time were analyzed via polynomial regression, and relationships between categorical variables determined via correspondence analyses. Results: Approximately 300,000 SAS-B approvals to prescribe MC had been issued in the time period under investigation. This included approvals for 38 different DSM-5-TR defined psychiatric conditions (33.9% of total approvals). The majority of approvals were for anxiety disorders (66.7% of psychiatry-related prescribing), sleep-wake disorders (18.2%), trauma- and stressor-related disorders (5.8%), and neurodevelopmental disorders (4.4%). Oil products were most prescribed (53.0%), followed by flower (31.2%) and other inhaled products (12.4%). CBD-dominant products comprised around 20% of total prescribing and were particularly prevalent in the treatment of autism spectrum disorder. The largest proportion of approvals was for patients aged 25-39 years (46.2% of approvals). Recent dramatic increases in prescribing for attention deficit hyperactivity disorder were identified. Conclusion: A significant proportion of MC prescribing in Australia is for psychiatry-related indications. This prescribing often appears somewhat "experimental", given it involves conditions (e.g., ADHD, depression) for which definitive clinical evidence of MC efficacy is lacking. The high prevalence of THC-containing products being prescribed is of possible concern given the psychiatric problems associated with this drug. Evidence-based clinical guidance around the use of MC products in psychiatry is lacking and would clearly be of benefit to prescribers.
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Affiliation(s)
- Elizabeth A. Cairns
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Melissa J. Benson
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Miguel A. Bedoya-Pérez
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Sara L. Macphail
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Adith Mohan
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Neuropsychiatric Institute, The Prince of Wales Hospital, Randwick, NSW, Australia
| | - Rhys Cohen
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Neuropsychiatric Institute, The Prince of Wales Hospital, Randwick, NSW, Australia
| | - Iain S. McGregor
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
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Altman BR, Earleywine M. Induced negative affect's impact on self-reported cannabis use, expectancies, and problems. Addict Behav 2023; 141:107652. [PMID: 36805814 DOI: 10.1016/j.addbeh.2023.107652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023]
Abstract
Substance use disorders and affective disturbances often covary. Even momentary experiences of negative affect (NA) appear linked with substance use. While strong evidence of these relations exists, NA might bias endorsements of substance use due to hindered recall and reporting processes. This hypothesis warrants further research, as accurate assessment of substance-related variables is crucial in both research and treatment settings. The present study examined the influence of NA on reporting of cannabis variables using an affect-induction paradigm. Over 700 individuals recruited from Amazon's MTurk participated. After reporting demographics and baseline affect, participants were randomly assigned to either a NA induction or control condition. Follow-up measures assessed post-induction affect and cannabis-related variables. Results revealed that the NA induction task significantly increased NA and decreased positive affect relative to the control condition. Participants assigned to the NA induction reported greater negative cannabis expectancies and more cannabis problems, even after controlling for age and educational attainment. Cannabis use and cannabis problems appeared positively related. Future research should continue to assess for the influence of NA in reporting of cannabis variables. Should subsequent work find differences in reporting of substance use that appear to covary with negative affect, clinicians and researchers alike should be mindful of the implications of potentially biased reporting on assessment, intervention, and research outcomes.
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Affiliation(s)
- Brianna R Altman
- Rutgers, The State University of New Jersey, Department of Psychology, New Brunswick, NJ, United States.
| | - Mitch Earleywine
- Rutgers, The State University of New Jersey, Department of Psychology, New Brunswick, NJ, United States; University at Albany, State University of New York (SUNY), Department of Psychology, Albany, NY, United States
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10
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Satre DD, Sarovar V, Leyden WA, Leibowitz AS, Lam JO, Hojilla JC, Davy-Mendez T, Hare CB, Silverberg MJ. Age group differences in substance use, social support, and physical and mental health concerns among people living with HIV two years after receiving primary care-based alcohol treatment. Aging Ment Health 2023; 27:1011-1019. [PMID: 35765902 PMCID: PMC9797622 DOI: 10.1080/13607863.2022.2084504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 05/26/2022] [Indexed: 12/31/2022]
Abstract
Objectives: People living with HIV (PWH) have seen reduction in HIV-associated morbidity and increase in near-normal life expectancy, yet unhealthy alcohol use poses substantial risks to older as well as younger adults. Further research regarding age-associated physical and mental health concerns among PWH who drink alcohol is needed to inform services, given the expanding age range of patients in care.Methods: We compared age group differences (18-34, 35-44, 45-54, ≥55 years old) in two-year patient-reported outcomes and HIV viral control among PWH enrolled in a primary care-based behavioral alcohol intervention trial; with 90% follow up from baseline.Results: Of 553 PWH, 50 (9%) were 18-34, 85 (15%) were 35-44, 197 (36%) were 45-54, and 221 (40%) were ≥55 years old. Most were men (97%) and White (64%). At two years, PWH ≥55 reported less substance use in the prior 30 days, fewer social contacts, and more pain; younger PWH had lower antiretroviral therapy (ART) adherence. In adjusted analyses, PWH ages 18-34 had higher odds of unhealthy alcohol use, tobacco, cannabis, or other substances compared to those ≥55; with higher odds of anxiety among PWH 35-44 compared with those ≥55; and physical quality of life was worse among those ≥55 compared with younger groups.Conclusions: While older PWH report less substance use than younger PWH and have better ART adherence post-treatment, they are more likely to experience limited social support and worse physical quality of life. Findings can inform interventions to address varying needs of PWH across the lifespan.
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Affiliation(s)
- Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Wendy A. Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Amy S. Leibowitz
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Jennifer O. Lam
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - J. Carlo Hojilla
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Thibaut Davy-Mendez
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Charles B. Hare
- Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, United States
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
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11
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Livingston NR, Hetelekides E, Bravo AJ, Looby A. Negative Affect Regulation and Marijuana Use in College Students: Evaluating the Mediating Roles of Coping and Sleep Motives. J Psychoactive Drugs 2023; 55:203-212. [PMID: 35341474 PMCID: PMC9512938 DOI: 10.1080/02791072.2022.2054747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 10/18/2022]
Abstract
Negative affect regulation models suggest that marijuana may be used to reduce negative affect. Extant research has provided support for these models, indicating that specific motives for marijuana use, particularly coping motives (i.e., using to alleviate negative affects), mediate relations between affective vulnerabilities and marijuana outcomes. However, sleep motives (i.e., using to promote sleep) have been neglected from such models, despite their theoretical relevance. The present study tested two multiple mediation models in a large sample of marijuana-using college students (N = 1,453) to evaluate the indirect effects of coping and sleep motives in paths from depressive and anxiety symptoms to marijuana outcomes (use, consequences, and cannabis use disorder [CUD] symptoms). Both coping and sleep motives mediated the effects of depressive/anxiety symptoms on each marijuana variable. Moreover, significant double mediated effects were found, such that higher affective symptoms were associated with greater motives; which were associated with more marijuana use; which was related to more negative consequences and CUD symptoms. The findings provide support for sleep motives as a relevant pathway between affective vulnerabilities and marijuana outcomes. Additional research is needed to evaluate the potential benefits of interventions targeting specific marijuana motives.
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Affiliation(s)
| | | | - Adrian J. Bravo
- Department of Psychological Sciences, William & Mary, Williamsburg, VA USA
| | - Alison Looby
- Department of Psychology, University of Wyoming, Laramie, WY USA
| | - Stimulant Norms and Prevalence (SNAP) Study Team
- This project was completed by the Stimulant Norms and Prevalence Study (SNAP) Team, which includes the following investigators (in alphabetical order): Adrian J. Bravo, William & Mary (Co-PI); Bradley T. Conner, Colorado State University; Mitch Earleywine, University at Albany, State University of New York; James Henson, Old Dominion University; Alison Looby, University of Wyoming (Co-PI); Mark A. Prince, Colorado State University; Ty Schepis, Texas State University; Margo Villarosa-Hurlocker, University of New Mexico
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12
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Rodas JD, Sorkhou M, George TP. Contingency Management for Treatment of Cannabis Use Disorder in Co-Occurring Mental Health Disorders: A Systematic Review. Brain Sci 2022; 13:brainsci13010036. [PMID: 36672017 PMCID: PMC9855987 DOI: 10.3390/brainsci13010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Amongst individuals with a mental health disorder, a comorbid diagnosis of cannabis use disorder (CUD) is associated with numerous adverse consequences, including more severe symptom profiles, poorer treatment response, and reduced psychosocial functioning. Contingency management (CM), a method to specifically reinforce target behavior attainment (e.g., substance use abstinence), may provide an effective intervention in treating cannabis use in patients with a dual diagnosis of CUD and a mental health disorder. A systematic search examining the effects of CM on cannabis use, clinical, cognitive, and psychosocial outcomes in patients with a mental health disorder on PubMed, PsycINFO, and EMBASE databases up to November 2022 was performed. Six studies met inclusion criteria for our review. We found CM to be efficacious in producing cannabis use reductions and abstinence amongst individuals with a psychotic-spectrum or major depressive disorder. Additional longitudinal studies with larger sample sizes, other psychiatric populations, and longer follow-up periods are needed to evaluate the sustained effects of CM.
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Affiliation(s)
- Justyne D. Rodas
- Centre for Complex Interventions and Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Maryam Sorkhou
- Centre for Complex Interventions and Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Tony P. George
- Centre for Complex Interventions and Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Correspondence: ; Tel.: +1-(416)-535-8501 (ext. 32662)
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13
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Rock KL, Englund A, Morley S, Rice K, Copeland CS. Can cannabis kill? Characteristics of deaths following cannabis use in England (1998-2020). J Psychopharmacol 2022; 36:1362-1370. [PMID: 35946604 PMCID: PMC9716494 DOI: 10.1177/02698811221115760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cannabis is the most widely used illegal drug but is rarely considered a causal factor in death. AIMS This study aimed to understand trends in deaths in England where cannabinoids were detected at post-mortem, and to evaluate the clinical utility of post-mortem cannabinoid concentrations in coronial investigations. METHODS Deaths with cannabinoid detections reported to the National Programme on Substance Abuse Deaths (NPSAD) were extracted and analysed. RESULTS From 1998 to 2011, on average 7% of all cases reported to NPSAD had a cannabinoid detected (n = 110 deaths per year), rising to 18% in 2020 (n = 350). Death following cannabis use alone was rare (4% of cases, n = 136/3455). Traumatic injury was the prevalent underlying cause in these cases (62%, n = 84/136), with cannabis toxicity cited in a single case. Polydrug use was evident in most cases (96%, n = 3319/3455), with acute drug toxicity the prevalent underlying cause (74%, n = 2458/3319). Cardiac complications were the most cited physiological underlying cause of death (4%, n = 144/3455). The median average Δ9-tetrahydrocannabinol post-mortem blood concentrations were several magnitudes lower than previously reported median blood concentrations in living users (cannabis alone: 4.3 µg/L; cannabis in combination with other drugs: 3.5 µg/L). CONCLUSIONS Risk of death due to cannabis toxicity is negligible. However, cannabis can prove fatal in circumstances with risk of traumatic physical injury, or in individuals with cardiac pathophysiologies. These indirect harms need careful consideration and further study to better elucidate the role cannabis plays in drug-related mortality. Furthermore, the relevance of cannabinoid quantifications in determining cause of death in coronial investigations is limited.
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Affiliation(s)
- Kirsten L Rock
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Sciences, King’s College London, London, UK
| | - Amir Englund
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephen Morley
- Toxicology Unit, Leicester Royal Infirmary, Leicester, UK
| | - Kathleen Rice
- Toxicology Unit, Leicester Royal Infirmary, Leicester, UK
| | - Caroline S Copeland
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Sciences, King’s College London, London, UK,National Programme on Substance Abuse Deaths, London, UK,Caroline Copeland, Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Sciences, King’s College London, London, UK.
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14
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Keen L, Turner AD, George L, Lawrence K. Cannabis use disorder severity and sleep quality among undergraduates attending a Historically Black University. Addict Behav 2022; 134:107414. [PMID: 35810645 DOI: 10.1016/j.addbeh.2022.107414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/09/2022] [Accepted: 06/15/2022] [Indexed: 11/20/2022]
Abstract
Nearly one third of Americans experience poor sleep, which is associated with numerous deleterious health outcomes. Poor sleep may be exacerbated when an individual attends college, as they experience drastic shifts in lifestyle and sleep patterns. Previous research suggests cannabis has therapeutic potential for sleep disorders but may also impair sleep quality long-term. However, no study has examined the differences in sleep quality within individuals who meet criteria for Cannabis Use Disorder (CUD). The purpose of the current study was to determine differences in sleep quality among undergraduate students who met criteria for mild CUD (n = 18), moderate CUD (n = 22), severe CUD (n = 16) and students who did not meet criteria for CUD (n = 244). Participants included 300 predominantly Black/African American undergraduate students (79% female), aged between 18 and 25 years. Each participant completed an online survey that included measures assessing sleep quality and CUD criteria. Employing analysis of covariance, the moderate CUD subgroup (M = 9.00, SD = 3.32) reported poorer sleep quality than individuals who did not meet criteria for CUD (M = 6.93, SD = 3.03). Interestingly, the severe CUD subgroup (M = 6.75, SD = 2.52) reported similar sleep quality to individuals who did not meet criteria for CUD (M = 6.93, SD = 3.03). Individuals meeting criteria for mild and moderate CUD reported the poorest sleep quality among the groups, suggesting a differentiation within CUD severity. Future research should assess withdrawal and cannabis use frequency among individuals who meet criteria for CUD to further elucidate disturbances in sleep quality among those with CUD.
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Affiliation(s)
- Larry Keen
- Psychology Department, Virginia State University, USA
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15
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Mangoo S, Erridge S, Holvey C, Coomber R, Barros DAR, Bhoskar U, Mwimba G, Praveen K, Symeon C, Sachdeva-Mohan S, Rucker JJ, Sodergren MH. Assessment of clinical outcomes of medicinal cannabis therapy for depression: analysis from the UK Medical Cannabis Registry. Expert Rev Neurother 2022; 22:995-1008. [PMID: 36573268 DOI: 10.1080/14737175.2022.2161894] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although pre-clinical experiments associate cannabinoids with reduced depressive symptoms, there is a paucity of clinical evidence. This study aims to analyze the health-related quality of life changes and safety outcomes in patients prescribed cannabis-based medicinal products (CBMPs) for depression. METHODS A series of uncontrolled cases from the UK Medical Cannabis Registry were analyzed. The primary outcomes were changes from baseline in the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Sleep Quality Scale (SQS), and EQ-5D-5 L at 1, 3, and 6 months. Secondary outcomes included adverse events incidence. RESULTS 129 patients were identified for inclusion. Median PHQ-9 at baseline was 16.0 (IQR: 9.0-21.0). There were reductions in PHQ-9 at 1-month (median: 8.0; IQR: 4.0-14.0; p < 0.001), 3-months (7.0; 2.3-12.8; p < 0.001), and 6-months (7.0; 2.0-9.5; p < 0.001). Improvements were also observed in GAD-7, SQS, and EQ-5D-5L Index Value at 1, 3, and 6 months (p < 0.050). 153 (118.6%) adverse events were recorded by 14.0% (n = 18) of participants, 87% (n = 133) of which were mild or moderate. CONCLUSION CBMP treatment was associated with reductions in depression severity at 1, 3, and 6 months. Limitations of the study design mean that a causal relationship cannot be proven. This analysis provides insights for further study within clinical trial settings.
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Affiliation(s)
- Sajed Mangoo
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Simon Erridge
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Carl Holvey
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Ross Coomber
- Department of Medicine, Sapphire Medical Clinics, London, UK.,St. George's Hospital NHS Trust, London, UK
| | - Daniela A Riano Barros
- Department of Medicine, Sapphire Medical Clinics, London, UK.,South London & Maudsley NHS Foundation Trust, London, UK
| | - Urmila Bhoskar
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Gracia Mwimba
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Kavita Praveen
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Chris Symeon
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | | | - James J Rucker
- Department of Medicine, Sapphire Medical Clinics, London, UK.,South London & Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine, Kings College London, London, UK
| | - Mikael H Sodergren
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Medicine, Sapphire Medical Clinics, London, UK
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16
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Sorkhou M, Rabin RA, Rabin JS, Kloiber S, McIntyre RS, George TP. Effects of 28 days of cannabis abstinence on cognition in major depressive disorder: A pilot study. Am J Addict 2022; 31:454-462. [PMID: 35690891 DOI: 10.1111/ajad.13305] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cannabis is a widely used substance that may impair select cognitive domains, including attention and memory. Problematic cannabis use is a common clinical problem among patients with major depressive disorder (MDD). Few studies have investigated the effects of cannabis abstinence on cognition in MDD. Thus, our study aimed to determine whether a 28-day period of cannabis abstinence is associated with improvements in cognition in patients with MDD and comorbid cannabis use disorder (CUD). METHODS We evaluated the effects of 28 days of cannabis abstinence on cognition in MDD patients with comorbid CUD facilitated by contingency management, motivational interviewing, psychoeducation, and coping-skills training (N = 11). Primary outcomes included Baseline to Day 28 changes in verbal memory and learning, while secondary outcomes included Baseline to Day 28 changes in working memory, visuospatial working memory (VSWM), visual search speed, mental flexibility, response inhibition, attention, manual dexterity, and fine motor movement. RESULTS Eight participants (72.7%) met the pre-specified criteria for cannabis abstinence and three participants significantly reduced their cannabis use (≥90%). Visual search speed, selective attention, and VSWM improved over the study period. These improvements were not associated with changes in cannabis metabolite levels from baseline to endpoint. DISCUSSION AND CONCLUSIONS Our findings suggest that 28 days of cannabis abstinence may improve select cognitive domains in patients with MDD and comorbid CUD. SCIENTIFIC SIGNIFICANCE This is the first study to longitudinally examine the effects of cannabis on cognition in MDD. CLINICAL TRIAL Effects of Cannabis Abstinence on Symptoms and Cognition in Depression (NCT03624933; https://www. CLINICALTRIALS gov).
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Affiliation(s)
- Maryam Sorkhou
- Institute of Medical Sciences (IMS), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Centre for Complex Interventions, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Rachel A Rabin
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Jennifer S Rabin
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Stefan Kloiber
- Institute of Medical Sciences (IMS), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Adult Psychiatry and Health Systems Division, CAMH, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Institute of Medical Sciences (IMS), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Mood Disorders Psychopharmacology Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Tony P George
- Institute of Medical Sciences (IMS), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Centre for Complex Interventions, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Addictions Divisions, Centre for Complex Interventions, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
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17
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Satre DD, Parthasarathy S, Young-Wolff KC, Meacham MC, Borsari B, Hirschtritt ME, Van Dyke L, Sterling SA. Cost-Effectiveness of Motivational Interviewing to Reduce Alcohol and Cannabis Use Among Patients With Depression. J Stud Alcohol Drugs 2022; 83:662-671. [PMID: 36136436 PMCID: PMC9523750 DOI: 10.15288/jsad.21-00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 02/09/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Motivational interviewing (MI) is a promising intervention for helping patients with mental health problems reduce their substance use. Examining the cost-effectiveness of MI and associations between MI and the use of health services can inform appropriate intervention strategies for these patients. METHOD Kaiser Permanente adult patients with depression symptoms (Patient Health Questionnaire [PHQ-9] score > 5) seen in outpatient psychiatry (N = 302) who reported unhealthy alcohol use or other substance use (primarily cannabis) were randomized to three sessions of MI (intervention) or printed literature (control) with telephone follow-up interviews at 6 and 12 months. Cost-effectiveness analyses compared intervention costs associated with 30-day abstinence from unhealthy alcohol use (i.e., any days of ≥4/≥5 drinks for women/men) and cannabis use. Multivariable analyses examined associations between MI and healthcare utilization at 12 months (emergency department, primary care, psychiatry, and addiction treatment). RESULTS MI resulted in greater likelihood of abstaining from unhealthy alcohol use (70.0% vs. 60.2%, p < .01) and cannabis use (74.6% vs. 63.9%, p < .01) than the control at 6 months, but outcomes did not differ at 12 months. The 6-month incremental cost-effectiveness ratios were $1,207-$1,523 per abstinent patient for unhealthy drinking and $1,040-$1,313 per abstinent patient for cannabis. There were no differences between groups on health service utilization. CONCLUSIONS MI cost more than the control condition but yielded better outcomes at 6 months; MI had no relationship to health service utilization. Findings can inform implementation of substance use interventions through understanding MI's potential clinical and cost impact and its relationship to health services use.
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Affiliation(s)
- Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California
- Division of Research, Kaiser Permanente Northern California Region, Oakland, California
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California Region, Oakland, California
| | - Kelly C. Young-Wolff
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California
- Division of Research, Kaiser Permanente Northern California Region, Oakland, California
| | - Meredith C. Meacham
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California
| | - Brian Borsari
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California
- San Francisco Veterans Administration Health Care System, San Francisco, California
| | - Matthew E. Hirschtritt
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California
- Division of Research, Kaiser Permanente Northern California Region, Oakland, California
- Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Lucas Van Dyke
- Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Stacy A. Sterling
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California
- Division of Research, Kaiser Permanente Northern California Region, Oakland, California
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18
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Sato T. Interventions for Co-occurring Cannabis Use and Depression. Cureus 2022; 14:e27632. [PMID: 36072196 PMCID: PMC9438295 DOI: 10.7759/cureus.27632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
This review aimed to investigate the effective intervention options for depression in patients with a history of cannabis use. The study eligibility criteria were as follows: English-language, peer-reviewed human studies; data not previously reported elsewhere; randomized controlled trials, non-randomized trials comparing an intervention group and a control group, and single-group trials. In total, eight studies of interventions for patients with depression who reported cannabis use were identified. Four studies evaluated the effectiveness of the following three pharmacological interventions: extended quetiapine release, extended venlafaxine release, and fluoxetine. However, all studies failed to demonstrate the effectiveness of these drugs. Four studies evaluated the following psychological interventions: motivational interviewing (MI) and cognitive behavior therapy (CBT). These studies found that CBT may improve depression symptoms and cannabis dependence, and MI was associated with improvements in cannabis dependence. CBT and MI may be effective in improving depression and reducing cannabis use. However, the conclusions of this review are limited because of the small number of studies and their low quality. Higher-quality research is required to evaluate the effectiveness of CBT, MI, and other interventions for comorbid cannabis use and depression.
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19
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Lee C, Round JM, Hanlon JG, Hyshka E, Dyck JR, Eurich DT. Generalized Anxiety Disorder 7-Item (GAD-7) Scores in Medically Authorized Cannabis Patients-Ontario and Alberta, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:470-480. [PMID: 34520280 PMCID: PMC9149533 DOI: 10.1177/07067437211043393] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Despite increasing rates of legalization of medical cannabis worldwide, the current evidence available on its effect on mental health outcomes including anxiety is of mixed results. This study assesses the effect of medical cannabis on generalized anxiety disorder 7-item (GAD-7) scores in adult patients between 2014 and 2019 in Ontario and Alberta, Canada. METHODS An observational cohort study of adults authorized to use medical cannabis. The GAD-7 was administered at the time of the first visit to the clinic and subsequently over the follow-up time period of up to 3.2 years. Overall changes in GAD-7 scores were computed (mean change) and categorized as: no change (<1 point); improvement; or worsening-over time. RESULTS A total of 37,303 patients had initial GAD-7 scores recorded and 5,075 (13.6%) patients had subsequent GAD-7 follow-up scores. The average age was 54.2 years (SD 15.7 years), 46.0% were male, and 45.6% noted anxiety symptoms at the baseline. Average GAD-7 scores were 9.11 (SD 6.6) at the baseline and after an average of 282 days of follow-up (SD 264) the average final GAD-7 score recorded was 9.04 (SD 6.6): mean change -0.23 (95% CI, -0.28 to -0.17, t[5,074]: -8.19, p-value <0.001). A total of 4,607 patients (90.8%) had no change in GAD-7 score from their initial to final follow-up, 188 (3.7%) had a clinically significant decrease, and 64 (1.3%) noted a clinically significant increase in their GAD-7 scores. CONCLUSIONS Overall, there was a statistically significant decrease in GAD-7 scores over time (in particular, in the 6-12-month period). However, this change did not meet the threshold to be considered clinically significant. Thus, we did not detect clinical improvements or detriment in GAD-7 scores in medically authorized cannabis patients. However, future well-controlled clinical trials are needed to fully examine risks or benefits associated with using medical cannabis to treat anxiety conditions.
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Affiliation(s)
- Cerina Lee
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jessica M. Round
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - John G. Hanlon
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Ontario, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jason R.B. Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T. Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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20
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Javanbakht M, Takada S, Akabike W, Shoptaw S, Gelberg L. Cannabis use, comorbidities, and prescription medication use among older adults in a large healthcare system in Los Angeles, CA 2019-2020. J Am Geriatr Soc 2022; 70:1673-1684. [PMID: 35234291 DOI: 10.1111/jgs.17719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/18/2022] [Accepted: 01/26/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To describe the reported prevalence of cannabis use and co-use with prescription medications among older adult patients attending primary care (PC) clinics in Los Angeles, CA. METHODS We used electronic health record (EHR) data from sixty PC clinics part of a university-based, urban healthcare system. Patients' ≥50 years of age with an annual physical examination between July 2019 and May 2020 were eligible for inclusion (n = 42,555). Cannabis use was assessed by clinic staff at the time of the visit and recorded in the EHR. We also used EHR data on clinical characteristics including current prescriptions and comorbidities. RESULTS The median age was 63 years (range: 50-101) and 56% were female. Recent cannabis use was reported by 7.6%, which was higher than tobacco use (4.0%; p < 0.01). Prevalence of cannabis use was higher among patients prescribed psychotropic medications. For instance, 10.9% of patients prescribed benzodiazepines reported cannabis use as compared with 7.3% among patients without a prescription for benzodiazepines (p < 0.01). Patients with neurologic/musculoskeletal medications such as antiepileptics also had a higher prevalence of cannabis use when compared with those without these prescriptions (13.6% vs. 7.6% respectively; p < 0.01) as did those who were prescribed muscle relaxants (10.3% vs. 7.5% respectively; p < 0.01). After adjusting for age, sex, race/ethnicity, and comorbidities those prescribed medications for psychiatric (adjusted OR = 1.5; 95% CI 1.4-1.7), respiratory (adjusted OR = 1.2; 95% CI 1.1-1.3), or neurologic conditions (adjusted OR = 1.4; 95% CI 1.2-1.5) had increased odds of cannabis use compared with those not prescribed these medications. DISCUSSION The prevalence of cannabis use among older adults attending PC clinics in a university-based healthcare system was higher among those prescribed medications, which may interact with cannabis. These findings suggest that key groups of older patients who may benefit from routine PC screening for cannabis use and brief advice.
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Affiliation(s)
- Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Sae Takada
- Department of Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Whitney Akabike
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Steve Shoptaw
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Lillian Gelberg
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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21
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Hoeh NR, Menkes DB. Doctors' support of medical cannabis: an evidential rather than moral imperative. BMJ 2022; 376:o447. [PMID: 35228209 DOI: 10.1136/bmj.o447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nicholas R Hoeh
- Auckland Clinical Campus, University of Auckland, Auckland, New Zealand
| | - David B Menkes
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
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22
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Eddie D, Bergman BG, Hoffman LA, Kelly JF. Abstinence versus moderation recovery pathways following resolution of a substance use problem: Prevalence, predictors, and relationship to psychosocial well-being in a U.S. national sample. Alcohol Clin Exp Res 2022; 46:312-325. [PMID: 34931320 PMCID: PMC8858850 DOI: 10.1111/acer.14765] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Many people who report resolving an alcohol or other drug (AOD) problem continue some level of substance use. Little information exists, however, regarding the prevalence of this resolution pathway, or how continued substance use after resolving an AOD problem, relative to abstinence, relates to functioning, quality of life, and happiness (i.e., well-being). Greater knowledge of the prevalence and correlates of non-abstinent AOD problem resolution could inform public health messaging and clinical guidelines, while encouraging substance use goals likely to maximize well-being and reduce risks. METHODS We analyzed data from a nationally representative sample of individuals who endorsed having resolved an AOD problem (N = 2002). Analyses examined: (1) The prevalence of various substance use statuses coded from lowest to highest risk: (a) continuous abstinence from all AOD since problem resolution; (b) current abstinence from all AOD with some use since problem resolution; (c) current use of a substance reported as a secondary substance; (d) current use of the individual's primary substance only; or, (e) current use of a secondary and primary substance; (2) relationships between substance use status and demographic, clinical, and service use history measures; and (3) the relationship between substance use status and well-being. Weighted, controlled, regression analyses examined the influence of independent variables on substance use status. RESULTS (1) Prevalence: In this sample, 20.3% of patients endorsed continuous abstinence; 33.7% endorsed current abstinence; 21.0% endorsed current use of a secondary substance; 16.2% endorsed current use of a primary substance; and 8.8% endorsed current use of both a secondary and a primary substance. (2) Correlates: Lower-risk substance use status was associated with the initiation of regular substance use at an older age, more years since problem resolution, and fewer lifetime psychiatric diagnoses. (3) Well-Being: Controlling for pertinent confounds, lower-risk substance use status was independently associated with greater self-esteem, happiness, quality of life and functioning, and recovery capital, as well as less psychological distress. CONCLUSIONS About half of Americans who self-identify as having resolved an AOD problem continue to use AOD in some form. It appears that, although for many abstinence is not necessary to overcome an AOD problem, it is likely to lead to better functioning and greater well-being. Further, people appear to gravitate toward abstinence/lower risk substance use with greater time since problem resolution.
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Affiliation(s)
- David Eddie
- Recovery Research Institute Center for Addiction Medicine Massachusetts General HospitalHarvard Medical School Boston Massachusetts USA
| | - Brandon G. Bergman
- Recovery Research Institute Center for Addiction Medicine Massachusetts General HospitalHarvard Medical School Boston Massachusetts USA
| | - Lauren A. Hoffman
- Recovery Research Institute Center for Addiction Medicine Massachusetts General HospitalHarvard Medical School Boston Massachusetts USA
| | - John F. Kelly
- Recovery Research Institute Center for Addiction Medicine Massachusetts General HospitalHarvard Medical School Boston Massachusetts USA
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23
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Hirschtritt ME, Avalos LA, Sarovar V, Ridout KK, Goler NC, Ansley DR, Satre DD, Young-Wolff KC. Association Between Prenatal Cannabis Use and Psychotropic Medication Use in Pregnant Patients With Depression and Anxiety. J Addict Med 2022; 16:e269-e273. [PMID: 35020701 PMCID: PMC9271523 DOI: 10.1097/adm.0000000000000946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES This cross-sectional study examined associations between prenatal cannabis use and prescribed psychotropic medication use among pregnant patients with depression or anxiety in a large, integrated healthcare system. METHODS Study patients had a confirmed pregnancy and a depressive or anxiety disorder defined by International Classification of Diseases codes between 2012 and 2018 at Kaiser Permanente Northern California. Patients were screened for prenatal substance use via a self-reported questionnaire and urine toxicology test as part of standard prenatal care. Generalized estimating equation models tested for associations between prenatal cannabis use and any dispensation of antidepressants, benzodiazepines, and hypnotics during gestation. Models were stratified by diagnosis (depression or anxiety) and depression symptom severity. RESULTS This study included 35,047 pregnancies (32,278 patients; 17.6% aged <25 years, 48.1% non-Hispanic White). Adjusting for patient age, income, race/ethnicity, and depression symptom severity, the 12.6% of patients who screened positive for prenatal cannabis use demonstrated higher odds of prenatal benzodiazepine (adjusted odds ratios [aOR] = 1.40; 95% confidence interval [CI] = 1.20-1.62) and hypnotic (aOR = 1.28; 95% CI = 1.11-1.48), but not antidepressants (aOR = 1.05, 95% CI = 0.96-1.14) use. This pattern persisted when diagnostic groups were examined separately. The odds of prenatal benzodiazepine and hypnotic use associated with prenatal cannabis use were higher among pregnancies with severe depression symptom severity (31.8% of the sample). CONCLUSIONS Among pregnant patients with depression or anxiety, prenatal cannabis use was associated with higher odds of prenatal benzodiazepine and hypnotic use. As patients may be using cannabis to address depression and anxiety, prescribers should remain vigilant for under- or untreated psychiatric symptoms among pregnant patients and provide evidence-based treatments.
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Affiliation(s)
- Matthew E. Hirschtritt
- Division of Research, Kaiser Permanente Northern California; Oakland, CA, USA,Weill Institute for Neurosciences, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco; San Francisco, CA, USA,The Permanente Medical Group; Oakland, CA, USA
| | - Lyndsay A. Avalos
- Division of Research, Kaiser Permanente Northern California; Oakland, CA, USA
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California; Oakland, CA, USA
| | - Kathryn K. Ridout
- Division of Research, Kaiser Permanente Northern California; Oakland, CA, USA,The Permanente Medical Group; Santa Rosa, CA, USA
| | - Nancy C. Goler
- Regional Offices, Kaiser Permanente Northern California; Oakland, CA, USA
| | - Deborah R. Ansley
- Regional Offices, Kaiser Permanente Northern California; Oakland, CA, USA
| | - Derek D. Satre
- Division of Research, Kaiser Permanente Northern California; Oakland, CA, USA,Weill Institute for Neurosciences, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco; San Francisco, CA, USA
| | - Kelly C. Young-Wolff
- Division of Research, Kaiser Permanente Northern California; Oakland, CA, USA,Weill Institute for Neurosciences, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco; San Francisco, CA, USA
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24
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Sundström C, Edmonds M, Soucy JN, Titov N, Dear BF, Hadjistavropoulos HD. Alcohol and drug use among clients receiving internet-delivered cognitive behavior therapy for anxiety and depression in a routine care clinic - Demographics, use patterns, and prediction of treatment completion and outcomes. Internet Interv 2021; 27:100490. [PMID: 34987979 PMCID: PMC8693421 DOI: 10.1016/j.invent.2021.100490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 11/25/2021] [Accepted: 12/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Research shows that alcohol and drug use among mental health clients is common and has the potential to negatively impact treatment outcomes. Internet-delivered cognitive behavior therapy (ICBT) as a treatment for anxiety and depression is on the rise, but little is known about the prevalence of alcohol and drug use among clients and how this use affects treatment completion and outcomes. OBJECTIVE The objective of the current study was to explore the prevalence of alcohol and drug use among clients in ICBT for depression and anxiety, and to investigate the impact of alcohol and drug use on treatment completion and symptom outcomes. MATERIAL AND METHODS Data was collected from 1155 clients who participated in two randomized ICBT trials for depression and anxiety, conducted in a routine care clinic. Thirty-five individuals reporting severe substance use when applying to the trials were excluded. Demographic variables, and alcohol and drug use were measured at screening, and measures of depression and anxiety were administered at pre- and post-treatment. RESULTS Four out of five clients reported having used alcohol in the past year, while one in five reported having used drugs in the past year. Around a third of clients had reported either problematic alcohol use, drug problems, or both. The analyses showed that drug problems, and combined alcohol and drug problems were negatively associated with treatment completion, but neither alcohol nor drug use had an impact on depression and anxiety outcomes. CONCLUSIONS Alcohol and drug problems are likely to be present among a large proportion of patients using ICBT for anxiety and depression. This may not be a barrier to treatment benefit, at least when those with severe alcohol and drug problems have been excluded.
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Affiliation(s)
- Christopher Sundström
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden
- Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
- Corresponding author at: Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden.
| | - Michael Edmonds
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Joelle N. Soucy
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Nickolai Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
| | - Blake F. Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
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25
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Chmielowiec K, Chmielowiec J, Masiak J, Czekaj M, Krawczyk P, Soroka E, Śmiarowska M, Musiał W, Pawłowski T, Grzywacz A. DRD4 Exon 3 Gene Polymorphisms in Patients Diagnosed with Polysubstance Use Disorder and Co-Occurrence of a Depressive Episode. Genes (Basel) 2021; 12:genes12111834. [PMID: 34828440 PMCID: PMC8623079 DOI: 10.3390/genes12111834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 12/12/2022] Open
Abstract
Background: There has been a noticeable and systematic growth of the use of psychoactive substances over the past few decades. Dual diagnosis is a clinical term referring to the occurrence of psychoactive substance use disorder comorbid with another psychiatric disorder in the same person. The most common type of dual diagnosis is the co-occurrence of alcohol use disorder and mood disorders in the form of a depressive episode. Co-occurrent substance use disorders are frequently influenced by genetic factors. In selecting our area of research, we focused on dopamine and the DRD4 (Dopamine Receptor D4) gene polymorphism as well as associations with personality features. The aim of the study: The aim of the study was to compare DRD4 exon 3 (DRD4 Ex3) gene polymorphisms in patients diagnosed with polysubstance use disorder and co-occurrence of a depressive episode to DRD4 exon 3 gene polymorphisms in patients diagnosed with polysubstance use disorder and without co-occurrence of a depressive episode and a group of healthy volunteers. The study also aimed at establishing associations between personality features and DRD4 exon 3 gene polymorphisms of male patients diagnosed with polysubstance use disorder with co-occurrence of a depressive episode which may present a specific endophenotype of this group of patients. Methods: The study group comprised 602 male volunteers: patients diagnosed with polysubstance use disorder comorbid with a depressive episode (PUD MDD) (n = 95; mean age = 28.29, standard deviation (SD) = 7.40), patients diagnosed with polysubstance use disorder (PUD) (n = 206; mean age = 28.13, SD = 5.97), and controls (n = 301; mean age = 22.13, SD = 4.57). The patients and control subjects were diagnosed by a psychiatrist using the Mini International Neuropsychiatric Interview (MINI), the NEO Five-Factor Personality Inventory (NEO-FFI), and the State-Trait Anxiety Inventory (STAI) questionnaires. An analysis of the DRD4 exon 3 polymorphism was performed. Results: The patients diagnosed with PUD MDD compared to the control group of healthy volunteers showed significantly higher scores on both the STAI status and features scale and the NEO-FFI Neuroticism and Openness Scale, as well as lower scores on the Extraversion, Agreeableness, and Conscientiousness NEO-FFI scales. In the DRD4 exon 3 gene polymorphism, the s allele was more frequent in the PUD MDD compared to the l allele, which was less frequent. The results of the 2 × 3 factor analysis of variance (ANOVA) in patients and controls and the variant DRD4 exon 3 interaction were found on the Extraversion Scale and the Conscientiousness Scale of the NEO-FFI. Conclusions: The associations show that psychological factors combined with genetic data create a new area of research on addiction, including the problem of dual diagnosis. However, we want to be careful and draw no definite conclusions at this stage of our research.
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Affiliation(s)
- Krzysztof Chmielowiec
- Department of Hygiene and Epidemiology, Collegium Medicum, University of Zielona Góra, 28 Zyty St., 65-046 Zielona Góra, Poland; (K.C.); (J.C.)
| | - Jolanta Chmielowiec
- Department of Hygiene and Epidemiology, Collegium Medicum, University of Zielona Góra, 28 Zyty St., 65-046 Zielona Góra, Poland; (K.C.); (J.C.)
| | - Jolanta Masiak
- Second Department of Psychiatry and Psychiatric Rehabilitation, Medical University of Lublin, 1 Głuska St., 20-059 Lublin, Poland; (J.M.); (E.S.)
| | - Małgorzata Czekaj
- Department of Nervous System Diseases, Orthopedics, Traumatology and Oncology of the Locomotor System, Collegium Medicum, University of Zielona Góra, 28 Zyty St., 65-046 Zielona Góra, Poland; (M.C.); (P.K.); (W.M.)
| | - Piotr Krawczyk
- Department of Nervous System Diseases, Orthopedics, Traumatology and Oncology of the Locomotor System, Collegium Medicum, University of Zielona Góra, 28 Zyty St., 65-046 Zielona Góra, Poland; (M.C.); (P.K.); (W.M.)
| | - Ewelina Soroka
- Second Department of Psychiatry and Psychiatric Rehabilitation, Medical University of Lublin, 1 Głuska St., 20-059 Lublin, Poland; (J.M.); (E.S.)
| | - Małgorzata Śmiarowska
- Department of Pharmacokinetics and Therapeutic Drug Monitoring, Pomeranian Medical University, Aleja Powstancόw Wlkp. 72 St., 70-111 Szczecin, Poland;
| | - Wojciech Musiał
- Department of Nervous System Diseases, Orthopedics, Traumatology and Oncology of the Locomotor System, Collegium Medicum, University of Zielona Góra, 28 Zyty St., 65-046 Zielona Góra, Poland; (M.C.); (P.K.); (W.M.)
| | - Tomasz Pawłowski
- Division of Psychotherapy and Psychosomatic Medicine, Wroclaw Medical University, Wyb. L. Pasteura 10 St., 50-367 Wroclaw, Poland;
| | - Anna Grzywacz
- Independent Laboratory of Health Promotion, Pomeranian Medical University in Szczecin, 11 Chlapowskiego St., 70-204 Szczecin, Poland
- Correspondence: ; Tel.: +48-91441-47-46
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26
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Crook CL, Savin MJ, Byrd D, Summers AC, Guzman VA, Morris EP, Tureson K, Aghvinian M, Cham H, Mindt MR. The neurocognitive effects of a past cannabis use disorder in a diverse sample of people living with HIV. AIDS Care 2021; 33:1482-1491. [PMID: 32951441 PMCID: PMC10310357 DOI: 10.1080/09540121.2020.1822504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 09/07/2020] [Indexed: 12/11/2022]
Abstract
People living with HIV (PLWH) report higher rates of cannabis use than the general population, a trend likely to continue in light of recent policy changes and the reported therapeutic benefits of cannabis for PLWH. Therefore, it is important to better understand cannabis-associated effects on neurocognition, especially as PLWH are at heightened risk for neurocognitive impairment. This study aimed to elucidate the effects of a past cannabis use disorder on current neurocognition in a diverse sample of PLWH. This cross-sectional study included 138 PLWH (age M(SD) = 47.28(8.06); education M(SD) = 12.64(2.73); 73% Male; 71% Latinx) who underwent neuropsychological, DSM-diagnostic, and urine toxicology evaluations. One-way ANCOVAs were conducted to examine effects of a past cannabis use disorder (CUD+) on tests of attention/working memory, processing speed, executive functioning, verbal fluency, learning, memory, and motor ability. Compared to the past CUD- group, the past CUD+ group performed significantly better on tests of processing speed, visual learning and memory, and motor ability (p's < .05). Findings suggest PLWH with past cannabis use have similar or better neurocognition across domains compared to PLWH without past use.
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Affiliation(s)
- Cara L Crook
- Department of Psychology, Fordham University, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Micah J Savin
- Department of Psychology, Fordham University, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Desiree Byrd
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Queens College and The Graduate Center, CUNY, Queens, NY, USA
| | - Angela C Summers
- Department of Psychology, Fordham University, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vanessa A Guzman
- Department of Psychology, Fordham University, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily P Morris
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Kayla Tureson
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Maral Aghvinian
- Department of Psychology, Fordham University, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Heining Cham
- Department of Psychology, Fordham University, New York, NY, USA
| | - Monica Rivera Mindt
- Department of Psychology, Fordham University, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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27
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Kancherla N, Jeyanthi KM, Abbas R, Sathi TSCR, Upadhyay A, Garlapati SKP. Cannabis Associated Mental Health Effects: A Review. J Pharm Bioallied Sci 2021; 13:S943-S946. [PMID: 35017903 PMCID: PMC8686926 DOI: 10.4103/jpbs.jpbs_388_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 05/20/2021] [Accepted: 05/28/2021] [Indexed: 12/24/2022] Open
Abstract
According to the latest drift in Western countries, many lawmakers are trying to formulate policy to legalize the usage of Cannabis in the case of mentally vulnerable populations such as those suffering from depression, paranoia, and excessive anxiety. This particular trend has been due to short term success in the case of mood upliftment. Cannabis derivatives produce effects on both mood and cognitive function, which can be a double-edged sword if not followed with proper dosage. Beneficial effects, however, are limited and studies documenting those and even more meagre. Detrimental effects, especially those suffering from various hallucinating and delusional states, have been reported extensively in the literature. Here in the review article, we have tried to study and summarize various effects of Cannabis as well as Cannabis -derived products in the case of people who have various mental conditions. We have also tried to consider addiction to these substances and hence develop a framework for proper utilization of Cannabis in mentally ill people. Many clinicians are also in a dilemma when prescribing a Cannabis -based product to treat psychotic and mood-based disorders. Hence, a better understanding of the process of Cannabis -based treatment for the vulnerable population is necessary.
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Affiliation(s)
- Neeraj Kancherla
- Department of Psychiatry, King George Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Keerthana Mani Jeyanthi
- Department of Internal Medicine, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, India
| | - Ramsha Abbas
- Department of internal Medicine, Shifa College of Medicine, Islamabad, Pakistan
| | | | - Amrita Upadhyay
- Department of Internal Medicine, Nobel Medical College Teaching Hospital, Morang, Nepal
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29
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Langlois C, Potvin S, Khullar A, Tourjman SV. Down and High: Reflections Regarding Depression and Cannabis. Front Psychiatry 2021; 12:625158. [PMID: 34054594 PMCID: PMC8160288 DOI: 10.3389/fpsyt.2021.625158] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/15/2021] [Indexed: 12/20/2022] Open
Abstract
In light of the recent changes in the legal status of cannabis in Canada, the understanding of the potential impact of the use of cannabis by individuals suffering from depression is increasingly considered as being important. It is fundamental that we look into the existing literature to examine the influence of cannabis on psychiatric conditions, including mood disorders. In this article, we will explore the relationship that exists between depression and cannabis. We will examine the impact of cannabis on the onset and course of depression, and its treatment. We have undertaken a wide-ranging review of the literature in order to address these questions. The evidence from longitudinal studies suggest that there is a bidirectional relationship between cannabis use and depression, such that cannabis use increases the risk for depression and vice-versa. This risk is possibly higher in heavy users having initiated their consumption in early adolescence. Clinical evidence also suggests that cannabis use is associated with a worse prognosis in individuals with major depressive disorder. The link with suicide remains controversial. Moreover, there is insufficient data to determine the impact of cannabis use on cognition in individuals with major depression disorder. Preliminary evidence suggesting that the endogenous cannabinoid system is involved in the pathophysiology of depression. This will need to be confirmed in future positron emission tomography studies. Randomized controlled trials are needed to investigate the potential efficacy of motivational interviewing and/or cognitive behavioral therapy for the treatment of cannabis use disorder in individuals with major depressive major disorder. Finally, although there is preclinical evidence suggesting that cannabidiol has antidepressant properties, randomized controlled trials will need to properly investigate this possibility in humans.
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Affiliation(s)
| | - Stéphane Potvin
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
| | - Atul Khullar
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Smadar Valérie Tourjman
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
- Department of Psychiatry, Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
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30
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Milam J, Miller KA, Hoyt MA, Ritt-Olson A. Is substance use among young cancer survivors the result of emotional and physical pain? Cancer 2021; 127:3064-3066. [PMID: 33974727 DOI: 10.1002/cncr.33633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Joel Milam
- Department of Epidemiology and Biostatistics, Department of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, California
| | - Kimberly A Miller
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Michael A Hoyt
- Department of Population Health and Disease Prevention and the Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, California
| | - Anamara Ritt-Olson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
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31
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Choi NG, DiNitto DM. Comparing older nonmedical and medical cannabis users: health-related characteristics, cannabis use patterns, and cannabis sources. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:612-622. [PMID: 33915068 DOI: 10.1080/00952990.2021.1908318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: US epidemiologic data show that nearly one in 10 individuals aged 50+ report past-year cannabis use, and nearly one in five users report medical use. However, research on older cannabis users, especially medical cannabis users, is scant.Objectives: We examined medical and nonmedical cannabis users aged 50+ on health-related characteristics, cannabis use patterns, and cannabis sources. Hypotheses were that compared to nonmedical users, medical users are more likely to have physical and mental health problems, use healthcare services, discuss their drug use with a healthcare professional, use cannabis more frequently, and purchase cannabis from a medical dispensary and other sources rather than obtain it as a gift, share someone else's, or use other means.Methods: We used 2018 and 2019 National Survey on Drug Use and Health data (N = 17,685 aged 50+; male = 8,030; female = 9,655). Hypotheses were tested using logistic regression analysis.Results: The past-year cannabis use rate was 8.9%. Of past-year users, 18.5% reported medical use. Compared to nonmedical use, medical use was associated with lower odds of alcohol use disorder but higher odds of discussing drug use with a healthcare professional (AOR = 4.18, 95% CI = 2.53-6.89), high-frequency use (e.g., AOR = 2.56, 95% CI = 1.35-4.86 for 200-365 days), and purchase at a medical cannabis dispensary (AOR = 4.38, 95% CI = 2.47-7.76).Conclusion: Medical and nonmedical users did not differ on physical and most behavioral health indicators. Most obtained cannabis from private/informal sources. Some medical users are likely to self-treat without healthcare professional consultation. Healthcare professionals should engage older adults in discussions of cannabis use and behavioral health needs.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Diana M DiNitto
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
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Fontanella CA, Steelesmith DL, Brock G, Bridge JA, Campo JV, Fristad MA. Association of Cannabis Use With Self-harm and Mortality Risk Among Youths With Mood Disorders. JAMA Pediatr 2021; 175:377-384. [PMID: 33464286 PMCID: PMC7816117 DOI: 10.1001/jamapediatrics.2020.5494] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022]
Abstract
Importance Cannabis use and cannabis use disorder (CUD) are common among youths and young adults with mood disorders, but the association of CUD with self-harm, suicide, and overall mortality risk is poorly understood in this already vulnerable population. Objective To examine associations of CUD with self-harm, suicide, and overall mortality risk in youths with mood disorders. Design, Setting, and Participants A population-based retrospective cohort study was performed using Ohio Medicaid claims data linked with death certificate data. The analysis included 204 780 youths (aged 10-24 years) with a diagnosis of mood disorders between July 1, 2010, and December 31, 2017, who were followed up to 365 days from the index diagnostic claim until the end of enrollment, the self-harm event, or death. Statistical analysis was performed from April 4 to July 17, 2020. Exposure Physician-diagnosed CUD defined using outpatient and inpatient claims from 180 days prior to the index mood disorder diagnostic claim through the 365-day follow-up period. Main Outcomes and Measures Nonfatal self-harm, all-cause mortality, and deaths by suicide, unintentional overdose, motor vehicle crashes, and homicide. Marginal structural models using inverse probability weights examined associations between CUD and outcomes. Results This study included 204 780 youths (133 081 female participants [65.0%]; mean [SD] age at the time of mood disorder diagnosis, 17.2 [4.10] years). Cannabis use disorder was documented for 10.3% of youths with mood disorders (n = 21 040) and was significantly associated with older age (14-18 years vs 10-13 years: adjusted risk ratio [ARR], 9.35; 95% CI, 8.57-10.19; and 19-24 years vs 10-13 years: ARR, 11.22; 95% CI, 10.27-12.26), male sex (ARR, 1.79; 95% CI, 1.74-1.84), Black race (ARR, 1.39; 95% CI, 1.35-1.44), bipolar or other mood disorders (bipolar disorders: ARR, 1.24; 95% CI, 1.21-1.29; other mood disorders: ARR, 1.20; 95% CI, 1.15-1.25), prior history of self-harm (ARR, 1.66; 95% CI, 1.52-1.82), previous mental health outpatient visits (ARR, 1.26; 95% CI, 1.22-1.30), psychiatric hospitalizations (ARR, 1.66; 95% CI, 1.57-1.76), and mental health emergency department visits (ARR, 1.54; 95% CI, 1.47-1.61). Cannabis use disorder was significantly associated with nonfatal self-harm (adjusted hazard ratio [AHR], 3.28; 95% CI, 2.55-4.22) and all-cause mortality (AHR, 1.59; 95% CI, 1.13-2.24), including death by unintentional overdose (AHR, 2.40; 95% CI, 1.39-4.16) and homicide (AHR, 3.23; 95% CI, 1.22-8.59). Although CUD was associated with suicide in the unadjusted model, it was not significantly associated in adjusted models. Conclusions and Relevance Cannabis use disorder is a common comorbidity and risk marker for self-harm, all-cause mortality, and death by unintentional overdose and homicide among youths with mood disorders. These findings should be considered as states contemplate legalizing medical and recreational marijuana, both of which are associated with increased CUD.
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Affiliation(s)
- Cynthia A. Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
| | - Danielle L. Steelesmith
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
| | - Guy Brock
- Department of Biomedical Informatics, The Ohio State University, Columbus
| | - Jeffrey A. Bridge
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
| | - John V. Campo
- Rockefeller Neuroscience Institute, Behavioral Medicine and Psychiatry, West Virginia University, Morgantown
| | - Mary A. Fristad
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
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Petersen MJ, Bergien SO, Staerk D. A systematic review of possible interactions for herbal medicines and dietary supplements used concomitantly with disease-modifying or symptom-alleviating multiple sclerosis drugs. Phytother Res 2021; 35:3610-3631. [PMID: 33624893 DOI: 10.1002/ptr.7050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/18/2022]
Abstract
Multiple Sclerosis (MS) is a demyelinating disease affecting the central nervous system, with no curative medicine available. The use of herbal drugs and dietary supplements is increasing among people with MS (PwMS), raising a need for knowledge about potential interactions between conventional MS medicine and herbal drugs/dietary supplements. This systematic review provides information about the safety of simultaneous use of conventional MS-drugs and herbal drugs frequently used by PwMS. The study included 14 selected disease-modifying treatments and drugs frequently used for symptom-alleviation. A total of 129 published papers found via PubMed and Web of Science were reviewed according to defined inclusion- and exclusion criteria. Findings suggested that daily recommended doses of Panax ginseng and Ginkgo biloba should not be exceeded, and herbal preparations differing from standardized products should be avoided, especially when combined with anticoagulants or substrates of certain cytochrome P450 isoforms. Further studies are required regarding ginseng's ability to increase aspirin bioavailability. Combinations between chronic cannabis use and selective serotonin reuptake inhibitors or non-steroidal antiinflammatory drugs should be carefully monitored, whereas no significant evidence for drug-interactions between conventional MS-drugs and ginger, cranberry, vitamin D, fatty acids, turmeric, probiotics or glucosamine was found.
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Affiliation(s)
- Malene J Petersen
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Dan Staerk
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Li J, Zhang Y, Zhou Y, Feng XS. Cannabinoids: Recent Updates on Public Perception, Adverse Reactions, Pharmacokinetics, Pretreatment Methods and Their Analysis Methods. Crit Rev Anal Chem 2021; 52:1197-1222. [PMID: 33557608 DOI: 10.1080/10408347.2020.1864718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cannabinoids (CBDs) have been traditionally used as a folk medicine. Recently, they have been found to exhibit a high pharmacological potential. However, they are addicted and are often abused by drug users, thereby, becoming a threat to public safety. CBDs and their metabolites are usually found in trace levels in plants or in biological matrices and, are therefore not easy to be detected. Advances have been made toward accurately analyzing CBDs in plants or in biological matrices. This review aims at elucidating on the consumption of CBDs as well as its adverse effects and to provide a comprehensive overview of CBD pretreatment and detection methods. Moreover, novel pretreatment methods such as microextraction, Quick Easy Cheap Effective Rugged Safe and online technology as well as novel analytic methods such as ion-mobility mass spectrometry, application of high resolution mass spectrometry in nontarget screening are summarized. In addition, we discuss and compare the strengths and weaknesses of different methods and suggest their future prospect.
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Affiliation(s)
- Jie Li
- School of Pharmacy, China Medical University, Shenyang, China
| | - Yuan Zhang
- School of Pharmacy, China Medical University, Shenyang, China
| | - Yu Zhou
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue-Song Feng
- School of Pharmacy, China Medical University, Shenyang, China
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Hasin D, Walsh C. Cannabis Use, Cannabis Use Disorder, and Comorbid Psychiatric Illness: A Narrative Review. J Clin Med 2020; 10:E15. [PMID: 33374666 PMCID: PMC7793504 DOI: 10.3390/jcm10010015] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/10/2020] [Accepted: 12/19/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The landscape of attitudes, legal status and patterns of use of cannabis is rapidly changing in the United States and elsewhere. Therefore, the primary aim of this narrative review is to provide a concise overview of the literature on the comorbidity of cannabis use and cannabis use disorder (CUD) with other substance use and psychiatric disorders, and to use this information to accurately guide future directions for the field. METHODS A literature review of PubMed was conducted for studies relating to cannabis use, CUD, and a co-occurring psychiatric disorder. To provide an overview of representative data, the literature review focused on national-level, population-based work from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and National Survey on Drug Use and Health (NSDUH) surveys. Considering rapidly changing cannabis laws, recent (past five-year) studies were addressed. RESULTS A strong body of literature shows associations between cannabis use and CUD with other drug use, psychosis, mood disorders, anxiety disorders, and personality disorders. The strongest evidence of a potential causal relationship exists between cannabis use and psychotic disorders. While some evidence shows potential directionality between cannabis use and mood and anxiety disorders, results are inconsistent. Studies have established higher rates of CUD among those with personality disorders, but little about the specifics of this relationship is understood. CONCLUSIONS Although the general population in the United States increasingly perceives cannabis to be a harmless substance, empirical evidence shows that cannabis use is associated both with CUD and comorbid psychiatric illness. However, there is mixed evidence regarding the role of cannabis in the etiology, course, and prognosis of a co-occurring disorder across all categories of psychiatric disorders. Future research should expand on the existing body of literature with representative, longitudinal data, in order to better understand the acute and long-term effects of cannabis on comorbid psychiatric illness.
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Affiliation(s)
- Deborah Hasin
- New York State Psychiatric Institute, New York, NY 10032, USA;
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY 10032, USA
| | - Claire Walsh
- New York State Psychiatric Institute, New York, NY 10032, USA;
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Vidot DC, Islam JY, Marlene Camacho-Rivera, Harrell MB, Rao DR, Chavez JV, Lucas G Ochoa, Hlaing WM, Weiner M, Messiah SE. The COVID-19 cannabis health study: Results from an epidemiologic assessment of adults who use cannabis for medicinal reasons in the United States. J Addict Dis 2020; 39:26-36. [PMID: 32933383 DOI: 10.1080/10550887.2020.1811455] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Clinical indications for medicinal cannabis include chronic conditions; thus users (MCUs) are at an increased risk of morbidity and mortality resulting from SARS-CoV-2 infection (COVID-19). The study aimed to provide data on cannabis use and self-reported behavioral changes among MCUs with preexisting chronic conditions in response to the pandemic.Methods: An internet-based questionnaire was administered to adults ≥18 who self-reported medicinal cannabis use within the past year. Data are from respondents between March 21 and April 23, 2020; response rate was 83.3%. Health conditions and cannabis frequency, route, and patterns of use were assessed via the COVID-19 Cannabis Health Questionnaire (Vidot et al. 2020).Results: Participants (N = 1202) were predominantly non-Hispanic white (82.5%) and 52.0% male (mean age 47.2 years). Mental health (76.7%), pain (43.7%), cardiometabolic (32.9%), respiratory (16.8%), and autoimmune (12.2%) conditions were most reported. Those with mental health conditions reported increased medicinal cannabis use by 91% since COVID-19 was declared a pandemic compared to those with no mental health conditions (adjusted odds ratio: 1.91, 95% CI: 1.38-2.65). 6.8% reported suspected COVID-19 symptoms. Two percent (2.1%) have been tested for COVID-19 with only 1 positive test result. Some MCUs (16%) changed their route of cannabis administration, switching to nonsmoking forms.Conclusions: The majority of MCUs reported at least one preexisting chronic health condition. Over half report fear of COVID-19 diagnosis and giving the virus to someone else; yet only some switched from smoking to nonsmoking forms of cannabis. Clinicians may consider asking about cannabis use among their patients, particularly those with chronic health conditions.
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Affiliation(s)
- Denise C Vidot
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA.,Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jessica Y Islam
- Lineberger Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Devika R Rao
- Division of Respiratory Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer V Chavez
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Lucas G Ochoa
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - WayWay M Hlaing
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Michelle Weiner
- College of Osteopathic Medicine, Nova Southeastern University, Davie, FL, USA
| | - Sarah E Messiah
- University of Texas Health Science Center School of Public Health, Dallas Campus, Dallas, TX, USA.,Center for Pediatric Population Health, UT Health School of Public Health and Children's Health System of Texas, Dallas, TX, USA
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Garey L, Olofsson H, Garza T, Rogers AH, Kauffman BY, Zvolensky MJ. Directional Effects of Anxiety and Depressive Disorders with Substance Use: a Review of Recent Prospective Research. CURRENT ADDICTION REPORTS 2020. [DOI: 10.1007/s40429-020-00321-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Gorfinkel LR, Stohl M, Hasin D. Association of Depression With Past-Month Cannabis Use Among US Adults Aged 20 to 59 Years, 2005 to 2016. JAMA Netw Open 2020; 3:e2013802. [PMID: 32809032 PMCID: PMC7435337 DOI: 10.1001/jamanetworkopen.2020.13802] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Despite studies showing that repeated cannabis use may worsen depressive symptoms, the popular media increasingly presents cannabis as beneficial to mental health, and many members of the public view cannabis as beneficial for depression. Therefore, cannabis use among individuals with depression may be becoming more prevalent. OBJECTIVE To examine the association of depression with past-month cannabis use among US adults and the time trends for this association from 2005 to 2016. DESIGN, SETTING, AND PARTICIPANTS This repeated cross-sectional study used data from 16 216 adults aged 20 to 59 years who were surveyed by the National Health and Nutrition Examination Survey, a national, annual, cross-sectional survey in the United States, between 2005 and 2016. Data analysis was conducted from January to February 2020. EXPOSURES Survey year and depression, as indicated by a score of at least 10 on the Patient Health Questionnaire-9. MAIN OUTCOMES AND MEASURES Any past-month cannabis use (ie, ≥1 use in the past 30 days) and daily or near-daily past-month cannabis use (ie, ≥20 uses in the past 30 days). Logistic regression was used to examine time trends in the prevalence of cannabis use, depression, and the association between cannabis use and depression from 2005 to 2016. RESULTS The final analysis included 16 216 adults, of whom 7768 (weighted percentage, 48.9%) were men, 6809 (weighted percentage, 66.4%) were non-Hispanic White participants, and 9494 (weighted percentage, 65.6%) had at least some college education. They had a weighted mean age of 39.12 (95% CI, 38.23-39.40) years. Individuals with depression had 1.90 (95% CI, 1.62-2.24) times the odds of any past-month cannabis use and 2.29 (95% CI, 1.80-2.92) times the odds of daily or near-daily cannabis use compared with those without depression. The association between cannabis use and depression increased significantly from 2005 to 2016. The odds ratio for depression and any past-month cannabis use increased from 1.46 (95% CI, 1.07-1.99) in 2005 to 2006 to 2.30 (95% CI, 1.82-2.91) in 2015 to 2016. The odds ratio for depression and daily or near-daily past-month cannabis use increased from 1.37 (95% CI, 0.81-2.32) in 2005 to 2006 to 3.16 (95% CI, 2.23-4.48) in 2015 to 2016. CONCLUSIONS AND RELEVANCE The findings of this study indicate that individuals with depression are at increasing risk of cannabis use, with a particularly strong increase in daily or near-daily cannabis use. Clinicians should be aware of these trends and the evidence that cannabis does not treat depression effectively when discussing cannabis use with patients.
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Affiliation(s)
- Lauren R. Gorfinkel
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- New York State Psychiatric Institute, New York
| | - Malki Stohl
- New York State Psychiatric Institute, New York
| | - Deborah Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- New York State Psychiatric Institute, New York
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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Round JM, Lee C, Hanlon JG, Hyshka E, Dyck JRB, Eurich DT. Changes in patient health questionnaire (PHQ-9) scores in adults with medical authorization for cannabis. BMC Public Health 2020; 20:987. [PMID: 32576158 PMCID: PMC7310462 DOI: 10.1186/s12889-020-09089-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
Background Legal access to medical cannabis is increasing world-wide. Despite this, there is a lack of evidence surrounding its efficacy on mental health outcomes, particularly, on depression. This study assesses the effect of medical cannabis on Patient Health Questionnaire (PHQ-9) scores in adult patients between 2014 and 2019 in Ontario and Alberta, Canada. Methods An observational cohort study of medically authorized cannabis patients in Ontario and Alberta. Overall change in PHQ-9 scores from baseline to follow-up were evaluated (mean change) over a time period of up to 3.2 years. Results 37,338 patients from the cohort had an initial PHQ-9 score recorded with 5103 (13.7%) patients having follow-up PHQ-9 scores. The average age was 54 yrs. (SD 15.7), 46% male, 50% noted depression at baseline. The average PHQ-9 score at baseline was 10.5 (SD 6.9), following a median follow-up time of 196 days (IQR: 77–451) the average final PHQ-9 score was 10.3 (SD 6.8) with a mean change of − 0.20 (95% CI: − 0.26, − 0.14, p-value < 0.0001). Overall, 4855 (95.1%) had no clinically significant change in their PHQ-9 score following medical cannabis use while 172 (3.4%) reported improvement and 76 (1.5%) reported worsening of their depression symptoms. Conclusions Although the majority showed no clinically important changes in PHQ-9 scores, a number of patients showed improvement or deteriorations in PHQ-9 scores. Future studies should focus on the parallel use of screening questionnaires to control for PHQ-9 sensitivity and to explore potential factors that may have attributed to the improvement in scores pre- and post- 3-6 month time period.
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Affiliation(s)
- Jessica M Round
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Cerina Lee
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - John G Hanlon
- St. Michael's Hospital Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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Spechler PA, Stewart JL, Kuplicki R, Paulus MP. Attenuated reward activations associated with cannabis use in anxious/depressed individuals. Transl Psychiatry 2020; 10:189. [PMID: 32541777 PMCID: PMC7295993 DOI: 10.1038/s41398-020-0807-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/26/2020] [Accepted: 04/01/2020] [Indexed: 11/17/2022] Open
Abstract
Individuals with mood/anxiety disorders may use cannabis for "self-medication," i.e., to induce positive mood or attenuate aversive mood states. However, little neurobiological evidence supports such use. The goal of this investigation was to test the hypothesis that cannabis use attenuates striatal response to reward in those with mood/anxiety disorders. Reward-related processing was measured using a monetary incentive delay task under functional MRI. Individuals with any lifetime mood/anxiety disorder diagnoses and problematic cannabis use ("Mood/Anxiety+CB"; n = 41) were compared with a propensity score-matched group of similar subjects without cannabis use ("Mood/Anxiety-CB"; n = 41), and a cannabis-naïve healthy control group (n = 35). Activations during win- and loss-anticipations were extracted from bilateral nucleus accumbens, dorsal caudate, and dorsolateral putamen. Mixed models were estimated for each region separately for win- and loss-anticipations, with a test for the main effect of group, condition (e.g., high-win, low-win, neutral), and their interaction. A significant main effect of group for win- and loss-anticipation was observed for each striatal region. Specifically, the Mood/Anxiety+CB group exhibited the lowest striatal activations across condition levels relative to both the Mood/Anxiety-CB and healthy group. A significant group-by-condition interaction was only observed for the dorsolateral putamen and indicated divergent activation modulation as a function of win and loss-magnitude for Mood/Anxiety+CB subjects. Finally, individuals with heavier recent cannabis use showed greater attenuation of gain-related activation in all three striatal regions. There was no such relationship for other illicit drugs. These data support the hypothesis that cannabis use in individuals with mood/anxiety disorders is associated with attenuated brain processing of reward magnitude, which may contribute to persistent affective symptoms.
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Affiliation(s)
- Philip A. Spechler
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655S. Yale Ave, Tulsa, OK 74136 USA
| | | | - Rayus Kuplicki
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655S. Yale Ave, Tulsa, OK 74136 USA
| | | | - Martin P. Paulus
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655S. Yale Ave, Tulsa, OK 74136 USA ,grid.267360.60000 0001 2160 264XUniversity of Tulsa, Tulsa, OK USA
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41
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Pacek LR, Weinberger AH, Zhu J, Goodwin RD. Rapid increase in the prevalence of cannabis use among people with depression in the United States, 2005-17: the role of differentially changing risk perceptions. Addiction 2020; 115:935-943. [PMID: 31797462 PMCID: PMC7156311 DOI: 10.1111/add.14883] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/29/2019] [Accepted: 10/29/2019] [Indexed: 12/21/2022]
Abstract
AIMS To estimate trends in the prevalence of cannabis use and risk perceptions of cannabis use from 2005 to 2017 among United States people with and without depression. DESIGN Linear time trends of the prevalence of any, daily and non-daily past 30-day cannabis use and perceived great risk associated with regular cannabis use (outcome variables) among people with and without past-year depression were assessed using logistic regression with survey year as the predictor. All analyses were adjusted for gender, age, race/ethnicity and income; models assessing time trends of cannabis use prevalence were also adjusted for perceived risk. SETTING The United States: National Survey on Drug Use and Health, an annual cross-sectional survey, 2005-17 public use data files. PARTICIPANTS A total of 728 691 people aged ≥ 12 years. MEASUREMENTS Self-report of any, daily and non-daily past 30-day cannabis use and perceived great risk associated with regular cannabis use. FINDINGS The prevalence of any, daily and non-daily cannabis use in the past month was higher among those with depression versus those without [e.g. 2017 for any use: 18.94 versus 8.67%; adjusted odds ratio (aOR) = 2.17 (95% confidence interval (CI) = 1.92, 2.45)]. Any, daily and non-daily cannabis use increased among people with and without depression from 2005 to 2017, yet the increase in any (aORs = 1.06 versus 1.05; P = 0.008) and daily (aORs = 1.10 versus 1.07; P = 0.021) cannabis use adjusted for socio-demographic characteristics was more rapid among those with depression. Perception of great risk associated with regular cannabis use was significantly lower among those with depression (P < 0.001) and decreased significantly more rapidly over the study period among people with depression, compared with those without (aORs = 0.89 versus 0.92; P < 0.001). CONCLUSIONS The prevalence of cannabis use in the United States increased from 2005 to 2017 among people with and without depression and was approximately twice as common among those with depression. People with depression experienced a more rapid decrease in perception of risk, which may be related to the more rapid increase in any and daily past-month cannabis use in this group.
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Affiliation(s)
- Lauren R. Pacek
- Department of Psychiatry and Behavioral Sciences, Duke School of Medicine, Durham, NC, USA 27705
| | - Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA 10461,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA 10461
| | - Jiaqi Zhu
- Institute for Implementation Science in Population Health, The City University of New York, New York, NY, USA 10027
| | - Renee D. Goodwin
- Institute for Implementation Science in Population Health, The City University of New York, New York, NY, USA 10027,Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA 10027,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA 10032
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Rush AJ, Thase ME. Improving Depression Outcome by Patient-Centered Medical Management. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:244-254. [PMID: 33343242 DOI: 10.1176/appi.focus.18207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/30/2018] [Accepted: 06/11/2018] [Indexed: 12/01/2022]
Abstract
(Reprinted with permission from The American Journal of Psychiatry 2018; 175:1187-1198).
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Affiliation(s)
- A John Rush
- Duke-National University of Singapore Graduate Medical School, Singapore; the Department of Psychiatry, Duke University Medical School, Durham, N.C.; the Department of Psychiatry, Texas Tech Health Sciences Center-Permian Basin, Midland-Odessa; the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia
| | - Michael E Thase
- Duke-National University of Singapore Graduate Medical School, Singapore; the Department of Psychiatry, Duke University Medical School, Durham, N.C.; the Department of Psychiatry, Texas Tech Health Sciences Center-Permian Basin, Midland-Odessa; the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia
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Sex differences in bipolar disorder: Impact of lifetime cannabis use on clinical course, functioning, and quality of life in bipolar disorder. J Affect Disord 2020; 266:258-262. [PMID: 32056886 DOI: 10.1016/j.jad.2020.01.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/26/2019] [Accepted: 01/12/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cannabis use is markedly prevalent among patients with bipolar disorder (BD). However, to date, there have been no studies on this issue with a sex-based approach. This study examines if lifetime cannabis use (LCU) is differently associated with clinical course, functioning, and quality of life (QoL) in patients with BD by sex. METHODS Secondary analysis of a cross-sectional, naturalistic, multicentre study. LCU was defined as having had at least one day of use per month for at least 12 consecutive months in a patient's life. RESULTS A total of 224 patients with BD were included (65.2% women). Patients with LCU were younger (p = 0.001) and had their first hospitalization earlier (p<0.005) than those without LCU, regardless of sex. Among women, LCU was associated with being single (p = 0.006), worse sexual functioning (p = 0.006), financial functioning (p = 0.009), QoL [bodily pain (p = 0.009), vitality (p = 0.027), social functioning (p = 0.037), emotional role (p = 0.038), mental health (p = 0.001), and mental summary component (p = 0.012)]. After controlling for confounders, among women, LCU was associated with worse QoL, specifically on bodily pain (p = 0.049) and mental health (p = 0.016) subscales. Among males, no statistically significant differences were found between LCU and no LCU (NLCU) in any of the variables of the study. LIMITATIONS This study was a secondary analysis not powered specifically to analyze cannabis use. CONCLUSIONS LCU was associated with a younger age at first hospitalization in both women and men, while only women reported worse QoL on bodily pain and mental health subscales. Clinicians and public health providers should be aware of this and inform their patients and the general population of these detrimental effects.
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Abstract
Objective: This review discusses the relationship between cannabis use and psychotic, bipolar, depressive, and anxiety disorders, as well as suicide. It summarizes epidemiological evidence from cross-sectional and long-term prospective studies and considers possible etiological mechanisms. Methods: Systematic reviews and methodologically robust studies in the field (from inception to February 2019) were identified using a comprehensive search of Medline, PsychINFO, and Embase and summarized using a narrative synthesis. Results: Consistent evidence, both from observational and experimental studies, has confirmed the important role of cannabis use in the initiation and persistence of psychotic disorders. The size of the effect is related to the extent of cannabis use, with greater risk for early cannabis use and use of high-potency varieties and synthetic cannabinoids. Accumulating evidence suggests that frequent cannabis use also increases the risk for mania as well as for suicide. However, the effect on depression is less clear and findings on anxiety are contradictory with only a few methodologically robust studies. Furthermore, the relationship with common mental disorders may involve reverse causality, as depression and anxiety are reported to lead to greater cannabis consumption in some studies. Pathogenetic mechanisms focus on the effect of tetrahydrocannabinol (THC, the main psychoactive ingredient of cannabis) interacting with genetic predisposition and perhaps other environmental risk factors. Cannabidiol (CBD), the other important ingredient of traditional cannabis, ameliorates the psychotogenic effects of THC but is absent from the high-potency varieties that are increasingly available. Conclusions: The evidence that heavy use of high-THC/low-CBD types of cannabis increases the risk of psychosis is sufficiently strong to merit public health education. Evidence of similar but smaller effects in mania and suicide is growing, but is not convincing for depression and anxiety. There is much current interest in the possibility that CBD may be therapeutically useful.
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Affiliation(s)
- Lucia Sideli
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.,Department of Biomedicine, Neurosciences, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Harriet Quigley
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.,South London and Maudsley NHS Trust Biomedical Research Centre, London, UK
| | - Caterina La Cascia
- Department of Biomedicine, Neurosciences, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Robin M Murray
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.,Department of Biomedicine, Neurosciences, and Advanced Diagnostic, University of Palermo, Palermo, Italy.,South London and Maudsley NHS Trust Biomedical Research Centre, London, UK
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Black N, Stockings E, Campbell G, Tran LT, Zagic D, Hall WD, Farrell M, Degenhardt L. Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis. Lancet Psychiatry 2019; 6:995-1010. [PMID: 31672337 PMCID: PMC6949116 DOI: 10.1016/s2215-0366(19)30401-8] [Citation(s) in RCA: 223] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/30/2019] [Accepted: 08/30/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Medicinal cannabinoids, including medicinal cannabis and pharmaceutical cannabinoids and their synthetic derivatives, such as tetrahydrocannabinol (THC) and cannabidiol (CBD), have been suggested to have a therapeutic role in certain mental disorders. We analysed the available evidence to ascertain the effectiveness and safety of all types of medicinal cannabinoids in treating symptoms of various mental disorders. METHODS For this systematic review and meta-analysis we searched MEDLINE, Embase, PsycINFO, the Cochrane Central Register of Controlled Clinical Trials, and the Cochrane Database of Systematic Reviews for studies published between Jan 1, 1980, and April 30, 2018. We also searched for unpublished or ongoing studies on ClinicalTrials.gov, the EU Clinical Trials Register, and the Australian and New Zealand Clinical Trials Registry. We considered all studies examining any type and formulation of a medicinal cannabinoid in adults (≥18 years) for treating depression, anxiety, attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, post-traumatic stress disorder, or psychosis, either as the primary condition or secondary to other medical conditions. We placed no restrictions on language, publication status, or study type (ie, both experimental and observational study designs were included). Primary outcomes were remission from and changes in symptoms of these mental disorders. The safety of medicinal cannabinoids for these mental disorders was also examined. Evidence from randomised controlled trials was synthesised as odds ratios (ORs) for disorder remission, adverse events, and withdrawals and as standardised mean differences (SMDs) for change in symptoms, via random-effects meta-analyses. The quality of the evidence was assessed with the Cochrane risk of bias tool and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. This study is registered with PROSPERO (CRD42017059372, CRD42017059373, CRD42017059376, CRD42017064996, and CRD42018102977). FINDINGS 83 eligible studies (40 randomised controlled trials, n=3067) were included: 42 for depression (23 randomised controlled trials; n=2551), 31 for anxiety (17 randomised controlled trials; n=605), eight for Tourette syndrome (two randomised controlled trials; n=36), three for ADHD (one randomised controlled trial; n=30), 12 for post-traumatic stress disorder (one randomised controlled trial; n=10), and 11 for psychosis (six randomised controlled trials; n=281). Pharmaceutical THC (with or without CBD) improved anxiety symptoms among individuals with other medical conditions (primarily chronic non-cancer pain and multiple sclerosis; SMD -0·25 [95% CI -0·49 to -0·01]; seven studies; n=252), although the evidence GRADE was very low. Pharmaceutical THC (with or without CBD) worsened negative symptoms of psychosis in a single study (SMD 0·36 [95% CI 0·10 to 0·62]; n=24). Pharmaceutical THC (with or without CBD) did not significantly affect any other primary outcomes for the mental disorders examined but did increase the number of people who had adverse events (OR 1·99 [95% CI 1·20 to 3·29]; ten studies; n=1495) and withdrawals due to adverse events (2·78 [1·59 to 4·86]; 11 studies; n=1621) compared with placebo across all mental disorders examined. Few randomised controlled trials examined the role of pharmaceutical CBD or medicinal cannabis. INTERPRETATION There is scarce evidence to suggest that cannabinoids improve depressive disorders and symptoms, anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder, or psychosis. There is very low quality evidence that pharmaceutical THC (with or without CBD) leads to a small improvement in symptoms of anxiety among individuals with other medical conditions. There remains insufficient evidence to provide guidance on the use of cannabinoids for treating mental disorders within a regulatory framework. Further high-quality studies directly examining the effect of cannabinoids on treating mental disorders are needed. FUNDING Therapeutic Goods Administration, Australia; Commonwealth Department of Health, Australia; Australian National Health and Medical Research Council; and US National Institutes of Health.
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Affiliation(s)
- Nicola Black
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW, Australia
| | - Lucy T Tran
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW, Australia
| | - Dino Zagic
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW, Australia
| | - Wayne D Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane QLD, Australia; National Addiction Centre, Kings College London, London, UK
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW, Australia.
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Hutchison KE, Hagerty SL, Galinkin J, Bryan AD, Bidwell LC. Cannabinoids, Pain, and Opioid Use Reduction: The Importance of Distilling and Disseminating Existing Data. Cannabis Cannabinoid Res 2019; 4:158-164. [PMID: 31579833 PMCID: PMC6757236 DOI: 10.1089/can.2018.0052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The high prevalence of chronic pain conditions combined with an over-reliance on opioid prescriptions has resulted in an opioid epidemic and a desperate need for solutions. There is some debate about whether cannabis might play a role in addressing chronic pain conditions as well as the opioid epidemic. Recent surveys suggest that a large number of people are using cannabis as a treatment for pain and to reduce use of opioids, and cannabis-derived products demonstrate at least modest efficacy in the treatment of pain in randomized controlled trials. In addition, surveillance studies from countries that have approved the use of Sativex, which is a cannabis-based product, have demonstrated that a combination of Δ9-tetrahydrocannabinol and cannabidiol has low potential for harm, is well tolerated, and is helpful to patients. Given the number of people in the United States who are already using cannabis to manage pain and opioid use in state-regulated markets, it is imperative to conduct additional research in these areas, and to disseminate information on how to minimize harm and maximize any benefits of using cannabinoids to mitigate pain and reduce opioid use. The purpose of this article is to call attention to the fact that cannabis is being used in the management of chronic pain. Thus, this article also provides a set of guidelines on how to approach using cannabis to treat pain.
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Affiliation(s)
- Kent E. Hutchison
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado
| | - Sarah L. Hagerty
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado
| | - Jeffrey Galinkin
- Pediatric Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Angela D. Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado
| | - L. Cinnamon Bidwell
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, Colorado
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Loflin MJE, Babson K, Sottile J, Norman SB, Gruber S, Bonn-Miller MO. A cross-sectional examination of choice and behavior of veterans with access to free medicinal cannabis. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:506-513. [PMID: 31135227 DOI: 10.1080/00952990.2019.1604722] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: With a rise in public pressure to increase veteran access to medicinal cannabis, free cannabis collectives for military veterans are proliferating across the US. Objectives: The aim of the current study was to document which cannabis formulations and routes of administration are chosen by veterans with increased access to cannabis, and to determine whether cannabis is being used as a substitute for other licit and illicit drugs. Method: The current study collected cross-sectional self-report data on cannabis use, cannabinoid constituent composition, primary indication of use, and substitution practices among a sample of 93 US military veterans (84.9% male) with access to free cannabis. Result: Most of the sample reported using cannabinoids as a substitute for either alcohol, tobacco, prescription medications, or illicit substances, reported that they use cannabis frequently (Modal frequency >4x/day, Modal quantity = 5 to 8 grams/week), and primarily select higher-risk cannabis formulations (i.e., high THC/low CBD, smoked). The majority of the sample reported that they use cannabis to self-treat multiple physical and mental health conditions/symptoms. Conclusions: Results of the current study suggest that military Veterans with reduced barriers to access cannabis could be making both helpful and harmful choices regarding their cannabis use. These findings suggest that more guidance on the selection of cannabis-based products in this population is warranted, particularly as barriers to medicinal cannabis access are reduced.
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Affiliation(s)
| | | | - James Sottile
- c Department of Psychology, Palo Alto University , Palo Alto , CA , USA
| | - Sonya B Norman
- a VA San Diego Healthcare System , San Diego , CA.,d Executive Division, National Center for PTSD , VA , USA
| | - Staci Gruber
- e Harvard Medical School, McLean Hospital , Belmont , MA , USA
| | - Marcel O Bonn-Miller
- f Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
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Smith JM, Mader J, Szeto ACH, Arria AM, Winters KC, Wilkes TCR. Cannabis Use for Medicinal Purposes among Canadian University Students. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:351-355. [PMID: 30602305 PMCID: PMC6591886 DOI: 10.1177/0706743718818420] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The study sought to describe a Canadian sample of university students' medicinal use of cannabis, including prevalence of cannabis use disorder (CUD) and replacement of traditional treatments with cannabis. METHOD A random sample of 4000 university students was asked to complete a cross-sectional web-based survey. The survey was completed by 2212 (average age 23.2 years, SD = 5.2 years), representing a 55.3% response rate. To be eligible, students had to be enrolled in a class on campus and were 18 years or older. RESULT Half (52%) of respondents used cannabis at least once in their lifetime, with ∼11% reporting medicinal cannabis use. Recreational motives to use cannabis were common among medicinal users (85%), several (38%) replaced traditional medication with cannabis, and more than a third received authorization by a health care provider. Of the medicinal users, 13.6% met the criteria for CUD. Common ailments for medicinal cannabis use were anxiety, sleep problems, depression, and pain. When mental health-related categories are combined, 78.2% of medicinal users used for at least 1 mental health condition. CONCLUSIONS Medicinal cannabis use occurs among university students. None of the ailments listed by medicinal users meet the Canadian Family Physicians prescribing guidelines, and most are not among those viewed by the National Academies of Science, Engineering, and Medicine as having strong evidence for therapeutic value. The results raise concerns for health care providers who are authorizing or counselling patients' considering medicinal cannabis.
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Affiliation(s)
| | - Joel Mader
- Faculty of Nursing, University of Calgary, Calgary, Alberta
| | - Andrew C. H. Szeto
- Department of Psychology and Office of the Provost, University of Calgary,
Calgary, Alberta
| | - Amelia M. Arria
- Department of Behavioural and Community Health, Centre on Young Adult Health
and Development, School of Public Health, University of Maryland, College Park, MD,
USA
| | - Ken C. Winters
- Oregon Research Institute, Eugene, OR, USA
- Department of Psychology, University of Minnesota, Minneapolis, MN,
USA
| | - T. Chris R. Wilkes
- Alberta Health Services, Alberta
- Cumming School of Medicine, University of Calgary, Calgary, Alberta
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Weinberger AH, Pacek LR, Sheffer CE, Budney AJ, Lee J, Goodwin RD. Serious psychological distress and daily cannabis use, 2008 to 2016: Potential implications for mental health? Drug Alcohol Depend 2019; 197:134-140. [PMID: 30825793 PMCID: PMC6440801 DOI: 10.1016/j.drugalcdep.2019.01.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/14/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Daily cannabis use is increasing in the United States (US). Yet, it is not known whether daily cannabis use is disproportionately common, or whether it has increased differentially over time, by mental health status. This study estimated the prevalence of daily cannabis use among adults in the US with and without past-month serious psychological distress (SPD; measured by the Kessler Psychological Distress Scale (K6)) in 2016 and estimated trends in daily cannabis use by past-30-day SPD status from 2008 to 2016. METHODS Data were drawn from adults age 18 and older in the 2008-2016 National Survey on Drug Use and Health (combined total analytic sample n = 356,413). Linear time trends of daily cannabis use, stratified by SPD status, were assessed using logistic regression models with continuous year as the predictor. RESULTS In 2016, past-month daily cannabis use was significantly more common among those with past-month SPD (8.07%), compared to those without past-month SPD (2.66%). Daily cannabis use increased significantly from 2008 to 2016 among those both with and without SPD although use among those with SPD was persistently higher than use among those without SPD over the time period studied. CONCLUSIONS Daily cannabis use is significantly more common among persons with serious psychological distress and is increasing in this group, as well as among those without. Given this increase and the high prevalence of cannabis use among those with SPD, it may be important to consider potential consequences of this increased use for those with mental health vulnerabilities.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Epidemiology and Population Health, Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA.
| | - Alan J Budney
- Geisel School of Medicine at Dartmouth, Center for Technology and Behavioral Health, Lebanon, NH, USA.
| | - Joun Lee
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
| | - Renee D Goodwin
- Institute for Implementation Science and Population Health, CUNY School of Public Health and Health Policy, New York, NY, USA; Department of Epidemiology and Biostatistics, CUNY School of Public Health, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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The Changing Landscape of Substance Use Disorders. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2019; 17:152-153. [PMID: 31975973 PMCID: PMC6527001 DOI: 10.1176/appi.focus.17201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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