Preparedness for healthy ageing and polysubstance use in long-term cannabis users: a population-representative longitudinal study

Trends in Cannabis-Related Hospitalizations in Arizona From 2016 to 2021 and Associations With Mental Health-Related Hospitalizations

OBJECTIVE

The purpose of this study was to examine trends in cannabis-related hospital visits in Arizona from 2016 to 2021 and associations with hospital visits for a mental health condition.

METHOD

Data were emergency department and inpatient hospital discharge records from all Arizona licensed hospitals from 2016 to 2021. Records comprised 18,758,614 hospital visits. Cannabis-related visits were defined by International Classification of Diseases (ICD) diagnostic codes for cannabis use (unspecified use, abuse, dependence) or poisoning. Mental health visits were defined by ICD diagnostic codes for mental health conditions.

RESULTS

The rate of cannabis-related hospital visits increased from 1,301.50 per 100,000 visits in 2016 to 1,565.54 per 100,000 visits in 2021, a 20% increase. The increase was larger for visits by adolescents and older adults ages 65+: 63.94% and 84.45%, respectively. Cannabis-related visits were 7.75 (95% CI [7.69, 7.81]) times as likely as visits unrelated to cannabis to have a mental health condition as the primary diagnosis from 2016 to 2021 and were 2.32 (95% CI [2.30, 2.34]) times as likely after adjustment for covariates, including alcohol and other substance-related diagnoses. The association between cannabis-related visits and mental health-related visits increased each year, particularly for older adults ages 65+.

CONCLUSIONS

The rate of cannabis-related hospital visits is increasing, as is the cannabis-related risk of a hospital visit for a mental health condition. The increases are especially pronounced among hospital visits by older adults (ages 65+), highlighting the need for prevention and intervention in this under-recognized at-risk group.

Cannabis at a crossroads: Pharmacist care considerations in the context of a changing cannabis regulatory landscape

The debate over whether cannabis should be handled as a vilified substance or potential therapeutic entity has persisted over the past 50 years, coupled with or supported by a changing state-level regulatory landscape in the United States. Pharmacists must be aware of potential health implications and keep abreast of regulatory implications likely to result from potential state and national regulation changes. In this commentary, we highlight key considerations for pharmacists in the evolving cannabis regulatory landscape, including historical perspectives, current regulations, and future implications. Special attention to vulnerable populations is outlined, given the potential health consequences that must be considered if cannabis is rescheduled. The substantive public health implications associated with adult cannabis use (e.g., substance use/misuse, driving, lung health) are outside the scope of this commentary.

Cannabis use in youth is associated with chronic inflammation

BACKGROUND

Markers of inflammation and cannabis exposure are associated with an increased risk of mental disorders. In the current study, we investigated associations between cannabis use and biomarkers of inflammation.

METHODS

Utilizing a sample of 914 participants from the Avon Longitudinal Study of Parents and Children, we investigated whether interleukin-6 (IL-6), tumor necrosis factor α (TNFα), C-reactive protein (CRP), and soluble urokinase plasminogen activator receptor (suPAR) measured at age 24 were associated with past year daily cannabis use, less frequent cannabis use, and no past year cannabis use. We adjusted for a number of covariates including sociodemographic measures, body mass index, childhood trauma, and tobacco smoking. We found evidence of a strong association between daily or near daily cannabis use and suPAR.

RESULTS

We did not find any associations between less frequent cannabis use and suPAR. We did not find evidence of an association between IL-6, TNFα or CRP, and cannabis use.

CONCLUSIONS

Our finding that frequent cannabis use is strongly associated with suPAR, a biomarker of systemic chronic inflammation implicated in neurodevelopmental and neurodegenerative processes is novel. These findings may provide valuable insights into biological mechanisms by which cannabis affects the brain and impacts the risk of serious mental disorders.

Anxiety and risk-taking behavior maps onto opioid and alcohol polysubstance consumption patterns in male and female mice

Polysubstance use is prevalent in the population but remains understudied in preclinical models. Alcohol and opioid polysubstance use is associated with negative outcomes, worse treatment prognosis, and higher overdose risk; but underlying mechanisms are still being uncovered. Examining factors that motivate use of one substance over another in different contexts in preclinical models will better our understanding of polysubstance use and improve translational value. Here we assessed baseline anxiety-like and locomotive behavior and then measured voluntary consumption of multiple doses of alcohol and fentanyl in group housed male and female mice using our novel Socially Integrated Polysubstance (SIP) system. Fifty-six male (n=32) and female (n=24) adult mice were housed in groups of 4 for one week with continuous access to food, water, two doses of ethanol (5% and 10%) and two doses of fentanyl (5 ug/ml and 20 ug/ml). Our analyses revealed sex differences across multiple domains - female mice consumed more liquid in the dark cycle, had higher activity, a higher preference for both ethanol and fentanyl over water, and their fentanyl preference increased over the seven days. We then used machine-learning techniques to reveal underlying relationships between baseline behavioral phenotypes and subsequent polysubstance consumption patterns, where anxiety-and risk-taking-like behavioral phenotypes mapped onto discrete patterns of polysubstance use, preference, and escalation. By simulating more translationally relevant substance use and improving our understanding of the motivations for different patterns of consumption, this study contributes to the developing preclinical literature on polysubstance use with the goal of facilitating better treatment outcomes and novel therapeutic strategies.

Assessing the association between global structural brain age and polygenic risk for schizophrenia in early adulthood: A recall-by-genotype study

Neuroimaging studies consistently show advanced brain age in schizophrenia, suggesting that brain structure is often 'older' than expected at a given chronological age. Whether advanced brain age is linked to genetic liability for schizophrenia remains unclear. In this pre-registered secondary data analysis, we utilised a recall-by-genotype approach applied to a population-based subsample from the Avon Longitudinal Study of Parents and Children to assess brain age differences between young adults aged 21-24 years with relatively high (n = 96) and low (n = 93) polygenic risk for schizophrenia (SCZ-PRS). A global index of brain age (or brain-predicted age) was estimated using a publicly available machine learning model previously trained on a combination of region-wise gray-matter measures, including cortical thickness, surface area and subcortical volumes derived from T1-weighted magnetic resonance imaging (MRI) scans. We found no difference in mean brain-PAD (the difference between brain-predicted age and chronological age) between the high- and low-SCZ-PRS groups, controlling for the effects of sex and age at time of scanning (b = -.21; 95% CI -2.00, 1.58; p = .82; Cohen's d = -.034; partial R2 = .00029). These findings do not support an association between SCZ-PRS and brain-PAD based on global age-related structural brain patterns, suggesting that brain age may not be a vulnerability marker of common genetic risk for SCZ. Future studies with larger samples and multimodal brain age measures could further investigate global or localised effects of SCZ-PRS.

Prenatal cannabis exposure is associated with localized brain differences that partially mediate associations with increased adolescent psychopathology

Prenatal cannabis exposure (PCE) is associated with mental health problems, but the neurobiological mechanisms remain unknown. We find that PCE is associated with localized differences across neuroimaging metrics that longitudinally mediate associations with mental health in adolescence (n=9,322-10,186). Differences in brain development may contribute to PCE-related variability in adolescent mental health.