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Wood S, Gabrys R, Freeman T, Hammond D. Canada's THC unit: Applications for the legal cannabis market. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104457. [PMID: 38772194 DOI: 10.1016/j.drugpo.2024.104457] [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: 02/13/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/23/2024]
Abstract
The legalization of cannabis in Canada has accelerated the need for a standardized approach to measuring and communicating the amount of delta-9-tetrahydrocannabinol (THC) in cannabis products. This article offers an overview of the considerations associated with establishing and implementing a standard THC unit in the Canadian context. The article begins by discussing the applications of a standard THC unit, emphasizing its potential use in product labelling, consumer education, and product reporting and surveillance. The article then examines key considerations for identifying what a Canadian THC unit should be set at, specifically within the context of a country with a regulated commercial cannabis market. This is followed by a discussion of additional considerations related to the adoption of a Canadian THC unit, including its use across various product formats and modes of administration. A significant focus of this article is on prioritizing public health and safety and informed decision-making among adult consumers as the legal cannabis market evolves. Collaboration among various stakeholders, such as government agencies, industry, and public health professionals, is highlighted as crucial for a successful transition to the use of Canada's THC unit.
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Affiliation(s)
- Shea Wood
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Suite 500, Ottawa, ON K1P 5E7, Canada.
| | - Robert Gabrys
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Suite 500, Ottawa, ON K1P 5E7, Canada; Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa K1S 5B6, ON, Canada
| | - Tom Freeman
- Addiction and Mental Health Group, Department of Psychology, University of Bath, Bath BA2 7AY, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
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Petrilli K, Lawn W, Lees R, Mokrysz C, Borissova A, Ofori S, Trinci K, Dos Santos R, Leitch H, Soni S, Hines LA, Lorenzetti V, Curran HV, Freeman TP. Enhanced cannabis timeline followback (EC-TLFB): Comprehensive assessment of cannabis use including standard THC units and validation through biological measures. Addiction 2024; 119:772-783. [PMID: 38105033 DOI: 10.1111/add.16405] [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: 01/31/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023]
Abstract
AIMS The aims of this study were to present an enhanced cannabis timeline followback (EC-TLFB) enabling comprehensive assessment of cannabis use measures, including standard tetrahydrocannabinol (THC) units, and to validate these against objectively indexed urinary 11-nor-9-carboxy-tetrahydrocannabinol (THC-COOH) concentrations. DESIGN We used cross-sectional baseline data from the 'CannTeen' observational longitudinal study. SETTING The study was conducted in London, UK. PARTICIPANTS A total of 147 participants who used cannabis regularly took part in the study (n = 71 female, n = 76 male; mean age = 21.90, standard deviation = 5.32). MEASUREMENTS The EC-TLFB was used to calculate frequency of cannabis use, method of administration, including co-administration with tobacco, amount of cannabis used (measured with unaided self-report and also using pictorial aided self-report) and type of cannabis product (flower, hash) which was used to estimate THC concentration (both from published data on THC concentration of products and analysis of cannabis samples donated by participants in this study). We calculated total weekly standard THC units (i.e. 5 mg THC for all cannabis products and methods of administration) using the EC-TLFB. The outcome variable for validation of past week EC-TLFB assessments was creatinine-normalized carboxy-tetrahydrocannabinol (THC-COOH) in urine. FINDINGS All measures of cannabis exposure included in this analysis were positively correlated with levels of THC-COOH in urine (r = 0.41-0.52). Standard THC units, calculated with average concentrations of THC in cannabis in the UK and unaided self-report measures of amount of cannabis used in grams showed the strongest correlation with THC-COOH in urine (r = 0.52, 95% bias-corrected and accelerated = 0.26-0.70). CONCLUSIONS The enhanced cannabis timeline followback (EC-TLFB) can provide a valid assessment of a comprehensive set of cannabis use measures including standard tetrahydrocannabinol units as well as and traditional TLFB assessments (e.g. frequency of use and grams of cannabis use).
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Affiliation(s)
- Kat Petrilli
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Will Lawn
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Rachel Lees
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Claire Mokrysz
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Anya Borissova
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK
| | - Shelan Ofori
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Katie Trinci
- Clinical Psychopharmacology Unit, University College London, London, UK
| | | | - Harry Leitch
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Shilpa Soni
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Lindsey A Hines
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Programme, the Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
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Wade NE, Wallace AL, Huestis MA, Lisdahl KM, Sullivan RM, Tapert SF. Cannabis use and neurocognitive performance at 13-14 Years-Old: Optimizing assessment with hair toxicology in the Adolescent brain cognitive development (ABCD) study. Addict Behav 2024; 150:107930. [PMID: 38091780 PMCID: PMC10829878 DOI: 10.1016/j.addbeh.2023.107930] [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: 09/01/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE Cannabis is widely used, including in early adolescence, with prevalence rates varying by measurement method (e.g., toxicology vs. self-report). Critical neurocognitive development occurs throughout adolescence. Given conflicting prior brain-behavior results in cannabis research, improved measurement of cannabis use in younger adolescents is needed. METHODS Data from the Adolescent Brain Cognitive Development (ABCD) Study Year 4 follow-up (participant age: 13-14 years-old) included hair samples assessed by LC-MS/MS and GC-MS/MS, quantifying THCCOOH (THC metabolite), THC, and cannabidiol concentrations, and the NIH Toolbox Cognitive Battery. Youth whose hair was positive for cannabinoids or reported past-year cannabis use were included in a Cannabis Use (CU) group (n = 123) and matched with non-using Controls on sociodemographics (n = 123). Standard and nested ANCOVAs assessed group status predicting cognitive performance, controlling for family relationships. Follow-up correlations assessed cannabinoid hair concentration, self-reported cannabis use, and neurocognition. RESULTS CU scored lower on Picture Memory (p = .03) than Controls. Within the CU group, THCCOOH negatively correlated with Picture Vocabulary (r = -0.20, p = .03) and Flanker Inhibitory Control and Attention (r = -0.19, p = .04), and past-year cannabis use was negatively associated with List Sorting Working Memory (r = -0.33, p = .0002) and Picture Sequence Memory (r = -0.19, p = .04) performances. CONCLUSIONS Youth who had used cannabis showed lower scores on an episodic memory task, and more cannabis use was linked to poorer performances on verbal, inhibitory, working memory, and episodic memory tasks. Combining hair toxicology with self-report revealed more brain-behavior relationships than self-report data alone. These youth will be followed to determine long-term substance use and neurocognition trajectories.
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Affiliation(s)
- Natasha E Wade
- Department of Psychiatry, University of California, San Diego, USA.
| | | | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - Krista M Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | - Ryan M Sullivan
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | - Susan F Tapert
- Department of Psychiatry, University of California, San Diego, USA
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Chesney E, Lawn W, McGuire P. Assessing Cannabis Use in People with Psychosis. Cannabis Cannabinoid Res 2024; 9:49-58. [PMID: 37971872 PMCID: PMC10874830 DOI: 10.1089/can.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Introduction: Cannabis use is common in people with psychotic disorders and is associated with the exacerbation of symptoms, poor treatment adherence, and an increased risk of relapse. Accurate assessment of cannabis use is thus critical to the clinical management of psychosis. Discussion: Cannabis use is usually assessed with self-report questionnaires that were originally developed for healthy individuals or people with a cannabis use disorder. Compared to these groups, the pattern of cannabis use and the associated harms in patients with psychosis are quite different. Moreover, in people with psychosis, the accuracy of self-reported use may be impaired by psychotic symptoms, cognitive deficits, and a desire to conceal use when clinicians have advised against it. Although urinary screening for delta-9-tetrahydrocannabinol is sometimes used in the assessment of acute psychotic episodes, it is not used in routinely. Cannabis use could be assessed by measuring the concentration of cannabinoids in urine and blood, but this is rarely done in either clinical settings or research. Conclusion: Using quantitative biological measures could provide a more accurate guide to the effects of use on the disorder than asking patients or using questionnaires.
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Affiliation(s)
- Edward Chesney
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Will Lawn
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Philip McGuire
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, United Kingdom
- NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
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Borodovsky JT, Struble CA, Habib MI, Hasin DS, Shmulewitz D, Walsh C, Livne O, Aharonovich E, Budney AJ. Exploring survey methods for measuring consumption quantities of cannabis flower and concentrate products. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:733-745. [PMID: 37774316 PMCID: PMC10795727 DOI: 10.1080/00952990.2023.2246635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/06/2023] [Indexed: 10/01/2023]
Abstract
Background: Researchers need accurate measurements of cannabis consumption quantities to assess risks and benefits. Survey methods for measuring cannabis flower and concentrate quantities remain underdeveloped.Objective: We examined "grams" and "hits" units for measuring flower and concentrate quantities, and calculating milligrams of THC (mgTHC).Methods: Online survey participants (n = 2,381) reported preferred unit (hits or grams), past-week hits and grams for each product, and product %THC. Quantile regression compared mgTHC between unit-preference subgroups. Hits-based mgTHC calculations assumed a universal grams-per-hit ratio (GPHR). To examine individualized GPHRs, we tested a "two-item approach," which divided total grams by total hits, and "one-item approach," which divided 0.5 grams by responses to the question: "How many total hits would it take you to finish 1/2 g of your [product] by [administration method]?"Results: Participants were primarily daily consumers (77%), 50% female sex, mean age 39.0 (SD 16.4), 85% White, 49% employed full-time. Compared to those who preferred the hits unit, those who preferred the grams unit reported consuming more hits and grams, higher %THC products, and consequently, larger median mgTHC (flower-hits mgTHC: 32 vs. 91 (95%CI: 52-67); flower-grams mgTHC: 27 vs. 113 (95%CI: 73-95); concentrate-hits mgTHC: 29 vs. 59 (95%CI: 15-43); concentrate-grams mgTHC: 61 vs. 129 (95%CI: 43-94)). "Two-item" and "one-item" approach GPHRs were similar and frequently 50% larger or smaller than the universal GPHR.Conclusion: Allowing respondents to choose "hits" or "grams" when reporting cannabis quantities does not compromise mgTHC estimates. A low-burden, one-item approach yields individualized "hit sizes" that may improve mgTHC estimates.
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Affiliation(s)
- Jacob T. Borodovsky
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 46 Centerra Pkwy, Lebanon, NH 03766, USA
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, 1 Rope Ferry Road, Hanover, NH 03755, USA
| | - Cara A. Struble
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 46 Centerra Pkwy, Lebanon, NH 03766, USA
| | - Mohammad I. Habib
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 46 Centerra Pkwy, Lebanon, NH 03766, USA
| | - Deborah S. Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168 St, New York, NY 10032, USA
| | - Dvora Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Claire Walsh
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Ofir Livne
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Alan J. Budney
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 46 Centerra Pkwy, Lebanon, NH 03766, USA
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6
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Rodríguez-Toscano E, Alloza C, Fraguas D, Durán-Cutilla M, Roldán L, Sánchez-Gutiérrez T, López-Montoya G, Parellada M, Moreno C, Gayer-Anderson C, Jongsma HE, Di Forti M, Quattrone D, Velthorst E, de Haan L, Selten JP, Szöke A, Llorca PM, Tortelli A, Bobes J, Bernardo M, Sanjuán J, Luis Santos J, Arrojo M, Tarricone I, Berardi D, Ruggeri M, Lasalvia A, Ferraro L, La Cascia C, La Barbera D, Menezes PR, Del-Ben CM, Rutten BP, van Os J, Jones PB, Murray RM, Kirkbride JB, Morgan C, Díaz-Caneja CM, Arango C. Differences in Patterns of Stimulant Use and Their Impact on First-Episode Psychosis Incidence: An Analysis of the EUGEI Study. Schizophr Bull 2023; 49:1269-1280. [PMID: 37467351 PMCID: PMC10483438 DOI: 10.1093/schbul/sbad013] [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: 07/21/2023]
Abstract
BACKGROUND Use of illegal stimulants is associated with an increased risk of psychotic disorder. However, the impact of stimulant use on odds of first-episode psychosis (FEP) remains unclear. Here, we aimed to describe the patterns of stimulant use and examine their impact on odds of FEP. METHODS We included patients with FEP aged 18-64 years who attended psychiatric services at 17 sites across 5 European countries and Brazil, and recruited controls representative of each local population (FEP = 1130; controls = 1497). Patterns of stimulant use were described. We computed fully adjusted logistic regression models (controlling for age, sex, ethnicity, cannabis use, and education level) to estimate their association with odds of FEP. Assuming causality, we calculated the population-attributable fractions for stimulant use associated with the odds for FEP. FINDINGS Prevalence of lifetime and recent stimulant use in the FEP sample were 14.50% and 7.88% and in controls 10.80% and 3.8%, respectively. Recent and lifetime stimulant use was associated with increased odds of FEP compared with abstainers [fully adjusted odds ratio 1.74,95% confidence interval (CI) 1.20-2.54, P = .004 and 1.62, 95% CI 1.25-2.09, P < .001, respectively]. According to PAFs, a substantial number of FEP cases (3.35% [95% CI 1.31-4.78] for recent use and 7.61% [95% CI 3.68-10.54] for lifetime use) could have been prevented if stimulants were no longer available and the odds of FEP and PAFs for lifetime and recent stimulant use varied across countries. INTERPRETATION Illegal stimulant use has a significant and clinically relevant influence on FEP incidence, with varying impacts across countries.
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Affiliation(s)
- Elisa Rodríguez-Toscano
- Institute of Psychiatry and Mental Health, Hospital Clínico San Carlos, IdISSC, School of Medicine, Universidad Complutense, Madrid, Spain
- Faculty of Psychology, Universidad Complutense, Madrid, Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Clara Alloza
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - David Fraguas
- Institute of Psychiatry and Mental Health, Hospital Clínico San Carlos, IdISSC, School of Medicine, Universidad Complutense, Madrid, Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Manuel Durán-Cutilla
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Laura Roldán
- Faculty of Psychology, Universidad Complutense, Madrid, Spain
| | | | - Gonzalo López-Montoya
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
- Faculty of Health Science, Universidad Internacional de la Rioja (UNIR), Madrid, Spain
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Charlotte Gayer-Anderson
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Hannah E Jongsma
- PsyLife Group, Division of Psychiatry, University College London, London, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Marta Di Forti
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Diego Quattrone
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, USA
- Early Psychosis Section, Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Early Psychosis Section, Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jean-Paul Selten
- Institute for Mental Health, GGZ Rivierduinen, Leiden, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Andrei Szöke
- Institut National de la Santé et de la Recherche Médicale, U955, Equipe 15 Neuro-Psychiatrie Translationnelle, Créteil, France
- AP-HP, Pôle de Psychiatrie des Hôpitaux Universitaires Henri Mondor, Créteil, France
- Fondation FondaMental, Créteil, France
| | | | - Andrea Tortelli
- Pôle Psychiatrie Précarité, Groupe Hospitalier Universitaire Paris Psychiatrie and Neurosciences, 75014 Paris, France
| | - Julio Bobes
- Department of Medicine, Psychiatry Area, School of Medicine, Universidad de Oviedo, ISPA, INEUROPA, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clínic of Barcelona; Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB); Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS); CIBERSAM, ISCIII, Barcelona, Spain
| | - Julio Sanjuán
- Department of Psychiatry, School of Medicine, Universidad de Valencia, Centro de Investigación Biomédica en Red de Salud Mental, Valencia, Spain
| | - José Luis Santos
- Department of Psychiatry, Hospital “Virgen de la Luz”, Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago, Spain
| | - Ilaria Tarricone
- Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, Alma Mater Studiorium Università di Bologna, Bologna, Italy
| | | | - Mirella Ruggeri
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
- Section of Psychiatry, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Laura Ferraro
- Department of Biomedicine, Neuroscience and advanced Diagnostic (BiND), Psychiatry section, University of Palermo, Palermo, Italy
| | - Caterina La Cascia
- Department of Biomedicine, Neuroscience and advanced Diagnostic (BiND), Psychiatry section, University of Palermo, Palermo, Italy
| | - Daniele La Barbera
- Department of Biomedicine, Neuroscience and advanced Diagnostic (BiND), Psychiatry section, University of Palermo, Palermo, Italy
| | - Paulo Rossi Menezes
- Department of Preventive Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Cristina Marta Del-Ben
- Division of Psychiatry, Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, Universidade de São Paulo, São Paulo, Brazil
| | - Bart P Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, Brain Center Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- CAMEO Early Intervention Service, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - James B Kirkbride
- PsyLife Group, Division of Psychiatry, University College London, London, UK
| | - Craig Morgan
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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7
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Petrilli K, Hines L, Adams S, Morgan CJ, Curran HV, Freeman TP. High potency cannabis use, mental health symptoms and cannabis dependence: Triangulating the evidence. Addict Behav 2023; 144:107740. [PMID: 37121087 DOI: 10.1016/j.addbeh.2023.107740] [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: 01/05/2023] [Revised: 03/30/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Cannabis potency (concentration of Δ-9-Tetrahydrocannabinol) has been associated with risks of adverse mental health outcomes and addiction but no studies have triangulated evidence from self-report and objective measures of cannabis potency. We hypothesised that users of high potency cannabis would have higher levels of (a) anxiety, (b) depression and (c) psychosis-like symptoms (d) cannabis dependence than users of lower potency cannabis. METHODS A cross-sectional study of 410 participants donated a sample of cannabis for analysis of THC concentration and reported their cannabis potency preference. These two exposure measures were investigated for their association with cannabis dependence, depression, anxiety, and psychosis-like symptoms in separate linear/logistic regression models. RESULTS High potency cannabis preference was associated with a slight increased risk of cannabis dependence after adjusting for confounding, with the exception of cannabis use frequency (OR = 1.16, 95% CI 1.04-1.28). No association was found between THC concentration in cannabis and cannabis dependence. There was weak evidence of a small association between cannabis potency and depression and anxiety. There was no association between high potency cannabis preference or THC concentration in cannabis and psychosis-like symptoms. CONCLUSIONS Users of cannabis who preferred high potency types might be at increased risk of problematic cannabis use. This should be considered with caution as we were not able to triangulate these results with an objective measure of cannabis potency. More research is needed to understand the association between high potency cannabis use and depression and anxiety.
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Affiliation(s)
- Kat Petrilli
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK.
| | - Lindsey Hines
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK; Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sally Adams
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Celia J Morgan
- Washington Singer Laboratories, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology Department, University College London, London, UK
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
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8
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Abstract
Cannabis is one of the most widely used recreational drugs among people with clinical psychosis, after nicotine and alcohol. There has been a debate in psychiatry about whether or not we can infer a cause-and-effect relationship between the use of cannabis and psychotic disorders. In this editorial, we first present and critically discuss the evidence to date of the association between heavy cannabis use and psychosis. We argue that while the biological mechanisms underlying individual susceptibility to develop a psychotic disorder following heavy cannabis use are still unknown, heavy cannabis use remains the most modifiable risk factor for the onset of psychotic disorders and for its clinical and functional outcome. This demands a clear move towards both primary and secondary prevention intervention to reduce the impact of heavy cannabis use on the incidence and prevalence of psychotic disorders.
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Affiliation(s)
- L Johnson-Ferguson
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
- Psychiatric University Hospital, Zurich, Switzerland
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - M Di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK
- South London and Maudsley NHS Mental Health Foundation Trust, London, UK
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9
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Teeters JB, Armstrong NM, King SA, Hubbard SM. A randomized pilot trial of a mobile phone-based brief intervention with personalized feedback and interactive text messaging to reduce driving after cannabis use and riding with a cannabis impaired driver. J Subst Abuse Treat 2022; 142:108867. [PMID: 36007434 PMCID: PMC10810297 DOI: 10.1016/j.jsat.2022.108867] [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: 10/19/2021] [Revised: 07/27/2022] [Accepted: 08/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Driving after cannabis use (DACU) and riding with a cannabis-impaired driver (RWCD) are national public health concerns. Though driving impairments and increased crash risk make DACU and RWCD two of the riskiest cannabis-related behaviors, many continue to drive after use and ride with others who are under the influence and do not view DACU or RWCD as dangerous. The current study examined the efficacy of an accessible, low-cost, mobile phone-based brief intervention aimed at reducing DACU and RWCD among college cannabis users in the context of a randomized three-group pilot trial. METHOD Participants were 97 college cannabis users (67.4 % women; average age = 21.34; 80.4 % Caucasian) who endorsed DACU at least three times in the past three months. After completing baseline measures, the study randomly assigned participants to one of three conditions: a) a substance impaired-driving personalized feedback plus MI-style interactive text messaging intervention (PF + MIT); b) a substance impaired-driving personalized feedback only intervention (PF); and c) a substance information control condition (IC). All conditions completed outcome measures three months postintervention. RESULTS Generalized linear mixed models (GLMM) analyses indicated that after controlling for sex, cannabis users in the PF + MIT condition significantly reduced DACU and RWCD over time compared to those in the IC condition. CONCLUSIONS These findings provide preliminary support for the short-term efficacy of a mobile phone-based intervention in decreasing DACU and RWCD among college cannabis users. Future research should determine whether these reductions in driving behaviors persist past three months.
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Affiliation(s)
- Jenni B Teeters
- Psychological Sciences Department, Western Kentucky University, United States of America.
| | - Nicole M Armstrong
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, United States of America
| | - Shelby A King
- Psychology Department, East Tennessee State University, United States of America
| | - Sterling M Hubbard
- Counseling Psychology Department, Iowa State University, United States of America
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10
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Schoeler T, Ferris J, Winstock AR. Rates and correlates of cannabis-associated psychotic symptoms in over 230,000 people who use cannabis. Transl Psychiatry 2022; 12:369. [PMID: 36068202 PMCID: PMC9448725 DOI: 10.1038/s41398-022-02112-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/09/2022] Open
Abstract
Cannabis, a widely used psychoactive substance, can trigger acute cannabis-associated psychotic symptoms (CAPS) in people who use cannabis (PWUC). To assess rates and correlates of CAPS requiring emergency medical treatment, we analyzed data from an international sample of PWUC (n = 233,475). We found that 0.47% (95%CI 0.42; 0.52) PWUC reported lifetime occurrence of CAPS, defined as the occurrence of hallucinations and/or paranoia requiring emergency medical treatment following the use of cannabis. A range of factors correlated with risk of CAPS in the last year: higher rates were observed in young individuals [risk ratio (RR) 2.66, compared to older PWUC] and those residing in Denmark (RR 3.01, compared to PWUC from other countries). Furthermore, risk was elevated in those using predominantly high-potency resin (RR 2.11, compared to PWUC using herbal cannabis), those mixing cannabis with tobacco (RR 2.15, compared to PWUC not mixing with tobacco) and those with a diagnosis of psychosis (RR 14.01), bipolar (RR 4.30), anxiety (RR 2.92) and depression (RR 2.68), compared to individuals without a mental health diagnosis. Taken together, acute self-limiting psychotic symptoms in the context of cannabis use may occur in about 1 in 200 PWUC's lifetime. Some individuals could be particularly sensitive to the adverse psychological effects of cannabis, such as young individuals or those with pre-existing mental health vulnerabilities. In light of the movements towards legalization of recreational cannabis, more research should focus on the potential harms related to cannabis use, to educate PWUC and the public about risks related to its use.
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Affiliation(s)
- Tabea Schoeler
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland. .,Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Jason Ferris
- grid.1003.20000 0000 9320 7537The Centre for Health Services Research, The University of Queensland, Brisbane, QLD Australia
| | - Adam R. Winstock
- grid.83440.3b0000000121901201Institute of Epidemiology and Health Care, University College London, London, UK ,Global Drug Survey, GDS, London, UK
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11
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Hill ML, Loflin M, Nichter B, Na PJ, Herzog S, Norman SB, Pietrzak RH. Cannabis use among U.S. military veterans with subthreshold or threshold posttraumatic stress disorder: Psychiatric comorbidities, functioning, and strategies for coping with posttraumatic stress symptoms. J Trauma Stress 2022; 35:1154-1166. [PMID: 35275431 DOI: 10.1002/jts.22823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/27/2021] [Accepted: 01/19/2022] [Indexed: 11/07/2022]
Abstract
Cannabis use is common among individuals with posttraumatic stress disorder (PTSD) symptoms, but its impact on psychiatric symptoms and functioning in this population is unclear. To clarify the clinical and functional correlates of cannabis use in individuals with PTSD symptoms, we analyzed data from the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative survey of U.S. military veterans. Participants with current subthreshold or full PTSD (N = 608) reported on their past-6-month cannabis use and current psychiatric symptoms, functioning, treatment utilization, and PTSD symptom management strategies. Veterans with subthreshold/full PTSD who used cannabis more than weekly were more likely to screen positive for co-occurring depression, anxiety, and suicidal ideation than those who did not use cannabis, ORs = 3.4-3.8, or used cannabis less than weekly, ORs = 2.7-3.7. Veterans who used cannabis more than weekly also scored lower in cognitive functioning than veterans with no use, d = 0.25, or infrequent use, d = 0.71, and were substantially more likely to endorse avoidance coping strategies, ORs = 8.2-12.2, including substance use, OR = 4.4, and behavioral disengagement, ORs = 2.7-9.1, to manage PTSD symptoms. Despite more psychiatric and functional problems, veterans with frequent cannabis use were not more likely to engage in mental health treatment, ORs = 0.87-0.99. The results suggest enhanced cannabis use screening, interventions targeting risky use, and strategies promoting treatment engagement may help ameliorate more severe clinical presentations associated with frequent cannabis use among veterans with subthreshold/full PTSD.
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Affiliation(s)
- Melanie L Hill
- Department of Psychiatry, University of California, San Diego, California, USA.,VA San Diego Healthcare System, San Diego, California, USA
| | - Mallory Loflin
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Brandon Nichter
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Sarah Herzog
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, New York, USA.,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California, San Diego, California, USA.,VA San Diego Healthcare System, San Diego, California, USA.,National Center for PTSD, White River Junction, Vermont, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
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12
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Lorenzetti V, Hindocha C, Petrilli K, Griffiths P, Brown J, Castillo‐Carniglia Á, Caulkins JP, Englund A, ElSohly MA, Gage SH, Groshkova T, Gual A, Hammond D, Lawn W, López‐Pelayo H, Manthey J, Mokrysz C, Pacula RL, van Laar M, Vandrey R, Wadsworth E, Winstock A, Hall W, Curran HV, Freeman TP. The International Cannabis Toolkit (iCannToolkit): a multidisciplinary expert consensus on minimum standards for measuring cannabis use. Addiction 2022; 117:1510-1517. [PMID: 34590359 PMCID: PMC9298052 DOI: 10.1111/add.15702] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The lack of an agreed international minimum approach to measuring cannabis use hinders the integration of multidisciplinary evidence on the psychosocial, neurocognitive, clinical and public health consequences of cannabis use. METHODS A group of 25 international expert cannabis researchers convened to discuss a multidisciplinary framework for minimum standards to measure cannabis use globally in diverse settings. RESULTS The expert-based consensus agreed upon a three-layered hierarchical framework. Each layer-universal measures, detailed self-report and biological measures-reflected different research priorities and minimum standards, costs and ease of implementation. Additional work is needed to develop valid and precise assessments. CONCLUSIONS Consistent use of the proposed framework across research, public health, clinical practice and medical settings would facilitate harmonisation of international evidence on cannabis consumption, related harms and approaches to their mitigation.
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Affiliation(s)
- Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, the Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health SciencesAustralian Catholic UniversityMelbourneAustralia
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit (CPU)University College LondonLondonUK
| | - Kat Petrilli
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
| | - Paul Griffiths
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)LisbonPortugal
| | - Jamie Brown
- Behavioural Science and Health Institute of Epidemiology and HealthUniversity College LondonLondonUK
| | - Álvaro Castillo‐Carniglia
- Society and Health Research Center and School of Public HealthUniversidad MayorSantiagoChile
- Department of Population HealthNYU Grossman School of MedicineNew YorkNYUSA
| | | | - Amir Englund
- Addictions Department, Institute of Psychiatry, Psychology & NeuroscienceKings College LondonLondonUK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Mahmoud A. ElSohly
- National Center for Natural Products Research, School of PharmacyUniversity of MississippiUniversityMSUSA
- Department Pharmaceutics and Drug Delivery, School of PharmacyUniversity of Mississippi, UniversityMSUSA
| | - Suzanne H. Gage
- Department of Psychology, Institute of Population HealthUniversity of LiverpoolLiverpoolUK
| | - Teodora Groshkova
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)LisbonPortugal
| | - Antoni Gual
- Psychiatry DepartmentNeurosciences Institute, Hospital Clínic, IDIBAPS, RTABarcelonaSpain
| | - David Hammond
- School of Public Health and Health SystemsUniversity of WaterlooWaterlooCanada
| | - Will Lawn
- Clinical Psychopharmacology Unit (CPU)University College LondonLondonUK
- Addictions Department, Institute of Psychiatry, Psychology & NeuroscienceKings College LondonLondonUK
| | - Hugo López‐Pelayo
- Psychiatry DepartmentNeurosciences Institute, Hospital Clínic, IDIBAPS, RTABarcelonaSpain
| | - Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and PsychotherapyUniversity Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
| | - Claire Mokrysz
- Clinical Psychopharmacology Unit (CPU)University College LondonLondonUK
| | - Rosalie Liccardo Pacula
- USC Sol Price School of Public PolicyUSC Leonard D. Schaeffer Center for Health Policy & EconomicsLos AngelesCAUSA
| | | | - Ryan Vandrey
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Elle Wadsworth
- School of Public Health and Health SystemsUniversity of WaterlooWaterlooCanada
| | - Adam Winstock
- Behavioural Science and Health Institute of Epidemiology and HealthUniversity College LondonLondonUK
- Global Drug SurveyLondonUK
| | - Wayne Hall
- National Addiction Centre, King's College LondonLondonUK
- National Centre for Youth Substance Use ResearchThe University of QueenslandBrisbaneAustralia
| | - H. Valerie Curran
- Clinical Psychopharmacology Unit (CPU)University College LondonLondonUK
| | - Tom P. Freeman
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
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13
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Berberian S, Broussard ML, Tully C, Methuku V, Pardini DA, Meier MH. Young adults' familiarity with different cannabis product terms: the need for standardized cannabis surveys. J Cannabis Res 2022; 4:14. [PMID: 35365236 PMCID: PMC8974070 DOI: 10.1186/s42238-022-00125-0] [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] [Received: 01/19/2021] [Accepted: 03/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background Cannabis legalization has resulted in the proliferation of cannabis products. Participants’ familiarity with terms for these products may have implications for assessment, as unfamiliarity with particular terms may result in under-reports of use. Methods A convenience sample of 861 college students from one U.S. university completed a survey in the spring of 2020 about their familiarity with a variety of cannabis product terms and use of a variety of cannabis products. Results Participants varied in their familiarity with cannabis product terms. For example, with regard to terms for cannabis concentrates with very high concentrations of THC, 85% of participants reported being familiar with the term “wax pen or THC oil,” but only 27% reported being familiar with the term “butane hash oil (BHO)” (i.e., the oil that composes most concentrates). Moreover, of participants who reported use of concentrates based on selecting pictures of the products they had used (n = 324, 40%), 99% (n = 322) reported having seen a “wax pen or THC oil” based on a written list of product terms, whereas only 20% (n = 65) reported having seen “butane hash oil (BHO).” This suggests that asking about use of “butane hash oil” use may result in lower rates of cannabis concentrate use than asking about use of “wax pen/THC oil.” With regard to terms for marijuana flower, 29% of participants (n = 248) reported being unfamiliar with the term marijuana “buds or flowers.” Of participants who reported use of marijuana flower based on selecting pictures of the products they had used (38% of the sample, n = 329), only 86% (n = 282) reported having seen marijuana “buds or flowers” based on a written list of product terms. This suggests that asking about use of marijuana “buds or flowers” use could result in under-reporting due to lack of familiarity with that term. Finally, when asked to select pictures of the cannabis product(s) that participants thought constituted “marijuana,” participants most commonly selected pictures of marijuana flower (93%), followed by wax pen/THC oil (57%) and edibles (49%). Conclusions Young adults vary in their familiarity with cannabis product terms, and some may under-report cannabis use in surveys that rely on written cannabis product terms. Young adults also differ in terms of which cannabis products they think constitute “marijuana.” Although participants’ familiarity with specific cannabis product terms in this sample may not generalize to other populations, results highlight the need for standardized surveys of cannabis use that incorporate pictures of cannabis products to overcome issues related to variability in familiarity with cannabis product terms. Supplementary Information The online version contains supplementary material available at 10.1186/s42238-022-00125-0.
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Affiliation(s)
- S Berberian
- Department of Psychology, Arizona State University, PO Box 871104, Tempe, AZ, 85287-1104, USA
| | - M L Broussard
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - C Tully
- Department of Psychology, Arizona State University, PO Box 871104, Tempe, AZ, 85287-1104, USA
| | - V Methuku
- Department of Psychology, Arizona State University, PO Box 871104, Tempe, AZ, 85287-1104, USA
| | - D A Pardini
- Department of Criminology and Criminal Justice, Arizona State University, Phoenix, AZ, USA
| | - M H Meier
- Department of Psychology, Arizona State University, PO Box 871104, Tempe, AZ, 85287-1104, USA.
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14
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Mills L, Lintzeris N, O'Malley M, Arnold JC, McGregor IS. Prevalence and correlates of cannabis use disorder among Australians using cannabis products to treat a medical condition. Drug Alcohol Rev 2022; 41:1095-1108. [PMID: 35172040 DOI: 10.1111/dar.13444] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/14/2021] [Accepted: 01/21/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Prior research has examined the prevalence and correlates of cannabis use disorder (CUD) in people who use cannabis; however, these are poorly described for people using cannabis for medical reasons. METHODS Data came from a 2018 to 2019 online, anonymous, cross-sectional survey of Australians reporting using either illicit or licit cannabis for medical reasons within the past year. Included were questions on demographics, current and lifetime patterns of cannabis use, clinical conditions for which medical cannabis was used, and individual criteria for CUD and cannabis withdrawal syndrome. Bayesian Horseshoe logistic regression models were used to identify covariates associated with meeting CUD DSM-5 conditions for any-CUD (≥2/11 criteria) and moderate-severe-CUD (≥4/11). RESULTS A total of 905 participants were included in the analysis. The majority (98%) used illicit cannabis products. Criteria for any-CUD criteria were met by 290 (32.0%), and 117 (12.9%) met criteria for moderate-severe-CUD. Tolerance (21%) and withdrawal (35%) were the most commonly met criteria. Correlates with the strongest association with CUD were inhaled route of administration [odds ratio (OR) = 2.96, 95% credible interval 1.11, 7.06], frequency of cannabis use (OR = 1.24, 1.11-1.35), proportion of cannabis for medical reasons (OR = 0.83, 0.74, 0.94), frequency of tobacco use (OR = 1.10, 1.03, 1.17), age (OR = 0.75, 0.64, 0.90) and pain as main clinical indication (OR = 0.58, 0.36, 1.00). DISCUSSION AND CONCLUSIONS Prevalence of CUD in medical cannabis users appears comparable to 'recreational' users, with many similar correlates. CUD was associated with using cannabis to treat mental health rather than pain conditions and inhaled over other routes of administration.
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Affiliation(s)
- Llewellyn Mills
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, Australia.,Discipline of Addiction Medicine, Faculty of Medicine and Public Health, The University of Sydney, Sydney, Australia.,Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, Australia.,Discipline of Addiction Medicine, Faculty of Medicine and Public Health, The University of Sydney, Sydney, Australia.,Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Michael O'Malley
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, Australia.,Discipline of Addiction Medicine, Faculty of Medicine and Public Health, The University of Sydney, Sydney, Australia
| | - Jonathon C Arnold
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, Australia.,Discipline of Pharmacology, Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Iain S McGregor
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
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15
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Binkowska AA, Ruban A, Gogolewska M, Sawicz P, Rychlewski L, Brzezicka A. Who Is at Risk of Developing Cannabis Dependence? Findings From an Extensive Online Study on Cannabis Users. J Addict Nurs 2022; 33:37-44. [PMID: 35230059 DOI: 10.1097/jan.0000000000000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Although frequency of cannabis use is considered to be the strongest risk factor for developing cannabis dependence, only up to half of daily users become dependent. In this study, we explored an array of risk factors and moderators of cannabis dependence symptoms from the International Classification of Diseases, Tenth Edition endorsed by participants. METHODS A sample of 1,635 cannabis users completed an Internet survey consisting of measures of cannabis and other drug use. Multiple linear regression with a backward elimination method was employed to identify predictors of cannabis dependence symptoms. After that, a series of hierarchical multiple regression analyses were performed to test the predictive validity of the interactions between frequency of cannabis use and other predictors. RESULTS Frequency of cannabis use appeared to be the strongest predictor of developing cannabis dependence symptoms; other significant predictors of cannabis dependence symptoms were substance-dependency-related treatment seeking, mental health problems in the family and pattern of substance use. Duration of cannabis use, relationship status, and drug use history in the family were identified as significant moderators of the relationship between frequency of cannabis use and the number of cannabis dependence symptoms. CONCLUSIONS This study confirms that the frequency of cannabis use is the strongest predictor of cannabis dependence symptoms but this relationship is significantly moderated by three abovementioned factors.
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16
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Kaur N, Bastien G, Gagnon L, Graham J, Mongeau-Pérusse V, Bakouni H, Morissette F, Theriault C, Fischer B, Jutras-Aswad D. Variations of cannabis-related adverse mental health and addiction outcomes across adolescence and adulthood: A scoping review. Front Psychiatry 2022; 13:973988. [PMID: 36299544 PMCID: PMC9590692 DOI: 10.3389/fpsyt.2022.973988] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Evidence supporting associations between cannabis use and many health outcomes is growing, however it remains unclear how such associations vary across the lifespan. We therefore aim to answer the following questions: (1) Are the risks of cannabis's adverse effects on mental health and addiction-related outcomes different in adolescents than in adults? (2) What are the relationships between these cannabis's adverse effects and (a) an individual's age at first cannabis use, (b) age at assessment, and (c) duration of cannabis use? METHODS We searched Medline, Embase, CINAHL, and PsychINFO from inception to 18 October 2021. Two reviewers independently screened studies and descriptively synthesized results. RESULTS We included 140 studies. Cannabis effects on mental health and addiction-related outcomes were worse in adolescents, early cannabis initiators and cannabis users who consumed for longest periods. Evidence of worse long-term adverse effects in adolescents was substantial for psychosis, cannabis, and nicotine use disorders; mixed for depression, suicidality, other substance use and disorders; and limited for anxiety. Additionally, acute cannabis exposure had the opposite trend with adults more often reporting adverse effects than adolescents. CONCLUSION The available evidence suggests that cannabis use should be delayed as late as possible in adulthood and shortened in duration across the lifespan to decrease the risk of negative outcomes, while emphasizing the need for adapted harm reduction approaches. This scoping review provides evidence on the role of age and duration of exposure as determinants of cannabis-related adverse effects, which may inform prevention and harm reduction strategies. SYSTEMATIC REVIEW REGISTRATION https://doi.org/10.17605/OSF.IO/BYG72.
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Affiliation(s)
- Navdeep Kaur
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Gabriel Bastien
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Lea Gagnon
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Johann Graham
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Violaine Mongeau-Pérusse
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Hamzah Bakouni
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Florence Morissette
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Camille Theriault
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Benedikt Fischer
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.,Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Didier Jutras-Aswad
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
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17
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Steeger CM, Hitchcock LN, Bryan AD, Hutchison KE, Hill KG, Bidwell LC. Associations between self-reported cannabis use frequency, potency, and cannabis/health metrics. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103278. [PMID: 34062287 PMCID: PMC8585676 DOI: 10.1016/j.drugpo.2021.103278] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Research shows that cannabis use frequency is associated with cannabis dependence and health metrics. However, much less is known about how self-reported cannabis potency (THC and CBD) may be associated with the same metrics, and whether any associations exist after accounting for frequency of cannabis use. Moreover, even less is known about how these relations may differ across cannabis product forms. This exploratory study examined 1) associations between cannabis frequency, potency, and cannabis/health metrics, and 2) whether associations between potency and cannabis/health metrics remained after controlling for frequency of use. METHODS Using a sample of adult recreational cannabis users in Colorado (N = 300), we tested the relationship between self-reported cannabis use metrics of frequency and potency of flower, edible, and concentrate products with separate measures of problematic cannabis use (i.e., dependence, withdrawal, craving), depression, anxiety, and general perceived health. RESULTS Greater frequency of flower and concentrate (but not edible) use were associated with greater problematic cannabis use, and greater concentrate use frequency was also associated with more mental health problems. Partial correlations controlling for average frequency of use across all product forms and CBD potency per product showed that one significant association between THC potency and cannabis/health metrics remained (i.e., higher THC concentrate potency with better health), and one emerged (i.e., higher THC concentrate potency with lower cannabis withdrawal). CONCLUSIONS Frequency of use is reliably associated with problematic cannabis use for flower and concentrates, but it did not account for all observed associations in this study. Differences in patterns of associations between frequency and potency and cannabis/health metrics across cannabis forms suggest a need for better understanding user reports of THC and CBD potency, individual differences among users, and improved measurement.
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Affiliation(s)
- Christine M Steeger
- Institute of Behavioral Science, University of Colorado Boulder, 1440 15th St., Boulder, CO 80309, USA.
| | - Leah N Hitchcock
- Institute of Cognitive Science, University of Colorado Boulder, 344 UCB, Boulder, CO 80309, USA
| | - Angela D Bryan
- Institute of Cognitive Science, University of Colorado Boulder, 344 UCB, Boulder, CO 80309, USA; Department of Psychology & Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO 80309, USA
| | - Kent E Hutchison
- Institute of Cognitive Science, University of Colorado Boulder, 344 UCB, Boulder, CO 80309, USA; Department of Psychology & Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO 80309, USA
| | - Karl G Hill
- Institute of Behavioral Science, University of Colorado Boulder, 1440 15th St., Boulder, CO 80309, USA
| | - L Cinnamon Bidwell
- Institute of Cognitive Science, University of Colorado Boulder, 344 UCB, Boulder, CO 80309, USA; Department of Psychology & Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO 80309, USA
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18
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Sami M, Quattrone D, Ferraro L, Tripoli G, Cascia EL, Gayer-Anderson C, Selten JP, Arango C, Bernardo M, Tarricone I, Tortelli A, Gatto G, Del Peschio S, Del-Ben CM, Rutten BP, Jones PB, van Os J, de Haan L, Morgan C, Lewis C, Bhattacharyya S, Freeman TP, Lynskey M, Murray RM, Forti MD. Association of extent of cannabis use and psychotic like intoxication experiences in a multi-national sample of first episode psychosis patients and controls. Psychol Med 2021; 51:2074-2082. [PMID: 32340643 DOI: 10.1017/s0033291720000847] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND First episode psychosis (FEP) patients who use cannabis experience more frequent psychotic and euphoric intoxication experiences compared to controls. It is not clear whether this is consequent to patients being more vulnerable to the effects of cannabis use or to their heavier pattern of use. We aimed to determine whether extent of use predicted psychotic-like and euphoric intoxication experiences in patients and controls and whether this differs between groups. METHODS We analysed data on patients who had ever used cannabis (n = 655) and controls who had ever used cannabis (n = 654) across 15 sites from six countries in the EU-GEI study (2010-2015). We used multiple regression to model predictors of cannabis-induced experiences and to determine if there was an interaction between caseness and extent of use. RESULTS Caseness, frequency of cannabis use and money spent on cannabis predicted psychotic-like and euphoric experiences (p ⩽ 0.001). For psychotic-like experiences (PEs) there was a significant interaction for caseness × frequency of use (p < 0.001) and caseness × money spent on cannabis (p = 0.001) such that FEP patients had increased experiences at increased levels of use compared to controls. There was no significant interaction for euphoric experiences (p > 0.5). CONCLUSIONS FEP patients are particularly sensitive to increased psychotic-like, but not euphoric experiences, at higher levels of cannabis use compared to controls. This suggests a specific psychotomimetic response in FEP patients related to heavy cannabis use. Clinicians should enquire regarding cannabis related PEs and advise that lower levels of cannabis use are associated with less frequent PEs.
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Affiliation(s)
- Musa Sami
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- Institute of Mental Health, Jubilee Campus, University of Nottingham, Nottingham, UK
| | - Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Laura Ferraro
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 9012 9Palermo, Italy
| | - Giada Tripoli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Erika La Cascia
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 9012 9Palermo, Italy
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Jean-Paul Selten
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZLeiden, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MDMaastricht, The Netherlands
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM (CIBERSAM), C/Doctor Esquerdo 46, 28007Madrid, Spain
| | - Miguel Bernardo
- Department of Medicine, Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Ilaria Tarricone
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Viale Pepoli 5, 40126Bologna, Italy
| | - Andrea Tortelli
- Etablissement Public de Santé Maison Blanche, Paris, 75020, France
| | - Giusy Gatto
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Viale Pepoli 5, 40126Bologna, Italy
| | - Simona Del Peschio
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Viale Pepoli 5, 40126Bologna, Italy
| | - Cristina Marta Del-Ben
- Division of Psychiatry, Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Bart P Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MDMaastricht, The Netherlands
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
- CAMEO Early Intervention Service, Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MDMaastricht, The Netherlands
- Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Meibergdreef 5, 1105 AZAmsterdam, The Netherlands
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Cathryn Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Tom P Freeman
- Department of Psychology, Addiciton and Mental Health Group (AIM), University of Bath, BA2 7AY, UK
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, LondonSE5 8BB, UK
| | - Michael Lynskey
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, LondonSE5 8BB, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Marta Di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
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Patel H, Holshausen K, Oshri A, Andrews K, Penta S, Raymond H, McKinnon M, Brasch J, MacKillop J, Amlung M. Posttraumatic Stress Disorder Symptomatology and Substance Use in an Outpatient Concurrent Disorders Sample. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:788-797. [PMID: 33878938 PMCID: PMC8504290 DOI: 10.1177/07067437211011851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) present a complex and often severe clinical presentation within a concurrent disorders context. The objective of this study was to examine associations between PTSD symptoms and SUD outcomes to better understand the clinical phenomenon of comorbid PTSD and SUD. Multivariate statistical methods were used to test the hypothesis that elevated PTSD symptoms, both at the level of global severity and specific PTSD symptom clusters, are associated with greater substance use and related problems. METHODS Data were collected from an intake assessment battery within a specialized concurrent disorders outpatient service in Hamilton, ON. The sample comprised 326 participants (mean age = 37.19, 45.4% female). Structural equation models examined associations between PTSD and alcohol, cannabis, and substance use frequency and problems, controlling for age and sex. Alcohol was ultimately dropped from the model due to non-significant bivariate associations. RESULTS Higher global PTSD symptomatology was significantly associated with higher cannabis and other substance use frequency and related problems. Analyses using PTSD cluster scores showed higher scores for alterations in arousal were positively associated with cannabis-related problems, drug-related problems, and cannabis and other substance use frequency. Avoidance was significantly associated with cannabis frequency and cannabis-related problems. In general, effect sizes were small in magnitude, accounting for between 9% and 25% of variance. CONCLUSION Significant cluster-level associations indicate the importance of specific PTSD symptoms (hyperarousal, avoidance) in relation to substance use when identifying therapeutic targets among individuals presenting with comorbid PTSD-SUD. This multivariate approach provides a higher resolution and potentially more clinically informative representation of the complex clinical presentation of PTSD and SUD in a concurrent disorder population and could guide the development of more effective treatment paths.
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Affiliation(s)
- Herry Patel
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph’s Healthcare Hamilton, Ontario, Canada
| | - Katherine Holshausen
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph’s Healthcare Hamilton, Ontario, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Mental Health and Addictions Program, St. Joseph’s Healthcare Hamilton, Ontario, Canada
| | - Assaf Oshri
- Department of Human Development and Family Science, University of Georgia, Athens, Georgia, USA
| | - Krysta Andrews
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Penta
- Mental Health and Addictions Program, St. Joseph’s Healthcare Hamilton, Ontario, Canada
| | - Holly Raymond
- Mental Health and Addictions Program, St. Joseph’s Healthcare Hamilton, Ontario, Canada
| | - Margaret McKinnon
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Mental Health and Addictions Program, St. Joseph’s Healthcare Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
| | - Jennifer Brasch
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph’s Healthcare Hamilton, Ontario, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Mental Health and Addictions Program, St. Joseph’s Healthcare Hamilton, Ontario, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph’s Healthcare Hamilton, Ontario, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
| | - Michael Amlung
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph’s Healthcare Hamilton, Ontario, Canada
- Department of Applied Behavioral Science, University of Kansas, Lawrence, Kansas, USA
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, Kansas, USA
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20
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Kvamme SL, Pedersen MM, Rømer Thomsen K, Thylstrup B. Exploring the use of cannabis as a substitute for prescription drugs in a convenience sample. Harm Reduct J 2021; 18:72. [PMID: 34246279 PMCID: PMC8272272 DOI: 10.1186/s12954-021-00520-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/24/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The use of cannabis as medicine (CaM) both prescribed and non-prescribed has increased markedly in the last decade, mirrored in a global shift in cannabis policy towards a more permissive stance. There is some evidence that cannabis functions as a substitute for prescription drugs, particularly opioids; however, more knowledge is needed on the motives of substitution users, their patterns of use, and perceived effects of substitution use. AIMS To explore who substitutes prescription drugs with cannabis, the type of prescription drugs substituted and the type of cannabis used, and the impact that substitution with cannabis has on prescription drug use as well as the motives for substitution in terms of experienced effects and side effects. METHODS A self-selected convenience sample was recruited through social media, public media, and patient organizations to take part in an anonymous online survey. Inclusion criteria were 18 years or older and use of cannabis (prescribed or non-prescribed) with a medical purpose. RESULTS The final sample included 2.841 respondents of which the majority (91%) used non-prescribed cannabis, and more than half (54.6%) had used CaM with the purpose of replacing a prescribed drug. Compared to non-substitution users, substitution users were more likely to be women and to use CaM in the treatment of chronic pain and other somatic conditions. Pain medication (67.2%), antidepressants (24.5%), and arthritis medication (20.7%) were the most common types of drugs replaced with CaM. Among substitution users, 38.1% reported termination of prescription drug use, and 45.9% a substantial decrease in prescription drug use. The most frequent type of cannabis used as a substitute was CBD-oil (65.2%), followed by 'hash, pot or skunk' (36.6%). More than half (65.8%) found CaM much more effective compared to prescription drugs, and 85.5% that the side effects associated with prescription drug use were much worse compared to use of CaM. CONCLUSION CaM is frequently used as a substitute for prescription drugs, particularly opioids. More research is needed on the long-term consequences of use of CaM, including the impact from low and high THC cannabis products on specific somatic and mental health conditions.
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Affiliation(s)
- Sinikka L Kvamme
- Center for Alcohol and Drug Research, Aarhus BSS, Aarhus University, Building 1322. Bartholins Allé 10, 8000, Aarhus C, Denmark.
| | - Michael M Pedersen
- Center for Alcohol and Drug Research, Aarhus BSS, Aarhus University, Building 1322. Bartholins Allé 10, 8000, Aarhus C, Denmark
| | - Kristine Rømer Thomsen
- Center for Alcohol and Drug Research, Aarhus BSS, Aarhus University, Building 1322. Bartholins Allé 10, 8000, Aarhus C, Denmark
| | - Birgitte Thylstrup
- Center for Alcohol and Drug Research, Aarhus BSS, Aarhus University, Artillerivej 90, 2. Floor, 2300, Copenhagen S, Denmark
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21
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Sideli L, Trotta G, Spinazzola E, La Cascia C, Di Forti M. Adverse effects of heavy cannabis use: even plants can harm the brain. Pain 2021; 162:S97-S104. [PMID: 32804835 PMCID: PMC8216111 DOI: 10.1097/j.pain.0000000000001963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Lucia Sideli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neurosceince, King's College London, De Crespigny Park, Denmark Hill, London, United Kingdom
| | - Giulia Trotta
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neurosceince, King's College London, De Crespigny Park, Denmark Hill, London, United Kingdom
| | - Edoardo Spinazzola
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neurosceince, King's College London, De Crespigny Park, Denmark Hill, London, United Kingdom
- Department of Neuroscience, Mental Health, and Sensory Organs (NeSMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Caterina La Cascia
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, Palermo University, Palermo, Italy
| | - Marta Di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
- South London and Maudsley NHS Mental Health Foundation Trust, London, United Kingdom
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22
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Freeman AM, Mokrysz C, Hindocha C, Lawn W, Morgan CJ, Freeman TP, Saunders R, Curran HV. Does variation in trait schizotypy and frequency of cannabis use influence the acute subjective, cognitive and psychotomimetic effects of delta-9-tetrahydrocannabinol? A mega-analysis. J Psychopharmacol 2021; 35:804-813. [PMID: 33427016 DOI: 10.1177/0269881120959601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While the acute effects of cannabis are relatively benign for most users, some individuals experience significant adverse effects. This study aimed to identify whether variation in schizotypal personality traits and frequency of cannabis use influence the acute effects of delta-9-tetrahydrocannabinol (THC). METHODS Individual participant data from four double-blind, randomised, placebo-controlled, acute crossover studies involving 128 cannabis users were combined for a mega-analysis. Using multilevel linear models and moderation analyses, frequency of cannabis use and schizotypal personality traits were investigated as potential moderators of the subjective, cognitive and psychotomimetic effects of acute THC. RESULTS There was evidence of a moderating effect where increased frequency of cannabis use was associated with reduced intensity of subjective (changes in alertness and feeling stoned) and psychosis-like effects following THC when compared with placebo. Moderating effects of cannabis use frequency on acute memory impairment were weak. Trait schizotypy did not moderate the acute psychosis-like effects of THC compared with placebo. CONCLUSIONS Our results suggest that a pattern of domain-specific tolerance develops to the acute effects of THC. Tolerance to the alertness-reducing effects occurred more readily than tolerance to psychotomimetic effects. Only partial tolerance to feeling stoned was found, and there was weak evidence for tolerance to memory impairment. Trait schizotypy did not moderate THC's effects on psychotomimetic symptoms.
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Affiliation(s)
- Abigail M Freeman
- Clinical Psychopharmacology Unit, University College London, Gower Street, London, UK
| | - Claire Mokrysz
- Clinical Psychopharmacology Unit, University College London, Gower Street, London, UK
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit, University College London, Gower Street, London, UK
| | - Will Lawn
- Clinical Psychopharmacology Unit, University College London, Gower Street, London, UK
| | - Celia Ja Morgan
- Psychopharmacology and Addiction Research Centre (PARC), Department of Psychology, University of Exeter, Exeter, UK
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), University of Bath, Bath, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, University College London, Gower Street, London, UK
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23
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Cannabis, schizophrenia genetic risk, and psychotic experiences: a cross-sectional study of 109,308 participants from the UK Biobank. Transl Psychiatry 2021; 11:211. [PMID: 33837184 PMCID: PMC8035271 DOI: 10.1038/s41398-021-01330-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/25/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023] Open
Abstract
Cannabis is known to produce acute, transient psychotic-like experiences. However, it is unclear whether cannabis disproportionately increases the risk of specific types of psychotic experiences and whether genetic predisposition influences the relationship between cannabis use and psychotic experiences. In this cross-sectional study of 109,308 UK Biobank participants, we examined how schizophrenia polygenic risk modulates the association between self-reported cannabis use and four types of self-reported psychotic experiences (auditory hallucinations, visual hallucinations, persecutory delusions, and delusions of reference). Cohort-wide, we found a strong, dose-dependent relationship between cannabis use and all four types of psychotic experiences, especially persecutory delusions. Cannabis users' psychotic experiences tended to be earlier-onset and cause greater distress than non-users', but were not more likely to lead to help-seeking. Participants with high schizophrenia polygenic risk scores showed stronger associations between cannabis use and auditory hallucinations, visual hallucinations, and delusions of reference, as well as psychotic experiences overall. For instance, cannabis ever-use was associated with 67% greater adjusted odds of delusions of reference among individuals in the top fifth of polygenic risk, but only 7% greater adjusted odds among the bottom fifth. Our results suggest that cannabis use is a predictive risk factor for psychotic experiences, including early-onset and distressing experiences. Individuals genetically predisposed to schizophrenia may be especially vulnerable to psychotic experiences as a result of using cannabis, supporting a long-postulated hypothesis. This study exemplifies the utility of population-scale biobanks for elucidating gene-by-environment interactions relating substance use to neuropsychiatric outcomes and points to the translational potential of using polygenic risk scores to inform personalized harm reduction interventions.
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24
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Richards DK, Schwebel FJ, Sotelo M, Pearson MR. Self-reported symptoms of cannabis use disorder: Psychometric testing and validation. Exp Clin Psychopharmacol 2021; 29:157-165. [PMID: 34043399 PMCID: PMC8375671 DOI: 10.1037/pha0000455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cannabis use disorder (CUD) is commonly assessed using self-report items based on its symptoms as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) that are scored on a dichotomous scale (yes/no) to indicate symptom presence; however, scoring items on a dichotomy may result in relatively limited sensitivity for research. Thus, we developed a 13-item measure of CUD, the Self-Reported Symptoms of CUD (SRSCUD), based on the 11 symptoms described in the DSM-5 that is scored on a 4-point response scale indicating degree of severity. In the present study, we conduct an initial evaluation of the psychometric properties of the SRSCUD. Past-month cannabis users (N = 2,077) were recruited from nine universities in nine states throughout the U.S. Each item of the SRSCUD loaded saliently onto a single factor of CUD symptoms in both exploratory and confirmatory factor analyses. The SRSCUD was strongly correlated with measures of cannabis use, dependence severity, and cannabis-related problems. In addition, the SRSCUD was moderately positively correlated with a well-known risk factor for CUD (coping motives) and moderately negatively correlated with a well-known protective factor for CUD (protective behavioral strategies). These correlations mostly remained statistically significant while controlling for CUD symptom count and diagnosis using dichotomized SRSCUD items. Receiver operator characteristic curve analyses revealed that the SRSCUD had excellent sensitivity/specificity for predicting probable CUD. Although more research evaluating performance of the SRSCUD compared to a clinical diagnosis is needed, we found preliminary evidence for construct validity of this measure. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Dylan K Richards
- Center on Alcohol, Substance Use, And Addictions (CASAA), University of New Mexico
| | - Frank J Schwebel
- Center on Alcohol, Substance Use, And Addictions (CASAA), University of New Mexico
| | - Melissa Sotelo
- Center on Alcohol, Substance Use, And Addictions (CASAA), University of New Mexico
| | - Matthew R Pearson
- Center on Alcohol, Substance Use, And Addictions (CASAA), University of New Mexico
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25
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Teeters JB, Woodward MJ, Meshesha LZ, Tripp JC. Cannabis use in civilian college students and college student service members/veterans: the moderating effect of anxiety. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:777-783. [PMID: 32469609 DOI: 10.1080/00952990.2020.1753758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Cannabis is the most commonly used illicit drug on college campuses. Research suggests that Student Service Members/Veterans (SSM/V) may be more likely to use alcohol than civilian students, but little research has focused on cannabis use in these two samples. Objectives: The purpose of the current study was to compare cannabis use frequency, cannabis use disorder (CUD) symptoms, and cannabis-related problems between civilian students and SSM/V. A second aim was to determine if group differences in these outcomes were moderated by symptoms of depression, stress, or anxiety. Methods: The sample included 164 college SSM/V (80.4% female, 19.6% male) and 456 civilian (78% female, 22% male) college students. Participants completed an online survey assessing demographics, number of days of past month cannabis use, cannabis-related problems, CUD symptoms, and a measure of anxiety, depression, and stress. Results: Negative binomial regressions indicated no significant differences in number of days of past-month cannabis use or past-year cannabis-related problems between civilian students and SSM/V, although SSM/V reported more past-year CUD symptoms. Moderation analyses revealed that at elevated levels of anxiety, SSM/V students used cannabis more frequently than civilian students. Conclusion: These findings indicate that when experiencing elevated levels of anxiety, SSM/V use cannabis more frequently than civilian students, suggesting that anxiety may be a more prominent risk factor for frequency of cannabis use for SSM/V compared to civilian students. Education, prevention, and intervention efforts specifically addressing anxiety in this demographic are needed.
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Affiliation(s)
- Jenni B Teeters
- Department of Psychological Sciences, aWestern Kentucky University , Bowling Green, KY, USA
| | - Matthew J Woodward
- Department of Psychological Sciences, aWestern Kentucky University , Bowling Green, KY, USA
| | - Lidia Z Meshesha
- Center for Alcohol and Addiction Studies, Brown University School of Public Health , Providence, RI, USA
| | - Jessica C Tripp
- VA San Diego Healthcare System , San Diego, CA, USA.,School of Medicine, University of California , San Diego, CA, USA
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26
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Craft S, Winstock A, Ferris J, Mackie C, Lynskey MT, Freeman TP. Characterising heterogeneity in the use of different cannabis products: latent class analysis with 55 000 people who use cannabis and associations with severity of cannabis dependence. Psychol Med 2020; 50:2364-2373. [PMID: 31607281 DOI: 10.1017/s0033291719002460] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND As new cannabis products and administration methods proliferate, patterns of use are becoming increasingly heterogeneous. However, few studies have explored different profiles of cannabis use and their association with problematic use. METHODS Latent class analysis (LCA) was used to identify subgroups of past-year cannabis users endorsing distinct patterns of use from a large international sample (n = 55 240). Past-12-months use of six different cannabis types (sinsemilla, herbal, hashish, concentrates, kief, edibles) were used as latent class indicators. Participants also reported the frequency and amount of cannabis used, whether they had ever received a mental health disorder diagnosis and their cannabis dependence severity via the Severity of Dependence Scale (SDS). RESULTS LCA identified seven distinct classes of cannabis use, characterised by high probabilities of using: sinsemilla & herbal (30.3% of the sample); sinsemilla, herbal & hashish (20.4%); herbal (18.4%); hashish & herbal (18.8%); all types (5.7%); edibles & herbal (4.6%) and concentrates & sinsemilla (1.7%). Relative to the herbal class, classes characterised by sinsemilla and/or hashish use had increased dependence severity. By contrast, the classes characterised by concentrates use did not show strong associations with cannabis dependence but reported greater rates of ever receiving a mental health disorder diagnosis. CONCLUSIONS The identification of these distinct classes underscores heterogeneity among cannabis use behaviours and provides novel insight into their different associations with addiction and mental health.
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Affiliation(s)
- Sam Craft
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adam Winstock
- University College London, London, UK
- Global Drug Survey Ltd, London, UK
| | - Jason Ferris
- Centre for Health Services Research, University of Queensland, QLD, Australia
| | - Clare Mackie
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael T Lynskey
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tom P Freeman
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- University College London, London, UK
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
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Cannabidiol for the treatment of cannabis use disorder: a phase 2a, double-blind, placebo-controlled, randomised, adaptive Bayesian trial. Lancet Psychiatry 2020; 7:865-874. [PMID: 32735782 PMCID: PMC7116091 DOI: 10.1016/s2215-0366(20)30290-x] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 11/24/2022]
Abstract
UNLABELLED Background A substantial and unmet clinical need exists for pharmacological treatment of cannabis use disorders. Cannabidiol could offer a novel treatment, but it is unclear which doses might be efficacious or safe. Therefore, we aimed to identify efficacious doses and eliminate inefficacious doses in a phase 2a trial using an adaptive Bayesian design. METHODS We did a phase 2a, double-blind, placebo-controlled, randomised, adaptive Bayesian trial at the Clinical Psychopharmacology Unit (University College London, London, UK). We used an adaptive Bayesian dose-finding design to identify efficacious or inefficacious doses at a-priori interim and final analysis stages. Participants meeting cannabis use disorder criteria from DSM-5 were randomly assigned (1:1:1:1) in the first stage of the trial to 4-week treatment with three different doses of oral cannabidiol (200 mg, 400 mg, or 800 mg) or with matched placebo during a cessation attempt by use of a double-blinded block randomisation sequence. All participants received a brief psychological intervention of motivational interviewing. For the second stage of the trial, new participants were randomly assigned to placebo or doses deemed efficacious in the interim analysis. The primary objective was to identify the most efficacious dose of cannabidiol for reducing cannabis use. The primary endpoints were lower urinary 11-nor-9-carboxy-δ-9-tetrahydrocannabinol (THC-COOH):creatinine ratio, increased days per week with abstinence from cannabis during treatment, or both, evidenced by posterior probabilities that cannabidiol is better than placebo exceeding 0·9. All analyses were done on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov (NCT02044809) and the EU Clinical Trials Register (2013-000361-36). FINDINGS Between May 28, 2014, and Aug 12, 2015 (first stage), 48 participants were randomly assigned to placebo (n=12) and to cannabidiol 200 mg (n=12), 400 mg (n=12), and 800 mg (n=12). At interim analysis, cannabidiol 200 mg was eliminated from the trial as an inefficacious dose. Between May 24, 2016, and Jan 12, 2017 (second stage), randomisation continued and an additional 34 participants were allocated (1:1:1) to cannabidiol 400 mg (n=12), cannabidiol 800 mg (n=11), and placebo (n=11). At final analysis, cannabidiol 400 mg and 800 mg exceeded primary endpoint criteria (0·9) for both primary outcomes. For urinary THC-COOH:creatinine ratio, the probability of being the most efficacious dose compared with placebo given the observed data was 0·9995 for cannabidiol 400 mg and 0·9965 for cannabidiol 800 mg. For days with abstinence from cannabis, the probability of being the most efficacious dose compared with placebo given the observed data was 0·9966 for cannabidiol 400 mg and 0·9247 for cannabidiol 800 mg. Compared with placebo, cannabidiol 400 mg decreased THC-COOH:creatinine ratio by -94·21 ng/mL (95% interval estimate -161·83 to -35·56) and increased abstinence from cannabis by 0·48 days per week (0·15 to 0·82). Compared with placebo, cannabidiol 800 mg decreased THC-COOH:creatinine ratio by -72·02 ng/mL (-135·47 to -19·52) and increased abstinence from cannabis by 0·27 days per week (-0·09 to 0·64). Cannabidiol was well tolerated, with no severe adverse events recorded, and 77 (94%) of 82 participants completed treatment. INTERPRETATION In the first randomised clinical trial of cannabidiol for cannabis use disorder, cannabidiol 400 mg and 800 mg were safe and more efficacious than placebo at reducing cannabis use. FUNDING Medical Research Council.
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Chester L, Chesney E, Oliver D, Wilson J, Englund A. How experimental cannabinoid studies will inform the standardized THC unit. Addiction 2020; 115:1217-1218. [PMID: 32022348 DOI: 10.1111/add.14959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Lucy Chester
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Edward Chesney
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Dominic Oliver
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Jack Wilson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Amir Englund
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- King's College London, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, London, UK and UK Centre for Tobacco and Alcohol Studies, London, UK
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Abstract
PURPOSE OF REVIEW Cannabis enjoys a unique social status, widely perceived as a relatively harmless drug, with several benefits reported by the people who use it. Several jurisdictions have opened up access to cannabis to their populations for medicinal and/or recreational reasons. Given this changing regulatory environment, this article is intended to prompt debate about what is known about cannabis dependence and what has still to be revealed. RECENT FINDINGS Evidence suggests that 1 in 10 cannabis users are at risk of developing dependence. However, investigation of the way risk is estimated and the diagnosis of cannabis use disorder is constructed highlight some methodological problems, which call into question the incidence and prevalence of this diagnosis. SUMMARY There is scope to improve the way cannabis dependence is defined and counted in at-risk populations. Improving our understanding of this risk could lead to identifying who might be at risk of developing dependence prior to exposure to the drug.
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Vadhan NP, Corcoran CM, Keilp JG, Haney M. Correspondence on Curran et al. (2018): 'Which biological and self-report measures of cannabis use predict cannabis dependency and acute psychotic-like effects'. Psychol Med 2019; 49:1227-1228. [PMID: 30691542 PMCID: PMC6499630 DOI: 10.1017/s0033291718004178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nehal P. Vadhan
- Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine and the Center for
Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Cheryl M. Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John G. Keilp
- Department of Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute,
New York, NY, USA
| | - Margaret Haney
- Department of Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute,
New York, NY, USA
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Premoli M, Aria F, Bonini SA, Maccarinelli G, Gianoncelli A, Pina SD, Tambaro S, Memo M, Mastinu A. Cannabidiol: Recent advances and new insights for neuropsychiatric disorders treatment. Life Sci 2019; 224:120-127. [DOI: 10.1016/j.lfs.2019.03.053] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/21/2019] [Accepted: 03/21/2019] [Indexed: 01/28/2023]
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Di Forti M, Quattrone D, Freeman TP, Tripoli G, Gayer-Anderson C, Quigley H, Rodriguez V, Jongsma HE, Ferraro L, La Cascia C, La Barbera D, Tarricone I, Berardi D, Szöke A, Arango C, Tortelli A, Velthorst E, Bernardo M, Del-Ben CM, Menezes PR, Selten JP, Jones PB, Kirkbride JB, Rutten BP, de Haan L, Sham PC, van Os J, Lewis CM, Lynskey M, Morgan C, Murray RM. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. Lancet Psychiatry 2019; 6:427-436. [PMID: 30902669 PMCID: PMC7646282 DOI: 10.1016/s2215-0366(19)30048-3] [Citation(s) in RCA: 434] [Impact Index Per Article: 86.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 01/20/2019] [Accepted: 01/21/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cannabis use is associated with increased risk of later psychotic disorder but whether it affects incidence of the disorder remains unclear. We aimed to identify patterns of cannabis use with the strongest effect on odds of psychotic disorder across Europe and explore whether differences in such patterns contribute to variations in the incidence rates of psychotic disorder. METHODS We included patients aged 18-64 years who presented to psychiatric services in 11 sites across Europe and Brazil with first-episode psychosis and recruited controls representative of the local populations. We applied adjusted logistic regression models to the data to estimate which patterns of cannabis use carried the highest odds for psychotic disorder. Using Europe-wide and national data on the expected concentration of Δ9-tetrahydrocannabinol (THC) in the different types of cannabis available across the sites, we divided the types of cannabis used by participants into two categories: low potency (THC <10%) and high potency (THC ≥10%). Assuming causality, we calculated the population attributable fractions (PAFs) for the patterns of cannabis use associated with the highest odds of psychosis and the correlation between such patterns and the incidence rates for psychotic disorder across the study sites. FINDINGS Between May 1, 2010, and April 1, 2015, we obtained data from 901 patients with first-episode psychosis across 11 sites and 1237 population controls from those same sites. Daily cannabis use was associated with increased odds of psychotic disorder compared with never users (adjusted odds ratio [OR] 3·2, 95% CI 2·2-4·1), increasing to nearly five-times increased odds for daily use of high-potency types of cannabis (4·8, 2·5-6·3). The PAFs calculated indicated that if high-potency cannabis were no longer available, 12·2% (95% CI 3·0-16·1) of cases of first-episode psychosis could be prevented across the 11 sites, rising to 30·3% (15·2-40·0) in London and 50·3% (27·4-66·0) in Amsterdam. The adjusted incident rates for psychotic disorder were positively correlated with the prevalence in controls across the 11 sites of use of high-potency cannabis (r = 0·7; p=0·0286) and daily use (r = 0·8; p=0·0109). INTERPRETATION Differences in frequency of daily cannabis use and in use of high-potency cannabis contributed to the striking variation in the incidence of psychotic disorder across the 11 studied sites. Given the increasing availability of high-potency cannabis, this has important implications for public health. FUNDING SOURCE Medical Research Council, the European Community's Seventh Framework Program grant, São Paulo Research Foundation, National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London and the NIHR BRC at University College London, Wellcome Trust.
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Affiliation(s)
- Marta Di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK; South London and Maudsley NHS Mental Health Foundation Trust, London, UK.
| | - Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK; South London and Maudsley NHS Mental Health Foundation Trust, London, UK
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Giada Tripoli
- Institute of Psychiatry, Psychology and Neuroscience and Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK
| | - Harriet Quigley
- Institute of Psychiatry, Psychology and Neuroscience and Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Victoria Rodriguez
- Institute of Psychiatry, Psychology and Neuroscience and Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Hannah E Jongsma
- Department of Psychiatry, University of Cambridge, Cambridge, UK; Psylife Group, Division of Psychiatry, University College London, London, UK
| | - Laura Ferraro
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - Caterina La Cascia
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - Daniele La Barbera
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - Ilaria Tarricone
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Domenico Berardi
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Andrei Szöke
- INSERM U955, Equipe 15, Institut National de la Santé et de la Recherche Médicale, Créteil, Paris, France
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM (CIBERSAM), Madrid, Spain
| | | | - Eva Velthorst
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital clinic, Department of Medicine, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Cristina Marta Del-Ben
- Division of Psychiatry, Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Paulo Rossi Menezes
- Department of Preventative Medicine, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil
| | - Jean-Paul Selten
- Rivierduinen Institute for Mental Health Care, Leiden, Netherlands
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK; CAMEO Early Intervention Service, Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - James B Kirkbride
- Psylife Group, Division of Psychiatry, University College London, London, UK
| | - Bart Pf Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Pak C Sham
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK; Centre for Genomic Sciences, Li KaShing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jim van Os
- Institute of Psychiatry, Psychology and Neuroscience and Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK
| | - Michael Lynskey
- Department of Addiction, Institute of Psychiatry, King's College London, London, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK
| | - Robin M Murray
- Institute of Psychiatry, Psychology and Neuroscience and Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; South London and Maudsley NHS Mental Health Foundation Trust, London, UK
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Lorenzetti V, Chye Y, Silva P, Solowij N, Roberts CA. Does regular cannabis use affect neuroanatomy? An updated systematic review and meta-analysis of structural neuroimaging studies. Eur Arch Psychiatry Clin Neurosci 2019; 269:59-71. [PMID: 30706169 DOI: 10.1007/s00406-019-00979-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/03/2019] [Indexed: 12/22/2022]
Abstract
Regular cannabis use is associated with adverse cognitive and mental health outcomes that have been ascribed to aberrant neuroanatomy in brain regions densely innervated with cannabinoid receptors. Neuroanatomical differences between cannabis users and controls have been assessed in multiple structural magnetic resonance imaging (sMRI) studies. However, there is heterogeneity in the results leading to cautious interpretation of the data so far. We examined the sMRI evidence to date in human cannabis users, to establish more definitely whether neuroanatomical alterations are associated with regular cannabis use. The regional specificity and association with cannabis use indices (i.e. cumulative dosage, duration) were also explored. We systematically reviewed and meta-analysed published sMRI studies investigating regional brain volumes (cortical, subcortical and global) in cannabis users and non-user controls. Three electronic databases were searched (PubMed, Scopus, and PsycINFO). A total of 17 meta-analyses were conducted (one for each cortical, subcortical and global volume) using the generic inverse variance method, whereby standardised mean difference in volume was calculated between users and non-users. Exploratory meta-regressions were conducted to investigate the association between cannabis use indices and regional brain volumes. A total of 30 articles were eligible for inclusion, contributing 106 effect sizes across 17 meta-analyses. Regular cannabis users had significantly smaller volumes of the hippocampus (SMD = 0.14, 95% CIs [0.02, 0.27]; Z = 2.29, p = 0.02, I2 = 74%) and orbitofrontal cortex {medial (SMD = 0.30, 95% CIs [0.15, 0.45]; Z = 3.89, p = 0.0001, I2 = 51%), lateral (SMD = 0.19, 95% CIs [0.07, 0.32]; Z = 3.10, p = 0.002, I2 = 26%)} relative to controls. The volumes of the hippocampus and orbitofrontal cortex were not significantly associated with cannabis duration and dosage. Our findings are consistent with evidence of aberrance in brain regions involved in reward, learning and memory, and motivation circuits in the regular use of substances other than cannabis, pointing to commonality in neurobiological abnormalities between regular users of cannabis and of other substances.
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Affiliation(s)
- Valentina Lorenzetti
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Daniel Mannix building, Fitzroy, VIC, 3065, Australia.
| | - Yann Chye
- Brain and Mental Health Research Hub, Monash Institute of Cognitive and Clinical Neuroscience, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Pedro Silva
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Nadia Solowij
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Carl A Roberts
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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Abstract
PURPOSE OF REVIEW This paper provides an update from the literature on understanding of the relationship between cannabis and schizophrenia. In particular, the paper focuses on the latest findings and remaining areas that require investigation. RECENT FINDINGS Three hypotheses have emerged as potential explanations for the association between cannabis and schizophrenia, namely cannabis can trigger schizophrenia, cannabis is used to mitigate symptoms of schizophrenia, and there are common factors which might account for the association. Biological and genetic factors dominate this field of research; this has been at the expense of exploring social and cultural contributory factors which influence cannabis and schizophrenia. The evidence for cannabis acting as a causal factor for schizophrenia has so far not been established. Research needs to extend beyond males drawn from western countries if we are to advance knowledge and understanding of the link between cannabis use and schizophrenia.
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Affiliation(s)
| | - Mark Monaghan
- Social Policy, University of Birmingham, Birmingham, UK
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Bloomfield MAP, Hindocha C, Green SF, Wall MB, Lees R, Petrilli K, Costello H, Ogunbiyi MO, Bossong MG, Freeman TP. The neuropsychopharmacology of cannabis: A review of human imaging studies. Pharmacol Ther 2018; 195:132-161. [PMID: 30347211 PMCID: PMC6416743 DOI: 10.1016/j.pharmthera.2018.10.006] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The laws governing cannabis are evolving worldwide and associated with changing patterns of use. The main psychoactive drug in cannabis is Δ9-tetrahydrocannabinol (THC), a partial agonist at the endocannabinoid CB1 receptor. Acutely, cannabis and THC produce a range of effects on several neurocognitive and pharmacological systems. These include effects on executive, emotional, reward and memory processing via direct interactions with the endocannabinoid system and indirect effects on the glutamatergic, GABAergic and dopaminergic systems. Cannabidiol, a non-intoxicating cannabinoid found in some forms of cannabis, may offset some of these acute effects. Heavy repeated cannabis use, particularly during adolescence, has been associated with adverse effects on these systems, which increase the risk of mental illnesses including addiction and psychosis. Here, we provide a comprehensive state of the art review on the acute and chronic neuropsychopharmacology of cannabis by synthesizing the available neuroimaging research in humans. We describe the effects of drug exposure during development, implications for understanding psychosis and cannabis use disorder, and methodological considerations. Greater understanding of the precise mechanisms underlying the effects of cannabis may also give rise to new treatment targets.
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Affiliation(s)
- Michael A P Bloomfield
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, United Kingdom; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, United Kingdom.
| | - Chandni Hindocha
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, United Kingdom
| | - Sebastian F Green
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom
| | - Matthew B Wall
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine, Imperial College London, United Kingdom; Invicro UK, Hammersmith Hospital, London, United Kingdom
| | - Rachel Lees
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, United Kingdom
| | - Katherine Petrilli
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, United Kingdom
| | - Harry Costello
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom
| | - M Olabisi Ogunbiyi
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom
| | - Matthijs G Bossong
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Tom P Freeman
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Department of Psychology, University of Bath, United Kingdom; National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
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