Incidence of inpatient cases with mental disorders due to use of cannabinoids in Germany: a nationwide evaluation

Treatment demand for cannabis use problems: analyses of routine data from 30 European countries

Cannabis use and treatment demand has risen in the past decade. Previous analyses of treatment demand are limited by methodological constraints or are outdated. Cross-country differences and trends in cannabis treatment demand are described using data from the European Monitoring Centre for Drugs and Drug Addiction. Two novel indicators are employed: firstly, the cannabis-attributable treatment fraction (CATF) is obtained by dividing the number of treatment entrants for cannabis use problems by the number of treatment entrants for any substance use problem, accounting for possible changes in the reporting system. Secondly, comparing the number of treatment entrants for cannabis use problems to the number of people who use cannabis (near) daily yields the treated-user-ratio (TUR), which considers a proxy for treatment need (frequent use). Across 30 countries with available data, the importance of cannabis in European treatment facilities varies greatly (CATF: min = 3%; max = 65%), with lower estimates in Eastern European countries. Across 20 countries with complete data, the CATF has risen from 29.4% in 2013 to 37.1% in 2020. The TUR calculated on 26 countries suggests that about 3 in 100 frequent users have sought treatment for their cannabis use problems. Over time, treatment demand has increased at a slower pace than treatment need in most countries. One in three treatment entrants for substance use problems in Europe are due to cannabis, with large variations between countries. There are indications for a widening treatment gap for cannabis use problems. In countries liberalising cannabis laws, monitoring changes in treatment access and demand is warranted.

Cannabis use, health problems, and criminal offences in Germany: national and state-level trends between 2009 and 2021

The German federal government plans to decriminalise cannabis. The impact of this policy on use prevalence, cannabis-related health and legal problems cannot be fully anticipated and should be viewed in context with current trends. We used routine data on (a) cannabis use (population-based surveys), (b) cannabis-related diagnoses (ICD-10 code F12) in outpatient medical settings and (c) minor law offences (registered violations against the narcotics law for possessing small amounts) to analyse age and sex-specific trends by federal state between 2009 and 2021. To enable comparisons across time and federal state besides crude prevalence rates, age-standardised rates were calculated. Between 2009 and 2021, the age-standardised prevalence of cannabis use (5.7-10.6%), rate of diagnoses (1.1-3.7 per 1,000), and legal offences (1.8-3.1 per 1,000) increased, with the largest increase noted for cannabis-related diagnoses. Relatively, increases were most pronounced for older users (40-to-59-year-olds: use and offences; 35-to-44-year-olds: cannabis-related diagnoses) and rather stagnant for minors. Cannabis use and health problems appear to be more pronounced in Northern and city states, while no clear geographic trend was observed for law offences. Cannabis-related outpatient treatment demand has risen more steeply than use prevalence suggesting an increasing challenge for the health care system. Despite rising rates for documented offences, the long-term implications of law violations on social and occupational life are poorly understood but may be considered for evaluations of the proposed law changes.

Trends and projection in the proportion of (heavy) cannabis use in Germany from 1995 to 2021

AIMS

To measure the current trends of cannabis use in Germany, measure trends in the proportion of heavy cannabis users and estimate future cannabis use rates.

DESIGN

Repeated waves of the Epidemiological Survey on Substance Abuse, a cross-sectional survey conducted between 1995 and 2021 with a two-stage participant selection strategy where respondents completed a survey on substance use delivered through the post, over the telephone or on-line.

SETTING

Germany.

PARTICIPANTS/CASES

German-speaking participants aged between 18 and 59 years living in Germany who self-reported on their cannabis use in the past 12 months (n = 78 678). With the application of a weighting scheme, the data are nationally representative.

MEASUREMENTS

Questions on the frequency of cannabis use in the past 12 months and self-reported changes in frequency of use due to the COVID-19 pandemic.

FINDINGS

The prevalence of past 12-month cannabis users increased from 4.4% [95% confidence interval (CI) = 3.7, 5.1] in 1995 to 10.0% (95% CI = 8.9, 11.3) in 2021. Modeling these trends revealed a significant increase that accelerated over the past decade. The proportion of heavy cannabis users [cannabis use (almost) daily or at least 200 times per year] among past-year users has remained steady from 1995 (11.4%, 95% CI = 7.7, 16.5) to 2018 (9.5%, 95% CI = 7.6, 11.9), but significantly increased to 15.7% (95% CI = 13.1, 18.8) in 2021 during the COVID-19 pandemic. Extrapolating from these models, the prevalence of 12-month cannabis users in 2024 is expected to range between 10.4 and 15.0%, while the proportion of heavy cannabis users is unclear.

CONCLUSIONS

Trends from 1995 to 2021 suggest that the prevalence of past 12-month cannabis users in Germany will continue to increase, with expected rates between 10.4 and 15.0% for the German-speaking adult population, and that at least one in 10 cannabis users will continue to use cannabis heavily (almost daily or 200 + times in the past year).

Risk of readmission among individuals with cannabis use disorder during a 15-year cohort study: the impact of socio-economic factors and psychiatric comorbidity

BACKGROUND AND AIM

Cannabis use disorder (CUD) is one of the main reasons for seeking substance treatment in the Nordic countries, but there are few studies on readmission to care. We aimed to characterize CUD readmission and estimate the magnitude of how socio-economic factors and psychiatric comorbidity influence the risk of CUD readmission.

DESIGN, SETTING AND PARTICIPANTS

This was a nation-wide cohort study carried out between 2001 and 2016 in Sweden. The participants were individuals with CUD, aged 17 years and above (n = 12 143).

MEASUREMENTS

Information on predictors was obtained from registers and included education, income and psychiatric comorbidity assessed by six disease groups. The outcome measure was readmission, defined as a CUD visit to health-care at least 6 months after initial CUD diagnosis. Hazard ratios (HR) were estimated using Cox survival analyses and flexible parametric survival analyses to assess risk of readmission and how the risk varied with age.

FINDINGS

The vast majority of CUD visits took place in outpatient care (~80%). Approximately 23% of the included individuals were readmitted to care during follow-up. The fully adjusted model showed an increased risk of readmission among those with schizophrenia and other psychotic disorders [HR = 1.54, 95% confidence interval (CI) = 1.29-1.84], low education (HR = 1.40, 95% CI = 1.24-1.57), personality disorders (HR = 1.27, 95% CI = 1.05-1.54) or mood disorders (HR = 1.27, 95% CI = 1.12-1.45). Flexible parametric modeling revealed increased risk of readmission mainly in individuals aged 18-35 years.

CONCLUSIONS

The risk of readmission was highest among those with low education, schizophrenia and other psychotic disorders, mood-related disorders or personality disorders. Individuals aged 18-35 years showed the highest risk of readmission. Our findings highlight individuals with complex health-care needs.

Hilfe, sie kommen!

Zusammenfassung: Unter aktuell Cannabiskonsumierenden weisen etwa 15 % ein problematisches Konsumverhalten auf. Der Anteil der Klient_innen mit einer cannabisbezogenen Störung ist in den vergangenen Jahren, sowohl in der Suchthilfe, als auch in der psychiatrischen Versorgung deutlich gestiegen. International ist eine Vielzahl von Interventionsprogrammen für die Beratung und Behandlung Cannabisabhängiger entwickelt worden. Studien konnten zeigen, dass intensivere Interventionen bessere Effekte zeigten als Kurzinterventionen. Dabei erwiesen sich die Motivierende Gesprächsführung und verhaltenstherapeutische Interventionen als besonders wirksam. Bei jugendlichem Cannabiskonsum gelten familientherapeutische Ansätze als am wirkungsvollsten. In Deutschland wurden ab den 2000er Jahren mehrere Beratungs- und Behandlungsprogramme entwickelt, evaluiert und in die Fläche implementiert. Dennoch nehmen Cannabisklient_innen noch immer zu spät professionelle Hilfen in Anspruch. Insbesondere familienorientierte Beratungs- und Therapieangebote sollten ausgebaut werden, die Eltern bzw. Familien cannabiskonsumierender Jugendlicher in die Hilfen einbeziehen.

A Nationwide Study of Inpatient Case Rate Incidence of Cannabis-Related Diagnoses in Switzerland

Objectives: Cannabis is the most commonly used illicit substance and has been associated with mental health issues. In this study, we examined trends in hospitalizations due to cannabis use. Methods: Data were obtained from the Swiss Federal Statistics Office and comprised hospital main diagnoses, gender, age group and region of all psychiatric inpatient cases in Switzerland from 1998 to 2020. We performed trend analyses of annual case rates with cannabinoid-related diagnoses and compared them to trend analyses of alcohol-related and psychotic disorders. Results: Case rates of CRDs significantly increased in the observed time period. From all psychiatric main diagnoses, CRDs were overrepresented in the age groups of 15-24 and 25-44 years. Conclusion: We found a sharp increase in hospitalizations for CRD. Future studies should test whether changes in the upcoming cannabis regulation, which can facilitate the implementation of interventions to address mental health among users, impact future hospitalization rates of CRD.

The Use of Psychoactive Substances in Germany

BACKGROUND

Monitoring the use of psychoactive substances and substance-related problems in the population allows for the assessment of prevalence and associated health and social consequences.

METHODS

The data are derived from the Epidemiological Survey of Substance Abuse (ESA) 2021 (n = 9046, 18-64 years). We estimated prevalence rates of the use of tobacco, alcohol, illegal drugs, and psychoactive medications, as well as the prevalence rates of their problematic use (indicating dependence) using screening instruments, and extrapolated the results to the resident population (N = 51 139 451).

RESULTS

Alcohol was the most frequently used substance, with a 30-day prevalence of 70.5% (36.1 million people), followed by non-opioid analgesic drugs (47.4%; 24.2 million) and conventional tobacco products (22.7%; 11.6 million). E-cigarettes were used by 4.3% (2.2 million) and heat-not-burn products by 1.3% (665 000). Among illegal drugs (12-month prevalence), cannabis was the most frequently used (8.8%; 4.5 million), followed by cocaine/crack (1.6%; 818 000) and amphetamine (1.4%; 716 000). Rates of problematic use among the study participants were 17.6% for alcohol (9.0 million), 7.8% for tobacco (4.0 million), 5.7% for psychoactive medications (2.9 million), and 2.5% for cannabis (1.3 million).

CONCLUSION

The consumption of psychoactive substances continues to be widespread in Germany. In view of the imminent legal changes, the high prevalence of cannabis use and its problematic use need to be taken into consideration.