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Cors-Cepeda X, Armas-Neira M, Herrera-Barron O, Bochm A. Integrating traditional and modern Practices: Qualitative perspectives from mental health professionals in Mexico. Complement Ther Clin Pract 2025; 60:102003. [PMID: 40381497 DOI: 10.1016/j.ctcp.2025.102003] [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: 03/03/2025] [Revised: 04/28/2025] [Accepted: 05/10/2025] [Indexed: 05/20/2025]
Abstract
BACKGROUND AND PURPOSE In Mexico, traditional practices like herbal remedies, spiritual rituals, and energy-based therapies remain integral to mental health care. These are deeply rooted in cultural beliefs and often coexist with modern treatments. This study explores mental health professionals' perspectives on the prevalence, factors influencing, and integration of traditional practices into modern psychiatric care. MATERIALS AND METHODS This qualitative phenomenological study is part of a broader investigation into sociocultural factors in Mexican mental health care. Participants were selected through convenience and snowball sampling. Data were gathered through 1-hour semi-structured interviews, covering various aspects of mental health care. This analysis specifically focused on participants' discussions about traditional treatments, which were identified and extracted from the transcripts for thematic analysis. RESULTS The study highlighted a wide range of traditional practices used by patients, including spiritual healing, energy therapies, medicinal plants, psychedelics, and complementary therapies. Factors influencing the use of these practices included cultural beliefs, emotional motivations, and issues within the healthcare system. Mental health professionals had varied attitudes toward these practices: most were respectful but did not integrate them into treatment, some were skeptical of their safety, and a few adopted an integrative approach, incorporating traditional practices into care. CONCLUSION The study emphasizes the widespread use of traditional therapies in Mexico, influenced by cultural beliefs and gaps in access to modern care. While most professionals respect these practices, integrating them with evidence-based approaches requires a balance between cultural sensitivity and scientific validation, which is essential for providing comprehensive, culturally appropriate care.
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Affiliation(s)
- Ximena Cors-Cepeda
- School of Medicine and Health Sciences at Tecnológico de Monterrey, Mexico.
| | - Monica Armas-Neira
- School of Medicine and Health Sciences at Tecnológico de Monterrey, Mexico
| | | | - Alexa Bochm
- School of Medicine and Health Sciences at Tecnológico de Monterrey, Mexico
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Strong SJ, Thomas HA, Adams ZW, Hulvershorn LA. Comorbid Cannabis Use and Mood Disorders Among Adolescents. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2025; 23:133-140. [PMID: 40235605 PMCID: PMC11995898 DOI: 10.1176/appi.focus.20240049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2025]
Abstract
Adolescence is a unique developmental period marked by increased exploration and risk-taking, as well as important brain development milestones. Many people who use substances will begin using during adolescence, and cannabis is the most commonly used illicit substance among adolescents. For adolescents with mood disorders, cannabis use (and, by extension, cannabis use disorder) is even more likely, and the associated consequences are even more significant. In this review, we explore the assessment of cannabis use disorder among adolescents, the impact of cannabis use on mood symptoms, level-of-care recommendations for adolescents with comorbid cannabis use and mood disorders, and effective treatment options.
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Affiliation(s)
- Stephane J Strong
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis (all authors); Department of Psychology, Wayne State University, Detroit, Michigan (Thomas)
| | - Halle A Thomas
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis (all authors); Department of Psychology, Wayne State University, Detroit, Michigan (Thomas)
| | - Zachary W Adams
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis (all authors); Department of Psychology, Wayne State University, Detroit, Michigan (Thomas)
| | - Leslie A Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis (all authors); Department of Psychology, Wayne State University, Detroit, Michigan (Thomas)
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Valter R, Nezet OL, Obradovic I, Spilka S, Falissard B, Josseran L, Gautier S, Airagnes G. Cannabis and mental health in adolescents: changes in associations over 15 years. Soc Psychiatry Psychiatr Epidemiol 2025:10.1007/s00127-025-02859-7. [PMID: 39966163 DOI: 10.1007/s00127-025-02859-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 02/07/2025] [Indexed: 02/20/2025]
Abstract
PURPOSE Recent changes in the cannabis market, including decreased adolescence usage, increased Δ9-tetrahydrocannabinol levels and rising mental disorders over the last decade raises questions about the changing profile of cannabis consumers. METHODS This study explores the trends of associations between regular cannabis use and mental health in five waves of a national representative survey of 17-year-old French adolescents, including more than 150,000 participants. Multivariable models, adjusted for gender and socioeconomic variables, were used. RESULTS Cannabis use and mental health indicators showed some variations over time, with increasing divergence between 2017 and 2022. Regular use of cannabis decreased from 7.4% in 2008 to 3.8% in 2022 (p < 0.001). In contrast, suicidal ideation in the past year increased from 16% in 2008 to 18% in 2022 (p = 0.009), although it followed a U-shaped trend. The association between regular cannabis use and suicidal ideation in the past year increased from 1.44 (CI: 1.29-1.61) in 2008 to 2.52 (CI: 2.05-3.10) in 2022. Similarly, the association between cannabis use and antidepressant use in the past year increased from 2.57 (CI: 2.18-3.03) in 2008 to 4.47 (CI: 3.35-5.97) in 2022. CONCLUSION These results suggest that cannabis users are now more prone to mental health disorders compared to 15 years ago. Several mechanisms might explain these findings, including the self-selection of a population with both vulnerabilities, changes in the effects of cannabis, or the use of cannabis as a self-medication strategy.
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Affiliation(s)
- R Valter
- Département hospitalier d'épidémiologie et de santé publique, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France.
| | - O Le Nezet
- French Monitoring Centre for Drugs and Drug Addiction - Observatoire français des drogues et des tendances addictives (OFDT), 69, rue de Varenne, 75007, Paris, France
| | - I Obradovic
- French Monitoring Centre for Drugs and Drug Addiction - Observatoire français des drogues et des tendances addictives (OFDT), 69, rue de Varenne, 75007, Paris, France
| | - S Spilka
- French Monitoring Centre for Drugs and Drug Addiction - Observatoire français des drogues et des tendances addictives (OFDT), 69, rue de Varenne, 75007, Paris, France
| | - B Falissard
- University of Paris-Saclay, University of Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Villejuif, France
| | - L Josseran
- Département hospitalier d'épidémiologie et de santé publique, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France
- University of Paris-Saclay, University of Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Villejuif, France
| | - S Gautier
- Département hospitalier d'épidémiologie et de santé publique, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France
- University of Paris-Saclay, University of Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Villejuif, France
| | - G Airagnes
- French Monitoring Centre for Drugs and Drug Addiction - Observatoire français des drogues et des tendances addictives (OFDT), 69, rue de Varenne, 75007, Paris, France.
- AP-HP.Centre-Université Paris Cité, Faculté de Santé, UFR de Médecine, 20 rue Leblanc, 75015, Paris, France.
- INSERM UMS011, « Population-based epidemiologic cohorts », 94800, Villejuif, France.
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Rhew IC, Oesterle S, Kuklinski MR, Guttmannova K, Cadigan JM. The Longitudinal Association of Cumulative Depression With Cannabis Use Disorder Among Young Adults. J Stud Alcohol Drugs 2025; 86:85-94. [PMID: 38900055 PMCID: PMC11822757 DOI: 10.15288/jsad.23-00301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE This study examined whether the cumulative experience of elevated depressive symptoms from ages 19 to 23 was associated with cannabis use disorder (CUD) at age 26 and whether the association varied by perceived ease of access to cannabis and perceived risk for harms from cannabis use. METHOD Data were from 4,407 young adults participating in the Community Youth Development Study. Cumulative experience of elevated depressive symptoms was calculated by summing the number of times a participant scored ≥10 on the 9-item Patient Health Questionnaire across three biennial survey waves (ages 19 to 23). To assess CUD, the Diagnostic Interview Schedule was used. Participants also self-reported their ease of access to cannabis and the perceived harm of regular cannabis use at the age 19, 21, and 23 waves. Marginal structural modeling was used to account for multiple time-varying and time-fixed covariates using inverse probability weights. RESULTS In the final weighted models, a greater number of time points (i.e., study waves) showing elevated depressive symptoms was associated with an increased likelihood of CUD at age 26 (prevalence ratio = 1.46, 95% CI [1.20, 1.77]). There was no strong evidence for moderation of this association by perceived ease of access or perceived risk for harms because of regular cannabis use. CONCLUSIONS Persistent experience of elevated depressive symptoms may place young adults at risk for CUD. Strategies to reduce the burden of depressive symptoms among young adults may lead to downstream effects such as reducing the prevalence of cannabis-related problems.
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Affiliation(s)
- Isaac C. Rhew
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Sabrina Oesterle
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, Arizona
| | - Margaret R. Kuklinski
- Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington
| | - Katarina Guttmannova
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Jennifer M. Cadigan
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
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Sorkhou M, Johnstone S, Weinberger AH, Cooper ZD, Sanches M, Castle DJ, Hall W, Rabin RA, Hammond D, George TP. Changes in Cannabis Use Patterns in Psychiatric Populations Pre- and Post-Legalization of Recreational Cannabis Use in Canada: A Repeated Cross-Sectional Survey. CANNABIS (ALBUQUERQUE, N.M.) 2024; 7:1-13. [PMID: 39781550 PMCID: PMC11705070 DOI: 10.26828/cannabis/2024/000238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
Abstract
Objective Since the federal Canadian government legalized cannabis in 2018, cannabis use in the general population has slightly increased. However, little is known about the impact of cannabis legalization on pattens of cannabis use in psychiatric populations. Method We studied changes in daily/almost daily and average 30-day cannabis use amongst individuals currently using cannabis who reported past 12-month experiences of specific mental health disorders and among those without past 12-month experiences of any mental health disorder before and after Canadian legalization of recreational cannabis use (N = 13,527). Data came from Canadian respondents in Wave 1 (August-October 2018), Wave 2 (September-October 2019), and Wave 3 (September-November 2020) of the International Cannabis Policy Study (ICPS). Results After adjustment for covariates, among individuals currently using cannabis, the odds of using cannabis daily/almost daily increased only in individuals with schizophrenia between Wave 1 and Waves 3 (aOR = 9.19, 95% CI: 2.46 - 34.37). Similarly, significant increases in average 30-day cannabis use between Wave 1 (M = 12.80, SE = 1.65) and Wave 3 (M = 18.07, SE = 1.03) were observed only among individuals with schizophrenia, F (1,2) = 4.58, p < .05. No significant changes in daily/almost daily or average past 30-day cannabis use were observed in those without mental health problems or those reporting anxiety, depression, PTSD, bipolar disorder, or substance use disorders. Conclusions Since legalization, cannabis use has significantly increased only among people with schizophrenia, highlighting the need for targeted public health prevention programs.
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Affiliation(s)
- Maryam Sorkhou
- Institute for Mental Health and Policy Research, Centre for Addiction and Mental Health
- Institute of Medical Sciences, University of Toronto
| | - Samantha Johnstone
- Institute for Mental Health and Policy Research, Centre for Addiction and Mental Health
| | - Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences and Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles
| | - Ziva D. Cooper
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences and Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles
| | - Marcos Sanches
- Institute for Mental Health and Policy Research, Centre for Addiction and Mental Health
| | - David J. Castle
- Tasmania Centre for Mental Health Service Innovation, University of Tasmania
| | - Wayne Hall
- The National Centre for Youth Substance Use Research, Queensland University
| | | | - David Hammond
- School of Public Health Sciences, University of Waterloo
| | - Tony P. George
- Institute for Mental Health and Policy Research, Centre for Addiction and Mental Health
- Institute of Medical Sciences, University of Toronto
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Lemaire M, Durieux V, Meert AP, Berghmans T. [Non-small cell lung cancer in adults under 40 years of age]. Rev Mal Respir 2024; 41:727-737. [PMID: 39490318 DOI: 10.1016/j.rmr.2024.09.005] [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] [Received: 07/05/2024] [Accepted: 09/05/2024] [Indexed: 11/05/2024]
Abstract
INTRODUCTION Non-small cell lung cancers (NSCLC) are the most common lung cancers, withpeak incidence at 65years of age. These cancers rarely occur before the age of 40. METHODS Based on an illustrative clinical case, a systematic review of the literature was conducted to study the epidemiological, clinical, histological, and biological characteristics of NSCLC in adults under 40years of age. Two equations were developed to search for articles on Medline and Scopus. RESULTS Sixty-five articles were included in the review; 1.7% of patients were under 40years old, 50.7% were women, 66.7% presented adenocarcinoma, 51.9% were diagnosed at stage IV, 75% were non-smokers, 39.9% were exposed to other toxins, 33% had an EGFR mutation, 6.6% had a KRAS mutation, 25% had an ALK translocation, 73.7% were symptomatic, and over 75% had PS<2. CONCLUSION NSCLC in patients under 40years of age presents characteristics different from those in older patients. Various factors are implicated, one example being lower exposure to tobacco, and they can influence the distribution of histological subtypes and the frequency of mutations.
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Affiliation(s)
- M Lemaire
- Université libre de Bruxelles (ULB), Bruxelles, Belgique.
| | - V Durieux
- Bibliothèque des sciences de la santé, université libre de Bruxelles (ULB), Bruxelles, Belgique
| | - A-P Meert
- Unité de diagnostic et d'orientation - urgences oncologiques, service de médecine interne, institut Jules-Bordet, hôpital universitaire de Bruxelles (HUB), université libre de Bruxelles (ULB), Bruxelles, Belgique
| | - T Berghmans
- Unité fonctionnelle d'oncologie thoracique, institut Jules-Bordet, hôpital universitaire de Bruxelles (HUB), université libre de Bruxelles (ULB), Bruxelles, Belgique
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Wiese JL, Watson TM, Bozinoff N, Rush B, Stergiopoulos V, Le Foll B, Rueda S. "Like the Wild West": Health care provider perspectives on impacts of recreational cannabis legalization on patients and providers at a tertiary psychiatric hospital in Ontario, Canada. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 167:209487. [PMID: 39153735 DOI: 10.1016/j.josat.2024.209487] [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: 01/21/2024] [Revised: 07/18/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Legalization has increased cannabis availability in Canada. Research shows complex relationships between cannabis use and mental health, and a need for health care providers to engage with patients about cannabis use. Providers have noted gaps in knowledge and research on the medical effects of cannabis as barriers to service delivery. It is unclear how providers and patients in mental health care settings have been impacted by legalization. METHODS From June 1 to July 2, 2021, we conducted a qualitative study involving semi-structured interviews with 20 health care providers in a range of roles (e.g., physicians, pharmacists, nurses) within a psychiatric hospital setting. Participants responded to open-ended questions with follow-up probes on various topics related to cannabis legalization. Topics included impacts on patient mental and physical health, clinical impacts, education and training, legal cannabis retail system and the medical cannabis access system. RESULTS Thematic analysis identified several themes in the data. Participants reported that legalization has had some positive impacts relating to clinical care and cannabis safety. They also expressed concerns with increased rates of cannabis use, risks to mental health and ongoing challenges engaging with patients about cannabis. Participants made recommendations for medical educators and regulators (e.g., updated curriculums, clinical guidelines), the mental health care sector (e.g., implementation of standardized screening), government (e.g., public health campaigns, safe use guidelines), the medical cannabis access system (e.g., increased regulation, research), and the legal cannabis system (e.g., zoning changes, point-of-sale information). CONCLUSIONS This study begins to address the paucity of data on impacts of legalization from mental health service delivery settings. Findings show that although legalization has had some positive impacts, there are ongoing patient concerns and unmet provider needs. More research is needed to understand the experiences of providers delivering care to populations experiencing mental health and/or substance use concerns who use cannabis in the post-legalization era.
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Affiliation(s)
- Jessica L Wiese
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada.
| | - Tara Marie Watson
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada.
| | - Nikki Bozinoff
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Addictions Division, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON M6J 1H4, Canada.
| | - Brian Rush
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Homewood Research Institute, 150 Delhi Street, Guelph, ON N1E 6K9, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada.
| | - Vicky Stergiopoulos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Centre for Addiction and Mental Health, 1000 Queen Street West, Toronto, ON M6J 1H4, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada; Acute Care Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON M6J 1H1, Canada.
| | - Bernard Le Foll
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada; Acute Care Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON M6J 1H1, Canada; Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada; Institute of Medical Sciences, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada.
| | - Sergio Rueda
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada; Institute of Medical Sciences, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON M5T 3M6, Canada.
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Olufemi E, Olatokunbo O, Wei L, Ben Taleb Z, Kalan ME. Cannabis Vaping Among US Adults With Disabilities: Findings From the 2022 Behavioral Risk Factor Surveillance System. Public Health Rep 2024:333549241292447. [PMID: 39513335 PMCID: PMC11556670 DOI: 10.1177/00333549241292447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2024] Open
Abstract
OBJECTIVES Studies have demonstrated that people with disabilities are more likely to use cannabis than people without disabilities. However, less is known about novel forms of use, such as cannabis vaping, in this population. We examined the correlates of cannabis vaping among people with disabilities and the association between cannabis vaping and the frequency of cannabis use in any form. METHODS We used data from the 2022 Behavioral Risk Factor Surveillance System to examine the association between disabilities and past-month cannabis vaping, as well as the number of days that cannabis was used in the past month, among US adults. We used weighted multivariable logistic and modified Poisson regression models with incidence rate ratios to examine the associations. RESULTS The prevalence of cannabis vaping was higher among adults with any disability (4.6%) than among adults without disabilities (2.8%); adults with only cognitive disabilities had the highest prevalence (8.2%). Daily nicotine vaping (adjusted odds ratio [AOR] = 6.04; 95% CI, 4.14-8.80), former cigarette smoking status (AOR = 1.67; 95% CI, 1.25-2.25), and being aged 18-24 years (vs ≥65 y) (AOR = 11.07; 95% CI, 7.05-17.38) were associated with higher odds of cannabis vaping among adults with any disability. Disability status modified the relationship between cigarette smoking and cannabis vaping (P < .001). Additionally, among adults with disabilities, the rate of cannabis-use days was higher among adults who vaped cannabis (adjusted incidence rate ratio = 1.28; 95% CI, 1.19-1.36) than among adults who did not vape cannabis. CONCLUSIONS Among adults with disabilities, nicotine consumption by vaping was associated with cannabis vaping. Our findings highlight the need for interventions that reduce the risk of polysubstance use (ie, nicotine and cannabis) in this population.
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Affiliation(s)
- Erinoso Olufemi
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, Reno, NV, USA
| | - Osibogun Olatokunbo
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Li Wei
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Mohammad Ebrahimi Kalan
- School of Health Professions, Eastern Virginia Medical School, Norfolk, VA, USA
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
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Clarke H, Miles S, Peer M, Fitzcharles MA. The Elusive Truth of Cannabinoids for Rheumatic Pain. Curr Rheumatol Rep 2024; 26:392-402. [PMID: 39120750 DOI: 10.1007/s11926-024-01162-9] [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] [Accepted: 07/23/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE OF REVIEW Medical cannabis (MC) has entered mainstream medicine by a unique route. Regulatory acceptance as a medical product in many jurisdictions has bypassed the traditional evidence-based pathway required for therapies. Easier access to MC, especially related to recreational legalization of cannabis, has led to widespread use by patients for symptom relief of a variety of medical conditions and often without medical oversight. Musculoskeletal pain remains the most common reason for MC use. This review examines real-world issues pertaining to MC and offers some guidance for clinical care of patients with rheumatic diseases being treated with MC. RECENT FINDINGS Controlled clinical studies of cannabis products in patients with rheumatic diseases have been small and tested a range of compounds, routes of administration, and clinical populations, limiting our ability to generate conclusions on MC's effectiveness in this population. Observational cohort studies and surveys suggest that use of MC and related products in patients with rheumatic diseases improves pain and associated symptoms but is commonly accompanied by mild to moderate side effects. Conflicting evidence contributes to practitioner and patient uncertainty regarding the use of MC for rheumatic disease-related pain. Despite promising preclinical and observational evidence that MC and cannabis-derived compounds are useful in the management of rheumatic disease-related pain, there remains limited high-quality clinical evidence to substantiate these findings. There are a significant number of clinical trials on this topic currently planned or underway, however, suggesting the next decade may yield more clarity. Nevertheless, given that many people with rheumatic diseases are using cannabis products, healthcare professionals must remain apprised of the evidence pertaining to cannabinoids, communicate such evidence to patients in a meaningful way that is free from personal bias and stigma, and maintain strong collaborative clinical care pertaining to MC.
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Affiliation(s)
- Hance Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Department of Anesthesia and Pain Management, Pain Research Unit, Toronto General Hospital, Toronto, Canada
- Transitional Pain Service, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Sarah Miles
- Department of Anesthesia and Pain Management, University Health Network, Sinai Health System, and Women's College Hospital, Toronto, ON, Canada
| | - Miki Peer
- Department of Anesthesia and Pain Management, University Health Network, Sinai Health System, and Women's College Hospital, Toronto, ON, Canada
| | - Mary-Ann Fitzcharles
- Department of Rheumatology, Montreal General Hospital, McGill University, Montreal, Canada.
- Alan Edwards Pain Management Unit, Montreal General Hospital, McGill University, Montreal, Canada.
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Hyatt AS, William Flores M, Lê Cook B. Disproportionate increase in cannabis use among people with serious psychological distress and associations with psychiatric service use in the United States, 2009-2019. Addict Behav 2024; 157:108095. [PMID: 38905902 PMCID: PMC11283347 DOI: 10.1016/j.addbeh.2024.108095] [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: 03/29/2024] [Revised: 06/05/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Cannabis use is on the rise, but it is unclear how use is changing among individuals with serious psychological distress (SPD) compared to the general population as well as what associations this may have with mental health service use. METHODS Retrospective cohort study using the National Survey on Drug Use and Health (NSDUH) 2009-19 public use files of 447,228 adults aged ≥ 18 years. Multivariable logistic regression and predictive margin methods were used to estimate linear time trends in any and greater-than-weekly levels of cannabis use by year and SPD status and rates of psychiatric hospitalization and outpatient mental health care. FINDINGS Rates of any and weekly-plus cannabis use increased similarly among individuals with SPD compared to those without from 200 to 2014 but more rapidly in SPD every year from 2015 to 2019 (p < 0.001). Among individuals with SPD, no use was associated with a 4.2 % probability of psychiatric hospitalization, significantly less than less-than-weekly (5.0 %, p = 0.037) and weekly-plus cannabis use (5.1 %, p = 0.028). For outpatient mental health care, no use was associated with a 27.4 % probability (95 % CI 26.7-28.1 %) of any outpatient care, significantly less than less than weekly use (32.6 % probability, p < 0.001) and weekly-plus use (29.9 % probability, p = 0.01). CONCLUSIONS Cannabis use is increasing more rapidly among individuals with SPD than the general population, and is associated with increased rates of psychiatric hospitalization and outpatient service use. These findings can inform policy makers looking to tailor regulations on advertising for cannabis and develop public health messaging on cannabis use by people with mental illness.
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Affiliation(s)
- Andrew S Hyatt
- Health Equity Research Lab, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Michael William Flores
- Health Equity Research Lab, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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11
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Halladay J, Sunderland M, Chapman C, Teesson M, Slade T. The InterSECT Framework: a proposed model for explaining population-level trends in substance use and emotional concerns. Am J Epidemiol 2024; 193:1066-1074. [PMID: 38400654 PMCID: PMC11299025 DOI: 10.1093/aje/kwae013] [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: 04/12/2023] [Revised: 02/06/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024] Open
Abstract
Across high-income countries, adolescent emotional concerns have been increasing in prevalence over the past two decades and it is unclear why this is occurring, including whether and how substance use relates to these changing trends. On the other hand, substance use has been generally declining, and little is known about the role of emotional concerns in these trends. Several studies have explored the changes in co-occurring substance use and emotional concerns among adolescents over time, with mixed results and inconsistent messaging about the implications of the findings. In response, we developed a theoretical framework for exploring the intersection between trends in substance use and emotional concerns (InterSECT Framework). This framework includes a discussion and related examples for 3 core hypotheses: (1) strengthening of co-occurrence, or the "hardening" hypothesis; (2) co-occurrence staying the same, or the "consistency" hypothesis; and (3) weakening of co-occurrence, or the "decoupling" hypothesis. This framework seeks to guide the conceptualization, evaluation, and understanding of changes in the co-occurrence of substance use and emotional concerns over time, including outlining a research agenda informed by pre-existing research and youth perspectives.
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Affiliation(s)
- Jillian Halladay
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney 2006, Camperdown 2006, New South Wales, Australia
- School of Nursing, McMaster University, Hamilton, Ontario L8S 4K1, Canada
- Peter Boris Centre for Addictions Research, McMaster University / St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8P 3P2, Canada
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney 2006, Camperdown 2006, New South Wales, Australia
| | - Cath Chapman
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney 2006, Camperdown 2006, New South Wales, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney 2006, Camperdown 2006, New South Wales, Australia
| | - Tim Slade
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney 2006, Camperdown 2006, New South Wales, Australia
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12
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Halladay J, Freibott CE, Lipson SK, Zhou S, Eisenberg D. Trends in the co-occurrence of substance use and mental health symptomatology in a national sample of US post-secondary students from 2009 to 2019. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1911-1924. [PMID: 35834773 DOI: 10.1080/07448481.2022.2098030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 05/20/2022] [Accepted: 06/27/2022] [Indexed: 05/18/2023]
Abstract
Objective: This study examined joint trends over time in associations between substance use (heavy drinking, cannabis, and cigarette smoking) and mental health concerns (depression, anxiety, and suicidal ideation) among US post-secondary students. Participants: Data came from 323,896 students participating in the Healthy Minds Study from 2009 to 2019, a national cross-sectional survey of US post-secondary students. Weighted two-level logistic regression models with a time by substance interaction term were used to predict mental health status. Results: Use of each substance was associated with a greater odds of students endorsing depression, anxiety, and suicidal ideation. Over time, the association with mental health concerns strengthened substantially for cannabis, modestly for heavy drinking, and remained stable for smoking. Conclusion: Given co-occurrence is common and increasing among post-secondary students, college and university health systems should prioritize early identification, psychoeducation, harm-reduction, and brief interventions to support students at risk.
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Affiliation(s)
- Jillian Halladay
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Christina E Freibott
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sarah K Lipson
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sasha Zhou
- Department of Public Health, Wayne State University, Detroit, Michigan, USA
| | - Daniel Eisenberg
- Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California, USA
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13
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Halladay J, Sunderland M, Chapman C, Repchuck R, Georgiades K, Boak A, Hamilton HA, Slade T. Examining temporal trends in psychological distress and the co-occurrence of common substance use in a population-based sample of grade 7-12 students from 2013 to 2019. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1367-1377. [PMID: 38311705 PMCID: PMC11291599 DOI: 10.1007/s00127-024-02619-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 01/01/2024] [Indexed: 02/06/2024]
Abstract
PURPOSE Characterizing trends and correlates of adolescent psychological distress is important due to observed global increases over the last 20 years. Substance use is a commonly discussed correlate, though we lack an understanding about how co-occurrence of these concerns has been changing over time. METHODS Data came from repeated, representative, cross-sectional surveys of grade 7-12 students across Ontario, Canada conducted biennially from 2013 to 2019. Poisson regression with robust standard errors was used to examine changes in the joint association between psychological distress (operationalized as Kessler-6 [K6] scores ≥ 13) and substance use over time. Weighted prevalence ratios (PR) and their 99% confidence intervals were estimated, where p < 0.01 denotes statistical significance. RESULTS The prevalence of psychological distress doubled between 2013 and 2019, with adjusted increases of about 1.2 times each survey year. This biennial increase did not differ based on sex, perceived social standing, school level, or any substance use. Students using substances consistently reported a higher prevalence of psychological distress (between 1.2 times and 2.7 times higher). There were similarly no differential temporal trends based on substance use for very high distress (K6 ≥ 19) or K6 items explored individually. CONCLUSION Psychological distress steeply increased among adolescents and substance use remains important to assess and address alongside distress. However, the magnitude of temporal increases appears to be similar for adolescents reporting and not reporting substance use.
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Affiliation(s)
- J Halladay
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6, Jane Foss Russell Building, G02, Camperdown, NSW, 2006, Australia.
| | - M Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6, Jane Foss Russell Building, G02, Camperdown, NSW, 2006, Australia
| | - C Chapman
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6, Jane Foss Russell Building, G02, Camperdown, NSW, 2006, Australia
| | - R Repchuck
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - K Georgiades
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - A Boak
- The Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Canada
| | - H A Hamilton
- The Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Canada
| | - T Slade
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6, Jane Foss Russell Building, G02, Camperdown, NSW, 2006, Australia
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14
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Choi NG, Marti CN, Choi BY. Associations between Cannabis Consumption Methods and Cannabis Risk Perception. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:986. [PMID: 39200597 PMCID: PMC11353858 DOI: 10.3390/ijerph21080986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/18/2024] [Accepted: 07/24/2024] [Indexed: 09/02/2024]
Abstract
Given diversified cannabis products, we examined associations between cannabis consumption methods and cannabis risk perception of smoking cannabis 1-2 times a week. Using the 2022 U.S. National Survey on Drug Use and Health data (N = 12,796 past-year adult cannabis users; M = 6127 and F = 6669), we used multinomial and binary logistic regression models. Smoking was the most prevalent method, followed by eating/drinking, vaping, and dabbing. One-half of cannabis users reported no perceived risk of smoking cannabis 1-2 times a week, 37.5% perceived slight risk, 9.2% moderate risk, and 2.9% great risk. Those with moderate or great risk perception had a lower likelihood of using 4+ methods of consumption (e.g., RRR = 0.40, 95% CI = 0.20, 0.77 for great risk perception). Any perceived risk was associated with higher odds of edibles/drinks only (e.g., aOR = 2.81, 95% CI = 1.43, 5.54 for great risk perception). Along with medical use and CUD, sociodemographic factors, mental illness, and other substance use were also significant correlates of cannabis consumption methods. Understanding the varying risk perceptions associated with different consumption methods is needed for harm reduction initiatives. More research is needed on cannabis products, particularly edibles/drinks and dabs/concentrates, to better understand the potential risks associated with them.
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Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX 78712, USA;
| | - C. Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX 78712, USA;
| | - Bryan Y. Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DL 19901, USA;
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15
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Swartz HA, Bylsma Ph D LM. Should Psychotherapy Be Approved and Prescribed Like a Drug? Am J Psychother 2024; 77:43-45. [PMID: 38877754 DOI: 10.1176/appi.psychotherapy.20240015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Affiliation(s)
- Holly A Swartz
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh
| | - Lauren M Bylsma Ph D
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh
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16
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Mosandl CF, Baltes-Flückiger L, Kronschnabel J, Meyer M, Guessoum A, Herrmann O, Vogel M, Walter M, Pichler EM. Cannabis use and its association with psychopathological symptoms in a Swiss adult population: a cross-sectional analysis. Front Public Health 2024; 12:1356988. [PMID: 38841675 PMCID: PMC11151851 DOI: 10.3389/fpubh.2024.1356988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/10/2024] [Indexed: 06/07/2024] Open
Abstract
Background As the most commonly used illicit substance, cannabis is gaining global acceptance through increasing legalization efforts. This shift intensifies the need for research to guide policymakers and healthcare providers in harm reduction and treatment strategies. Nonetheless, the relationship between psychopathological symptoms and cannabis use remains inadequately understood. Methods A sample of regular cannabis consumers completed self-reported assessments for depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), Attention-Deficit/Hyperactivity Disorder (ADHD; Adult ADHD Self-Report Scale V1.1), and psychosis (Early Recognition Inventory based on IRAOS) as well as previous black-market cannabis use patterns. Cannabis Use Disorder Identification Test Revised (CUDIT-R) was used to identify cannabis use disorder (CUD). To understand psychopathological symptom load related to cannabis consumption as well as cannabis use motives, multiple regression models were performed to identify psychopathological variables predicting cannabis use frequency and quantity. Linear regression and correlation analyses were conducted, adjusting for relevant covariates (age, gender, education, alcohol, other substance use). Results Three-hundred-sixty regular cannabis users interested in a study on regulated cannabis access in Basel, Switzerland were examined. In bivariate analysis, cannabis use frequency correlated with depressive (r(358) = 0.16, p = 0.003) and anxiety symptom load (r(358) = 0.11, p = 0.034). Cannabis quantity correlated with depressive (r(358) = 0.15, p = 0.005), ADHD (r(358) = 0.14, p = 0.008), and psychosis symptom load (r(358) = 0.16, p = 0.002). However, in the adjusted regression models only depressive and ADHD symptom loads were significantly associated with cannabis use frequency (p = 0.006 and p = 0.034, respectively) and quantity (p = 0.037 and p = 0.019, respectively). No significant correlations between cannabis consumption and anxiety or psychosis remained after adjustment. Conclusion ADHD and depressive symptoms correlate with increased cannabis use in a cohort of regular users, suggesting potential self-medication in nonclinical populations. With the rising availability of cannabis worldwide, these results highlight the necessity for longitudinal studies to disentangle the complex dynamics between cannabis consumption and mental health symptoms.
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Affiliation(s)
- Christoph Felix Mosandl
- Clinic of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | | | - Jens Kronschnabel
- Clinic of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
| | - Maximilian Meyer
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Adrian Guessoum
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Oliver Herrmann
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Marc Vogel
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Marc Walter
- Clinic of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
| | - Eva-Maria Pichler
- Clinic of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
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17
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Harrison ME, Kanbur N, Canton K, Desai TS, Lim-Reinders S, Groulx C, Norris ML. Adolescents' Cannabis Knowledge and Risk Perception: A Systematic Review. J Adolesc Health 2024; 74:402-440. [PMID: 37966406 DOI: 10.1016/j.jadohealth.2023.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/31/2023] [Accepted: 09/08/2023] [Indexed: 11/16/2023]
Abstract
To systematically review evidence evaluating cannabis-related knowledge and perception of risk in children and adolescents. We systematically searched Medline, PsycINFO, and EMBASE using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. 133 studies from around the world (including ages 10-18 yrs) met inclusion criteria, with 70% meeting grade 2C quality. Increased knowledge and perception of risk of cannabis frequently correlated with lower levels of current use and intent to use. Studies examining correlations over time generally demonstrated increased adolescent cannabis use and decreased perception of risk. Included prevention-based interventions often enhanced knowledge and/or perception of risk in adolescents exposed to the intervention. Studies exploring outcomes relating to legislative changes for recreational marijuana use demonstrated considerable heterogeneity regarding knowledge and perception of risk whereas studies that focused on medicinal marijuana legislative changes overwhelmingly demonstrated a decrease in perception of risk post legalization. Increased knowledge and perception of risk of cannabis in adolescents often correlate with lower levels of current use and intention to use in the future. Further study and implementation of public health and clinically-oriented strategies that seek to increase knowledge among youth about the potential health harms of cannabis use should continue and be prioritized.
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Affiliation(s)
- Megan E Harrison
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Division of Adolescent Health, CHEO, Ottawa, Ontario, Canada; CHEO Research Institute, Ottawa, Ontario, Canada.
| | - Nuray Kanbur
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Division of Adolescent Health, CHEO, Ottawa, Ontario, Canada; CHEO Research Institute, Ottawa, Ontario, Canada
| | - Kyle Canton
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Tejas S Desai
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Chase Groulx
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Mark L Norris
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Division of Adolescent Health, CHEO, Ottawa, Ontario, Canada; CHEO Research Institute, Ottawa, Ontario, Canada
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18
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Vidal C, Simon KM, Brooks C, White J, Hinckley JD. A systematic review of evidence on integrated management of psychiatric disorders in youth who use cannabis. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 10:100216. [PMID: 38288007 PMCID: PMC10823056 DOI: 10.1016/j.dadr.2023.100216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 01/31/2024]
Abstract
Given the risks to mental health associated with cannabis use in youth and the increase in cannabis legalization worldwide and in the U.S., there is a need to understand existing evidence-based approaches to integrated management of psychiatric disorders in youth who use cannabis. This systematic review aimed to appraise the current evidence on integrated treatment for adolescents and young adults with common psychiatric disorders who engage in regular cannabis use. A total of 989 studies were screened for inclusion. Study's titles and abstracts were screened and advanced to full text review for further screening by two independent reviewers. Thirty-five full-text articles were reviewed, with five articles ultimately meeting all criteria for inclusion. Five randomized controlled trials examined the effects of therapeutic interventions in youth with common psychiatric disorders who used cannabis, including two studies on depression, one on bipolar disorder, one on anxiety and one on PTSD were reviewed. No studies were considered high in risk of bias. Overall, there is a paucity of research on the treatment of comorbid adolescent mental health disorders and cannabis use, which limits the ability to draw evidence-based treatment recommendations.
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Affiliation(s)
- Carol Vidal
- Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Kevin M Simon
- Harvard Medical School, Department of Psychiatry, USA
| | - Caroline Brooks
- Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Jacob White
- SOM Admin Welch Informationist Services, USA
| | - Jesse D Hinckley
- University of Colorado School of Medicine, Department of Psychiatry, USA
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19
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Mennis J, Mason MJ, Coatsworth JD, Russell M, Zaharakis NM. Young Adult Depression and Cannabis Use: Associations Before and After Recreational Legalization. Am J Prev Med 2024; 66:333-341. [PMID: 37778528 DOI: 10.1016/j.amepre.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION The co-occurrence of depression with cannabis use worsens both mood and substance use disorder outcomes, with young adults particularly at risk of co-occurrence. This research investigates whether the association of state-level prevalence rates of young adult (age 18-25) depression and cannabis use in the U.S. changed following enactment of recreational (adult use) cannabis legalization between 2008 and 2019. METHODS Annual, state prevalence data on past-year major depressive episode (hereafter, depression) and past-month cannabis use were extracted from the National Survey on Drug Use and Health (N=600 state-year observations). Moderated regression models tested whether the association of depression with cannabis use differed before versus after recreational legalization by comparing prevalence rates of depression and cannabis use in states that enacted recreational legalization to those that did not, while fixing state, year, and medical legalization effects. Data were accessed and analyzed in 2023. RESULTS Prevalence rates of both depression and cannabis use increased throughout the study period. The positive statistical effect of depression on cannabis use more than doubled in magnitude after legalization (β=0.564, 95% CI=0.291, 0.838) as compared to before (β=0.229, 95% CI=0.049, 0.409), representing a significant change (β=0.335, 95% CI=0.093, 0.577). CONCLUSIONS These results suggest that the association between prevalence rates of young adult depression and cannabis use strengthened following recreational legalization in the U.S. This is potentially due to increases in cannabis accessibility and the acceptance of the health benefits of cannabis, which may enhance the use of cannabis as a coping mechanism among young adults with depression.
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Affiliation(s)
- Jeremy Mennis
- Department of Geography and Urban Studies, Temple University, Philadelphia, Pennsylvania.
| | - Michael J Mason
- Center for Behavioral Health Research, University of Tennessee, Knoxville, Tennessee
| | - J Douglas Coatsworth
- Center for Behavioral Health Research, University of Tennessee, Knoxville, Tennessee
| | - Michael Russell
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania
| | - Nikola M Zaharakis
- Center for Behavioral Health Research, University of Tennessee, Knoxville, Tennessee
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Livne O, Malte CA, Olfson M, Wall MM, Keyes KM, Maynard C, Gradus JL, Saxon AJ, Martins SS, Keyhani S, McDowell Y, Fink DS, Mannes ZL, Gutkind S, Hasin DS. Trends in Prevalence of Cannabis Use Disorder Among U.S. Veterans With and Without Psychiatric Disorders Between 2005 and 2019. Am J Psychiatry 2024; 181:144-152. [PMID: 38018141 PMCID: PMC10843609 DOI: 10.1176/appi.ajp.20230168] [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] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Cannabis use disorder diagnoses are increasing among U.S. adults and are more prevalent among people with comorbid psychiatric disorders. Recent changes in cannabis laws, increasing cannabis availability, and higher-potency cannabis may have placed people with cannabis use and psychiatric disorders at disproportionately increasing risk for cannabis use disorder. The authors used Veterans Health Administration (VHA) data to examine whether trends in cannabis use disorder prevalence among VHA patients differ by whether they have psychiatric disorders. METHODS VHA electronic health records from 2005 to 2019 (N range, 4,332,165-5,657,277) were used to identify overall and age-group-specific (<35, 35-64, and ≥65 years) trends in prevalence of cannabis use disorder diagnoses among patients with depressive, anxiety, posttraumatic stress, bipolar, or psychotic spectrum disorders and to compare these to corresponding trends among patients without any of these disorders. Given transitions in ICD coding, differences in trends were tested within two periods: 2005-2014 (ICD-9-CM) and 2016-2019 (ICD-10-CM). RESULTS Greater increases in prevalence of cannabis use disorder diagnoses were observed among patients with psychiatric disorders compared to those without (difference in prevalence change, 2005-2014: 1.91%, 95% CI=1.87-1.96; 2016-2019: 0.34%, 95% CI=0.29-0.38). Disproportionate increases in cannabis use disorder prevalence among patients with psychiatric disorders were greatest among those under age 35 between 2005 and 2014, and among those age 65 or older between 2016 and 2019. Among patients with psychiatric disorders, the greatest increases in cannabis use disorder prevalences were observed among those with bipolar and psychotic spectrum disorders. CONCLUSIONS The findings highlight disproportionately increasing disparities in risk of cannabis use disorder among VHA patients with common psychiatric disorders. Greater public health and clinical efforts are needed to monitor, prevent, and treat cannabis use disorder in this population.
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Affiliation(s)
- Ofir Livne
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Carol A Malte
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Mark Olfson
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Melanie M Wall
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Katherine M Keyes
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Charles Maynard
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Jaimie L Gradus
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Andrew J Saxon
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Silvia S Martins
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Salomeh Keyhani
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Yoanna McDowell
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - David S Fink
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Zachary L Mannes
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Sarah Gutkind
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Deborah S Hasin
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
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21
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Johnstad PG. Unhealthy behaviors associated with mental health disorders: a systematic comparative review of diet quality, sedentary behavior, and cannabis and tobacco use. Front Public Health 2024; 11:1268339. [PMID: 38249418 PMCID: PMC10797041 DOI: 10.3389/fpubh.2023.1268339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/14/2023] [Indexed: 01/23/2024] Open
Abstract
Background There are well-established literatures documenting the associations between mental disorders and unhealthy behaviors such as poor diet quality, sedentary behavior, and cannabis and tobacco use. Few studies have attempted to understand the respective findings in light of each other, however. Objective The purpose of this review was to assemble comparable data for each behavior-disorder association and assess the associations in terms of their overall strength. The review aimed to include a representative, but not exhaustive, range of studies that would allow for explorative comparisons. Methods Eligible studies were identified via Pubmed searches and citation searching, restricted to publications no older than 2015 written in English. To obtain comparable data, only studies that reported findings as odds ratios were included, and risk of bias related to study samples, behavioral measurement disparities, and control variables was assessed via sensitivity analyses. Findings for each disorder were compared on the basis of different measures of central tendency. Results From 3,682 records, 294 studies were included. The review found evidence of associations between each of the four unhealthy behaviors and psychosis, depression, anxiety, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), while personality disorder was only investigated in relation to cannabis and tobacco use. In overall comparison, the associations were generally of similar strength, and only the association between cannabis use and personality disorder was exceptional in terms of being significantly stronger than its counterparts across disorders and across behaviors. Analyses of bias risk identified some influence from behavioral measurement disparities and lack of adequate statistical control, but findings were generally robust across a range of sensitivity analyses. Conclusion This explorative and comparative review found that poor diet quality, sedentary behavior, and cannabis and tobacco use are about equally strongly associated with a range of different mental disorders. Given the general nature of these associations, we should probably understand them to reflect a general and shared etiology. However, the findings in this review should be regarded as tentative until confirmed by more comprehensive investigations.
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Voci S, Veldhuizen S, Ivanova A, Melamed OC, Selby P, Zawertailo L. Cannabis Use Among Adults in Cigarette Smoking Cessation Treatment in Ontario, Canada: Prevalence and Association With Tobacco Cessation Outcome, 2015-2021. Am J Public Health 2024; 114:98-107. [PMID: 38091559 PMCID: PMC10726933 DOI: 10.2105/ajph.2023.307445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Objectives. To examine cannabis use prevalence and its association with tobacco cessation among adults enrolled in cigarette smoking cessation treatment before and after Canada legalized recreational cannabis in October 2018. Methods. The sample comprised 83 206 adults enrolled in primary care-based cigarette smoking cessation treatment between 2015 and 2021 in Ontario, Canada. Past-30-day cannabis use was self-reported at enrollment and cigarette smoking abstinence at 6-month follow-up. Results. Past-30-day prevalence of cannabis use increased from 20.2% in 2015 to 37.7% in 2021. The prevalence increased linearly both before and after legalization. Cannabis and tobacco co-use was associated with lower odds of self-reported cigarette smoking abstinence at 6-month follow-up than tobacco use only (24.4% vs 29.3%; odds ratio [OR] = 0.78; 95% confidence interval [CI] = 0.75, 0.81). This association was attenuated after adjustment for covariates (OR = 0.93; 95% CI = 0.89, 0.97) and weakened slightly over time. Conclusions. Cannabis use prevalence almost doubled from 2015 to 2021 among primary care patients in Ontario seeking treatment to quit cigarettes and was associated with poorer quit outcomes. Further research into the impact of cannabis policy on cannabis and tobacco co-use is warranted to mitigate harm. (Am J Public Health. 2024;114(1):98-107. https://doi.org/10.2105/AJPH.2023.307445).
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Affiliation(s)
- Sabrina Voci
- Sabrina Voci, Scott Veldhuizen, and Anna Ivanova are with the INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Osnat C. Melamed is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, University of Toronto. Peter Selby is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, Department of Psychiatry, and Dalla Lana School of Public Health, University of Toronto. Laurie Zawertailo is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Pharmacology and Toxicology, University of Toronto
| | - Scott Veldhuizen
- Sabrina Voci, Scott Veldhuizen, and Anna Ivanova are with the INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Osnat C. Melamed is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, University of Toronto. Peter Selby is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, Department of Psychiatry, and Dalla Lana School of Public Health, University of Toronto. Laurie Zawertailo is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Pharmacology and Toxicology, University of Toronto
| | - Anna Ivanova
- Sabrina Voci, Scott Veldhuizen, and Anna Ivanova are with the INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Osnat C. Melamed is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, University of Toronto. Peter Selby is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, Department of Psychiatry, and Dalla Lana School of Public Health, University of Toronto. Laurie Zawertailo is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Pharmacology and Toxicology, University of Toronto
| | - Osnat C Melamed
- Sabrina Voci, Scott Veldhuizen, and Anna Ivanova are with the INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Osnat C. Melamed is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, University of Toronto. Peter Selby is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, Department of Psychiatry, and Dalla Lana School of Public Health, University of Toronto. Laurie Zawertailo is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Pharmacology and Toxicology, University of Toronto
| | - Peter Selby
- Sabrina Voci, Scott Veldhuizen, and Anna Ivanova are with the INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Osnat C. Melamed is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, University of Toronto. Peter Selby is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, Department of Psychiatry, and Dalla Lana School of Public Health, University of Toronto. Laurie Zawertailo is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Pharmacology and Toxicology, University of Toronto
| | - Laurie Zawertailo
- Sabrina Voci, Scott Veldhuizen, and Anna Ivanova are with the INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Osnat C. Melamed is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, University of Toronto. Peter Selby is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, Department of Psychiatry, and Dalla Lana School of Public Health, University of Toronto. Laurie Zawertailo is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Pharmacology and Toxicology, University of Toronto
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Pérez-Valenzuela E, Hudson R, Uzuneser T, De Felice M, Szkudlarek H, Rushlow W, Laviolette SR. Sex-Dependent Synergism of an Edible THC: CBD Formulation in Reducing Anxiety and Depressive-like Symptoms Following Chronic Stress. Curr Neuropharmacol 2024; 22:2059-2078. [PMID: 37702237 PMCID: PMC11333796 DOI: 10.2174/1570159x21666230912101441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/26/2023] [Accepted: 07/16/2023] [Indexed: 09/14/2023] Open
Abstract
Cannabis has shown therapeutic potential in mood and anxiety-related pathologies. However, the two primary constituents of cannabis, cannabidiol (CBD) and Δ-9-tetrahydrocannabinol (THC) produce distinct effects on molecular pathways in neural circuits associated with affective disorders. Moreover, it has been proposed that the combination of THC: and CBD may have unique synergistic properties. In the present study, the effects of a 1:100 THC: CBD ratio edible formulation were tested in behavioural, neuronal and molecular assays for anxiety and depressive-like endophenotypes. Adult male and female Sprague-Dawley rats were stressed for 14 days. Then, for three weeks, open field, elevated plus maze, light/dark box, social interaction, sucrose preference, and the forced swim test were performed 90 minutes after acute consumption of CBD (30 mg/kg), THC (0.3 mg/kg), or 1:100 combination of THC:CBD. After behavioural tests, in vivo, neuronal electrophysiological analyses were performed in the ventral tegmental area and prefrontal cortex (PFC). Furthermore, western-blot experiments examined the expression of biomarkers associated with mood and anxiety disorders, including protein kinase B (Akt), glycogen synthase kinase-3 (GSK-3), BDNF, mTOR, D1, and D2 receptor in nucleus accumbens (NAc) and PFC.Edible THC:CBD produces significant anxiolytic and antidepressant effects only in stressed male rats. In most cases, the combination of THC and CBD had stronger effects than either phytochemical alone. These synergistic effects are associated with alterations in Akt/GSK3 and D2-R expression in NAc and BDNF expression in PFC. Furthermore, THC:CBD reverses chronic stress-induced alterations in PFC neuronal activity. These findings demonstrate a novel synergistic potential for THC:CBD edible formulations in stress-related pathologies.
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Affiliation(s)
- Enzo Pérez-Valenzuela
- Addiction Research Group, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Roger Hudson
- Addiction Research Group, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Taygun Uzuneser
- Addiction Research Group, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Marta De Felice
- Addiction Research Group, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Hanna Szkudlarek
- Addiction Research Group, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Walter Rushlow
- Addiction Research Group, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Steven R. Laviolette
- Addiction Research Group, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
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24
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Botella-Juan L, Fernández-Suárez N, Marcos-Delgado A, Molina-de la Torre AJ, Fernández-Villa T. [Impact of the COVID-19 pandemic on cannabis use in young adults and general population: a systematic review]. Rev Esp Salud Publica 2023; 97:e202312106. [PMID: 38087956 PMCID: PMC11571766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/25/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE The first COVID-19 lockdown was a very restrictive situation that may have impacted on the prevalence and patterns of cannabis use. The aim of this systematic review was to assess the evidence on cannabis use and reasons for use in different countries during first lockdown in young adults and general population. METHODS This study followed PRISMA guidelines, and the review protocol was registered in PROSPERO (registration CRD42022303181). The search was carried out in PubMed, Scopus, Web of Science y Embase databases. Inclusion criteria were: cross-sectional or cohort studies; population ≥16 years; exploring cannabis use during lockdown; and English or Spanish language. RESULTS Thirty studies, conducted in European countries (n=17), North America (n=12) and rest of the world (n=1), were analysed. The overall prevalence of cannabis use was found to be largely unchanged, but regular users tended to maintain (between 39.5% and 96.8% of the sample) or increase cannabis use (between 2.9% and 51.6%). The main decreases were among occasional users. Some reasons for the increase were boredom, loneliness, stress, coping and depressive symptoms. In addition, young people were the heaviest users, and being younger, live without family, financial problems and a low educational level were significantly (p-value<0.05) associated with increased use. CONCLUSIONS Most regular users maintained or slightly increased their use, with young people being the main users. Concerning reasons for use like coping and depressive symptoms were found. Cannabis use needs to be addressed with strategies focused on the young population, considering occasional and regular use, as well as motivations.
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Affiliation(s)
- Lorena Botella-Juan
- Área de Medicina Preventiva y Salud Pública; Facultad Universitaria de Ciencias de la Salud; Universidad de León. León. España
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS) / Instituto de Biomedicina (IBIOMED); Universidad de León. León. España
| | - Nuria Fernández-Suárez
- Área de Medicina Preventiva y Salud Pública; Facultad Universitaria de Ciencias de la Salud; Universidad de León. León. España
| | - Alba Marcos-Delgado
- Área de Medicina Preventiva y Salud Pública; Facultad Universitaria de Ciencias de la Salud; Universidad de León. León. España
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS) / Instituto de Biomedicina (IBIOMED); Universidad de León. León. España
| | - Antonio José Molina-de la Torre
- Área de Medicina Preventiva y Salud Pública; Facultad Universitaria de Ciencias de la Salud; Universidad de León. León. España
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS) / Instituto de Biomedicina (IBIOMED); Universidad de León. León. España
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP). España
| | - Tania Fernández-Villa
- Área de Medicina Preventiva y Salud Pública; Facultad Universitaria de Ciencias de la Salud; Universidad de León. León. España
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS) / Instituto de Biomedicina (IBIOMED); Universidad de León. León. España
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP). España
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25
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Macatee RJ, Schermitzler BS, Minieri JB, Moeller SJ, Afshar K, Preston TJ. Neurophysiological error processing and addiction self-awareness correlates of reduced insight in cannabis use disorder. Addiction 2023; 118:2397-2412. [PMID: 37612599 PMCID: PMC10730014 DOI: 10.1111/add.16321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND AND AIMS Cannabis use disorder (CUD) prevalence has increased, while perceived risks of cannabis use and CUD treatment need have decreased. Chronic cannabis use may also impair the neural and behavioral mechanisms of insight, further hampering treatment-seeking. This study aimed to measure whether CUD is characterized by reduced self-monitoring in drug-related contexts (objectively-assessed insight), subserved by functional neural abnormalities in error-processing and manifested clinically as decreased awareness of the need to change. DESIGN Case-control laboratory study was used. SETTING University setting was in Alabama, USA. PARTICIPANTS There were 42 CUD participants and 47 age-, sex-, and nicotine use-matched controls. MEASUREMENTS Participants completed a probabilistic choice task, adapted for the first time for CUD, in which they selected pleasant, unpleasant, neutral, and cannabis-related images according to their preference. Reduced versus accurate insight was operationalized as the correspondence between self-reported and actual most chosen image type. Neurophysiological error-processing during an inhibitory control task was recorded using electroencephalography. Participants with CUD completed measures of cannabis problem recognition and motivation to change. FINDINGS Compared with controls, the CUD group made significantly more cannabis selections on the choice task (mean difference [MD] = 8.11, 95% confidence interval [CI] [4.88 11.35], p < 0.001) and had significantly reduced insight into cannabis choice (odds ratio [OR] = 9.69, 95% CI [1.06 88.65], p = 0.04). CUD participants with reduced insight on the choice task had significantly decreased neurophysiological reactivity to errors on the inhibitory control task (error-related negativity) compared with CUD participants with accurate insight (MD = 2.64 μV, 95% CI [0.74 μV 4.54 μV], p = 0.008) and controls (MD = 4.05 μV, 95% CI [1.29 μV 6.80 μV], p = 0.005). Compared with CUD participants with accurate insight on the choice task, CUD participants with reduced insight reported significantly less agreement that they had a cannabis problem (MD = -5.06, 95% CI [-8.49-1.62], p = 0.003). CONCLUSIONS People with CUD who show reduced insight on a drug-related choice task may also have decreased early neural error-processing and less cannabis problem recognition.
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Affiliation(s)
| | | | | | | | - Kaveh Afshar
- Auburn University, Department of Psychological Sciences
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Kim C, Dusing GJ, Nielsen A, MacMaster FP, Rittenbach K, Allin S, O'Campo P, Penney TL, Hamilton HA, Kirst M, Chum A. Disparities in cannabis-related emergency department visits across depressed and non-depressed individuals and the impact of recreational cannabis policy in Ontario, Canada. Psychol Med 2023; 53:7127-7137. [PMID: 37345465 PMCID: PMC10719623 DOI: 10.1017/s0033291723000569] [Citation(s) in RCA: 2] [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: 08/30/2022] [Revised: 01/23/2023] [Accepted: 02/16/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Recreational cannabis policies are being considered in many jurisdictions internationally. Given that cannabis use is more prevalent among people with depression, legalisation may lead to more adverse events in this population. Cannabis legalisation in Canada included the legalisation of flower and herbs (phase 1) in October 2018, and the deregulation of cannabis edibles one year later (phase 2). This study investigated disparities in cannabis-related emergency department (ED) visits in depressed and non-depressed individuals in each phase. METHODS Using administrative data, we identified all adults diagnosed with depression 60 months prior to legalisation (n = 929 844). A non-depressed comparison group was identified using propensity score matching. We compared the pre-post policy differences in cannabis-related ED-visits in depressed individuals v. matched (and unmatched) non-depressed individuals. RESULTS In the matched sample (i.e. comparison with non-depressed people similar to the depressed group), people with depression had approximately four times higher risk of cannabis-related ED-visits relative to the non-depressed over the entire period. Phases 1 and 2 were not associated with any changes in the matched depressed and non-depressed groups. In the unmatched sample (i.e. comparison with the non-depressed general population), the disparity between individuals with and without depression is greater. While phase 1 was associated with an immediate increase in ED-visits among the general population, phase 2 was not associated with any changes in the unmatched depressed and non-depressed groups. CONCLUSIONS Depression is a risk factor for cannabis-related ED-visits. Cannabis legalisation did not further elevate the risk among individuals diagnosed with depression.
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Affiliation(s)
- Chungah Kim
- Faculty of Health, York University, School of Kinesiology and Health Science, Toronto, Ontario, Canada
| | - Gabriel John Dusing
- Faculty of Health, York University, School of Kinesiology and Health Science, Toronto, Ontario, Canada
| | - Andrew Nielsen
- Canadian Institute for Health Information, Toronto, Ontario, Canada
| | - Frank P. MacMaster
- University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Katherine Rittenbach
- Faculty of Medicine & Dentistry, Psychiatry Department, University of Alberta, Edmonton, Alberta
| | - Sara Allin
- University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario
| | - Patricia O'Campo
- St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Tarra L. Penney
- Faculty of Health, York University, School of Kinesiology and Health Science, Toronto, Ontario, Canada
| | | | - Maritt Kirst
- Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Antony Chum
- Faculty of Health, York University, School of Kinesiology and Health Science, Toronto, Ontario, Canada
- University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario
- St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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Capaldi DM, Tiberio SS, Kerr DCR, Owen LD. The Co-Occurrence of Conduct Problems and Depressive Symptoms From Childhood to Adulthood for Men: Stability Over Time and Prediction to Substance Use. Subst Abuse 2023; 17:11782218231204776. [PMID: 37854876 PMCID: PMC10580731 DOI: 10.1177/11782218231204776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/14/2023] [Indexed: 10/20/2023]
Abstract
The dual pathway hypothesis of risk for substance use was tested by examining risk from symptoms of conduct problems and depressive symptoms in adolescence (from ages 10-11 to 17-18 years) to substance use-including tobacco, alcohol, cannabis, and other illicit drugs-in both early adulthood (approximately from ages 20 to 29 years) and middle adulthood (approximately from ages 29 to 38 years). Hypotheses were tested on a sample of boys who were at risk for conduct problems by virtue of the neighborhoods where they lived in childhood (the Oregon Youth Study; N = 206 at Wave 1). Dual-trajectory modeling (Latent Class Analysis) resulted in a 3-group solution of high, moderate, and low co-occurring symptoms. The latent class of boys with co-occurring symptoms in adolescence showed higher levels of substance use in adulthood; namely, higher levels of cannabis and illicit substance use during early adulthood compared to either of the moderate or low symptom classes, and higher use of cannabis in midadulthood than the low symptom class. Those with co-occurring symptoms also showed, overall, higher vulnerability to use of tobacco in these 2 periods, but not to higher use of alcohol. Regression analyses indicated that the higher substance use of the co-occur group of men was related to their adolescent conduct problems, but was not related to their adolescent depressive symptoms; however, these associations were nonsignificant when adolescent use of the respective substances were included in the models. Thus, the dual-trajectory hypothesis was not supported. However, the findings indicated that, as assessed in the present study, the psychopathology symptoms of boys with conduct problems in adolescence who show risk for later substance use may be complex, involving depressive symptoms.
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Affiliation(s)
| | | | | | - Lee D Owen
- Oregon Social Learning Center, Eugene, OR, USA
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28
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Nguyen N, Peyser ND, Olgin JE, Pletcher MJ, Beatty AL, Modrow MF, Carton TW, Khatib R, Djibo DA, Ling PM, Marcus GM. Associations between tobacco and cannabis use and anxiety and depression among adults in the United States: Findings from the COVID-19 citizen science study. PLoS One 2023; 18:e0289058. [PMID: 37703257 PMCID: PMC10499225 DOI: 10.1371/journal.pone.0289058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/10/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Little is known about whether people who use both tobacco and cannabis (co-use) are more or less likely to have mental health disorders than single substance users or non-users. We aimed to examine associations between use of tobacco and/or cannabis with anxiety and depression. METHODS We analyzed data from the COVID-19 Citizen Science Study, a digital cohort study, collected via online surveys during 2020-2022 from a convenience sample of 53,843 US adults (≥ 18 years old) nationwide. Past 30-day use of tobacco and cannabis was self-reported at baseline and categorized into four exclusive patterns: tobacco-only use, cannabis-only use, co-use of both substances, and non-use. Anxiety and depression were repeatedly measured in monthly surveys. To account for multiple assessments of mental health outcomes within a participant, we used Generalized Estimating Equations to examine associations between the patterns of tobacco and cannabis use with each outcome. RESULTS In the total sample (mean age 51.0 years old, 67.9% female), 4.9% reported tobacco-only use, 6.9% cannabis-only use, 1.6% co-use, and 86.6% non-use. Proportions of reporting anxiety and depression were highest for the co-use group (26.5% and 28.3%, respectively) and lowest for the non-use group (10.6% and 11.2%, respectively). Compared to non-use, the adjusted odds of mental health disorders were highest for co-use (Anxiety: OR = 1.89, 95%CI = 1.64-2.18; Depression: OR = 1.77, 95%CI = 1.46-2.16), followed by cannabis-only use, and tobacco-only use. Compared to tobacco-only use, co-use (OR = 1.35, 95%CI = 1.08-1.69) and cannabis-only use (OR = 1.17, 95%CI = 1.00-1.37) were associated with higher adjusted odds for anxiety, but not for depression. Daily use (vs. non-daily use) of cigarettes, e-cigarettes, and cannabis were associated with higher adjusted odds for anxiety and depression. CONCLUSIONS Use of tobacco and/or cannabis, particularly co-use of both substances, were associated with poor mental health. Integrating mental health support with tobacco and cannabis cessation may address this co-morbidity.
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Affiliation(s)
- Nhung Nguyen
- Department of Medicine, Center for Tobacco Control Research and Education and Division of General Internal Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Noah D. Peyser
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, United States of America
| | - Jeffrey E. Olgin
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, United States of America
| | - Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Alexis L. Beatty
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Madelaine F. Modrow
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Thomas W. Carton
- Louisiana Public Health Institute, New Orleans, Louisiana, United States of America
| | - Rasha Khatib
- Advocate Aurora Health, Downers Grove, Illinois, United States of America
| | | | - Pamela M. Ling
- Department of Medicine, Center for Tobacco Control Research and Education and Division of General Internal Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Gregory M. Marcus
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, United States of America
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Choi NG, Marti CN, DiNitto DM, Choi BY. Psychological Distress, Cannabis Use Frequency, and Cannabis Use Disorder Among US Adults in 2020. J Psychoactive Drugs 2023; 55:445-455. [PMID: 36318094 DOI: 10.1080/02791072.2022.2142708] [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: 03/25/2022] [Revised: 08/20/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022]
Abstract
Using 2020 National Survey on Drug Use and Health data (N = 27,170, age 18+), we examined associations of psychological distress with: (1) cannabis use frequency among all adults, and (2) cannabis use disorder (CUD) among cannabis users. Of all adults, 18.2% reported past-year cannabis use, 12.9% reported mild-moderate psychological distress, and 12.9% reported serious psychological distress. Greater proportions of cannabis users, especially those under age 35, reported psychological distress. Of cannabis users, 28.1% met DSM-5 CUD criteria. Multinomial logistic regression results showed that serious, compared to no, psychological distress was significantly associated with cannabis use at all frequency levels. Both mild-moderate and serious levels of distress were associated with similar elevated CUD risk (RRR = 1.57, 95% CI = 1.15-2.15 for mild-moderate distress; RRR = 1.58, 95% CI = 1.19-2.09 for serious distress) and 2-4 times higher risks of having moderate or severe, compared to mild, CUD and higher odds of having alcohol use disorder. The prevalence of CUD and other substance use/use disorder among cannabis users is concerning as are the significant associations of psychological distress with greater cannabis use frequency, CUD, and other substance use/use disorder. Younger adults especially may benefit from increased behavioral health services given their high prevalence of psychological distress, cannabis use, and CUD.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - C Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Diana M DiNitto
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia School of Osteopathic Medicine and BayHealth, Dover, DE, USA
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30
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Weidberg S, González-Roz A, Castaño Y, Secades-Villa R. Emotion dysregulation in relation to cannabis use and mental health among young adults. Addict Behav 2023; 144:107757. [PMID: 37224581 DOI: 10.1016/j.addbeh.2023.107757] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Emotion dysregulation (ED) is a transdiagnostic variable that accounts for the onset and maintenance of mental health disorders. The interplay between ED, cannabis use and mental health has not been appraised in the young adult population and whether there are sex-dependent effects has yet to be examined. This study looked at whether ED mediates the association between past-month cannabis use and mental health, while considering sex as a moderator. METHODS 2,762 (64.2% women) undergraduate Spanish students completed an online battery. Among others, they fulfilled the Depression Anxiety Stress Scale-21 (DASS-21) and the Difficulties in Emotion Regulation Scale (DERS-28). A two-way ANOVA assessed the effects of sex and past-month cannabis use on participants' DASS-21 scores. A set of moderated mediations tested whether the indirect effect of past-month cannabis use on DASS-21 through DERS differed by sex. RESULTS Past-month cannabis female users showed higher levels of depression, anxiety and stress (M = 51.10, SD = 26.72) than did men [(M = 33.76, SD = 20.31); F(1, 2758) = 5.119, p =.024, η2p =.002]. In female young adults only, the effect of past-month cannabis use on mental health was mediated by ED (total score), non-acceptance of emotional responses, lack of emotional control, difficulties in engaging in goal-directed behavior, and lack of emotional clarity (all p's < 0.005) CONCLUSIONS: Findings indicate the importance of considering ED in assessment and intervention practices. Interventions targeting ED may be particularly effective for female young adult cannabis users.
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Affiliation(s)
- Sara Weidberg
- Department of Psychology. Addictive Behaviors Research Group (GCA), University of Oviedo. Plaza Feijoo s/n, 33003, Oviedo, Spain
| | - Alba González-Roz
- Department of Psychology. Addictive Behaviors Research Group (GCA), University of Oviedo. Plaza Feijoo s/n, 33003, Oviedo, Spain.
| | - Yasmina Castaño
- Department of Psychology. University of the Balearic Islands. Ctra. Valldemossa, km 7.5, 07122, Palma, Spain
| | - Roberto Secades-Villa
- Department of Psychology. Addictive Behaviors Research Group (GCA), University of Oviedo. Plaza Feijoo s/n, 33003, Oviedo, Spain
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31
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Kalayasiri R, Boonthae S. Trends of cannabis use and related harms before and after legalization for recreational purpose in a developing country in Asia. BMC Public Health 2023; 23:911. [PMID: 37208663 PMCID: PMC10197039 DOI: 10.1186/s12889-023-15883-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/11/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Thailand was the first country in Asia to legalize the use and purchase of cannabis leaves in February 2021 and the whole plant in June 2022 after the 2019 allowance for medical purposes. The study explored trends in cannabis use in Thailand before and after the recreational cannabis allowance was imposed. METHODS Cannabis and other variables of substance use, cannabis use disorder, and attitude towards cannabis of the Thai population aged 18 to 65 years in 2019 (n = 5,002), 2020 (n = 5,389) and 2021 (n = 5,669) were obtained from annual surveys conducted in the last two months of each year by the Centre for Addiction Studies. The surveys were repeat cross-sectional surveys of the general population of Thailand. Repeated variables from at least two annual surveys were included for analysis using the Chi-square test and the t-test. RESULTS The prevalence of cannabis use in the past year had increased from 2.2% in 2019 to 2.5% and 4.2% in 2020 and 2021 respectively, while those of methamphetamine, alcohol, and tobacco use had decreased. Trends in past-year drinking/eating cannabis products had increased, especially among the middle age group (40-49 years) from 2.1% (95% confidence interval (CI): 1.3, 3.1) in 2019 and 1.1% (95% CI: 0.6, 1.9) in 2020 to 3.8% (95% CI: 2.8, 5.0) in 2021. The younger population aged 18-19 had an increase in cannabis smoking from 0.9% (95% CI: 0.1, 3.3) in 2019 to 2.0% (95% CI: 0.5, 5.1) and 2.2% (95% CI: 0.7, 5.1) in 2020 and 2021 respectively. Symptoms of cannabis use disorder among cannabis users increased from 2019 to 2020 and then reversed afterwards in 2021. Thais had greater health knowledge about the benefits and harms of cannabis and had attitudes toward more harm of cannabis in 2021; however, 35.6% or a third of the sample in 2021 truly believed that cannabis was a cure for cancer, and 23.2% or one-fourth were uncertain or did not believe that cannabis was addictive. CONCLUSIONS Although most of the substances had a lower prevalence of use during the COVID-19 pandemic in Thailand, cannabis had a higher use after legalization. Thai youth had a growing trend to smoke cannabis.
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Affiliation(s)
- Rasmon Kalayasiri
- Department of Psychiatry, Epidemiology of Psychiatric Disorders and Mental Health Research Unit, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, 10330, Thailand.
- Department of Psychiatry, King Chulalongkorn Memorial Hospital, Pathumwan, Bangkok, 10330, Thailand.
| | - Suriyan Boonthae
- Research Centre for Social and Business Development, Chatuchak, Bangkok, 10900, Thailand
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Farrelly KN, Wardell JD, Marsden E, Scarfe ML, Najdzionek P, Turna J, MacKillop J. The Impact of Recreational Cannabis Legalization on Cannabis Use and Associated Outcomes: A Systematic Review. Subst Abuse 2023; 17:11782218231172054. [PMID: 37187466 PMCID: PMC10176789 DOI: 10.1177/11782218231172054] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
Background Recreational cannabis legalization has become more prevalent over the past decade, increasing the need to understand its impact on downstream health-related outcomes. Although prior reviews have broadly summarized research on cannabis liberalization policies (including decriminalization and medical legalization), directed efforts are needed to synthesize the more recent research that focuses on recreational cannabis legalization specifically. Thus, the current review summarizes existing studies using longitudinal designs to evaluate impacts of recreational cannabis legalization on cannabis use and related outcomes. Method A comprehensive bibliographic search strategy revealed 61 studies published from 2016 to 2022 that met criteria for inclusion. The studies were predominantly from the United States (66.2%) and primarily utilized self-report data (for cannabis use and attitudes) or administrative data (for health-related, driving, and crime outcomes). Results Five main categories of outcomes were identified through the review: cannabis and other substance use, attitudes toward cannabis, health-care utilization, driving-related outcomes, and crime-related outcomes. The extant literature revealed mixed findings, including some evidence of negative consequences of legalization (such as increased young adult use, cannabis-related healthcare visits, and impaired driving) and some evidence for minimal impacts (such as little change in adolescent cannabis use rates, substance use rates, and mixed evidence for changes in cannabis-related attitudes). Conclusions Overall, the existing literature reveals a number of negative consequences of legalization, although the findings are mixed and generally do not suggest large magnitude short-term impacts. The review highlights the need for more systematic investigation, particularly across a greater diversity of geographic regions.
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Affiliation(s)
- Kyra N Farrelly
- Department of Psychology, York
University, Toronto, ON, Canada
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
| | - Jeffrey D Wardell
- Department of Psychology, York
University, Toronto, ON, Canada
- Institute for Mental Health Policy
Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of
Toronto, Toronto, ON, Canada
| | - Emma Marsden
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
| | - Molly L Scarfe
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
| | - Peter Najdzionek
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
| | - Jasmine Turna
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
- Michael G. DeGroote Centre for
Medicinal Cannabis Research, McMaster University & St. Joseph’s Healthcare
Hamilton, Hamilton, ON, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
- Michael G. DeGroote Centre for
Medicinal Cannabis Research, McMaster University & St. Joseph’s Healthcare
Hamilton, Hamilton, ON, Canada
- Homewood Research Institute, Guelph,
ON, Canada
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Tourjman SV, Buck G, Jutras-Aswad D, Khullar A, McInerney S, Saraf G, Pinto JV, Potvin S, Poulin MJ, Frey BN, Kennedy SH, Lam RW, MacQueen G, Milev R, Parikh SV, Ravindran A, McIntyre RS, Schaffer A, Taylor VH, van Ameringen M, Yatham LN, Beaulieu S. Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Report: A Systematic Review and Recommendations of Cannabis use in Bipolar Disorder and Major Depressive Disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:299-311. [PMID: 35711159 PMCID: PMC10192829 DOI: 10.1177/07067437221099769] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Given the increasing acceptability and legalization of cannabis in some jurisdictions, clinicians need to improve their understanding of the effect of cannabis use on mood disorders. OBJECTIVE The purpose of this task force report is to examine the association between cannabis use and incidence, presentation, course and treatment of bipolar disorder and major depressive disorder, and the treatment of comorbid cannabis use disorder. METHODS We conducted a systematic literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching PubMed, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials from inception to October 2020 focusing on cannabis use and bipolar disorder or major depressive disorder, and treatment of comorbid cannabis use disorder. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to evaluate the quality of evidence and clinical considerations were integrated to generate Canadian Network for Mood and Anxiety Treatments recommendations. RESULTS Of 12,691 publications, 56 met the criteria: 23 on bipolar disorder, 21 on major depressive disorder, 11 on both diagnoses and 1 on treatment of comorbid cannabis use disorder and major depressive disorder. Of 2,479,640 participants, 12,502 were comparison participants, 73,891 had bipolar disorder and 408,223 major depressive disorder without cannabis use. Of those with cannabis use, 2,761 had bipolar disorder and 5,044 major depressive disorder. The lifetime prevalence of cannabis use was 52%-71% and 6%-50% in bipolar disorder and major depressive disorder, respectively. Cannabis use was associated with worsening course and symptoms of both mood disorders, with more consistent associations in bipolar disorder than major depressive disorder: increased severity of depressive, manic and psychotic symptoms in bipolar disorder and depressive symptoms in major depressive disorder. Cannabis use was associated with increased suicidality and decreased functioning in both bipolar disorder and major depressive disorder. Treatment of comorbid cannabis use disorder and major depressive disorder did not show significant results. CONCLUSION The data indicate that cannabis use is associated with worsened course and functioning of bipolar disorder and major depressive disorder. Future studies should include more accurate determinations of type, amount and frequency of cannabis use and select comparison groups which allow to control for underlying common factors.
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Affiliation(s)
- Smadar V. Tourjman
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montreal, Quebec, Canada
| | - Gabriella Buck
- Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, Quebec, Canada
| | - Atul Khullar
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Shane McInerney
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gayatri Saraf
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jairo V. Pinto
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephane Potvin
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, Quebec, Canada
| | | | - Benicio N. Frey
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sidney H. Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Raymond W. Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Glenda MacQueen
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada
| | - Sagar V. Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Arun Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Roger S. McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Valerie H. Taylor
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Michael van Ameringen
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Lakshmi N. Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Gravely S, Driezen P, McClure EA, Smith DM, Fong GT. Prevalence of depressive symptoms and cannabis use among adult cigarette smokers in Canada: cross-sectional findings from the 2020 International Tobacco Control Policy Evaluation Project Canada Smoking and Vaping Survey. CMAJ Open 2023; 11:E516-E526. [PMID: 37311596 DOI: 10.9778/cmajo.20220081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Tobacco smoking and cannabis use are independently associated with depression, and evidence suggests that people who use both tobacco and cannabis (co-consumers) are more likely to report mental health problems, greater nicotine dependence and alcohol misuse than those who use either product exclusively. We examined prevalence of cannabis use and depressive symptoms among Canadian adults who smoke cigarettes and tested whether co-consumers of cannabis and tobacco were more likely to report depressive symptoms than cigarette-only smokers; we also tested whether cigarette-only smokers and co-consumers differed on cigarette dependence measures, motivation to quit smoking and risky alcohol use by the presence or absence of depressive symptoms. METHODS We analyzed cross-sectional data from adult (age ≥ 18 yr) current (≥ monthly) cigarette smokers from the Canadian arm of the 2020 International Tobacco Control Policy Evaluation Project Four Country Smoking and Vaping Survey. Canadian respondents were recruited from Leger's online probability panel across all 10 provinces. We estimated weighted percentages for depressive symptoms and cannabis use among all respondents and tested whether co-consumers (≥ monthly use of cannabis and cigarettes) were more likely to report depressive symptoms than cigarette-only smokers. Weighted multivariable regression models were used to identify differences between co-consumers and cigarette-only smokers with and without depressive symptoms. RESULTS A total of 2843 current smokers were included in the study. The prevalence of past-year, past-30-day and daily cannabis use was 44.0%, 33.2% and 16.1%, respectively (30.4% reported using cannabis at least monthly). Among all respondents, 30.0% screened positive for depressive symptoms, with co-consumers being more likely to report depressive symptoms (36.5%) than those who did not report current cannabis use (27.4%, p < 0.001). Depressive symptoms were associated with planning to quit smoking (p = 0.01), having made multiple attempts to quit smoking (p < 0.001), the perception of being very addicted to cigarettes (p < 0.001) and strong urges to smoke (p = 0.001), whereas cannabis use was not (all p ≥ 0.05). Cannabis use was associated with high-risk alcohol consumption (p < 0.001), whereas depressive symptoms were not (p = 0.1). INTERPRETATION Co-consumers were more likely to report depressive symptoms and high-risk alcohol consumption; however, only depression, and not cannabis use, was associated with greater motivation to quit smoking and greater perceived dependence on cigarettes. A deeper understanding of how cannabis, alcohol use and depression interact among people who smoke cigarettes is needed, as well as how these factors affect cessation activity over time.
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Affiliation(s)
- Shannon Gravely
- Department of Psychology (Gravely, Driezen, Fong), University of Waterloo, Waterloo, Ont.; Hollings Cancer Center (McClure), Medical University of South Carolina, Charleston, SC; Roswell Park Comprehensive Cancer Center (Smith), Buffalo, NY; Ontario Institute for Cancer Research (Fong), Toronto, Ont.
| | - Pete Driezen
- Department of Psychology (Gravely, Driezen, Fong), University of Waterloo, Waterloo, Ont.; Hollings Cancer Center (McClure), Medical University of South Carolina, Charleston, SC; Roswell Park Comprehensive Cancer Center (Smith), Buffalo, NY; Ontario Institute for Cancer Research (Fong), Toronto, Ont
| | - Erin A McClure
- Department of Psychology (Gravely, Driezen, Fong), University of Waterloo, Waterloo, Ont.; Hollings Cancer Center (McClure), Medical University of South Carolina, Charleston, SC; Roswell Park Comprehensive Cancer Center (Smith), Buffalo, NY; Ontario Institute for Cancer Research (Fong), Toronto, Ont
| | - Danielle M Smith
- Department of Psychology (Gravely, Driezen, Fong), University of Waterloo, Waterloo, Ont.; Hollings Cancer Center (McClure), Medical University of South Carolina, Charleston, SC; Roswell Park Comprehensive Cancer Center (Smith), Buffalo, NY; Ontario Institute for Cancer Research (Fong), Toronto, Ont
| | - Geoffrey T Fong
- Department of Psychology (Gravely, Driezen, Fong), University of Waterloo, Waterloo, Ont.; Hollings Cancer Center (McClure), Medical University of South Carolina, Charleston, SC; Roswell Park Comprehensive Cancer Center (Smith), Buffalo, NY; Ontario Institute for Cancer Research (Fong), Toronto, Ont
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Kutzner J, Elam KK, Ha T. Genetic influences on the interplay between obsessive-compulsive behavior symptoms and cannabis use during adolescence. J Adolesc 2023; 95:427-436. [PMID: 36443914 PMCID: PMC10588756 DOI: 10.1002/jad.12125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/05/2022] [Accepted: 11/05/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There are overlapping biological origins and behaviors associated with obsessive-compulsive symptoms (OCS) and cannabis use. There is also evidence that OCS and cannabis use are associated over time. Thus, we investigated polygenic predisposition for OCS as predictive of OCS and cannabis use from age 17 to 19. We hypothesized that greater genetic risk for OCS would predict both OCS and cannabis use. METHODS The current study used participants from the Project Alliance 1 study, a US-based sample, for whom genomic, OCS, and cannabis use data were available (n = 547). Polygenic risk scores (PRS) were formed via a meta-genome-wide association study on OCS and examined as a predictor of OCS and cannabis use at age 17 and 19. The sample was diverse (52.4% male; 45% European American, 30% African American, 14% multiracial, 5% Hispanic/Latino, 4% Asian American, and 2% other groups). Sensitivity analysis was performed by gender for European American and African American subsamples. RESULTS Across the whole sample, the greater polygenic risk for OCS was negatively associated with cannabis use at age 17 and positively associated with OCS at 19. Cannabis use at age 17 was positively associated with OCS at age 19. The association between polygenic risk for OCS and cannabis use at age 17 was replicated in European American males, whereas the association between cannabis use at age 17 and OCS at age 19 was replicated in African American males. CONCLUSIONS Cannabis use may exacerbate OCS through adolescence, and genetic predisposition for OCS may be associated with lower cannabis use in efforts to avoid exacerbation of OCS.
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Affiliation(s)
- Jodi Kutzner
- Department of Applied Health Science, Indiana University, Bloomington, Indiana, USA
| | - Kit K. Elam
- Department of Applied Health Science, Indiana University, Bloomington, Indiana, USA
| | - Thao Ha
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
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36
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Macatee RJ, Preston TJ, Afshar K, Blaine SK, Schermitzler B. Temporal stability of neurophysiological drug cue reactivity before and after acute stress in cannabis users: A test of incentive sensitization. Drug Alcohol Depend 2023; 247:109862. [PMID: 37062250 DOI: 10.1016/j.drugalcdep.2023.109862] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/02/2023] [Accepted: 03/21/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Given increasing rates of Cannabis Use Disorder (CUD), objective measures are needed that can reliably index risk and track cannabis use progression. Based on incentive sensitization models, neurophysiological reactivity to cannabis cues, measured with the electroencephalography-recorded late positive potential (LPP), may be a candidate biomarker. To serve as such, the cannabis cue-elicited LPP must demonstrate adequate retest reliability and sensitivity to cannabis use change. Moreover, incentive sensitization theory suggests that state-level contextual variables, such as acute stress, can impact drug cue reactivity. Therefore, the present study evaluated the three-month retest reliability of the cannabis cue-elicited LPP, recorded before and after a laboratory stress induction, as well as its sensitivity to cannabis use change. METHOD Cannabis and neutral cue-elicited LPPs were measured in 102 adults reporting frequent cannabis use (86 % with current CUD) before and after an acute stress induction at two lab visits three-months apart. Physiological and subjective stress reactivity were also measured. RESULTS Manipulation checks confirmed expected cannabis cue and acute stress effects. Cannabis cue-elicited LPP amplitudes showed significant three-month retest reliability of poor-to-fair through moderate-to-good size. Change in cannabis use frequency significantly predicted change in cannabis cue-elicited LPP amplitudes, particularly at post-stress. CONCLUSION Consistent with incentive sensitization models of addiction, the cannabis cue-elicited LPP demonstrated trait-like, moderate three-month stability and responsivity to change in cannabis use behavior. Greater predictive validity of the post-stress LPP may arise through kindling effects of acute stress on incentive salience-related neural activity, which should be explored in future studies.
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Affiliation(s)
- Richard J Macatee
- Auburn University, Department of Psychological Sciences, 226 Thach Hall, Auburn, AL 36849, USA..
| | - Thomas J Preston
- Auburn University, Department of Psychological Sciences, 226 Thach Hall, Auburn, AL 36849, USA
| | - Kaveh Afshar
- Auburn University, Department of Psychological Sciences, 226 Thach Hall, Auburn, AL 36849, USA
| | - Sara K Blaine
- Auburn University, Department of Psychological Sciences, 226 Thach Hall, Auburn, AL 36849, USA
| | - Brandon Schermitzler
- Auburn University, Department of Psychological Sciences, 226 Thach Hall, Auburn, AL 36849, USA
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Wipfler K, Simon TA, Katz P, Wolfe F, Michaud K. Increase in Cannabis Use Among Adults With Rheumatic Diseases: Results From a 2014-2019 United States Observational Study. Arthritis Care Res (Hoboken) 2022; 74:2091-2099. [PMID: 34269524 DOI: 10.1002/acr.24752] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 06/25/2021] [Accepted: 07/13/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Despite advances in treatments and outcomes among patients with rheumatic diseases, there is an unmet need in pain management. Cannabis has emerged as a potential opioid-sparing alternative, with arthritic pain as a commonly cited reason for medicinal cannabis use. However, little is known, and we set out to understand patterns of cannabis use in a US-wide rheumatic disease population. METHODS The study included participants in FORWARD, The National Databank for Rheumatic Diseases. Participants were asked in 2014 and 2019 about their past and current cannabis use. Demographic characteristics, patient-reported outcomes, medications, comorbidities, and diagnoses were compared between cannabis users and non-users with t-tests, chi-square tests, logistic regression, and geographic assessment. RESULTS Among 11,006 respondents, cannabis use increased from 6.3% in 2014 to 18.4% in 2019, with the greatest prevalence of use in states where cannabis use was legalized. Most users (74% and 62% in 2014 and 2019, respectively) reported that cannabis was effective in the relief of arthritis symptoms. Cannabis users were more likely to be taking weak opioids (odds ratio 1.2 [95% confidence interval 1.0, 1.5], P = 0.03), to have a history of smoking tobacco (odds ratio 1.7 [95% confidence interval 1.5, 2.1], P < 0.001), and had worse measures on all assessed patient-reported outcomes. CONCLUSION Reported cannabis use in this cohort increased significantly between 2014 and 2019. Characteristics of users suggest that those who try cannabis are feeling worse symptomatically, and their pain management needs may not be adequately addressed by other therapies. The association between cannabis, opioids, and patient-reported outcomes highlight areas for future work.
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Affiliation(s)
- Kristin Wipfler
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | | | | | - Frederick Wolfe
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | - Kaleb Michaud
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, and University of Nebraska Medical Center, Omaha, Nebraska
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González-Ponce BM, Rojas-Tejada AJ, Carmona-Márquez J, Lozano-Rojas ÓM, Díaz-Batanero C, Fernández-Calderón F. Harm Reduction Strategies among University Students Who Use Alcohol and Cannabis, and Related Psychological Variables: A Systematic Review. J Psychoactive Drugs 2022; 54:403-418. [PMID: 35060424 DOI: 10.1080/02791072.2021.2023240] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 10/06/2021] [Accepted: 10/18/2021] [Indexed: 02/07/2023]
Abstract
This systematic review identifies the psychological variables associated with the use of harm reduction strategies (HRS) among university students who use alcohol or cannabis. The reviewed studies are categorized according to the psychological variables studied and the different analytic approaches used (direct effects, mediation, and moderation). Among the empirical peer-reviewed studies identified (n = 76), most (94.7%) were cross-sectional studies conducted in the US (90.8%) with samples of alcohol-using university students (86.8%). Five categories were identified: mental health, motives/expectancies, personality, social cognition, and self-efficacy. The most studied constructs were motives, anxiety and depression, impulsivity, and social norms. Most studies conducted mediation or moderation analyses including psychological variables, HRS and alcohol outcomes. Social, enhancement and coping motives, impulsivity, and social norms of alcohol use were associated with lower use of HRS, which, in turn, was associated with a higher number of alcohol/cannabis outcomes. The results of moderation studies consistently suggest that HRS use was more protective for students with poor mental health, high impulsivity, and low self-regulation. The synthesis of evidence provided in this review could be useful for guiding future research and informing the design of interventions aimed at promoting the use of HRS among university students who use alcohol and/or cannabis.
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Affiliation(s)
| | | | - José Carmona-Márquez
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Óscar M Lozano-Rojas
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Carmen Díaz-Batanero
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Fermín Fernández-Calderón
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
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Daneshmend AZB, Stewart J, Jarkas DA, Franklyn SI, Gabrys RL, Patterson ZR, Abizaid A, Hellemans KGC, McQuaid RJ. Examining Risk Factors in the Cannabis–Suicide Link: Considering Trauma and Impulsivity among University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159307. [PMID: 35954661 PMCID: PMC9368410 DOI: 10.3390/ijerph19159307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 02/07/2023]
Abstract
Cannabis is a commonly used substance among university students that may have several negative health repercussions, including suicidal ideation (SI) and suicide attempts (SA). The factors that contribute to or help explain this relation remain uncertain. Earlier negative experiences, especially trauma encountered during early life, have been associated with the development of psychopathology upon later stressor encounters. In the current study, we examined the associations between SI and SA with problematic cannabis use among young adults and the role of earlier trauma experiences and trait impulsiveness in understanding this link. Among university students (N = 539), problematic cannabis use was moderately related to lifetime and past-12-months suicidal ideation and attempts. Impulsiveness mediated the relationship between problematic cannabis use and lifetime SI and SA. Moreover, previous life trauma moderated the relationship between problematic cannabis use and SA, such that the association between problematic cannabis use and SA was stronger among those who experienced high levels of trauma. These findings highlight behavioral and environmental factors that could predict suicide ideation and attempts among young cannabis users. Accordingly, trait impulsiveness and early trauma experiences should be considered, alongside problematic cannabis use, in suicide-risk detection and prevention strategies among young adults.
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Affiliation(s)
- Ayeila Z. B. Daneshmend
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada; (D.A.J.); (R.L.G.); (Z.R.P.); (A.A.); (K.G.C.H.); (R.J.M.)
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, ON K1Z 7K4, Canada
- Correspondence:
| | - Jayme Stewart
- Department of Psychology, Carleton University, Ottawa, ON KIS 5B6, Canada; (J.S.); (S.I.F.)
| | - Dana A. Jarkas
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada; (D.A.J.); (R.L.G.); (Z.R.P.); (A.A.); (K.G.C.H.); (R.J.M.)
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, ON K1Z 7K4, Canada
| | - Sabina I. Franklyn
- Department of Psychology, Carleton University, Ottawa, ON KIS 5B6, Canada; (J.S.); (S.I.F.)
| | - Robert L. Gabrys
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada; (D.A.J.); (R.L.G.); (Z.R.P.); (A.A.); (K.G.C.H.); (R.J.M.)
| | - Zachary R. Patterson
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada; (D.A.J.); (R.L.G.); (Z.R.P.); (A.A.); (K.G.C.H.); (R.J.M.)
| | - Alfonso Abizaid
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada; (D.A.J.); (R.L.G.); (Z.R.P.); (A.A.); (K.G.C.H.); (R.J.M.)
| | - Kim G. C. Hellemans
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada; (D.A.J.); (R.L.G.); (Z.R.P.); (A.A.); (K.G.C.H.); (R.J.M.)
| | - Robyn J. McQuaid
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada; (D.A.J.); (R.L.G.); (Z.R.P.); (A.A.); (K.G.C.H.); (R.J.M.)
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, ON K1Z 7K4, Canada
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Goodwin RD, Sun MX, Cheslack-Postava K. Everything old is new again: Creating and maintaining a population-level 'shared reality' of health risks associated with cigarette use toward both reducing the prevalence and eliminating disparities in cigarette use among all Americans. NICOTINE & TOBACCO RESEARCH : OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON NICOTINE AND TOBACCO 2022; 24:1521-1522. [PMID: 35896040 DOI: 10.1093/ntr/ntac177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Meng Xi Sun
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Keely Cheslack-Postava
- New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Weinberger AH, Wyka K, Kim JH, Smart R, Mangold M, Schanzer E, Wu M, Goodwin RD. A difference-in-difference approach to examining the impact of cannabis legalization on disparities in the use of cigarettes and cannabis in the United States, 2004-17. Addiction 2022; 117:1768-1777. [PMID: 34985165 DOI: 10.1111/add.15795] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022]
Abstract
AIMS To estimate the impact of recreational and medical cannabis laws (RCL, MCL) on the use of cannabis and cigarettes in the United States. DESIGN A difference-in-difference approach was applied to data from the 2004-17 National Survey on Drug Use and Health (NSDUH). SETTING United States. PARTICIPANTS Nationally representative cross-sectional survey of Americans aged 12 years and older (combined analytical sample for 2004-17, n = 783 663). MEASUREMENTS Data on past-month use of (1) cigarettes and (2) cannabis were used to classify respondents into four groups: cigarette and cannabis co-use, cigarette-only use, cannabis-only use or no cigarette or cannabis use. State of residence was measured by self-report. MCL/RCL status came from state government websites. FINDINGS Difference-in-difference analyses suggest that MCL was associated with an increase in cigarette-cannabis co-use overall [adjusted odds ratio (aOR) = 1.09; 95% confidence interval (CI) = 1.02-1.16], with the greatest increases among those aged 50 years and above (aOR = 1.60; CI = 1.39-1.84), married (aOR = 1.19; CI = 1.07-1.31), non-Hispanic (NH) black (aOR = 1.14; CI = 1.02-1.07) and with a college degree or above (aOR = 1.15; CI = 1.06-1.24). MCL was associated with increases in cigarette-only use among those aged 50 years and above (aOR = 1.07; CI = 1.01-1.14) and NH black (aOR = 1.16; CI = 1.06-1.27) and increases in cannabis-only use among those aged 50 years and above (aOR = 1.24; CI = 1.07-1.44) and widowed/divorced/separated (aOR = 1.18; CI = 1.01-1.37). RCL was associated with an increase in cannabis-only use overall (aOR = 1.21; 95% CI = 1.09-1.34), a decline in cigarette-only use overall (aOR = 0.89; 95% CI = 0.81-0.97) and increases in co-use among those who were married (aOR = 1.24; CI = 1.02-1.50) and aged 50 years and above (aOR = 1.37; CI = 1.03-1.84). CONCLUSIONS Recreational and medical cannabis legalization have had a varying impact on the use, and co-use, of cannabis and cigarettes in the United States.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.,Department of Epidemiology and Population Health, Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA
| | - Katarzyna Wyka
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
| | - June H Kim
- Institute for Implementation Science in Population Health, The City University of New York, New York, NY, USA
| | | | - Michael Mangold
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Ellen Schanzer
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Melody Wu
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Kuhns L, Kroon E, Colyer-Patel K, Cousijn J. Associations between cannabis use, cannabis use disorder, and mood disorders: longitudinal, genetic, and neurocognitive evidence. Psychopharmacology (Berl) 2022; 239:1231-1249. [PMID: 34741634 PMCID: PMC9520129 DOI: 10.1007/s00213-021-06001-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 10/11/2021] [Indexed: 12/16/2022]
Abstract
RATIONALE Cannabis use among people with mood disorders increased in recent years. While comorbidity between cannabis use, cannabis use disorder (CUD), and mood disorders is high, the underlying mechanisms remain unclear. OBJECTIVES We aimed to evaluate (1) the epidemiological evidence for an association between cannabis use, CUD, and mood disorders; (2) prospective longitudinal, genetic, and neurocognitive evidence of underlying mechanisms; and (3) prognosis and treatment options for individuals with CUD and mood disorders. METHODS Narrative review of existing literature is identified through PubMed searches, reviews, and meta-analyses. Evidence was reviewed separately for depression, bipolar disorder, and suicide. RESULTS Current evidence is limited and mixed but suggestive of a bidirectional relationship between cannabis use, CUD, and the onset of depression. The evidence more consistently points to cannabis use preceding onset of bipolar disorder. Shared neurocognitive mechanisms and underlying genetic and environmental risk factors appear to explain part of the association. However, cannabis use itself may also influence the development of mood disorders, while others may initiate cannabis use to self-medicate symptoms. Comorbid cannabis use and CUD are associated with worse prognosis for depression and bipolar disorder including increased suicidal behaviors. Evidence for targeted treatments is limited. CONCLUSIONS The current evidence base is limited by the lack of well-controlled prospective longitudinal studies and clinical studies including comorbid individuals. Future studies in humans examining the causal pathways and potential mechanisms of the association between cannabis use, CUD, and mood disorder comorbidity are crucial for optimizing harm reduction and treatment strategies.
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Affiliation(s)
- Lauren Kuhns
- Department of Psychology, Neuroscience of Addiction (NofA, University of Amsterdam, Amsterdam, the Netherlands.
- The Amsterdam Brain and Cognition Center (ABC), University of Amsterdam, Amsterdam, the Netherlands.
| | - Emese Kroon
- Department of Psychology, Neuroscience of Addiction (NofA, University of Amsterdam, Amsterdam, the Netherlands
- The Amsterdam Brain and Cognition Center (ABC), University of Amsterdam, Amsterdam, the Netherlands
| | - Karis Colyer-Patel
- Department of Psychology, Neuroscience of Addiction (NofA, University of Amsterdam, Amsterdam, the Netherlands
| | - Janna Cousijn
- Department of Psychology, Neuroscience of Addiction (NofA, University of Amsterdam, Amsterdam, the Netherlands
- The Amsterdam Brain and Cognition Center (ABC), University of Amsterdam, Amsterdam, the Netherlands
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Wang N, Yao T, Sung HY, Max W. The Association of Cannabis Use and Cigarette Smoking with Psychological Distress Among Adults in California. Subst Use Misuse 2022; 57:193-201. [PMID: 34753379 DOI: 10.1080/10826084.2021.1995758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In November 2016, California voters passed the Adult Use of Marijuana Act making recreational cannabis sales legal to adults aged 21and older starting January 1st, 2018. This study aims to understand the relationship of cannabis use and cigarette smoking with serious psychological distress (SPD) in California in light of the legalization of recreational cannabis sales. METHODS This cross-sectional study included 42,313 adult participants from the 2017 to 2018 California Health Interview Surveys. We used the Kessler-6 (K6) scale to measure psychological distress in the past 30 days. Multiple logistic regression models were used to examine the association between cannabis/cigarette use and SPD. RESULTS Cannabis use was positively associated with SPD (AOR = 2.48, 95% CI = 1.57, 3.91), but this association was not significantly different before and after recreational cannabis sales legalization in California (AOR = 0.82, 95% CI = 0.72, 2.05). Cigarette smoking was also positively associated with SPD (AOR = 2.76, 95% CI = 2.05, 3.71). Compared to those who used neither cannabis nor cigarettes, sole cannabis users (AOR = 2.51, 95% CI = 1.75, 3.60), sole cigarette smokers (AOR = 3.23, 95% CI = 2.28, 4.60), and dual users of cannabis and cigarettes (AOR = 5.65, 95% CI = 4.04, 7.89) were more likely to report SPD. Dual users were also more likely to report SPD than sole cannabis users (AOR = 2.25; 95% CI = 1.48, 3.43) and sole cigarette smokers (AOR = 1.75; 95% CI = 1.18, 2.59). CONCLUSIONS These findings provide evidence for the need to develop effective cessation intervention strategies targeting individuals with SPD to reduce their cannabis use and dual-use of cannabis and cigarettes.
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Affiliation(s)
- Nan Wang
- Department of Public Health Sciences, School of Medicine, University of California, Davis, California, USA
| | - Tingting Yao
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, California, USA.,Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| | - Hai-Yen Sung
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, California, USA.,Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| | - Wendy Max
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, California, USA.,Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
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Obuobi-Donkor G, Eboreime E, Shalaby R, Agyapong B, Agyapong VIO. Prevalence and correlates of cannabis abuse among residents in the community of Fort McMurray, a city in Northern Alberta which had endured multiple natural disasters. Front Psychiatry 2022; 13:962169. [PMID: 36213902 PMCID: PMC9533067 DOI: 10.3389/fpsyt.2022.962169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cannabis is one of the widely used drugs for relaxation and may be abuse among users. Researchers have given attention to cannabis use among the general population while vulnerable populations who have experience multiple traumas may be at risk of cannabis abuse. Other factors may influence cannabis abuse among people exposed to traumas. OBJECTIVE The study aims to determine the prevalence and correlates of self-reported cannabis abuse among residents of Fort McMurray, a city in Northern Alberta, Canada. METHODS A cross-sectional survey was conducted using an online questionnaire. Sociodemographic data, trauma exposure, and clinical characteristics were collected to identify the possible risk factor of cannabis abuse. Data were analyzed with SPSS version 25 using a chi-square test and binary logistic regression analysis. Correlation analysis was also performed to ascertain likely cannabis abuse and the association with other mental health conditions. RESULTS Overall, participants who completed the survey were one hundred and eighty-sixed out of the two hundred and forty-nine residents who accessed the online survey, giving a response rate of 74.7%. The prevalence of self-reported cannabis abuse among participants was 14%. Most of the participants were females (159, 85.5%), more than 40 years of age (98, 52.7%), employed (175, 94.1%), owned their house (145, 78.0%), and 103 (60.6%) reported being exposed to at least a trauma (COVID-19, flooding, or wildfire). Regarding regression analysis results, participants living in a rented accommodation were nearly four times more likely to abuse cannabis (OR = 3.86; 95% CI: 1.34-11.14) than those owning their houses. Similarly, male participants were more than 6-folds more likely to abuse cannabis than the female gender (OR= 6.25; 95% CI: 1.89-20), and participants in a relationship were six times more likely to abuse cannabis than participants not in a relationship (OR = 6.33; 95% CI: 1.67-24.39). The study also found significant association of depressive symptoms (X 2 = 4.561; p = 0.033) and anxiety symptoms (X 2 = 4.700; p = 0.030) with likely cannabis abuse. CONCLUSION Demographic factors significantly predicted likely cannabis abuse in the Fort McMurray population, and cannabis abuse significantly correlated with presence of moderate to high anxiety and depression symptoms. It is essential to mobilized resources to support vulnerable communities and manage cannabis abuse.
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Affiliation(s)
| | - Ejemai Eboreime
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.,Global Psychological E-Health Foundation, Edmonton, AB, Canada
| | - Vincent I O Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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Streck JM, Regan S, Bearnot B, Gupta PS, Kalkhoran S, Kalagher KM, Wakeman S, Rigotti NA. Prevalence of Cannabis Use and Cannabis Route of Administration among Massachusetts Adults in Buprenorphine Treatment for Opioid Use Disorder. Subst Use Misuse 2022; 57:1104-1110. [PMID: 35410577 PMCID: PMC10091221 DOI: 10.1080/10826084.2022.2063899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Recent prevalence estimates of cannabis use among individuals receiving medication treatment for OUD (MOUD) are lacking, and no study has characterized cannabis route of administration (cROA) in this population. These knowledge gaps are relevant because cannabis' effects and health outcomes vary by cROA and the availability and perceptions of cROA (e.g., vaping devices) are changing. METHODS The Vaping In Buprenorphine-treated patients Evaluation (VIBE) cross-sectional survey assessed the prevalence and correlates of cannabis use and cROA among adults receiving buprenorphine MOUD from 02/20 to 07/20 at five community health centers in Massachusetts, a state with legal recreational and medical cannabis use. RESULTS Among the 92/222 (41%) respondents reporting past 30-day cannabis use, smoking was the most common cROA (75%), followed by vaping (38%), and eating (26%). Smoking was more often used as a single cROA vs. in combination others (p = 0.01), whereas vaping, eating, and dabbing were more often used in combination with another cROA (all p < 0.05). Of the 39% of participants reporting multiple cROA, smoking and vaping (61%), and smoking and eating (50%), were the most prevalent combinations. Nonwhite race (vs. white) and current cigarette smoking (vs. no nicotine use) were associated with past 30-day cannabis use in multiple logistic regression. CONCLUSIONS Prevalence of past 30-day cannabis use among individuals receiving buprenorphine MOUD in Massachusetts in 2020 was nearly double the prevalence of cannabis use in Massachusetts' adult general population in 2019 (21%). Our data are consistent with state and national data showing smoking as the most common cROA.
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Affiliation(s)
- Joanna M Streck
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Regan
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin Bearnot
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Priya S Gupta
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Kalkhoran
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Kelly M Kalagher
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah Wakeman
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Substance use disorders among adults who are deaf or hard of hearing in the United States. Drug Alcohol Depend 2021; 228:109106. [PMID: 34610517 DOI: 10.1016/j.drugalcdep.2021.109106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/31/2021] [Accepted: 09/22/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND There has been limited research on substance use disorders (SUDs) among individuals who are deaf or hard of hearing (DHH). This study explored associations among activities of daily living, instrumental activities of daily living, major depressive episode, risk perceptions for substance use, religiosity, and past-year SUDs within the DHH population. METHODS Data was drawn from the 2015-2019 National Survey on Drug Use and Health (N = 214,505) to compare rates of past-year SUDs between DHH (weighted % = 5.4) and non-DHH populations. SUD measures included were past-year alcohol, marijuana, pain reliever, and illicit drug use disorders. RESULTS SUDs are more prevalent among the DHH population than the non-DHH population. When adjusted for sociodemographic variables, DHH adults were more likely to report experiencing all four types of measured SUDs. Significant associations were also found between all four measured SUDs and disability status, major depressive episodes, and perception of risk. An association between regular religious service attendance and alcohol, marijuana, or illicit drug use disorders was also identified, as well as an association between peer religiosity and marijuana use disorders. CONCLUSION Given the high prevalence of SUDs and limited understanding of the mechanisms associated with the SUDs within the DHH population, more research is needed to address these issues.
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Perlman AI, McLeod HM, Ventresca EC, Salinas MG, Post PJ, Schuh MJ, Abu Dabrh AM. Medical Cannabis State and Federal Regulations: Implications for United States Health Care Entities. Mayo Clin Proc 2021; 96:2671-2681. [PMID: 34607636 DOI: 10.1016/j.mayocp.2021.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/16/2021] [Accepted: 05/11/2021] [Indexed: 10/20/2022]
Abstract
Thirty-six states and four territories in the United States have legalized cannabis for medical and/or recreational use. Marijuana, however, continues to be classified as a schedule I substance under the Federal Controlled Substance Act and remains illegal under US federal law. The incongruity between state and federal legislation creates various challenges for stakeholders: patients, medical trainees, providers, and health care institutions. This communication provides an overview of the major policies impacting Cannabis sativa use within the United States, various state and federal regulations, and highlights potential implications for health care institutions moving forward. Existing literature, regulations, and policies on medical marijuana (MMJ) use in health care settings were searched, reviewed, analyzed, and distilled. As a consequence of legislative inconsistencies, there is insufficient clarity and resultant challenges regarding MMJ usage, prescription, possession, education, and research-related policies for health care stakeholders across the United States. Coupled with limited scientific evidence on the clinical efficacy of MMJ, the needs of the patient and the quality of health care delivery may be affected as hospitals balance the competing risks of being legislatively compliant while protecting the rights of patients and health care employees. There is a recognized need to better define acceptable MMJ policies and regulations in health care settings that are evidence-based, legally compliant, and adequately address the needs of both patients and providers. Given the complexity of the legal and policy landscape, there are potential opportunities for improvement, including in medical education and training, research, and usage oversight of MMJ for stakeholders in the United States.
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Affiliation(s)
- Adam I Perlman
- Department of Integrative Health, Mayo Clinic, Jacksonville, FL.
| | - Heidi M McLeod
- Department of Integrative Health, Mayo Clinic, Jacksonville, FL
| | | | | | - Peter J Post
- Department of Pharmacy, Mayo Clinic, Rochester, NY
| | - Michael J Schuh
- Department of Family Medicine and Palliative Medicine and Pharmacy, Mayo Clinic, Jacksonville, FL
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Hindocha C, Brose LS, Walsh H, Cheeseman H. Cannabis use and co-use in tobacco smokers and non-smokers: prevalence and associations with mental health in a cross-sectional, nationally representative sample of adults in Great Britain, 2020. Addiction 2021; 116:2209-2219. [PMID: 33345423 DOI: 10.1111/add.15381] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/05/2020] [Accepted: 12/09/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS In Great Britain, cannabis and tobacco are commonly used substances, both independently and together. Use of either substance is associated with mental health problems, but prevalence of co-use within these populations is unknown. We aimed to (1) estimate prevalence of cannabis use, frequency of use and routes of administration (ROA) among tobacco smokers and non-smokers and (2) investigate mental health problems among non-users, tobacco-only, cannabis-only and co-users of both substances. DESIGN Cross-sectional national on-line survey (Action on Smoking and Health) fielded in February-March 2020. SETTING Great Britain. PARTICIPANTS Adults in Great Britain aged ≥ 18 years (n = 12 809) MEASUREMENTS: Tobacco use status [smoker (daily or non-daily) or non-smoker (never or ex-smoker)], cannabis use frequency (never to daily), detailed ROAs of cannabis, self-reported treatment for mental health disorders (depression, anxiety and any). Statistically weighted prevalence estimates were computed to ensure representativeness. Correlates were assessed using χ2 tests and logistic regression. FINDINGS In Great Britain in 2020, 7.1% of the sample had used cannabis in the past year. Tobacco smokers had greater odds of using cannabis in the past year (21.9%) and using cannabis daily (8.7%) than non-smokers [past-year: 4.7%; adjusted odds ratio (aOR) = 10.07, 95% confidence interval (CI) = 8.4-12.0; daily: 0.7%; aOR = 24.6, 95% CI = 18.0-33.6)]. Co-administration with tobacco was common (46.2% of non-smokers, 80.8% of tobacco smokers). Co-users reported the highest prevalence of any treatment for mental health problems (54.2%) in comparison to cannabis-only (45.8%), tobacco-only (33.2%) and non-users (22.7%; all P ≤ 0.05). CONCLUSION Approximately one in 13 adults in Great Britain reports having used cannabis in the past year, approximately four times as many among cigarette smokers as non-smokers. Co-administration of cannabis and tobacco, via smoking, appears to be common, including among self-identified non-smokers. Mental health problems appear to be particularly common among dual users.
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Affiliation(s)
- Chandni Hindocha
- Clinical Psychopharmacology Unit, Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK.,University College Hospital National Institute of Health Research (NIHR) Biomedical Research Centre, London, UK
| | - Leonie S Brose
- National Addictions Centre, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), Kings' College London, London, UK.,SPECTRUM Consortium, London, UK
| | - Hannah Walsh
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings' College London, London, UK
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Han BH, Funk-White M, Ko R, Al-Rousan T, Palamar JJ. Decreasing perceived risk associated with regular cannabis use among older adults in the United States from 2015 to 2019. J Am Geriatr Soc 2021; 69:2591-2597. [PMID: 34037250 DOI: 10.1111/jgs.17213] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/21/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND/OBJECTIVES Cannabis use among older adults is increasing sharply in the United States. While the risks and benefits of cannabis use remain unclear, it is important to monitor risk factors for use, including low perception of harm. The objective of this study was to estimate recent national trends in perceived risk associated with cannabis use among older adults. DESIGN Trend analysis. SETTING/PARTICIPANTS A total of 18,794 adults aged 65 and older participating in the 2015-2019 National Survey on Drug Use and Health, a cross-sectional nationally representative survey of non-institutionalized individuals in the United States. MEASUREMENTS We estimated the prevalence of older adults who believe that people who smoke cannabis once or twice a week are at great risk of harming themselves physically and in other ways. This was examined across cohort years and stratified by demographic characteristics, diagnosis of chronic disease, past-month tobacco and binge alcohol use, and all-cause emergency department use. RESULTS Between 2015 and 2019, perceived risk associated with regular use decreased from 52.6% to 42.7%, an 18.8% relative decrease (p < 0.001). Decreases in perceived risk were detected in particular among those never married (a 32.6% relative decrease), those who binge drink (a 31.3% relative decrease), use tobacco (a 26.8% relative decrease), have kidney disease (a 32.1% relative decrease), asthma (a 31.7% relative decrease), heart disease (a 16.5% relative decrease), chronic obstructive pulmonary disease (a 21.5% relative decrease), two or more chronic conditions (a 20.2% relative decrease), and among those reporting past-year emergency department use (a 21.0% relative decrease) (ps < 0.05). CONCLUSIONS The perceived risk of regular cannabis use is decreasing among older adults. We detected sharp decreases in risk perception among those with chronic disease and high-risk behaviors, including tobacco and binge alcohol use. As the number of older adults who use cannabis increases, efforts are needed to raise awareness of the possible adverse effects with special emphasis on vulnerable groups.
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Affiliation(s)
- Benjamin H Han
- Division of Geriatrics, Gerontology, and Palliative Care, University of California, San Diego School of Medicine, La Jolla, California, USA
| | - Makaya Funk-White
- Division of Geriatrics, Gerontology, and Palliative Care, University of California, San Diego School of Medicine, La Jolla, California, USA
| | - Roxanne Ko
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, USA
| | - Joseph J Palamar
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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50
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Hasin D, Walsh C. Trends over time in adult cannabis use: A review of recent findings. Curr Opin Psychol 2021; 38:80-85. [PMID: 33873044 PMCID: PMC8905582 DOI: 10.1016/j.copsyc.2021.03.005] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 01/06/2023]
Abstract
In the United States, policies regarding the medical and nonmedical use of cannabis are changing rapidly. In 2021, a total of 34 US states have legalized cannabis for adult medical use, and 15 of these states have legalized adult non-medical use. These changing policies have raised questions about increasing prevalences of cannabis use, changing perceptions regarding frequent use, and potentially related outcomes such as comorbid psychiatric illness or driving under the influence of cannabis. Research regarding the correlates of any and frequent cannabis use is also developing quickly. This article reviews recent empirical studies concerning (1) adult trends in cannabis use, (2) state cannabis laws and related outcomes, and (3) emerging evidence regarding how the global coronavirus 19 pandemic may impact cannabis use patterns. We summarize recent findings and conclude with suggestions to address unanticipated effects of rapidly changing cannabis laws and policies.
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Affiliation(s)
- Deborah Hasin
- New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Claire Walsh
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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