Demographic, Cannabis Use, and Depressive Correlates of Cannabis Use Consequences in Regular Cannabis Users

Extending Gender- and Sex-Based Analyses in Cannabis Research: Findings from an Online Sample of Gender Diverse Young Adult Consumers

Background: Gender and sex can influence cannabis behaviors and consequences (Cannabis Use Disorder [CUD]). Research typically examines sex and gender independently. Gender analyses often exclude transgender and gender diverse (TGD) populations. The objectives of this study were to (a) replicate less frequent cannabis use among TGD young adults compared to cisgender counterparts (b) compare severity of CUD, and (c) examine the role of sex on cannabis outcomes. Method: Online survey participants between 18 and 34 (N=1213) from the United States who reported past-week cannabis consumption provided information on cannabis practices and CUD from February to April 2022. Bivariate analyses explored gender differences across frequency (daily frequency across routes of administration [ROAs]; daily use of 2+ ROAs, use throughout the day) and CUD. Adjusted regression models provided model-estimated marginal probabilities and means to examine differences across four gender-by-sex categories (cisgender men: n=385; cisgender women: n=681; male-at-birth TGD: n=26; female-at-birth TGD: n=121). Benjamini-Hochberg adjustments (10% false discovery rate) were applied. Results: Among past-week consumers, female-at-birth TGD participants demonstrated lower probability of daily flower smoking compared to cisgender men (0.54 vs. 0.67). Cisgender men reported greater probability of daily concentrate vaping (0.55) compared to cisgender women (0.45) and female-at-birth TGD participants (0.27); they were also more likely to report daily use of 2+ ROAs (cisgender men: 0.51 vs. cisgender women: 0.39 and female at-birth TGD: 0.27). TGD participants reported greater CUD severity compared to cisgender counterparts, t(1096)=-3.69, p=0.002. Model-estimated means found lower severity among cisgender women compared to cisgender men and female-at-birth TGD participants. Stratified regression models support positive associations between daily cannabis use and CUD in both TGD in cisgender groups. Among cisgender participants, greater severity was predicted by male sex, younger age, and younger age of onset. Conclusions: The present study replicates and extends a prior finding that among past-week cannabis consumers, TGD young adults report less frequent use than cisgender counterparts. Despite this, TGD participants demonstrated greater severity of CUD. While analyses were limited by the small sample of male-at-birth TGD participants, the article highlights the importance of expanding sex- and gender-focused analyses. Future work is expanding efforts to target hard-to-reach consumers.

Patterns of Use and Withdrawal Syndrome in Dual Cannabis and Tobacco Users (DuCATA_GAM-CAT): Protocol for a Mixed Methods Study

BACKGROUND

Approximately 1 in 6 cannabis users develop a cannabis use disorder (CUD) and the odds increase to 1 in 2 for daily users.

OBJECTIVE

The Dual use of Cannabis and Tobacco Monitoreing through a Gamified Web app (DuCATA_GAM-CaT) project aims to identify cannabis-tobacco patterns of use and withdrawal symptoms among individuals with CUD who are attending substance abuse programs.

METHODS

The project uses a mixed methods approach consisting of 3 studies. First, a participatory qualitative study involves focus groups comprising individuals with CUD, clinicians, project researchers, and an expert gamification company to co-design a gamified web app. Second, a longitudinal prospective study to follow up individuals over 6 weeks with CUD attending substance abuse programs . Participants report their cannabis-tobacco usage patterns, type and frequency of tobacco use, nicotine dependence, withdrawal symptoms, psychoemotional factors, and motivation to quit both substances. Predictive analysis techniques are used to analyze clinical, demographic, psychological, and environmental data to predict the probability of achieving abstinence. Third, homogeneous focus groups to explore participants' experiences during their CUD treatment.

RESULTS

By June 2024, the project had completed the first study, defining eligible cannabis user profiles, developed the initial web app prototype, and initiated recruitment across 10 centers, with 74 participants enrolled, aiming to reach 150 participants in total.

CONCLUSIONS

All participants are required to provide informed consent, and their information is kept confidential and anonymized following confidentiality rules. The research team is committed to disseminating the results obtained to professional and patient groups, as well as informing public health agents, to positively influence political and social decision makers and design programmers. Additionally, we aim to prioritize the publication of the results in high-impact journals specialized in drug abuse, public health, and health care services research.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05512091; https://clinicaltrials.gov/study/NCT05512091.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/58335.

Exploring the intersection of sexual identity and route of administration in relation to cannabis use among young adult females

BACKGROUND AND OBJECTIVE

Rates of cannabis use continue to increase with sexual minority women (SMW) reporting greater use than heterosexual women. Along with these increasing trends, the routes of administration (ROA) for cannabis are evolving. The current study examined associations between cannabis ROA and frequency of use, as well as differences across sexual identity (heterosexual vs. SMW).

METHODS

Participants were 949 young adult (18-25 years old) women (29.8% SMW) who reported past month cannabis use and were recruited through Amazon Mechanical Turk. Number of cannabis use days and each ROA used (joint, pipe, blunt, bong, vape, edible, and ointment) in the past 30 days were measured. Analysis of covariance models examined if sexual identity moderated the association between each ROA and cannabis use frequency.

RESULTS

Among the full sample, joints were the most common ROA (78.6%); cannabis vaping was the most common noncombustible ROA (25.9%). SMW were more likely than heterosexual women to use each ROA except for joints. SMW who used pipes or edibles reported greater cannabis use frequency, compared to those who did not; there were no differences in frequency of use across ROA for heterosexual women.

DISCUSSION AND CONCLUSIONS

SMW may use a greater variety of ROA, potentially increasing the harms associated with cannabis. Marketing strategies targeting the sexual minority community may increase the likelihood of using various cannabis ROA and subsequent use.

SCIENTIFIC SIGNIFICANCE

Findings further our knowledge about how young adult women are using cannabis, and highlight how ROA may contribute to the disparities observed among SMW.

Should Marijuana Be Legalized: A Scoping Review of Associations of Marijuana and Depression

People with addiction to marijuana and those who have ever consumed marijuana at any time during their life suffer from depression at some point in their life. Depression has been associated with substance use as both a trigger and repercussion. A total of 3663 articles were analyzed, and 26 articles were collectively selected for this study. Consuming marijuana was linked to the development of depression in the majority of individuals. Marijuana consumption and its repercussions have both been connected to negative effects on the body, such as respiratory disorders and even psychological disorders, including stress and depressive disorders. Studies potentially point to a complicated causal relationship between marijuana consumption and depressive disorder, stating that early depressive symptoms enable marijuana usage, which then reduces depression. A research article clearly states that consuming marijuana can be helpful in elevating mood and anxiolytic initially, but it is subsequently followed by a rise in depressive symptoms, which manifest as mental distress and frustration. Discussions with patients about the extent of their marijuana consumption, techniques for reducing the use, and the impact of marijuana on depression may be beneficial in medical facilities where depressive disorder is treated. This research paper highlights the importance of understanding depression and the use of marijuana for temporary relief from depressive symptoms and its long-term consequences on mental health.

A Scoping Review of Risk and Protective Factors for Negative Cannabis Use Consequences

Objective

Numerous reviews have examined risk and protective factors for alcohol-related negative consequences, but no equivalent review of risk and protective factors exists for cannabis-related negative consequences (CRNCs)-a gap filled by the present study. This scoping review examined survey-based research of risk and protective factors for CRNCs such as neglecting responsibilities, blacking out, or needing more cannabis.

Methods

Three databases (PubMed, PsycINFO, and Google Scholar) were searched for peer-reviewed manuscripts published between January 1, 1990, and December 31, 2021. A qualitative synthesis was performed using the matrix method and the results were organized using the socioecological model as a framework.

Results

Eighty-three studies were included in the review. There was considerable variation in measures and operationalizations of CRNCs across studies. Risk factors were identified in the intrapersonal (depression, social anxiety, PTSD, impulsivity, sensation seeking, motives, expectancies), interpersonal/community (trauma, victimization, family and peer substance use, social norms), and social/policy (education, employment, community attachment, legalization, availability of substances) domains of influence. Protective behavioral strategies were a robust protective factor for CRNCs. Males consistently reported more CRNCs than females, but there were no differences observed across race.

Conclusions

Future research should identify person- and product-specific patterns of CRNCs to refine theoretical models of cannabis misuse and addiction. Public health interventions to reduce the risk of negative consequences from cannabis should consider utilizing multilevel interventions to attenuate the cumulative risk from a combination of psychological, contextual, and social influences.

Impacts of recreational cannabis legalization on use and harms: A narrative review of sex/gender differences

Legalization of cannabis use for non-medical (recreational) purposes is changing the global cannabis landscape. As attitudes toward cannabis use become more positive and prevalence of use increases in complex ways, concerns emerge about the potential for increased cannabis-attributable harms. Understanding the who, why, and when of this likely increase in cannabis-attributable harms is thus an important public health priority. Both sex and gender contribute to variability in the use, effects, and harms of cannabis and thus sex/gender considerations are important when evaluating the impacts of cannabis legalization. The goal of this narrative review is to broadly discuss sex/gender differences in attitudes toward and prevalence of cannabis use, whether there are sex/gender differences in the impacts of cannabis legalization, and why these sex/gender differences might exist. One of our strongest conclusions is that men have always been more likely to use cannabis than women, yet the sex/gender gap in prevalence of cannabis use has narrowed over time, and this might be partly due to cannabis legalization. The existing evidence suggests that there have also been sex/gender differences in the impacts of legalization on cannabis-attributable harms such as cannabis-involved motor vehicle collisions and hospitalizations, though these results are more variable. The body of literature reviewed has focused almost exclusively on samples of cisgender research participants, and thus future research should encourage inclusion of transgender and gender-diverse participants. More consideration of sex- and gender-based analysis in research evaluating long-term impacts of cannabis legalization is a clear research priority.

Cannabis Practices Among a Gender-Diverse Sample of Young Adults

Background

Gender is an important factor in understanding cannabis patterns, yet few studies have explored cannabis patterns among gender minority (GM) individuals - particularly among high-risk age groups including young adults. The evolving cannabis market is reshaping typical patterns of cannabis use in the U.S. The combination of these factors warrants increased efforts to examine cannabis practices in gender-diverse samples.

Methods

Online survey participants between 18-34 years (N=2377) from the U.S. provided information on cannabis practices from May - July 2021. Gender differences across several cannabis outcomes (onset, methods of consumption, product potency, frequency, and quantity) were assessed. Bivariate tests and multiple regression models examined associations between gender (cisgender men: n=1020; cisgender women: n=1178; and GM: n=179) and cannabis outcomes adjusting for sociodemographic characteristics.

Results

In regression models adjusted for sociodemographic characteristics, GM identity was associated with later age of onset and lower likelihood of daily use compared to cisgender men and women. Identifying as GM or cisgender woman was associated with fewer lifetime methods of consumption and lower plant and concentrate potency usage.

Conclusions

Findings provide initial insights into potential gender differences in cannabis practices from a sample of heavy cannabis users. GM young adults report use patterns indicative of lower risk compared to cisgender men and women in our sample. Future investigations of gender differences in cannabis use that explore specific gender minority categories and that include alternative sampling strategies are needed to better understand differential risks associated with gender.

Abstinence phobia among adult African American/Black cannabis users

OBJECTIVE

African American/Black individuals experience significant health disparities, particularly as it relates to cannabis use. As such, there is a need to identify intrapersonal factors related to more severe patterns of use among this subpopulation. Worry about quitting or reducing cannabis as a result of the anticipated anxiety-related states during deprivation (i.e., abstinence phobia) is one factor that is theoretically important in the context of cannabis-related disparities.

METHOD

The current study sought to examine the cross-sectional association between abstinence phobia and cannabis use problems, perceived barriers for cannabis cessation, and cannabis withdrawal symptoms. Participants included 83 African American/Black cannabis users (31.3% female, M_age = 38.12, SD = 10.42).

RESULTS

Cannabis abstinence phobia was associated with greater severity of cannabis use problems, more perceived barriers for quitting cannabis use, and more severe cannabis withdrawal symptoms.

CONCLUSIONS

Abstinence phobia may represent an underrecognized intervention target for addressing cannabis use problems and quit success.

Correlates of cannabis use disorder in the United States: A comparison of logistic regression, classification trees, and random forests

Although several recent studies have examined psychosocial and demographic correlates of cannabis use disorder (CUD) in adults, few, if any, recent studies have evaluated the performance of machine learning methods relative to standard logistic regression for identifying correlates of CUD. The present study used pooled data from the 2015-2018 National Survey on Drug Use and Health to evaluate psychosocial and demographic correlates of CUD in adults. In addition, we compared the performance of logistic regression, classification trees, and random forest methods in classifying CUD. When comparing the performance of each method on the test data set, classification trees (AUC = 0.84, 95%CI: 0.82, 0.85) and random forest (AUC = 0.83, 95%CI: 0.82, 8.05) performed similarly and superior to logistic regression (AUC = 0.77, 95%CI: 0.74, 0.79). Results of the random forests reveal that marital status, risk propensity, age, and cocaine dependence variables contributed most to node purity, whereas model accuracy would decrease significantly if county type, income, race, and education variables were excluded from the model. One possible approach to improving the efficiency, interpretability, and clinical insights of CUD correlates is the employment of machine learning techniques.

Practical Strategies Using Medical Cannabis to Reduce Harms Associated With Long Term Opioid Use in Chronic Pain

Background: Chronic non-cancer pain (CNCP) is estimated to affect 20% of the adult population. Current United States and Canadian Chronic non-cancer pain guidelines recommend careful reassessment of the risk-benefit ratio for doses greater than 90 mg morphine equivalent dose (MED), due to low evidence for improved pain efficacy at higher morphine equivalent dose and a significant increase in morbidity and mortality. There are a number of human studies demonstrating cannabis opioid synergy. This preliminary evidence suggests a potential role of cannabis as an adjunctive therapy with or without opioids to optimize pain control.

Methods: In 2017, the Canadian Opioid Guidelines Clinical Tool was created to encourage judicious opioid prescribing for CNCP patients and to reevaluate those who have been chronically using high MED. Mirroring this approach, we draw on our clinical experiences and available evidence to create a clinical tool to serve as a foundational clinical guideline for the initiation of medical cannabis in the management of CNCP patients using chronic opioid therapy.

Findings: Following principles of harm reduction and risk minimization, we suggest cannabis be introduced in appropriately selected CNCP patients, using a stepwise approach, with the intent of pain management optimization. We use a structured approach to focus on low dose cannabis (namely, THC) initiation, slow titration, dose optimization and frequent monitoring.

Conclusion: When low dose THC is introduced as an adjunctive therapy, we observe better pain control clinically with lower doses of opioids, improved pain related outcomes and reduced opioid related harm.

Opioid and Cannabis Use During Pregnancy and Breastfeeding in Relation to Sociodemographics and Mental Health Status: A Descriptive Study

OBJECTIVE

This study of Canadian women estimates the prevalence of opioid and cannabis use during pregnancy and cannabis use during the breastfeeding period and explores the sociodemographic and mental health characteristics associated with use.

METHODS

A total of 13 000 women who gave birth between January and June 2018 were invited to participate in the Survey on Maternal Health by Statistics Canada; 7111 women participated for a response rate of 54.7%. Participants were asked about their mental health, supports during pregnancy, and substance use. Multivariable logistic regression was used to describe the relationship between sociodemographic and mental health characteristics and substance use during pregnancy and while breastfeeding.

RESULTS

The prevalence of self-reported opioid use during pregnancy was 1.4% (95% confidence interval [CI] 1.1%-1.8%). A higher proportion of women reported using cannabis during pregnancy and while breastfeeding, at 3.1% (95% CI 2.5%-3.6%) and 2.6% (95% CI 2.1%-3.1%), respectively. Younger age, not being in a relationship, lower level of education, and thoughts of self-harm were significantly associated with cannabis use during pregnancy. Lower level of education and thoughts of self-harm were also significantly associated with cannabis use while breastfeeding, as were symptoms of postpartum depression and/or generalized anxiety. Lower level of education and symptoms of postpartum depression and/or generalized anxiety were also significantly associated with opioid use during pregnancy.

CONCLUSION

The results of this survey show relatively low levels of opioid and cannabis use during pregnancy and cannabis use while breastfeeding in Canada. Different sociodemographic and mental health characteristics are associated with the use of these substances, and public health interventions and policies should take into account these factors.