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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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2
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López-Pelayo H, Matrai S, Balcells-Olivero M, Campeny E, Braddick F, Bossong MG, Cruz OS, Deluca P, Dom G, Feingold D, Freeman TP, Guzman P, Hindocha C, Kelly BC, Liebregts N, Lorenzetti V, Manthey J, Matias J, Oliveras C, Pons MT, Rehm J, Rosenkranz M, Swithenbank Z, van Deurse L, Vicente J, Vuolo M, Wojnar M, Gual A. Standard units for cannabis dose: Why is it important to standardize cannabis dose for drug policy and how can we enhance its place on the public health agenda? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103350. [PMID: 34246016 DOI: 10.1016/j.drugpo.2021.103350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Hugo López-Pelayo
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain.
| | - Silvia Matrai
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain
| | - Mercè Balcells-Olivero
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain
| | - Eugènia Campeny
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain
| | - Fleur Braddick
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain
| | - Matthijs G Bossong
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Olga S Cruz
- University Institute of Maia - ISMAI and Interdisciplinary Research Centre for Human Rights - JusGov, University of Minho- Avenida Carlos de Oliveira Campos, 4475-690 Maia, Portugal and JusGov - Escola de Direito, Campus de Gualtar, Braga 4710-057, Portugal
| | - Paolo Deluca
- King's College London, Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8BB, United Kingdom
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Belgium. European Federation of Addiction Societies (EUFAS), Belgium
| | | | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, United Kingdom
| | - Pablo Guzman
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit, Research Department of Clinical and Health Psychology, University College London, London WC1E 7HB, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, United Kingdom
| | - Brian C Kelly
- Departament of Sociology, Purdue University, United States
| | - Nienke Liebregts
- Bonger Institute of Criminology, University of Amsterdam, the Netherlands
| | | | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, Dresden 01187, Germany; Center for Interdisciplinary Addiction Research of Hamburg University (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg 20246, Germany; Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, Leipzig 04103, Germany
| | - João Matias
- European Monitoring Centre for Drugs and Drug Addiction, Portugal
| | - Clara Oliveras
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain
| | - Maria Teresa Pons
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain
| | - Jürgen Rehm
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Canada; Dalla Lana School of Public Health and Department of Psychiatry, University of Toronto (UofT), Canada; Epidemiological Research Unit, Technische Universität Dresden, Klinische Psychologie & Psychotherapie, Dresden, Germany; Department of International Health Projects, Institute for Leadership and HealthManagement, I.M.Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Moritz Rosenkranz
- Center for Interdisciplinary Addiction Research (ZIS) of Hamburg University, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg 20246, Germany
| | - Zoe Swithenbank
- Public Health Institute, Liverpool John Moores University, Exchange Station Tithebarn Street, Liverpool L2 2QP, United Kingdom
| | - Luc van Deurse
- Student Governance and Leadership in European Public Health, Maastricht University, the Netherlands
| | - Julian Vicente
- European Monitoring Centre for Drugs and Drug Addiction, Portugal
| | - Mike Vuolo
- Department of Sociology, The Ohio State University, Columbus, OH, United States
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland; University of Michigan, Ann Arbor, MI, United States
| | - Antoni Gual
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain
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3
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Soler S, Montout C, Pepin B, Abbar M, Mura T, Lopez-Castroman J. Impact of cannabis use on outcomes of patients admitted to an involuntary psychiatric unit: A retrospective cohort study. J Psychiatr Res 2021; 138:507-513. [PMID: 33975067 DOI: 10.1016/j.jpsychires.2021.04.024] [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] [Received: 11/16/2020] [Revised: 03/15/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Cannabis is associated with an increased risk of mental disorders, including the onset or adverse evolution of schizophrenia, bipolar disorder and depression. The aim of our study was to examine how cannabis use influences length of stay and readmissions in a unit of involuntary care. METHOD All patients admitted to one secure adult psychiatry unit in France in 2016 were included (n = 370). Patients were assigned to one of two groups according to detection of urinary tetrahydrocannabinol (THC + or -). Clinical outcomes, such as length of stay and readmissions, were compared between the groups in multivariate analyses. RESULTS We identified 130 THC + patients and 240 THC- patients. THC + patients were often young men. In adjusted analyses, THC + status was significantly associated with one-year readmissions (OR = 2.29, p = .0082) and more prescriptions of benzodiazepines (OR = 1.93, p = .02), but not antipsychotics, at discharge. CONCLUSIONS Cannabis users seem to have a particular profile in secure units, and are associated with specific diagnoses and treatments, and a higher risk of readmissions. Adapted management strategies might be warranted for these patients.
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Affiliation(s)
- Stephan Soler
- Department of Psychiatry, CHU Nimes, Univ Montpellier, Nimes, France.
| | - Christine Montout
- Department of Psychiatry, CHU Nimes, Univ Montpellier, Nimes, France; INSERM et Université de Montpellier, Montpellier, France; Department of Biostatistics, CHU Nimes, Univ Montpellier, Nimes, France
| | - Berengere Pepin
- Department of Psychiatry, CHU Nimes, Univ Montpellier, Nimes, France
| | - Mocrane Abbar
- Department of Psychiatry, CHU Nimes, Univ Montpellier, Nimes, France
| | - Thibault Mura
- INSERM et Université de Montpellier, Montpellier, France; Department of Biostatistics, CHU Nimes, Univ Montpellier, Nimes, France
| | - Jorge Lopez-Castroman
- Department of Psychiatry, CHU Nimes, Univ Montpellier, Nimes, France; INSERM et Université de Montpellier, Montpellier, France; CIBERSAM, Spain.
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Madero S, Oliveras C, Pons MT, Sague M, López-Pelayo H, Gual A, Balcells M. Cannabis use the week before admission to psychiatric in-patient service as a marker of severity. J Psychiatr Res 2020; 129:40-46. [PMID: 32563776 DOI: 10.1016/j.jpsychires.2020.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate if cannabis dose recorded as standard joint unit (SJU) consumed before admission and other related factors have an influence on psychiatric inpatient's symptom severity and clinical outcomes. METHODS Cross-sectional study in an acute psychiatric inpatient unit including 106 individuals. Quantity of cannabis was measured as SJU and symptoms severity through the Brief Psychiatric Rating Scale (BPRS). Secondary outcomes (e.g. length of stay) were also assessed. Bivariate analyses and multivariate analyses were performed to determine the effect of SJU consumed before admission on measures of clinical severity. RESULTS Point prevalence of cannabis use before admission was 25.5%. Mean BPRS score was 55.8 (SD = 16.1); and 62.9 (SD = 11.1) among cannabis users. A low degree positive correlation between SJU consumed the week before admission and BPRS score (rs = 0.28, p = 0.03) was found. In the multivariate analyses both main diagnostic group, Schizophrenia and other psychotic disorders vs. others (Bipolar and Unipolar Affective Disorders and Addictive disorders) (B = 8.327; 95% CI 4.976-11.677) and need of PRN ("pre re nata" or when necessary) administration of antipsychotics and benzodiazepines (B = 12.13; 95% CI 6.868-17.393) were significant predictors, both increasing BPRS score. CONCLUSIONS The study did not find a correlation between SJU consumed last week and psychiatric severity. On the other hand, individuals with psychotic disorders reported a higher prevalence of cannabis use the week before admission and displayed higher BPRS scores, which points to the need for the development of tailored interventions for high-risk groups. The SJU is a useful quantification tool suitable for further clinical research.
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Affiliation(s)
- S Madero
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.
| | - C Oliveras
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - M T Pons
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain
| | - M Sague
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain
| | - H López-Pelayo
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - A Gual
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - M Balcells
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
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5
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Fischer B, Russell C, Rehm J, Leece P. Assessing the public health impact of cannabis legalization in Canada: core outcome indicators towards an 'index' for monitoring and evaluation. J Public Health (Oxf) 2020; 41:412-421. [PMID: 29860521 DOI: 10.1093/pubmed/fdy090] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/13/2018] [Accepted: 05/02/2018] [Indexed: 12/31/2022] Open
Abstract
The legalization of non-medical cannabis use and supply is impending in Canada. This constitutes a major policy change with the declared objective of improving public health outcomes, which requires rigorous monitoring and evaluation. While numerous different aspects associated with legalization will be examined, a focused perspective is required for effective policy evaluation purposes. To these ends, we have identified a set of 10 core indicators associated with cannabis-related risk/harm outcomes-based on current best evidence-that are expected to measure the primary impacts of legalization on public health outcomes. We briefly review these indicators, and their respective data availability in Canada. As ideally an integrated outcome assessment of cannabis legalization's impact on public health will be available, we further propose options to merge the individual indicators into an integrated, weighted 'index', considering their expected relative impact for public health. One possible approach to undertake this is 'multi-criteria decision analysis' as a method to weight the relative indicator impact on public health; alternative approaches are proposed. The integrated 'public health index' for cannabis legalization will allow for scientifically comprehensive, while focused, monitoring and evaluation of the effects of legalization in Canada for the benefits of science and evidence-based policy alike.
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Affiliation(s)
- Benedikt Fischer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Canada.,Centre for Criminology & Sociolegal Studies, University of Toronto, Toronto, Canada.,Department of Psychiatry, Federal University of São Paulo (UNIFESP), 785 05403-903 São Paulo, Brazil
| | - Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany
| | - Pamela Leece
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada
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Fekih-Romdhane F, Hakiri A, Fadhel SB, Cheour M. [Cannabis use in subjects at ultra high risk for psychosis]. Presse Med 2019; 48:1229-1236. [PMID: 31732360 DOI: 10.1016/j.lpm.2019.09.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 07/10/2019] [Accepted: 09/23/2019] [Indexed: 11/30/2022] Open
Abstract
Cannabis use is widespread among people at ultra-high risk (UHR) for psychosis. The causal link as well as the temporal link between cannabis use and further occurrence of psychosis in UHR people remain inconclusive. Current science data supported an increased risk of transition to psychosis in cannabis users who are genetically predisposed to psychosis. This risk would be even greater in the presence of a family history of psychosis, in case of a strong use and an early onset use. Several models have been cited to explain the link between cannabis use and the subsequent onset of psychosis or prepsychotic states: cannabis-induced modifications of some brain structures, a dysregulation of the hypothalamic-pituitary axis and an alteration of normal neurological development via the endocannabinoid system. Cannabis represents a modifiable risk for psychosis. Current interventions aim to reduce or stop the cannabis use in order to reduce the risk of transition to psychosis.
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Affiliation(s)
- Feten Fekih-Romdhane
- Hôpital Razi, service de psychiatrie Ibn-Omrane, 1, rue des orangers, 2010 La-Manouba, Tunisie; Université Tunis El-Manar, faculté de médecine de Tunis, Tunis, Tunisie.
| | - Abir Hakiri
- Hôpital Razi, service de psychiatrie Ibn-Omrane, 1, rue des orangers, 2010 La-Manouba, Tunisie; Université Tunis El-Manar, faculté de médecine de Tunis, Tunis, Tunisie
| | - Sinda Ben Fadhel
- Hôpital Razi, service de psychiatrie Ibn-Omrane, 1, rue des orangers, 2010 La-Manouba, Tunisie; Université Tunis El-Manar, faculté de médecine de Tunis, Tunis, Tunisie
| | - Majda Cheour
- Hôpital Razi, service de psychiatrie Ibn-Omrane, 1, rue des orangers, 2010 La-Manouba, Tunisie; Université Tunis El-Manar, faculté de médecine de Tunis, Tunis, Tunisie
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7
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Rylander M, Winston HR, Medlin H, Hull M, Nussbaum A. The association of cannabis use on inpatient psychiatric hospital outcomes. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:73-84. [PMID: 28613973 DOI: 10.1080/00952990.2017.1329313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The associations between cannabis use and psychosis are well documented in numerous studies. There is a need to evaluate the impact of cannabis use on inpatient psychiatric utilization and outcomes. OBJECTIVES To evaluate the impact of cannabis use on psychiatric hospital outcomes. METHODS This study was conducted between April 20, 2015 and October 20, 2015. All patients (n = 120) admitted to Denver Health with psychotic symptoms were administered a urine toxicology screening testing for the presence of 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH, the active metabolite of cannabis). Patients with positive tests were compared to those with negative tests on several measures, including length of stay, presence or lack of 30-day readmission, Brief Psychotic Rating Scale (BPRS) score, and use of antipsychotics and/or sedatives/anxiolytics. RESULTS There were 120 patients. Twenty nine were women and 91 were men. Patients testing positive for THC-COOH had a shorter length of stay compared to patients testing negative for THC-COOH, after adjusting for age, prior psychiatric admissions, history of a psychotic-spectrum disorder, and comorbid additional substance use (p = 0.02). There were no differences in 30-day readmissions, 30-day post-discharge presentation to the Denver Health psychiatric emergency department, BPRS scores, and medication administration. CONCLUSION Patients presenting with psychotic symptoms and cannabis use require shorter inpatient psychiatric hospitalizations. This study is the first to quantify this observation and highlights the need for future clinical decision-making tools that would ideally correlate cannabis use with the degree of potential need for expensive and scarce mental health resources, such as psychiatric hospitalization.
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Affiliation(s)
- Melanie Rylander
- a University of Colorado School of Medicine , Department of Psychiatry, Denver Health Medical Center , Denver , CO , USA
| | - Helena R Winston
- b Department of Psychiatry , University of Colorado School of Medicine , Denver , CO , USA
| | - Haley Medlin
- a University of Colorado School of Medicine , Department of Psychiatry, Denver Health Medical Center , Denver , CO , USA
| | - Madelyne Hull
- c Department of Internal Medicine , Denver Health Medical Center , Denver , CO , USA
| | - Abraham Nussbaum
- a University of Colorado School of Medicine , Department of Psychiatry, Denver Health Medical Center , Denver , CO , USA.,d Denver Health Medical Center , Denver , CO , USA
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Suryadevara U, Bruijnzeel DM, Nuthi M, Jagnarine DA, Tandon R, Bruijnzeel AW. Pros and Cons of Medical Cannabis use by People with Chronic Brain Disorders. Curr Neuropharmacol 2017; 15:800-814. [PMID: 27804883 PMCID: PMC5652027 DOI: 10.2174/1570159x14666161101095325] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/26/2016] [Accepted: 10/28/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cannabis is the most widely used illicit drug in the world and there is growing concern about the mental health effects of cannabis use. These concerns are at least partly due to the strong increase in recreational and medical cannabis use and the rise in tetrahydrocannabinol (THC) levels. Cannabis is widely used to self-medicate by older people and people with brain disorders such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Alzheimer's disease (AD), Parkinson's disease (PD), bipolar disorder, and schizophrenia. OBJECTIVE This review provides an overview of the perceived benefits and adverse mental health effects of cannabis use in people with ALS, MS, AD, PD, bipolar disorder, and schizophrenia. RESULTS The reviewed studies indicate that cannabis use diminishes some symptoms associated with these disorders. Cannabis use decreases pain and spasticity in people with MS, decreases tremor, rigidity, and pain in people with PD, and improves the quality of life of ALS patients by improving appetite, and decreasing pain and spasticity. Cannabis use is more common among people with schizophrenia than healthy controls. Cannabis use is a risk factor for schizophrenia which increases positive symptoms in schizophrenia patients and diminishes negative symptoms. Cannabis use worsens bipolar disorder and there is no evidence that bipolar patients derive any benefit from cannabis. In late stage Alzheimer's patients, cannabis products may improve food intake, sleep quality, and diminish agitation. CONCLUSION Cannabis use diminishes some of the adverse effects of neurological and psychiatric disorders. However, chronic cannabis use may lead to cognitive impairments and dependence.
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Affiliation(s)
- Uma Suryadevara
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | | | - Meena Nuthi
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | | | - Rajiv Tandon
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Adriaan W. Bruijnzeel
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
- Department of Neuroscience, University of Florida, Gainesville, Florida, USA
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA
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Abstract
Partial hospitalization is an understudied bridge between outpatient and inpatient care. One of its primary functions is to prevent the need for inpatient hospitalization. We examined potential demographic and clinical risk factors for inpatient hospitalization for current partial hospital patients. We conducted separate multiple logistic regression analyses for patients referred from inpatient care and the community. For individuals referred from inpatient care, suicidal ideation and greater psychotic symptoms upon admission to the partial program were associated with acute inpatient re-hospitalization. For individuals referred from the community, suicidal ideation and worse relationship functioning upon partial hospital admission were significant risk factors for inpatient hospitalization. Number of previous inpatient hospitalizations and greater substance abuse were not associated with inpatient hospitalization in either sample. Implications at the provider and program level are discussed.
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10
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Ameller A, Gorwood P. Poids de la comorbidité addictive dans le risque d’observance partielle au traitement médicamenteux et de rechute dans la schizophrénie. Encephale 2015; 41:174-83. [DOI: 10.1016/j.encep.2015.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/03/2015] [Indexed: 11/26/2022]
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Løberg EM, Helle S, Nygård M, Berle JØ, Kroken RA, Johnsen E. The Cannabis Pathway to Non-Affective Psychosis may Reflect Less Neurobiological Vulnerability. Front Psychiatry 2014; 5:159. [PMID: 25477825 PMCID: PMC4235385 DOI: 10.3389/fpsyt.2014.00159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/24/2014] [Indexed: 12/19/2022] Open
Abstract
There is a high prevalence of cannabis use reported in non-affective psychosis. Early prospective longitudinal studies conclude that cannabis use is a risk factor for psychosis, and neurochemical studies on cannabis have suggested potential mechanisms for this effect. Recent advances in the field of neuroscience and genetics may have important implications for our understanding of this relationship. Importantly, we need to better understand the vulnerability × cannabis interaction to shed light on the mediators of cannabis as a risk factor for psychosis. Thus, the present study reviews recent literature on several variables relevant for understanding the relationship between cannabis and psychosis, including age of onset, cognition, brain functioning, family history, genetics, and neurological soft signs (NSS) in non-affective psychosis. Compared with non-using non-affective psychosis, the present review shows that there seem to be fewer stable cognitive deficits in patients with cannabis use and psychosis, in addition to fewer NSS and possibly more normalized brain functioning, indicating less neurobiological vulnerability for psychosis. There are, however, some familiar and genetic vulnerabilities present in the cannabis psychosis group, which may influence the cannabis pathway to psychosis by increasing sensitivity to cannabis. Furthermore, an earlier age of onset suggests a different pathway to psychosis in the cannabis-using patients. Two alternative vulnerability models are presented to integrate these seemingly paradoxical findings.
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Affiliation(s)
- Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Siri Helle
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Merethe Nygård
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Jan Øystein Berle
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rune A. Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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van Gastel WA, MacCabe JH, Schubart CD, van Otterdijk E, Kahn RS, Boks MPM. Cannabis use is a better indicator of poor mental health in women than in men: a cross-sectional study in young adults from the general population. Community Ment Health J 2014; 50:823-30. [PMID: 24728845 DOI: 10.1007/s10597-014-9699-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 01/13/2014] [Indexed: 11/30/2022]
Abstract
Cannabis use is a known risk factor for a range of mental health problems, but less is known on the association with general mental health. We aim to explore the relationship between cannabis use and general mental health. We did a cross-sectional online survey of 1,929 young adults aged 18-30 years. Participants reported socio-demographic data, substance use and the Symptom Checklist-90 (SCL-90). Monthly cannabis use was associated with a higher total score on the SCL-90, both in a crude (OR 1.94, 95% CI 1.57-2.38) and fully adjusted model (OR 1.48, 95% CI 1.07-2.03). The association between cannabis and mental health was stronger in women and weekly users, and was independent of age at first use of cannabis. We conclude that moderate cannabis use is associated with general mental health problems in young adulthood. This relationship is independent of age at first use and of other risk factors, and is strongest in women.
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Affiliation(s)
- W A van Gastel
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, HP. A01.489, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands,
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13
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Vleeschouwer M, Schubart CD, Henquet C, Myin-Germeys I, van Gastel WA, Hillegers MHJ, van Os JJ, Boks MPM, Derks EM. Does assessment type matter? A measurement invariance analysis of online and paper and pencil assessment of the Community Assessment of Psychic Experiences (CAPE). PLoS One 2014; 9:e84011. [PMID: 24465389 PMCID: PMC3898946 DOI: 10.1371/journal.pone.0084011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 11/19/2013] [Indexed: 11/21/2022] Open
Abstract
Background The psychometric properties of an online test are not necessarily identical to its paper and pencil original. The aim of this study is to test whether the factor structure of the Community Assessment of Psychic Experiences (CAPE) is measurement invariant with respect to online vs. paper and pencil assessment. Method The factor structure of CAPE items assessed by paper and pencil (N = 796) was compared with the factor structure of CAPE items assessed by the Internet (N = 21,590) using formal tests for Measurement Invariance (MI). The effect size was calculated by estimating the Signed Item Difference in the Sample (SIDS) index and the Signed Test Difference in the Sample (STDS) for a hypothetical subject who scores 2 standard deviations above average on the latent dimensions. Results The more restricted Metric Invariance model showed a significantly worse fit compared to the less restricted Configural Invariance model (χ2(23) = 152.75, p<0.001). However, the SIDS indices appear to be small, with an average of −0.11. A STDS of −4.80 indicates that Internet sample members who score 2 standard deviations above average would be expected to score 4.80 points lower on the CAPE total scale (ranging from 42 to 114 points) than would members of the Paper sample with the same latent trait score. Conclusions Our findings did not support measurement invariance with respect to assessment method. Because of the small effect sizes, the measurement differences between the online assessed CAPE and its paper and pencil original can be neglected without major consequences for research purposes. However, a person with a high vulnerability for psychotic symptoms would score 4.80 points lower on the total scale if the CAPE is assessed online compared to paper and pencil assessment. Therefore, for clinical purposes, one should be cautious with online assessment of the CAPE.
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Affiliation(s)
- Marloes Vleeschouwer
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Chris D. Schubart
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cecile Henquet
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Inez Myin-Germeys
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Willemijn A. van Gastel
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon H. J. Hillegers
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jim J. van Os
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marco P. M. Boks
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eske M. Derks
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Psychiatry, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
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van Winkel R, Kuepper R. Epidemiological, neurobiological, and genetic clues to the mechanisms linking cannabis use to risk for nonaffective psychosis. Annu Rev Clin Psychol 2014; 10:767-91. [PMID: 24471373 DOI: 10.1146/annurev-clinpsy-032813-153631] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Epidemiological studies have shown that the association between cannabis and psychosis is robust and consistent across different samples, with compelling evidence for a dose-response relationship. Because longitudinal work indicates that cannabis use precedes psychotic symptoms, it seems reasonable to assume a causal relationship. However, more work is needed to address the possibility of gene-environment correlation (for example, genetic risk for psychosis causing onset of cannabis use). Moreover, knowledge about underlying biological mechanisms linking cannabis use and psychosis is still relatively limited. In order to understand how cannabis use may lead to an increased risk for psychosis, in the present article we (a) review the epidemiological, neurobiological, and genetic evidence linking cannabinoids and psychosis, (b) assess the quality of the evidence, and finally (c) try to integrate the most robust findings into a neurodevelopmental model of cannabis-induced psychosis and identify the gaps in knowledge that are in need of further investigation.
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Affiliation(s)
- Ruud van Winkel
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, European Graduate School of Neuroscience (EURON), South Limburg Mental Health Research and Teaching Network (SEARCH), Maastricht University Medical Center, Maastricht, The Netherlands;
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Jónsdóttir H, Opjordsmoen S, Birkenaes AB, Simonsen C, Engh JA, Ringen PA, Vaskinn A, Friis S, Sundet K, Andreassen OA. Predictors of medication adherence in patients with schizophrenia and bipolar disorder. Acta Psychiatr Scand 2013; 127:23-33. [PMID: 22900964 DOI: 10.1111/j.1600-0447.2012.01911.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate potential risk factors for medication non-adherence in patients with schizophrenia and bipolar disorder. METHOD A total of 255 patients underwent clinical assessments, neurocognitive testing and blood sampling. The patients were divided into groups of 'No', 'Partial' or 'Full' adherence. Relationships to different risk factors were analyzed. RESULTS In schizophrenia, use of illicit substances, alcohol and poor insight were related to worse adherence. Schizophrenia patients with No adherence did better on tests of executive functioning, verbal learning and memory and had higher IQ than patients with better adherence. There were higher levels of autonomic side effects in the non-adherence group, but body mass index was lower in the Partial adherence group than in the Full adherence group. In the bipolar disorder patients, there was an association between the use of illicit substances and alcohol and poor adherence. We found no relationship between adherence behavior and neurocognition in the bipolar disorder group. CONCLUSION Substance use is an important risk factor for non-adherence in patients with schizophrenia and bipolar disorder. Poor insight is also a risk factor in schizophrenia. The results suggest that cognitive dysfunction is not a risk factor for non-adherence in these diagnostic groups.
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Affiliation(s)
- H Jónsdóttir
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
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16
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Deiana S. Medical use of cannabis. Cannabidiol: a new light for schizophrenia? Drug Test Anal 2012; 5:46-51. [PMID: 23109356 DOI: 10.1002/dta.1425] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 09/04/2012] [Accepted: 09/05/2012] [Indexed: 11/12/2022]
Abstract
The medical properties of cannabis have been known for many centuries; its first documented use dates back to 2800 BC when it was described for its hallucinogenic and pain-relieving properties. In the first half of the twentieth century, a number of pharmaceutical companies marked cannabis for indications such as asthma and pain, but since then its use has sharply declined, mainly due to its unpredictable effects, but also for socio-political issues. Recently, great attention has been directed to the medical properties of phytocannabinoids present in the cannabis plant alongside the main constituent Δ⁹-Tetrahydrocannabinol (THC); these include cannabinoids such as cannabidiol (CBD), cannabigerol (CBG), and tetrahydrocannabivarin (THCV). Evidence suggests an association between cannabis and schizophrenia: schizophrenics show a higher use of marijuana as compared to the healthy population. Additionally, the use of marijuana can trigger psychotic episodes in schizophrenic patients, and this has been ascribed to THC. Given the need to reduce the side effects of marketed antipsychotics, and their weak efficacy on some schizophrenic symptoms, cannabinoids have been suggested as a possible alternative treatment for schizophrenia. CBD, a non-psychoactive constituent of the Cannabis sativa plant, has been receiving growing attention for its anti-psychotic-like properties. Evidence suggests that CBD can ameliorate positive and negative symptoms of schizophrenia. Behavioural and neurochemical models suggest that CBD has a pharmacological profile similar to that of atypical anti-psychotic drugs and a clinical trial reported that this cannabinoid is a well-tolerated alternative treatment for schizophrenia.
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Affiliation(s)
- Serena Deiana
- Department CNS Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. K., Biberach an der Riss, Germany.
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Man Xiong Lai H, Sitharthan T. A six‐year study of substance use and mental health disorders: ascertaining the prevalence of comorbidity. DRUGS AND ALCOHOL TODAY 2012. [DOI: 10.1108/17459261211263497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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18
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Bostwick JM. Blurred boundaries: the therapeutics and politics of medical marijuana. Mayo Clin Proc 2012; 87:172-86. [PMID: 22305029 PMCID: PMC3538401 DOI: 10.1016/j.mayocp.2011.10.003] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 10/20/2011] [Accepted: 10/24/2011] [Indexed: 01/09/2023]
Abstract
For 5 millennia, Cannabis sativa has been used throughout the world medically, recreationally, and spiritually. From the mid-19th century to the 1930s, American physicians prescribed it for a plethora of indications, until the federal government started imposing restrictions on its use, culminating in 1970 with the US Congress classifying it as a Schedule I substance, illegal, and without medical value. Simultaneous with this prohibition, marijuana became the United States' most widely used illicit recreational drug, a substance generally regarded as pleasurable and relaxing without the addictive dangers of opioids or stimulants. Meanwhile, cannabis never lost its cachet in alternative medicine circles, going mainstream in 1995 when California became the first of 16 states to date to legalize its medical use, despite the federal ban. Little about cannabis is straightforward. Its main active ingredient, δ-9-tetrahydrocannabinol, was not isolated until 1964, and not until the 1990s were the far-reaching modulatory activities of the endocannabinoid system in the human body appreciated. This system's elucidation raises the possibility of many promising pharmaceutical applications, even as draconian federal restrictions that hamstring research show no signs of softening. Recreational use continues unabated, despite growing evidence of marijuana's addictive potential, particularly in the young, and its propensity for inducing and exacerbating psychotic illness in the susceptible. Public approval drives medical marijuana legalization efforts without the scientific data normally required to justify a new medication's introduction. This article explores each of these controversies, with the intent of educating physicians to decide for themselves whether marijuana is panacea, scourge, or both. PubMed searches were conducted using the following keywords: medical marijuana, medical cannabis, endocannabinoid system, CB1 receptors, CB2 receptors, THC, cannabidiol, nabilone, dronabinol, nabiximols, rimonabant, marijuana legislation, marijuana abuse, marijuana dependence, and marijuana and schizophrenia. Bibliographies were hand searched for additional references relevant to clarifying the relationships between medical and recreational marijuana use and abuse.
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Affiliation(s)
- J Michael Bostwick
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
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Casadio P, Fernandes C, Murray RM, Di Forti M. Cannabis use in young people: the risk for schizophrenia. Neurosci Biobehav Rev 2011; 35:1779-87. [PMID: 21530584 DOI: 10.1016/j.neubiorev.2011.04.007] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 03/09/2011] [Accepted: 04/06/2011] [Indexed: 12/13/2022]
Abstract
Cannabis is one of the most commonly used illicit drugs, and despite the widely held belief that it is a safe drug, its long-term use has potentially harmful consequences. To date, the research on the impact of its use has largely been epidemiological in nature and has consistently found that cannabis use is associated with schizophrenia outcomes later in life, even after controlling for several confounding factors. While the majority of users can continue their use without adverse effects, it is clear from studies of psychosis that some individuals are more vulnerable to its effects than others. In addiction, evidence from both epidemiological and animal studies indicates that cannabis use during adolescence carries particular risk. Further studies are warranted given the increase in the concentration of the main active ingredient (Δ(9)-tetrahydrocannabinol) in street preparations of cannabis and a decreasing age of first-time exposure to cannabis.
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Affiliation(s)
- Paola Casadio
- Mental Health Department, AUSL Ravenna, Via Baliatico 3, Faenza (RA), Italy.
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