Characterizing motivations for cannabis use in a cohort of people who use illicit drugs: A latent class analysis

Stephanie Lake,Thomas Kerr,M Eugenia Socías,Jane Buxton,Ekaterina Nosova,M J Milloy,Kanna Hayashi,Zach Walsh,Lucy J Troup

doi:10.1371/journal.pone.0233463

Abstract

BackgroundCannabis use is common among marginalized people who use illicit drugs (PWUD) but reasons for use remain poorly investigated. We sought to explore how different intentions for cannabis use relate to social, structural, and behavioural factors among PWUD in Vancouver, Canada.MethodsWe used data from cannabis-using participants in two community-recruited prospective cohort studies of PWUD. Using latent class analysis, we identified discrete cannabis-using groups based on self-reported intentions for use. Generalized estimating equations were used to examine correlates of class membership.ResultsBetween June 2016 and December 2018, 2,686 observations from 897 participants cannabis-using PWUD were analyzed. Four latent classes of cannabis use emerged: Class 1 (31.6%), characterized by non-medical purposes; Class 2 (37.5%), characterized by non-pain therapeutic use (e.g., stress, nausea/loss of appetite, and insomnia); characterized by Class 3 (21.9%) predominantly pain relief; and Class 4 (9.0%), characterized by a wide range of therapeutic uses in addition to pain management, including insomnia, stress, nausea/loss of appetite, and harm reduction. Class-specific structural, substance-, and health-related differences were observed, including indicators of better physical and mental health among the “recreational” class, despite evidence of more structural vulnerabilities (e.g., homelessness, incarceration).ConclusionsOur findings demonstrate a wide spectrum of motivations for cannabis use among PWUD. We observed important health-related differences between latent classes, demonstrating possible unmet healthcare needs among PWUD reporting therapeutic cannabis use. These findings inform ongoing policy surrounding access to cannabis for harm reduction purposes and applications of medical cannabis for PWUD.

Highlights

Cannabis is the most common illicit drug consumed worldwide [1]
Our findings demonstrate a wide spectrum of motivations for cannabis use among people who use illicit drugs (PWUD)
We observed important health-related differences between latent classes, demonstrating possible unmet healthcare needs among PWUD reporting therapeutic cannabis use

Summary

Introduction

Cannabis is the most common illicit (i.e., internationally scheduled) drug consumed worldwide [1]. PWUD describe purposefully engaging in cannabis use as a form of harm reduction (e.g., to manage opioid cravings or prevent escalation to higher-intensity opioid use [9,10]). These accounts are further supported by emerging experimental research demonstrating a potential role of cannabinoids in reducing opioid craving and withdrawal [11]. In light of an ongoing opioid overdose crisis throughout Canada and the United States in which marginalized PWUD have borne the brunt of morbidity and mortality, the evolving understanding of cannabis’ therapeutic potential raises important questions about whether—and, if so, how—cannabinoid-based interventions could be implemented and individual-tailored as a form of harm reduction [12].

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