Abstract
BackgroundEpidemiological studies show wide variability in the occurrence of cannabis smoking and related disorders across countries. This study aims to estimate cross-national variation in cannabis users' experience of clinically significant cannabis-related problems in three countries of the Americas, with a focus on cannabis users who may have tried alcohol or tobacco, but who have not used cocaine, heroin, LSD, or other internationally regulated drugs.MethodsData are from the World Mental Health Surveys Initiative and the National Latino and Asian American Study, with probability samples in Mexico (n = 4426), Colombia (n = 5,782) and the United States (USA; n = 8,228). The samples included 212 'cannabis only' users in Mexico, 260 in Colombia and 1,724 in the USA. Conditional GLM with GEE and 'exact' methods were used to estimate variation in the occurrence of clinically significant problems in cannabis only (CO) users across these surveyed populations.ResultsThe experience of cannabis-related problems was quite infrequent among CO users in these countries, with weighted frequencies ranging from 1% to 5% across survey populations, and with no appreciable cross-national variation in general. CO users in Colombia proved to be an exception. As compared to CO users in the USA, the Colombia smokers were more likely to have experienced cannabis-associated 'social problems' (odds ratio, OR = 3.0; 95% CI = 1.4, 6.3; p = 0.004) and 'legal problems' (OR = 9.7; 95% CI = 2.7, 35.2; p = 0.001).ConclusionsThis study's most remarkable finding may be the similarity in occurrence of cannabis-related problems in this cross-national comparison within the Americas. Wide cross-national variations in estimated population-level cumulative incidence of cannabis use disorders may be traced to large differences in cannabis smoking prevalence, rather than qualitative differences in cannabis experiences. More research is needed to identify conditions that might make cannabis-related social and legal problems more frequent in Colombia than in the USA.
Highlights
Epidemiological studies show wide variability in the occurrence of cannabis smoking and related disorders across countries
The cumulative occurrence of cannabis only (CO) use was larger in the United States (USA) population at large (NCS-R), followed by the Latino population living in the USA (NLAAS), Colombia, and Mexico, with statistically robust differences in that order (p < 0.05)
Given that these differences might vary as a function of the respective cumulative incidence for cannabis smoking, regardless of the illegal use of other internationally regulated drugs (IRD), we estimated the relative proportion of CO users among all cannabis users
Summary
Epidemiological studies show wide variability in the occurrence of cannabis smoking and related disorders across countries. According to the UN, in the Americas, the prevalence of cannabis problems for Mexico was 1%, for Peru, 2-3%, for Venezuela, 8%, and for the United States (USA), 9-10% [2] Most likely, these wide variations in the UN estimates can be traced back to variations in administrative recordkeeping of each government or to differences in study methods and instruments used [3,4]. These wide variations in the UN estimates can be traced back to variations in administrative recordkeeping of each government or to differences in study methods and instruments used [3,4] Another possibility is that these cross-country variations are more than artifactual. There are at least two hypotheses that might explain the observed variations
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