Differentiating Cannabis Use: Associations Between Product Type and Mental Health Outcomes

While cannabis is the most commonly used illicit substance, few studies have focused on the relationship between sociodemographic factors and primary method or form of cannabis use. The primary aims of this study were to understand the effects of age and sex on primary form (marijuana, concentrates, edibles) and method (joints, blunts, hand pipe, bong, hookah, vaporizer, edibles) of cannabis use. Participants (n=852; n=536 male) completed an online survey that included the ‘Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory’ used to collect information on the primary method and form of cannabis use in male and female participants divided into young adults ages 18 to 25 (Y) and adults 26 and older (O). Chi square analysis showed a significant effect of sex for primary method (χ2 (1)=122.4, p<.001) and primary form (χ2 (1)=24.6, p<.001) of cannabis use. Post hoc comparisons using Bonferroni corrections (adjusted p=0.002) showed that males were significantly more likely to report blunts (M=35%; F=10%), while females were significantly more likely to report joints (F=16%; M=8%) and edibles (F=15%; M=4%) as their primary method of cannabis use. Males were also significantly more likely to report marijuana (M=66%; F=55%), while females were significantly more likely to endorse edibles (F=17%; M=10%) as their primary form of cannabis use. Chi square analysis showed a significant effect of age for primary method (χ2 (1)=139.9, p<.001) of cannabis use. Young adults were significantly more likely to report using bongs (Y=19%; O=11%), vaporizers (Y=26%; O=9%), and edibles (Y=12%; O=5%), while participants 26 or older were significantly more likely to report using blunts (O=39%; Y=10%) as their primary method of cannabis use. There were no significant differences between age groups for the primary form of cannabis use. Findings from this study suggest there are significant effects of age and sex on primary method and form of cannabis use. Future studies should examine how other sociodemographic factors may affect cannabis use and how method and form of cannabis use affect long-term health outcomes.

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The many forms of cannabis use: Prevalence and correlates of routes of administration among nationally representative samples of U.S. adult and adolescent cannabis users

Background: While cannabis is the most commonly used illicit substance, few studies have focused on the relationship between sociodemographic factors and preference for primary form or method of cannabis use. Methods: The ‘Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory’ was used to collect information on the primary form and method of cannabis use in young adults ages 18 to 25 and adults 26 and older. Chi-square analysis was used to examine differences by age and sex (n = 852; n = 536 male). Results: Young adults were more likely to report using bongs, vaporizers, and edibles, while older participants were more likely to report using blunts. Males were more likely to report marijuana, while females were more likely to report edibles as their primary form of cannabis use. Males were more likely to report using blunts, while females were more likely to report using joints and edibles. Conclusions: Findings from this study suggest there are significant effects of age and sex on primary form and method of cannabis use. Future studies should examine how personality and environmental influences may affect preferences for forms and methods of cannabis use and how these affect long-term health outcomes.

Are the adverse consequences of cannabis use age-dependent?

Abstract: Youth cannabis use is a major public health crisis. Cannabis laws carry significant health implications for American youth. Relaxing of these laws – through decriminalization, medical and recreational legalization – by a majority of states in the United States (US) over the past 25 years has dramatically shifted societal perceptions and adult use. How cannabis policy changes have affected the population-wide health of US youth and downstream public health implications of cannabis laws remain topics of significant debate. Cannabis is the most commonly used federally-illicit drug by US adolescents and the main drug for which US teens obtain substance use treatment. Adolescent cannabis use is associated with negative long-term consequences for mental health, risk-taking behaviors, and academic/job achievement. As of January 2023, 37 states and the District of Columbia (DC) have enacted medical cannabis laws; of these, 21 states and DC have recreational cannabis laws. Multiple studies have assessed the association between cannabis laws and youth cannabis use; results indicate mostly null effects for medical laws and mixed effects for recreational laws. Little is known about the effects of cannabis laws on mental health and mortality outcomes for American youth. Methodological limitations have made the interpretation of this literature difficult. This article presents a narrative review of current scientific literature investigating the impact of changing cannabis policies on cannabis and other drug use, mental health, and mortality outcomes in US youth. Implications are framed within a larger discussion on national trends in youth drug use, effects of adolescent cannabis exposure on health outcomes, and research-based policymaking.

Over the past 20 years epidemiological studies have left us better informed about the adverse effects of regular cannabis use in young adulthood on mental health and psychosocial outcomes [1]. The Christchurch Health and Development Study (CHDS) of David Fergusson and colleagues has made an especially valuable contribution to this literature, as indicated by the summary of its key findings on the mental health and psychosocial outcomes of cannabis use in the current issue. The CHDS followed the life course of a birth cohort of 1000 New Zealanders, 80 % of whom had used cannabis by their mid-20s. Nearly a third used cannabis regularly enough, and for long enough, to enable assessment of associations between common adverse psychosocial and mental health outcomes and regular cannabis use. The study also collected detailed information on the personal and social situations of the cohort that enabled the researchers to assess whether the associations they observed between daily cannabis use and adverse outcomes could be explained by pre-existing differences between those who had and had not used cannabis regularly. This study has consistently found associations between daily cannabis use and poor mental health and psychosocial outcomes. Daily cannabis users had poorer educational attainment in adolescence and poorer employment outcomes in young adulthood, were more likely to use other illicit drugs, and were more likely to report more symptoms of psychosis, depression and suicide. Many of these risks increased with the intensity of cannabis use, and these associations persisted after statistical adjustment for plausible confounding factors. Many of these results have been replicated in the Dunedin birth cohort (e.g. [2]), and in longitudinal studies in other countries such as Australia (e.g. [3]), Germany [4] and the Netherlands [5]. Fergusson and colleagues show that the adverse health effects of cannabis are most concentrated among daily users (nearly 20 % of those who ever used the drug). This pattern was most common among young people who began using cannabis in their mid-teens and continued to use daily throughout young adulthood. Not all cannabis users experienced harm: many adolescent users did not use cannabis regularly enough or for long enough to do so; and a substantial proportion of adult cannabis users, the majority of whom reported using cannabis less than daily, did not report any harms related to their cannabis use. The cannabis policy debate has been presented in many countries as a forced choice between two packages of belief: (1) that cannabis use does not harm users, and so it should be legalized to avoid users acquiring criminal records; and (2) that cannabis use can harm some users, and so we should continue to prohibit its use [1]. This framing has often hindered a fair appraisal of the adverse health effects of cannabis. Evidence on the harms of cannabis use cannot decide cannabis policy [6]. The policy choice will depend upon societal beliefs about the priority that should be given to competing social values, such as, preserving individual freedom and protecting human health and well-being. It will also depend on political views on the extent to which the state should use criminal law to prevent adults from & Wayne Hall w.hall@uq.edu.au

Cannabis use is consistently linked to poorer mental health outcomes, and there is evidence that use of higher-potency cannabis increases these risks. To date, no studies have described the association between cannabis potency and concurrent mental health in a general population sample or addressed confounding using longitudinal data. To explore the association between cannabis potency and substance use and mental health outcomes, accounting for preceding mental health and frequency of cannabis use. This cohort study used data from the Avon Longitudinal Study of Parents and Children, a UK birth cohort of participants born between April 1, 1991, and December 31, 1992. Present data on outcomes and exposures were collected between June 2015 and October 2017 from 1087 participants at 24 years of age who reported recent cannabis use. Self-reported type of cannabis most commonly used in the past year, coded to a binary exposure of use of high-potency cannabis or lower-potency cannabis. Outcomes were reported frequency of cannabis use, reported cannabis use problems, recent use of other illicit drugs, tobacco dependence, alcohol use disorder, depression, generalized anxiety disorder, and psychotic-like experiences. The study used secondary data; consequently, the hypotheses were formulated after data collection. Past-year cannabis use was reported by 1087 participants (580 women; mean [SD] age at onset of cannabis use, 16.7 [3.0] years). Of these, 141 participants (13.0%) reported the use of high-potency cannabis. Use of high-potency cannabis was associated with increased frequency of cannabis use (adjusted odds ratio [AOR], 4.38; 95% CI, 2.89-6.63), cannabis problems (AOR, 4.08; 95% CI, 1.41-11.81), and increased likelihood of anxiety disorder (AOR, 1.92; 95% CI, 1.11-3.32). Adjustment for frequency of cannabis use attenuated the association with psychotic experiences (AOR 1.29; 95% CI, 0.67-2.50), tobacco dependence (AOR, 1.42; 95% CI, 0.89-2.27), and other illicit drug use (AOR, 1.29; 95% CI, 0.77-2.17). There was no evidence of association between the use of high-potency cannabis and alcohol use disorder or depression. To our knowledge, this study provides the first general population evidence suggesting that the use of high-potency cannabis is associated with mental health and addiction. Limiting the availability of high-potency cannabis may be associated with a reduction in the number of individuals who develop cannabis use disorders, the prevention of cannabis use from escalating to a regular behavior, and a reduction in the risk of mental health disorders.

According to the World Drug Report (2005), the use of illicit drugs has increased throughout the world in recent years. The report further states that a major world trend is the increasing availability of many kinds of drugs to an ever-widening socio-economic spectrum of consumers. In Kenya, cannabis has been found to be the most widely used narcotic drug. According to a study done by NACADA (2015) it found that use of narcotics especially bhang was very high among the youth and the problem was endemic across the country. This study was guided by the following objectives: to find out the forms of cannabis used frequently by university students in the South Rift Region of Kenya and to investigate the role of guidance and counselling in managing the commonly abused forms of cannabis use. The purpose of this study was, therefore, to investigate the role of guidance and counselling in addressing commonly used forms of cannabis. The theory guiding the study was the Social Cognitive Theory of Bandura (1961). Quantitative data was collected through a structured questionnaire while qualitative data was collected through interviews and focused group discussions. The population of the study consisted of 13,603 students in five universities in the south rift region of Kenya. The sample was identified using random and purposive sampling techniques. The data obtained was analysed by use of descriptive statistics using frequencies, means and standard deviations and inferential statistics using Pearson Correlation Coefficient and multiple regression. The study unveiled four consumption methods common with the youth and that includes: smoking, vaping, dabbing and vaporization. It was found that the most common method of consuming cannabis is through smoking. The results of the study showed that guidance and counselling has not played a significant role in addressing the most commonly used forms of cannabis (r=0.485 and p=0.490). It has contributed 11.2% in handling the different forms of cannabis used by the students. The study recommends that guidance and counselling services should be strengthened to address the most common forms of cannabis used by students. There was also need to initiate prevention and interventions of drug use in primary and secondary levels so as to address the root cause of the problem and students who are affected should be identified and supported through guidance and counselling. Lastly, there is need to introduce compulsory courses that reflect new emerging trends of drug use in institutions of higher learning. Keywords : Guidance and counselling, commonly used forms, cannabis, university students DOI: 10.7176/DCS/13-3-01 Publication date: May 31 st 2023

Cannabis and mental health: Prevalence of use and modes of cannabis administration by mental health status

Background: Whilst many studies have linked increased drug and cannabis exposure to adverse mental health (MH) outcomes their effects on whole populations and geotemporospatial relationships are not well understood.MethodsEcological cohort study of National Survey of Drug Use and Health (NSDUH) geographically-linked substate-shapefiles 2010–2012 and 2014–2016 supplemented by five-year US American Community Survey. Drugs: cigarettes, alcohol abuse, last-month cannabis use and last-year cocaine use. MH: any mental illness, major depressive illness, serious mental illness and suicidal thinking. Data analysis: two-stage, geotemporospatial, robust generalized linear regression and causal inference methods in R.Results410,138 NSDUH respondents. Average response rate 76.7%. When drug and sociodemographic variables were combined in geospatial models significant terms including tobacco, alcohol, cannabis exposure and various ethnicities remained in final models for all four major mental health outcomes. Interactive terms including cannabis were related to any mental illness (β-estimate = 1.97 (95%C.I. 1.56–2.37), P < 2.2 × 10− 16), major depressive episode (β-estimate = 2.03 (1.54–2.52), P = 3.6 × 10− 16), serious mental illness (SMI, β-estimate = 2.04 (1.48–2.60), P = 1.0 × 10− 12), suicidal ideation (β-estimate = 1.99 (1.52–2.47), P < 2.2 × 10− 16) and in each case cannabis alone was significantly associated (from β-estimate = − 3.43 (− 4.46 − −2.42), P = 3.4 × 10− 11) with adverse MH outcomes on complex interactive regression surfaces. Geospatial modelling showed a monotonic upward trajectory of SMI which doubled (3.62 to 7.06%) as cannabis use increased. Extrapolated to whole populations cannabis decriminalization (4.26%, (4.18, 4.34%)), Prevalence Ratio (PR) = 1.035(1.034–1.036), attributable fraction in the exposed (AFE) = 3.28%(3.18–3.37%), P < 10− 300) and legalization (4.75% (4.65, 4.84%), PR = 1.155 (1.153–1.158), AFE = 12.91% (12.72–13.10%), P < 10− 300) were associated with increased SMI vs. illegal status (4.26, (4.18–4.33%)).ConclusionsData show all four indices of mental ill-health track cannabis exposure across space and time and are robust to multivariable adjustment for ethnicity, socioeconomics and other drug use. MH deteriorated with cannabis legalization. Cannabis use-MH data are consistent with causal relationships in the forward direction and include dose-response and temporal-sequential relationships. Together with similar international reports and numerous mechanistic studies preventative action to reduce cannabis use is indicated.

Serious psychological distress and higher associations with tobacco and cannabis use among college students in the United States

Objective:Cannabis legalization may impact both cannabis and tobacco use, given the high prevalence of co-use (including blunt use) among young adults (YAs) in the United States. The objective of this descriptive ecological study was to examine trends in YA cannabis and tobacco use from 2002-2018 in states that passed adult and medical use (AMU) or medical use only (MUO) cannabis laws during that time (N = 16).Method:Using data from the National Survey on Drug Use and Health, we conducted a segmented regression analysis to calculate absolute percent change in past 30-day cannabis, blunt, cigarette, and cigar use between time points. We descriptively compared points of slope inflection with key legalization dates.Results:All states showed a decline in YA cigarette smoking over time, a slight decline in cigar smoking, and increases in cannabis and blunt use. Cannabis use increased following opening of MUO retail outlets and, in several states, increased following adult use law implementation and/or opening of retail outlets. For example, in Maine, cannabis use plateaued after a MUO law was adopted (2009) until about 1-2 years after retail outlets opened (2011), when YA cannabis use increased by 22.4% (95% CI: 19.0, 29.4) and continued increasing steadily after adult use was adopted (2017).Conclusions:Cannabis and blunt use increased more in states where AMU laws were in place compared to those with MUO laws, though causality was not assessed. Varying trends may correlate with cannabis policies, tobacco policies and other political, economic, or social factors at the state level.

Cannabis use among adolescents and emerging adults who use e-cigarettes: Findings from an online, national U.S. Sample

The Epidemiology of DSM-5 Cannabis Use Disorders Among U.S. Adults: Science to Inform Clinicians Working in a Shifting Social Landscape.