Long\u2010Acting Naltrexone Restores Network Connectivity in Subjects With Comorbid Cannabis and Opioid Use Disorder

Co-morbid substance use disorders (SUDs) are common but difficult to study due to the complex, interacting, and overlapping mechanisms through which they affect brain networks. Many datasets collected to investigate a specific SUD include participants with co-morbid SUDs. While most studies treat comorbid SUDs as covariates of no interest, these covariates also contain untapped information. This is particularly relevant as cannabis use disorder (CanUD) has become increasingly prevalent and co-morbid with other SUDs that have been more thoroughly studied. While treatments have been established for multiple SUDs, none have been approved for CanUD, although naltrexone (NTX) has been associated with reduced use. Here, we conducted a retrospective secondary analysis of functional magnetic resonance imaging (fMRI) data from individuals with primary opioid use disorder (OUD) with co-morbid CanUD, alcohol use disorder (AUD), or cocaine use disorder (CocUD), while controlling for opioid use. All participants underwent imaging prior to receiving a therapeutic dose of long-acting intramuscular NTX (Vivitrol®), an approved treatment for OUD and AUD but not for CocUD, and again two weeks post-administration. At baseline, OUD individuals with co-morbid CanUD, AUD, or CocUD exhibited distinct functional connectivity (FC) alterations compared to those with OUD-only. These differences were greater in younger participants and primarily involved the default mode network. Following NTX administration, FC differences between the co-morbid CanUD and OUD-only groups globally diminished. A similar FC response to NTX was observed in the parietal, subcortical, sensory, and cerebellar networks in the co-morbid AUD group. In contrast, little change in FC was observed in co-morbid CocUD. These findings, combined with prior evidence that NTX reduces cannabis use by dampening the experience of reward, suggest NTX may hold promise as a treatment for CanUD.

Association between cannabis use disorder symptom severity and probability of clinically-documented diagnosis and treatment in a primary care sample

Outcomes from a computer-assisted intervention simultaneously targeting cannabis and tobacco use

The authors compared the risk of mental disorders between patients with cannabis use disorder (CUD) and those with other substance use disorders (SUDs). The TriNetX Research Network was queried to identify patients with SUDs and no preceding mental disorders and compare 1) adult patients with CUD only versus those with other SUDs, 2) pediatric patients with CUD only versus those with other SUDs, and 3) adult patients with CUD plus another SUD versus those with comorbid noncannabis SUDs. Propensity score matching was performed on demographic characteristics and 24 risk factors or comorbidities. Subsequent diagnosis of schizophrenia and other common mental disorders was assessed. Compared to adults with other SUDs, those with noncomorbid CUD (N=345,903 for both cohorts) had a lower risk of schizophrenia (0.34% vs. 0.42%; relative risk [RR]=0.81, 95% CI=0.75, 0.88), depression (1.35% vs. 1.74%; RR=0.78, 95% CI=0.75, 0.81), and psychotic disorders (0.36% vs. 0.52%; RR=0.68, 95% CI=0.63, 0.73). Compared to pediatric patients with other SUDs, those with CUD (N=24,793 for both cohorts) had a higher risk of schizophrenia (0.29% vs. 0.19%; RR=1.52, 95% CI=1.06, 2.19), depression (1.65% vs. 1.27%; RR=1.30, 95% CI=1.13, 1.51), and anxiety disorders (8.13% vs. 6.71%; RR=1.21, 95% CI=1.14, 1.29). Compared to adult patients with other SUDs, those with CUD and a comorbid SUD (N=203,916 for both cohorts) had a decreased risk of schizophrenia (1.94% vs. 2.25%; RR=0.86, 95% CI=0.83, 0.90), depression (3.98% vs. 5.67%; RR=0.70, 95% CI=0.68, 0.72), bipolar disorder (4.23% vs. 5.60%; RR=0.76, 95% CI=0.74, 0.78), and anxiety disorders (16.20% vs. 21.36%; RR=0.76, 95% CI=0.75, 0.77). CUD-associated mental health risks varied by age and comorbid SUDs, possibly due to earlier onset of mental disorders in cannabis users or age-related differences in CUD effects.

Poster Abstracts from the AAAP 20th Annual Meeting and Symposium

Complementary and integrative health approaches such as meditation have become popular in recent years, and there is a growing interest in using these self-care practices to alleviate stress and anxiety. These mindfulness-based practices, often described as “mind and body” practices, have a long history of use for increasing calmness and physical relaxation, improving psychological balance, coping with illness, and enhancing overall health and well-being. In recent years, mindfulness-based practices have been examined within the framework of psychology and neuroscience. There is an increasing understanding of the cognitive processes and neurobiological mechanisms underlying these practices. Working with the general principles of meditative practices, treatment involving the fostering of mindfulness has been used to address the practical needs of patients with substance use disorder (SUD). From a cannabis use disorder (CUD) perspective, many symptoms associated with cannabis withdrawal such as irritability, anger, or depression; nervousness or anxiety; and restlessness or depressed mood may be improved or ameliorated through meditative practices. While little research has directly examined the efficacy of contemplative, meditative practices for CUD, mindfulness-based approaches have shown some success when applied to the treatment of substance abuse and addiction. This chapter focuses on approaches involving mindfulness-based contemplative, meditative practices, as well as their origin, conceptual framework, neurobiological mechanism of action, and application to the treatment and prevention of CUD and, more broadly, SUD.

Young adult cannabis use disorder treatment admissions declined as past month cannabis use increased in the U.S.: An analysis of states by year, 2008–2017

IntroductionAlcohol and cannabis use disorders are the most frequent comorbid substance use disorders (SUDs) among patients with eating disorders (EDs). EDs and SUDs involving alcohol and cannabis are independently associated with excess mortality.ObjectivesTo investigate the impact of comorbid alcohol use disorder (AUD) and cannabis use disorder (CUD) on mortality in anorexia nervosa (AN), bulimia nervosa (BN), and unspecified eating disorder (USED) compared with matched control subjects.MethodsThis retrospective cohort study was conducted using Danish nationwide registers. The risk of mortality among ED patients with/without AUD and/or CUD was compared to matched control subjects with/without AUD and/or CUD using hazard ratios (HRs).ResultsOf the 20,759 included ED patients, 4.7% and 4.3% had AUD and CUD, respectively. The corresponding figures for the 83,036 control subjects were 1.0% (AUD) and 1.3% (CUD). ED patients without SUDs exhibited an increased risk of mortality compared to control subjects without SUDs (adjusted HR 2.9, P<.001). Mortality risk was higher among ED patients with AUD (adjusted HR 11.8, P<.001) or CUD (adjusted HR 4.6, P<.001) compared to control subjects without AUD/CUD. In addition, patients with AN, BN, and USED, who had comorbid AUD and/or CUD, exhibited an elevated risk of mortality compared to control subjects without AUD/CUD (AN: adjusted HR 11.3, P<.001; BN: adjusted HR 5.9, P<.001; USED: adjusted HR 10.9, P<.001).ConclusionsComorbid AUD and/or CUD increase mortality risk in patients with EDs. In order to reduce mortality in ED patients, prevention and treatment of AUD and CUD is important.DisclosureNo significant relationships.

Integrated cognitive behavioral therapy for cannabis use and anxiety disorders: Rationale and development

State medical cannabis laws, currently in place in 39 states and Washington, DC, provide an avenue for therapeutic use of cannabis to manage chronic noncancer pain stemming from conditions such as arthritis and low back pain. These laws may also influence cannabis and opioid addiction and overdose, for example, if people substitute cannabis in place of opioids to manage pain. No studies, to our knowledge, have examined how state medical cannabis laws influence health care use related to addiction to or overdose from cannabis or opioids among people with chronic noncancer pain. We used a difference-in-differences design and augmented synthetic control analyses comparing changes in cannabis use disorder (CUD) and opioid use disorder (OUD) treatment and cannabis and opioid overdose-related health care use before and after medical cannabis law implementation among Medicare beneficiaries with chronic noncancer pain in seven states (Florida, Maryland, Minnesota, New Hampshire, New York, Oklahoma, and Pennsylvania) relative to changes in outcomes over the same period in 17 comparison states (Alabama, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Mississippi, Nebraska, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Virginia, Wisconsin, and Wyoming) without medical cannabis laws. State medical cannabis laws had an estimated average effect of less than 0.005 percentage points on the overall proportion of patients receiving any CUD or OUD treatment, less than 0.009 percentage points on the proportion of patients newly initiating CUD or OUD treatment, and less than 0.0005 percentage points on the proportion of patients receiving overdose-related health care for cannabis or opioid overdoses (p > 0.05 for all findings). Our study did not identify effects of state medical cannabis laws on health care use related to CUD or OUD treatment or overdose among Medicare beneficiaries younger than age 65 years with chronic noncancer pain.

ABSTRACTBackground: Despite cannabis being the most widely used illicit substance in the United States, individuals diagnosed with cannabis use disorder (CUD) have few well-researched, affordable treatment options available to them. Although found to be effective for improving treatment outcomes in other drug populations, exercise is an affordable and highly accessible treatment approach that has not been routinely investigated in cannabis users. Objectives: The aim of this paper is to inform the topic regarding exercise’s potential as an adjunctive treatment for individuals with CUD. Methods: We reviewed the evidence surrounding cannabis use and its current treatment in the United States, explored the rationale for including exercise in the treatment of substance use disorders (SUDs), and in particular, proposed a biological mechanism (i.e., endocannabinoids (eCBs)) that should be examined when utilizing exercise for the treatment of CUD. Results: Cannabis use is widespread and increasing in the United States. Chronic, heavy cannabis use may dysregulate the endogenous cannabinoid system, which has implications for several psychobiological processes that interact with the eCB system such as reward processing and the stress response. Given that exercise is a potent activator of the eCB system, it is mechanistically plausible that exercise could be an optimal method to supplement cessation efforts by reducing psychophysical withdrawal, managing stress, and attenuating drug cravings. Conclusion: We suggest there is a strong behavioral and physiological rationale to design studies which specifically assess the efficacy of exercise, in combination with other therapies, in treating CUD. Moreover, it will be especially important to include the investigation of psychobiological mechanisms (e.g., eCBs, hippocampal volume), which have been associated with both exercise and SUDs, to examine the broader impact of exercise on behavioral and physiological responses to treatment.

Associations of cannabis use, use frequency, and cannabis use disorder with violent behavior among young adults in the United States

Comorbid Cannabis Use Disorder with Major Depression and Generalized Anxiety Disorder: A Systematic Review with Meta-analysis of Nationally Representative Epidemiological Surveys

ObjectiveTo determine the impact of cannabis use disorder (CUD) on the inpatient outcomes of attention deficit hyperactivity disorder (ADHD) in adolescentsBackgroundPrevious studies have evaluated the impact of CUD on the health-related quality of life in ADHD patients.MethodsWe used the nationwide inpatient sample (NIS) from the Healthcare Cost and Utilization Project (HCUP) from years 2010­–2014. We identified ADHD and cannabis use (CU) as the primary and the other diagnosis, respectively, using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD­9–­CM) codes. We used the binomial logistic regression model to generate adjusted odds ratios (aOR).ResultsWe analyzed a total of 11,232 ADHD adolescent hospital admissions from years 2010–2014; of these, 1.79% had CUD. The mean age of adolescents was 14.1 years (SD = 1.79). The prevalence of CUD was highest in ADHD adolescents of 15-18 years (73%) and common in the white race (71%). A higher proportion of ADHD with CUD was transferred to acute care hospitals and skilled/other nursing facilities (5.4% and 7.4% vs. 1.1% and 2.6%, respectively, p-value < 0.001). CUD increases the risk of inpatient charges > $12,247 (median) by 0.6 times (aOR = 1.835; p-value = 0.002) and increases the risk of inpatient stay > 5 days (median) by 0.7 times (aOR = 2.099; p-value < 0.001). The utilization of psychotropic medications was reduced by 0.8 times in ADHD with CUD adolescents by 0.8 times (aOR = 0.448; p-value = 0.017), and the implication of behavioral therapy in the management of ADHD with CUD adolescents was reduced by 0.9 times (aOR = 0.412; p-value = 0.048). Also, there is a 2.8 times higher risk of comorbid alcohol abuse in ADHD with CUD adolescents (aOR = 17.141; p-value < 0.001).ConclusionThe increased risk of substance use is a long-term implication of ADHD in adolescents. It has been determined that comorbid CUD in patients with ADHD not only increases the risk of acute inpatient care but also prolongs the inpatient stay, thus increasing the healthcare cost. Surprisingly, comorbid CUD decreases the utilization of psychotropic medications and behavioral therapy in ADHD. Another major issue is the higher risk of comorbid alcohol abuse in ADHD with CUD adolescents. Further exploration with randomized controlled studies would be required to support and highlight the growing issue of cannabis use among adolescents with ADHD.

Aims/backgroundAs cannabis use continues to increase in the United States, racialized stereotypes and structural barriers to care might lead to inequitable treatment uptake across racialized groups. A greater understanding of racial disparities in cannabis treatment uptake and perceived treatment need among people with cannabis use disorder (CUD) in community-based samples is needed.MethodsNationally representative data from the 2002–2019 National Survey on Drug Use and Health (N=1,005,421) included community-based people ages 12+ First, we assessed trends in CUD (i.e., meeting 2+ DSM-5 proxy CUD criteria) by racialized group. Among people with CUD (n=48,768), weighted logistic models regressed any CUD treatment, specialty CUD treatment, and perceived need for CUD treatment on racialized group and year, adjusting for age, gender, education, insurance, and criminal legal system exposure. We use interaction terms to examine group-specific trend differences.ResultsOverall, 2.64% of the US population ages 12+ had CUD, including 2.47% of white, 1.23% of AAPI (Asian American and Pacific Islander), 4.83% of AIAN (American Indian and Alaska Native), 3.70% of Black, and 2.71% of Hispanic people. CUD increased slightly across all groups (overall annual OR: 1.01, 95% CI =1.01,1.02), with AAPI, Hispanic and people with more than one race seeing steeper increases (ORs: 1.02-1.04). Treatment use and perceived need decreased consistently and there were no group differences in these trends across racialized groups with CUD (ORs: 0.93-0.97). Black people with CUD had 21% lower odds of any treatment than white people (aOR: 0.79, 95% CI=0.65, 0.95). All racialized groups (except AAPI people) had higher odds of perceived need than white people (aORs: 1.59–1.73).ConclusionAlthough all racialized groups had increasing CUD and decreasing CUD treatment use during the study period, the observed racialized disparities also persisted. For example, despite a higher prevalence of CUD among Black people compared to white people, Black people with CUD were less likely than their white counterparts to receive treatment and more likely to report perceived need. These disparities in CUD, treatment use, and perceived need underscore the need for CUD-related services overall and tailored services for racialized minorities, and especially Black people.