Abstract
ObjectiveOver the past decade, cannabis use has become increasingly popular in states that include Colorado. During this time, alcohol use disorders (AUDs) and alcohol-related medical conditions have also been consistently recognized as public health problems with increasing prevalence in the state. Despite the widespread use of cannabis in Colorado, the epidemiology of cannabis use among those with AUDs has been poorly described. Therefore, we sought to examine cannabis use among individuals with likely AUDs and individuals with low-risk alcohol use during a time of major Colorado legislative changes before and after legalization of recreational cannabis in 2012.MethodsThis study was a secondary data analysis conducted with information from 303 participants (80% male) in the Denver, CO metropolitan enrolled between August 2007 and April 2016 for studies related to alcohol and lung health. Of these participants, 188 (62%) were completing inpatient alcohol detoxification with likely AUDs. All participants completed the Alcohol Use Disorder Identification Test (AUDIT) to establish their likelihood of an AUD, and all had information on current cannabis use assessed by questionnaire and urine toxicology testing.ResultsIndividuals with likely AUDs more commonly used cannabis compared to control participants (42% vs 27%, p = 0.007). In multiple logistic regression analyses, participant type (likely AUD versus control), tobacco smoking, and age were significantly associated with cannabis smoking; however, the year of participant enrollment was not. Adjusted odds for cannabis use among participants with likely AUDs were 2.97 (1.51–5.82), p = 0.002, while odds for cannabis use among tobacco smokers were 3.67 (1.94–6.93), p < 0.0001. Among control participants, tobacco smoking increased odds of cannabis use seven-fold.ConclusionsOur findings highlight the exceptionally high odds of cannabis use among individuals with likely AUDs undergoing alcohol detoxification at a Colorado treatment facility before and after legalization of recreational cannabis. Targeted investigations into the medical and psychiatric consequences of combined alcohol and cannabis use are urgently needed to define its health impact in these vulnerable individuals.
Highlights
As cannabis legislation has rapidly evolved in the United States, cannabis’ acceptability and use have increased steadily
All participants completed the Alcohol Use Disorder Identification Test (AUDIT) to establish their likelihood of an alcohol use disorders (AUDs), and all had information on current cannabis use assessed by questionnaire and urine toxicology testing
In multiple logistic regression analyses, participant type, tobacco smoking, and age were significantly associated with cannabis smoking; the year of participant enrollment was not
Summary
As cannabis legislation has rapidly evolved in the United States, cannabis’ acceptability and use have increased steadily. Some studies indicating deleterious health outcomes from cannabis use have emerged, the evidence remains sparse (Lee and Hancox 2011; Committee on the Health Effects of Marijuana 2017; Pletcher et al 2012). Both alcohol (Mayfield et al 2013; Moss and Burnham 2006) and cannabinoids (Cabral et al 2015) possess potent immunomodulatory effects, but their combined effects on health are not well understood. Data collected during 2013–2014 revealed that over 60% of adults reported alcohol consumption within the past month, and 6.9% were diagnosed with alcohol abuse or dependence (SAMHSA 2014) based on Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV definitions During this same period, cannabis use was reported in 16.80% of Colorado adults older than 26 years in the prior year, an increase from 10.73% in 2003 (SAMHSA 2014). In recently sober patients with AUDs, continued cannabis use was associated with fewer days of alcohol abstinence (Subbaraman et al 2017), while use of cannabis for medical indications has been linked to less problem drinking (Subbaraman and Kerr 2018)
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