Concomitant Use Of Cannabis Research Articles

Concomitant cannabis abuse/dependence in patients treated with opioids for non-cancer pain.

Cannabis use is common among patients taking prescription opioids, although rates of concomitant cannabis use disorder (CUD) have been largely unexamined. CUD may increase safety risks in those taking opioid pain medications but it is unknown whether cannabis and opioids function as substitutes (cannabis use is associated with less prescription opioid use), or rather as complements (cannabis is associated with increased use of prescription opioids). We examined rates of CUD in a national sample of Veterans Health Administration (VHA) patients (n = 1,316,464) with non-cancer pain diagnoses receiving opioid medications in fiscal year 2012. Using bivariate analysis to identify potentially confounding variables associated with CUD (e.g., psychotropic medication, other substance use disorders) in this population, we then utilized logistic regression to examine rates of cannabis use disorder among individuals receiving different numbers of opioid prescriptions (0, 1-2, 3-10, 11-19, 20+). Descriptive analysis, largely confirmed by logistic regression, demonstrated that greater numbers of prescription opioid fills were associated with greater likelihood of CUD. This relationship was reduced somewhat for those receiving the most opioid prescriptions (20+) in the logistic regression, which controlled for potentially confounding variables. These results warrant increased attention to CUDs among patients receiving numerous opioid prescriptions. Increasing legalization of cannabis is likely to further increase use and abuse of cannabis in patients prescribed opioids. These findings suggest that clinicians should be alert to concomitant CUD and prescription opioid use, as these substances appear to complement each other.

Medical Cannabis and Chronic Opioid Therapy

ABSTRACTFourteen states and the District of Columbia have legalized the use of cannabis for medical purposes. A small, high-quality literature supports the efficacy of medical cannabis for the treatment of neuropathic pain. The smoked botanical product, however, is associated with a number of adverse medical and psychiatric consequences. Furthermore, experimental data indicate that acute use of cannabis results in impairment of every important metric related to the safe operation of a motor vehicle. Epidemiological data show associations between recent cannabis use and both psychomotor impairment and motor vehicle crashes, associations that are strengthened by the concomitant use of alcohol and other central nervous system depressants. Finally, data from pain clinics reveals an unusually high prevalence of cannabis use in nearly all age groups and an association between cannabis use and opioid and other substance misuse. Based on available data and expert opinion, concomitant use of cannabis and opioids is an absolute contraindication to the operation of a motor vehicle. In patients who use cannabis and are prescribed opioids, heightened vigilance for opioid- and other substance-related problems is warranted. It is appropriate to refrain from prescribing opioids to individuals using medical cannabis if there is reasonable suspicion that the combination will pose a risk to the patient or others.

Pattern of cannabis use in ecstasy polydrug users: moderate cannabis use may compensate for self‐rated aggression and somatic symptoms

Cannabis is one of the most common 'co-drugs' for ecstasy users. The aim of the present study was to explore self-reported psychobiological problems in ecstasy polydrug users in relation to their pattern of cannabis use. Two hundred and eighty ecstasy polydrug users were allocated into five cannabis groups according to the frequency of their cannabis use. The control group comprised 121 alcohol-tobacco users. There were no significant group differences with regard to age, diagnosed family psychiatric history and level of self-rated stress experienced during 6 months prior to the study. The present study produced three main findings: (a) Ecstasy users with no concomitant use of cannabis displayed more self-rated aggression and somatic symptoms compared with ecstasy users who were smoking cannabis on a monthly or weekly basis. (b) Ecstasy users who reported heavy cannabis use in the past displayed higher paranoid symptoms compared with ecstasy weekly and daily cannabis users. (c) Former heavy cannabis users were the most likely to complain of a variety of ecstasy related long-term problems. In conclusion, moderate cannabis use may help to ameliorate or mask MDMA-induced aggressivity and somatic symptoms. However, this study confirms that heavy cannabis and ecstasy use is associated with several psychobiological problems, which may emerge after a period of abstinence from both drugs.

Self-reported psychopathological symptoms in recreational ecstasy (MDMA) users are mainly associated with regular cannabis use: further evidence from a combined cross-sectional/longitudinal investigation.

3,4-Methylenedioxymethamphetamine (MDMA, ecstasy) has become a widely used recreational drug among young people. This is of great concern, since MDMA is neurotoxic in animal studies and its use has been associated with psychological distress and a variety of self-reported psychiatric symptoms. However, exploring the origins of psychopathology in ecstasy users is hampered by the frequent polydrug use and by the cross-sectional design of all investigations, so far. The present study combines a cross-sectional with a longitudinal approach to further clarify the impact of the use of other illicit drugs on psychopathological symptoms reported by ecstasy users. At baseline, we administered self-rating scales for impulsivity, sensation seeking and general psychological complaints to 60 recreational ecstasy users and 30 matched controls. From the initial sample of ecstasy users, 38 subjects were re-examined 18 months later. RESULTS. At baseline, ecstasy users reported significantly more psychological complaints than controls. However, self-reported psychopathology was mainly associated with regular cannabis use. At follow-up, subjects who had abstained from ecstasy use during the follow-up period did not differ from those reporting continued consumption. In contrast, subjects with regular concomitant cannabis use during the follow-up period reported more anxiety, interpersonal sensitivity and obsessive-compulsive behaviour than cannabis-abstinent users. Finally, higher levels of obsessive-compulsive behaviour, interpersonal sensitivity, depression, anxiety, phobic anxiety and paranoid ideation were significantly correlated with the duration of regular interim cannabis use. The present findings suggest that self-reported psychopathology in ecstasy users is predominantly attributable to concomitant use of cannabis. Abstinence from cannabis and not ecstasy seems to be a reliable predictor for remission of psychological complaints in ecstasy users.

Neuroendocrine abnormalities in recreational ecstasy (MDMA) users: is it ecstasy or cannabis?

Background: The purpose of this study was to investigate neuroendocrine function in ecstasy (3,4-methylenedioxymethamphetamine = MDMA) users and controls. Methods: Prolactin response to d-fenfluramine was assessed in abstinent ecstasy users with concomitant use of cannabis only ( n = 24, male/female 13/11) and in two control groups: healthy nonusers ( n = 13, female) and exclusive cannabis users ( n = 7, male). Results: Prolactin response to d-fenfluramine was slightly blunted in female ecstasy users. Both male user samples exhibited a weak prolactin response to d-fenfluramine, but this was weaker in the group of cannabis users. Baseline prolactin and prolactin response to d-fenfluramine were associated with the extent of previous cannabis use. Conclusions: Endocrinological abnormalities of ecstasy users may be closely related to their coincident cannabis use. Cannabis use may be an important confound in endocrinological studies of ecstasy users and should be looked for more systematically in future studies.

Psychological profile of abstinent recreational Ecstasy (MDMA) users and significance of concomitant cannabis use.

The popular recreational drug Ecstasy (3,4-methylenedioxymethamphetamine, or MDMA, and related congeners) is neurotoxic upon central serotonergic systems in animal studies. So far, the most convincing evidence for neurotoxicity-related functional deficits in humans derives from neurocognitive studies demonstrating dose-related memory problems in Ecstasy users. The aim of the current investigation was to study the relationship between the psychological profile of recreational Ecstasy users and the patterns of their drug use. Twenty-eight abstinent recreational Ecstasy users with concomitant use of cannabis only and two equally sized, matched groups of cannabis users and non-users were administered standardized self-rating scales for the assessment of psychological problems which are thought to be related to central serotonergic function. Ecstasy users had elevated scores on subscales measuring impulsiveness, anxiety, sensation seeking, somatic complaints, obsessive-compulsive behavior and psychoticism. Higher scores were associated with both heavier Ecstasy and heavier cannabis use. After controlling for cannabis use, most group differences in psychometric scores no longer achieved statistical significance. The present data are in line with other reports demonstrating a broad range of psychological problems in Ecstasy users. However, the concomitant use of other drugs, specifically cannabis, seems to be crucial in this respect. Therefore, compared with cognitive deficits, psychological problems appear to be less suitable functional indices of Ecstasy-related neurotoxic damage of central serotonergic systems in humans. Copyright 2001 John Wiley & Sons, Ltd.

Cognitive performance amongst recreational users of "ecstasy".

Previous work has suggested that memory impairments have been associated with the recreational use of "ecstasy". This previous work, however, has not taken into consideration the additional use of cannabis amongst those examined. Cannabis use has also been associated with memory impairment. There is therefore a clear need to explore the impact of both of these illicit substances upon memory ability. To determine whether recreational use of ecstasy impairs memory and attentional ability and to explore the impact of the concomitant use of cannabis upon these cognitive functions. In addition, an exploration of subjective accounts of cognitive ability was undertaken to determine whether objective impairments were perceived by users in everyday functioning. Cognitive functioning was examined in three groups of young people: 15 regular users of ecstasy; 15 regular users of cannabis who had never taken ecstasy and 15 control subjects who had never taken any illicit substances. The Weschler Memory Scale (revised) and a computerised reaction time task were administered on a day when the subjects claimed to be drug free. In addition, subjects completed a biographical questionnaire and the Cognitive Failures Questionnaire (CFQ) in order to assess subjective accounts of cognitive slips. Performance was similar across all three groups for measures of visual reaction time, auditory reaction time, complex reaction time, visual memory and attention and concentration. Significant impairment was found on measures of verbal memory in both cannabis users and ecstasy users. A significant impairment in performance was found on measures of delayed memory for the ecstasy users compared to both the cannabis group and the control group. Despite these findings, no differences in subjective ratings of cognitive failures were found between the groups. The present study provides additional evidence for longterm neuropsychological sequelae associated with the use of ecstasy, particularly with regard to delayed memory ability.

Impaired cognitive performance in drug free users of recreational ecstasy (MDMA)

OBJECTIVESEcstasy (3,4-methylenedioxymethamphetamine (MDMA) and related congerers: MDA, MDEA) is the name given to a group of popular recreational drugs. Animal data raise concern about neurotoxic effects of high doses of...