Criteria For Cannabis Dependence Research Articles

Face validity of the ICD-10 criteria of substance abuse and dependence for patients prescribed cannabis-based medicines for chronic pain-A survey of pain medicine physicians in Canada, Germany and Israel.

A major concern with cannabis-based medicines (CbM) and medical cannabis (MC) is the risk of abuse and dependence. The face validity of the International Classification of Diseases (ICD-10) criteria for cannabis dependence in patients prescribed CbM for chronic pain has not been assessed. Physicians from Canada, Germany and Israel were recruited via the mailing lists of national pain societies. To be eligible, physicians had to have prescribed CbM for chronic pain treatment in the past 12 months. Participants were asked to rate the appropriateness of items adapted from the substance use module of the Composite International Diagnostic Interview Version 3.0 to assess dependence in the context of chronic pain treatment with CbM and the appropriateness of two additional items. In case of disagreement, participants were asked to give reasons. Furthermore, they were asked to suggest potential additional criteria. On average 69.0% of 178 participating physicians indicated agreement with the appropriateness of the ICD-10 criteria, while 20.6% indicated disagreement. The highest disagreement rate was observed for the item on repeated use despite legal problems (35.4% disagreement or strong disagreement). Reasons for disagreement were summarized into six content categories using qualitative methods of analysis. Additional criteria suggested by participants were summarized into 10 content categories. A collaboration of psychiatrists and pain physicians is required to define criteria and develop instruments to capture abuse and dependence of CbM in chronic pain patients. Sixty-nine per cent of 178 pain medicine physicians in Canada, Germany and Israel who participated in a survey on the appropriateness of the ICD-10 criteria for cannabis abuse and dependence for patients prescribed cannabis-derived products for chronic pain assessed the criteria as appropriate, whereas 20.6% deemed the criteria as not appropriate.

17. The impact of preoperative cannabis on outcomes following cervical spinal fusion: a propensity score-matched analysis

BACKGROUND CONTEXT Cannabis is the most commonly used illicit drug in the United States with 4 million Americans meeting clinical criteria for cannabis dependence or abuse in 2015. With recent state-level legalization efforts and changing public perception, its use is expected to grow. Considering these changes and the reported medicinally beneficial effects, studies evaluating cannabis use and its impact on outcomes following cervical fusion (CF) are quite limited; further detailed study is warranted. PURPOSE This study sought to identify if adverse outcomes, such as complications, readmissions, and revisions, are comparable between cannabis users and noncannabis users undergoing CF. We compared 90-day complication and readmission rates and 2-year revision rates between baseline cannabis users and nonusers following CF. STUDY DESIGN/SETTING Retrospective cohort study of a prospectively collected database. PATIENT SAMPLE All patients who underwent CF between January 2009 and September 2013 in the New York Statewide Planning and Research Cooperative System (SPARCS) were identified. Patients were included if they had ≤90-day follow-up for complications and readmissions, or ≥2-year follow-up for revisions. Patients with a preoperative ICD-9-CM diagnosis of cannabis abuse (Cannabis) or dependence were identified. Patients were excluded for systemic disease, osteomyelitis, cancer, trauma, or concomitant substance or polysubstance abuse/dependence. OUTCOME MEASURES Demographic information, fusion approach, fusion levels, complications, readmissions, and revisions. METHODS All patients aged ≥18y who underwent CF from 2009-13 were identified via the SPARCS database and included if they had ≤90D follow-up for complications and readmissions or 2Y follow-up for revisions. Pts with preoperative cannabis abuse/dependence identified (Cannabis). Pts were excluded for systemic disease, osteomyelitis, cancer, trauma, or concomitant substance or polysubstance abuse/dependence. Following patient selection in the SPARCS database, Cannabis patients were 1:1 propensity score-matched by age, gender, race, Deyo score, fusion levels and approach, and tobacco use to nonusers (Non-Cannabis). These groups were compared for hospital-related parameters, rates of 90-day complications and readmissions, and 2-year revisions. Multivariate binary stepwise logistic regression models identified independent predictors of these outcomes. RESULTS A total of 432 pts (n=216 each) were identified, with comparable age, sex, Deyo scores, tobacco use rates, and distribution of anterior or posterior approach (all p>0.05). Cannabis patients were more frequently African American (27.8% vs 12.0%), primarily utilized Medicaid (29.6% vs 12.5%), and incurred longer lengths of stay (3.0 vs 1.9 days), all p≤0.001. Both cohorts experienced comparable rates of 90-day medical, surgical and overall complications (5.6% vs 3.7%) and 2-year revisions (4.3% vs 2.8%), p≤0.430. Cannabis users experienced higher 90-day readmission rates (11.6% vs 6.0%, p=0.042). Cannabis use was an independent predictive factor of 90-day readmission (OR=2.0, 95%CI, 1.0-4.1, p=0.049), but did not predict any 90-day complications or 2-year revisions (all p>0.05). CONCLUSIONS Baseline cannabis dependence/abuse was associated with increased 90-day readmission odds following CF. Further investigation of the physiologic impact of cannabis on musculoskeletal patients may identify what measurable or overlooked patient factors contribute to this association. FDA DEVICE/DRUG STATUS Unavailable from authors at time of publication.

Co-Occurrence of Substance-Related and Other Mental Health Disorders Among Adolescent Cannabis Users.

Cannabis is the most commonly used illicit substance in the United States and is increasingly being legalized throughout the United States. Many believe that cannabis is relatively harmless, and some believe that cannabis is not addictive. We wondered what the rates of cannabis abuse and dependence might be among adolescents referred for substance use evaluations and also about the incidence of co-occurring psychiatric illnesses and substance use disorders among those individuals. Herein, we analyze intake data from 483 adolescents referred for evaluation at an adolescent substance abuse clinic, with information gleaned from the adolescents and their parents or caregivers. Forty-seven percent of our sample met the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria for cannabis dependence and another 32% for cannabis abuse. Among adolescents with cannabis use disorders, the co-occurrence of alcohol and opioid abuse or dependence was high. These individuals also suffered from significant psychiatric comorbidities otherwise. Our results show that cannabis use carries the risk of dependence and also carries with it significant risk of comorbidities, both with respect to other substance use disorders and other psychiatric illness. Given the growing body of research linking cannabis use with addiction and other psychiatric illness, public health efforts ought to center on the potential dangers of cannabis use.

Sociodemographic and Drug Use Characteristics of Treatment-seeking Cannabis Users at a Tertiary Care Center in India

Background: Cannabis is a common drug of abuse that has got some religious and social sanction in India. It is often perceived as relatively harmless compared with other substances. The rate of treatment seeking is low among its users. Objective: To describe the sociodemographic and drug use profile of treatment-seeking cannabis users visiting a tertiary care center in northern India. Methods: A retrospective chart review was conducted over a period of 1 year for cannabis-dependent subjects who sought treatment and underwent laboratory investigations. Results: A total of 51 subjects fulfilled the DSM-IV-TR criteria for cannabis dependence. All subjects were male with mean age of 28±10.2 years. Among them, 37.3% subjects started substance use before 15 years of age. Although 94% subjects were literate, only 33.3% were employed and 82% were socioeconomically poor. Majority of the subjects initiated substance use with smokable tobacco (66.7%). Cannabis was the initial substance among 15% subjects. Among all 64.7% subjects were comorbid opioid dependent and 58.9% subjects were seeking treatment for the same. Ganja was the most common form of cannabis used (66.7%). Health risk due to cannabis was known to 35.3% subjects, 47% never made any abstinent attempt. Cannabis-related complication was present in 84.37% subjects. Conclusions: Treatment-seeking cannabis users are mostly codependent on other substances that become the main reason for their treatment-seeking. Despite high rate of cannabis-related complications, awareness about its health-risk, treatment seeking, and attempt to abstain remains low.

Cannabis Dependence and Peer Selection in Social Networks of Frequent Users

In a Dutch longitudinal study on the dynamics of cannabis dependence, at baseline 600 frequent cannabis users (? 3 days cannabis use per week in past 12 months) aged 18–30 years were interviewed. Nearly half of all participants (42%) met DSM-IV criteria for cannabis dependence in the 12 months prior to the interview. Participants were recruited by respondent-driven sampling; referrals were understood as proxy for social networks to explore peer associations and social exclusion. Analyses revealed that networks of frequent cannabis users were mostly heterogeneous. Cannabis dependence did not emerge as a main selector. However, within segments of networks some clustering of cannabis dependence (indicating differential inclusion), sex and ethnicity was found. Methodological questions are discussed regarding the applicability of respondent-driven sampling in noninjecting, nonmarginalized drug users. The study's limitations are noted.

Cannabis Dependence in Swiss Adolescents

This naturalistic cross-sectional study explores how and to what extent cannabis dependence was associated with intrapersonal aspects (anxiety, coping styles) and interpersonal aspects of adolescent functioning (school status, family relationships, peer relationships, social life). A convenience sample of 110 adolescents (aged 12 to 19) was recruited and subdivided into two groups (38 with a cannabis dependence and 72 nondependent) according to DSM-IV-TR criteria for cannabis dependence. Participants completed the State-Trait Anxiety Inventory (STAI-Y), the Coping Across Situations Questionnaire (CASQ), and the Adolescent Drug Abuse Diagnosis (ADAD) interview investigating psychosocial and interpersonal problems in an adolescent’s life. Factors associated with cannabis dependence were explored with logistic regression analyses. The results indicated that severity of problems in social life and peer relationships (OR = 1.68, 95% CI = 1.21 – 2.33) and avoidant coping (OR = 4.22, 95% CI = 1.01 – 17.73) were the only discriminatory factors for cannabis dependence. This model correctly classified 84.5% of the adolescents. These findings are partially consistent with the “self-medication hypothesis” and underlined the importance of peer relationships and dysfunctional coping strategies in cannabis dependence in adolescence. Limitations of the study and implications for clinical work with adolescents are discussed.

Is There Evidence for Symptoms of Cannabis Withdrawal in the National Epidemiologic Survey of Alcohol and Related Conditions?

We examined the prevalence of 20 individual symptoms of cannabis withdrawal in the U.S. general population. More than 29% of past 12-month cannabis users reported experiencing at least two cannabis withdrawal symptoms, with 8% reporting impairment from at least two symptoms or withdrawal relief. The most common withdrawal symptom was eating more than usual/gaining weight. Co-occurring tobacco use modestly increased the likelihood of reporting certain symptoms, as did other illicit drug use, though to a lesser degree. Even after controlling for intensity of cannabis use, a history of parental alcohol/drug problems was associated with an increased likelihood of experiencing cannabis withdrawal. Evidence from this and prior studies demonstrating withdrawal strongly suggest that future editions of DSM need to reconsider the exclusion of withdrawal from criteria for cannabis dependence.

Linkage scan for quantitative traits identifies new regions of interest for substance dependence in the Collaborative Study on the Genetics of Alcoholism (COGA) sample

Dependence on alcohol and illicit drugs frequently co-occur. Results from a number of twin studies suggest that heritable influences on alcohol dependence and drug dependence may substantially overlap. Using large, genetically informative pedigrees from the Collaborative Study on the Genetics of Alcoholism (COGA), we performed quantitative linkage analyses using a panel of 1717 SNPs. Genome-wide linkage analyses were conducted for quantitative measures of DSM-IV alcohol dependence criteria, cannabis dependence criteria and dependence criteria across any illicit drug (including cannabis) individually and in combination as an average score across alcohol and illicit drug dependence criteria. For alcohol dependence, LOD scores exceeding 2.0 were noted on chromosome 1 (2.0 at 213 cM), 2 (3.4 at 234 cM) and 10 (3.7 at 60 cM). For cannabis dependence, a maximum LOD of 1.9 was noted at 95 cM on chromosome 14. For any illicit drug dependence, LODs of 2.0 and 2.4 were observed on chromosome 10 (116 cM) and 13 (64 cM) respectively. Finally, the combined alcohol and/or drug dependence symptoms yielded LODs >2.0 on chromosome 2 (3.2, 234 cM), 10 (2.4 and 2.6 at 60 cM and 116 cM) and 13 (2.1 at 64 cM). These regions may harbor genes that contribute to the biological basis of alcohol and drug dependence.

Negative consequences associated with dependence in daily cannabis users.

BackgroundCannabis is the most widely consumed illicit substance in America, with increasing rates of use. Some theorists tend to link frequency of use with cannabis dependence. Nevertheless, fewer than half of daily cannabis users meet DSM-IV-TR criteria for cannabis dependence. This study seeks to determine whether the negative aspects associated with cannabis use can be explained by a proxy measure of dependence instead of by frequency of use.ResultsOver 2500 adult daily cannabis users completed an Internet survey consisting of measures of cannabis and other drug use, in addition to measures of commonly reported negative problems resulting from cannabis use. We compared those who met a proxy measure of DSM-IV-TR criteria for cannabis dependence (N = 1111) to those who did not meet the criteria (N = 1770). Cannabis dependent subjects consumed greater amounts of cannabis, alcohol, and a variety of other drugs. They also had lower levels of motivation, happiness, and satisfaction with life, with higher levels of depression and respiratory symptoms.ConclusionAlthough all of our subjects reported daily use, only those meeting proxy criteria for cannabis dependence reported significant associated problems. Our data suggest that dependence need not arise from daily use, but consuming larger amounts of cannabis and other drugs undoubtedly increases problems.