Daily Cannabis Use Research Articles

Adaptive Treatment for Youth With Substance Use and Depression: Early Depression Response and Short-term Outcomes.

To investigate prevalence and predictors of early depression response (EDR) in adolescents with substance use and depression receiving cognitive-behavioral therapy (CBT) for substance use and to test the efficacy of supplemental CBT targeting depression (CBT-D) for non-EDR adolescents in an adaptive treatment approach. At 2 sites, 95 youths (ages 14-21, mean [SD]= 17.4 [1.8]) with alcohol or cannabis use and depressive symptoms received up to 12 sessions of CBT for substance use over 14 weeks. Assessments were at baseline and weeks 4, 9, and 14. The Children's Depression Rating Scale-Revised was the primary depression measure, with a reduction of 50% or more on this scale at week 4 defining EDR. The primary substance use outcomes of alcohol use, heavy alcohol use, and cannabis use frequency were assessed via interview report on the Alcohol Consumption Questionnaire and the Drug Checklist. Urinalysis provided a secondary measure of cannabis use. Non-EDR adolescents were randomly assigned to supplemental CBT-D or enhanced treatment as usual (ETAU). Thirty-five adolescents (37%; 95% CI, 27%-47%) demonstrated EDR. Fewer days of cannabis use (odds ratio 0.977; 95% CI, 0.961-0.992) and absence of conduct disorder (odds ratio 0.149; 95% CI, 0.031-0.716) predicted EDR. Frequency of drinking (F1,82= 11.09, η2= 0.119, p= .001), heavy drinking (F1,82= 19.91, η2= 0.195, p< .0001), and cannabis use (F1,220= 35.01, η2= 0.137, p< .001) decreased over time for EDR, CBT-D, and ETAU adolescents, with EDR adolescents evidencing earlier lower cannabis use (F2,220= 4.16, η2= 0.036, p= .0169). Negative (clean) urine screens increased over time (F1,219= 5.10, η2= 0.023, p= .0249). Comparison of CBT-D and ETAU indicated that depression significantly decreased over time in both groups (F1,48= 64.20, η2= 0.572, p< .001), with no advantage for CBT-D. Approximately one-third of adolescents with substance use and depression attain EDR during substance use treatment. Less frequent cannabis use facilitates depression response. The relatively small sample may have precluded identification of additional EDR predictors. Treatment for Teens With Alcohol Abuse and Depression; https://clinicaltrials.gov/; NCT02227589.

Comparing a mindfulness- and CBT-based guided self-help Internet- and mobile-based intervention against a waiting list control condition as treatment for adults with frequent cannabis use: a randomized controlled trial of CANreduce 3.0

BackgroundThough Internet- and mobile-based interventions (IMIs) and mindfulness-based interventions (generally delivered in-situ) appear effective for people with substance use disorders, IMIs incorporating mindfulness are largely missing, including those targeting frequent cannabis use.MethodsThis paper details the protocol for a three-arm randomized controlled trial comparing a mindfulness-based self-help IMI (arm 1) and cognitive-behavioral therapy (CBT)-based self-help IMI (arm 2) versus being on a waiting list (arm 3) in their effectiveness reducing cannabis use in frequent cannabis users. Predictors of retention, adherence and treatment outcomes will be identified and similarities between the two active intervention arms explored. Both active interventions last six weeks and consist of eight modules designed to reduce cannabis use and common mental health symptoms. With a targeted sample size of n = 210 per treatment arm, data will be collected at baseline immediately before program use is initiated; at six weeks, immediately after program completion; and at three and six months post baseline assessment to assess the retention of any gains achieved during treatment.The primary outcome will be number of days of cannabis use over the preceding 30 days. Secondary outcomes will include further measures of cannabis use and use of other substances, changes in mental health symptoms and mindfulness, client satisfaction, intervention retention and adherence, and adverse effects. Data analysis will follow ITT principles and primarily employ (generalized) linear mixed models.DiscussionThis RCT will provide important insights into the effectiveness of an IMI integrating mindfulness to reduce cannabis use in frequent cannabis users.Trial registrationInternational Standard Randomized Controlled Trial Number Registry: ISRCTN14971662; date of registration: 09/09/2021.

Characteristics of adults with a medical cannabis license, reasons for use, and perceptions of benefit following medical cannabis legalization in Oklahoma

Little is known about the risks and benefits associated with medical cannabis legalization. The current study was an online panel survey of adult Oklahomans recruited between September and October 2020 (N = 1898). Respondents with and without a medical cannabis license were compared on sociodemographic, substance use and health characteristics, and sub-analyses focused on the characteristics of licensed and unlicensed past 30-day cannabis users. Among all participants, 19.34% (n = 367) reported that they had a medical cannabis license, and 35.73% (n = 676) reported past 30-day cannabis use. Licensees were more likely to be younger (i.e., 18–35 years of age; p = 0.001), identify as a sexual minority (p < 0.001), and report past 30-day cannabis, cigarette, alcohol, and prescription opiate use (all p’s ≤ 0.003). Licensed participants most commonly reported medically-recommended cannabis use for anxiety (42.51%), depression (33.24%), sleep problems (26.98%), chronic pain (24.25%), and arthritis (12.81%). The likelihood of medically-recommended cannabis use for anxiety, depression, and chronic pain differed by age group (all p’s ≤ 0.028). Licensees were most likely to perceive that cannabis delivered “very much/extreme” relief from anxiety (78.57%), sleep problems (76.30%), nausea/vomiting (70.00%), and depression (67.05%). Compared to licensed past 30-day cannabis users (n = 308), unlicensed users (n = 368) were more likely to be non-White, to have ≤ high school education, to report an annual household income <$30,000, and to report current smoking (all p’s ≤ 0.027). Findings provide initial information about the personal characteristics associated with having a medical cannabis license in Oklahoma, the reasons for medical cannabis use, and the perceived medical benefits.

Daily cannabis use during the novel coronavirus disease (COVID-19) pandemic in Canada: a repeated cross-sectional study from May 2020 to December 2020

BackgroundDaily cannabis use is most strongly implicated in the cannabis-attributable burden of disease. In the context of the novel coronavirus disease (COVID-19) pandemic in Canada, we characterized trends in daily cannabis use in the overall sample and various population subgroups, and examined risk characteristics associated with daily cannabis use.MethodsA cross-sectional design was operationalized using data from six waves of a national, online survey of adults residing in Canada who spoke English (N = 6,021; May-08 2020 to December-01 2020). Trends were characterized using the Cochran-Armitage test and risk characteristics were identified using chi-square test and logistic regression analysis.ResultsDaily cannabis use in the overall sample remained stable (5.34% – 6.10%; p = 0.30). This pattern of findings extended to various population subgroups as well. The odds of daily cannabis use were higher for those who: were males (Odds Ratio; 95% Confidence Interval: 1.46; 1.15 – 1.85), were between 18 – 29 years (2.36; 1.56 – 3.57), 30 – 39 years (2.65; 1.93 – 3.64) or 40–49 years (1.74; 1.19 – 2.54), self-identified as white (1.97; 1.47 – 2.64), had less than college or university completion (1.78; 1.39 – 2.28), engaged in heavy episodic drinking (2.05; 1.62 – 2.61), had a job that increased the risk of contracting COVID-19 (1.38; 1.01 – 1.88), experienced loneliness 5–7 days in the past week (1.86; 1.26 – 2.73) and felt very worried (2.08; 1.21 – 3.58) or somewhat worried (1.83; 1.11 – 3.01) about the pandemic’s impact on their financial situation.ConclusionsDaily cannabis use did not change in the overall sample or various population subgroups during the pandemic. Pandemic-related risks and impacts were associated with daily cannabis use.

Adverse childhood experiences and past 30-day cannabis use among middle and high school students: The protective influence of families and schools

Exposure to adverse childhood experiences (ACEs) is a risk factor for adolescent cannabis use (CU). We explored whether family communication and school connectedness can offer direct protection (the compensatory model of resiliency) or moderating protection (the protective factors model of resiliency).Using cluster random sampling, a Youth Risk Behavior Survey (YRBS) was conducted with 5,341 middle school and 4,980 high school students in 2019. Generalized estimating equations were used to estimate whether family communication and school connectedness offered independent direct protection (multiple regression) or moderating protection (multiplicative interaction) in the relationship between ACEs and past 30-day CU. Adjusted prevalence ratios (APR) and 95% confidence intervals (95% CI) were calculated.There was a graded relationship between ACEs and past 30-day CU for all students that was particularly strong among middle school students: 1 ACE (APR = 2.37, 95% CI = 2.16, 2.62), 2 ACEs (APR = 2.89, 95% CI = 2.60, 3.23), 3 ACEs (APR = 5.30, 95% CI = 4.75, 5.90), 4 + ACEs (APR = 7.86, 95% CI = 7.13, 8.67). Results supported the compensatory model of resiliency with both family communication (middle school APR = 0.90, 95% CI = 0.88, 0.93; high school APR = 0.90, 95% CI = 0.87, 0.93) and school connectedness (middle school APR = 0.76, 95% CI = 0.72, 0.79; high school APR = 0.72, 95% CI = 0.68, 0.77) demonstrating a direct, independent protective relationship with past 30-day CU. There was no consistent evidence supporting the protective factors resiliency model.

Cannabinoid and substance relationships of European congenital anomaly patterns: a space-time panel regression and causal inferential study.

With reports from Australia, Canada, USA, Hawaii and Colorado documenting a link between cannabis and congenital anomalies (CAs), this relationship was investigated in Europe. Data on 90 CAs were accessed from Eurocat. Tobacco and alcohol consumption and median household income data were from the World Bank. Amphetamine, cocaine and last month and daily use of cannabis from the European Monitoring Centre for Drugs and Drug Addiction. Cannabis herb and resin Δ9-tetrahydrocannabinol concentrations were from published reports. Data were processed in R. Twelve thousand three hundred sixty CA rates were sourced across 16 nations of Europe. Nations with a higher or increasing rate of daily cannabis use had a 71.77% higher median CA rates than others [median ± interquartile range 2.13 (0.59, 6.30) v. 1.24 (0.15, 5.14)/10 000 live births (P = 4.74 × 10−17; minimum E-value (mEV) = 1.52]. Eighty-nine out of 90 CAs in bivariate association and 74/90 CAs in additive panel inverse probability weighted space-time regression were cannabis related. In inverse probability weighted interactive panel models lagged to zero, two, four and six years, 76, 31, 50 and 29 CAs had elevated mEVs (< 2.46 × 1039) for cannabis metrics. Cardiovascular, central nervous, gastrointestinal, genital, uronephrology, limb, face and chromosomalgenetic systems along with the multisystem VACTERL syndrome were particularly vulnerable targets. Data reveal that cannabis is related to many CAs and fulfil epidemiological criteria of causality. The triple convergence of rising cannabis use prevalence, intensity of daily use and Δ9-tetrahydrocannabinol concentration in herb and resin is powerfully implicated as a primary driver of European teratogenicity, confirming results from elsewhere.

Associations of cannabis retail outlet availability and neighborhood disadvantage with cannabis use and related risk factors among young adults in Washington State

BackgroundThis study examined associations of local cannabis retail outlet availability and neighborhood disadvantage with cannabis use and related risk factors among young adults. MethodsData were from annual cross-sectional surveys administered from 2015 to 2019 to individuals ages 18–25 residing in Washington State (N = 10,009). As outcomes, this study assessed self-reported cannabis use at different margins/frequencies (any past year, at least monthly, at least weekly, at least daily) and perceived ease of access to cannabis and acceptability of cannabis use in the community. Cannabis retail outlet availability was defined as the presence of at least one retail outlet within a 1-kilometer road network buffer of one’s residence. Sensitivity analyses explored four other spatial metrics to define outlet availability (any outlet within 0.5-km, 2-km, and the census tract; and census tract density per 1000 residents). Census tract level disadvantage was a composite of five US census variables. ResultsAdjusting for individual- and area-level covariates, living within 1-kilometer of at least one cannabis retail outlet was statistically significantly associated with any past year and at least monthly cannabis use as well as high perceived access to cannabis. Results using a 2-km buffer and census tract-level metrics for retail outlet availability showed similar findings. Neighborhood disadvantage was statistically significantly associated with at least weekly and at least daily cannabis use and with greater perceived acceptability of cannabis use. ConclusionsResults may have implications for regulatory and prevention strategies to reduce the population burden of cannabis use and related harms.

School-related Promotive Factors Related to Cannabis Use Among American Indian Adolescents.

Reservation-dwelling American Indian adolescents are at exceedingly high risk for cannabis use. Prevention initiatives to delay onset and escalation of use are needed. School engagement and student's positive experiences at school have been identified as key promotive factors against cannabis use in the general population of adolescents, but little work has examined these factors among American Indian youth. Seven school-related promotive factors were examined as predictors of past 30-day cannabis use (measured 6 months later), controlling for previous onset of cannabis use as well as a set of relevant potential confounders. Models were tested using 280 adolescents in 6th or 7th grade at the start of the study from two reservation-based schools in the US. Students were surveyed three times, with 6 months in between each survey. The average age at the start of the study was 11.99 years (SD = 0.87) and 54% of participants were female. Using a cumulative logit model to predict past 30-day use, American Indian youth who reported greater school bonding, academic aspirations, proclivity to endeavor in their studies, and interest in school at Wave 2 reported less 30-day cannabis use at Wave 3 (controlling for onset of cannabis at Wave 1 and several other control variables). No evidence of an effect of self-reported grades, perceived safety, or participation in school-related extracurricular activities was found. Given substantial deterioration of these school-related promotive factors over time, and the effect of the school-related promotive factors on subsequent cannabis use, efforts to design and test interventions to promote school engagement as a protective measure against cannabis use is warranted.

Role of Mental Health in the Association Between E-Cigarettes and Cannabis Use

E-cigarette use may be associated prospectively with subsequent cannabis use among U.S. adolescents. However, it remains unclear whether this association differs by individual mental health status. This longitudinal study examines effect modifications by mental health status. The first 4 waves (2013-2017) of the Population Assessment of Tobacco and Health study were analyzed in 2020. Adolescents (aged 12-17 years) who reported never using cannabis at baseline waves were included. Waves 1-3 were each considered as baseline for their 12-month follow-up waves. Generalized estimating equations were used to evaluate the effect modification of internalizing mental health and externalizing mental health problems on the associations between baseline past 30-day e-cigarette use and past 30-day cannabis use at follow-up, controlling for individual characteristics and state recreational cannabis laws. Baseline e-cigarette use was significantly associated with cannabis use at follow-up (AOR=4.81, 95% CI=2.93, 7.90). Adolescents with high severity of internalizing mental health/externalizing mental health problems were significantly more likely to initiate cannabis use. However, current e-cigarette users who reported high severity of internalizing mental health symptoms were less likely to initiate cannabis use (AOR=2.51, 95% CI=0.92, 6.83) than those who reported low severity of internalizing mental health problems (AOR=8.84, 95% CI=4.19, 18.65). There were no differences by the severity of externalizing mental health problems. Baseline e-cigarette use and endorsement of severe internalizing mental health/externalizing mental health problems were significantly associated with subsequent cannabis use among U.S. adolescents. Efforts to reduce youth vaping and improve youth mental health could help curb cannabis initiation. Tailored interventions may be warranted for e-cigarette‒using adolescents with internalizing mental health problems.

E-cigarette, cannabis and combustible tobacco use: associations with xerostomia among California adolescents.

Xerostomia (subjective experience of dry mouth), while less common in younger populations, can contribute to caries and oral discomfort. Use of e-cigarettes and cannabis among adolescents is increasing and may be a xerostomia risk factor. This study evaluates xerostomia prevalence in an adolescent population, overall and by e-cigarette, cannabis and combustible tobacco use. Cross-sectional analyses of 12-month follow-up data (N=976; collected 2020-2021) from a cohort of adolescents recruited from public high schools in Northern California (USA) compared self-reported past 30-day e-cigarette, cannabis and other tobacco use and dry mouth (overall dry mouth experience; shortened xerostomia inventory, SXI). Dry mouth experience (never, occasionally, frequently/always) was modelled using ordered logistic regression with school-level clustering and adjustment for gender, race/ethnicity, alcohol use, asthma, physical activity and mutually for e-cigarette, cannabis and tobacco use. Past 30-day use prevalence was 12% for e-cigarettes, 16% for cannabis and 3% for combustible tobacco. Occasional dry mouth experience (54%) was more common than frequent/always experience (5%). Frequent/always dry mouth was more prevalent among frequent (>5days/month) e-cigarette (14%) and cannabis (19%) users and combustible tobacco users (19%) than non-users of those respective products (all comparisons p<0.001). In covariable-adjusted models, frequent e-cigarette use was no longer significantly associated with dry mouth experience (OR: 1.40; 95% CI: 0.69, 2.84), while frequent cannabis use (OR: 3.17; 95% CI: 1.47, 6.82) and combustible tobacco use (OR: 1.92; 95% CI: 1.38, 2.68) were associated with greater odds of reporting more frequent dry mouth. Findings were qualitatively similar using the SXI. In this study, xerostomia was not independently associated with e-cigarette use but was one potential health concern of adolescent cannabis and combustible tobacco use.

Effects of cocaine and/or heroin use on resting cardiovascular function

BackgroundRegular cocaine and/or heroin use is associated with major health risks, especially cardiovascular disease, but confounded by other factors. We examined effects of chronic (years regular use) and recent (past-month) cocaine and heroin use, controlling for other factors, on resting cardiovascular function. MethodsIn a sample of 292 cocaine and/or heroin users, we assessed demographics, body mass index (BMI), substance use history, electrocardiogram, heart rate (HR) and blood pressure (BP). Three-block (1: demographics, BMI; 2: tobacco, alcohol, cannabis; 3: cocaine, heroin) regression analyses were conducted to predict cardiovascular measures. ResultsHigher BMI predicted increased systolic and diastolic BP (as did older age), increased supine HR, and longer QRS duration, QTc interval, PR interval, and P-wave duration. Past-month cannabis-use days predicted higher systolic BP, lower supine HR, and greater likelihood of early repolarization and ST elevation; average daily cannabis use predicted shorter QTc interval. Average daily alcohol use predicted higher diastolic BP, higher supine HR and lower likelihood of sinus bradycardia (HR < 60 bpm). Past-month tobacco-use days predicted shorter QTc interval and lower lower likelihood of profound bradycardia (HR < 50 bpm). Past-month heroin-use days predicted lower seated HR, greater likelihood of sinus bradycardia and lower likelihood of left ventricular hypertrophy. More years of regular cocaine use and past-month cocaine-use days predicted longer QTc interval. ConclusionsCocaine and heroin use incrementally predicted modest variance in resting bradycardia and QTc interval. Clinicians should first consider demographics and recent use of tobacco, alcohol and cannabis before assuming cocaine and heroin affect these measures.

Sociodemographic Characteristics Associated With and Prevalence and Frequency of Cannabis Use Among Adults in the US

Cannabis use has increased, but there are few studies on frequent and daily cannabis use among US adults. Individuals who engage in higher frequency use may suffer more health consequences. To examine frequency of cannabis use and associated factors among US adults. This survey study included data from 21 US states and 2 US territories reported in the Behavioral Risk Factor Surveillance System surveys from 2016 to 2019. Cross-sectional data on US adults ages 18 years and older were used to estimate demographic, socioeconomic, and behavioral risk factors for cannabis use, taking into account the survey strata and sampling weights for the 4 years of combined data. Using a multivariable ordinal logistic analysis, the association of demographic, socioeconomic status, and behavioral risk factors with past month cannabis frequency were examined. Sociodemographic characteristic, ie, age, gender, race and ethnicity, educational attainment, employment status, and annual household income. Ordinal categorization of number of days of cannabis use in the past 30 days in terms of nonuse, infrequent use (1-5 days), frequent use (6-29 days), and daily use. Among the 387 179 respondents, 58 009 (27.9%) were ages 18 to 34 years, 186 923 (50.3%) were ages 35 to 64 years, and 142 225 (21.8%) were age 65 years or older (mean [SD] age, 48.3 [0.1] years). The sample included 28 345 (9.8%) Black, 36 697 (22.6%) Hispanic, and 292 210 (57.3%) White respondents. Smoking was the most common form of cannabis use. The frequency of cannabis use varied significantly by age, gender, race, marital status, education, and employment. Higher frequency cannabis use was associated with younger age (ages 18-34 years: adjusted odds ratio [aOR],4.12; 95% CI, 3.63-4.68; ages 35-64 years: aOR,2.22; 95% CI, 1.98-2.49), Black (aOR, 1.46; 95% CI, 1.33-1.71) and Native American (aOR, 1.25; 95% CI, 1.04-1.52) race, and less educational attainment (high school or less: aOR,1.09; 95% CI, 1.02-1.17; some college: aOR,1.27; 95% CI, 1.19-1.35). Being married (aOR, 0.54; 95% CI, 0.51-0.58) or identifying as Asian (aOR, 0.60; 95% CI, 0.51-0.71) or Hispanic (aOR, 0.71; 95% CI, 0.65-0.77) was associated with lower-frequency cannabis use after accounting for other baseline factors. This nationally based study found that higher-frequency cannabis use is more common among young and racial minority populations, as well as respondents with low socioeconomic status. Given the known and emerging negative health effects of cannabis use, more attention may need to be paid to high-frequency use among underserved populations in the form of screening, risk stratification, and treatment.

Cigarette dependence is more prevalent and increasing among US adolescents and adults who use cannabis, 2002–2019

SignificanceCannabis use is increasing among cigarette smokers. If cannabis use is associated with cigarette dependence, a barrier to smoking cessation, this could have public health implications for tobacco control. The...

The Cannabis-Dependent Relationship Between Methadone Treatment Dose and Illicit Opioid Use in a Community-Based Cohort of People Who Use Drugs.

Background: Methadone maintenance treatment (MMT) is an effective treatment for opioid use disorder. However, subtherapeutic dosing may lead to continued opioid use by failing to suppress opioid withdrawal and craving. Preclinical and pilot experimental research suggests that cannabinoids may reduce opioid withdrawal and craving. We sought to test whether the association between low methadone dose and illicit opioid use differs according to concurrent cannabis use patterns. Methods: Data for this study were derived from two community-recruited cohorts of people (≥18 years old) who use illicit drugs in Vancouver, Canada. We used generalized estimating equations to estimate the adjusted association between lower daily MMT dose (<90 mg/day) and daily illicit opioid use, testing for interaction between dose and daily cannabis use. Results: Between December 2005 and December 2018, 1389 participants reported MMT enrolment and were included in the study. We observed a significant interaction (p<0.01) between daily cannabis and lower MMT dose on concurrent daily illicit opioid use: lower MMT doses increased the odds of daily illicit opioid use by 86% (adjusted odds ratio [AOR]=1.86, 95% confidence interval [CI]=1.61-2.16) during periods of no or low-frequency cannabis use and by 30% during periods of daily cannabis use (AOR=1.30, 95% CI=1.01-1.67). Discussion: This study provides preliminary observational evidence that cannabis may mitigate some of the negative effects of subtherapeutic MMT dosing, guiding future clinical investigations into the safety and efficacy of cannabis and cannabinoids as adjunct treatment for MMT.

Abstract 14284: "Weeding" Out Wellens' Syndrome

Introduction: Wellens’ syndrome, most often associated with proximal left anterior descending coronary artery stenosis, is considered highly specific for impending myocardial infarction (MI). Its diagnosis relies on symmetric biphasic or deeply inverted T waves in leads V1-V4, normal precordial R wave progression and normal to slightly elevated cardiac markers. Pseudo-Wellens’ syndrome presents similarly, but in the absence of coronary artery disease (CAD). We present a challenging case of a patient with history of excessive recreational cannabis use and incidental electrocardiogram (ECG) findings concerning for Wellens’ syndrome who ultimately was diagnosed with Pseudo-Wellens’ syndrome. With familiarity of cannabis associated Pseudo-Wellens’ syndrome, unnecessary invasive diagnostic and therapeutic procedures were avoided. Case: A 20 year old male without significant past medical history presented for evaluation of vomiting and abdominal pain of 2 days duration. In view of his daily cannabis use, he was diagnosed with cannabis hyperemesis syndrome. An ECG to measure QTc prior to administration of ondansetron demonstrated ST elevation in lead V2. A repeat ECG showed T-wave inversions in leads V2-4. Troponin levels were negative. The patient denied chest pain or shortness of breath. An echocardiogram showed normal cardiac wall motion and an estimated ejection fraction of 55-60%. The diagnosis of Pseudo-Wellens’ syndrome secondary to cannabis use was made and the patient was subsequently discharged home following extensive cannabis cessation counseling. Discussion: The definitive treatment of Wellens’ Syndrome relies on cardiac catheterization even in patients without cardiac history or risk factors for CAD. This immediate intervention is required to halt the evolution of MI and is crucial for a positive outcome. In contrast, Pseudo-Wellens’ syndrome occurs in the absence of CAD and has been reported in younger, healthy patients in association with illicit drug use. In the era of increased legalized marijuana use, it is imperative that health care providers are familiar with cannabis induced Pseudo-Wellens’ syndrome as to avoid the potential for inappropriate invasive diagnostic modalities in otherwise healthy individuals.

Trends in cannabis use among U.S. adults amid the COVID-19 pandemic.

BackgroundThe COVID-19 pandemic has had an impact on mental health and alcohol use in the US, however there is little research on its impacts on cannabis use. Considering the role of cannabis as a coping strategy or self-medicating behavior, there is a need to understand how individuals who use cannabis have adapted their use amid the pandemic. Therefore, this study examined changes in self-reported cannabis use among US adults in the context of COVID-19 pandemic by (1) describing trends of use during the first 8 months of the pandemic among adults who used cannabis in this period; and (2) characterizing trends of use within sociodemographic subgroups and by state cannabis policy status.MethodsThe sample consisted of 1,761 US adults who used cannabis at least once during the 8-month study period from the nationally representative Understanding America Study. Linear mixed-effect models were used to model changes in the number of days of past-week cannabis use across 16 waves from March 10, 2020, to November 11, 2020.ResultsCompared to early March, the number of days cannabis was used per week was significantly higher at the start of April (β=0.11, 95% CI=0.03, 0.18) and May (β=0.21,95% CI=0.05, 0.36). In subsequent months (June - November), the number of days of cannabis use attenuated to levels comparable to March. Trends of cannabis use across the study period generally did not differ across sociodemographic characteristics and state cannabis policy status.ConclusionThough increases in use were marginal among many groups, the evolving pandemic and the growing concern for the mental health of segments of the U.S. population warrant close monitoring of coping behaviors, including substance use.

43.7 Sex-Based Differences in Clinical Profiles and Cannabis Abstinence in Adolescents Receiving Combination Treatment for ADHD and Comorbid Cannabis Use Disorder

Recent studies indicate sex-based differences in clinical presentation and treatment response for both ADHD and cannabis use disorders (CUDs). Given the high rate of comorbidity of ADHD and CUD, the present study sought to investigate whether sex differences are present in adolescents (ages 13-18 years) with co-occurring ADHD and CUD. This post hoc analysis examined sex-based differences in baseline clinical profiles, cannabis abstinence, and ADHD and substance use disorder (SUD) treatment outcomes in 271 adolescents (19% female, mean age = 16.5 years) meeting DSM-IV criteria for ADHD and comorbid CUD. The sample represents a subset of participants from a 16-week multisite randomized controlled trial of osmotic-release methylphenidate (OROS-MPH) + CBT vs placebo + CBT for the treatment of ADHD and nontobacco SUD (CTN-0028). Compared to males, females with ADHD and CUD had lower self-reported ADHD symptoms and higher global functioning measured via Children's Global Assessment Scale (CGAS) scores at baseline. Both males and females showed significant reductions in days of cannabis use and ADHD symptoms following treatment. There was no evidence of differential improvement in ADHD and nontobacco/noncannabis substance use outcomes with treatment, with persistent sex differences in ADHD symptoms and CGAS scores. Female participants showed greater reductions in cannabis use compared to males, but these differences did not reach statistical significance (eg, reduction in days of cannabis use: –12.0 vs –9.4 days; p = 0.07; end-of-treatment cannabis abstinence: 35% vs 25%; p = 0.13). Sex-based differences in the severity of ADHD symptoms and global functioning are present in adolescents with ADHD and comorbid CUD and largely persist during OROS-MPH + CBT treatment. Identifying overlapping and distinct mechanisms of behavioral change in males and females with co-occurring ADHD and CUD may guide sex-specific and sex-shared intervention development.

Reactivity to Daily Self-Monitoring of Cannabis Use in Biological Females.

Assessment reactivity involves changes to behaviours from self-monitoring those behaviours (Nelson & Hayes, 1981). In the substance use field, reactivity has been identified both as a potential confound in daily diary research (Cohn et al., 2015) and as a possible intervention tool in clinical practice (Cohn et al., 2018). Reactivity to daily self-monitoring of alcohol and tobacco use has been inconsistent in prior research. Reactivity to daily self-monitoring of cannabis use quantity has received far less study. This study involved secondary analyses of data from N = 88 females who self-monitored their cannabis use for 32 days. We examined objective reactivity of cannabis use to daily self-monitoring by assessing changes in daily cannabis use over 32 days. We also explored participants' perceptions of the impact daily self-monitoring had on their cannabis use at study completion (i.e., subjective reactivity). In hurdle models testing objective reactivity, neither probability of cannabis use, nor quantity of cannabis use, changed significantly over the study period. Many respondents (45%) reported no subjective reactivity, though a slight majority (55%) reported some subjective reactivity. Subjective reactivity did not moderate objective reactivity over time; however, higher subjective reactivity was significantly associated with increased variability (interquartile range [IQR]) in cannabis use across the self-monitoring period. Overall, reactivity appears unlikely to confound research utilizing daily diary cannabis measures, and daily self-monitoring of cannabis use may be unlikely to serve as a useful stand-alone intervention for reducing cannabis use in non-treatment-seeking individuals. Potential clinical implications of the novel finding of a link between subjective reactivity and objective cannabis use variability are discussed.

Effects of Risk Perception and Accessibility on Cannabis Use among Young Population in Spain: Findings from the 2016 National Survey (ESTUDES)

Background Cannabis use in the young population has undergone a significant increase in Europe. Empirical assessments of individual and contextual mediating variables in relation to cannabis use are informative for prevention actions and have yet to be conducted in Spain. Objectives: This study used the 2016 National Survey on Drug Use in Secondary Education in Spain (ESTUDES) to inform on potentially relevant cannabis prevention targets. We examined individual variables (sex, age, and cannabis risk perception), past 30-day legal and illicit substance use, substance-free activities, and contextual factors (perceived accessibility to cannabis) associated to past 30-day cannabis use. Methods: Data were drawn from 35,369 adolescents (% females: 50.1). Structural equation modeling (SEM) was implemented to identify predictors of cannabis use, and indirect paths were tested via bootstrapping to examine the mediating effects of cannabis risk perception and accessibility. Results: Demographics (male sex, higher age), and past 30-day tobacco, alcohol, and illicit substance use were associated with past 30-day cannabis use. Frequency of past-year engagement in hobbies and reading did also predict past 30-day cannabis use. The mediators worked on most of the relationships examined, except for hobbies and illegal substance use in the case of accessibility and reading and hobbies in the case of risk perception. Conclusions/importance: Cannabis use is more likely to emerge in the event of low risk perception and high accessibility. Lower frequency of past year reading and higher engagement in some hobbies that are often carried out alone represent risk factors, which could potentially influence prevention programs.

Drinking less on cannabis use days: The moderating role of UPPS-P impulsive personality traits.

Objective: Several studies suggest that alcohol and cannabis co-users are heavier drinkers and experience more alcohol-related consequences. However, day-level associations between co-use and drinking levels are mixed. One reason may be that individual characteristics moderate the daily impact of using alcohol alone or in conjunction with cannabis. The theory would suggest that highly impulsive individuals may drink more on co-use days, yet this assertion remains untested. Therefore, the current study tested whether impulsivity moderated the effect of co-use on same-day drinking quantity within veterans, a high-risk sample for substance use and impulsivity. Method: In a longitudinal observational study, co-using veterans (N = 139) completed three semi-annual assessments reporting on their daily drinking quantity and cannabis use via Timeline Followback (Observations = 19,245) and impulsivity via the UPPS-P. Mixed effect modeling was used to test hypotheses that co-use (compared to alcohol-only) days would be associated with heavier drinking for those high (but not low) in positive and negative urgency. Results: Significant interactions were found for positive urgency (PU) and lack of perseverance (LP), such that individuals at mean and low levels of PU and LP drank less on co-use (compared to alcohol-only) days. There were no significant interactions for other UPPS-P impulsivity facets. Conclusion: Findings are consistent with a substitution/compensatory effect for individuals at mean and low levels of both UPPS-P facets, and may be a byproduct of frequent cannabis use in veterans. In contrast, findings suggest that co-use and alcohol-only days may be characterized by similarly high levels of drinking for highly impulsive individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).