Frequency Of Cannabis Use Research Articles

Using ecological momentary assessment to quantify Δ-9-tetrahydrocannabinol and cannabidiol use across different forms of cannabis: Feasibility in a sample of Canadian young adults reporting frequent cannabis use.

To establish the feasibility of using ecological momentary assessment (EMA) to estimate total quantities of Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) used across different forms of cannabis, and to assess the predictive validity of THC estimates for predicting acute cannabis-related consequences. 14-day EMA using a smartphone application to assess cannabis use in real time. Canada. Targeted sample of n = 42 young adults (59.52% women, mean age 25 years) reporting frequent cannabis use. Surveys completed immediately prior to cannabis use assessed the quantities, THC content and CBD content of various forms of cannabis to be used in the current session; participants also uploaded photos of the cannabis product labels when available. Surveys administered at fixed times throughout the day (84.81% completion rate) assessed acute cannabis-related consequences. Participants completed a total of 786 pre-cannabis surveys, of which 79.39% and 77.35% contained sufficient information to calculate total THC and CBD (in milligrams), respectively. High agreement was observed between participant-entered THC and CBD contents and those shown in corresponding photos of cannabis product labels. Aggregating across all products used, participants reported using an average of 141.41 [standard deviation (SD)=224.62, range = 0.00-2000.00] milligrams of THC (i.e. 28.28 standard five-milligram units) and 7.53 (SD = 34.87, range = 0.00-484.22) milligrams of CBD per day. Multilevel models revealed that participants were more likely to report acute negative consequences following sessions when their estimated THC use was higher than their typical THC use. At the between-person level, participants reporting more THC use on average across sessions were less likely to report negative consequences overall. Using ecological momentary assessment to estimate total quantities of Δ-9-tetrahydrocannabinol and cannabidiol used across different forms of cannabis appears to be feasible, with preliminary predictive validity for acute negative cannabis-related consequences.

Age of onset of cannabis use and substance use problems: A systematic review of prospective studies.

The association between the age of cannabis use (CU) onset and substance use (SU) problems has been extensively studied, yet findings remain inconsistent. This systematic review aimed to examine prospective studies on the association between age of CU onset and later SU problems, controlling for key individual, social, and SU-related risk factors. PsycINFO, Web of Science and PubMed were searched for studies published between January 2000 and December 2024. Studies were included if they: 1) were prospective; 2) measured CU onset during adolescence; 3) measured CU or SU problems after CU onset, 4) examined whole plant or phytocannabinoids. Studies were excluded if they exclusively focused on high-risk samples. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies-of Interventions tool. The review was registered with PROSPERO, number CRD42022332092. Sixteen studies met eligibility criteria. Earlier age of CU onset was associated with CU disorder (CUD) and CU negative consequences, with mixed findings for other SU problems (e.g., alcohol). CU frequency accounted for a significant portion of the risk for CU negative consequences, but the association with CUD remained independent of frequency. Only one study had low risk of bias, while seven had some concerns, and eight had a high or very high risk of bias. Findings suggest that early age of CU onset is a specific risk factor in the development of CUD, but not other SU problems. Prevention approaches should aim to delay the onset and reduce the frequency of CU among youth to reduce risk of the development of CUD.

Cannabis use characteristics and associations with problematic use outcomes, quitting-related factors, and mental health among US young adults

ObjectiveGiven the changes in trends of cannabis use (e.g., product types), this study examined latent classes of young adult use and associations with use-related outcomes.MethodsWe analyzed 2023 survey data among 4,031 US young adults (Mage=26.29, 59.4% female, 19.0% Hispanic, 13.5% Black, 13.6% Asian). Among those reporting past-month use (48.8%), latent class analysis (LCA) indicators included: days used (1–5; 6–20; 21–30), use/day (1; 2–4; ≥5), and type usually used (herb/flower; edibles; oils/vape; concentrates/other). Multivariable regressions examined class in relation to problematic use, quitting-related factors, and mental health, controlling for sociodemographics and state non-medical cannabis laws.ResultsLCA identified 4 classes of cannabis use frequency and types used: ‘infrequent-herb/edibles’ (41.4%), ‘frequent-herb’ (16.8%), ‘moderate-herb’ (28.0%), and ‘moderate-oil/other’ (13.8%). In multivariable analyses (referent group: ‘moderate-herb’ class), ‘frequent-herb’ reported less problematic use (B=-0.18, 95%CI=-0.30, -0.07), while ‘moderate-oil/other’ reported greater (B = 0.39, 95%CI = 0.27, 0.51). ‘Infrequent-herb/edibles’ had lower odds of driving post-use of cannabis (aOR = 0.28, 95%CI = 0.22, 0.37) and cannabis/alcohol (aOR = 0.52, 95%CI = 0.35, 0.76), whereas ‘frequent-herb’ (aOR = 1.52, 95%CI = 1.02, 2.28) and ‘moderate-oil/other’ (aOR = 3.98, 95%CI = 2.72, 5.82) reported greater odds of driving post-cannabis/alcohol use. ‘Moderate-oil/other’ reported higher quitting importance (B = 0.59, 95%CI = 0.17, 1.01), while ‘frequent-herb’ reported lower (B=-0.33, 95%CI=-0.99, -0.18). ‘Infrequent-herb/edibles’ reported higher quitting confidence (B = 0.56, 95%CI = 0.20, 0.92), whereas ‘frequent-herb’ (B=-1.01, 95%CI=-1.45, -0.57) and ‘moderate-oil/other’ (B=-1.27, 95%CI=-1.74, -0.81) reported lower. ‘Infrequent-herb/edibles’ reported fewer mental health symptoms (B=-0.55, 95%CI=-0.93, -0.17), while ‘moderate-oil/other’ reported more (B = 1.03, 95%CI = 0.53, 1.52).ConclusionsPreventing frequent and moderate use of cannabis, particularly of oils/concentrates, is crucial given the potential negative implications for problematic use, quitting, and mental health.

Determining the diagnostic cut-off on the Chinese version of severity of dependence scale for cannabis

IntroductionCannabis use and misuse are surging among the Chinese community in East and Southeast Asia. A quick screening instrument that can effectively identify users with dependence for early intervention is in utmost need. This study examined the psychometric properties of the Chinese version of the Severity of Dependence Scale for cannabis (C-SDS-C) in screening for the DSM-5 defined Cannabis Use Disorder (CUD).MethodsA retrospective chart review was conducted on Chinese-speaking individuals reporting cannabis use from three different substance use studies. Their demographic data, frequency of cannabis use within the past 30 days, scorings for the C-SDS-C and the severity of CUD at baseline were analyzed.ResultsThe C-SDS-C exhibited high reliability (Cronbach’s alpha = 0.778). It had a strong correlation with the severity of CUD (r = 0.456, p <.001) and a moderate correlation with the frequency of cannabis use within the past 30 days (r = 0.335, p = .001). All items loaded into a single factor which accounted for 56.64% of the variance. Receiver operating characteristic analysis demonstrated that a C-SDS-C cut-off score of ≥ 3 provided optimal discrimination for moderate to severe CUD among Chinese-speaking individuals using cannabis.ConclusionThe C-SDS-C is a valid and reliable screening instrument to identify cannabis users with moderate-to-severe CUD in the Chinese-speaking population.

Risk thresholds for the frequency of cannabis use during pregnancy and adverse neonatal outcomes: protocol for a systematic review and dose–response meta-analysis

BackgroundCannabis use during pregnancy has been increasing and is associated with adverse neonatal outcomes, such as low birth weight (LBW) and preterm birth (PTB). It remains largely unknown whether the association between cannabis use in pregnancy and increased risk of adverse neonatal outcomes is impacted by the frequency of cannabis use and whether thresholds exist below which risk is not significantly increased. The objective of this systematic review is to assess whether the association between cannabis use during pregnancy and the risk of adverse neonatal outcomes is dependent on the frequency of use and whether risk thresholds exist.MethodsFor this systematic review and dose–response meta-analysis, the Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science databases will be searched for relevant studies published in English from January 2010 onwards. Studies that include pregnant individuals with singleton pregnancies and evaluate the association between cannabis use in pregnancy and adverse neonatal outcomes using case–control, cohort, or cross-sectional designs will be considered for inclusion. Studies must include information on cannabis use frequency reported according to at least three of the pre-defined categories of no use, yearly (1–11 days per year), monthly (1–3 days per month), weekly (1–4 days per week), and daily/near daily use (5–7 days per week). At least one of the following neonatal outcomes must be reported, according to the frequency of cannabis use: LBW (< 1500 g), PTB (before 37 weeks gestation), neonatal intensive care unit (NICU) admission, and mortality. Studies will be included that report results as risk ratios (RR), odds ratios (OR), hazard ratios (HR), or that include the raw data to be able to calculate them. A two-stage dose–response meta-analysis will be conducted. The risk of bias of included studies will be assessed using the JBI tools for cohort, case–control, and cross-sectional studies. Certainty of the evidence will be reported according to the GRADE approach and the review will be reported according to PRISMA guidelines.DiscussionThe frequency of cannabis is one factor that may influence the relationship between cannabis use in pregnancy and adverse neonatal outcomes. This review will quantify this relationship by determining whether risk thresholds exist.Systematic review registrationPROSPERO CRD42023479978.

Polygenic and Polyenvironment Interplay in Schizophrenia-Spectrum Disorder and Affective Psychosis; the EUGEI First Episode Study.

Multiple genetic and environmental risk factors play a role in the development of both schizophrenia-spectrum disorders and affective psychoses. How they act in combination is yet to be clarified. We analyzed 573 first episode psychosis cases and 1005 controls, of European ancestry. Firstly, we tested whether the association of polygenic risk scores for schizophrenia, bipolar disorder, and depression (PRS-SZ, PRS-BD, and PRS-D) with schizophrenia-spectrum disorder and affective psychosis differed when participants were stratified by exposure to specific environmental factors. Secondly, regression models including each PRS and polyenvironmental measures, including migration, paternal age, childhood adversity and frequent cannabis use, were run to test potential polygenic by polyenvironment interactions. In schizophrenia-spectrum disorder vs controls comparison, PRS-SZ was the strongest genetic predictor, having a nominally larger effect in nonexposed to strong environmental factors such as frequent cannabis use (unexposed vs exposed OR 2.43 and 1.35, respectively) and childhood adversity (3.04 vs 1.74). In affective psychosis vs controls, the relative contribution of PRS-D appeared to be stronger in those exposed to environmental risk. No evidence of interaction was found between any PRS with polyenvironmental score. Our study supports an independent role of genetic liability and polyenvironmental risk for psychosis, consistent with the liability threshold model. Whereas schizophrenia-spectrum disorders seem to be mostly associated with polygenic risk for schizophrenia, having an additive effect with well-replicated environmental factors, affective psychosis seems to be a product of cumulative environmental insults alongside a higher genetic liability for affective disorders.

Examining the Relationship Between Cannabis Use and Mood, Anxiety, and Psychotic Symptoms in Psychiatric Patients with Severe Concurrent Mental Health and Substance Use Disorders Before and After Recreational Cannabis Legalization in Canada.

The relationship between cannabis use and mental health has garnered significant attention in recent decades. However, studies have largely been in general populations or in countries in which recreational cannabis use is illegal. The current cross-sectional study examines the relationship between cannabis use, mood disorders, anxiety, and psychosis in an inpatient psychiatric population with severe concurrent mental health and substance use disorders, exploring the potential moderating effect of the legalization of recreational cannabis in Canada. Cannabis use compared to non-use was associated with higher self-reported depression, anxiety, and psychotic symptoms but was not associated with diagnosis of a mood, anxiety, or psychotic disorder. Frequency of cannabis use was unrelated to mental health outcomes, but age of first use was negatively associated with self-reported psychoticism symptoms. There were some significant associations between recreational cannabis legalization and mental health, but legalization was largely unrelated to outcomes. There were also some significant differences by demographics. While findings are relatively consistent with prior literature, some significant associations differed, suggesting the importance of examining concurrent disorder patients as a unique population when examining relationships between cannabis use and mental health.

Correlates of Using Medically-Authorized Cannabis in a Large Cohort of People Living with HIV Who Use Cannabis.

Many people living with HIV (PLWH) use cannabis to manage symptoms, but a large proportion do so without medical cannabis authorization and use cannabis obtained outside the medical stream. In jurisdictions where non-medical cannabis use is legal, PLWH who hold medical cannabis authorization may represent a unique subgroup; yet, research on the correlates of using medical cannabis (authorized by a healthcare provider) in the context of non-medical cannabis legalization is lacking. Thus, this study examined the cannabis- and health-related correlates of medical cannabis use among PLWH in Ontario, Canada, where non-medical cannabis is legal. PLWH (N = 868; 85.37% men, mean age 51.34years [SD = 12.25]) who were enrolled in the Ontario HIV Treatment Network Cohort Study in 2022 and who reported past-year cannabis use completed an assessment of sociodemographic characteristics, HIV-related variables, cannabis and other substance use, and health-related quality of life. Relatively few participants (n = 122; 14.06%) reported any medical cannabis use, with most (n = 746; 85.94%) reporting exclusive use of non-medical cannabis. Logistic regression analyses showed that greater HIV symptom distress, poorer physical-health-related quality of life, more frequent cannabis use, and using smokeless forms of cannabis were each uniquely associated with increased likelihood of using medical cannabis relative to exclusively using non-medical cannabis. Results suggest that even in jurisdictions where non-medical cannabis is legal, a subset of PLWH continue to access cannabis through the medical stream, and these individuals report distinct patterns of cannabis use and poorer physical health. Findings may inform cannabis policy and clinical care for PLWH who use cannabis.

Cannabis use in youth is associated with chronic inflammation.

Markers of inflammation and cannabis exposure are associated with an increased risk of mental disorders. In the current study, we investigated associations between cannabis use and biomarkers of inflammation. Utilizing a sample of 914 participants from the Avon Longitudinal Study of Parents and Children, we investigated whether interleukin-6 (IL-6), tumor necrosis factor α (TNFα), C-reactive protein (CRP), and soluble urokinase plasminogen activator receptor (suPAR) measured at age 24 were associated with past year daily cannabis use, less frequent cannabis use, and no past year cannabis use. We adjusted for a number of covariates including sociodemographic measures, body mass index, childhood trauma, and tobacco smoking. We found evidence of a strong association between daily or near daily cannabis use and suPAR. We did not find any associations between less frequent cannabis use and suPAR. We did not find evidence of an association between IL-6, TNFα or CRP, and cannabis use. Our finding that frequent cannabis use is strongly associated with suPAR, a biomarker of systemic chronic inflammation implicated in neurodevelopmental and neurodegenerative processes is novel. These findings may provide valuable insights into biological mechanisms by which cannabis affects the brain and impacts the risk of serious mental disorders.

Haven't I waited long enough? The role of wait times and subjective impairment in cannabis-related driving behavior

BackgroundDriving under the influence of cannabis (DUIC) poses a significant public health threat. This study explores DUIC through a multifaceted lens, examining correlates of various wait times between cannabis use and driving, subjective perceptions of impairment, and differences between medical and non-medical cannabis users. MethodCross-sectional data from 979 cannabis users in Israel were collected through an online survey. DUIC risk was measured using reported wait times (categorized as low, moderate, and high risk) and driving while feeling cannabis effects. Logistic and multinomial regression identified correlates of DUIC risk. Results23 % of the respondents drove within two hours of use (high risk), 37 % waited 3 to 6 h (moderate risk), and 40 % waited over 7 h (low risk). Multinomial regression showed that being male (RRR = 2.11, p < 0.001), having a medical cannabis license (RRR = 4.14, p < 0.01), more frequent cannabis and alcohol co-use (RRR = 1.18, p < 0.05), and more frequent cannabis use (RRR = 1.21, p < 0.001) were associated with moderate risk compared to low risk. Being male (RRR = 1.89, p < 0.01) and reporting higher cannabis use frequency (RRR = 1.70, p < 0.001) was associated with high DUIC risk. Cannabis use frequency was a significant predictor of subjective DUIC (AOR = 1.26, p < 0.001). ConclusionFindings highlight the need for targeted prevention efforts, particularly for male and frequent cannabis users. The complex relationship between medical cannabis use and DUIC risk warrants further investigation to inform evidence-based policies and interventions.

Avatar Intervention in Virtual Reality for Cannabis Use Disorder in Individuals With Severe Mental Disorders: Results From a 1-Year, Single-Arm Clinical Trial.

The dual diagnosis of cannabis use disorder (CUD) and severe mental disorder (SMD) results in clinically complex individuals. Cannabis use is known to have negative consequences on psychiatric symptoms, medication compliance, and disease prognosis. Moreover, the effectiveness of currently available psychotherapeutic treatments is limited in this population. In this context, our research team developed avatar intervention, an approach using virtual reality as a therapeutic tool to treat CUD in individuals with SMD. This pilot clinical trial aimed to evaluate, until the 1-year follow-up, the efficacy of avatar intervention for CUD among 32 participants with a dual diagnosis of SMD and CUD. Over the course of the 8 intervention sessions, participants were given the opportunity to enter a dialogue in virtual reality with an avatar representing a person with a significant role in their consumption, who was animated in real time by a therapist. The primary outcomes were the quantity of cannabis consumed and the frequency of use. Secondary outcomes included severity of problematic cannabis use, motivation for change, protective strategies for cannabis use, consequences of cannabis use, psychiatric symptoms, and quality of life. Changes in reported outcomes during the assessment periods before the intervention; postintervention; and 3, 6, and 12 months after the end of the intervention were assessed using a linear mixed-effects model. Significant reductions were observed in the quantity of cannabis consumed, and these were maintained until the 12-month follow-up visit (d=0.804; P<.001; confirmed by urine quantification). Frequency of cannabis use showed a small significant reduction at the 3-month follow-up (d=0.384; P=.03). Moreover, improvements were observed in the severity of CUD, cannabis-related negative consequences, the motivation to change cannabis use, and the strategies used to mitigate harms related to cannabis use. Finally, moderate benefits were observed for quality of life and psychiatric symptoms. Overall, this unique intervention shows promising results that seem to be maintained up to 12 months after the end of the intervention. With the aim of overcoming the methodological limitations of a pilot study, a single-blind randomized controlled trial is currently underway to compare the avatar intervention for CUD with a conventional addiction intervention.

Cannabis Vaping Among US Adults With Disabilities: Findings From the 2022 Behavioral Risk Factor Surveillance System.

Studies have demonstrated that people with disabilities are more likely to use cannabis than people without disabilities. However, less is known about novel forms of use, such as cannabis vaping, in this population. We examined the correlates of cannabis vaping among people with disabilities and the association between cannabis vaping and the frequency of cannabis use in any form. We used data from the 2022 Behavioral Risk Factor Surveillance System to examine the association between disabilities and past-month cannabis vaping, as well as the number of days that cannabis was used in the past month, among US adults. We used weighted multivariable logistic and modified Poisson regression models with incidence rate ratios to examine the associations. The prevalence of cannabis vaping was higher among adults with any disability (4.6%) than among adults without disabilities (2.8%); adults with only cognitive disabilities had the highest prevalence (8.2%). Daily nicotine vaping (adjusted odds ratio [AOR] = 6.04; 95% CI, 4.14-8.80), former cigarette smoking status (AOR = 1.67; 95% CI, 1.25-2.25), and being aged 18-24 years (vs ≥65 y) (AOR = 11.07; 95% CI, 7.05-17.38) were associated with higher odds of cannabis vaping among adults with any disability. Disability status modified the relationship between cigarette smoking and cannabis vaping (P < .001). Additionally, among adults with disabilities, the rate of cannabis-use days was higher among adults who vaped cannabis (adjusted incidence rate ratio = 1.28; 95% CI, 1.19-1.36) than among adults who did not vape cannabis. Among adults with disabilities, nicotine consumption by vaping was associated with cannabis vaping. Our findings highlight the need for interventions that reduce the risk of polysubstance use (ie, nicotine and cannabis) in this population.

Efficiently Quantifying Egocentric Social Network Cannabis Use: Initial Psychometric Validation of the Brief Cannabis Social Density Assessment.

Social environment is a key determinant of substance use, but cannabis-related social network analysis is not common, in part because of the assessment burden of comprehensive egocentric social network analysis. The current pre-registered secondary analysis assessed the psychometric properties (i.e., convergent, criterion-related, incremental validity) of the Brief Cannabis Social Density Assessment (B-CaSDA) in a cross-sectional sample of adults who use cannabis (N = 310) using a survey-based design. The B-CaSDA assesses the quantity and frequency of cannabis use for the respondent's four closest (nonparent) relationships. Ego cannabis use severity was elevated for each additional person who used cannabis at all or daily in the individual's social network. B-CaSDA indices (i.e., frequency, quantity, total score) were positively correlated with cannabis consumption, cannabis use severity indicators, and established risk factors for harmful cannabis use. B-CaSDA indices also discriminated between those above and below a clinical cutoff on the Cannabis Use Disorder Identification Test-Revised (CUDIT-R). Finally, in omnibus models that included common risk factors for cannabis use severity, the B-CaSDA quantity index contributed additional variance when predicting CUDIT-R total score, and B-CaSDA frequency contributed additional variance in predicting the CUDIT-R quantity-frequency subscale. The results suggest that the B-CaSDA has the potential to expand social network research on cannabis use and misuse by increasing its assessment feasibility in diverse designs.

Examining the Potential Impact of Recreational Cannabis Legalization on Individuals Receiving Treatment for Substance Use Disorder: An Interrupted Time Series Study in Guelph, Ontario, Canada.

The present research evaluated the impact of legalizing recreational cannabis among individuals with substance use disorders (SUDs) who may already use cannabis at high rates. Using an interrupted time series study design, we evaluated the potential impact of legalizing recreational cannabis among individuals seeking treatment for SUD within a hospital-based treatment setting in Guelph, Ontario. We examined 2,925 individuals who entered an inpatient SUD treatment program between April 2017 and December 2021. We performed segmented regression analyses using both the date of cannabis legalization and the date of edibles legalization as the interruption time point. We also performed stratified analyses to examine potential sex differences. We found no significant changes in the frequency of cannabis use using either of the interruption time points. However, among the subsample who had used cannabis, there was evidence of increasing CUD severity post-legalization of edibles, as well as an overall decreasing trend in readiness to quit over time. Stratified analyses also suggested possible sex differences in frequency of cannabis use, CUD severity, and readiness to quit. Results point to some small but potentially important impacts of recreational cannabis legalization that may only continue with time. Nevertheless, there is a need to continue to monitor cannabis use trends over time to understand any potential lagged effects.

Maternal Cannabis Use During Pregnancy and Maternal and Neonatal Adverse Outcomes.

Cannabis is a psychoactive substance the availability and use of which, in various forms, has been liberalized in many countries across the world. Cannabis use, including by women of reproductive age, has become increasingly common, with (in some studies) >5% of women using the substance even during pregnancy to self treat nausea, vomiting, stress, anxiety, depression, insomnia, chronic pain, and other conditions. Women who use cannabis during pregnancy are more likely to have a medical or mental health condition; they are commonly unaware that cannabis is associated with pregnancy related risks. These risks arise from effects of cannabis on cannabinoid receptors in the placenta as well as from cannabis constituents that cross the placenta and act on receptors in the developing fetal brain; other mechanisms may also operate. This article examines recent cohort studies and meta-analyses on specific maternal and neonatal adverse outcomes associated with gestational exposure to cannabis. Maternal cannabis use during pregnancy is associated with small to moderately increased risks of gestational hypertension, gestational weight gain less than as well as greater than guidelines, and placental abruption. Maternal cannabis use during pregnancy is also associated with small to moderately increased risks of preterm birth (<36 weeks, <34 weeks, and <32 weeks), small for gestational age, low birth weight, neonatal intensive care unit admission, and fetal death. The risk of some of these adverse outcomes is greater with greater frequency of cannabis use. These adverse outcomes have been identified even in women who do not use other substances during pregnancy. Other adverse outcomes, such as major congenital malformations and neurodevelopmental disorders, are also reported (but are not discussed in this article). For these and other reasons, many professional bodies across the world are already discouraging women from using cannabis during pregnancy. It is important for pregnant women to be educated about cannabis and pregnancy related risks in a shared decision-making process.

Cannabis use and sleep problems among young adults by mental health status: A prospective cohort study.

Young adult cannabis use is common; while cannabis is often marketed as a product that can improve sleep, evidence supporting these claims is limited, and effects may differ for individuals with underlying mental health issues. This study measured the association between cannabis use and sleep problems among young adults and determined whether associations differ by mental health status. Using two waves of a young adult cohort study (baseline: March-September 2020; follow-up: January-June 2021), we measured the association of cannabis use frequency with subsequent sleep problems overall and stratified by baseline sleep quality and mental health status in separate moderation analyses. This study was conducted in Southern California, USA, and included 1926 participants aged 20-23 years (mean age = 21; 61% female, 46% Hispanic). Exposure was baseline cannabis use frequency (never use, prior use, 1-5 days/month, 6-19 days/month, ≥ 20 days/month). The outcome was sleep problems at follow-up (range = 4-24, higher score indicating worse sleep). Models were adjusted for socio-demographic factors, baseline sleep problems, mental health symptoms (depression and/or anxiety versus neither) and past 30-day nicotine or alcohol use. In moderation analyses, models were additionally stratified by mental health symptoms and baseline sleep quality (excellent versus imperfect sleep). Among the young adult sample, 11% used cannabis ≥ 20 days/month at baseline. For participants without baseline anxiety or depression symptoms, using cannabis ≥ 20 days/month (versus never use) was associated with greater sleep problems at follow-up [mean difference (MD) = 1.66, 95% confidence interval (CI) = 0.59-2.74]. Among participants with anxiety and/or depression and pre-existing sleep problems at baseline, using cannabis ≥ 20 days/month (versus never use) was associated with fewer sleep problems at follow-up (MD = -1.42, 95% CI = -2.81 to -0.02). The effects of cannabis use on sleep appear to differ by underlying mental health symptoms. Frequent cannabis use may improve sleep for young adults with depression and/or anxiety who have pre-existing sleep problems, but worsen sleep for young adults without depression and/or anxiety.

Cannabis Use and Cannabis Use Disorder Among U.S. Adults with Psychiatric Disorders: 2001-2002 and 2012-2013

Background Rates of cannabis use disorder (CUD) have increased disproportionately among Veterans Administration (VA) patients with psychiatric disorders compared to patients with no disorder. However, VA patient samples are not representative of all U.S. adults, so results on disproportionate increases in CUD prevalence could have been biased. To address this concern, we investigated whether disproportionate increases in the prevalence of cannabis outcomes among those with psychiatric disorders would replicate in nationally representative samples of U.S. adults. Methods Data came from two national surveys conducted in 2001-2002 (n = 43,093) and 2012-2013 (n = 36,309). Outcomes were any past-year non-medical cannabis use, frequent non-medical use (≥3 times weekly), and DSM-IV CUD. Psychiatric disorders included mood, anxiety and antisocial personality disorders. Logistic regression was used to generate predicted prevalences of the outcomes, prevalence differences calculated and additive interactions compared differences between those with and without psychiatric disorders. Results Cannabis outcomes increased more among those with psychiatric disorders. The difference in prevalence differences included any past-year non-medical cannabis use, 2.45% (95%CI = 1.29-3.62); frequent non-medical cannabis use, 1.58% (95%CI = 0.83-2.33); CUD, 1.40% (95%CI = 0.58-2.21). For most specific disorders, prevalences increased more among those with the disorder. Conclusions In the U.S. general population, rates of cannabis use and CUD increased more among adults with psychiatric disorders than other adults, similar to findings from VA patient samples. Results suggest that although VA patients are not representative of all U.S. adults, findings from this important patient group can be informative. Greater clinical and policy attention to CUD is warranted for adults with psychiatric disorders.

Concentrations of Delta 9-tetrahydrocannabinol (THC) in oral fluid at different time points after use: An individual participant meta-analysis

BackgroundDelta 9-tetrahydrocannabinol (THC) concentrations in oral fluid (OF) at different time points after cannabis administration and factors related to these concentrations have not been previously described in a meta-analysis. This information is critical for better understanding of these tests for detection of prior cannabis use and cannabis impairment. Objectives1: To describe the summary statistics of THC concentrations at different time points after cannabis administration. 2: To describe the relationship between the variables of dose of THC, frequency of using cannabis, route of administration (i.e., inhaled or ingested), OF collection device and sex, with THC concentrations in OF, based on bivariate analyses. 3: To describe the independent contribution of each of the variables in Objective 2, based on a multivariate analysis of THC concentrations. MethodsA meta-analysis of studies from two databases (PubMed and Scopus) was conducted. Our inclusion criteria included published empirical articles that administered natural cannabis to subjects in a controlled setting, with OF drug tests showing the exact THC concentrations in OF for each subject (i.e., raw data) for at least two time points after cannabis administration using confirmatory methods. Seven studies of tests with published raw data for OF THC after cannabis administration met these criteria (n observations = 1157). ResultsSummary statistics showed OF THC concentrations by time after use were highly dispersed at every time point, positively skewed, and declined over time. Many positive OF THC concentrations were found after 24-h in one study, but most studies did not conduct observations past 24 h. In a multivariate analysis, we found that increased dose, increased frequency of cannabis use, and inhaled (versus ingested) cannabis were statistically related to higher OF THC concentrations. OF collection with the intercept DOA device was significantly higher than expectorant (i.e. saliva) and being male (versus female) were only significant in a bivariate analysis. Too little data existed to reliably analyze the possible influence of other variables of age, race and body mass index (BMI) on OF THC concentrations. DiscussionFalse negatives exist when the tests are used to detect prior use. OF test results are related to confounders of frequency of cannabis use and inhaled (versus ingested) cannabis. OF tests can produce positives at a cut-off 1.0 ng/mL well beyond 24 h. The tests are not valid to detect cannabis impairment. More information is needed on the influence of potential confounders for OF concentrations. We do not have a good idea of the degree to which the subjects in these studies are representative of persons who use cannabis. Overall, more research is needed for these tests to be used in workplace settings.

Cannabis use, mental health and suicide attempts among adolescents in Puerto Rico

Abstract Cannabis is the most widely used illicit substance worldwide, with recent reports estimating an 11.6% annual prevalence of use in North America. Mental health, suicidal ideation, suicide attempts and completed suicides, has been the focus of several studies exploring its association with frequent cannabis use. The purpose of this study is to evaluate the association between cannabis use, mental health symptoms and suicide attempts among adolescent students in Puerto Rico. Consulta Juvenil X is a monitoring program that aims to study the prevalence of substance use, mental health and violent behavior as well as the risk factors associated with those practices. The survey was conducted during the 2018-20 academic year. The study utilizes a self-administered questionnaire. The sample included 4,668 (54%) females and 3,977 (46%) males. Half of the sample was between seventh and ninth grade with a median age of 15 years old. The majority of the sample was recruited from the public school system in Puerto Rico (70.3%). The prevalence of marihuana use in the public and private schools participating in the study was 9.4% and the suicide attempts was 7.6%. Multiple logistic regression analyses revealed that students who use marihuana during the last year were significantly more likely to report depressive and anxiety symptoms after controlling for sociodemographic variables. Moreover, adolescents who use marihuana were significantly more likely to report suicide attempts after controlling for depression symptoms (OR = 3.07; 95%CI: 2.53-3.72). Findings of this study suggest that adolescents who report marihuana use seem to be at higher risk for mental health problems and suicide attempts. Understanding who is most likely to report marihuana use is important in developing interventions to prevent mental health problems and suicidal behaviors. Key messages • Findings of this study suggest that adolescents who report marihuana use seem to be at higher risk for mental health problems and suicide attempts. • Understanding who is most likely to report marihuana use is important in developing interventions to prevent mental health problems and suicidal behaviors.

Prevalence of Cannabis Use Disorder Among Primary Care Patients with Varying Frequency of Past-Year Cannabis Use.

Valid, single-item cannabis screens for the frequency of past-year use (SIS-C) can identify patients at risk for cannabis use disorder (CUD); however, the prevalence of CUD for patients who report varying frequencies of use in the clinical setting remains unexplored. Compare clinical responses about the frequency of past-year cannabis use to typical use and CUD severity reported on a confidential survey. Among adult patients in an integrated health system who completed the SIS-C as part of routine care (3/28/2019-9/12/2019; n = 108,950), 5000 were selected for a confidential survey using stratified random sampling. Among 1688 respondents (34% response rate), 1589 who reported past-year cannabis use on the SIS-C were included. We compared patients with varying frequency of cannabis use on the SIS-C (< monthly, monthly, weekly, daily) to survey responses on the Composite International Diagnostic Interview Substance Abuse Module for CUD (any and moderate-severe CUD) and cannabis exposure measures (typical use per-week, per-day). Adjusted multinomial (categorical) and logistic regression (binary), weighted for population estimates, estimated the prevalence of outcomes across frequencies. Patients were predominantly middle-aged (mean = 43.3years [SD = 16.9]), male (51.8%), white (78.2%), non-Hispanic (94.0%), and commercially insured (68.9%). The prevalence of any and moderate-severe CUD increased with greater frequency of past-year cannabis use reported on the SIS-C (p-values < 0.001) and ranged from 12.7% (6.3-19.2%) and 0.9% (0.0-2.7%) for < monthly to 44.6% (41.4-47.7%) and 20.3% (17.8-22.9%) for daily use, respectively. Greater frequency of use on the SIS-C in the clinical setting corresponded with greater per-week and per-day use on the confidential survey. Among patients who reported past-year cannabis use as part of routine screening, the prevalence of CUD and other cannabis exposure measures increased with greater frequency of cannabis use, underscoring the utility of brief cannabis screens for identifying patients at risk for CUD.