Hazardous Cannabis Use Research Articles

Cross-Sectional Associations Between Expectancies for Cannabis use and Pain in an Emerging Adult Sample.

Pain and cannabis use are highly prevalent among emerging adults but research regarding how pain is associated with cannabis-related expectancies is limited. Emerging adults who reported past three-month cannabis use (N = 173) were recruited through an online sampling platform. Participants completed the Graded Chronic Pain Scale, Cannabis Use Disorders Identification Test - Revised, and Marijuana Effect Expectancy Questionnaire. Multiple linear regressions indicated that pain intensity and disability were associated with hazardous cannabis use and expectancies for global negative effects (ps < .001). Sex did not moderate any of these relationships (ps > .14). Findings suggest that emerging adults who experience pain report greater hazardous cannabis use and may expect more negative effects of cannabis use. Researchers and clinicians should consider assessing pain in the context of cannabis studies and interventions.

Lessons Learned in Developing a Behavioral Economic Measure of Cannabis Use Using a Predominantly White Sample.

Behavioral economic approaches to measuring cannabis demand represent a well-validated, low-cost method of assessing risk for hazardous cannabis use. One widely used measure of cannabis demand is the Marijuana Purchase Task (MPT), which has shown good psychometric properties across multiple samples. However, preliminary data suggest that changes could improve task ecological validity and acceptability. Using a predominantly White convenience sample, this study aimed to develop a revised MPT that uses a modern dispensary scenario to better reflect national trends in cannabis use (e.g., multiple forms of cannabis consumption). Participant inattentiveness due to increased task length and difficulty estimating purchases for the next month may have impacted demand measures. Lessons learned are discussed to inform future efforts to assess cannabis demand in a manner that is more reflective of naturalistic use: including minimizing participant burden, setting higher price ceilings to increase task utility, and considering person-level factors that may influence demand.

T17 - Sex Differences in the Prospective Association of Intra-Individual Reaction Time Variability in Stroop and Hazardous Cannabis Use at Six Months

T17 - Sex Differences in the Prospective Association of Intra-Individual Reaction Time Variability in Stroop and Hazardous Cannabis Use at Six Months

T27 - Positive Association Between Self-Reported Autonomic Symptoms and Hazardous Cannabis Use Scores in a Community-Based Sample of Adults

T27 - Positive Association Between Self-Reported Autonomic Symptoms and Hazardous Cannabis Use Scores in a Community-Based Sample of Adults

Sex differences in the prospective association of excessively long reaction times and hazardous cannabis use at six months

ObjectiveThe neurocognitive risk mechanisms predicting divergent outcomes likely differ between men and women who use cannabis recreationally. Increasingly, the use of descriptive distributions including the ex-Gaussian has been applied to draw stronger inferences about neurocognitive health in clinical populations. The current project examines whether the long tail of reaction times (RTs) in a distribution, as characterized by the ex-Gaussian parameter tau which may represent difficulty with the regulation of arousal, predicts problematic cannabis use 6 months later in those who use cannabis recreationally, and whether sex moderates these prospective associations. MethodYoung adults (ages 18–30, mean age 20.5 years, N =159, 57.2% women, 69.2% Caucasian) who recreationally used cannabis either occasionally (at least once per month) or frequently (three times or more per week) completed the Stroop Color-Word Task at baseline. Ex-Gaussian parameter tau was estimated for each participant. Self-report of hazardous cannabis use (CUDIT-R) and dysregulation of negative (DERS) and positive emotions (DERS-Positive) were obtained at baseline and 6-month follow-up. ResultsFor those with larger tau at baseline, being a man (but not a woman) was associated with increased difficulty regulating positive emotions concurrently (b = −0.01, F (1,159) = 5.48, p = 0.02), and with hazardous cannabis use six months later (b = −0.007, F (1,159) = 4.42, p = 0.037) after controlling for baseline hazardous cannabis use. ConclusionsExcessively long RTs during cognitive performance may help characterize men at risk for increased hazardous use, which contributes to understanding between-sex heterogeneity in pathways towards cannabis use disorders.

Density of cannabis outlets vs. cannabis use behaviors and prevalent cannabis use disorder: findings from a nationally-representative survey.

Thailand recently decriminalized (de facto legalized) cannabis use and sales. However, nationally representative data are scarce with regard to cannabis use behaviors and its association with cannabis outlet density. The objectives of this study are: (1) to describe the prevalence of cannabis use behaviors and cannabis use disorder among the general adult population of Thailand; (2) to describe the extent that the density of cannabis outlets is associated with cannabis use behaviors, cannabis use disorder, and the amount of cannabis smoked per day. We conducted a community-based cross-sectional study in 11 provinces and the Bangkok Metropolitan Area. Participants were residents of sampled communities aged 20 years or older. We requested literate participants to self-administer the questionnaire and interviewed participants who could not read. We analyzed data using descriptive statistics with sampling weight adjustments and multivariate logistic regression analyses. The prevalence of current cannabis use was 15 percent. At a 400-m radius, participants who reported three cannabis outlets had 4.2 times higher odds of being current users than participants who reported no outlet (Adjusted OR = 4.82; 95% CI [3.04-7.63]). We found no association between outlet density and hazardous cannabis use or cannabis use disorder, nor association with the amount of cannabis use among cannabis smokers. The patterns of association between outlet density and cannabis use behaviors were inconsistent. Furthermore, limitations regarding outlet density measurement and lack of temporality should be considered as caveats in the interpretation of the study findings.

Emotion Regulation Moderates Associations between Discrimination and Cannabis Use Patterns among Sexual Minority Young Adult Women.

Sexual minority young adults (SMYAs) experience discrimination and have high cannabis use prevalence. Discrimination may be associated with cannabis use, including hazardous use and co-use with tobacco, depending on emotion regulation and gender. Fall 2020 survey data assessed discrimination, use frequency of emotion regulation strategies (i.e., cognitive reappraisal, expressive suppression), current cannabis use, hazardous use, and cannabis-tobacco dual use among SMYAs (age 18-34) in 6 United States metropolitan areas (women: n=450, M age =24.1, SD=4.7, 69.6% bisexual, 18.2% lesbian/gay, 12.2% other; men: n=254, M age=24.7, SD=4.5, 33.5% bisexual, 54.3% gay, 12.2% other). Multivariable logistic regression examined the moderating roles of cognitive reappraisal and expressive suppression on associations of discrimination with cannabis use outcomes, stratified by gender and adjusted for age, race and ethnicity, and employment. Among SMYA women, 89.5% experienced any discrimination; 53.1% reported current cannabis use, of whom 49.4% and 47.7% reported hazardous use and cannabis-tobacco dual use, respectively. Adjusting for sociodemographics, experiencing greater discrimination was associated with greater odds of hazardous cannabis use (aOR=1.08, 95% CI [1.02, 1.15]) and cannabis-tobacco dual use (aOR=1.04, 95% CI [1.01, 1.08]) among SMYA women with greater use of expressive suppression. Among SMYA men, 83.9% experienced any discrimination; 49.2% reported current cannabis use, of whom 55.2% and 44.0% reported hazardous use and cannabis-tobacco dual use. Discrimination and emotion regulation were unrelated to cannabis use outcomes among men. Conclusions: Given high rates of discrimination experiences among SMYAs, emotion regulation skills training may empower SMYAs, particularly women, to cope with discrimination without using cannabis.

Testing a Brief Quitline Intervention for Tobacco Cannabis Co-Users: A Randomized Controlled Pilot Study.

Background: Tobacco cannabis co-use is common and becoming more prevalent. Frequent and heavy users of cannabis may struggle to quit smoking. Quitlines offer free cessation treatment in the United States and 25% of quitline callers may also be cannabis users. The present paper describes a randomized pilot study of a tailored intervention for cannabis and cigarette co-users. The intervention combines the quitline smoking cessation treatment with a motivational enhancement therapy-based cannabis intervention. Methods: The randomized pilot study was conducted within four state-funded quitlines with quitline coaches as interventionists. 102 quitline callers who were cannabis and cigarette co-users were randomized to receive treatment as usual (TAU) or the new Quitline Check-Up (QLCU) intervention. Outcomes were collected 90 days post-randomization. Primary outcomes included feasibility and acceptability of delivering the QLCU in the quitline setting. Secondary outcomes included 7-day point prevalence tobacco abstinence, past 30-day cannabis use, and Cannabis Use Disorder Identification Test scores. Results: Study participants were heavy cannabis users, averaging 25 days of use in the past 30; nearly 70% used at a level considered hazardous. Fidelity ratings indicated coaches were successful at delivering the intervention. Treatment engagement was high for both groups (TAU m = 3.4 calls; QLCU m = 3.6 calls) as was treatment satisfaction. Intent-to-treat quit rates (with survey non-responders classified as smokers) were 28.6% for the TAU control group and 24.5% for the QLCU group (P = .45). Discussion: Hazardous cannabis use rates were high in this sample of tobacco cannabis co-users calling quitlines to quit smoking. The intervention for co-users was acceptable and feasible to deliver. No improvements in tobacco cessation outcomes were observed. Pragmatic intervention development within a real-world clinical setting can streamline the intervention development process. More research is needed on tobacco cannabis co-users and who can benefit from a tailored intervention. Registered: ClinicalTrials.gov NCT04737772, February 4, 2021.

Sleep-Related Cannabis Expectancy Questionnaire (SR-CEQ): Factor Analysis Replication, Internal Reliability, and Construct Validity

ABSTRACT Expectancies regarding the sleep-promoting effects of cannabis may exacerbate the propensity to self-medicate sleep problems with cannabis. Given the potential clinical importance of expectancies for the sedative effects of cannabis, Goodhines et al (2020) developed the Sleep-Related Cannabis Expectancies Questionnaire (SR-CEQ). However, concurrent validity of this instrument has not been evaluated. This study aimed to replicate the two-factor structure and internal reliability and explore incremental construct validity of the SR-CEQ. Cross-sectional online survey data were collected from 287 college students (M age = 19.07 ± 1.44 years, range 18–25; 47% male; 84% non-Hispanic White; 61% lifetime cannabis use). Confirmatory factor analysis replicated an adequate fit of the two-factor model (SRMR = 0.08) with excellent internal consistency within positive (α = .94) and negative (α = .91) subscales. Novel correlates were observed for positive (greater mood, sleep, cannabis risk; rs = .16–.48, ps = .001–.03) and negative (lesser cannabis risk; rs = -.18–.61, ps = .001–.03) subscales. Positive expectancies were greater among students with insomnia (t[285] = 2.70, p < .01; d = .33) and hazardous cannabis use (t[284] = 6.63, p < .001; d = 0.91). No group differences were observed by sex or for negative sleep-related cannabis expectances. This study extends psychometric validation of the SR-CEQ and highlights positive expectancies as a potential risk factor for insomnia and hazardous cannabis use.

Patterns of Adverse Childhood Experiences and Problematic Health Outcomes Among US Young Adults: A Latent Class Analysis.

Adverse childhood experiences (ACEs) predict problematic health outcomes (eg, substance use, mental health) among young adults; whether specific ACEs are differentially associated with specific substance use and mental health symptoms is understudied. Latent class analysis (LCA) identified classes of ACEs among 2209 US young adults (Mage = 24.69, range: 18-34; 57.4% female; 30.9% sexual minority; 35.8% racial/ethnic minority) in a 2-year study (2018-2020). Multivariable logistic regressions examined ACEs (reported in 2019) in relation to 2020 reports of current (past 30-day) substance use (ie, tobacco use; cannabis use and hazardous use; alcohol use and binge drinking) and mental health (ie, ≥moderate depression and anxiety symptoms), controlling for sociodemographics (ie, age, gender, race, ethnicity, sexual orientation, education). Overall, 65.4% reported ≥1 ACE (M = 2.09, SD = 2.30); 34.8%, 39.1%, and 71.1% current tobacco, cannabis, and alcohol use; 39.1% and 15.3% hazardous cannabis use and binge drinking; and 24.2% and 34.5% ≥moderate depression and anxiety symptoms, respectively. LCA yielded 4 classes: Low ACEs (referent; 55.6%), Poor family health and divorce (16.3%), Parental abuse (16.0%), and High ACEs (12.1%). High ACEs (vs Low ACEs) was associated with each adverse substance use and mental health outcome except alcohol use. Poor family health and divorce was associated with tobacco use, cannabis use, and both mental health outcomes. Parental abuse was associated with tobacco use, cannabis use, hazardous cannabis use, and both mental health outcomes. Health promotion interventions for young adults must assess ACEs, given that certain types of ACEs may be associated with distinct substance use and mental health outcomes.

Alcohol and cannabis use among women with infertility: associations with psychiatric symptoms, attempts to conceive, and engagement in fertility treatment.

Little is known about substance use among women with infertility, yet substance use has implications for fertility and pregnancy. The purpose was to estimate the prevalence of substance use among women with infertility and examine whether substance use was associated with psychiatric symptoms, active attempts to conceive, and engagement in fertility treatments. Eligible patients were from a single healthcare system who received a female infertility diagnosis within the past 2years. Participants (n = 188) completed an online questionnaire regarding substance use, psychiatric symptoms, attempts to conceive, and fertility treatments. The prevalence of hazardous alcohol use, any cannabis use, and hazardous cannabis use were 30.3%, 30.9%, and 8.5%, respectively. Hazardous alcohol use was not associated with psychiatric symptoms (p > .05). Those with any cannabis use were more likely to have higher depression scores than those without (p = .02). Those with hazardous cannabis use were more likely to have higher depression scores (p = .001) and higher anxiety scores (p = .03). Substance use was not associated with actively trying to conceive. Those pursuing fertility treatments had a lower percentage engaging in hazardous alcohol use compared to those not pursuing fertility treatments (19.0% vs. 36.3%, p = .02). Substance use among women with infertility is common. Hazardous cannabis use was associated with greater psychiatric symptoms, suggesting that cannabis may be used to cope with distress. Pursuing fertility treatments may serve as a protective factor for hazardous alcohol use. Clinicians treating patients with infertility may want to screen for substance use.

Behavioral economic analysis of legal and illegal cannabis demand in Spanish young adults with hazardous and non-hazardous cannabis use

BackgroundIn October 2021, a legal framework that regulates cannabis for recreational purposes in Spain was proposed, but research on its potential impacts on cannabis use is currently limited. This study examined the reliability and discriminant validity of two Marijuana Purchase Tasks (MPTs) for measuring hypothetical legal and illegal cannabis demand, and to examine differences in demand of both commodities in young adults at hazardous vs. non-hazardous cannabis use risk levels. MethodsA total of 171 Spanish young adults [Mage = 19.82 (SD = 1.81)] with past-month cannabis use participated in a cross-sectional study from September to November 2021. Two 27-item MPTs were used to estimate hypothetical demand for legal and illegal cannabis independently. The Cannabis Use Disorder Identification Test (CUDIT-R) was used to assess hazardous cannabis use and test for discriminant validity of the MPTs. Reliability analyses were conducted using Classical Test Theory (Cronbach’s alpha) and Item Response Theory (Item Information Functions). ResultsThe MPT was reliable for measuring legal (α = 0.94) and illegal (α = 0.90) cannabis demand. Breakpoint (price at which demand ceases), and Pmax (price associated with maximum expenditure) were the most sensitive indicators to discriminate participants with different levels of the cannabis reinforcing trait. No significant differences between legal and illegal cannabis demand in the whole sample were observed, but hazardous vs. non-hazardous users showed higher legal and illegal demand, and decreased Breakpoint and Pmax if cannabis were legal vs illegal. ConclusionThe MPT exhibits robust psychometric validity and may be useful to inform on cannabis regulatory science in Spain.

Cannabis Use Patterns and Whole-Blood Cannabinoid Profiles of Emergency Department Patients With Suspected Cannabinoid Hyperemesis Syndrome.

The objectives of this study were to characterize the detailed cannabis use patterns (eg, frequency, mode, and product) and determine the differences in the whole-blood cannabinoid profiles during symptomatic versus asymptomatic periods of participants with suspected cannabinoid hyperemesis syndrome recruited from the emergency department (ED) during a symptomatic episode. This is a prospective observational cohort study of participants with symptomatic cyclic vomiting onset after chronic cannabis use. Standardized assessments were conducted to evaluate for lifetime and recent cannabis use, cannabis use disorder, and cannabis withdrawal symptoms. Quantitative whole-blood cannabinoid testing was performed at 2 times, first when symptomatic (ie, baseline) and at least 2 weeks after the ED visit when asymptomatic. The differences in cannabinoid concentrations were compared between symptomatic and asymptomatic testing. The study was conducted from September 2021 to August2022. There was a difference observed between delta-9-tetrahydrocannabinol metabolites, but not the parent compound during symptomatic episodes and asymptomatic periods. Most participants (84%) reported using cannabis > once per day (median 3 times per day on weekdays, 4 times per day on weekends). Hazardous cannabis use was universal among participants; the mean cannabis withdrawal discomfort score was 13, indicating clinically significant rates of cannabis withdrawal symptoms with cessation of use. Most participants (79%) previously tried to stop cannabis use, but a few (13%) of them had sought treatment. Patients presenting to the ED with cannabinoid hyperemesis syndrome have high cannabis use disorder scores. Further studies are needed to better understand the influence of THC metabolism and concentrations on symptomatic cyclic vomiting.

Investigating the Relation between Anxiety Sensitivity and Substance Use: What Are the Roles of Social Anxiety and Outcome Expectancies?

Objective: Research on the association between anxiety sensitivity (AS) and substance use is mixed, with some studies showing a positive association and others showing no association. Other relevant variables, such as social anxiety and outcome expectancies, may help us understand how and for whom AS is linked to substance use. This study tested (a) the associations between AS and alcohol use, cannabis use, and drinking games and pregaming behaviors among young adults, and (b) the mediating role of social anxiety and moderating role of outcome expectancies in these associations. Method: Participants (N = 199, 69% women) were young adults (19 to 25 years) who completed a 30-minute online self-report questionnaire on their substance use. Results: Results revealed significant negative associations between AS and drinking game and pregaming participation. AS was not directly associated with other substance use outcomes. The association between AS and hazardous cannabis use was moderated by relaxation and tension reduction expectancies, but outcome expectancies did not moderate any of the other associations between AS and substance use outcomes. Social anxiety mediated the associations between AS and hazardous cannabis use and both drinking game and pregaming participation. Conclusions: Findings highlight the complex association between AS and different substance use outcomes. Outcome expectancies and social anxiety may help explain how AS is associated with hazardous cannabis use and drinking game/pregaming participation, respectively. More effective interventions can be developed by understanding the relation between AS and substance use.

Cannabis use breaks in young adults: The highs and lows of tolerance breaks

Background/purposeCannabis tolerance breaks, or T-breaks, are believed to benefit persons who use cannabis (PUCs) by decreasing tolerance levels to cannabis. However, no prior research, to our knowledge, has compared the effects of T-breaks and other use breaks on cannabis use patterns and outcomes. The current study examined whether the occurrence of cannabis use breaks (tolerance and other use breaks), or the duration of these breaks, is associated with changes in hazardous cannabis use (CUDIT-R), CUD severity, cannabis use frequency, and withdrawal symptoms over a 6-month follow-up. MethodsYoung adults, who recreationally use cannabis, (N=170, 55.9% female, Mean age=21 yo) completed baseline and on-time 6-month assessments of hazardous cannabis use (CUDIT-R), CUD severity, cannabis use frequency, and withdrawal symptoms. The occurrence of cannabis use breaks and the duration of these breaks during the intervening period was assessed at 6 months. ResultsTaking a T-break was associated with an increase in hazardous cannabis use and CUD severity at 6 months. When considering cannabis use breaks for other reasons, a longer break was associated with a significant decrease in hazardous cannabis use (CUDIT-R), CUD severity, and cannabis use frequency at 6 months. ConclusionFindings from our study suggest recreational PUCs who take a T-break may be at greater risk for problematic cannabis use. In addition, taking a longer cannabis use break for other reasons may have beneficial effects on cannabis-related outcomes. The ability to abstain from cannabis for other reasons may be protective while individuals who take T-breaks may be important targets for intervention and prevention.

Increased identification of cannabis use among drivers involved in motor vehicle collisions using an expanded cannabis inventory.

The objectives of this study were to implement and examine the potential capture rate of a novel instrument, the Expanded Cannabis Inventory, in a population of emergency department (ED) patients presenting after motor vehicle collisions (MVC). Study participants who presented to the ED after MVC were recruited from three hospitals in cannabis-legal states (Denver, CO; Portland, OR; and Sacramento, CA). Research assistants (RAs) administered the Expanded Cannabis Inventory, which includes a wide variety of products that have become readily available in states where cannabis is legal, in addition to assessments related to patient demographic characteristics, general health, cannabis attitudes, and dependency measures. RAs also obtained blood samples for delta-9-THC and metabolites. Among 692 participants who provided responses to questions about cannabis use, 292 (42%) reported past-year use. Seventy-eight (27%) of those identified as using cannabis were only captured due to items in the expanded instrument. These patients were more likely to be White and were more likely to perceive daily use to be of high risk. Fewer had Cannabis Use Disorder Inventory Test (CUDIT) scores consistent with hazardous cannabis use. However, more of the patients only captured by the expanded instrument had high measured blood levels of delta-9-THC on samples obtained in the ED. Changing cannabis use patterns must be reflected in our measurements for clinical practice, research, and surveillance. Instruments that are the current standard in clinical practice capture limited data and may no longer perform well enough to identify a complete cohort or to provide insight into the health behaviors of patients.

Evaluating the Protective Behavioral Strategies for Marijuana Scale (PBSM) short-form: Support for a two-factor structure and measurement invariance

BackgroundThe present study evaluated the two-factor structure of the Protective Behavioral Strategies for Marijuana Scale (PBSM-SF) Short-Form, a 13-item measure of harm reduction behaviors related to cannabis use. Additionally, the PBSM was evaluated for measurement invariance based on sex and state cannabis legalization status. MethodParticipants were 1,048 college students (Mage = 19.00) reporting past 30-day cannabis use who primarily identified as White (75.5%) females (64.9%) recruited from 11 universities in 11 states representative of the United States. All participants provided demographic information and completed the PBSM-SF, Marijuana Use Grid assessing cannabis use frequency, Cannabis Use Disorder Identification Test-Revised assessing hazardous cannabis use, and Brief Marijuana Consequences Questionnaire evaluating negative consequences. ResultsThe two-factor structure (i.e., Quantity and Context) of the PBSM-SF identified in Mian et al. (2021) was supported in the present study. Additionally, analyses demonstrated evidence of convergent and concurrent validity. Finally, the two-factor PBSM-SF demonstrated some degree of invariance by sex and state legalization status. ConclusionsThis study provides additional support for a two-factor model of PBSM-SF (i.e., Quantity and Context) that functions similarly for men and women college students as well as for students from states without legalized cannabis use and states with legalized cannabis use.

Predicting Self-Medication with Cannabis in Young Adults with Hazardous Cannabis Use.

Using cannabis to reduce psychological and physical distress, referred to as self-medication, is a significant risk factor for cannabis use disorder. To better understand this high-risk behavior, a sample of 290 young adults (ages 18–25; 45.6% female) were recruited from two U.S. universities in January and February of 2020 to complete a survey about their cannabis use and self-medication. Results: seventy-six percent endorsed using cannabis to reduce problems such as anxiety, sleep, depression, pain, loneliness, social discomfort, and concentration. When predicting reasons for self-medication with cannabis, logistic regression models showed that lower CUDIT-R scores, experiencing withdrawal, living in a state where cannabis was illegal, and being female were all associated with higher rates of self-medication. Withdrawal symptoms were tested to predict self-medication with cannabis, and only insomnia and loss of appetite were significant predictors. To further explore why young adults self-medicate, each of the original predictors were regressed on seven specified reasons for self-medication. Young adults experiencing withdrawal were more likely to self-medicate for pain. Participants living where cannabis is legal were less likely to self-medicate for anxiety and depression. Living where cannabis is illegal also significantly predicted self-medicating for social discomfort—though the overall model predicting social discomfort was statistically non-significant. Finally, female participants were more likely to self-medicate for anxiety. These results suggest widespread self-medication among young adults with likely CUD and underscore the complexity of their cannabis use. The findings have implications for understanding why young adults use cannabis in relation to psychological and physical distress and for accurately treating young adults with cannabis use disorder.

Joint risk prediction for hazardous use of alcohol, cannabis, and tobacco among adolescents: A preliminary study using statistical and machine learning

For some, substance use during adolescence may be a stepping stone on the way to substance use disorders in adulthood. Risk prediction models may help identify adolescent users at elevated risk for hazardous substance use. This preliminary analysis used cross-sectional data (n = 270, ages 13–18) from the baseline dataset of a randomized controlled trial intervening with adolescent alcohol and/or cannabis use. Models were developed for jointly predicting quantitative scores on three measures of hazardous substance use (Rutgers Alcohol Problems Index, Adolescent Cannabis Problem Questionnaire, and Hooked on Nicotine Checklist) based on personal risk factors using two statistical and machine learning methods: multivariate covariance generalized linear models (MCGLM) and penalized multivariate regression with a lasso penalty. The predictive accuracy of a model was evaluated using root mean squared error computed via leave-one-out cross-validation. The final proposed model was an MCGLM model. It has eleven risk factors: age, early life stress, age of first tobacco use, age of first cannabis use, lifetime use of other substances, age of first use of other substances, maternal education, parental attachment, family cigarette use, family history of hazardous alcohol use, and family history of hazardous cannabis use. Different subsets of these risk factors feature in the three outcome-specific components of this joint model. The quantitative risk estimate provided by the proposed model may help identify adolescent substance users of cannabis, alcohol, and tobacco who may be at an elevated risk of developing hazardous substance use.

Associations between modes of cannabis use in daily life with concurrent and longitudinal hazardous use and consequences

BackgroundAs diverse cannabis use patterns among recreational users continue to evolve, little is known about how modes of use may contribute to long-term risk. The current study examined the association between types and number of modes of cannabis used over a 21-day ecological momentary assessment (EMA) period with hazardous cannabis use and consequences both concurrently and six months later. MethodsA sample of 155 young adult recreational cannabis users, aged 18–30 (M = 21.1), reported on cannabis use patterns over 21-days, and completed baseline and six-month assessments of hazardous cannabis use and cannabis consequences. ResultsAt baseline, more frequent bowl use was associated with hazardous cannabis use and cannabis consequences. More frequent use of hash-oil was associated with more consequences at six months, while a greater proportion of hash-oil use relative to total use was associated with increased risk for hazardous cannabis use at six months. ConclusionWhile bowl use is characteristic of concurrent problematic use and consequences, only hash-oil predicted increased risk for hazardous use and consequences later. It may be that more frequent use of high-potency cannabis products, such as hash-oil, present unique risks for cannabis problems and consequences.