Heavy Cannabis Research Articles

Adolescent alcohol drinking and cannabis use: Longitudinal, and cohort analysis of high school students in Australia

Aims: The final year of high school is a challenging phase, during which substance use is common. We conducted longitudinal and cohort comparisons on the levels of alcohol and cannabis use among final year (Year 12) high school students compared to the previous year. Design: Longitudinal and cohort analyses of self-reported survey data. Setting: Ten independent schools across South-East Queensland, Australia. Participants: Year 12 students in 2020 (n = 1024) were compared (a) longitudinally with themselves in Year 11; and (b) to the 2019 Year 12 cohort (n = 632). Measures: Self-reported alcohol and cannabis use. Analyses adjusted for socio-demographic, parental, and schooling variables. Findings: Longitudinally, Year 12 students of 2020 had higher odds of having six or more drinks per occasion, monthly or more often, and reporting lifetime cannabis use, compared to themselves in 2019. However, they were not more likely to drink alcohol weekly or more often in 2020 versus 2019. Compared to the 2019 cohort, the 2020 cohort had higher odds of drinking weekly or more often, having six or more drinks per occasion monthly, and reporting lifetime cannabis use. Conclusions: The 2020 cohort of Year 12 adolescents were more likely to engage in heavy drinking and cannabis use, compared to themselves the previous year, and compared to the previous cohort. Greater alcohol consumption and likelihood of cannabis use among the 2020 cohort might be explained by increased age and impacts of the COVID-19 pandemic. Future research to monitor if this is a continuing trend is warranted.

Cannabinoid hyperemesis syndrome: genetic susceptibility to toxic exposure.

Cannabinoid hyperemesis syndrome presents as a complex of symptoms and signs encompassing nausea, vomiting, abdominal pain, and hot water bathing behavior, most typically in a heavy cannabis user. Its presentation is frequently associated with hypothalamic-pituitary-adrenal axis activation with stress and weight loss. Recent investigation has identified five statistically significant mutations in patients distinct from those of frequent cannabis users who lack the symptoms, affecting the TRPV1 receptor, two dopamine genes, the cytochrome P450 2C9 enzyme that metabolizes tetrahydrocannabinol, and the adenosine triphosphate-binding cassette transporter. The syndrome is associated with escalating intake of high potency cannabis, or alternatively, other agonists of the cannabinoid-1 receptor including synthetic cannabinoids. Some patients develop environmental triggers in scents or foods that suggest classical conditioned responses. Various alternative "causes" are addressed and refuted in the text, including exposure to pesticides, neem oil or azadirachtin. Nosological confusion of cannabinoid hyperemesis syndrome has arisen with cyclic vomiting syndrome, whose presentation and pathophysiology are clearly distinct. The possible utilization of non-intoxicating antiemetic cannabis components in cannabis for treatment of cannabinoid hyperemesis syndrome is addressed, along with future research suggestions in relation to its genetic foundation and possible metabolomic signatures.

Alcohol and cannabis co-use: Probing subjective response in eliciting cross-substance craving

The co-use of alcohol and cannabis is rising in prevalence, yet the mechanisms driving individuals to co-use are not well understood. Subjective response to alcohol or cannabis may predict the desire to use either substance. However, which specific facets of subjective response predict cross-substance craving remains unclear. The present study investigated whether acute administration of alcohol or cannabis facilitates cue-induced craving for the other substance, with an emphasis on the underlying subjective response mechanisms contributing to co-use. This is a secondary analysis of a behavioral pharmacology study that combined alcohol/cannabis administration with a cross-substance cue-reactivity paradigm in individuals who were heavy alcohol and heavy cannabis co-users. Over two sessions, twenty-nine individuals (17M/12F) self-administered alcohol or cannabis (in a crossover design), and then completed a cue-reactivity exercise with the other substance. Analyses tested how changes in subjective response variables following substance administration predicted cross-substance cue-induced craving. Following alcohol administration, greater subjective ratings of positive mood predicted significantly greater cue-induced cannabis craving (β = 1.14, SE = 0.41, t = 2.80, p = 0.010). Following cannabis administration, lower subjective effects ratings of positive mood/arousal predicted significantly greater cue-induced alcohol craving (β = −1.08, SE = 0.38, t = −2.85, p = 0.009; β = −2.38, SE = 1.13, t = −2.10, p = 0.047). This study identified subject response mechanisms contributing to cross-substance cue induced craving. These mechanisms include increases in positive mood following alcohol use and decreases in positive mood and arousal, akin to increases in relaxation, following cannabis use.

Abnormal developmental of hippocampal subfields and amygdalar subnuclei volumes in young adults with heavy cannabis use: A three-year longitudinal study

BackgroundDifferences in the volumes of the hippocampus and amygdala have consistently been observed between young adults with heavy cannabis use relative to their non-using counterparts. However, it remains unclear whether the subfields of these functionally and structurally heterogenous regions exhibit similar patterns of change in young adults with long-term heavy cannabis use disorder (CUD). ObjectivesThis study aims to investigate the effects of long-term heavy cannabis use in young adults on the subregional structures of the hippocampus and amygdala, as well as their longitudinal alterations. MethodsThe study sample comprised 20 young adults with heavy cannabis use and 22 matched non-cannabis using healthy volunteers. All participants completed the Cannabis Use Disorder Identification Test (CUDIT) and underwent two T1-structural magnetic resonance imaging (MRI) scans, one at baseline and another at follow-up 3 years later. The amygdala, hippocampus, and their subregions were segmented on T1-weighted anatomical MRI scans, using a previously validated procedure. ResultsAt baseline, young adults with heavy CUD exhibited significantly larger volumes in several hippocampal (bilateral presubiculum, subiculum, Cornu Ammonis (CA) regions CA1, CA2-CA3, and right CA4-Dentate Gyrus (DG)) and amygdala (bilateral paralaminar nuclei, right medial nucleus, and right lateral nucleus) subregions compared to healthy controls, but these differences were attenuated at follow-up. Longitudinal analysis revealed an accelerated volumetric decrease in these subregions in young adults with heavy CUD relative to controls. Particularly, compared to healthy controls, significant accelerated volume decreases were observed in the right hippocampal subfields of the parasubiculum, subiculum, and CA4-DG. In the amygdala, similar trends of accelerated volumetric decreases were observed in the left central nucleus, right paralaminar nucleus, right basal nucleus, and right accessory basal nucleus. ConclusionsThe current findings suggest that long-term heavy cannabis use impacts maturational process of the amygdala and hippocampus, especially in subregions with high concentrations of cannabinoid type 1 receptors (CB1Rs) and involvement in adult neurogenesis.

Associations of Cannabis Use, Metabolic Dysfunction-Associated Steatotic Liver Disease, and Liver Fibrosis in U.S. Adults.

Introduction: Following the introduction of metabolic dysfunction-associated steatotic liver disease (MASLD) as a replacement term for nonalcoholic fatty liver disease, the relationship between MASLD and cannabis use has yet to be established. With the global rise in cannabis consumption, understanding its impact on MASLD is critical for clinical guidance. Our study investigated the association between cannabis use, MASLD, and clinically significant fibrosis (CSF) among U.S. adults. Methods: Data were collected from the National Health and Nutrition Examination Survey for the period 2017 to 2018 to conduct a cross-sectional analysis. The diagnosis of hepatic steatosis and CSF was based on median values of the controlled attenuation parameter and liver stiffness measurement, with thresholds of 285 dB/m and 8.6 kPa, respectively. Information on cannabis use was obtained through self-report questionnaires. Multinomial logistic regression models and subgroup analyses were used to investigate the association between cannabis use and MASLD with CSF. Results: Our study assessed data from 2,756 U.S. adults (51.1% female; 32.2% white; mean age 39.41 ± 11.83 years), who had complete information on liver stiffness measurements through transient elastography alongside reported cannabis use. Results indicated that cannabis use overall was not associated with liver stiffness in patients with MASLD. However, among females, cannabis use was associated with MASLD accompanied by CSF, with an adjusted odds ratio (OR) of 0.47 (95% confidence interval [CI]: 0.24-0.91). Heavy cannabis use (9 to 30 times per month) was associated with MASLD accompanied by CSF among female participants, with an adjusted OR of 0.12 (95% CI: 0.02-0.88). Conclusion: In our study, cannabis use did not show a significant association with liver stiffness in patients diagnosed with MASLD. However, heavy cannabis consumption in women was associated with MASLD accompanied by CSF. These findings suggest that the effects of cannabis on liver health may differ based on gender and frequency of cannabis use, emphasizing the need for further research in this area.

Effects of in utero exposure to Δ-9-tetrahydrocannabinol on cardiac extracellular matrix expression and vascular transcriptome in rhesus macaques.

Delta-9-tetrahydrocannabinol (THC), the psychoactive component of cannabis, remains a schedule I substance, thus safety data regarding the effects on the cardiovascular and prenatal health are limited. Importantly, there is evidence showing prenatal cannabis exposure can negatively impact fetal organ development, including the cardiovascular system. THC can cross the placenta and bind to cannabinoid receptors expressed in the developing fetus, including on endothelial cells. To understand the impact of prenatal THC exposure on the fetal cardiovascular system, we used our rhesus macaque model of prenatal daily edible THC consumption. Before conception, animals were acclimated to THC (2.5 mg/7 kg/day, equivalent to a heavy medical cannabis dose) and maintained on this dose daily throughout pregnancy. Fetal tissue samples were collected at gestational day 155 (full term is 168 days). Our model showed that in utero THC exposure was associated with a decreased heart weight-to-body weight ratio in offspring, warranting further mechanistic investigation. Histological examination of the fetal cardiac and vascular tissues did not reveal any significant effect of THC exposure on the maturity of collagen within the fetal heart or the aorta. Total collagen III expression and elastin production and organization were unchanged. However, bulk RNA-sequencing of vascular cells in the umbilical vein, umbilical artery, and fetal aorta demonstrated that THC alters the fetal vascular transcriptome and is associated with upregulated expression of genes involved in carbohydrate metabolism and inflammation. The long-term consequences of these findings are unknown but suggest that prenatal THC exposure may affect cardiovascular development in offspring.NEW & NOTEWORTHY Prenatal cannabis use is increasing and despite the public health relevance, there is limited safety data regarding its impact on offspring cardiovascular health outcomes. We used a translational, nonhuman primate model of daily edible Δ-9-tetrahydrocannabinol (THC) consumption during pregnancy to assess its effects on the fetal cardiovascular system. THC-exposed fetal vascular tissues displayed upregulation of genes involved in cellular metabolism and inflammation, suggesting that prenatal THC exposure may impact fetal vascular tissues.

Residual and enduring effects of cannabis use on cognitive and psychomotor function: A study of adults during unrestricted cannabis use, short-term abstinence, and protracted abstinence.

The impact of cannabis on cognitive and psychomotor function is important to understand, given the role of the endocannabinoid system in these critical processes. The literature has shown robust acute negative effects of cannabis on cognition and psychomotor skills during intoxication, and to a lesser degree, persisting effects following short-term abstinence up to 4 weeks. However, whether these decrements resolve after long-term cessation of use remains unclear. We evaluated cognitive and psychomotor function in 31 adults with current cannabis use during unrestricted use (UNR) and after a 3-day abstinence (RES), 23 adults with former cannabis use (> 90 days abstinent; FU), and 58 nonusing controls (CON) using the cognition and motor batteries of the National Institutes of Health Toolbox. Linear mixed models showed no significant differences in cognitive and motor performance between UNR, RES, and FU groups. Group effects emerged such that CON outperformed UNR on the Oral Reading Recognition Test, and CON outperformed both UNR and RES on the Picture Vocabulary Test. In terms of psychomotor function, FU, RES, and UNR performed better than CON on the Grip Strength Test. In this comprehensive examination of cognitive and psychomotor performance in adults with cannabis use with 3 days to > 90 days of abstinence, our results indicated that the cognitive impacts of chronic, heavy cannabis use are observable during short-term abstinence but remit after > 90 days of abstinence. This highlights widespread impacts of cannabis use abstinence across cognitive and psychomotor domains. Future studies are needed to evaluate whether these effects are also observable with use reduction, as opposed to abstinence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Daily cannabis use and cognitive impairment in community residents aged 50 and over

ABSTRACT Background Cannabis use is associated with cognitive dysfunction in younger adults, but little is known about its role as a risk factor for dementia. This study aimed to explore the association between daily cannabis use and cognitive impairment in a cohort study of middle-aged and older people at risk of dementia. Methods Sample drawn from a cross-sectional study involving 15,582 people aged 50 and over from PROTECT study. Lifetime heavy cannabis use was defined by daily use. Results A total of 4203 (27%) participants reported lifetime cannabis use, of whom 4097 responses to frequency of use were obtained. Among them, 259 participants reported lifetime daily, and 3838 reported less than daily use. Those with lifetime daily cannabis use were more likely than those without to be unmarried, of lower educational attainment, and current or past tobacco smokers. They were more likely to show moderate or moderate-to-severe anxiety and depression. Baseline lifetime daily cannabis use was also associated with improved verbal reasoning but not with change in other cognitive scores. Conclusions Given improved verbal reasoning in people with daily lifetime cannabis use, the relationship between quantity and frequency of cannabis use and cognitive impairment in later life warrants further examination.

Prediction of suicidal thoughts and behaviors based on the diurnal cortisol pattern and THC dosage in continued cannabis users, a 5 year population-based matched cohort study

It appears that the THC dosage is the link between dysregulation of the hypothalamic pituitary adrenal (HPA) axis and suicidal thoughts and behaviors (STB). We proposed a new model to understand the underlying pathophysiological mechanism of STB based on the interaction of cortisol and THC dosage.From September 1, 2019, to January 1, 2024, we conducted a population-based, matched-pair, nested case-control study resulting from a three-wave complete longitudinal, multicenter cohort study on a sample of congress 60 clients. A total of 368 male continued cannabis users (CCu) were allocated to four categories, including low, moderate and high THC dosages and relapse, using optimal matching. Several HPA axis measures were analyzed in the saliva using liquid chromatography with tandem mass spectrometry (LC-MS-MS), and carboxylic acids levels in the urine were assessed via gas chromatography/mass spectrometry (GC–MS). We used structural equation modeling (SEM) to examine the relationship between the variables of interest and the model fit test, and used the Akaike information criterion (AIC) to compare the model fit and select the best-fitting model. Population attributable fractions (PAFs) and cumulative risk score were also calculated for the best-fitting pattern.The analysis showed that the likelihood of STB in individuals with a cortisol awakening response (CAR) and a blunted diurnal cortisol slope (DCS) and higher area under the curve (AUC) who reported heavy cannabis use was more than three times higher than the control group (OR 3.2, 95 % CI 2.4–4.1).These findings indicate the importance of the specific cortisol secretion pattern in the increased clinical expression of STB and may be an important factor for guiding preventive efforts in this area.

Predictors of changes in marijuana consumption in Germany during the covid-19 pandemic.

During the Covid-19 pandemic Germany experienced its first increase in the proportion of heavy cannabis users since 1995. With the expected nationwide decriminalization of cannabis before 2025, we investigate the potential causes for that increase. Data were from the 2021 European Web Survey on Drugs (EWSD) including 762 12-month marijuana users from Germany (72.9% male, mean age = 29.5 years). Both heavy and regular cannabis consumers reported an increase in marijuana consumption during the pandemic, with infrequent users reporting a decrease. Using multinomial logistic regression, we found younger individuals (OR = 0.95 [95% CI = 0.92, 0.98]) and those not pursuing or completing higher education (OR = 1.86 [1.23, 2.81]) had increased use. Additionally, using cannabis to self-medicate (OR = 2.79 [1.56, 4.99]) and purchasing marijuana (OR = 2.26 [1.35, 3.77]) was associated with increased use. We found, relative to infrequent users, both regular (OR = 4.00 [2.39, 6.72]) and notably heavy users (OR = 31.17 [12.10, 80.32]) were more likely to use cannabis to self-medicate. Both regular (OR = 4.09 [2.47, 6.77]) and especially heavy users (OR = 13.53 [6.74, 27.16]) were also more likely to purchase marijuana. Heavy users were also more likely to be past 30-day tobacco users (OR = 5.92 [2.81, 12.45]). We identified the self-reported motivation of using cannabis to self-medicate as well as act of purchasing marijuana as having the strongest relation to being a heavy user and increasing marijuana use during the Covid-19 pandemic.

M53 - White Matter Structural Organization Alterations in People Living With HIV With Heavy Cannabis Use

M53 - White Matter Structural Organization Alterations in People Living With HIV With Heavy Cannabis Use

Estimating substance use disparities across intersectional social positions using machine learning: An application of group-lasso interaction network.

An aim of quantitative intersectional research is to model the joint impact of multiple social positions on health risk behaviors. Although moderated multiple regression is frequently used to pursue intersectional research hypotheses, such parametric approaches may produce unreliable effect estimates due to data sparsity and high dimensionality. Machine learning provides viable alternatives, offering greater flexibility in evaluating many candidate interactions amid sparse data conditions, yet remains rarely employed. This study introduces group-lasso interaction network (glinternet), a novel machine learning approach involving hierarchical regularization, to assess intersectional differences in substance use prevalence. Utilizing variable selection and parameter stabilization functionality for main and interaction effects, glinternet was employed to examine two-way interactions between three primary social positions (gender, sexual orientation, and race) predicting heavy episodic drinking, cannabis use, and cigarette use prevalence. Analyses were conducted using the All of Us Research Program (N = 283,403), a national sample with high representation from populations historically underrepresented in biomedical research. Results were replicated using holdout cross-validation and compared against logistic regression estimates. Glinternet prevalence estimates were more stable across discovery and replication samples relative to logistic regression, particularly among sparsely represented groups. Prevalence estimates for cigarette and cannabis use were elevated among sexual minority and White cisgender women compared to heterosexual and non-White women, respectively. Glinternet may improve upon traditional moderated multiple regression methods for pursuing intersectional hypotheses by improving model parsimony and parameter stability, providing novel means for quantifying health disparities among intersectional social positions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cross-ancestry genetic investigation of schizophrenia, cannabis use disorder, and tobacco smoking

Individuals with schizophrenia frequently experience co-occurring substance use, including tobacco smoking and heavy cannabis use, and substance use disorders. There is interest in understanding the extent to which these relationships are causal, and to what extent shared genetic factors play a role. We explored the relationships between schizophrenia (Scz; European ancestry N = 161,405; African ancestry N = 15,846), cannabis use disorder (CanUD; European ancestry N = 886,025; African ancestry N = 120,208), and ever-regular tobacco smoking (Smk; European ancestry N = 805,431; African ancestry N = 24,278) using the largest available genome-wide studies of these phenotypes in individuals of African and European ancestries. All three phenotypes were positively genetically correlated (rgs = 0.17–0.62). Genetic instrumental variable analyses suggested the presence of shared heritable factors, but evidence for bidirectional causal relationships was also found between all three phenotypes even after correcting for these shared genetic factors. We identified 327 pleiotropic loci with 439 lead SNPs in the European ancestry data, 150 of which were novel (i.e., not genome-wide significant in the original studies). Of these pleiotropic loci, 202 had lead variants which showed convergent effects (i.e., same direction of effect) on Scz, CanUD, and Smk. Genetic variants convergent across all three phenotypes showed strong genetic correlations with risk-taking, executive function, and several mental health conditions. Our results suggest that both shared genetic factors and causal mechanisms may play a role in the relationship between CanUD, Smk, and Scz, but longitudinal, prospective studies are needed to confirm a causal relationship.

Heavy Lifetime Cannabis Use and Mortality by Sex

The association between mortality and cannabis use remains unclear. To examine sex-stratified associations of cumulative lifetime cannabis use with all-cause, cardiovascular disease (CVD), and cancer mortality in the UK Biobank population. This cohort study used data from volunteers in the UK Biobank population. Participant monitoring for mortality in the UK Biobank study commenced from the point of their inclusion between 2006 and 2010 and continued until December 19, 2020. Data regarding the causes of death were sourced from the National Health Service Information Centre. Data were analyzed from inception of study inclusion to December 2020. Cannabis use status was assessed by questionnaire and categorized as heavy, moderate, low, and never. The main outcomes were all-cause, CVD, and cancer mortality. Sex-stratified associations of cumulative lifetime cannabis use with mortality were estimated using Cox proportional hazards regression with adjustment for demographic and clinical variables. Among 121 895 participants (54.51% females with mean [SD] age of 55.15 [7.64] years; 45.49% males with mean [SD] age of 56.46 [7.79] years) during an overall median of 11.80 years (IQR, 10.53-13.22 years) of follow-up, 2375 total deaths occurred, including 1411 deaths from CVD and 440 from cancer. In males, after full adjustment, the hazard ratios (HRs) were 1.28 (95% CI, 0.90-1.81) for all-cause mortality, 0.98 (95% CI, 0.43-2.25) for CVD mortality, and 1.09 (95% CI, 0.71-1.67) for cancer mortality among heavy cannabis users compared with never users. In females, after full adjustment, the HRs were 1.49 (95% CI, 0.92-2.40) for all-cause mortality, 2.67 (95% CI, 1.19-4.32) for CVD mortality, and 1.61 (95% CI, 0.91-2.83) for cancer mortality among heavy cannabis users compared with never users. In female current tobacco users, after full adjustment, heavy cannabis use was associated with all-cause mortality (HR, 2.25; 95% CI, 1.12-4.53), CVD mortality (HR, 2.56; 95% CI, 1.43-15.36), and cancer mortality (HR, 3.52; 95% CI, 1.50-8.33) and among never tobacco users was associated with CVD mortality (HR, 2.98; 95% CI, 1.67-6.61). In male current tobacco users, heavy cannabis use was associated with cancer mortality (HR, 2.44; 95% CI, 1.14-5.23). In this study, a positive association between CVD mortality and heavy lifetime cannabis use was observed among females. Longitudinal studies are needed in general populations to investigate the potential effects of cannabis on mortality.

Executive functions and behavioral economic demand for cannabis among young adults: Indirect associations with cannabis consumption and cannabis use disorder.

Behavioral economic demand for cannabis is robustly associated with cannabis consumption and cannabis use disorder (CUD). However, few studies have examined the processes underlying individual differences in the relative valuation of cannabis (i.e., demand). This study examined associations between executive functions and cannabis demand among young adults who use cannabis. We also examined indirect associations of executive functions with cannabis consumption and CUD symptoms through cannabis demand. Young adults (N = 113; 58.4% female; mean age 22 years) completed a Marijuana Purchase Task. Participants also completed cognitive tasks assessing executive functions (set shifting, inhibitory control, working memory) and semistructured interviews assessing past 90-day cannabis consumption (number of grams used) and number of CUD symptoms. Poorer inhibitory control was significantly associated with greater Omax (peak expenditure on cannabis) and greater intensity (cannabis consumption at zero cost). Poorer working memory was significantly associated with lower elasticity (sensitivity of consumption to escalating cost). Lower inhibitory control was indirectly associated with greater cannabis consumption and CUD symptoms through greater Omax and intensity, and poorer working memory was indirectly associated with greater cannabis consumption and CUD symptoms through reduced elasticity. This study provides novel evidence that executive functions are associated with individual differences in cannabis demand. Moreover, these results suggest that cannabis demand could be a mechanism linking poorer executive functioning with heavier cannabis use and CUD, which should be confirmed in future longitudinal studies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The social-structural contexts of cannabis consumption and harm reduction among young Nigerian women

BackgroundYoung women remain under-represented in the research literature on young people's cannabis use. This study explored cannabis use and harm reduction practices of young Nigerian women. MethodsThe study draws on 19 in-depth interviews conducted with young women aged 21–35 years who were recruited through time-location sampling in Uyo, Nigeria. Interview transcripts were subjected to thematic coding and analysis. ResultsAccounts highlighted a rapid progression from occasional consumption during hang-outs to regular and heavy consumption for most participants. Frequent and heavy cannabis use, shaped by trauma, stress and mental health problems linked to participants’ marginal social locations, established a context of risk for health harms. The participants sought to reduce harms by attempting to reduce frequency and quantity of cannabis consumed, often with limited success. They also micro-dosed to monitor drug effects, avoided mixing cannabis with more potent drugs, sought out cannabis strains with lower THC as well as consuming privately to reduce social harms such as violence and police arrest associated with using in street milieus. On the other hand, cannabis consumption was seen as helping to reduce harms by providing a relatively safer and less addictive alternative to drugs such as heroin and pharmaceutical opioids, preventing high-risk sexual exchanges often associated with opioid withdrawal among women, and relieving pain. ConclusionsCannabis was consumed recreationally at first, and harmful consumption patterns developed from using cannabis to treat the psychological symptoms of structural inequalities. The analysis supports the social-structural production of drug-related harms, foregrounding the importance of structural-level interventions for creating an enabling environment for safer consumption.

In patients who endorse heavy cannabis use, is there an increased risk for lung cancer?

In patients who endorse heavy cannabis use, is there an increased risk for lung cancer?

Latent profile analysis of college students’ alcohol and cannabis co-use patterns after recreational cannabis legalization

ObjectiveEvidence is mixed on how young adults’ cannabis and alcohol use and co-use patterns have changed following recreational cannabis legalization (RCL). Incorporating measures of frequency and intensity of use we examined changes in college students' use and co-use patterns following RCL. MethodFour-year college students (n = 845,589) ages 18–24 years participated in the National College Health Assessment between 2008 and 2018, including students from 7 states that enacted RCL and 42 that did not. Latent profile analyses identified six patterns of use from four indicator variables tapping frequency of cannabis use and frequency and intensity of alcohol use: Abstainers, Light Alcohol Only, Heavy Alcohol Only, Predominantly Heavy Cannabis Use, Moderate Co-use, and Heavy Co-use. ResultsRegression models that adjusted for time and person- and institution-level covariates indicated that students’ exposure to RCL was associated with lower odds of being in the two alcohol-only use classes, higher odds of being in the Predominantly Heavy Cannabis Use, Heavy Co-Use and Abstainers classes, and was not significantly related to Moderate Co-Use class membership. ConclusionsRCL was positively associated with patterns of frequent cannabis use and frequent and intense co-use but also with abstinence. Use of alcohol-only became less prevalent after RCL. Research on how RCL influences the prevalence of problematic patterns of substance use will inform and improve prevention efforts.

The Association of Frequency of Worry About Financial Debt With Substance Use Among Adults in Ontario, Canada

Background Financial debt and associated stress might increase the risk of substance use problems or exacerbate existing ones. Little evidence is available about the degree of debt stress and its association with substance use. The objective of this study was to examine the associations of the frequency of worry about debt with heavy episodic drinking (HED), daily smoking, e-cigarette use, and cannabis use in the past 30 days. Methods Data were utilized from the 2020/2022 Monitor study, a repeated cross-sectional survey of adults 18 years and older in Ontario, Canada. The surveys employed a web-based panel survey of 6038 adults and collected data on debt-related stress, HED, tobacco smoking, e-cigarettes, and cannabis use in the past 30 days. Odds ratios (OR) were estimated from logistic regression models accounting for sociodemographic factors. Results Overall, 18.4% of respondents reported that they were worried about their debt most or all of the time. Accounting for household income, educational status, employment status, and other factors, the results revealed that there was a dose-response relationship between the frequency of worry about debt and substance use including daily smoking, e-cigarette use, and cannabis use in the past 30 days compared to those who were not worried at all about their debt. Sex differences were also found in the association between worry about debt and e-cigarette use. Conclusions The frequency of worry about debt might have an important role in substance use, which suggests that financial well-being is vital in substance use prevention and harm reduction.

Polysubstance Use Profiles and HIV Viremia in a South African Cohort of Female Sex Workers: A Latent Class Analysis.

Given intersecting social and structural factors, female sex workers (FSW) exhibit elevated risk of HIV and substance use. However, there is limited study of how distinct substance use typologies influence HIV treatment outcomes among FSW. A cross-sectional survey with objective viral load assessments of 1391 FSW enrolled into a treatment optimization-focused trial in Durban, South Africa (2018-2020). We used latent class analysis to uncover discrete patterns in past-month self-reported use of the following substances: heavy alcohol use, cannabis, cocaine, crack, ecstasy, methamphetamine, heroin, and Whoonga . We used Wald tests to identify multilevel predictors of latent class membership and multivariable mixture modeling to quantify associations of substance use classes with HIV viremia (≥50 RNA copies/mL). Substance use (87%) and HIV viremia (62%) were highly prevalent. Latent class analysis uncovered 3 polysubstance use profiles: Heavy Alcohol Use Only (∼54%); Cannabis, Heavy Alcohol, & Crack Use (∼28%); and Whoonga & Crack Use (∼18%). Whoonga & Crack Use was associated with social and structural adversities, including homelessness, outdoor/public sex work, HIV stigma, and violence. Relative to Heavy Alcohol Use Only , HIV viremia was significantly higher in the Whoonga & Crack Use class (adjusted odds ratio 1.97, 95% confidence interval: 1.13 to 3.43), but not in the Cannabis, Heavy Alcohol, & Crack Use class (adjusted odds ratio 1.17, 95% confidence interval: 0.74 to 1.86). HIV viremia differed significantly across identified polysubstance use profiles among South African FSW. Integrating drug treatment and harm reduction services into HIV treatment programs is key to improving virologic outcomes in marginalized communities.