High-risk Cannabis Use Research Articles

High-Risk Cannabis Use: A Proposal of an Operational Definition through Delphi Methodology for Scientific Consensus

Introduction: Cannabis ranks as one of the most widely used psychoactive substances worldwide. Its usage has been reported as a risk factor for developing a variety of physical and mental health issues, alongside social and economic problems. According to the World Health Organization (WHO), hazardous (or high-risk) substance use is defined as “a pattern of substance use that increases the risk of harmful consequences for the user.” The primary objective of this study was to achieve a consensus on an operational definition of high-risk cannabis use suitable for a European jurisdiction (Spain). Methods: A three round Delphi study was conducted. The Delphi technique entails group decision-making and iterative forecasting by consulting a panel of experts and conducting systematic feedback rounds. An online survey was distributed among a diverse expert panel comprising professionals from Spain working on fields related to cannabis use (research, policy planning, and clinical professionals). One-hundred ninety-nine invitations were sent to experts, of which forty-five (22.6%) accepted to participate. All participants were provided the option to revise a background document with the latest compiled scientific evidence and guidelines related to health and social conditions associated to cannabis usage. This background document also proposed the quantification of dose using a standardized unit established for the population of Spain (the Standard Joint Unit or SJU) based on quantity of cannabis main psychoactive constituent, 9-tetrahydrocannabinol (9-THC) (1 SJU = 1 joint = 0.25 g of cannabis = 7 mg of 9-THC). Three rounds of Likert scale and open-ended questions were administered until consensus, defined as ≥75% agreement, was attained. Results: Consensus was reached on defining high-risk cannabis use as the usage of more than 4 SJU (>28 mg THC) per week or any use of cannabis with potency >10% THC. Concurrent use of cannabis with other drugs was also considered high risk, while the smoked route was considered the riskiest administration route. It was also agreed that vulnerable groups for high-risk cannabis use (for whom any pattern of cannabis use represents high risk of harm) include individuals under the age of 21, pregnant or breastfeeding women, individuals with psychiatric history, those with medical health issues related to cannabis use, professional drivers and heavy machine operators. Conclusion: This operational definition of high-risk cannabis use for Spain elucidates usage patterns and individual vulnerability factors predictive of heightened harm. Its adoption holds potential to inform decision-making among individuals, professionals, and policy-makers, facilitating evidence-based interventions aimed at prevention and risk reduction.

“Wake-and-bake” cannabis use: Predictors and cannabis-related outcomes of use shortly after waking

BackgroundGiven recent historical increases in young adults frequent cannabis use and changes in cannabis policies throughout the United States, there is a need to examine high-risk patterns of use. This paper examined predictors and cannabis-related outcomes of “wake-and-bake” cannabis use, operationalized as use within 30min of waking. MethodsParticipants were 409 young adults (Mage=21.61 years, 50.8% female) enrolled in a longitudinal study on simultaneous alcohol and cannabis use (i.e., using alcohol and cannabis at the same time such that their effects overlap). Eligibility criteria included reporting alcohol use 3+ times and simultaneous alcohol and cannabis use 1+ times in the past month. Participants completed twice-daily surveys for six 14-day bursts across two calendar years. Aims were tested using multilevel models. ResultsAnalyses were limited to cannabis use days (9406 days; 33.3% of all sampled days), and thereby to participants who reported using cannabis (384 participants; 93.9% of the sample). Wake-and-bake use was reported on 11.2% of cannabis use days and at least once by 35.4% of participants who used cannabis. On wake-and-bake use days, participants were high for more hours and had greater odds of driving under the influence of cannabis, but did not experience more negative consequences, relative to non-wake-and-bake cannabis use days. Participants who reported more cannabis use disorder symptoms and those reporting higher average social anxiety motives for cannabis use reported more frequent wake-and-bake use. ConclusionsWake-and-bake cannabis use may be a useful marker of high-risk cannabis use, including driving under the influence of cannabis.

Initial development and validation of a brief assessment of marijuana demand among young adult college students.

Hypothetical purchase tasks assess substance demand, but the length of purchase tasks makes repeated assessment of state-dependent changes in demand difficult, often limiting clinical utility. Although brief assessments of alcohol and cigarette demand exist, brief measures of cannabis demand do not. College students (N = 209, Mage = 19.92, SD = 1.45; 63% female; 56.9% non-Hispanic Caucasian) who reported using cannabis at least 3 days in the past month, completed an online survey including the full-length marijuana purchase task (MPT), a three-item brief assessment of marijuana demand (BAMD) assessing intensity, Omax and breakpoint, and cannabis use outcomes. Convergent and divergent validity were examined. Independent samples t tests compared demand on the BAMD and MPT based on presence or absence of cannabis use disorder (CUD) symptoms, and one-way between-subject analyses of variance compared effects of CUD severity (mild/moderate/severe) on BAMD indices. All indices were significantly correlated across both assessment measures (ps < .01). Similarly, all indices on both demand measures were significantly correlated with craving, CUD severity, and cannabis-related consequences (ps < .01); whereas only intensity and Omax were significantly correlated with cannabis use frequency (ps < .01). Individuals with (vs. without) CUD symptoms reported significantly greater intensity and Omax (ps < .01) and significant differences in CUD severity on BAMD indices were found as well (ps < .05). The BAMD demonstrated convergent and divergent validity with the MPT. Findings suggest that brief cannabis demand can be easily assessed as an indicator for high-risk cannabis use. Thus, the BAMD may be a useful and clinically relevant tool to assess cannabis demand in real-world settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Surviving but not thriving: Burden of care and quality of life for caregivers of patients with schizophrenia spectrum disorders and comorbid substance use in South Africa.

Schizophrenia and schizophrenia spectrum disorders can be devastating for the patient and family. Early recognition and interventions for caregivers, who form part of an overburdened 'invisible health care system' in resource-limited settings with an extensive mental health treatment gap, are crucial for improved outcomes for patients and carers. The study investigated the burden of care and quality of life (QOL) among caregivers of patients with schizophrenia spectrum disorders and its determinants in South Africa. We conducted a study of 101 matched-paired samples of family caregivers and adult patients (N=202) seeking care from two psychiatric hospitals in South Africa. The assessment consisted of the Zarit Burden Interview for caregiver burden, WHO-Quality of life scale and WHO ASSIST for substance use. Most caregivers (n=81; 80.2%) reported high or severe caregiver burden. None of the four QOL domains surpassed the 60% mark where the observed scores (out of 100) for physical health (56.2, SD=16.2), psychological health (55.3, SD=17,6), social relationships (47.1, SD=19.3) and environment (53.5, SD=16.3). Lower burden was associated with greater QOL score across all four domains among caregivers (p ≤ .05). Lower educational attainment was associated with poorer QOL, and higher household income with higher QOL in certain domains. Patient comorbid alcohol (p ≤ .05) and high-risk cannabis use (p < .02) were the only significant factors of increased caregiver burden scores. The high caregiver burden, and its association with alcohol and cannabis use, suggests the need to address comorbid substance use and early pragmatic support for families.

4/20 Cannabis Use is Greater than Other High-Risk Events: Identification of Psychosocial Factors Related to 4/20 Use

Cannabis is the most commonly used federally illicit drug, yet little research has identified risk factors for high-risk use. Although April 20 (“4/20”) has been identified as a day on which cannabis users use more cannabis than they typically do, it remains unknown whether 4/20 is a high-risk event for greater use than other heavy use days (e.g., other holidays) and whether use on 4/20 is related to greater use-related problems. Such information has important implications for event-specific prevention efforts. Thus, the present study tested whether 4/20 is associated with greater cannabis use than other high-risk cannabis use events (e.g., Spring Break), whether 4/20 cannabis use is associated with event-specific use-related problems and subjective intoxication, and whether event-specific psychosocial factors (i.e., motives, normative beliefs) influence 4/20 use among 68 past-year cannabis using undergraduates who reported using cannabis on 4/20 (in a state where cannabis is legal for medical but not recreational purposes). A majority reported experiencing problems related to their 4/20 use and use was greater on 4/20 than on all other high-risk days. Quantity of 4/20 use was significantly, positively correlated with 4/20 cannabis use-related problems and subjective intoxication. 4/20-specific descriptive norms were a stronger predictor of 4/20 cannabis use and use-related problems than 4/20-specific cannabis use motives whereas 4/20-specific enjoyment motives were stronger predictors of subjective intoxication on 4/20. The current study identifies 4/20 as an especially high-risk cannabis use event and is the first to test psychosocial factors related to 4/20 use and use-related problems. Event-specific descriptive norms and enjoyment motives may be important targets for campus-wide efforts to prevent risky use on this high-use day.

The Role of Individual and Social Mediators in the Association Between Drug Consumption and Mental Health Among Adolescents in Barcelona

This study aims to analyze whether there is an association between poor mental health and high-risk cannabis and alcohol use in adolescents attending secondary schools in the city of Barcelona, and to analyze which individual and/or contextual variables mediate this association. Prevalence of risk of poor mental health, binge drinking, high-risk cannabis use, and comorbidity were stratified by sex. To analyze the association between poor mental health and high-risk cannabis and alcohol use, multilevel linear regression models were constructed, obtaining regression coefficients and confidence intervals at 95%. Poor mental health among adolescents is associated with high-risk cannabis use, and association remains after adjusting for individual and contextual variables. Binge drinking shows a weak association with poor mental health that is only significant in girls. This study emphasizes the relevance of focusing on the context in which students live, specifically the school environment, in order to prevent high-risk drug use and poor mental health.

Direct and indirect effects of false safety behaviors on cannabis use and related problems.

In light of increasing rates of cannabis use and use-related problems, efforts to understand malleable psychological vulnerability factors related to use and related problems remain important as they can inform prevention and treatment efforts. Recent data indicate that false safety behaviors (FSB; ie, behaviors that may be effective in decreasing anxiety in the short-term, but can maintain and even exacerbate anxiety in the long-term) are related to cannabis problem severity. Thus, an important next step is to identify factors implicated in the relation between FSB and cannabis use behavior. The current study tested whether FSB were uniquely related to cannabis use problems and high-risk cannabis use motives. We also tested whether FSB were indirectly related to cannabis outcomes via high-risk motives. The sample consisted of 349 current (69.6% female) cannabis-using undergraduates who completed an online survey. FSB was robustly related to cannabis-related problems and cannabis use motives (ie, coping and availability) after controlling for anxiety and cannabis use frequency. FSB was indirectly related to cannabis problems via coping and availability motives and to cannabis use frequency via coping motives. Results add to a growing literature indicating that FSB are related to cannabis problem severity and extend this work by identifying mechanisms underlying this relationship. Data indicate that FSB may be an under recognized, yet clinically important, vulnerability factor related to cannabis use problems. (Am J Addict 2018;27:29-34).

Event-Specific Cannabis Use and Cannabis Use Motives

ABSTRACTBackground: Specific events such as Mardi Gras (MG) and St. Patrick's Day (SPD) have been identified as high-risk events for cannabis use. Further, some campuses may have traditions that are associated with more event-specific cannabis use. Objectives: Campus A has specific traditions regarding MG whereas Campus B has specific traditions regarding SPD and these campuses are differentially related to event-specific cannabis use (Buckner, Henslee, & Jeffries, 2015). Yet, little work has identified individual difference variables related to high-risk cannabis use events. Methods: Current cannabis using undergraduates (N = 154) at two campuses completed an online survey of event-specific cannabis use motives, cannabis use, and cannabis-related problems. Results: Campus A endorsed more MG-specific social and enhancement motives than Campus B. Campus A reported more socially, enhancement, coping, conformity, and expansion motivated cannabis use on MG than on SPD, whereas Campus B reported more socially and enhancement motivated cannabis use on SPD than on MG. Campus A was indirectly related to more MG-specific cannabis use through MG-specific social and enhancement motives. Conclusions/Importance: Event-specific cannabis motives are differentially related to specific high-risk cannabis use events and may be important therapeutic targets.

Mechanisms Underlying Sex Differences in Cannabis Use.

Cannabis is the most commonly used illicit substance worldwide. In recent decades, highly concentrated products have flooded the market, and prevalence rates have increased. Gender differences exist in cannabis use, as men have higher prevalence of both cannabis use and cannabis use disorder (CUD), while women progress more rapidly from first use to CUD. This paper reviews findings from preclinical and human studies examining the sex-specific neurobiological underpinnings of cannabis use and CUD, and associations with psychiatric symptoms. Sex differences exist in the endocannabinoid system, in cannabis exposure effects on brain structure and function, and in the co-occurrence of cannabis use with symptoms of anxiety, depression and schizophrenia. In female cannabis users, anxiety symptoms correlate with larger amygdala volume and social anxiety disorder symptoms correlate with CUD symptoms. Female cannabis users are reported to be especially vulnerable to earlier onset of schizophrenia, and mixed trends emerge in the correlation of depressive symptoms with cannabis exposure in females and males. As prevalence of cannabis use may continue to increase given the shifting policy landscape regarding marijuana laws, understanding the neurobiological mechanisms of cannabis exposure in females and males is key. Examining these mechanisms may help inform future research on sex-specific pharmacological and behavioral interventions for women and men with high-risk cannabis use, comorbid psychiatric disease, and CUD.

Distress Tolerance Among Students Referred for Treatment Following Violation of Campus Cannabis Use Policy: Relations to Use, Problems, and Motivation.

Students referred to treatment after violating campus drug policies represent a high-risk group. Identification of factors related to these students' cannabis use could inform prevention and treatment efforts. Distress tolerance (DT) is negatively related to substance-related behaviors and may be related to high-risk cannabis use vulnerability factors that can impact treatment outcome. Thus, the current study tested whether DT was related to cannabis use frequency, cannabis-related problems, and motivation to change cannabis use among 88 students referred for treatment after violating campus cannabis policies. DT was robustly, negatively related to cannabis use and related problems. DT was also significantly, negatively correlated with coping, conformity, and expansion motives. DT was directly and indirectly related to cannabis problems via coping (not conformity or expansion) motives. Motives did not mediate the relation of DT to cannabis use frequency. DT may be an important target in treatment with students who violate campus cannabis policies.

Estimating high-risk cannabis and opiate use in Ankara, Istanbul and Izmir.

Information on high-risk drug use in Turkey, particularly at the regional level, is lacking. The present analysis aims at estimating high-risk cannabis use (HRCU) and high-risk opiate use (HROU) in the cities of Ankara, Istanbul and Izmir. Capture-recapture and multiplier methods were applied based on treatment and police data stratified by age and gender in the years 2009 and 2010. Case definitions refer to ICD-10 cannabis (F.12) and opiate (F.11) disorder diagnoses from outpatient and inpatient treatment records and illegal possession of these drugs as recorded by the police. High-risk cannabis use was estimated at 28 500 (8.5 per 1000; 95% confidence interval 7.3-10.3) and 33 400 (11.9 per 1000; 95% confidence interval 10.7-13.5) in Ankara and Izmir, respectively. Using multipliers based on capture-recapture estimates for Izmir, HRCU in Istanbul was estimated up to 166 000 (18.0 per 1000; range: 2.8-18.0). Capture-recapture estimates of HROU resulted in 4800 (1.4 per 1000; 95% confidence interval 0.9-1.9) in Ankara and multipliers based on these gave estimates up to 20 000 (2.2 per 1000; range: 0.9-2.2) in Istanbul. HROU in Izmir was not estimated due to the low absolute numbers of opiate users. While HRCU prevalence in both Ankara and Izmir was considerably lower in comparison to an estimate for Berlin, the rate for Istanbul was only slightly lower. Compared with the majority of European cities, HROU in these three Turkish cities may be considered rather low. [Kraus L, Hay G, Richardson C, Yargic I, Ilhan N M, Ay P, Karasahin F, Pinarci M, Tuncoglu T, Piontek D, Schulte B Estimating high-risk cannabis and opiate use in Ankara, Istanbul and Izmir Drug Alcohol Rev 2016;00:000-000].

Event-specific cannabis use and use-related impairment: the relationship to campus traditions.

Despite high rates of college cannabis use, little work has identified high-risk cannabis use events. For instance, Mardi Gras (MG) and St. Patrick's Day (SPD) are characterized by more college drinking, yet it is unknown whether they are also related to greater cannabis use. Further, some campuses may have traditions that emphasize substance use during these events, whereas other campuses may not. Such campus differences may affect whether students use cannabis during specific events. The present study tested whether MG and SPD were related to more cannabis use at two campuses with different traditions regarding MG and SPD. Further, given that Campus A has specific traditions regarding MG whereas Campus B has specific traditions regarding SPD, cross-campus differences in event-specific use were examined. Current cannabis-using undergraduates (N = 154) at two campuses completed an online survey of event-specific cannabis use and event-specific cannabis-related problems. Participants used more cannabis during MG and SPD than during a typical weekday, typical day on which the holiday fell, and a holiday unrelated to cannabis use (Presidents' Day). Among those who engaged in event-specific use, MG and SPD cannabis use was greater than typical weekend use. Campus differences were observed. For example, Campus A reported more cannabis-related problems during MG than SPD, whereas Campus B reported more problems during SPD than MG. Specific holidays were associated with more cannabis use and use-related problems. Observed between-campus differences indicate that campus traditions may affect event-specific cannabis use and use-related problems.

12-month follow-up of an exploratory ‘brief intervention’ for high-frequency cannabis users among Canadian university students

BackgroundOne in three young people use cannabis in Canada. Cannabis use can be associated with a variety of health problems which occur primarily among intensive/frequent users. Availability and effectiveness of conventional treatment for cannabis use is limited. While Brief Interventions (BIs) have been shown to result in short-term reductions of cannabis use risks or problems, few studies have assessed their longer-term effects. The present study examined 12-month follow-up outcomes for BIs in a cohort of young Canadian high-frequency cannabis users where select short-term effects (3 months) had previously been assessed and demonstrated.FindingsN = 134 frequent cannabis users were recruited from among university students in Toronto, randomized to either an oral or a written cannabis BI, or corresponding health controls, and assessed in-person at baseline, 3-months, and 12-months. N = 72 (54 %) of the original sample were retained for follow-up analyses at 12-months where reductions in ‘deep inhalation/breathholding’ (Q = 13.1; p < .05) and ‘driving after cannabis use’ (Q = 9.3; p < .05) were observed in the experimental groups. Reductions for these indicators had been shown at 3-months in the experimental groups; these reductions were maintained over the year. Other indicators assessed remained overall stable in both experimental and control groups.ConclusionsThe results confirm findings from select other studies indicating the potential for longer-term and sustained risk reduction effects of BIs for cannabis use. While further research is needed on the long-term effects of BIs, these may be a valuable – and efficient – intervention tool in a public health approach to high-risk cannabis use.

Trajectories of adolescent alcohol and cannabis use into young adulthood

Both alcohol and cannabis use carry health risks. Both are commonly initiated in adolescence. To date little research has described trajectories of adolescent cannabis or alcohol use or compared their respective consequences in young adulthood. The design was a 10-year eight-wave cohort study of a state-wide community sample of 1943 Victorians initially aged 14-15 years. Moderate- and high-risk alcohol use was defined according to total weekly alcohol consumption. Moderate- and high-risk cannabis use were defined as weekly and daily use, respectively. Around 90% of young adults used either alcohol or cannabis. Although an association existed between alcohol and cannabis use, there was a tendency for heavy users to use one substance predominantly at any one time. Weekly or more frequent cannabis use in the absence of moderate-risk alcohol use in teenagers predicted a sevenfold higher rate of daily cannabis use in young adults but only a twofold increase in high-risk alcohol use. Conversely, moderate-risk adolescent alcohol use in the absence of weekly cannabis predicted an approximately threefold increased rate of both high-risk drinking and daily cannabis use in young adulthood. Selective heavy cannabis use in both adolescence and young adulthood was associated with greater illicit substance use and poorer social outcomes in young adulthood than selective alcohol use. Heavier teenage cannabis users tend to continue selectively with cannabis use. Considering their poor young adult outcomes, regular adolescent cannabis users appear to be on a problematic trajectory.

Promoting Healthy Choices: The Importance of Differentiating Between Ordinary and High Risk Cannabis Use Among High-School Students

Education can affect the lives of adolescents by reinforcing healthy choices and promoting a healthy lifestyle. However, difficulties experienced in the school and family environments may interfere with these goals. This may be particularly true for those youth already participating in health-compromising behaviors such as drug use. Of course, patterns of drug use take many forms, and some are more serious than others. Youth using cannabis at more intensive levels have often been overlooked in the literature. This paper, based on 1997 data, addressed this gap by examining the effects of individual and cumulative school and family factors on not only the probability of any cannabis use but also the progression to problem use among 1980 Ontario students. The results suggested that disrupted family structure increased the likelihood of cannabis use in general. However, patterns of problem use were displayed among youth experiencing problems in school and poor family relationships. As anticipated, adolescents experiencing multiple school and family factors were also significantly more likely to engage in cannabis use, and in its more serious form, when controlling for other demographic predictors. The implications for health promotion initiatives in the school are discussed.

The impact of peers and social disapproval on high-risk cannabis use: gender differences and implications for drug education

Drug education programs that rely on an abstinence based philosophy neglect, and may even contribute to, the potentially adverse consequences experienced by young people who already engage in this potentially health-compromising behaviour. A predominant focus of drug research during the initial wave of rising cannabis use by young people in the 1960's and 1970's, was centred on identifying the factors that contributed to this trend. Less attention has been devoted to uncovering those factors that may inhibit the progression to high-risk levels of use and particularly whether their impact differs for adolescent males and females. In spite of the questionable effectiveness, formal control mechanisms (i.e., criminal laws) and a reliance on prevention-based drug education remain primary approaches for combating drug use. This paper identifies a sub-group of adolescents already using cannabis and estimates the effects of peers, social disapproval and perceived health effects on inhibiting the escalation of use to problem levels. The results suggest that the risk for problem cannabis use among adolescents may be attenuated by some of these informal control items. The findings also suggest however, that the effects of these factors may be different for males and females. The implications for drug education initiatives are discussed.The impact of peers and social disapproval on high-risk cannabis use: Gender differences and implications for drug education.