Treatment For Cannabis Use Research Articles

Clinician perspectives on barriers and facilitators to the treatment of adolescent cannabis use: A qualitative study

IntroductionCannabis use among adolescents is prevalent, and clinicians who work with adolescents have unique insights about how to treat cannabis use in this population. MethodsThis qualitative study interviewed 32 clinicians from addiction medicine recovery services (AMRS), the emergency department (ED), mental health (MH), and pediatrics in an integrated healthcare system to understand their perspectives and experiences regarding barriers and facilitators to treating adolescent cannabis use. The analysis was developed using thematic analysis of interviews. ResultsThirty-two clinicians (Mean age = 45.9, SD =7.6; 56.3 % Female; 56.3 % White) were recruited from AMRS (n = 13; 41.9 %), the ED (n = 7; 22.5 %), MH (n = 7; 22.5 %) and pediatrics (n = 5; 16.1 %). Clinicians discussed several key barriers and facilitators of treating adolescent cannabis use. Facilitators include the use of multiple screening tools for adolescent cannabis use (i.e., self-report and toxicology testing) which provide more comprehensive information; patient-centered treatment approaches; and discussing cannabis use in the context of adolescents' mental health. Barriers discussed included adolescents' and parents' minimization of adolescent cannabis use risks. Several factors were discussed as potential facilitators or barriers, depending on context, including the influence of peers, virtual treatment, and parental involvement or lack thereof in treatment. ConclusionsInterviews with clinicians who work with adolescents across settings highlighted factors that serve as barriers and facilitators to treating adolescent cannabis use. These findings have important implications for guiding future research and intervention efforts, including the inclusion of universal screening practices, addressing stigma, reducing adolescents' and parents' minimization of cannabis use-related harms, and improving adolescent and parent engagement in treatment.

Technology-Based Psychotherapeutic Interventions for Decreasing Cannabis Use in People with Psychosis: A Systematic Review Update.

Cannabis use is highly prevalent in people with psychotic disorders and is associated with adverse outcomes. We updated our 2020 systematic review related to the efficacy of technology-based psychological interventions (TBPIs) to decrease cannabis use in individuals with psychosis, the design of TBPIs, and their acceptability. We searched Medline, PubMed, Embase, CINAHL, PsycINFO, and EMB Reviews for references indexed between November 27, 2019, and July 27, 2023, and used the PRISMA guidelines to report the results. We screened 5083 unique records and retained three studies for the narrative synthesis. Two quantitative studies showed promising results of internet or virtual reality-based psychological interventions that incorporate cognitive behavioral therapy, motivational interviewing, and psychoeducation principles on the frequency and quantity of cannabis use. A qualitative exploratory study provided an integrative synthesis of patient and clinician opinions pertaining to the use of psychological approaches and technology to tackle cannabis misuse in individuals with psychosis. In contradiction with the rapidly expanding mobile-health solutions in the field of mental health, there is a dearth of research related to the use of internet and app-based psychological interventions for cannabis use in individuals with psychosis. The use of qualitative research is pivotal in the development of TBPIs. Our initial review and its update show that only 11 peer-reviewed journal articles that met our inclusion criteria have been published so far.

Significant Psychedelic Experiences Evaluated for Mystical Characteristics Associated with Cannabis Use Reduction and Psychological Flexibility Improvement: A Naturalistic Cross-Sectional Retrospective Survey

ABSTRACT Treating cannabis use disorder remains a significant challenge in the field of addiction medicine. Some recent studies point to psychedelic-assisted psychotherapy as a potential treatment option for substance use disorders. The objective of this study was therefore to explore the impact of naturalistic psychedelic experiences on cannabis use and psychological flexibility. An online retrospective survey was carried out on 152 cannabis users who also reported a significant experience induced by psychedelics in the past. Following a psychedelic experience, there was a significant and sustained reduction of average CUDIT score (p < .001), frequency of cannabis use (p < .001), and acute duration of daily intoxication (p < .001). Cannabis use reduction during the first month post-experience was significantly associated with the intensity of the mystical experience (p = .01). Participants reported a concomitant increased lasting improvement of psychological flexibility following the experience (p < .001), which was correlated to the intensity of the mystical experience during the first month post-experience (p = .04). This study demonstrates that naturalistic psychedelic experiences may be followed by a decrease in cannabis use. Positive health outcomes appear potentially connected to the intensity of the mystical experience, as well as an improvement in psychological flexibility.

A pilot trial of a brief intervention for cannabis use supplemented with a substance-free activity session or relaxation training.

Cannabis use is increasing among college students and commonly co-occurs with anxiety symptoms in this age group. Interventions that reduce anxiety may also reduce cannabis use. Behavioral economic theory suggests that substance use reductions are most likely when there is an increase in substance-free reinforcement. This randomized pilot trial evaluated the efficacy of a brief motivational intervention (BMI) for cannabis supplemented by either a substance-free activity session (SFAS) or a relaxation training (RT) session for reducing cannabis use, problems, craving, and anxiety symptoms. One hundred thirty-two college students (Mage = 19.9; 54% female; 67% White, 31% Black) who reported five or more past-month cannabis use days were randomized to: (a) assessment-only (AO); (b) BMI plus SFAS; or (c) BMI plus RT. Participants in the BMI conditions received two individual counselor-administered sessions plus a brief phone booster session. Outcomes were evaluated 1- and 6-months postintervention. Relative to assessment, both BMI + SFAS and BMI + RT were associated with significant reductions in cannabis problems and craving at 1-month follow-up, and significant reductions in anxiety at 6-month follow-up. Relative to AO, BMI + RT was associated with significant reductions in cannabis use at 1-month follow-up. There were no differences between BMI conditions. This pilot trial was not adequately powered to conclusively evaluate relative efficacy but provides preliminary support for the short-term efficacy of both two-session interventions for reducing anxiety and cannabis-related risk among nontreatment seeking emerging adults. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Digital Interventions for Recreational Cannabis Use Among Young Adults: Systematic Review, Meta-Analysis, and Behavior Change Technique Analysis of Randomized Controlled Studies.

The high prevalence of cannabis use among young adults poses substantial global health concerns due to the associated acute and long-term health and psychosocial risks. Digital modalities, including websites, digital platforms, and mobile apps, have emerged as promising tools to enhance the accessibility and availability of evidence-based interventions for young adults for cannabis use. However, existing reviews do not consider young adults specifically, combine cannabis-related outcomes with those of many other substances in their meta-analytical results, and do not solely target interventions for cannabis use. We aimed to evaluate the effectiveness and active ingredients of digital interventions designed specifically for cannabis use among young adults living in the community. We conducted a systematic search of 7 databases for empirical studies published between database inception and February 13, 2023, assessing the following outcomes: cannabis use (frequency, quantity, or both) and cannabis-related negative consequences. The reference lists of included studies were consulted, and forward citation searching was also conducted. We included randomized studies assessing web- or mobile-based interventions that included a comparator or control group. Studies were excluded if they targeted other substance use (eg, alcohol), did not report cannabis use separately as an outcome, did not include young adults (aged 16-35 y), had unpublished data, were delivered via teleconference through mobile phones and computers or in a hospital-based setting, or involved people with mental health disorders or substance use disorders or dependence. Data were independently extracted by 2 reviewers using a pilot-tested extraction form. Authors were contacted to clarify study details and obtain additional data. The characteristics of the included studies, study participants, digital interventions, and their comparators were summarized. Meta-analysis results were combined using a random-effects model and pooled as standardized mean differences. Of 6606 unique records, 19 (0.29%) were included (n=6710 participants). Half (9/19, 47%) of these articles reported an intervention effect on cannabis use frequency. The digital interventions included in the review were mostly web-based. A total of 184 behavior change techniques were identified across the interventions (range 5-19), and feedback on behavior was the most frequently used (17/19, 89%). Digital interventions for young adults reduced cannabis use frequency at the 3-month follow-up compared to control conditions (including passive and active controls) by -6.79 days of use in the previous month (95% CI -9.59 to -4.00; P<.001). Our results indicate the potential of digital interventions to reduce cannabis use in young adults but raise important questions about what optimal exposure dose could be more effective, both in terms of intervention duration and frequency. Further high-quality research is still needed to investigate the effects of digital interventions on cannabis use among young adults. PROSPERO CRD42020196959; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=196959.

Trends in Prevalence of Cannabis Use Disorder Among U.S. Veterans With and Without Psychiatric Disorders Between 2005 and 2019.

Cannabis use disorder diagnoses are increasing among U.S. adults and are more prevalent among people with comorbid psychiatric disorders. Recent changes in cannabis laws, increasing cannabis availability, and higher-potency cannabis may have placed people with cannabis use and psychiatric disorders at disproportionately increasing risk for cannabis use disorder. The authors used Veterans Health Administration (VHA) data to examine whether trends in cannabis use disorder prevalence among VHA patients differ by whether they have psychiatric disorders. VHA electronic health records from 2005 to 2019 (N range, 4,332,165-5,657,277) were used to identify overall and age-group-specific (<35, 35-64, and ≥65 years) trends in prevalence of cannabis use disorder diagnoses among patients with depressive, anxiety, posttraumatic stress, bipolar, or psychotic spectrum disorders and to compare these to corresponding trends among patients without any of these disorders. Given transitions in ICD coding, differences in trends were tested within two periods: 2005-2014 (ICD-9-CM) and 2016-2019 (ICD-10-CM). Greater increases in prevalence of cannabis use disorder diagnoses were observed among patients with psychiatric disorders compared to those without (difference in prevalence change, 2005-2014: 1.91%, 95% CI=1.87-1.96; 2016-2019: 0.34%, 95% CI=0.29-0.38). Disproportionate increases in cannabis use disorder prevalence among patients with psychiatric disorders were greatest among those under age 35 between 2005 and 2014, and among those age 65 or older between 2016 and 2019. Among patients with psychiatric disorders, the greatest increases in cannabis use disorder prevalences were observed among those with bipolar and psychotic spectrum disorders. The findings highlight disproportionately increasing disparities in risk of cannabis use disorder among VHA patients with common psychiatric disorders. Greater public health and clinical efforts are needed to monitor, prevent, and treat cannabis use disorder in this population.

A systematic review of economic evaluations for opioid misuse, cannabis and illicit drug use prevention.

Substance use disorders negatively affect global disease burden. Effective preventive interventions are available, but whether they provide value for money is unclear. This review looks at the cost-effectiveness evidence of preventive interventions for cannabis use, opioid misuse and illicit drug use. Literature search was undertaken in Medline, CINAHL, PsycINFO, EconLit through EBSCOhost and EMBASE, up to May 2021. Grey literature search was conducted as supplement. Studies included were full economic evaluations or return-on-investment (ROI) analyses for preventing opioid misuse, cannabis and illicit drug use. English-language restriction was used. Outcomes extracted were incremental cost-effectiveness ratios (ICER) or ROI ratios, with costs presented in 2019 United States dollars. Quality was assessed with the Drummond checklist. Eleven full economic evaluation studies were identified from 5674 citations, with all studies conducted in high-income countries. Most aimed to prevent opioid misuse (n = 4), cannabis (n = 3) or illicit drug use (n = 5). Modelling was the predominant methodology (n = 7). Five evaluated school-based universal interventions targeting children and adolescents (aged <18 years). Five cost-benefit studies reported cost-savings. One cost-effectiveness and two cost-utility analysis studies supported the cost-effectiveness of interventions, as ICERs fell under prespecified value-for-money thresholds. There are limited economic evaluations of preventive interventions for opioid misuse, cannabis and illicit drug use. Family-based intervention (ParentCorps), school-based interventions (Social and Emotional Training and Project ALERT) and a doctor's programme to assess patient risk of misusing narcotics ('the Network System to Prevent Doctor-Shopping for Narcotics') show promising cost-effectiveness and warrant consideration.

Youth cannabis use in Canada post-legalization: service providers’ perceptions, practices, and recommendations

BackgroundIn 2018, Canada legalized recreational cannabis use with the purpose of protecting youth and restricting access. However, concerns have been raised that this objective has not been met as rates of cannabis use among youth aged 16–24 have not declined. Youth cannabis use is associated with various adverse effects including psychosis, anxiety, depression, suicidality, respiratory distress, cannabinoid hyperemesis syndrome, and intoxications. Service providers play a crucial role in addressing youth cannabis use. This study aimed to understand Ontario service providers’ perceptions, practices, and recommendations on youth cannabis use.MethodsThis mixed method study included a survey and two focus groups. The survey was distributed to mental health service providers serving youth aged 16–24 across Ontario who were given the option to participate in a focus group. The survey included closed and open-ended questions regarding perceptions, practices, and recommendations, while the focus groups explored these categories in greater depth. Descriptive statistics were used to analyze close-ended questions and interpretative content analysis was applied for open-ended questions. Focus group data were analyzed using thematic analysis.ResultsThe survey was completed by 160 service providers and 12 participated in two focus groups. Regarding perceptions, 60% of survey participants agreed with legalization, 26% had a strong understanding of medical versus recreational cannabis, 84% believed that cannabis has physical and mental health risks, and 49% perceived stigmatization. Less than half of the survey participants reported screening or assessing cannabis use, 16% stated they are highly familiar with treating cannabis use, and 67% reported that they rarely work with families. Subthemes identified in the focus groups under perceptions included normalization and stigmatization, harms for youth, and stigma, racism, and discrimination. Subthemes under practice included cannabis not being the primary focus, challenges with screening, assessment, and intervention, and referral to specialized services. Both the survey and focus group participants recommended increasing public education, enhancing service provider training, improving regulation and policies, reducing stigma and minimization, improving service access, and providing more culturally responsive services.ConclusionYouth cannabis use in Canada remains a significant public health concern, necessitating a more comprehensive plan to protect Ontario youth and reduce associated harms.

Exploring the Impact of Adult‐use Cannabis Legalization on Legal System Referrals to Treatment for Cannabis Use: Do Age and Race Have a Moderating Effect?

PurposeDespite the progression of recreational cannabis legalization, the legal system remains the largest source of referral to treatment for cannabis use. The legal system's continued practice of requiring participation in cannabis treatment programs raises questions regarding the extent to which individuals who interact with the legal system are monitored for cannabis use post-legalization. This article presents trends in justice-system referrals to treatment for cannabis use in legal and nonlegal states for 2007–2019. The relationship between legalization and justice system treatment referrals for black, Hispanic/Latino, and white adults and juveniles was explored. Given that minority and youth populations are subject to disproportionate levels of cannabis enforcement, legalization is expected to have a weaker relationship with justice-system referral rates in white juveniles and black and Hispanic/Latino adults and juveniles compared to white adults. MethodsUsing 2007–2019 data from the Treatment Episode Data Set—Admissions (TEDS-A), variables were created for state-level rates of legal system–referred treatment admissions for cannabis use in black, Hispanic/Latino, and white adults and juveniles. Rate trends were compared across populations and staggered difference-in-difference and event analyses were conducted to determine whether legalization is associated with a decline in justice-system referrals to treatment for cannabis use . FindingsFor the study period, the mean rate of legal system–referred admissions in the total population was 2.75 per 10,000 residents. Black juveniles had the highest mean rate (20.16), followed by Hispanic/Latino juveniles (12.35), black adults (9.18), white juveniles (7.58), Hispanic/Latino adults (3.42), and white adults (1.66). Legalization did not have a significant impact on treatment-referral rates in any population of study. Events analyses indicated significant rate increases in black juveniles in legalized states compared to controls at 2 and 6 years after policy change, and in black and Hispanic/Latino adults at 6 years after policy change (all, P < 0.05). While racial/ethnic disparities in referral rates declined in absolute terms, the relative size of these disparities increased in legalized states. ImplicationsTEDS-A captures only publicly funded treatment admissions and relies on the quality of individual-state reporting. Individual-level factors that may impact decisions regarding treatment referrals for cannabis use could not be controlled for. Despite limitations, the present findings suggest that for individuals who interact with the criminal legal system, cannabis use may still result in legal monitoring after reform. The upward trend in legal system referrals for black (but not white) adults and juveniles several years after states legalize cannabis warrants further examination and may reflect continued disparate treatment of these populations at multiple points along the legal-system continuum.

Cannabinoids for Substance Use Disorder Treatment: What Does the Current Evidence Say?

Background: The prevalence of Substance Use Disorder (SUD) is increasing along with the need to develop approaches to reduce the harm associated with substance use, including investigating alternatives such as cannabinoids, which show promising results, although the current evidence is limited. This scoping review focuses on the limitations and potentials of cannabinoid-based treatments for SUDs. Methods: We examined between-subject randomized controlled trials (RCTs) investigating the use of CBD and THC as pharmacological treatment for SUDs in adults, with the procedures attending the expectations of the Preferred Reporting Items for Scoping reviews and Meta-Analyses (PRISMA) for Scoping Reviews guidelines and assessed risk of bias using the Cochrane Risk of Bias Assessment Tool 2. Results: Ten RCTs were included, with six demonstrating low risk of bias, and positive results were found for treating Cannabis Use Disorder, while contradictory results were found for Opioid Use Disorder, and inconclusive results for treating Cocaine Use Disorder. Conclusions: CBD and THC demonstrate potential for treating some SUDs, but evidence is limited. Robust RCTs with larger samples and longer follow-up periods are necessary to assess carefully developed outcomes for different SUD patients. New cannabinoid-based medications and scientific-based policies may advance SUD treatment. A comprehensive approach to treatment and careful methodological choices may benefit patients with SUD.

Effect of four-week cannabidiol treatment on cognitive function: secondary outcomes from a randomised clinical trial for the treatment of cannabis use disorder

RationaleChronic cannabis use is associated with impaired cognitive function. Evidence indicates cannabidiol (CBD) might be beneficial for treating cannabis use disorder. CBD may also have pro-cognitive effects; however, its effect on cognition in people with cannabis use disorder is currently unclear.ObjectivesWe aimed to assess whether a 4-week CBD treatment impacted cognitive function. We hypothesised that CBD treatment would improve cognition from baseline to week 4, compared to placebo.MethodsCognition was assessed as a secondary outcome in a phase 2a randomised, double-blind, parallel-group and placebo-controlled clinical trial of 4-week daily 200 mg, 400 mg and 800 mg CBD for the treatment of cannabis use disorder. Participants had moderate or severe DSM-5 cannabis use disorder and intended to quit cannabis use. Our pre-registered primary cognitive outcome was delayed prose recall. Secondary cognitive outcomes were immediate prose recall, stop signal reaction time, trail-making task performance, verbal fluency and digit span.ResultsSeventy participants were randomly assigned to placebo (n = 23), 400 mg CBD (n = 24) and 800 mg CBD (n = 23). A 200 mg group was eliminated from the trial because it was an inefficacious dose at interim analysis (n = 12) and was not analysed here. For the primary cognitive outcome, there was no effect of CBD compared to placebo, evidenced by a lack of dose-by-time interaction at 400 mg (0.46, 95%CIs: − 1.41, 2.54) and 800 mg (0.89, 95%CIs: − 0.99, 2.81). There was no effect of CBD compared to placebo on secondary cognitive outcomes, except backwards digit span which increased following 800 mg CBD (0.30, 95%CIs: 0.02, 0.58).ConclusionsIn this clinical trial for cannabis use disorder, CBD did not influence delayed verbal memory. CBD did not have broad cognitive effects but 800 mg daily treatment may improve working memory manipulation.Clinical trial registrationThe trial was registered with ClinicalTrials.gov (NCT02044809) and the EU Clinical Trials Register (2013–000,361-36).

Savoring as an intervention for cannabis use: acceptability, feasibility, and preliminary results

Although savoring appears protective against cannabis problems, researchers have yet to apply it to reduce cannabis-related harms. Study I surveyed a large (N = 557, M age = 36.9, 50.1% Male, 73% White) sample who rated a hypothetical savoring intervention as feasible and acceptable; those who savored more reported fewer cannabis problems, less use, and less intoxication. Study II, a pilot experiment (N = 26, M age = 18, 34.6% Male, 42% White), randomly assigned participants to either a week-long savoring intervention (n = 15) or control group (n = 11). Savorers reported moderate to large decreases across time in cannabis use, amount consumed, and intoxication as well as increases in happiness and negative cannabis expectancies. Both studies suggest that savoring can reduce use and protect against negative outcomes. These preliminary findings suggest that further work to examine the efficacy of savoring as an intervention for substance use appears warranted.

Contingency Management for Treatment of Cannabis Use Disorder in Co-Occurring Mental Health Disorders: A Systematic Review.

Amongst individuals with a mental health disorder, a comorbid diagnosis of cannabis use disorder (CUD) is associated with numerous adverse consequences, including more severe symptom profiles, poorer treatment response, and reduced psychosocial functioning. Contingency management (CM), a method to specifically reinforce target behavior attainment (e.g., substance use abstinence), may provide an effective intervention in treating cannabis use in patients with a dual diagnosis of CUD and a mental health disorder. A systematic search examining the effects of CM on cannabis use, clinical, cognitive, and psychosocial outcomes in patients with a mental health disorder on PubMed, PsycINFO, and EMBASE databases up to November 2022 was performed. Six studies met inclusion criteria for our review. We found CM to be efficacious in producing cannabis use reductions and abstinence amongst individuals with a psychotic-spectrum or major depressive disorder. Additional longitudinal studies with larger sample sizes, other psychiatric populations, and longer follow-up periods are needed to evaluate the sustained effects of CM.

Cannabis Use Disorder: A Review

Background: Cannabis use is rising and becoming a trending drug among youth. The drug is used in different forms, leading to intoxication, acute and long-term consequences. About 2.8% of Indians aged 10-75 years are current users of any cannabis product. Withdrawal from the drug use requires medical intervention and counselling. &#x0D; Objectives: To identify existing evidence in homoeopathy on drug deaddiction and cannabis use disorder and to update the physicians on diagnosis, risk behaviours, treatment and investigations associated with cannabis use disorder. &#x0D; Methods: A review of existing literature was conducted through internet sources and the CCRH headquarters library using keywords i.e. substance use, substance abuse, marijuana, cannabis abuse, drug abuse, cannabis use disorder etc. Data from studies reporting drug abuse to identify the type of drug use and homoeopathic treatment response in the withdrawal and long-term management and treatment of drug dependents was tabulated. &#x0D; Results: Although some studies have been conducted on drug withdrawal, no studies have been conducted on cannabis use disorder. More case studies and research on treatment of cannabis use disorder using Homoeopathy are needed. &#x0D; Interpretation: Physicians need to update themselves on diagnosis, risk behaviours, treatment and investigations to counter the condition and contribute to generating evidence-based literature on the homoeopathic approach for treating cannabis use disorder.

Estimating the Effects of a Complex, Multidimensional Moderator: An Example of Latent Class Moderation to Examine Differential Intervention Effects of Substance Use Services.

Improvements in substance use disorder recovery may be achieved by recognizing that effective interventions do not work equally well for all individuals. Heterogeneity of intervention effects is traditionally examined as a function of a single variable, such as gender or baseline severity. However, responsiveness to an intervention is likely a result of multiple, intersecting factors. Latent class moderation enables the examination of heterogeneity in intervention effects across subgroups characterized by profiles of characteristics. This study analyzed data from adolescents (aged 13 to 18years old) who needed treatment for cannabis use (n = 14,854) and participated in the Global Appraisal of Individual Needs to evaluate differential effects of substance use services on cannabis use outcomes. We demonstrate an adjusted three-step approach using weights that account for measurement error; sample codes in Mplus and Latent Gold are provided and data are publicly available. Indicators of the latent class moderator comprised six contextual (e.g., recovery environment risk) and individual (e.g., internal mental distress) risk factors. The latent class moderator comprised four subgroups: low risk (21.1%), social risk (21.1%), environmental risk (12.5%), and mixed risk (45.2%). Limited moderation of associations between level of care and any past 90-day cannabis use were observed. In predicting number of cannabis use-days, compared to individuals with low risk, those with environmental risk showed improved outcomes from intensive outpatient care whereas individuals with social risk and mixed risk showed improved outcomes from residential care (all compared to early intervention/outpatient care). Latent class moderation holds potential to elucidate heterogeneity in intervention effectiveness that otherwise may go undetected.

Assessment of patient perception of treatment assignment and patient-reported outcomes in a cannabis use disorder trial

ABSTRACT Background: Blinding is a cornerstone of trial methodology. Prior work indicates participant-perceived assignment may be associated with trial outcomes. Less is known about how perception changes over time and if this is associated with outcomes. Objectives: To evaluate if participants change their perception of assignment over time in a blinded trial, and if perception is associated with different types of patient-reported outcomes (PROs). Methods: This was a secondary analysis of data from the Achieving Cannabis Cessation-Evaluating N-Acetylcysteine Treatment (ACCENT) trial, which evaluated the efficacy of N-acetylcysteine (NAC) relative to placebo for treating cannabis use disorder. Participants (N = 234; 164 men, 70 women) were asked at weeks 5 and 9 what treatment (placebo or NAC) they believed they were receiving. We included PROs proximal (cannabis-associated problems, craving) and distal (anxiety) to the intervention. Analysis was by multiple linear regression and mixed models. Results: Approximately 20% of participants in both arms changed their perception over time. Relative to participants who consistently perceived assignment to placebo, participants who consistently perceived assignment to NAC did not always have comparatively better average scores (coefficient −3.3 [95% CI: −7.0, 0.5]). In some analyses, participants who switched to guessing NAC from placebo had comparatively better average scores (coefficient −3.0 [95% CI: −9.3, 3.4]), but this was inconsistent across outcomes or strata defined by actual assignment or guess accuracy. Conclusion: The study suggests that the proportion of individuals who switch their perception over time is modest. However, this group may influence the estimates of intervention effects on some PROs.

A social media intervention for cannabis use among emerging adults: Randomized controlled trial

PurposeCannabis use is increasing among emerging adults (ages 18–25), necessitating the need for prevention interventions. Using a novel platform – social media – we developed an 8-week motivational interviewing and cognitive-behavioral intervention targeting cannabis use among emerging adults. Herein, we report on the feasibility and acceptability of the intervention in a pilot trial. ProceduresFor NCT 04187989 we recruited N = 149 emerging adults who used cannabis (at least 3 times/week for the past month) using social media advertising. Their mean age was 21.0 years (SD = 2.2); 55.7% were female. Most were White (70.5%; 20.1% Black/African American, 9.4% Other races), with 20.1% identifying as Hispanic/Latinx. Participants were randomized to the 8-week intervention or an 8-week attention-placebo control condition, both delivered in secret Facebook groups by electronic health coaches (e-coaches). Follow-up assessments occurred at 3- and 6-months. ResultsThe intervention was well-received and follow-up rates were high; fidelity was good. Intervention participants rated e-coaches significantly higher in terms of helpfulness, warmth, etc., compared to control participants. Intervention participants were more likely to engage with and recommend the group. In terms of percentage reductions in cannabis outcomes, the intervention group evidenced absolute reductions over time in several measures of cannabis consumption across modalities. In an adjusted model, reductions in vaping days in the intervention group, relative to attention-control, reached statistical significance (p = .020, D =.40). ConclusionsThis social media intervention for emerging adults’ cannabis use was feasible and acceptable in the target population warranting future testing in a fully powered trial.

Responsiveness to mHealth Intervention for Cannabis Use in Young Adults Predicts Improved Outcomes.

Mobile health (mHealth) interventions have proliferated rapidly in part because of their advantages in reducing consumer and provider burden, but less attention has been paid to participant responsiveness to mHealth programs and how this may affect outcomes. This study adds to that literature by examining whether participant responsiveness to a text messaging-delivered intervention was predictive of treatment outcomes over baseline levels of the outcome. We analyzed data from a pilot-randomized controlled trial of a text messaging-intervention to treat young adults with cannabis use disorder (treatment arm, N = 47), examining three indicators of responsiveness (two behavioral: treatment completion and booster message participation; and one subjective: perceived helpfulness of treatment) on abstinence from cannabis use and use-related problems measured at 3-month follow-up. With the exception of completion, the indicators were positively correlated with each other. Each of the indicators was predictive of better treatment outcomes above and beyond baseline risk. Treatment completion and booster participation-measured via technical data captured during intervention administration-appeared to be stronger predictors of improved outcomes than self-reported perceived helpfulness. Results suggest that behavioral and subjective responsiveness measures appear to be valid indicators of treatment response to mHealth interventions for substance use. Responsiveness measured via technical data captured during intervention administration may be a stronger and more efficient strategy for monitoring continued engagement. We discuss implications of these findings for deploying mHealth interventions at scale and monitoring responsiveness.

Racial and Ethnic Differences in Cannabis Use and Cannabis Use Disorder: Implications for Researchers.

Heavy and prolonged use of cannabis is associated with several adverse health, legal and social consequences. Although cannabis use impacts all U.S. racial/ethnic groups, studies have revealed racial/ethnic disparities in the initiation, prevalence, prevention and treatment of cannabis use and Cannabis Use Disorder (CUD). This review provides an overview of recent studies on cannabis and CUD by race/ethnicity and a discussion of implications for cannabis researchers. The majority of studies focused on cannabis use and CUD among African American/Black individuals, with the smallest number of studies found among Native Hawaiians/Pacific Islanders. The limited number of studies highlight unique risk and protective factors for each racial/ethnic group, such as gender, mental health status, polysubstance use and cultural identity. Future cannabis studies should aim to provide a deeper foundational understanding of factors that promote the initiation, maintenance, prevention and treatment of cannabis use and CUD among racial/ethnic groups. Cannabis studies should be unique to each racial/ethnic group and move beyond racial comparisons.

Cannabis use disorder treatment use and perceived treatment need in the United States: Time trends and age differences between 2002 and 2019

BackgroundAs trends in CUD treatment are understudied, we examined time trends in CUD treatment and perceived treatment need among people with CUD overall and by age group. MethodsData from the 2002–2019 National Survey on Drug Use and Health included 43,307 individuals who met past-year DSM-5-proxy CUD criteria. Last/current treatment for cannabis use (i.e., any or specialty CUD treatment) and perceived treatment need were regressed on survey year and age (12–17, 18–25, ≥26) using generalized linear spline models. Time-varying effect modification assessed the magnitude of age-treatment associations over time. ResultsBetween 2002 and 2019, 6.1% of people with CUD used any CUD treatment, 2.8% used specialty treatment, and 2.2% perceived a treatment need. CUD treatment use decreased by 54.23% between 2002 and 2019 (9.11%–4.17%). Compared with adolescents, adults ages 18–25 were less likely to use specialty CUD treatment [aRR: 0.70: 95% CI: 0.52, 0.93] and ages ≥26 were more likely to perceive treatment need [aRR: 1.84: 95% CI: 1.19, 2.83]. Age-specific differences in the time-varying magnitude of associations were observed (e.g., in 2010 perceived treatment need was higher in ages ≥26 versus ages 12–17 [aOR: 2.34, 95% CI: 1.47, 3.71]). ConclusionsCUD treatment is decreasing and young adults have lower treatment use compared with adolescents. Attitudes towards cannabis use harms are shifting, potentially contributing to decreasing CUD treatment utilization and perceived treatment need. Future research should identify treatment barriers, especially among young adults with the lowest CUD treatment use.