Cannabis Dependence Research Articles

Mobile Intervention to Address Cannabis Use Disorder Among Black Adults: Protocol for a Randomized Controlled Trial.

African American or Black (hereafter referred to as Black) adults who use cannabis use it more frequently and are more likely to meet criteria for cannabis use disorder (CUD) than both White and Hispanic or Latin individuals. Black adults may be more apt to use cannabis to cope with distress, which constitutes a false safety behavior (FSB; a behavior designed to reduce psychological distress in the short term). Although FSB engagement can perpetuate the cycle of high rates of CUD among Black individuals, limited work has applied an FSB elimination treatment approach to Black adults with CUD, and no previous work has evaluated FSB reduction or elimination in the context of a culturally tailored and highly accessible treatment developed for Black individuals. This study aims to develop and pilot-test a culturally tailored adaptive intervention that integrates FSB reduction or elimination skills for cannabis reduction or cessation among Black adults with probable CUD (Culturally Tailored-Mobile Integrated Cannabis and Anxiety Reduction Treatment [CT-MICART]). Black adults with probable CUD (N=50) will complete a web-based screener, enrollment call, baseline assessment, 3 daily ecological momentary assessments (EMAs) for 6 weeks, and a follow-up self-report assessment and qualitative interview at 6 weeks after randomization. Participants will be randomized into 1 out of the 2 conditions after baseline assessment: (1) CT-MICART+EMAs for 6 weeks or (2) EMAs only for 6 weeks. The enrollment started in June 2023 and ended in November 2023. Data analysis will be completed in March 2024. No culturally tailored, evidence-based treatment currently caters to the specific needs of Black individuals with CUD. This study will lay the foundation for a new approach to CUD treatment among Black adults that is easily accessible and has the potential to overcome barriers to treatment and reduce practitioner burden in order to support Black individuals who use cannabis with probable CUD. ClinicalTrials.gov NCT05566730; https://clinicaltrials.gov/study/NCT05566730. DERR1-10.2196/52776.

Association of Cannabis Use Disorder with Major Adverse Cardiac and Cerebrovascular Events in Older Non-Tobacco Users: A Population-Based Analysis.

Tobacco use disorder (TUD) adversely impacts older patients with established cardiovascular disease (CVD) risk. However, CVD risk in chronic habitual cannabis users without the confounding impact of TUD hasn't been explored. We aimed to determine the risk of major adverse cardiac and cerebrovascular events (MACCE) in older non-tobacco smokers with established CVD risk with vs. without cannabis use disorder (CUD). We queried the 2019 National Inpatient Sample for hospitalized non-tobacco smokers with established traditional CVD risk factors aged ≥65 years. Relevant ICD-10 codes were used to identify patients with vs. without CUD. Using multivariable logistic regression, we evaluated the odds of MACCE in CUD cohorts compared to non-CUD cohorts. Prevalence of CUD in the sample was 0.3% (28,535/10,708,815, median age 69), predominantly male, black, and non-electively admitted from urban teaching hospitals. Of the older patients with CVD risk with CUD, 13.9% reported MACCE. The CUD cohort reported higher odds of MACCE (OR 1.20, 95% CI 1.11-1.29, p < 0.001) compared to the non-CUD cohort. Comorbidities such as hypertension (OR 1.9) and hyperlipidemia (OR 1.3) predicted a higher risk of MACCE in the CUD cohort. The CUD cohort also had higher unadjusted rates of acute myocardial infarction (7.6% vs. 6%) and stroke (5.2% vs. 4.8%). Among older non tobacco smokers with known CVD risk, chronic cannabis use had a 20% higher likelihood of MACCE compared to those who did not use cannabis.

Proportion of At-Risk Alcohol Consumers According to the New French Guidelines: Cross-Sectional Weighted Analyses From the CONSTANCES Cohort.

Objective: To estimate the proportion of the participants of the French national population-based CONSTANCES cohort exceeding the new low-risk drinking guidelines according to sociodemographic and clinical factors. Methods: From 34,470 participants with follow-up data in 2019, among volunteers aged 18-69years and invited to enroll in the CONSTANCES cohort in 2016 and 2017, weighted prevalence and odds ratios with 95% confidence intervals (CI) exceeding the guidelines using logistic regressions were presented stratified for age, gender, education, occupational grade, employment, income, marital status, pregnancy, work stress, depression, alcohol dependence, binge drinking, cannabis use, smoking status, e-cigarette use, cardiovascular diseases, and cancer. Results: The guidelines were exceeded more by men at 60.2% (95%CI: 59.3%-61.0%) than by women at 36.6% (95%CI: 35.9%-37.4%). Exceeding the guidelines increased with age, socioeconomic status, smoking, vaping, using cannabis, binge drinking, and alcohol dependence. Being depressed was associated with exceeding the guidelines in women. Even though pregnant women were less likely to exceed the guidelines, 7.6% (95%CI: 5.4%-10.6%) were at-risk drinkers. Conclusion: These findings highlight the need to implement effective prevention measures for at-risk alcohol use among the French population.

Prevalence of cannabis use disorder and perioperative outcomes in adult colectomy patients: A propensity score-matched analysis.

The decriminalization of cannabis across the United States has led to an increased number of patients reporting cannabis use prior to surgery. However, it is unknown whether preoperative cannabis use disorder (CUD) increases the risk of postoperative complications among adult colectomy patients. Adult patients undergoing an elective colectomy were retrospectively analyzed from the National Inpatient Sample database (2004-2018). To control for potential confounders, patients with CUD, defined using ICD-9/10 codes, were propensity score matched to patients without CUD in a 1:1 ratio. The association between preoperative CUD and composite morbidity, the primary outcome of interest, was assessed. Subgroup analyses were performed after stratification by age (≥50years). Among 432,018 adult colectomy patients, 816 (0.19%) reported preoperative CUD. The prevalence of CUD increased nearly three-fold during the study period from 0.8/1000 patients in 2004 to 2.0/1000 patients in 2018 (P-trend<0.001). After propensity score matching, patients with CUD exhibited similar rates of composite morbidity (140 of 816; 17.2%) as those without CUD (151 of 816; 18.5%) (p=0.477). Patients with CUD also had similar anastomotic leak rates (CUD: 5.64% vs. No CUD: 6.25%; p=0.601), hospital lengths of stay (CUD: 5days, IQR 4-7 vs. No CUD: 5days, IQR 4-7) (p=0.415), and hospital charges as those without CUD. Similar findings were seen among patients aged ≥50years in the subgroup analysis. Though the prevalence of CUD has increased drastically over the past 15years, preoperative CUD was not associated with an increased risk of composite morbidity among adult patients undergoing an elective colectomy.

Abstract TP228: Association of Dependent Cannabis Use in Patients With Chronic Liver Disease With Stroke Hospitalizations and Subsequent Mortality: A Nationwide Analysis

Introduction: Chronic liver disease (CLD) predisposes to systemic manifestations like thrombocytopenia and coagulopathy that can trigger stroke onset. Cannabis, due to its anti-inflammatory effects, could have a potential benefit for CLD patients. We aimed to study the impact of cannabis use disorder (CUD) or dependent use on stroke risk in CLD, considering recent American and Canadian surveys reporting 85% overlap between medicinal and recreational use. Methods: The National Inpatient Sample, 2019, was queried to identify adult stroke hospitalizations in patients with CLD. Two cohorts were created based on the presence of CUD. The primary outcomes were the rates and odds of stroke or acute ischemic stroke (AIS), with subsequent mortality in CUD vs. non-CUD cohorts. Secondary outcomes were resource utilization. Multivariable regression was controlled for patient-hospital-level factors and relevant comorbidities. Results: The CUD+ cohort had a lower rate of both overall stroke hospitalization (1.2% vs. 2.0%) and AIS hospitalization (0.8% vs. 1.2%) as compared to the CUD- cohort (p&lt;0.001). The median age of admissions for stroke and CLD with CUD was 58 years, whereas it was 64 years in the non-CUD cohort. Traditional CVD risk burden was lower, but uncomplicated hypertension, PVD, prior MI, and drug abuse were more prevalent in the CUD+ cohort. Patients with CLD and CUD showed lower odds of any stroke (OR: 0.61, 95% CI: 0.51-0.73; p &lt;0.001) and AIS (OR: 0.68, 95% CI: 0.55-0.85; p = 0.001) vs. the CUD- cohort. When adjusted for confounders, the odds of overall stroke risk were still lower (OR: 0.81; 95% CI: 0.66-0.98; p = 0.029) among the CUD+ cohort. However, adjusted odds for AIS showed no statistical significance (OR: 0.94; 95% CI: 0.74-1.19; p = 0.594). The all-cause mortality in the CUD+ cohort was lower compared to the CUD- cohort: 11.0% vs. 14.4%, p= 0.017, with shorter hospital stays and frequent routine discharges. Conclusion: This nationwide study revealed significantly reduced odds [20%] of stroke hospitalization in adults with CLD using cannabis on a regular, habitual basis. However, more prospective controlled studies are required to evaluate its impact on cardio-cerebrovascular risk with clarity on dose, duration, and mode of CUD in the long term.

Abstract WP235: Cannabis Use Disorder in Elderly Stroke Survivors (≥65 Years) Elevates the Risk of Stroke Recurrence: An Analysis From the National Inpatient Sample (2016-2019)

Introduction: Amid the rising prevalence of cannabis use disorder (CUD) in older adults and with surveys reporting ~85% of overlapping use for medicinal and recreational purposes in American cannabis users, the link between CUD and stroke is paramount. This study explores the risk of recurrent acute ischemic stroke (AIS) or hemorrhagic stroke (HS) in CUD while also evaluating the effects of coexisting substance abuse and mental health conditions. Methods: Elderly (age &gt;65 years) stroke survivors were identified using ICD-10 codes from the National Inpatient Sample (2016-2019) and categorized based on the presence or absence of CUD and recurrent AIS or HS. Multivariable statistical methods assessed demographics, comorbidities, and temporal trends. Results: Out of 5,284,119 elderly stroke survivors, 16,820 (0.3%) had CUD and presented younger (median age: 69 vs. 79), predominantly male (68.8% vs. 45.1%), with a larger representation of black individuals (30.8% vs. 12.8%), and higher prevalence in the lowest income quartile (39.7% vs. 28.4%). Comorbidities like diabetes, hyperlipidemia, obesity, and hypothyroidism were less common in CUD patients, but substance abuse and mental health disorders were more prevalent. From 2016 to 2019, CUD among stroke survivors rose from 0.24% to 0.37%. The uptrend was observed across genders, racial groups (except Asians and Native Americans), income quartiles, hospital regions, and in cohorts with and without anxiety, depression, alcohol abuse, and tobacco use. Additionally, the recurrence of AIS decreased from 5.32% to 5.13% in the non-CUD group. After adjustment, the odds of recurrent AIS in the CUD cohort was 1.56 (95% CI:1.35-1.79), and for any stroke type (AIS or HS) 1.44 (95% CI:1.26-1.65). Conclusion: Elderly stroke survivors with concurrent CUD have a 56% increased risk of recurrent AIS and a 44% heightened risk for AIS or HS. The growing prevalence of CUD in this demographic underscores it's escalating clinical significance.

Abstract WP151: Prevailing Income-Based Disparities in Acute Ischemic Stroke and Cardiovascular Events in Young Hospitalized Adults With Cannabis Use Disorder: Insights From a Population-Based Analysis

Introduction: Cannabis use and low socioeconomic status are recognized as distinct risk factors for stroke and cardiovascular pathologies. This observational study aims to investigate the association between income status in acute ischemic stroke (AIS) and cardiovascular events among young, hospitalized adults with dependent cannabis use or cannabis use disorder (CUD). Methods: We analyzed young adult hospitalizations (18-44 years) with known CUD from the 2020 National Inpatient Sample. Propensity score-matched analysis (1:1) was used to compare comorbidities, including AIS and cardiovascular events, between the high-income quartile (HIQ) and low-income quartile (LIQ) within the CUD cohort. Results: Out of the young adult admissions, a total of 286,855 individuals were identified as dependent cannabis users. After propensity matching, we divided the CUD cohort into 63,355 patients with HIQ (41.1% female) and LIQ (41.4% female). While both cohorts exhibited comparable ages and racial distribution (&gt;65% white), the individuals from LIQ cohort were predominantly from South (45.7% vs. 27.9%), visiting rural hospitals (13.9% vs. 1.3%), with Medicaid (56.3% vs. 41.1%) as the predominant payer. Additionally, LIQ cohort had a higher prevalence of drug abuse (65.5% vs. 58.4%), tobacco use (24.9% vs. 22.6%), HTN (17% vs. 14.7%), chronic pulmonary disease (13.2% vs. 12.7%), DM (8% vs. 6.6%), and obesity (10.9% vs. 10.0%). Additionally, in-hospital outcomes like AIS (0.5% vs. 0.3%) and MACCE (2% vs. 0.8%) were higher in the LIQ cohort. After adjusting for confounding factors, the risk of AIS in the HIQ cohort was 37% lower than in the LIQ cohort (OR: 0.63 [95% CI: 0.42-0.96]). (all-p&lt;0.05). Conclusion: Higher prevalence of CVD risk factors in the LIQ-CUD group and lower odds of AIS-related admissions in the HIQ-CUD group warrant targeted interventions and policy measures to understand and address behavioral risk of cannabis use by economic status and disparities in MACCE.

Abstract WP277: Stroke Etiology in Young Adults With Substance Abuse

Introduction: Recent public health trends suggest increasing rates of substance abuse among young people. Substance use has been associated with an increased risk of stroke, and specifically, cocaine use is known to more likely cause lacunar and cardioembolic strokes. However, less is known about the stroke etiology with other substances. Methods: We conducted a retrospective review of stroke patients between the ages of 18 to 50 years presenting to our Young Stroke Center between April 2022 through August 2023. For each case, data including basic demographics and medical history were collected, and stroke etiology was determined by a vascular neurologist. Patients with substance use at the time of stroke were compared to all non-substance use related stroke and analyzed with respect to TOAST stroke etiology. Substance use was defined as use of opioids, cocaine, marijuana, or alcohol abuse. Analysis was performed with logistic regression adjusting for age, sex, and race. Results: Of 187 patients in the registry, 25 patients had substance use at time of stroke compared with 162 patients with non-substance use related stroke. There were 10 marijuana, 4 opioid, 0 cocaine, 3 alcohol abuse and 8 polysubstance use (including 3 cocaine) cases. There were no significant differences in age at time of stroke (36.9 ± 7.1 vs. 38.8 ± 8.2 years) and race (50.0% vs. 53.4% Black) between substance use and non-substance use related stroke groups, respectively. There was a significantly higher proportion of males with substance use (62.5% vs. 31.9% male; OR [95% CI]: 4.0 [1.6-10.0]). In the substance use group, a higher proportion had cardioembolic stroke etiology (20.8% vs. 9.2%; OR [95% CI]: 4.1 [1.2-14.0]); however, there was no significant difference with respect to the other TOAST stroke etiologies. In patients with active substance use and cardioembolic stroke etiology, heart failure with reduced ejection fraction and atrial fibrillation were the etiologies found. Conclusion: Our findings indicate that among young individuals with active substance use at the time of their stroke, cardioembolic etiology appears to be more likely than in young stroke patients without substance use. This underscores the need for comprehensive cardiac evaluation in this population.

Predicting Time to Return to Cannabis Use After a Cessation Attempt: Impact of Cumulated Exposure to Nicotine-Containing Products

Objective: Cannabis is frequently co-used with tobacco/nicotine products, especially among young adults. Little is known about the effects of this co-use on cannabis cessation outcomes. Within a sample of young adults using cannabis frequently (current use of ≥5 days/week in the past 3 months), this study aimed to (a) document sources of exposure to tobacco/nicotine products, whether used simultaneously with cannabis or on different occasions, (b) examine if the level of cumulated exposure to tobacco/nicotine (self-reported or from biochemical testing) could predict time to cannabis lapse during a cannabis abstinence period, and (c) explore the relationship between nicotine/tobacco exposure and time to cannabis lapse according to tobacco cigarette smoking status. Method: Urine cotinine measures and self-reported data on use of different tobacco/nicotine products, collected from 32 participants (aged 19 to 23), were analyzed to predict time to lapse during a 2-week period of attempted abstinence from cannabis, controlling for cannabis dependence and sex. Results: Half of participants (56.3%) used at least one tobacco/nicotine product. Higher urine cotinine, representing higher cumulated tobacco/nicotine exposure, was related to a higher risk of lapsing (Hazard Ratio [HR] = 1.64; 95%CI [1.04, 2.58]). The risk of lapsing was even higher ([HR] = 3.46; 95%CI [1.17, 10.25]) among heavily tobacco/nicotine exposed (&gt;600 ng/mL, urine cotinine) participants than among unexposed (&lt;50 ng/mL) or lightly/moderately exposed (50-600 ng/mL) participants. Among those smoking cigarettes (solely or in combination with other products), there was no relation between cotinine level and time to lapse, likely due to a reduced variability in abstinence probability and a high likelihood of lapse observed for higher cotinine levels, mainly achieved by cigarette use. Conclusions: With a rapidly changing landscape of tobacco/nicotine use, our results underscore the need to consider all sources of tobacco/nicotine exposure to fully understand the specific and cumulative contributions of tobacco/nicotine to cannabis cessation outcomes.

Psychosexual dysfunction in male patients with cannabis dependence and synthetic cannabinoid dependence.

There are contradicting reports regarding the relationship between cannabis use and male sexual functions with almost no data about synthetic cannabinoids (SC) and its effect on male sexual functions. This study investigates psychological concerns related to male sexual functions among cannabis and SC users. The research aims to assess different sexual functions and aspects of sexual psychopathology in cannabis and SCs dependent men compared to controls. Thirty male patients with cannabis dependence, thirty male patients with SCs dependence and thirty matched controls from the outpatient clinic of Kasr Al Ainy hospital, Egypt, were assessed using Structured Clinical Interview for DSM-IV TR Axis I Disorders (SCID-I), International Index of Erectile Function (IIEF), and Sexuality scale. The means of IIEF questionnaire in the cannabis and SC group were significant lower than the means of the control group (P < .001) except the orgasmic function in cannabis group (P = .052). In the SCs group, sexual depression was higher and preoccupation lower than the cannabis (P < .020; P < .003, respectively) and control groups (P < .001; P < .001, respectively). The duration and dose of intake of cannabis and SCs correlated significant with sexual esteem, sexual preoccupation and all domains of IIEF. Cannabis and SC dependence were associated with lower erectile function, sexual desire, intercourse satisfaction and overall satisfaction, and lower orgasmic functions in the SC group than controls. Both groups showed higher sexual depression, lower sexual esteem and sexual preoccupation than controls. SC has a higher negative impact on male sexual functions and psychopathology than cannabis.

Why Are Adolescent Cannabis Use Disorder Treatment Admissions Declining in the US? The Mediated Pathway of State Treatment Admissions Rates before and after Recreational Cannabis Legalization

Purpose: State-level prevalence data are used to investigate whether recreational cannabis legalization moderates the mediated pathway from the perception of low risk of harm, to cannabis use, to cannabis use disorder (CUD) treatment admissions, among adolescents (age 12–17) in the US. Methods: Annual state prevalence measures of perception of low risk, cannabis use, and CUD treatment admissions between 2008 and 2019 (N = 542 state-year observations) were collected from the National Survey on Drug Use and Health (NSDUH) and the Treatment Episode Dataset – Admissions (TEDS-A). A two-way fixed effects (state and year) moderated mediation model was used to test whether recreational legalization moderated the indirect effect of perception of low risk on treatment admissions via cannabis use. Results: A positive indirect effect of perceiving cannabis as low risk on CUD treatment admissions via cannabis use was observed prior to legalization but not afterwards. After legalization, the positive association of perceiving cannabis as low risk with cannabis use was strengthened, and the positive association of cannabis use with treatment admissions was suppressed, as compared to before legalization. Discussion: Recreational legalization may alter the social acceptability and medical self-administration of cannabis, potentially leading to CUD treatment utilization decline among adolescents even as risk factors for CUD increase. Linking recreational cannabis legalization to advancing awareness of the health risks associated with adolescent cannabis use and promoting adolescent CUD treatment engagement through mHealth approaches and primary care providers are key to addressing potential adolescent health challenges brought about by expanding cannabis legalization.

Neurocognitive Dysfunctions in People with Concurrent Cannabis Use and Opioid Dependence: A Cross-Sectional, Controlled Study

ABSTRACT Cannabis and opioid co-dependence is independently associated with cognitive impairments. We examined neurocognitive dysfunctions in people with concurrent opioid dependence with cannabis dependence (OD+CD) or cannabis use (OD+CU) compared to those with only opioid dependence (OD) and healthy controls (HC). We selected adult participants, any sex, who met the diagnosis of OD (N = 268), OD+CU (N = 58), and OD + CD (N = 115). We recruited 68 education-matched HC. We administeredStandard progressive matrices (SPM), Wisconsin card sorting test (WCST), Iowa gambling task (IGT), Trail making tests A and B (TMT), and verbal and visual working memory 1-, 2-backtests. 496 (97.5%) were men, and 13 (2.5%) were women. In WCST, OD and OD+CD had significantly higher non-perseverative errors than HC. OD+CD group completed significantly lesser categories than HC. In verbal working memory 2-back, HC scored significantly fewer errors than OD and OD +CD. All patient groups, OD, OD+CU, and OD+CD, scored higher commission errors than HC in visual working memory 1-back. OD and OD+CD scored higher commission and total errors than the controls. OD+CU showed lesser error score than HC in TMT B. Cannabis and opioid co-dependence contribute to cognitive impairments, especially in working memory and executive functions.

Contingency management is associated with positive changes in attitudes and reductions in cannabis use even after discontinuation of incentives among non-treatment seeking youth

BackgroundIt is important to identify interventions that reduce harm in youth not motivated to change their cannabis use. This study evaluated how short-duration contingency management (CM) impacts cannabis use attitudes and behavior after abstinence incentives are discontinued among non-treatment seeking youth. MethodsParticipants (N=220) were randomized to 4 weeks of abstinence-based CM (CB-Abst; n=126) or monitoring (CB-Mon; n=94). Participants completed self-report and provided biochemical measures of cannabis exposure at baseline, end-of-intervention, and 4-week follow-up. Changes in self-reported cannabis use frequency (days/week; times/week) and biochemically verified creatinine-adjusted 11-nor-9-carboxy-tetrahydrocannabinol concentrations (CN-THCCOOH) were analyzed between groups from baseline to follow-up. In CB-Abst, cannabis use goals at end-of-intervention were described and changes in cannabis use at follow-up were explored by goals and cannabis use disorder (CUD) diagnosis. ResultsThere was a group by visit interaction on cannabis use (days: beta=0.93, p=0.005; times: beta=0.71, p<0.001; CN-THCCOOH: beta=0.26, p=0.004), with reductions at follow-up detected only in CB-Abst. Following 4 weeks of abstinence, 68.4% of CB-Abst participants wanted to reduce or abstain from cannabis use following completion of CM. Those in CB-Abst who set end-of-intervention reduction goals and were without CUD had greater decreases in cannabis use frequency at follow-up (Goals*time on days/week: beta=−2.27, p<0.001; CUD*time on times/week: beta=0.48, SE=0.24, t=2.01, p=0.048). ConclusionsFindings support the utility of brief incentivized abstinence for generating motivation to reduce cannabis use and behavior change even after incentives end. This study supports CM as a potentially viable harm reduction strategy for those not yet ready to quit.

Cannabis use disorder contributes to cognitive dysfunction in Veterans with traumatic brain injury.

While emerging evidence supports a link between traumatic brain injury (TBI) and progressive cognitive dysfunction in Veterans, there is insufficient information on the impact of cannabis use disorder (CUD) on long-term cognitive disorders. This study aimed to examine the incidences of cognitive disorders in Veterans with TBI and CUD and to evaluate their relationship. This retrospective cohort study used the US Department of Veterans Affairs and Department of Defense administrative data from the Long-term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium Phenotype study. Diagnoses suggesting cognitive disorders after a TBI index date were identified using inpatient and outpatient data from 2003 to 2022. We compared the differential cognitive disorders incidence in Veterans who had the following: (1) no CUD or TBI (control group), (2) CUD only, (3) TBI only, and (4) comorbid CUD+TBI. Kaplan-Meier analyses were used to estimate the overall cognitive disorders incidence in the above study groups. The crude and adjusted Cox proportional hazards models were used to estimate crude and adjusted hazard ratios (HRs) for cognitive disorders. A total of 1,560,556 Veterans [82.32% male, median (IQR) age at the time of TBI, 34.51 (11.29) years, and 61.35% white] were evaluated. The cognitive disorder incidence rates were estimated as 0.68 (95% CI, 0.62, 0.75) for CUD only and 1.03 (95% CI, 1.00, 1.06) for TBI only per 10,000 person-months of observations, with the highest estimated cognitive disorder incidence observed in participants with both TBI and CUD [1.83 (95% CI, 1.72, 1.95)]. Relative to the control group, the highest hazard of cognitive disorders was observed in Veterans with CUD+TBI [hazard ratio (HR), 3.26; 95% CI, 2.91, 3.65], followed by those with TBI only (2.32; 95 CI%, 2.13, 2.53) and with CUD (1.79; 95 CI%, 1.60, 2.00). Of note, in the CUD only subgroup, we also observed the highest risk of an early onset cognitive disorder other than Alzheimer's disease and Frontotemporal dementia. The results of this analysis suggest that individuals with comorbid TBI and CUD may be at increased risk for early onset cognitive disorders, including dementia.

Resting state functional connectivity in dependent cannabis users: The moderating role of cannabis attitudes

BackgroundThe global increase in lenient cannabis policy has been paralleled by reduced harm perception, which has been associated with cannabis use initiation and persistent use. However, it is unclear how cannabis attitudes might affect the brain processes underlying cannabis use. MethodsResting state functional connectivity (RSFC) within and between the executive control network (ECN), salience network (SN), and default mode network (DMN) was assessed in 110 near-daily cannabis users with cannabis use disorder (CUD) and 79 controls from The Netherlands and Texas, USA. Participants completed a questionnaire assessing the perceived benefits and harms of cannabis use from their personal, friends-family’s, and country-state’s perspectives and reported on their cannabis use (gram/week), CUD severity, and cannabis-related problems. ResultsRSFC within the dorsal SN was lower in cannabis users than controls, while no group differences in between-network RSFC were observed. Furthermore, heavier cannabis use was associated with lower dorsal SN RSFC in the cannabis group. Perceived benefits and harms of cannabis – from personal, friends-family’s, and country-state’s perspectives – moderated associations of cannabis use, CUD severity, and cannabis use-related problems with within-network RSFC of the SN, ECN, and DMN. Personal perceived benefits and country-state perceived harms moderated the association between CUD severity and RSFC between the ventral and dorsal DMN. ConclusionsThis study highlights the importance of considering individual differences in the perceived harms and benefits of cannabis use as a factor in the associations between brain functioning and cannabis use, CUD severity, and cannabis use-related problems.

The economic impact of cannabis use disorder and dementia diagnosis in veterans diagnosed with traumatic brain injury.

Studies have demonstrated that individuals diagnosed with traumatic brain injury (TBI) frequently use medical and recreational cannabis to treat persistent symptoms of TBI, such as chronic pain and sleep disturbances, which can lead to cannabis use disorder (CUD). We aimed to determine the Veterans Health Administration (VHA) healthcare utilization and costs associated with CUD and dementia diagnosis in veterans with TBI. This observational study used administrative datasets from the population of post-9/11 veterans from the Long-term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium and the VA Data Warehouse. We compared the differential VHA costs among the following cohorts of veterans: (1) No dementia diagnosis and No CUD group, (2) Dementia diagnosis only (Dementia only), (3) CUD only, and (4) comorbid dementia diagnosis and CUD (Dementia and CUD). Generalized estimating equations and negative binomial regression models were used to estimate total annual costs (inflation-adjusted) and the incidence rate of healthcare utilization, respectively, by dementia diagnosis and CUD status. Data from 387,770 veterans with TBI (88.4% men; median [interquartile range (IQR)] age at the time of TBI: 30 [14] years; 63.5% white) were followed from 2000 to 2020. Overall, we observed a trend of gradually increasing healthcare costs 5 years after TBI onset. Interestingly, in this cohort of veterans within 5 years of TBI, we observed substantial healthcare costs in the Dementia only group (peak = $46,808) that were not observed in the CUD and dementia group. Relative to those without either condition, the annual total VHA costs were $3,368 higher in the CUD only group, while no significant differences were observed in the Dementia only and Dementia and CUD groups. The findings suggest that those in the Dementia only group might be getting their healthcare needs met more quickly and within 5 years of TBI diagnosis, whereas veterans in the Dementia and CUD group are not receiving early care, resulting in higher long-term healthcare costs. Further investigations should examine what impact the timing of dementia and CUD diagnoses have on specific categories of inpatient and outpatient care in VA and community care facilities.

Cannabis use and its association with psychopathological symptoms in a Swiss adult population: a cross-sectional analysis.

As the most commonly used illicit substance, cannabis is gaining global acceptance through increasing legalization efforts. This shift intensifies the need for research to guide policymakers and healthcare providers in harm reduction and treatment strategies. Nonetheless, the relationship between psychopathological symptoms and cannabis use remains inadequately understood. A sample of regular cannabis consumers completed self-reported assessments for depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), Attention-Deficit/Hyperactivity Disorder (ADHD; Adult ADHD Self-Report Scale V1.1), and psychosis (Early Recognition Inventory based on IRAOS) as well as previous black-market cannabis use patterns. Cannabis Use Disorder Identification Test Revised (CUDIT-R) was used to identify cannabis use disorder (CUD). To understand psychopathological symptom load related to cannabis consumption as well as cannabis use motives, multiple regression models were performed to identify psychopathological variables predicting cannabis use frequency and quantity. Linear regression and correlation analyses were conducted, adjusting for relevant covariates (age, gender, education, alcohol, other substance use). Three-hundred-sixty regular cannabis users interested in a study on regulated cannabis access in Basel, Switzerland were examined. In bivariate analysis, cannabis use frequency correlated with depressive (r(358) = 0.16, p = 0.003) and anxiety symptom load (r(358) = 0.11, p = 0.034). Cannabis quantity correlated with depressive (r(358) = 0.15, p = 0.005), ADHD (r(358) = 0.14, p = 0.008), and psychosis symptom load (r(358) = 0.16, p = 0.002). However, in the adjusted regression models only depressive and ADHD symptom loads were significantly associated with cannabis use frequency (p = 0.006 and p = 0.034, respectively) and quantity (p = 0.037 and p = 0.019, respectively). No significant correlations between cannabis consumption and anxiety or psychosis remained after adjustment. ADHD and depressive symptoms correlate with increased cannabis use in a cohort of regular users, suggesting potential self-medication in nonclinical populations. With the rising availability of cannabis worldwide, these results highlight the necessity for longitudinal studies to disentangle the complex dynamics between cannabis consumption and mental health symptoms.

ADVANCES IN THE TREATMENT OF ALCOHOL, OPIOID, AND CANNABIS ADDICTION

Substance use disorders, particularly those involving alcohol, opioids, and cannabis, present significant challenges in healthcare due to their widespread impact and complex nature. Recent advances in the treatment of these addictions offer new hope and more effective strategies for addressing these pervasive issues. This presentation will explore the latest developments in pharmacological, behavioral, and integrative approaches to treating alcohol, opioid, and cannabis addiction. For alcohol use disorder, pharmacotherapies such as acamprosate and extended-release naltrexone have shown promise in reducing cravings and relapse rates. Advances in behavioral therapies, including cognitive-behavioral therapy (CBT) and mindfulness-based interventions, have also proven effective in combination with medication. In the realm of opioid addiction, the introduction of long-acting buprenorphine formulations and the growing use of extended-release injectable naltrexone have revolutionized treatment, providing patients with more convenient and less stigmatizing options. The role of harm reduction strategies, such as supervised consumption sites and the distribution of naloxone, will also be discussed. For cannabis use disorder, emerging research highlights the potential of cannabinoid receptor antagonists, such as rimonabant, NAC and the application of motivational enhancement therapy (MET) and contingency management (CM) as effective treatment modalities. This presentation will also address the importance of personalized treatment plans, integrating pharmacological and behavioral approaches tailored to individual patient needs. The discussion will include insights into the role of technology in addiction treatment, such as telemedicine and digital therapeutics, which are expanding access and improving outcomes. By examining these advances, this presentation aims to provide healthcare professionals with a comprehensive overview of current best practices and innovative strategies for treating alcohol, opioid, and cannabis addiction, ultimately contributing to more effective patient care and better long-term outcomes.

Drug driving: a secondary analysis of factors associated with driving under the influence of cannabis in Jamaica

ObjectivesTo determine cannabis use patterns, the predictive sociodemographic correlates of driving under the influence of cannabis (DUIC) and the association between risk perception and cannabis dependence among vehicle drivers in...

Managing Opioid Addiction in Adolescents in the Community: Experiences from Two Cases

Abstract Introduction: Adolescent opioid use in India has emerged as a critical public health concern, with a 2018 survey revealing 1.8% of adolescents aged 10–17 years as past-year opioid users. We present here the experiences of two cases of adolescent opioid users from a community-based drug treatment clinic in Delhi. Case Description: Case 1 involved a 17-year-old male suffering from opioid and tobacco dependence. His treatment, starting about 3 years back, showcased challenges in withdrawal management, leading to successful opioid agonist treatment (OAT), employment, and positive social reintegration over follow-up. Case 2 was a 15-year-old male with opioid, cannabis, tobacco, and volatile solvent dependence who presented about 2.5 years back to us. Despite treatment initiation in February 2021 and positive strides in OAT, employment, and cessation of injecting drug use, challenges persisted, highlighting the necessity for effective tailored interventions in managing substance use disorder in adolescents. Conclusion: Adolescent opioid use disorder can be managed in the community with OAT, though challenges of dropout do remain.