humulene and Marijuana-Abuse

Given the increasing acceptability and legalization of cannabis in some jurisdictions, clinicians need to improve their understanding of the effect of cannabis use on mood disorders.. The purpose of this task force report is to examine the association between cannabis use and incidence, presentation, course and treatment of bipolar disorder and major depressive disorder, and the treatment of comorbid cannabis use disorder.. We conducted a systematic literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching PubMed, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials from inception to October 2020 focusing on cannabis use and bipolar disorder or major depressive disorder, and treatment of comorbid cannabis use disorder. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to evaluate the quality of evidence and clinical considerations were integrated to generate Canadian Network for Mood and Anxiety Treatments recommendations.. Of 12,691 publications, 56 met the criteria: 23 on bipolar disorder, 21 on major depressive disorder, 11 on both diagnoses and 1 on treatment of comorbid cannabis use disorder and major depressive disorder. Of 2,479,640 participants, 12,502 were comparison participants, 73,891 had bipolar disorder and 408,223 major depressive disorder without cannabis use. Of those with cannabis use, 2,761 had bipolar disorder and 5,044 major depressive disorder. The lifetime prevalence of cannabis use was 52%-71% and 6%-50% in bipolar disorder and major depressive disorder, respectively. Cannabis use was associated with worsening course and symptoms of both mood disorders, with more consistent associations in bipolar disorder than major depressive disorder: increased severity of depressive, manic and psychotic symptoms in bipolar disorder and depressive symptoms in major depressive disorder. Cannabis use was associated with increased suicidality and decreased functioning in both bipolar disorder and major depressive disorder. Treatment of comorbid cannabis use disorder and major depressive disorder did not show significant results.. The data indicate that cannabis use is associated with worsened course and functioning of bipolar disorder and major depressive disorder. Future studies should include more accurate determinations of type, amount and frequency of cannabis use and select comparison groups which allow to control for underlying common factors.

Topics: Anxiety; Bipolar Disorder; Canada; Cannabis; Depressive Disorder, Major; Humans; Marijuana Abuse; Substance-Related Disorders

The Marijuana Purchase Task (MPT) is increasingly used to measure cannabis reinforcing value and has potential use for cannabis etiological and regulatory research. This meta-analysis sought to evaluate for the first time the MPT's concurrent validity in relation to cannabis involvement.. Electronic databases and pre-print repositories were searched for MPT studies that examined the cross-sectional relationship between frequency and quantity of cannabis use, problems, dependence, and five MPT indicators: intensity (i.e. unrestricted consumption), O. The searches yielded 14 studies (n = 4077, median % females: 44.8%: weighted average age = 29.08 [SD = 6.82]), published between 2015 and 2022. Intensity, O. The marijuana purchase task presents adequate concurrent validity to measure cannabis demand, most robustly for intensity, O

Topics: Adult; Cannabis; Consumer Behavior; Costs and Cost Analysis; Economics, Behavioral; Female; Humans; Male; Marijuana Abuse

With increasing cannabis potency, increasing variety of methods of cannabis use, and lower perceived risk of cannabis use, it is increasingly important clinicians who work with adolescents remain up-to-date on the latest literature regarding cannabis use and its associated outcomes. Adolescent cannabis use is associated with chronic cognitive, psychosocial, psychiatric, and physical outcomes. Clinicians working in this field should be able to recognize cannabis use disorder, understand how adolescent cannabis use can impact the developing mind, and have informed discussions with patients and families regarding risks of use.

Topics: Adolescent; Cannabis; Humans; Marijuana Abuse; Substance-Related Disorders

This review summarizes treatments for cannabis use disorder (CUD) in adolescents. The best supported CUD treatments are cognitive behavioral psychotherapies, including family-based models that facilitate environmental changes and youth-focused models that incorporate skills training, motivational interviewing, and contingency management to promote reductions in cannabis use. Some medications show promise in reducing cannabis craving and withdrawal symptoms. Further research is needed on the efficacy and implementation of existing treatments given the changes in cannabis use trends over time and on emerging technologies that may expand access to evidence-based CUD treatments.

Topics: Adolescent; Cannabis; Humans; Marijuana Abuse; Motivational Interviewing; Substance Withdrawal Syndrome; Substance-Related Disorders

Psychosis and cannabis use may overlap in multiple ways in young people. Research suggests that cannabis use increases risk for having psychotic symptoms, both attenuated (subthreshold) and acute. Cannabis use may also exacerbate psychosis symptoms among young people with underlying psychosis risk and psychotic disorders. Although there are suggestions for treating co-occurring psychosis and cannabis use in young people (e.g., incorporating cannabis use assessment and treatment strategies into specialized early psychosis care), there are many gaps in clinical trial research to support evidence-based treatment of these overlapping concerns.

Topics: Adolescent; Cannabis; Humans; Marijuana Abuse; Psychotic Disorders; Risk Factors

Cannabis self-administration studies may be helpful for identifying factors that influence cannabis consumption and subjective response to cannabis. Additionally, these paradigms could be useful for testing novel pharmacotherapies for cannabis use disorder. This scoping review aims to summarize the findings from existing ad libitum cannabis self-administration studies to determine what has been learned from these studies as well as their limitations. We examined studies that specifically examined cannabis smoking, focusing on subjective response and self-administration behavior (e.g., smoking topography). A systematic search was conducted using PubMed and Embase from inception to October 22, 2022. Our search strategy identified 26 studies (total N = 662, 79% male) that met our eligibility criteria. We found that tetrahydrocannabinol (THC) concentration significantly affected subjective response to cannabis in some but not all studies. In general, cannabis self-administration tended to be most intense at the beginning of the laboratory session and decreased in later parts of the session. There was limited data on cannabis self-administration in adults older than 55. Data on external validity and test-retest reliability were also limited. Addressing these limitations in future ad libitum cannabis self-administration studies could lead to more valid and generalizable paradigms, which in turn could be used to improve our understanding of cannabis use patterns and to help guide medication development for cannabis use disorder.

Topics: Cannabinoid Receptor Agonists; Cannabis; Dronabinol; Female; Hallucinogens; Humans; Male; Marijuana Abuse; Marijuana Smoking; Reproducibility of Results

Cannabis use has risen dramatically in recent years due to global decriminalization and a resurgence in the interest of potential therapeutic benefits. While emerging research is shaping our understanding of the benefits and harms of cannabis, there remains a paucity of data specifically focused on how cannabis affects the female population. The female experience of cannabis use is unique, both in the societal context and because of the biological ramifications. This is increasingly important given the rise in cannabis potency, as well as the implications this has for the prevalence of Cannabis Use Disorder (CUD). Therefore, this scoping review aims to discuss the prevalence of cannabis use and CUD in women throughout their lifespan and provide a balanced prospective on the positive and negative consequences of cannabis use. In doing so, this review will highlight the necessity for continued research that goes beyond sex differences.

Topics: Cannabis; Female; Humans; Longevity; Male; Marijuana Abuse

Regular cannabis use during adolescence can lead to cognitive, psychological, and social consequences, causing significant distress. Although psychological interventions are the mainstay type of treatment for cannabis use disorder, the results remain mixed among youths. The objective of this review is twofold: to identify the existing psychological interventions for cannabis use among youths, and to assess the evidence regarding the effectiveness of those interventions. Randomized controlled trials focused exclusively on cannabis use among adolescents and young adults were included. Three databases-Embase, PsycInfo, and PubMed-were searched to identify relevant peer-reviewed manuscripts published before February 2022 in English and French. The risk of bias was assessed using the Cochrane Collaboration's tool. Twenty-five randomized controlled trials were included. Fourteen studies reported a significant outcome related to cannabis use. These were mainly non-intensive, online interventions that aimed to improve the patients' relationships and emotion regulation. This review highlights the need to conduct additional randomized control trials that target cannabis use disorder specifically among adolescents. These randomized control trials should also aim to reduce the risk of bias related to psychiatric comorbidities as well as detection and attrition problems.

Topics: Adolescent; Cannabis; Humans; Marijuana Abuse; Psychosocial Intervention; Randomized Controlled Trials as Topic; Young Adult

With increasing cannabis potency, increasing variety of methods of cannabis use, and lower perceived risk of cannabis use, it is increasingly important clinicians who work with adolescents remain up-to-date on the latest literature regarding cannabis use and its associated outcomes. Adolescent cannabis use is associated with chronic cognitive, psychosocial, psychiatric, and physical outcomes. Clinicians working in this field should be able to recognize cannabis use disorder, understand how adolescent cannabis use can impact the developing mind, and have informed discussions with patients and families regarding risks of use.

Topics: Adolescent; Cannabis; Humans; Marijuana Abuse; Substance-Related Disorders

This review summarizes treatments for cannabis use disorder (CUD) in adolescents. The best supported CUD treatments are cognitive behavioral psychotherapies, including family-based models that facilitate environmental changes and youth-focused models that incorporate skills training, motivational interviewing, and contingency management to promote reductions in cannabis use. Some medications show promise in reducing cannabis craving and withdrawal symptoms. Further research is needed on the efficacy and implementation of existing treatments given the changes in cannabis use trends over time and on emerging technologies that may expand access to evidence-based CUD treatments.

Topics: Adolescent; Cannabis; Cognitive Behavioral Therapy; Craving; Humans; Marijuana Abuse; Substance-Related Disorders

Several observational studies have investigated the association between cannabis use and intraocular pressure, but its association with primary open-angle glaucoma (POAG) remains unclear. In this study, we leveraged human genetic data to assess through Mendelian randomization (MR) whether cannabis use affects POAG. We used five single-nucleotide polymorphisms (SNPs) associated with lifetime cannabis use (P-value < 5 × 10

Topics: Cannabis; Genome-Wide Association Study; Glaucoma, Open-Angle; Humans; Marijuana Abuse; Mendelian Randomization Analysis; Polymorphism, Single Nucleotide

Cannabis use among people with mood disorders increased in recent years. While comorbidity between cannabis use, cannabis use disorder (CUD), and mood disorders is high, the underlying mechanisms remain unclear.. We aimed to evaluate (1) the epidemiological evidence for an association between cannabis use, CUD, and mood disorders; (2) prospective longitudinal, genetic, and neurocognitive evidence of underlying mechanisms; and (3) prognosis and treatment options for individuals with CUD and mood disorders.. Narrative review of existing literature is identified through PubMed searches, reviews, and meta-analyses. Evidence was reviewed separately for depression, bipolar disorder, and suicide.. Current evidence is limited and mixed but suggestive of a bidirectional relationship between cannabis use, CUD, and the onset of depression. The evidence more consistently points to cannabis use preceding onset of bipolar disorder. Shared neurocognitive mechanisms and underlying genetic and environmental risk factors appear to explain part of the association. However, cannabis use itself may also influence the development of mood disorders, while others may initiate cannabis use to self-medicate symptoms. Comorbid cannabis use and CUD are associated with worse prognosis for depression and bipolar disorder including increased suicidal behaviors. Evidence for targeted treatments is limited.. The current evidence base is limited by the lack of well-controlled prospective longitudinal studies and clinical studies including comorbid individuals. Future studies in humans examining the causal pathways and potential mechanisms of the association between cannabis use, CUD, and mood disorder comorbidity are crucial for optimizing harm reduction and treatment strategies.

Topics: Cannabis; Comorbidity; Humans; Marijuana Abuse; Mood Disorders; Prospective Studies

Cannabis withdrawal is a well-characterized phenomenon that occurs in approximately half of regular and dependent cannabis users after abrupt cessation or significant reductions in cannabis products that contain Δ. Narrative review of literature.. Symptom onset typically occurs 24-48 hours after cessation and most symptoms generally peak at days 2-6, with some symptoms lasting up to 3 weeks or more in heavy cannabis users. The most common features of cannabis withdrawal are anxiety, irritability, anger or aggression, disturbed sleep/dreaming, depressed mood and loss of appetite. Less common physical symptoms include chills, headaches, physical tension, sweating and stomach pain. Despite limited empirical evidence, supportive counselling and psychoeducation are the first-line approaches in the management of cannabis withdrawal. There are no medications currently approved specifically for medically assisted withdrawal (MAW). Medications have been used to manage short-term symptoms (e.g. anxiety, sleep, nausea). A number of promising pharmacological agents have been examined in controlled trials, but these have been underpowered and positive findings not reliably replicated. Some (e.g. cannabis agonists) are used 'off-label' in clinical practice. Inpatient admission for MAW may be clinically indicated for patients who have significant comorbid mental health disorders and polysubstance use to avoid severe complications.. The clinical significance of cannabis withdrawal is that its symptoms may precipitate relapse to cannabis use. Complicated withdrawal may occur in people with concurrent mental health and polysubstance use.

Topics: Analgesics; Cannabinoid Receptor Agonists; Cannabis; Dronabinol; Hallucinogens; Humans; Marijuana Abuse; Substance Withdrawal Syndrome

Cannabis use peaks during adolescence and emerging adulthood, and cannabis use disorder (CUD) is associated with a wide range of adverse outcomes. This is particularly pertinent in youth, because the developing brain may be more vulnerable to adverse effects of frequent cannabis use. Combining evidence-based psychosocial interventions with safe and effective pharmacotherapy is a potential avenue to improve youth outcomes, but we lack approved CUD pharmacotherapies. Here, we review new potential avenues for helping youth with CUD, with a particular focus on cannabinoid-based treatments. Evidence from placebo-controlled RCTs suggests synthetic delta-9-tetrahydrocannabinol (THC) decreases withdrawal symptoms, but not cannabis use, in adults with daily cannabis use/CUD, while findings regarding formulations containing THC combined with cannabidiol (CBD) are mixed. Preliminary evidence from two placebo-controlled RCTs in adults with CUD suggests that both Fatty Acid Amide Hydrolase inhibitors and CBD can reduce cannabis use. However, larger trials are needed to strengthen the evidence. Findings from adults point to cannabinoid-based treatments as a potential strategy that should be examined in youth with CUD.

Topics: Adolescent; Adult; Cannabidiol; Cannabinoids; Cannabis; Dronabinol; Humans; Marijuana Abuse

Cannabis is the most consumed illicit drug globally, with a high risk of developing cannabis use disorder (CUD). No approved pharmacological treatment exists for CUD, but N-Acetyl Cysteine (NAC) has shown promising results in different clinical studies. This study aims to conduct a systematic review of NAC clinical trials for the treatment of CUD.. Systematic review of randomized controlled trials (RCTs) was conducted to determine the effect of NAC for the treatment of cannabis dependence/cannabis use disorder (CUD). Articles were electronically searched across different databases using PubMed, Google Scholar, EMBASE, Cochrane Library, Medline and PsycINFO from inception to June 2021. Several study characteristics, including study duration, sample size, study population and age group, intervention, adverse effects, and outcome measure were extracted. A PICO table was used for data extraction.. We included 08 RCTs in the qualitative analysis. The risk of bias (RoB) was assessed according to Cochrane RoB criteria, and a 5 point grading system according to the Oxford Centre for Evidence-Based Medicine was used to rate the methodological quality (level of evidence) of the included articles. Mild and well-tolerated adverse events were reported in the placebo and NAC group.. The studies collectively offer mixed results, although the strength of the evidence available on which to make a recommendation is strong. NAC has shown to be effective in promoting abstinence, medication adherence and reducing cannabis use and craving among cannabis dependent users. This review also suggests recommendations for future research.

Topics: Acetylcysteine; Cannabis; Humans; Marijuana Abuse

The legalization of cannabis in many countries, as well as the decrease in perceived risks of cannabis, have contributed to the increase in cannabis use medicinally and recreationally. Like many drugs of abuse, cannabis and cannabis-derived drugs are prone to misuse, and long-term usage can lead to drug tolerance and the development of Cannabis Use Disorder (CUD). These drugs signal through cannabinoid receptors, which are expressed in brain regions involved in the neural processing of reward, habit formation, and cognition. Despite the widespread use of cannabis and cannabinoids as therapeutic agents, little is known about the neurobiological mechanisms associated with CUD and cannabinoid drug use. In this article, we discuss the advances in research spanning animal models to humans on cannabis and synthetic cannabinoid actions on synaptic transmission, highlighting the neurobiological mechanisms following acute and chronic drug exposure. This article also highlights the need for more research elucidating the neurobiological mechanisms associated with CUD and cannabinoid drug use.

Topics: Animals; Cannabinoid Receptor Agonists; Cannabinoids; Cannabis; Dronabinol; Marijuana Abuse; Receptors, Cannabinoid

The liberalisation of cannabis laws, the increasing availability and potency of cannabis has renewed concern about the risk of psychosis with cannabis.. The objective of the WFSBP task force was to review the literature about this relationship.. Converging lines of evidence suggest that exposure to cannabis increases the risk for psychoses ranging from transient psychotic states to chronic recurrent psychosis. The greater the dose, and the earlier the age of exposure, the greater the risk. For some psychosis outcomes, the evidence supports some of the criteria of causality. However, alternate explanations including reverse causality and confounders cannot be conclusively excluded. Furthermore, cannabis is neither necessary nor sufficient to cause psychosis. More likely it is one of the multiple causal components. In those with established psychosis, cannabis has a negative impact on the course and expression of the illness. Emerging evidence also suggests alterations in the endocannabinoid system in psychotic disorders.. Given that exposure to cannabis and cannabinoids is modifiable, delaying or eliminating exposure to cannabis or cannabinoids, could potentially impact the rates of psychosis related to cannabis, especially in those who are at high risk for developing the disorder.

Topics: Cannabinoids; Cannabis; Humans; Marijuana Abuse; Psychotic Disorders

Cannabis sativa is a recreational drug commonly consumed in Europe and is getting popularity for both recreational and therapeutic use. In some individuals, the use of cannabis leads to psychotic disorders. This systematic review summarizes the current evidence linking genetic polymorphisms and inter-individual susceptibility to psychosis induced by cannabis.. Studies published from 2005 to 2020 were identified through Medline using PubMed, Web of Science and Scopus database and searches were conducted according to PRISMA guidelines. Initial search was performed with terms: "cannabis induced psychosis" AND "genetics".. From the initial group of 108 papers, 18 studies met our inclusion criteria. Many of the findings revealed associations with genetic polymorphisms modulations of genes involved directly (COMT, DRD2 and DAT) or indirectly (AKT1) to dopamine pathways. The most consistent finding was with COMT rs4680, where the presence of the Val allele was associated with a higher risk for cannabis-induced psychosis. This higher susceptibility was also reported for AKT1 (rs2494732) with the CC genotype. Of note, the only genome-wide association study identified a significant signal close to the cholinergic receptor muscarinic 3 represented by rs115455482 and rs74722579 predisposing to cannabis-induced hallucinations and remarkably no dopaminergic target was found.. Actual evidence supports the role of dopamine in cannabis induced psychosis. However, most of genetic polymorphism studies have as a starting point the pre-existing dopaminergic theoretical basis for psychosis. This alerts to the importance of more broad genetic studies. Integrate genetic results into biological systems may enhance our knowledge of cannabis induced psychosis and could help in the prevention and treatment of these patients.

Topics: Cannabis; Catechol O-Methyltransferase; Dopamine; Genetic Predisposition to Disease; Genome-Wide Association Study; Humans; Marijuana Abuse; Polymorphism, Single Nucleotide; Psychotic Disorders

Cannabis use disorder (CUD) affects one-in-five cannabis users, presenting a major contributor to cannabis-associated disease burden. Epidemiological data identify the frequency of cannabis use as a risk factor for CUD. This review aimed to determine quantifiable risk-thresholds of the frequency of cannabis use for developing CUD.. Systematic search of Medline, EMBASE, PsycInfo, CINAHL, and Web of Science for cohort/case-control studies that assessed the association between frequency of cannabis use and CUD from 2000 to 2022. Effect estimates were converted to risk ratios (RR). A random-effects multi-level multivariate meta-analytic approach was utilized, and sensitivity analyses conducted. Quality of included studies was assessed with the Newcastle Ottawa Scale.. Six prospective cohort studies were included in this review, drawn from two main source studies. Random-effect modeling showed a significant log-linear dose-response association between the frequency of cannabis use and CUD risk (p < 0.0001). The risk of CUD increased from RR:2.03 (95% CI:1.85-2.22) for 'yearly' use, to RR:4.12 (95% CI:3.44-4.95) for 'monthly" use, RR:8.37 (95% CI:6.37-11.00) for 'weekly' use, and RR:16.99 (95% CI:11.80-24.46) for 'daily' use. Multi-level modeling showed an absolute risk increase (ARI) from 3.5% (95% CI:2.6-4.7) for 'yearly' use, to 8.0% (95% CI:5.3-12.1) for 'monthly' use, to 16.8% (95% CI:8.8-32.0) for 'weekly' use, and 36% (95% CI:27.047.9) for 'daily' use.. A limited risk of CUD as a potential outcome of cannabis use exists even at infrequent levels of use, but significantly increases as frequency of use increases. Corresponding information should be conveyed to cannabis users as part of targeted prevention messaging to promote safer cannabis use.

Topics: Cannabis; Cohort Studies; Humans; Marijuana Abuse; Prospective Studies; Risk Factors

Rates of cannabis use have been rising in the US due to the increasing legalization/decriminalization of cannabis products for medical and recreational use. Individuals with attention-deficit hyperactivity disorder (ADHD) may be at an increased risk of experiencing cannabis use problems due to deficits in self-regulation. This article explores motivations for cannabis use in ADHD populations. Research on the neural correlates and therapeutic potential of cannabis use are reviewed.

Topics: Attention Deficit Disorder with Hyperactivity; Cannabis; Humans; Marijuana Abuse; Motivation

Topics: Cannabis; Humans; Marijuana Abuse; Mental Health; Schizophrenia; Schizophrenic Psychology; Systemic Inflammatory Response Syndrome

Cannabis is an illegal drug whose use has increased in recent years, especially among adolescents. Despite its popularity, its use and abuse brings with it health consequences, being greater if consumption occurs in the adolescent stage, since the brain is in full development. The objective of this systematic review was to determine the effects of cannabis use on cognitive functions of attention and memory in adolescent population.. A systematic review of the literature was carried out in the main search portals (Pubmed, Web of Science, SciELO, Cochrane) referring to the last 10 years, following the PRISMA criteria. The systematic search strategy was carried out in the period from March to May 2021, applying the PICO method and the PEDro scale to guarantee the methodological quality of the included studies.. Both attention and memory are affected by cannabis use; however, memory functions improve with abstinence, not being so for attention. Memory deficits are an indicator of therapeutic abandonment of addiction treatment. In relation to psychosocial interventions aimed at improving memory, the contingency management, educational interventions and motivational interviewing have not been shown to be effective on the effects of substances. Working memory training offers positive results, although not clinically significant. Finally, memory deficits are an indicator of therapeutic abandonment of pharmacological treatment for cannabis addiction. Therefore, research is needed aimed both at reducing the side effects of drugs on memory processes and at establishing to what extent memory deficits associated with cannabis use can facilitate therapeutic abandonment.. More research is necessary, considering the dual consumption of cannabis-tobacco and the effects that both substances may have jointly and separately on attention and memory processes.. El cannabis es una droga ilegal cuyo consumo se ha visto incrementado en los últimos años, especialmente en población adolescente. A pesar de su popularidad, su uso y abuso trae consigo consecuencias para la salud, siendo mayores si el consumo se produce en la etapa adolescente, ya que el cerebro se encuentra en pleno desarrollo. El objetivo de esta revisión sistemática fue determinar los efectos del consumo de cannabis en las funciones cognitivas de atención y memoria en población adolescente.. Se llevó a cabo una revisión sistemática de la literatura en los principales portales de búsqueda (. Tanto la atención como la memoria se ven afectadas por el consumo de cannabis; sin embargo, la memoria mejora su funcionamiento con la abstinencia, no ocurriendo lo mismo con la atención. Los déficits de memoria son un indicador de abandono terapéutico del tratamiento para la adicción. En relación con las intervenciones psicosociales orientadas a la mejora de la memoria, tanto el manejo de contingencias como las intervenciones educativas y la entrevista motivacional no se han mostrado efectivas sobre los efectos de las sustancias. El entrenamiento en la memoria de trabajo ofrece resultados positivos, aunque clínicamente no significativos. Finalmente, los déficits de memoria son un indicador de abandono terapéutico del tratamiento farmacológico para la adicción al cannabis, por lo que se precisa investigación orientada tanto a reducir los efectos secundarios de los fármacos sobre los procesos mnésicos como a establecer en qué medida los déficits de memoria asociados al consumo de cannabis pueden facilitar el abandono terapéutico.. Se precisa mayor investigación, considerando el consumo dual de cannabis-tabaco y los efectos que ambas sustancias pueden tener, conjuntamente y por separado, sobre los procesos de atención y memoria.

Topics: Adolescent; Cannabis; Humans; Illicit Drugs; Marijuana Abuse; Memory Disorders; Spain

The idea that cannabis is a 'gateway drug' to more harmful substances such as opioids is highly controversial, yet has substantially impacted policy, education and how we conceptualize substance use. Given a rise in access to cannabis products and opioid-related harm, the current study aimed to conduct the first systematic review and meta-analysis on the likelihood of transitioning from cannabis use to subsequent first-time opioid use, opioid use disorders (OUD), dependence or abuse.. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, pubMed/MEDLINE, Scopus, EMBASE, PsychINFO, Cochrane Central Register of Controlled Trials and Informit Health Collection were searched for full-text articles assessing the likelihood of transitioning from cannabis to subsequent opioid use, and from opioid use to OUD, abuse or dependence given prior cannabis use. Analysis of subpopulations within studies were discussed narratively, and E-values were calculated to assess the potential influence of unmeasured confounding.. Six studies provided relevant data from the United States, Australia and New Zealand between 1977 and 2017, a total sample of 102 461 participants. Random-effects analysis of the adjusted pooled effect size indicates that the likelihood of transitioning from cannabis to opioid use, relative to non-cannabis users, is odds ratio (OR) = 2.76, 95% confidence interval (CI) = 2.26-3.36, whereas the likelihood of transitioning from opioid use to OUD, abuse or dependence given prior cannabis use is OR = 2.52, 95% CI = 1.65-3.84. While the evidence was determined to be of low quality with moderate risk of bias, E-values suggest that these findings are robust against unmeasured confounding.. A systematic review and meta-analysis found that while people who use cannabis are disproportionately more likely to initiate opioid use and engage in problematic patterns of use than people who do not use cannabis, the low quality of the evidence must be considered when interpreting these findings.

Topics: Analgesics, Opioid; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Opioid-Related Disorders

Regular cannabis use (i.e. ≥ monthly) is highly prevalent, with past year use being reported by ~ 200 million people globally.High reactivity to cannabis cues is a key feature of regular cannabis use and has been ascribed to greater cannabis exposure and craving, but the underlying neurobiology is yet to be systematically integrated.. We aim to systematically summarise the findings from fMRI studies which examined brain function in cannabis users while exposed to cannabis vs neutral stimuli during a cue-reactivity fMRI task.. A systematic search of PsycINFO, PubMed and Scopus databases was pre-registered in PROSPERO (CRD42020171750) and conducted following PRISMA guidelines. Eighteen studies met inclusion/exclusion criteria. Samples comprised 918 participants (340 female) aged 16-38 years. Of these, 603 were regular cannabis users, and 315 were controls.. The literature consistently reported greater brain activity in cannabis users while exposed to cannabis vs neutral stimuli in three key brain areas: the striatum, the prefrontal (anterior cingulate, middle frontal) and the parietal cortex (posterior cingulate/precuneus) and additional brain regions (hippocampus, amygdala, thalamus, occipital cortex). Preliminary correlations emerged between cannabis craving and the function of partially overlapping regions (amygdala, striatum, orbitofrontal cortex ).. Exposure to cannabis-cues may elicit greater brain function and thus trigger cravings in regular cannabis users and thus trigger cannabis craving. Standardised and longitudinal assessments of cannabis use and related problems are required to profile with greater precision the neurobiology of cannabis cue-reactivity, and its role in predicting  cravings and relapse.

Topics: Brain; Cannabis; Cues; Humans; Magnetic Resonance Imaging; Marijuana Abuse

Western democracies continue to 'legalize recreational cannabis use' after its 'medicinal approval', while India continues to debate whether to 'decriminalize' cannabis or not. One of the strongest arguments against cannabis decriminalization is cannabis dependence and the risk of psychosis, at-least in the vulnerable groups. Endocannabinoids are involved in neuronal proliferation and differentiation during 'patterning of the central nervous system'. Aberrant neurostimulation caused by repeated heavy exo-cannabinoid exposure may increase the probability of pro-psychotic experiences. Various animal and human studies have demonstrated increased but abnormal activation of cortical and subcortical areas due to chronic cannabis use. Some of these areas are involved in the pathogenesis of psychosis or schizophrenia. A review of the literature was done to hypothesize the possible role of cannabis to cause (or precipitate) psychosis through repeated "aberrant neurostimulation". The 'aberrant neurostimulation model of cannabis psychosis' may explain pathogenesis, individual vulnerabilities and developing therapeutic strategies for this debated entity. In future, well designed placebo-controlled studies may find the answer with more confidence.

Topics: Animals; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Psychotic Disorders; Schizophrenia

Amidst a rapidly changing legal landscape, cannabis use in the United States has become increasingly common in the past several years. There is strong evidence to suggest that chronic and early cannabis use increases the risk of developing a psychotic disorder, and there is at least moderate evidence that suggests ongoing cannabis use among individuals with a psychotic disorder worsens clinical outcomes (eg, decreased psychiatric medication adherence, more frequent psychiatric hospitalizations). In this Review Article, we provide a focused, clinically oriented overview of the epidemiology and characteristics of cannabis use among individuals with first-episode psychosis; evaluation of cannabis use; and treatment modalities, focusing on behavioral interventions suitable for outpatient primary care settings. We discuss the limited data supporting pharmacologic interventions for cannabis use disorder, specifically among individuals with first-episode psychosis, and the unique potential of cannabidiol to serve as a harm-reduction strategy for individuals who are not able or willing to achieve abstinence for cannabis.

Topics: Analgesics; Cannabidiol; Cannabis; Humans; Marijuana Abuse; Psychotic Disorders

Cannabis sativa L. (C. sativa) is a plant whose use as a therapeutic agent shares its origins with the first Far East's human societies. Cannabis has been used not only for recreational purposes but as food to obtain textile fibers, to produce hemp paper, to treat many physical and mental disorders.. This review aims to provide a complete assessment of the deep knowledge of the cannabis psychoactive effects and medicinal properties in the course of history covering i.) The empirical use of the seeds and the inflorescences to treat many physical ailments by the ancient Oriental physicians' ii.) The current use of cannabis as a therapeutic agent after the discovery of its key psychoactive constituent and the human endogenous endocannabinoid system.. This study was performed through a detailed analysis of the studies on the historical significance and medical applications of Cannabis sativa by using international scientific databases, historical and medical books, ancient Greek and Chinese manuscripts translations, library and statistical data from government reports and texts from the National Library of Greece (Stavros Niarchos Foundation), from the School of Health Sciences of the National and Kapodistrian University of Athens (Greece). We selected papers and texts focusing on a historical point of view about the medical importance of the plant and its applications for a therapeutic purpose in the past.. Through a detailed analysis of the available resources about the origins of C. sativa, we found that its use by ancient civilizations as a source of food and textile fibers dates back over 10,000 years, while its therapeutic applications have been improved over the centuries, from the ancient East medicine of the 2nd and 1st millennium B.C. to the more recent introduction in the Western world after the 1st century A.D. In the 20th and 21st centuries, Cannabis and its derivatives have been considered as a menace and banned throughout the world, but nowadays, they are still the most widely consumed illicit drugs all over the world. Its legalization in some jurisdictions has been accompanied by new lines of research to investigate its possible applications for medical and therapeutic purposes.

Topics: Cannabinoids; Cannabis; History, 15th Century; History, 16th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; History, Medieval; Humans; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Plant Extracts

Cannabis is the most widely used illicit substance among adolescents, and adolescent cannabis use is associated with various neurocognitive deficits that can extend into adulthood. A growing body of evidence supports the hypothesis that adolescence encompasses a vulnerable period of development where exposure to exogenous cannabinoids can alter the normative trajectory of brain maturation. In this review, we present an overview of studies of human and rodent models that examine lasting effects of adolescent exposure. We include evidence from meta-analyses, longitudinal, or cross-sectional studies in humans that consider age of onset as a factor that contributes to the behavioral dysregulation and altered structural or functional development in cannabis users. We also discuss evidence from preclinical rodent models utilizing well-characterized or innovative routes of exposure, investigating the effects of dose and timing to produce behavioral deficits or alterations on a neuronal and behavioral level. Multiple studies from both humans and animals provide contrasting results regarding the magnitude of residual effects. Combined evidence suggests that exposure to psychoactive cannabinoids during adolescence has the potential to produce subtle, but lasting, alterations in neurobiology and behavior.

Topics: Adolescent; Brain; Cannabinoids; Cannabis; Humans; Marijuana Abuse

Impulse control deficits are often found to co-occur with substance use disorders (SUDs). On the one hand, it is well known that chronic intake of drugs of abuse remodels the brain with significant consequences for a range of cognitive behaviors. On the other hand, individual variation in impulse control may contribute to differences in susceptibility to SUDs. Both of these relationships have been described, thus leading to a "chicken or the egg" debate which remains to be fully resolved. Does impulsivity precede drug use or does it manifest as a function of problematic drug usage? The link between impulsivity and SUDs has been most strongly established for cocaine and alcohol use disorders using both preclinical models and clinical data. Much less is known about the potential link between impulsivity and cannabis use disorder (CUD) or the directionality of this relationship. The initiation of cannabis use occurs most often during adolescence prior to the brain's maturation, which is recognized as a critical period of development. The long-term effects of chronic cannabis use on the brain and behavior have started to be explored. In this review we will summarize these observations, especially as they pertain to the relationship between impulsivity and CUD, from both a psychological and biological perspective. We will discuss impulsivity as a multi-dimensional construct and attempt to reconcile the results obtained across modalities. Finally, we will discuss possible avenues for future research with emerging longitudinal data.

Topics: Animals; Brain; Cannabis; Humans; Impulsive Behavior; Marijuana Abuse; Marijuana Use; Positron-Emission Tomography; Self-Control

This review provides the reader with an update on developments in research relating to cannabis psychosis. For over four decades researchers and clinicians have focused on the relationship between exposure to cannabis and the emergence of psychotic symptoms. This has proved to be a complicated topic to investigate but research has provided some valuable insights as to the nature of this relationship while also identifying the limits of our understanding. There are significant gaps in understanding of almost every aspect of the journey that people who have cannabis psychosis experience. Not only are treatment options limited, but we still have little evidence to help reliably predict who is at risk of developing cannabis psychosis. This would provide an opportunity to intervene early to reduce the number of people who experience this type of problem, although it is unrealistic to think it would be eliminated completely.

Topics: Cannabis; Causality; Humans; Marijuana Abuse; Psychotic Disorders; Risk Factors

Cannabis is one of the most widely used substances across the globe and its use has a substantial heritable component. However, the heritability of cannabis use varies according to substance use phenotype, suggesting that a unique profile of gene variants may contribute to the different stages of use, such as age of use onset, lifetime use, cannabis use disorder, and withdrawal and craving during abstinence. Herein, we review a subset of genes identified by candidate gene, family-based linkage, and genome-wide association studies related to these cannabis use phenotypes. We also describe their relationships with other substances, and their functions at the neurobiological, cognitive, and behavioral levels to hypothesize the role of these genes in cannabis use risk. Delineating genetic risk factors in the various stages of cannabis use will provide insight into the biological mechanisms related to cannabis use and highlight points of intervention prior to and following the development of dependence, as well as identify targets to aid drug development for treating problematic cannabis use.

Topics: Cannabis; Craving; Endocannabinoids; Genetic Association Studies; Humans; Marijuana Abuse; Phenotype; Substance Withdrawal Syndrome

There is a growing body of evidence pointing to the co-occurrence of cannabis use and depression. There is also some evidence that the use of cannabis may lead to the onset of depression; however, strong evidence points to the inverse association; i.e. that depression may lead to the onset or increase in cannabis use frequency. Observational and epidemiological studies have not indicated a positive long-term effect of cannabis use on the course and outcome of depression. The association between cannabis use and depression may be stronger among men during adolescence and emerging adulthood and stronger in women during midlife. There is an indication for potential genetic correlation contributing to the comorbidity of cannabis dependence and major depression, namely that serotonin (5-HT) may mediate such association and there is also evidence for specific risk alleles for cannabis addiction. There is preclinical evidence that alteration in the endocannabinoid system could potentially benefit patients suffering from depression. However, the issue of using cannabis as an anti-depressant is at an early stage of examination and there is little evidence to support it. Finally, there has been little support to the notion that selective serotonin reuptake inhibitors (SSRIs) may be effective in decreasing depressive symptoms or rates of substance use in adolescents treated for depression and a co-occurring substance use disorder. In conclusion, despite methodological limitations, research in the past decades has broadened our knowledge on the association between cannabis use and depression from epidemiological, neurological, genetic, and pharmacological perspectives.

Topics: Cannabis; Comorbidity; Depression; Depressive Disorder, Major; Humans; Marijuana Abuse

How to treat adults and adolescents with a Cannabis Use Disorder is a burgeoning research area. This article reviews the empirical literature pertaining to several psychosocial approaches (cognitive-behavior therapy, motivational enhancement, and contingency management), all of which are associated with favorable outcomes. We also review the emerging research on the use of pharmacotherapy, brief interventions and technology-delivered interventions, and conclude with an overview of future research needs.

Topics: Adolescent; Adult; Cannabis; Cognitive Behavioral Therapy; Humans; Marijuana Abuse; Motivation

Studies have shown a high degree of comorbidity between cannabis use disorder (CUD) and other mental illnesses. However, there is a paucity of research on the comorbidity between CUD with major depression (MD) and generalized anxiety disorder (GAD). This systematic review with meta-analysis aimed to assess the prevalence and strength of association between co-morbid CUD with MD and GAD.. An extensive search of Medline, CINAHL, PsycINFO, EMBASE, and grey literature were conducted to cover articles published between January 1. A total of 67 articles were identified by the electronic searches. A full-text review yielded 8 publications on nationally representative epidemiological surveys. 12-month and lifetime comorbidity estimates were extracted and used for the meta-analysis. CUD was strongly associated with MDE (OR 3.22; 2.31 - 4.49) and with GAD (OR 2.99; 2.14 - 4.16).. Limitations of this study include the heterogeneity observed due to the combination of studies from different geographic regions with different modifications of diagnostic criteria and varied response rates. This was addressed with a random-effects model.. This review confirms the evidence of high prevalence and a 3-fold comorbid association between CUD with MD and CUD with GAD. Implementation of evidence-based policy interventions with effective, integrated management of comorbid CUDs with psychiatric disorders may contribute to positive patient outcomes.

Topics: Adult; Anxiety Disorders; Cannabis; Comorbidity; Depression; Depressive Disorder, Major; Humans; Marijuana Abuse; Prevalence

Cannabis is the most widely used illicit drug worldwide, and it is estimated that up to 30% of people who use cannabis will develop a cannabis use disorder (CUD). Demand for treatment of CUD is increasing in almost every region of the world and cannabis use is highly comorbid with mental disorders, where sustained use can reduce treatment compliance and increase risk of relapse. In this narrative review, we outline evidence for psychosocial and pharmacological treatment strategies for CUD, both alone and when comorbid with psychosis, anxiety or depression. Psychosocial treatments such as cognitive behavioural therapy, motivational enhancement therapy and contingency management are currently the most effective strategy for treating CUD but are of limited benefit when comorbid with psychosis. Pharmacological treatments targeting the endocannabinoid system have the potential to reduce cannabis withdrawal and cannabis use in CUD. Mental health comorbidities including anxiety, depression and psychosis hinder effective treatment and should be addressed in treatment provision and clinical decision making to reduce the global burden of CUDs. Antipsychotic medication may decrease cannabis use and cannabis craving as well as psychotic symptoms in patients with CUD and psychosis. Targeted treatments for anxiety and depression when comorbid with CUD are feasible.

Topics: Antipsychotic Agents; Anxiety Disorders; Cannabis; Cognitive Behavioral Therapy; Comorbidity; Depressive Disorder; Humans; Marijuana Abuse; Psychotic Disorders; Treatment Outcome

Topics: Animals; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Medical Marijuana; Nervous System; Neurotoxicity Syndromes; Plants, Toxic; Receptors, Cannabinoid; Signal Transduction

Topics: Adolescent; Cannabis; Humans; Marijuana Abuse; Psychotic Disorders; Risk Factors

Cannabis use disorder (CUD) is an underappreciated risk of using cannabis that affects ~10% of the 193 million cannabis users worldwide. The individual and public health burdens are less than those of other forms of drug use, but CUD accounts for a substantial proportion of persons seeking treatment for drug use disorders owing to the high global prevalence of cannabis use. Cognitive behavioural therapy, motivational enhancement therapy and contingency management can substantially reduce cannabis use and cannabis-related problems, but enduring abstinence is not a common outcome. No pharmacotherapies have been approved for cannabis use or CUD, although a number of drug classes (such as cannabinoid agonists) have shown promise and require more rigorous evaluation. Treatment of cannabis use and CUD is often complicated by comorbid mental health and other substance use disorders. The legalization of non-medical cannabis use in some high-income countries may increase the prevalence of CUD by making more potent cannabis products more readily available at a lower price. States that legalize medical and non-medical cannabis use should inform users about the risks of CUD and provide information on how to obtain assistance if they develop cannabis-related mental and/or physical health problems.

Topics: Analgesics; Cannabis; Cognitive Behavioral Therapy; Humans; Marijuana Abuse; Prevalence

This comprehensive review discusses the adverse effects known today about marijuana, for either medical or recreational use. It reviews the role of cannabis in the treatment of chronic pain, cognitive and neurological adverse effects, special cases and addiction.. Cannabinoids work through the endocannabinoids system and inhibit the release of GABA and glutamate in the brain, impact neuromodulation, as well as dopamine, acetylcholine and norepinephrine release. They affect reward, learning and pain. The use of cannabis is increasing nationally and world-wide for both recreational and medicinal purposes, however, there is relatively only low quality evidence to the efficacy and adverse effects of this. Cannabis and its derivatives may be used for treatment of chronic pain. They are via CB1 receptors that are thought to modulate nociceptive signals in the brain. CB2 receptors in the DRG likely affect pain integration in the afferent pathways, and peripherally CB2 also affects noradrenergic pathways influencing pain. A large proportion of users may see more than 50% of chronic pain alleviation compared with placebo. Cannabis affects cognition, most notably executive function, memory and attention, and may deteriorate the boundary between emotional and executive processing. Cannabis impairs memory in the short run, which become more significant with chronic use, and may also be accompanied by poorer effort, slower processing and impacted attention. It is generally believed that long-term use and earlier age are risk factor for neurocognitive deficits; neuroimaging studies have shown reduced hippocampal volume and density. Executive functions and memory are worse in adolescent users versus adults. Cannabis addiction is different and likely less common than other addictive substances, but up to 10% of users meet criteria for lifetime cannabis dependence. Addiction patterns may be linked to genetic and epigenetic differences. It is still unclear whether abstinence reverses patterns of addiction, and more research is required into this topic.. Cannabis use has become more abundant for both medical and recreational use. It carries likely benefits in the form of analgesia, anti-emesis and improved appetite in chronic patients. The evidence reviewing adverse effects of this use are still limited, however, exiting data points to a clear link with neurocognitive deterioration, backed by loss of brain volume and density. Addiction is likely complex and variable, and no good data exists to support treatment at this point. It is becoming clear that use in earlier ages carries a higher risk for long-term deficits. As with any other drug, these risks should be considered alongside benefits prior to a decision on cannabis use.

Topics: Adolescent; Adult; Cannabinoids; Cannabis; Cognition; Humans; Marijuana Abuse; Medical Marijuana

Cannabis is widely used worldwide and cannabis use disorders are highly comorbid with anxiety disorders. In this review, we consider the recent literature on the effects of cannabis on the incidence, course, and treatment outcomes of anxiety disorders.. Although cannabis use is mostly found to be associated with increased incidence of anxiety disorders, these findings are generally not sustained in adjusted analyses controlling for multiple confounders. There are some equivocal data suggesting higher risk for anxiety disorders among heavy cannabis users. The scarce data available indicates no clear effect of cannabis use on the course and treatment outcomes of anxiety disorders.. Further research is needed focusing on trajectories of cannabis-induced acute anxiety, effects of cannabis use on treatment outcomes in anxiety disorders, and common genetic factors. Future epidemiological studies should utilize more precise measures of cannabis use and address several confounding factors which may affect the association between cannabis use and anxiety disorders.

Topics: Anxiety Disorders; Cannabis; Female; Humans; Male; Marijuana Abuse

Attentional bias, the automatic selective attentional orientation towards drug-related stimuli is well demonstrated in substance users. However, attentional bias studies of cannabis users specifically have thus far been inconclusive. Thus, the aim of this systematic review and meta-analysis was to synthesize the currently available literature regarding cannabis related attentional bias in cannabis users.. Literature search and selection was carried out, following the PRISMA guidelines, with all included studies investigating the relationship between cannabis use and attentional bias towards cannabis cues.. Fourteen manuscripts, reporting on 1271 participants (cannabis users n = 1044; controls n = 217), were considered for the systematic-review and majority were included in a meta-analysis. Studies reviewed used three types of attentional bias tasks: pictorial stimuli, word stimuli, and non-cannabis stimuli tasks. Greater attentional bias towards cannabis pictures (d = 0.42, P < 0.0001) and words (d = 0.63, P = 0.03) as well as both types of stimuli overall (d = 0.53, P < 0.0001) was observed in cannabis users compared to controls, though there was evidence of significant heterogeneity for both word stimuli and overall meta-analysis. Bigger effect sizes were associated with shorter durations of exposure to cannabis stimuli suggesting mainly automatic orientating rather than controlled attention processing.. These findings suggest that cannabis users display greater attentional bias towards cannabis cues, likely an automatic process, than control groups. Future studies employing shorter exposure durations may validate attentional bias as a treatment target for the development of interventions in people with cannabis use disorder.

Topics: Adult; Attentional Bias; Cannabis; Cues; Female; Humans; Male; Marijuana Abuse; Marijuana Use

Eleven US States and the District of Columbia legally allow personal (i.e., recreational) cannabis use by adults, and an additional 22 states allow use of cannabis for medicinal purposes. Of these jurisdictions, only two do not have some form of legalized gambling available (https://www.casino.org/local/guide/). In contrast to this rapid increase in legally available marijuana is the limited knowledge about the intersection of cannabis use and gambling. This paper strives to define the current status of the relevant literatures and consider the implication for future gambling research. We describe the research literature on the prevalence of cannabis use and co-existing gambling problems and the effects of cannabis use on gambling-related cognitive functions and decision-making. We also discuss clinical considerations with treating problem gamblers with a cannabis use disorder. Finally, the potential implications for responsible gambling practices and policies and the most pressing gaps in the research literature are offered.

Topics: Adult; Cannabis; Gambling; Humans; Legislation, Drug; Male; Marijuana Abuse; Marijuana Smoking

There is evidence that sex- and gender-related factors are involved in cannabis patterns of use, health effects and biological mechanisms. Women and men report different cannabis use disorder (CUD) symptoms, with women reporting worse withdrawal symptoms than men. The objective of this systematic review was to examine the effectiveness of cannabis pharmacological interventions for women and men and the uptake of sex- and gender-based analysis in the included studies. Two reviewers performed the full-paper screening, and data was extracted by one researcher. The search yielded 6098 unique records-of which, 68 were full-paper screened. Four articles met the eligibility criteria for inclusion. From the randomized clinical studies of pharmacological interventions, few studies report sex-disaggregated outcomes for women and men. Despite emergent evidence showing the influence of sex and gender factors in cannabis research, sex-disaggregated outcomes in pharmacological interventions is lacking. Sex- and gender-based analysis is incipient in the included articles. Future research should explore more comprehensive inclusion of sex- and gender-related aspects in pharmacological treatments for CUD.

Topics: Cannabis; Female; Humans; Male; Marijuana Abuse; Sex Factors; Substance Withdrawal Syndrome

The implications of cannabis use in the onset of early psychosis and the severity of psychotic symptoms have resulted in a proliferation of studies on this issue. However, few have examined the effects of cannabis use on the cognitive symptoms of psychosis (i.e., neurocognitive functioning) in patients with first-episode psychosis (FEP). This systematic review and meta-analysis aim to assess the neurocognitive functioning of cannabis users (CU) and nonusers (NU) with FEP.. Of the 110 studies identified through the systematic review of 6 databases, 7 met the inclusion criteria, resulting in 14 independent samples and 78 effect sizes. The total sample included 304 CU with FEP and 369 NU with FEP. The moderator variables were age at first use, duration of use, percentage of males, and age.. Effect sizes were not significantly different from zero in any neurocognitive domain when users and NU were compared. Part of the variability in effect sizes was explained by the inclusion of the following moderator variables: (1) frequency of cannabis use (β = 0.013, F = 7.56, p = 0.017); (2) first-generation antipsychotics (β = 0.019, F = 34.46, p ≤ 0.001); and (3) country where the study was carried out (β = 0.266, t = 2.06, p = 0.043).. This meta-analysis indicates that cannabis use is not generally associated with neurocognitive functioning in patients with FEP. However, it highlights the deleterious effect of low doses of cannabis in some patients. It also stresses the importance of the type of antipsychotic prescription and cannabis dose as moderator variables in the neurocognitive functioning of CU with FEP.

Topics: Antipsychotic Agents; Cannabis; Humans; Marijuana Abuse; Mental Status and Dementia Tests; Psychotic Disorders

The concept of a cannabis 'entourage effect' was first coined as a hypothetical afterthought in 1998. Since then, multiple scientific reviews, lay articles, and marketing campaigns have promoted the effect as a wholly beneficial manifestation of polypharmacy expected to modulate the therapeutic effects of cannabis and its derivatives. There is reason to wonder at the authenticity of such claims.. A broad definition of the entourage effect is presented, followed by brief summaries of the nature of cannabis polypharmacy and the commonly cited contributing phytochemicals, with special attention to their attendant adverse effects. A critical analysis is then offered of the primary literature that is often portrayed as suggestive of the effect in existing reviews, with further studies being drawn from PubMed and Google Scholar searches. A final discussion questions the therapeutic value of the entourage effect and offers alternate perspectives on how it might be better interpreted.. Claims of a cannabis entourage effect invoke ill-defined and unsubstantiated pharmacological activities which are commonly leveraged toward the popularization and sale of ostensible therapeutic products. Overestimation of such claims in the scientific and lay literature has fostered their misrepresentation and abuse by a poorly regulated industry.

Topics: Animals; Cannabis; Humans; Marijuana Abuse; Marijuana Use; Phytochemicals

Drug use during pregnancy is a critical global challenge, capable of severe impacts on neonatal development. However, the consumption of cannabis and synthetic cannabinoids is on the rise in pregnant women. Obstetric complications with increased risks of miscarriage, fetal growth restriction, and brain development impairment have been associated with perinatal cannabis exposure, but data on synthetic cannabinoid use during pregnancy are limited.. We reviewed studies that investigated the risks associated with cannabis and synthetic cannabinoid use and those that reported the concentrations of cannabinoids and synthetic cannabinoids in maternal (breast milk) and neonatal (placenta, umbilical cord, meconium, and hair) matrices during human pregnancy. A MEDLINE and EMBASE literature search to identify all relevant articles published in English from January 1998 to April 2019 was performed.. Cannabis use during pregnancy is associated with increased risks of adverse obstetrical outcomes, although neurobehavioral effects are still unclear. Analyses of cannabinoids in meconium are well documented, but further research on other unconventional matrices is needed. Adverse effects due to perinatal synthetic cannabinoid exposure are still unknown, and analytical data are scarce.. Awareness of the hazards of drug use during pregnancy should be improved to encourage health care providers to urge pregnant women to abstain from cannabis and, if cannabis-dependent, seek treatment. Moreover, substances used throughout pregnancy should be monitored as a deterrent to cannabis use, and potential cannabis-dependent women should be identified, so as to limit cannabis-fetal exposure during gestation, and provided appropriate treatment.

Topics: Cannabinoids; Cannabis; Drug Monitoring; Female; Hair; Humans; Marijuana Abuse; Meconium; Milk, Human; Placenta; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Prevalence; Risk Factors; Umbilical Cord

Cannabis is the most commonly used illicit drug among adolescents and young adults, including pregnant women. There is substantial evidence for a significant association between prenatal cannabis exposure and lower birth weight in offspring, and mixed results regarding later behavioural outcomes in the offspring. Adolescent cannabis use, especially heavy use, has been associated with altered executive function, depression, psychosis and use of other drugs later in life. Human studies have limitations due to several confounding factors and have provided scarce information about sex differences. In general, animal studies support behavioural alterations reported in humans and have revealed diverse sex differences and potential underlying mechanisms (altered mesolimbic dopaminergic and hippocampal glutamatergic systems and interference with prefrontal cortex maturation). More studies are needed that analyse sex and gender influences on cannabis-induced effects with great clinical relevance such as psychosis, cannabis use disorder and associated comorbidities, to achieve more personalized and accurate treatments.

Topics: Adolescent; Adolescent Behavior; Adolescent Health; Adult; Animals; Cannabis; Child; Child, Preschool; Endocannabinoids; Female; Humans; Infant; Infant, Newborn; Male; Marijuana Abuse; Models, Animal; Pregnancy; Prenatal Exposure Delayed Effects; Sex Characteristics; Young Adult

Nicotine is the specific psychoactive substance of tobacco while tetrahydrocannabinol (THC) is the specific component of cannabis. The inhalation technique of cannabis is different from that of tobacco smoking: the volume of puffs is larger, inhalation is deeper, and pulmonary retention time is longer. Cannabis addiction is difficult to evaluate, both products often being smoked concomitantly. The principle physical side effects of cannabis affect organs and functions in a similar way to tobacco: pulmonary, cardiovascular, endocrine and stomatological. Gastrointestinal complications such as cannabinoid hyperemesis are specific to cannabis. Some psychological effects of THC may be acute (altered time and space perception, sensory disability, decreased vigilance, mood and dissociative disorders, hallucinations and delirium, impaired learning and memory, impaired cognitive and motor performance, panic attacks and anxiety) or chronic (lack of motivation, disorganisation of thoughts, increase in frequency and severity of schizophrenic crises). Cannabis can also be implicated in traffic and workplace accidents. Synthetic cannabinoids have increased psychotropic and somatic effects due to a greater affinity for brain cannabinoid receptors.

Topics: Brain; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Nicotiana; Psychotropic Drugs; Receptors, Cannabinoid; Signal Transduction; Tobacco Smoking

Cannabis use is widespread in France, particularly among adolescents and young adults, and can induce severe somatic, psychiatric and social consequences. Early identification and appropriate care of cannabis use disorders thus constitute a major public health issue. Standardized questionnaires based on patient self-reporting are recognized as the best option for identifying cannabis use disorders because of their reliability and simplicity.. We conducted a narrative literature review on cannabis use assessment tools on PubMed and selected cannabis-specific questionnaires, validated for adolescent and/or adult populations, from scientific articles in English or French between 1995 and 2010.. Sixteen questionnaires were found according to the inclusion criteria. The CAGE-cannabis, the CAST, the CUDIT and its revised version the CUDIT-R, the PUM and the SDS are the only ones that have good characteristics for a short screening tool adapted to daily clinical practice, namely to be brief (fewer than 10 questions) and quick handover (less than 10minutes). Only the CAST has been validated in French, and the CUDIT-R is currently being validated. In the DSM-5, diagnoses of abuse or addiction have been grouped into a single diagnosis of cannabis use disorders with different levels of severity. It is relevant that tools used for screening take into account these new diagnostic concepts. The CUDIT-R is currently the only one to be validated based on DSM-5 diagnostic criteria.. Among the many questionnaires available, few are suited for daily clinical practice in France because of their complexity, their long duration or the absence of a validated French translation. The CUDIT-R has good psychometric characteristics, is simple to use, and has been validated according to the criteria of DSM-5. These questionnaires are obviously not a substitute for a clinical diagnosis and must be followed by a specialist's evaluation. However, they remain an interesting mediation, encouraging a patient's awareness and commitment to care.

Topics: Adolescent; Cannabis; Diagnostic and Statistical Manual of Mental Disorders; Humans; Marijuana Abuse; Psychometrics; Reproducibility of Results; Young Adult

We aim to quantify the prevalence and risk of having a cannabis use disorder (CUD), cannabis abuse (CA) or cannabis dependence (CD) among people in the general population who have used cannabis.. We conducted a systematic review of epidemiological cross-sectional and longitudinal studies on the prevalence and risks of CUDs among cannabis users. We identified studies published between 2009 and 2019 through PubMed, the Global Burden Disease (GBD) Database, and supplementary searches up to 2020. The outcomes of interest were CUDs based on DSM or ICD criteria. Estimates were synthesized using random-effects meta-analyses, followed by meta-regression of study characteristics on effect sizes.. From 1383 records identified, 21 studies were included. Meta-analyses showed that among people who used cannabis, 22% (18-26%) have CUD, 13% (8-18%) have CA, and 13% (10-15%) have CD. Estimates from cohort studies, showed that the risk of developing CD increased to 33% (22-44%) among young people who engaged in regular (weekly or daily) use of cannabis. There was a lack of data from cohort studies to estimate the risk of CUD or CA among regular cannabis users.. Cannabis users need to be informed about the risks of developing CUDs and the higher risks among those who initiate early and use frequently during adolescence. Future studies are needed to examine how changes in cannabis policies may affect the risks of CUDs in the population.

Topics: Adolescent; Cannabis; Cross-Sectional Studies; Humans; Longitudinal Studies; Marijuana Abuse; Prevalence

This is a comprehensive review of the association between cannabis use and psychological disorders. It reviews the latest and seminal evidence that is available and attempts to conclude the strength of such association.. Cannabis is a flowering plant with psychoactive properties, attributed to cannabinoids that naturally occur within the plant. These act through the CB1 and CB2 receptors to inhibit GABA and glutamate release, as well through other forms of neuromodulation through the modulation of the endocannabinoid system (eCBs); a system that is otherwise involved in different pathways, including reward, memory, learning, and pain. Recent societal changes have increased the use of both medical and recreational cannabis. Patients with mental illness are considered more vulnerable and are prone to reward-seeking behavior. Cannabis use disorder (CUD) has been shown to have an increased prevalence in individuals with mental illness, creating an explosive cocktail. Approximately 1 in 4 patients with schizophrenia are also diagnosed with CUD. Cannabis use is associated with 2-4 times the likelihood of developing psychosis in healthy individuals. It has also been associated with multiple poor prognostic factors in schizophrenia, as well as in patients with a history of psychosis who do not meet diagnostic criteria for schizophrenia. Cannabis has been linked with anxiety; THC has been shown to elicit anxiety; however, anxiety is also a trigger for cannabis use. However, a recent large meta-analysis did not find a convincing link between cannabis and anxiety. This was reiterated in a recent epidemiological study that did not find such a correlation; however, it did identify a link between cannabis use, substance disorder, alcohol use disorder, drug use disorder, and nicotine dependence. Similarly, contradicting data exists regarding the link of depression and cannabis use.. Cannabis use is increasing with recent societal shifts; however, its interaction with mental health is less well understood. CUD is highly prevalent in individuals with mental health disorders, especially those with other substance abuse disorders. There is evidence to support that cannabis use may trigger and worsen psychosis and schizophrenia. The link with depression and anxiety is less clear and needs further investigation. Personality disorder is linked with substance use disorder and shares similar risk factors with CUD.

Topics: Anxiety Disorders; Cannabis; Comorbidity; Humans; Marijuana Abuse; Psychotic Disorders; Substance-Related Disorders

Topics: Brain; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Mental Health

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Topics: Acute Coronary Syndrome; Animals; Arrhythmias, Cardiac; Cannabinoid Receptor Agonists; Cannabinoids; Cannabis; Cardiotoxicity; Heart; Heart Rate; Humans; Marijuana Abuse; Marijuana Smoking; Receptors, Cannabinoid; Risk Assessment; Risk Factors; Signal Transduction

Cannabis abuse is a common phenomenon among adolescents. The dominant psychoactive substance in Cannabis sativa is tetrahydrocannabinol (THC). However, in the past 40 years the content of the psychoactive ingredient THC in most of the preparations is not constant but has increased due to other breeding and culturing conditions. THC acts as the endocannabinoids at CB1 and CB2 receptors but pharmacologically can be described as a partial (not a pure) agonist. Recent evidence shows that activation of the CB1 receptor by THC can diminish the production of neuronal growth factor in neurons and affect other signalling cascades involved in synapsis formation. Since these factors play an important role in the brain development and in the neuronal conversion processes during puberty, it seems reasonable that THC can affect the adolescent brain in another manner than the adult brain. Accordingly, in adolescent cannabis users structural changes were observed with loss of grey matter in certain brain areas. Moreover, recent studies show different effects of THC on adolescent and adult brains and on behaviour. These studies indicate that early THC abuse can result in neuropsychological deficits. This review gives an overview over the present knowledge in this field.

Topics: Adolescent; Adult; Behavior; Brain; Cannabis; Dronabinol; Endocannabinoids; Humans; Marijuana Abuse; Receptors, Cannabinoid

Cannabinoids, the psychoactive compounds in marijuana, are one of the most commonly used substances in the United States. In this review, we summarize the impact of marijuana on child and adolescent health and discuss the implications of marijuana use for pediatric practice. We review the changing epidemiology of cannabis use and provide an update on medical use, routes of administration, synthetic marijuana and other novel products, the effect of cannabis on the developing brain, other health and social consequences of use, and issues related to marijuana legalization.

Topics: Adolescent; Adolescent Behavior; Animals; Brain; Cannabidiol; Cannabinoids; Cannabis; Child; Child Behavior; Drug Interactions; Endocannabinoids; Female; Fetus; Humans; Illicit Drugs; Male; Marijuana Abuse; Marijuana Use; Mass Media; Medical Marijuana; Milk, Human; Neurocognitive Disorders; Pregnancy; Prenatal Exposure Delayed Effects; Receptors, Cannabinoid; Tobacco Use

Despite the high prevalence in patients with schizophrenia, the association of cannabis and nicotine use with negative symptoms remains unclear. We performed a meta-analysis of observational studies addressing the association of cannabis and nicotine use with negative symptoms. Twenty cannabis studies (n = 2611) and 45 nicotine studies (n = 8942) were analyzed. There was no significant effect for current cannabis use alone or in combination with other substances. However, recently abstinent users of cannabis showed less severe negative symptoms than nonusers. Nicotine users were not different from nonusers with respect to negative symptoms. With respect to positive symptoms, very small increases were found for cannabis users and patients using nicotine along with other drugs. In conclusion, while patients with schizophrenia who use cannabis did not differ from nonusers, recently abstinent patients showed less severe negative symptoms than nonusers. This finding suggests that cannabis-using patients might be less susceptible to the development of negative symptoms. The amotivational effects of cannabis may obscure these differences in current users.

Topics: Cannabis; Hallucinogens; Humans; Marijuana Abuse; Nicotine; Observational Studies as Topic; Schizophrenia

As is the case for most drugs, cannabis use has costs and benefits, and so do the policies that attempt to minimize the first and maximize the second. This article summarizes what we know about the harmful effects of recreational cannabis use and the benefits of medical cannabis use under the policy of prohibition that prevailed in developed countries until 2012. It outlines three broad ways in which cannabis prohibition may be relaxed, namely, the depenalization of personal possession and use, the legalization of medical use, and the legalization of adult recreational use. It reviews evidence to date on the impacts of each of these forms of liberalization on the costs and benefits of cannabis use. It makes some plausible conjectures about the future impacts of the commercialization of cannabis using experience from the commercialization of the alcohol, tobacco, and gambling industries. Cannabis policy entails unavoidable trade-offs between competing social values in the face of considerable uncertainty about the effects that more liberal cannabis policies will have on cannabis use and its consequences for better or worse.
.. El consumo de cannabis, como se da con la mayoría de las drogas, tiene costos y beneficios ; igual ocurre con las políticas que intentan minimizar los primeros y maximizar los segundos. Este artículo resume lo que conocemos acerca de los daños provocados por el consumo recreativo de cannabis y los beneficios de su empleo medicinal según la política de prohibición que prevaleció en los países desarrollados hasta 2012. Se describen tres principales formas en las que la prohibición de cannabis se puede mitigar: la despenalización de la posesión y uso personal, la legalización del uso médico, y la legalización del uso recreativo en adultos. Se revisa la evidencia hasta la fecha sobre los impactos de cada una de estas formas de liberalización en los costos y beneficios del consumo de cannabis. Se hacen algunas posibles conjeturas acerca de los impactos futuros de la comercialización de cannabis utilizando la experiencia al respecto de las industrias del alcohol, el tabaco y de los juegos de azar. Se sabe poco sobre el impacto de la liberalización del consumo de cannabis, así como de sus consecuencias positivas o negativas. Cualquier política sobre este tema implica compromisos inevitables entre valores sociales opuestos.. Comme pour la plupart des drogues, la consommation de cannabis a ses coûts et ses bénéfices. Tout comme les politiques qui s’efforcent de minimiser les premiers et de maximiser les seconds.. Nous résumons dans cet article nos connaissances sur les dangers de l'usage récréatif du cannabis et les bénéfices de son usage médical dans le cadre de la politique d'interdiction qui a prévalu dans les pays développés jusqu'en 2012. Nous y décrivons trois grandes voies d'assouplissement de l'interdiction du cannabis, à savoir la dépénalisation de la possession et de la consommation personnelles, la légalisation de l'utilisation médicale et la légalisation de la consommation récréative par des adultes. Chacune de ces formes de libéralisation influe sur les coûts et les bénéfices de la consommation de cannabis, générant des données analysées ici. En nous inspirant de l'expérience acquise dans le cadre de la commercialisation de l'alcool et la légalisation des jeux de hasard, nous émettons des hypothèses sur les possibles conséquences de la commercialisation du cannabis. L’impact de la libéralisation du cannabis sur sa consommation est peu connu, de même que ses conséquences pour le meilleur ou pour le pire, et toute politique menée à ce sujet implique des compromis inévitables entre des valeurs sociales opposées.

Topics: Cannabis; Cost-Benefit Analysis; Humans; Legislation, Drug; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Public Policy

This chapter reviews pharmacotherapies that have been trialled for cannabis dependence, identifying those that warrant further research and those of little or uncertain value. A diverse range of medicines have been tested, representing a broad range of pharmacological strategies. These include tetrahydrocannabinol preparations, various types of antidepressant, anxiolytics, a glutamatergic modulator and the neuropeptide oxytocin. Cannabinoid agonists warrant further research. For the FAAH inhibitor PF-04457845, oxytocin, varenicline and gabapentin, although there is a signal to indicate further research is warranted, these medications do not yet have sufficient evidence to support clinical use, and larger, longer-term trials are needed in representative treatment-seeking populations. Special populations that warrant consideration are those with cannabis dependence and concurrent mental health conditions and those that develop dependence through therapeutic use.

Topics: Cannabinoid Receptor Agonists; Cannabis; Dronabinol; Humans; Marijuana Abuse

Evidence for an association between cannabis and psychosis has been documented in literature in many forms including experimental studies, epidemiological data, and case series. The association has implications for psychotic outcomes ranging from mild to severe and occurring over minutes to years. Due to the huge variety of exposures and outcome measures reported, creating a coherent account of all the available information is difficult. A useful way to conceptualize these wide-ranging results is to consider the association between cannabis and psychosis as it occurs within the context of widely used DSM-5 diagnoses. In the present review we examine cannabis/psychosis associations as they pertain to Cannabis Intoxication, Cannabis-Induced Psychotic Disorder, and Schizophrenia. This allows for an understanding of the cannabis and psychosis association along something approaching a continuum. Cannabis intoxication becomes Cannabis-Induced Psychotic Disorder once certain severity and duration criteria are met and Cannabis-Induced Psychotic Disorder is heavily associated with future schizophrenia diagnoses.

Topics: Age Factors; Cannabis; Catechol O-Methyltransferase; Diagnostic and Statistical Manual of Mental Disorders; Genetic Predisposition to Disease; Humans; Male; Marijuana Abuse; Psychoses, Substance-Induced; Schizophrenia; Time Factors

Cannabis use is widespread among people at ultra-high risk (UHR) for psychosis. The causal link as well as the temporal link between cannabis use and further occurrence of psychosis in UHR people remain inconclusive. Current science data supported an increased risk of transition to psychosis in cannabis users who are genetically predisposed to psychosis. This risk would be even greater in the presence of a family history of psychosis, in case of a strong use and an early onset use. Several models have been cited to explain the link between cannabis use and the subsequent onset of psychosis or prepsychotic states: cannabis-induced modifications of some brain structures, a dysregulation of the hypothalamic-pituitary axis and an alteration of normal neurological development via the endocannabinoid system. Cannabis represents a modifiable risk for psychosis. Current interventions aim to reduce or stop the cannabis use in order to reduce the risk of transition to psychosis.

Topics: Age Factors; Brain; Cannabis; Endocannabinoids; Genetic Predisposition to Disease; Humans; Hypothalamo-Hypophyseal System; Marijuana Abuse; Medical History Taking; Psychoses, Substance-Induced; Risk

Cannabis use has become increasingly common in the U.S. in recent years, with legalization for medical and recreational purposes expanding to more states. With this increase in use and access, providers should be prepared to have more conversations with patients about use. This review provides an overview of cannabis terminology, pharmacology, benefits, harms, and risk mitigation strategies to help providers engage in these discussions with their patients. Current evidence for the medical use of cannabis, cannabis-related diagnoses including cannabis use disorder (CUD) and withdrawal syndromes, and the co-use of opioids and cannabis are discussed. It is crucial that providers have the tools and information they need to deliver consistent, evidence-based assessment, treatment, prevention and harm-reduction, and we offer practical guidance in these areas.

Topics: Cannabis; Communication; Drug Administration Routes; Humans; Marijuana Abuse; Medical Marijuana; Opioid-Related Disorders; Primary Health Care; Professional-Patient Relations; Substance Withdrawal Syndrome; Synthetic Drugs; United States

The laws governing cannabis are evolving worldwide and associated with changing patterns of use. The main psychoactive drug in cannabis is Δ

Topics: Animals; Brain; Cannabis; Diagnostic Imaging; Dronabinol; Human Development; Humans; Marijuana Abuse; Psychotropic Drugs

Whether the effects of cannabis use on brain function persist or recover following abstinence remains unclear. Therefore, using meta-analytic techniques, we examined whether functional alterations measured using fMRI persist in cannabis users abstinent for over 25 days (or 600 h) as evidence suggests that the effects on cognitive performance no longer persist beyond this period. Systematic literature search identified 20 studies, of which, 12 examined current cannabis users (CCU) (361 CCU versus 394 non-cannabis using controls (NU)) and 3 examined abstinent cannabis users (ACU) in 5 separate comparisons (98 ACU versus 106 NU). Studies in ACU were carried out in adolescents and suggest significantly greater activation in components of the central executive and default mode networks in adolescent ACU compared to NU. While this evidence is to be interpreted with caution because studies were carried out in overlapping samples, they indicate a pressing need for independent confirmation whether certain neurofunctional alterations in adolescent cannabis users may persist even after cannabis and its metabolites are likely to have left their bodies.

Topics: Adolescent; Brain; Cannabis; Executive Function; Humans; Magnetic Resonance Imaging; Marijuana Abuse; Marijuana Use; Neural Pathways

Cannabis use disorder (CUD) is prevalent and demand for treatment is increasing, yet few individuals engage in formal treatment and the efficacy of established interventions for CUD is modest. Existing clinical trials evaluating psychosocial and pharmacological treatments for CUD have incorporated a wide variety of measures for assessing cannabis use outcomes, including abstinence, self-reported frequency and quantity used, withdrawal, use/dependence severity, and other psychosocial outcomes. The heterogeneity of measures and outcomes has limited quantitative analyses of the comparative effectiveness of existing interventions. The purpose of this systematic review is to: 1) identify and characterize approaches for measuring cannabis use in existing CUD intervention trials, including abstinence, frequency and quantity of use, and 2) summarize measures used to assess treatment efficacy in other outcome domains (e.g., cannabis use severity, psychosocial functioning, cannabis withdrawal), and provide a platform for future research to evaluate which outcome measures are most likely to reflect treatment efficacy and clinically significant improvement in other outcome domains.

Topics: Cannabis; Humans; Marijuana Abuse; Self Report; Substance Withdrawal Syndrome; Treatment Outcome

Cannabis is the third most used psychoactive drug worldwide. Despite being legally scheduled as a drug with high harm potential and no therapeutic utility in countries like the USA, evidence shows otherwise and legislative changes and reinterpretations of existing ambiguous laws make this drug increasingly available by legal means. Nevertheless, this substance is able to generate clear addiction syndromes in some individuals who use it, which are accompanied by brain alterations resembling those caused by other addictive drugs. Moreover, there is no available pharmacological treatment for this disorder. This fact motivates a deep study and comprehension of the neural basis of addiction-relevant cannabinoid effects. Interestingly, the cerebellum, a hindbrain structure which involvement in functions not related to motor control and planning is being increasingly recognized in the last decades, seems to be involved in the effects of addictive drugs and addiction-related processes and also presents a high density of cannabinoid receptors. Preclinical research on the involvement of the cerebellum in cannabis' effects has focused in the drug's motor incoordinating actions, potentially underestimating its participation in addiction. Therefore, this review addresses the studies reporting cerebellar involvement in cannabis effects both in experimental animals and human subjects and the possible relevance of these changes for addiction. Additionally, future experimental approaches will be proposed and hopefully this work will stimulate research on the cerebellum in cannabis addiction and help recognizing it as an important part of the neural circuitry affected in cannabis-related disorders.

Topics: Animals; Cannabis; Cerebellum; Dronabinol; Humans; Marijuana Abuse

The United States has recently undergone increases in the legalization and use of marijuana. There have been previous reports on the association of cannabis use and myocardial dysfunction, however, few on the association with acute stress cardiomyopathy and cardiogenic shock.. This is a case of a 58-year-old female with a history of inhaled cannabis use, no history of diabetes, and no known history of cardiac disease, that illustrates an association between cannabis use and the recurrent development of stress cardiomyopathy and cardiogenic shock. A review of medical records was performed from two hospitalizations and subsequent outpatient follow-up for similar presentations 6 years apart and review of literature regarding cannabis use and its association with cardiac dysfunction. In separate hospitalizations, the patient presented with clinical findings of cardiogenic shock, severe left ventricular dysfunction with morphologic features of stress cardiomyopathy, and normal coronary angiography. Laboratory results included elevated cardiac biomarkers and urine tetrahydrocannabinol levels > 300 ng/mL. The patient required intensive cardiovascular support, but recovered with normal cardiac function after each event. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: As use of cannabis becomes more prevalent, it will be important for physicians to recognize the potential association of cannabis use and acute myocardial dysfunction, and how early treatment may contribute to salutary outcomes.

Topics: Cannabis; Cardiomyopathies; Electrocardiography; Female; Humans; Hypotension; Intra-Aortic Balloon Pumping; Marijuana Abuse; Middle Aged; Recurrence; Shock

Marijuana is the most widely consumed illicit substance in the United States, and an increasing number of states have legalized it for both medicinal and recreational purposes. As it becomes more readily available, there will be a concurrent rise in the number of users and, consequently, the number of motor vehicle operators driving under the influence. This article examines the cognitive and psychomotor effects of cannabis, as well as current policy concerning driving under the influence of drugs. The authors performed a MEDLINE search on the epidemiology of cannabis use, its cognitive and psychomotor effects, and policies regarding driving under the influence of drugs. Twenty-eight epidemiological studies, 16 acute cognitive and psychomotor studies, 8 chronic cognitive and psychomotor studies, and pertinent state and federal laws and policies were reviewed. These search results revealed that marijuana use is associated with significant cognitive and psychomotor effects. In addition, the legalization of marijuana varies from state to state, as do the laws pertaining to driving under the influence of drugs. Marijuana is a commonly found illicit substance in motor vehicle operators driving under the influence of drugs. Current evidence shows that blood levels of tetrahydrocannabinol do not correlate well with the level of impairment. In addition, although acute infrequent use of cannabis typically leads to cognitive and psychomotor impairment, this is not consistently the case for chronic heavy use. To establish the framework for driving under the influence of cannabis policy, we must review the current published evidence and examine existing policy at state and federal levels.

Topics: Analgesics; Automobile Driving; Cannabis; Cognition; Driving Under the Influence; Dronabinol; Humans; Marijuana Abuse; Marijuana Smoking; Motor Skills; Policy; United States

The influence of cannabis use on the occurrence, clinical course and the treatment of the first psychotic episode (FEP) is well documented. However, the exact link is still not clearly established. The aim of this article is to review and report the noticed increase in the number of hospitalizations of young people with a clinical appearance of severe psychotic decompensation following cannabis consumption and to show the clinical challenges in treatment of the FEP. The case study describes the clinical course of a five selected patients with a diagnosis of the FEP and positive tetrahydrocannabinol (THC) urine test who were hospitalized in a similar pattern of events. They all have a history of cannabis consumption for at least 6 years in continuity and were presented with severe psychomotor agitation, disorganisation, confusion and aggression at admission. Although the chosen drug to treat all patients was atypical antipsychotic and benzodiazepines, the course of the disorder and the clinical response to therapy were noticeably different in each patient. The clinical presentation of FEP in cannabis users can be atypical and highly unpredictable from mild psychotic symptoms to severe substance intoxication delirium. In clinical practice clinicians treating new onset psychosis need to be watchful for cannabis and synthetic cannabinoids induced psychosis. Pharmacotherapeutic interventions include prompt and adequate use of the benzodiazepine, second-generation antipsychotic, and mood-stabilizers. Further research in the pharmacotherapy of cannabis-induced psychosis is required.

Topics: Adolescent; Antipsychotic Agents; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Psychoses, Substance-Induced; Psychotic Disorders

This paper provides an update from the literature on understanding of the relationship between cannabis and schizophrenia. In particular, the paper focuses on the latest findings and remaining areas that require investigation.. Three hypotheses have emerged as potential explanations for the association between cannabis and schizophrenia, namely cannabis can trigger schizophrenia, cannabis is used to mitigate symptoms of schizophrenia, and there are common factors which might account for the association. Biological and genetic factors dominate this field of research; this has been at the expense of exploring social and cultural contributory factors which influence cannabis and schizophrenia. The evidence for cannabis acting as a causal factor for schizophrenia has so far not been established. Research needs to extend beyond males drawn from western countries if we are to advance knowledge and understanding of the link between cannabis use and schizophrenia.

Topics: Cannabis; Humans; Male; Marijuana Abuse; Psychotic Disorders; Risk Factors; Schizophrenia

Jurisdictions considering or implementing alternatives to cannabis supply prohibition will confront several decisions that will influence health, safety, and social equity outcomes. This essay highlights 14 of these design considerations, which all conveniently begin with the letter

Topics: Canada; Cannabis; Commerce; Costs and Cost Analysis; Humans; Law Enforcement; Legislation, Drug; Marijuana Abuse; Marijuana Use; Marketing; Public Policy; United States; Uruguay

Electronic cigarettes (e-cigarettes) are increasing in popularity with 19% of UK smokers reporting to have used them. The ability to regulate the evaporation temperature in newer electronic nicotine delivery systems (ENDS) facilitates the potential for use of these devices to 'vape' cannabis, novel psychoactive substances (NPS) and other recreational drugs. Vaping cannabis does have the potential to reduce tobacco use and combustible cannabis/tobacco-related disease, but with over one-third of UK adults reporting life-time use of recreational drugs and increasing e-cigarette uptake in adolescent groups the misuse of these devices poses a serious potential public health risk. Further work is therefore urgently required to inform the appropriate treatment and primary prevention strategies for this emerging issue.

Topics: Cannabinoid Receptor Agonists; Cannabis; Electronic Nicotine Delivery Systems; Harm Reduction; Humans; Illicit Drugs; Marijuana Abuse; Public Health; Smoking Prevention; Vaping

Recent policy changes have led to significant increases in the use of cannabis for both medical and recreational purposes. Although men are more likely to endorse past month cannabis use and are more frequently diagnosed with Cannabis Use Disorder relative to women, a growing proportion of medical cannabis users are reported to be women. The increased popularity of cannabis for medical purposes and the narrowing gap in prevalence of use between men and women raises questions regarding sex-dependent effects related to therapeutic efficacy and negative health effects of cannabis and cannabinoids. The objective of this review is to provide a translational perspective on the sex-dependent effects of cannabis and cannabinoids by synthesizing findings from preclinical and clinical studies focused on sex comparisons of their therapeutic potential and abuse liability, two specific areas that are of significant public health relevance. Hormonal and pharmacological mechanisms that may underlie sex differences in the effects of cannabis and cannabinoids are highlighted.

Topics: Animals; Cannabinoid Receptor Modulators; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Medical Marijuana; Sex Characteristics

Cannabis use has become increasingly accepted socially and legally, for both recreational and medicinal purposes. Without reliable information about the effects of cannabis, people cannot make informed decisions regarding its use. Like alcohol and tobacco, cannabis can have serious adverse effects on health, and some people have difficulty discontinuing their use of the drug. Many cannabis users progress to using and becoming addicted to other drugs, but the reasons for this progression are unclear. The natural cannabinoid system of the brain is complex and involved in many functions, including brain development, reward, emotion, and cognition. Animal research provides an objective and controlled means of obtaining information about: (1) how cannabis affects the brain and behavior, (2) whether medications can be developed to treat cannabis use disorder, and (3) whether cannabis might produce lasting changes in the brain that increase the likelihood of becoming addicted to other drugs. This review explains the tactics used to address these issues, evaluates the progress that has been made, and offers some directions for future research.

Topics: Animals; Behavior, Addictive; Cannabinoid Receptor Modulators; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Reward

Cannabis use disorder (CUD) commonly occurs and carries a notable economic and functional burden at both individual and societal levels. While there are no clearly efficacious medication treatments for CUD, 20 years of committed and high-quality research in the human laboratory and clinical settings have resulted in medications with demonstrated effectiveness in the treatment of cannabis withdrawal, the ability to reduce cannabis use, and results that point to promising future work. The current state of pharmacology research for CUD highlights the need to consider particular characteristics of patients, such as gender, impulsivity, and severity of cannabis use, when selecting a medication in the off-label treatment of CUD or cannabis withdrawal. As a field, the body of work also exposes some areas in need of improvement in study design, selection of outcome measures, interpretation of results, and the overall process of evaluating candidate medications. Coming to a consensus as a field and addressing these gaps in future research will likely lend itself to further advances in improving the lives of patients with CUD.

Topics: Cannabis; Humans; Marijuana Abuse; Substance Withdrawal Syndrome

Cannabis is the most commonly used substance of abuse in the United States after alcohol and tobacco. With a recent increase in the rates of cannabis use disorder (CUD) and a decrease in the perceived risk of cannabis use, it is imperative to assess the addictive potential of cannabis. Here we evaluate cannabis use through the neurobiological model of addiction proposed by Koob and Volkow. The model proposes that repeated substance abuse drives neurobiological changes in the brain that can be separated into three distinct stages, each of which perpetuates the cycle of addiction. Here we review previous research on the acute and long-term effects of cannabis use on the brain and behavior, and find that the three-stage framework of addiction applies to CUD in a manner similar to other drugs of abuse, albeit with some slight differences. These findings highlight the urgent need to conduct research that elucidates specific neurobiological changes associated with CUD in humans.

Topics: Animals; Behavior, Addictive; Brain; Cannabis; Humans; Magnetic Resonance Imaging; Marijuana Abuse; Marijuana Smoking; Nerve Net; Receptor, Cannabinoid, CB1; Reinforcement, Psychology

A substantial body of credible evidence has accumulated that suggest that cannabis use is an important potentially preventable risk factor for the development of psychotic illness and its worse prognosis following the onset of psychosis. Here we summarize the relevant evidence to argue that the time has come to investigate the neurobiological effects of cannabis in patients with psychotic disorders. In the first section we summarize evidence from longitudinal studies that controlled for a range of potential confounders of the association of cannabis use with increased risk of developing psychotic disorders, increased risk of hospitalization, frequent and longer hospital stays, and failure of treatment with medications for psychosis in those with established illness. Although some evidence has emerged that cannabis-using and non-using patients with psychotic disorders may have distinct patterns of neurocognitive and neurodevelopmental impairments, the biological underpinnings of the effects of cannabis remain to be fully elucidated. In the second and third sections we undertake a systematic review of 70 studies, including over 3000 patients with psychotic disorders or at increased risk of psychotic disorder, in order to delineate potential neurobiological and neurochemical mechanisms that may underlie the effects of cannabis in psychotic disorders and suggest avenues for future research.

Topics: Animals; Cannabis; Humans; Longitudinal Studies; Marijuana Abuse; Marijuana Smoking; Psychotic Disorders; Risk Factors; Substance-Related Disorders

With rising rates of cannabis use in the general population and an increasing number of US states legalizing both recreational and medical cannabis use, it is important to be informed about the adverse consequences of cannabinoids. This Commentary provides an overview of the psychiatric effects of plant-based and synthetic cannabinoids, differentiating acute effects from effects associated with persistent use. Cannabinoids produce multiphasic and dose-dependent effects on anxiety, mood, and perception, in addition to impairing cognition and psychomotor function. Generally, in healthy individuals, the acute negative psychiatric effects of cannabinoids are rated as milder in severity compared with those in individuals with pre-existing psychiatric disorders. With chronic exposure to cannabinoids, the probability of developing tolerance and dependence can increase. A problematic pattern of cannabis use can lead to clinically significant impairment and distress. Cessation of cannabis use in individuals who are tolerant and dependent can lead to a withdrawal syndrome. Studies report long-term cannabis exposure has been linked to psychiatric disorders, such as anxiety, psychotic and mood disorders. Limitations to the existing evidence notwithstanding, the plausibility of a causal relationship between cannabinoid exposure and persistent negative psychiatric outcomes, and the potential for long-term brain changes by regular exposure, especially for adolescents, are sufficient to warrant discussions with clinicians and the public. Implications for clinicians who certify, prescribe, or care for patients receiving cannabinoids are discussed, and a case is made for further research to better understand the impact of legalization on public mental health.

Topics: Affect; Brain; Cannabinoids; Cannabis; Cognition; Endocannabinoids; Humans; Marijuana Abuse; Marijuana Use; Memory; Psychomotor Performance; Psychotic Disorders

Cannabis is globally the most commonly cultivated, trafficked and consumed illicit drug of abuse. The current article provides an updated overview of existing comprehensive interventions for preventing and reducing cannabis use.. The PubMed database was searched for evidence regarding comprehensive interventions for preventing and reducing cannabis use from June 2016 to January 2018. The search resulted in 274 articles. Twenty-one studies were selected for assessment and 13 fulfilled the inclusion criteria. Six systematic reviews regarding preventive, psychosocial, pharmacological and risk reduction interventions were identified. Psychosocial interventions included therapist-assisted and computerized interventions. Four therapist-assisted, one computerized and two pharmacological clinical trials were published over the review period. Overall, considering the three different approaches (preventive, psychosocial or pharmacological) promising results have been found in certain interventions in reducing cannabis use among different types of users. In addition, recommendations to reduce adverse health outcomes related to cannabis use have also been reviewed.. Although relevant findings have been found so far, further research with adequately powered trials assessing comprehensive interventions for reducing cannabis use remains a need before definitive treatment recommendations can be established.

Topics: Cannabis; Comprehensive Health Care; Humans; Marijuana Abuse; Preventive Health Services

Reduced motivation is often noted as a consequence of cannabis use. However, prior studies examining this association have suboptimally operationalized motivation and have yielded mixed findings. This review discusses motivation and the closely related construct of reward sensitivity. We summarize the available literature examining associations between motivation and cannabis use, addressing the following questions: (a) Is there evidence for decreased motivation among cannabis users? (b) Is there evidence that lack of motivation among cannabis users is specific to their use of cannabis (rather than to use of other addictive drugs)? and (c) Is there evidence suggesting a causal relationship between cannabis use and motivation? Using PubMed, PsycINFO, and WebofScience, we conducted a literature search of studies examining nonacute effects of cannabis use on motivation, apathy, amotivation, effort, and reward sensitivity in humans. This search yielded 22 studies, which were reviewed in detail. We conclude that, although cross-sectional evidence of a cannabis-specific effect on motivation is equivocal, there is partial support from longitudinal studies for a causal link between cannabis use and reduced motivation. Additionally, we propose that reward sensitivity and motivation represent distinct yet related constructs and that reductions in one may not always lead to reductions in the other. Future work should longitudinally examine associations between cannabis use, motivation, and reward sensitivity; carefully define and operationalize these constructs; and control for the influence of potential confounding factors. (PsycINFO Database Record

Topics: Cannabis; Cross-Sectional Studies; Humans; Marijuana Abuse; Marijuana Use; Motivation; Reward; Substance-Related Disorders

Marijuana is a substance with a long and controversial history. At different times in its history, which goes back over 5,000 years, this plant has been used for different purposes, ranging from recreational and leisure to its use in the treatment of several diseases or to offer relief in processes that entail a certain type of malaise, and including its consideration as a means of relaxation and meditation. Although it was supposed that the roots of marijuana lay in Central America, it is now known that this is but an urban legend with little credibility and that its origins can be found recorded in Chinese medical references dating back to the year 2737 BC. Although this plant was not originally from Central America, it has aroused interest around the world, and above all in Mexico. It is in this country where the use of cannabis has gone from applications in textiles and medicine to its free sale, the bans on its use due to political and social pressures, its tolerance and, recently, its decriminalisation for recreational and medicinal use. Unfortunately there are few references on the history of this plant in Mexico, and thus we have considered it interesting to present some data about the generalities of marijuana, a brief history in the world, the development of decriminalisation in North America, its medicinal uses and its course through Mexico to the present day.. Breve historia sobre la marihuana en Occidente.. La marihuana es una sustancia con una extensa y controvertida historia. A lo largo del tiempo, esta planta, y desde hace mas de 5.000 años, ha sido utilizada para diferentes fines, que van desde el uso ludico y recreativo, pasando por un medio de relajacion y meditacion, hasta su uso en el tratamiento de varias enfermedades o el alivio de procesos vinculados a cierto tipo de malestares. Aunque se supuso que la marihuana tenia su origen en Mesoamerica, ahora se sabe que es solo una leyenda urbana de poca credibilidad y que sus origenes los podemos registrar en referencias medicas chinas datadas alrededor del año 2737 a. de C. Si bien esta planta no tiene un origen mesoamericano, si ha generado interes en el mundo, y sobre todo en Mexico. Es en este pais donde el uso del cannabis ha ido desde intereses textiles y medicinales hasta el consumo ludico, pasando por su venta libre, la prohibicion por presiones politicas y sociales, su tolerancia y, recientemente, su despenalizacion para uso ludico y medicinal. Desgraciadamente existen pocas referencias de la historia de esta planta en Mexico, por lo que ha sido de nuestro interes presentar algunos datos sobre las generalidades de la marihuana, una breve historia en el mundo, el desarrollo de la despenalizacion en Norteamerica, sus usos medicinales y su paso por Mexico hasta nuestros dias.

Topics: Americas; Cannabidiol; Cannabinoids; Cannabis; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; Humans; Introduced Species; Legislation, Drug; Marijuana Abuse; Medical Marijuana; Medicine, Traditional; Public Policy

Previous studies have reported conflicting results in terms of acute effects of cannabis in man. Independently of other factors, such discrepancy may be attributable to the different cannabis use history of study volunteers. It is thought that regular cannabis users may develop tolerance to the effects of acute cannabis administration. Here we systematically review all studies examining the effects of single or repeated cannabinoid administration in man as a function of previous cannabis exposure. Research evidence tends to suggest that the acute effects of single cannabinoid administration are less prominent in regular cannabis users compared to non-regular users. Studies of repeated cannabinoid administration more consistently suggest less prominent effects upon repeated exposure. Cognitive function is the domain showing the highest degree of tolerance, with some evidence of complete absence of acute effect (full tolerance). The acute intoxicating, psychotomimetic, and cardiac effects are also blunted upon regular exposure, but to a lesser extent (partial tolerance). Limited research also suggests development of tolerance to other behavioral, physiological, and neural effects of cannabis.

Topics: Cannabinoid Receptor Agonists; Cannabis; Dronabinol; Drug Tolerance; Humans; Marijuana Abuse; Marijuana Use

Although cannabis is often used for the purposes of relieving negative affective states such as anxiety and depression, the associations between cannabis use and affect in daily life are unclear. Ecological momentary assessment (EMA) has been used to study these associations in individuals' natural environments, providing more ecological validity, minimizing retrospective bias, and allowing for the analysis of within-individual processes over time. This review focuses on studies that utilized EMA to examine daily-life associations of cannabis use and negative and positive affective states.. We review the findings of the 19 articles that met inclusion criteria, including clinical and community samples.. Results provide equivocal evidence regarding relations between cannabis use and affect for community samples. Findings are mixed for clinical samples as well, but more consistent patterns emerge for general negative affect (NA) and anger/hostility at the momentary level; cannabis use may be more likely following increased NA and lead to decreases in NA and anger/hostility in psychiatric populations.. Findings support a negative reinforcement hypothesis for clinical samples in terms of general NA and anger/hostility. However, discrepancies among studies point to a need to thoroughly characterize samples, consider motives for and expectancies of use, improve quantification of cannabis use, and consider co-use with other substances. Additional design recommendations are also offered for future studies.

Topics: Affect; Anger; Biomedical Research; Cannabis; Female; Forecasting; Humans; Male; Marijuana Abuse; Marijuana Use; Medical Records; Motivation; Retrospective Studies

The objective of the current narrative literature review is to provide an epidemiological, developmental and clinical overview on cannabis use during pregnancy. Cannabis use in pregnancy poses major health concerns for pregnant mothers and their developing children. Although studies on the short- and long-term consequences of prenatal cannabis exposure are increasing, findings have been inconsistent or difficult to interpret due to methodological issues. Thus, consolidating these findings into clinical recommendations based on the mixed studies in the literature remains a challenge. Synthesizing the available observational studies is also difficult, because some of the published studies have substantial methodological weaknesses. Improving observational studies will be an important step toward understanding the extent to which prenatal exposure to cannabis influences neurodevelopment in the offspring. Therefore, further research on prenatal cannabis exposure and the long-term consequences to offspring health in representative samples are needed to guide and improve clinical care for pregnant women and their children. Future research should also investigate the role of policies on prenatal cannabis use.

Topics: Cannabis; Female; Humans; Marijuana Abuse; Marijuana Smoking; Pregnancy; Prenatal Exposure Delayed Effects

Drug addiction affects a large extent of young people and disadvantaged populations. Drugs of abuse impede brain circuits or affect the functionality of brain circuits and interfere with bodily functions. Cannabinoids (Δ9-tetrahydrocannabinol) form key constituents of marijuana derived from the cannabis plant. Marijuana is a frequently used illegal drug in the USA. Here, we review the effects of cannabinoids at the epigenetic level and the potential role of these epigenetic effects in health and disease. Epigenetics is the study of alterations in gene expression that are transmitted across generations and take place without an alteration in DNA sequence, but are due to modulation of chromatin associated factors by environmental effects. Epigenetics is now known to offer an extra mechanism of control over transcription and how genes are expressed. Insights from research at the genetic and epigenetic level potentially provide venues that allow the translation of the biology of abused drugs to new means of how to treat marijuana substance use disorder or other addictions using pharmacotherapeutic tools.

Topics: Cannabinoids; Cannabis; Epigenesis, Genetic; Gene Expression; Humans; Illicit Drugs; Marijuana Abuse; Substance-Related Disorders

Cannabis consumption produces psychopathology, in some cases psychotic episodes, which are of our interest in this work. However, the relationship between cannabis use and psychosis has not been fully elucidated. The objectives of this work are to (1) review the current state of knowledge on the association of cannabis use with the risk of the development of psychosis or psychotic symptoms in people without schizophrenia and (2) assess the consistency of the hypothesis that cannabis use is associated with increased risk of psychosis in people without schizophrenia.. This work included research done in humans until May 2018 with the keywords 'cannabis' and 'psychosis', published in English and Spanish, in the PubMed database.. In all, 66 papers were analyzed, of which 23 were cohort trials and 43 were reviews.. Cannabis use doubles the risk of developing psychosis in vulnerable people. There even exists a relationship regarding the dose used and the age of first use. Gene-environment interactions that modulate the association between cannabis use and the presence of psychosis have also been described.

Topics: Cannabis; Gene-Environment Interaction; Humans; Marijuana Abuse; Psychotic Disorders; Risk Factors; Schizophrenia

Cannabis is the illicit drug with both the largest current levels of consumption and the highest reported lifetime prevalence levels in the world. Across different countries, the prevalence of cannabis use varies according to the individual income, with the highest use being reported in North America, Australia and Europe. Despite its 'soft drug' reputation, cannabis misuse may be associated with several acute and chronic adverse effects.. The present article aims at reviewing several papers on epidemiological, neurobiological and psychopathological aspects of the use of cannabis. The PubMed database was here examined in order to collect and discuss a range of identified papers.. Cannabis intake usually starts during late adolescence/early adulthood (15-24 years) and drastically decreases in adulthood with the acquisition of working, familiar and social responsibilities. Clinical evidence supports the current socio-epidemiological alarm concerning the increased consumption among youngsters and the risks related to the onset of psychotic disorders. The mechanism of action of cannabis presents some analogies with other abused drugs, e.g. opiates. Furthermore, it has been well demonstrated that cannabis intake in adolescence may facilitate the transition to the use and/or abuse of other psychotropic drugs, hence properly being considered a 'gateway drug'. Some considerations on synthetic cannabimimetics are provided here as well.. In conclusion, the highest prevalence of cannabis use and the social perception of a relatively low associated risk are in contrast with current knowledge based on biological and clinical evidence. Indeed, there are concerns relating to cannabis intake association with detrimental effects on both cognitive impairment and mental health.

Topics: Animals; Brain; Cannabis; Humans; Marijuana Abuse

Since ancient times, the use of cannabis as a medicine is well documented due to its potential therapeutic activity while subsequently its use as drug of abuse spread increasingly.. The present review sought to give an insight in the history of medical and recreational use of cannabis in India.. Indian use of cannabis dates back to Vedic time, mostly for the ritualistic and religious purposes, as documented in the ancient literature. It was India that introduced the medical use of cannabis to neighboring countries. Nevertheless, in the same India, medical use did not propagate due to religious and social stigma related to the plant itself. The pharmacoactive constituents of cannabis and their therapeutic values in Ayurvetic medicine have been here described together with the adverse effects they can cause with special reference to neurological ones, including withdrawal symptoms. Finally, how cannabis made its route to the Indian society has also been discussed.

Topics: Cannabis; History, Ancient; Humans; India; Marijuana Abuse; Medical Marijuana; Medicine, Ayurvedic; Phytotherapy

This paper explores European and national trends in specialised drug treatment entry for cannabis-related problems. The analysis is based on data for the years 2003-2014 from 22 European countries. Between 2003 and 2014, the overall number and proportion of primary cannabis-related first-time entrants increased significantly. A joinpoint regression analysis indicates that the overall increase of cannabis treatment entries is continuous, although country-related differences are observed. Possible explanations for the increase and different time trends are discussed including an increase in cannabis prevalence and cannabis-related problems, changes in risk perception, increases in cannabis potency, changes in referral practices and increased availability and accessibility of treatment services.

Topics: Cannabis; Europe; Humans; Marijuana Abuse; Substance Abuse Treatment Centers; Substance-Related Disorders

The use of cannabis during pregnancy and lactation is widely recognized as a health concern. The placenta is one of the several biological matrices that can be used to detect in utero drug exposure with the distinct advantage of easy and noninvasive collection. We conducted a PubMed search of selected literature published to June 30, 2016 to investigate the pharmacokinetics of cannabinoids, the active constituent of cannabis, in the placenta. The majority of the selected twelve papers was before 1990 and concerned animals at term gestation with great variability of experimental conditions. Only three were about human population and two of them reported equivocal findings on pre- term placenta. Our systematic review confirms that placental cannabis pharmacokinetics has been scarcely investigated and that further research is needed to determine advantages and disadvantages for monitoring maternal THC use or the degree of in utero exposure.

Topics: Animals; Cannabinoids; Cannabis; Female; Humans; Marijuana Abuse; Maternal Exposure; Placenta; Pregnancy

Cannabis is widely used among adolescents and adults. In the U.S., marijuana laws have been changing, and Americans increasingly favor legalizing cannabis for medical and recreational uses. While some can use cannabis without harm, others experience adverse consequences. The objective of this review is to summarize information on the legal status of cannabis, perceptions regarding cannabis, prevalence and time trends in use and related adverse consequences, and evidence on the relationship of state medical (MML) and recreational (RML) marijuana laws to use and attitudes. Twenty-nine states now have MMLs, and eight of these have RMLs. Since the early 2000s, adult and adolescent perception of cannabis use as risky has decreased. Over the same time, the prevalence of adolescent cannabis use has changed little. However, adult cannabis use, disorders, and related consequences have increased. Multiple nationally representative studies indicate that MMLs have had little effect on cannabis use among adolescents. However, while MML effects have been less studied in adults, available evidence suggests that MMLs increase use and cannabis use disorders in adults. While data are not yet available to evaluate the effect of RMLs, they are likely to lower price, increase availability, and thereby increase cannabis use. More permissive marijuana laws may accomplish social justice aims (e.g., reduce racial disparities in law enforcement) and generate tax revenues. However, such laws may increase cannabis-related adverse health and psychosocial consequences by increasing the population of users. Dissemination of balanced information about the potential health harms of cannabis use is needed.

Topics: Attitude; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Prevalence; Recreation; Risk; Substance-Related Disorders; Surveys and Questionnaires; United States

To analyze published reports of unintentional cannabis ingestions in children to determine presenting signs and symptoms, route of exposure, treatment, and outcome.. PubMed, OpenGrey, and Google Scholar were systematically searched. Articles were selected, reviewed, and graded using Oxford Center for Evidence-Based Medicine guidelines.. Of 3316 articles, 44 were included (3582 children age ≤12 years). We found no high quality (Oxford Center for Evidence-Based Medicine level I or II) studies and 10 level III studies documenting lethargy as the most common presenting sign and confirming increasing incidence of unintentional ingestion in states having decriminalized medical and recreational cannabis. We identified 16 level IV case series, and 28 level V case reports with 114 children, mean age 25.2 ± 18.7 months, range 8 months to 12 years, and 50 female children (44%). The most common ingestion (n = 43, 38%) was cannabis resin, followed by cookies and joints (both n = 15, 13%). Other exposures included passive smoke, medical cannabis, candies, beverages, and hemp oil. Lethargy was the most common presenting sign (n = 81, 71%) followed by ataxia (n = 16, 14%). Tachycardia, mydriasis, and hypotonia were also commonly observed. All cases were cared for in the emergency department or admitted, and mean length of stay was 27.1 ± 27.0 hours. Twenty (18%) were admitted to the pediatric intensive care unit, and 7 (6%) were intubated.. Unintentional cannabis ingestion by children is a serious public health concern and is well-documented in numerous studies and case reports. Clinicians should consider cannabis toxicity in any child with sudden onset of lethargy or ataxia.

Topics: Cannabis; Child; Child, Preschool; Eating; Emergency Service, Hospital; Female; Humans; Infant; Male; Marijuana Abuse

Globally, the most widely used set of compounds among the internationally regulated drugs is cannabis.. To review evidence from epidemiological research on cannabis, organized in relation to this field's five main rubrics: quantity, location, causes, mechanisms, and prevention/ control.. The review covers a selection of evidence from standardized population surveys, official statistics, and governmental reports, as well as published articles and books identified via MEDLINE, Web of Science, and Google Scholar as of July 2016.. In relation to quantity, an estimated 3% to 5% of the world population is thought to have tried a cannabis product, with at least one fairly recent use, mainly extra-medical and outside boundaries of prescribed use. Among cannabis users in the United States, roughly one in 7-8 has engaged in medical marijuana use. In relation to location, prevalence proportions reveal important variations across countries and between subgroups within countries. Regarding causes and mechanisms of starting to use cannabis, there is no compelling integrative and replicable conceptual model or theoretical formulation. Most studies of mechanisms have focused upon a 'gateway sequence' and person-to-person diffusion, with some recent work on disability-adjusted life years. A brief review of cannabis use consequences, as well as prevention and control strategies is also provided.. At present, we know much about the frequency and occurrence of cannabis use, with too little replicable definitive evidence with respect to the other main rubrics. Given a changing regulatory environment for cannabis products, new institutions such as an independent International Cannabis Products Safety Commission may be required to produce evidence required to weigh benefits versus costs. It is not clear that governmentsponsored research will be sufficient to meet consumer demand for balanced points of view and truly definitive evidence.

Topics: Cannabis; Humans; Marijuana Abuse; Medical Marijuana

The growing use and legalization of cannabis are leading to increased exposures across all age groups, including in adolescence. The touting of its medicinal values stems from anecdotal reports related to treatment of a broad range of illnesses including epilepsy, multiple sclerosis, muscle spasms, arthritis, obesity, cancer, Alzheimer disease, Parkinson disease, post-traumatic stress, inflammatory bowel disease, and anxiety. However, anecdotal data and the high level of interest in this treatment must not obscure objective assessments of any potential and realized short- and long-term adverse effects of cannabis, particularly with respect to age of onset and chronicity of exposure. This critical review focuses on evidence-based research designed to assess both therapeutic benefits and harmful effects of cannabis exposure and is combined with an illustration of the neuropathologic findings in a fatal case of cannabis-induced psychosis. The literature and reported case provide strong evidence that chronic cannabis abuse causes cognitive impairment and damages the brain, particularly white matter, where cannabinoid 1 receptors abound. Contrary to popular perception, there are few objective data supporting preferential use of cannabis over conventional therapy for restoration of central nervous system structure and function in disease states such as multiple sclerosis, epilepsy, or schizophrenia. Additional research is needed to determine if subsets of individuals with various neurological and psychiatric diseases derive therapeutic benefits from cannabis.

Topics: Animals; Brain; Cannabinoids; Cannabis; Fatal Outcome; Humans; Male; Marijuana Abuse; Middle Aged; Psychoses, Substance-Induced

A review of the evidence was conducted regarding asthma associated with the use of cocaine, heroin, and marijuana.. A search of the English literature was performed via PubMed/Medline and EMBASE using the search terms asthma AND cocaine, heroin, and marijuana. When pertinent articles were found, salient references in those articles were assessed.. Due to the relatively small number of studies, we included all studies and cases.. For several decades, case reports, retrospective studies, and laboratory investigations have demonstrated that inhalation of cocaine or heroin is associated with increased asthma symptoms and reduced pulmonary function. Smoking crack cocaine, nasal insufflation of cocaine or heroin, and smoking heroin increases the risk of emergency department visits and hospitalizations for asthma. Although frequent smoking of marijuana may cause symptoms of cough, sputum production, and wheezing in the general population, more studies are needed specifically in patients with asthma. Smoking marijuana with concomitant tobacco use is common and further worsens the respiratory symptoms.. Use of cocaine and heroin in patients with asthma should be avoided. Pending further studies, it would be prudent for patients with asthma to avoid smoking marijuana. Clinicians need to be vigilant regarding use of these drugs in their patients with hyperreactive airway disease.

Topics: Administration, Inhalation; Asthma; Cannabis; Cocaine-Related Disorders; Crack Cocaine; Heroin; Heroin Dependence; Humans; Marijuana Abuse; Marijuana Smoking; Respiratory Function Tests; Respiratory Sounds; Retrospective Studies; Substance-Related Disorders

Use and misuse of cannabis and marihuana are frequent. About 5% of the adult population are current users but only 1.2% are dependent. The medical use of cannabis is controversial but there is some evidence for improvement of chronic pain and spasticity. The somatic toxicity of cannabis is well proven but limited and psychiatric disorders induced by cannabis are of more relevance, e.g. cognitive disorders, amotivational syndrome, psychoses and delusional disorders as well as physical and psychological dependence. The withdrawal symptoms are usually mild and do not require pharmacological interventions. To date there is no established pharmacotherapy for relapse prevention. Psychosocial interventions include psychoeducation, behavioral therapy and motivational enhancement. The CANDIS protocol is the best established German intervention among abstinence-oriented therapies.

Topics: Behavior Therapy; Cannabis; Evidence-Based Medicine; Humans; Marijuana Abuse; Medical Marijuana; Motivational Interviewing; Treatment Outcome

In this review, I will consider the dual nature of Cannabis and cannabinoids. The duality arises from the potential and actuality of cannabinoids in the laboratory and clinic and the 'abuse' of Cannabis outside the clinic. The therapeutic areas currently best associated with exploitation of Cannabis-related medicines include pain, epilepsy, feeding disorders, multiple sclerosis and glaucoma. As with every other medicinal drug of course, the 'trick' will be to maximise the benefit and minimise the cost. After millennia of proximity and exploitation of the Cannabis plant, we are still playing catch up with an understanding of its potential influence for medicinal benefit.

Topics: Animals; Cannabinoids; Cannabis; Endocannabinoids; Humans; Marijuana Abuse; Phytotherapy

Associations between cannabis use and psychotic outcomes are consistently reported, but establishing causality from observational designs can be problematic. We review the evidence from longitudinal studies that have examined this relationship and discuss the epidemiologic evidence for and against interpreting the findings as causal. We also review the evidence identifying groups at particularly high risk of developing psychosis from using cannabis. Overall, evidence from epidemiologic studies provides strong enough evidence to warrant a public health message that cannabis use can increase the risk of psychotic disorders. However, further studies are required to determine the magnitude of this effect, to determine the effect of different strains of cannabis on risk, and to identify high-risk groups particularly susceptible to the effects of cannabis on psychosis. We also discuss complementary epidemiologic methods that can help address these questions.

Topics: Cannabinoids; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Meta-Analysis as Topic; Psychoses, Substance-Induced; Randomized Controlled Trials as Topic; Risk Factors

Marijuana is becoming legal in an increasing number of states for both medical and recreational use. Considerable controversy exists regarding the public health impact of these changes. The evidence for the legitimate medical use of marijuana or cannabinoids is limited to a few indications, notably HIV/AIDS cachexia, nausea/vomiting related to chemotherapy, neuropathic pain, and spasticity in multiple sclerosis. Although cannabinoids show therapeutic promise in other areas, robust clinical evidence is still lacking. The relationship between legalization and prevalence is still unknown. Although states where marijuana use is legal have higher rates of use than nonlegal states, these higher rates were generally found even prior to legalization. As states continue to proceed with legalization for both medical and recreational use, certain public health issues have become increasingly relevant, including the effects of acute marijuana intoxication on driving abilities, unintentional ingestion of marijuana products by children, the relationship between marijuana and opioid use, and whether there will be an increase in health problems related to marijuana use, such as dependence/addiction, psychosis, and pulmonary disorders. In light of this rapidly shifting legal landscape, more research is urgently needed to better understand the impact of legalization on public health.

Topics: Automobile Driving; Cannabis; Cognition Disorders; Dronabinol; Humans; Illicit Drugs; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Opioid-Related Disorders; Prevalence; Psychotic Disorders; Public Health; United States

The past decade has witnessed a number of societal and political changes that have raised critical questions about the long-term impact of marijuana (Cannabis sativa) that are especially important given the prevalence of its abuse and that potential long-term effects still largely lack scientific data. Disturbances of the epigenome have generally been hypothesized as the molecular machinery underlying the persistent, often tissue-specific transcriptional and behavioral effects of cannabinoids that have been observed within one's lifetime and even into the subsequent generation. Here, we provide an overview of the current published scientific literature that has examined epigenetic effects of cannabinoids. Though mechanistic insights about the epigenome remain sparse, accumulating data in humans and animal models have begun to reveal aberrant epigenetic modifications in brain and the periphery linked to cannabis exposure. Expansion of such knowledge and causal molecular relationships could help provide novel targets for future therapeutic interventions.

Topics: Animals; Brain; Cannabinoids; Cannabis; DNA Methylation; Endocannabinoids; Epigenesis, Genetic; Female; Histone Code; Humans; Marijuana Abuse; Mice; Models, Animal; Rats

With a political debate about the potential risks and benefits of cannabis use as a backdrop, the wave of legalization and liberalization initiatives continues to spread. Four states (Colorado, Washington, Oregon, and Alaska) and the District of Columbia have passed laws that legalized cannabis for recreational use by adults, and 23 others plus the District of Columbia now regulate cannabis use for medical purposes. These policy changes could trigger a broad range of unintended consequences, with profound and lasting implications for the health and social systems in our country. Cannabis use is emerging as one among many interacting factors that can affect brain development and mental function. To inform the political discourse with scientific evidence, the literature was reviewed to identify what is known and not known about the effects of cannabis use on human behavior, including cognition, motivation, and psychosis.

Topics: Adult; Behavior; Cannabis; Cognition; Humans; Legislation, Drug; Marijuana Abuse; Motivation; Psychoses, Substance-Induced; United States

Cannabis use has been associated with impaired cognition during acute intoxication as well as in the unintoxicated state in long-term users. However, the evidence has been mixed and contested, and no systematic reviews of the literature on neuropsychological task-based measures of cognition have been conducted in an attempt to synthesize the findings. We systematically review the empirical research published in the past decade (from January 2004 to February 2015) on acute and chronic effects of cannabis and cannabinoids and on persistence or recovery after abstinence. We summarize the findings into the major categories of the cognitive domains investigated, considering sample characteristics and associations with various cannabis use parameters. Verbal learning and memory and attention are most consistently impaired by acute and chronic exposure to cannabis. Psychomotor function is most affected during acute intoxication, with some evidence for persistence in chronic users and after cessation of use. Impaired verbal memory, attention, and some executive functions may persist after prolonged abstinence, but persistence or recovery across all cognitive domains remains underresearched. Associations between poorer performance and a range of cannabis use parameters, including a younger age of onset, are frequently reported. Little further evidence has emerged for the development of tolerance to the acutely impairing effects of cannabis. Evidence for potential protection from harmful effects by cannabidiol continues to increase but is not definitive. In light of increasing trends toward legalization of cannabis, the knowledge gained from this body of research needs to be incorporated into strategies to minimize harm.

Topics: Attention; Cannabinoids; Cannabis; Cognition; Cognition Disorders; Executive Function; Humans; Marijuana Abuse; Marijuana Smoking; Memory; Neuropsychological Tests; Psychomotor Performance; Verbal Learning

We lack a review of the epidemiological literature on cannabis use (acute use and chronic-usual quantity/frequency and heavy use) and suicidality (suicide death, suicide ideation, suicide attempt).. The English language literature on Medline, PsychInfo, Google Scholar, and public-use databases was searched for original articles, critical review reports, and public use data on cannabis use and suicide for the period ranging from 1990-2015 (February). Odds ratios (OR) from random effects in meta-analyses for any cannabis use and heavy cannabis use were calculated.. The acute cannabis-suicidality literature mostly includes descriptive toxicology reports. In terms of death by suicide, the average positive cannabis rate was 9.50% for studies sampling from all suicides, with higher cannabis detection rates amongst suicide decedents by non-overdose methods. We found only 4 studies providing estimates for any chronic cannabis use and death by suicide (OR=2.56 (1.25-5.27)). After deleting duplicates we found 6 studies on any cannabis use and suicide ideation (OR=1.43 (1.13-1.83)), 5 studies on heavy cannabis use and suicide ideation (OR=2.53 (1.00-6.39)), 6 studies on any cannabis use and suicide attempt (OR=2.23 (1.24-4.00)) and 6 studies on heavy cannabis use and suicide attempt (OR=3.20 (1.72-5.94)).. We currently lack evidence that acute cannabis use increases imminent risk for suicidality. The evidence tends to support that chronic cannabis use can predict suicidality, but the lack of homogeneity in the measurement of cannabis exposure and, in some instances, the lack of systematic control for known risk factors tempered this finding.

Topics: Cannabis; Diseases in Twins; Humans; Marijuana Abuse; Risk Factors; Social Environment; Substance-Related Disorders; Suicidal Ideation; Suicide; Suicide, Attempted

The major psychoactive compounds in marijuana (cannabis) are cannabinoids, the most significant of which is delta-9-tetrahydrocannabinol. There are also two synthetic pharmaceutical cannabinoids, nabilone and dronabinol, available by prescription in the United States. The use of marijuana has increased in the United States with passage of medical marijuana laws in many states and legalization of recreational marijuana use in several states. In addition, the potency of marijuana has increased in recent years. Marijuana has been used for a variety of medical purposes, including management of nausea and vomiting, appetite and immunologic stimulation in patients with HIV infection and AIDS, glaucoma, neurologic disorders, and pain relief. Studies on the benefits of marijuana as a treatment for various conditions have been inconsistent, except for those on pain management. Marijuana has adverse effects, and has been associated with driving impairment, psychosis, dependence and withdrawal syndromes, hyperemesis, acute cardiac events, some cancers, and impaired lung function. As with studies on the benefits of marijuana, studies of adverse effects have yielded inconsistent results. Except for impaired driving and the occurrence of dependence and withdrawal syndromes, the adverse effects of marijuana use have not been fully studied.

Topics: Cannabis; Culture; Drug and Narcotic Control; Humans; Leisure Activities; Marijuana Abuse; Medical Marijuana; United States

Herbal cannabis has been used for thousands of years for medical purposes. With elucidation of the chemical structures of tetrahydrocannabinol (THC) and cannabidiol (CBD) and with discovery of the human endocannabinoid system, the medical usefulness of cannabinoids has been more intensively explored. While more randomized clinical trials are needed for some medical conditions, other medical disorders, like chronic cancer and neuropathic pain and certain symptoms of multiple sclerosis, have substantial evidence supporting cannabinoid efficacy. While herbal cannabis has not met rigorous FDA standards for medical approval, specific well-characterized cannabinoids have met those standards. Where medical cannabis is legal, patients typically see a physician who "certifies" that a benefit may result. Physicians must consider important patient selection criteria such as failure of standard medical treatment for a debilitating medical disorder. Medical cannabis patients must be informed about potential adverse effects, such as acute impairment of memory, coordination and judgment, and possible chronic effects, such as cannabis use disorder, cognitive impairment, and chronic bronchitis. In addition, social dysfunction may result at work/school, and there is increased possibility of motor vehicle accidents. Novel ways to manipulate the endocannbinoid system are being explored to maximize benefits of cannabinoid therapy and lessen possible harmful effects.

Topics: Analgesics, Non-Narcotic; Cannabinoids; Cannabis; Drug and Narcotic Control; Endocannabinoids; Humans; Marijuana Abuse; Medical Marijuana; Meta-Analysis as Topic; Pain; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Receptors, Cannabinoid; United States

Findings on neurocognitive effects of sustained cannabis use are heterogeneous. Previous work has rarely taken time of abstinence into account. In this review, we focus on understanding sustained effects of cannabis, which begin when clinical symptoms of the drug have worn off after at least 14 days. We conducted a search between 2004 and 2015 and found 38 studies with such a prolonged abstinence phase. Study-design quality in terms of evidence-based medicine is similar among studies. Studies found some attention or concentration deficits in cannabis users (CU). There is evidence that chronic CU might experience sustained deficits in memory function. Findings are mixed regarding impairments in inhibition, impulsivity and decision making for CU, but there is a trend towards worse performance. Three out of four studies found evidence that motor function remains impaired even after a time of abstinence, while no impairments in visual spatial functioning can be concluded. Functional imaging demonstrates clear differences in activation patterns between CU and controls especially in hippocampal, prefrontal and cerebellar areas. Structural differences are found in cortical areas, especially the orbitofrontal region and the hippocampus. Twenty studies (57 %) reported data on outcome effects, leading to an overall effect size of r mean = .378 (CI 95 % = [.342; .453]). Heavy use is found to be more consistently associated with effects in diverse domains than early age of onset. Questions of causality-in view of scarce longitudinal studies, especially those targeting co-occurring psychiatric disorders-are discussed.

Topics: Adolescent; Adult; Cannabis; Humans; Marijuana Abuse

Existing cannabis treatment programs reach only a very limited proportion of people with cannabis-related problems. The aim of this systematic review and meta-analysis was to assess the effectiveness of digital interventions applied outside the health care system in reducing problematic cannabis use.. We systematically searched the Cochrane Central Register of Controlled Trials (2015), PubMed (2009-2015), Medline (2009-2015), Google Scholar (2015) and article reference lists for potentially eligible studies. Randomized controlled trials examining the effects of internet- or computer-based interventions were assessed. Study effects were estimated by calculating effect sizes (ESs) using Cohen's d and Hedges' g bias-corrected ES. The primary outcome assessed was self-reported cannabis use, measured by a questionnaire.. Fifty-two studies were identified. Four studies (including 1,928 participants) met inclusion criteria. They combined brief motivational interventions and cognitive behavioral therapy delivered online. All studies were of good quality. The pooled mean difference (x0394; = 4.07) and overall ES (0.11) give evidence of small effects at 3-month follow-up in favor of digital interventions.. Digital interventions can help to successfully reduce problematic cannabis use outside clinical settings. They have some potential to overcome treatment barriers and increase accessibility for at-risk cannabis users.

Topics: Cannabis; Humans; Internet; Marijuana Abuse; Marijuana Smoking; Randomized Controlled Trials as Topic; Self Care; Substance-Related Disorders

Whether alcohol and cannabis are used as substitutes or complements remains debated, and findings across various disciplines have not been synthesized to date.. This article is a first step towards organizing the interdisciplinary literature on alcohol and cannabis substitution and complementarity.. Electronic searches were performed using PubMed and ISI Web of Knowledge. Behavioral studies of humans with "alcohol" (or "ethanol") and "cannabis" (or "marijuana") and "complement(*)" (or "substitut(*)") in the title or as a keyword were considered. Studies were organized according to sample characteristics (youth, general population, clinical and community-based). These groups were not set a priori, but were informed by the literature review process.. Of the 39 studies reviewed, 16 support substitution, ten support complementarity, 12 support neither and one supports both. Results from studies of youth suggest that youth may reduce alcohol in more liberal cannabis environments (substitute), but reduce cannabis in more stringent alcohol environments (complement). Results from the general population suggest that substitution of cannabis for alcohol may occur under more lenient cannabis policies, though cannabis-related laws may affect alcohol use differently across genders and racial groups.. Alcohol and cannabis act as both substitutes and complements. Policies aimed at one substance may inadvertently affect consumption of other substances. Future studies should collect fine-grained longitudinal, prospective data from the general population and subgroups of interest, especially in locations likely to legalize cannabis.

Topics: Alcohol Drinking; Cannabis; Humans; Legislation, Drug; Marijuana Abuse; Prospective Studies; Racial Groups

Marijuana is the most widely used drug of abuse among adolescents. Adolescence is a vulnerable period for brain development, during which time various neurotransmitter systems such as the glutamatergic, GABAergic, dopaminergic, and endocannabinoid systems undergo extensive reorganization to support the maturation of the central nervous system (CNS). ▵-9-tetrahydrocannabinol (THC), the psychoactive component of marijuana, acts as a partial agonist of CB1 cannabinoid receptors (CB1Rs). CB1Rs are abundant in the CNS and are central components of the neurodevelopmental changes that occur during adolescence. Thus, overactivation of CB1Rs by cannabinoid exposure during adolescence has the ability to dramatically alter brain maturation, leading to persistent and enduring changes in adult cerebral function. Increasing preclinical evidence lends support to clinical evidence suggesting that chronic adolescent marijuana exposure may be associated with a higher risk for neuropsychiatric diseases, including schizophrenia. In this review, we present a broad overview of current neurobiological evidence regarding the long-term consequences of adolescent cannabinoid exposure on adult neuropsychiatric-like disorders.

Topics: Adolescent; Adolescent Behavior; Animals; Cannabis; Humans; Marijuana Abuse; Mental Disorders; Models, Animal; Rats

Cannabis use in the adolescent population poses a significant threat of addiction potential resulting in altered neurodevelopment. There are multiple mechanisms of treatment of cannabis use disorder including behavioral therapy management and emerging data on treatment via pharmacotherapy. Recognizing the diagnostic criteria for cannabis use disorder, cannabis withdrawal syndrome, and mitigating factors that influence adolescent engagement in cannabis use allows for comprehensive assessment and management in the adolescent population.

Topics: Adolescent; Cannabis; Humans; Marijuana Abuse; Substance Withdrawal Syndrome

Cannabis use typically commences during adolescence, a period during which the brain undergoes profound remodeling in areas that are high in cannabinoid receptors and that mediate cognitive control and emotion regulation. It is therefore important to determine the impact of adolescent cannabis use on brain function.. We investigate the impact of adolescent cannabis use on brain function by reviewing the functional magnetic resonance imaging studies in adolescent samples.. We systematically reviewed the literature and identified 13 functional neuroimaging studies in adolescent cannabis users (aged 13 to 18 years) performing working memory, inhibition and reward processing tasks.. The majority of the studies found altered brain function, but intact behavioural task performance in adolescent cannabis users versus controls. The most consistently reported differences were in the frontal-parietal network, which mediates cognitive control. Heavier use was associated with abnormal brain function in most samples. A minority of studies controlled for the influence of confounders that can also undermine brain function, such as tobacco and alcohol use, psychopathology symptoms, family history of psychiatric disorders and substance use.. Emerging evidence shows abnormal frontal-parietal network activity in adolescent cannabis users, particularly in heavier users. Brain functional alterations may reflect a compensatory neural mechanism that enables normal behavioural performance. It remains unclear if cannabis exposure drives these alterations, as substance use and mental health confounders have not been systematically examined.

Topics: Adolescent; Brain; Cannabis; Humans; Marijuana Abuse

Cannabis is the most widely used illicit psychoactive substance world-wide, yet no medication is approved for the treatment of intoxication, withdrawal, or cannabis use disorder (CUD).. To comprehensively review the current state of knowledge.. Search of the PubMed electronic data base and review of reference lists of relevant articles to identify controlled clinical trials of pharmacological treatment.. The search identified 4 trials for specific intoxication symptoms (none for global intoxication), 7 trials for withdrawal, and 12 phase II trials for CUD. One or two trials each suggest that propranolol is effective for some intoxication symptoms, antipsychotics for cannabis-induced psychosis, and dronabinol (synthetic THC) and gabapentin for cannabis withdrawal. Of 10 medications and one medication combination studied in 12 trials for CUD, only two medications were effective (in single trials): gabapentin and Nacetylcysteine (in adolescents). Not effective were dronabinol and several antidepressants, anticonvulsants, and antianxiety medications. Three trials of antidepressants for CUD with comorbid depression gave inconsistent results. A trial of atomoxetine for CUD with comorbid ADHD showed no efficacy. Five trials of second-generation antipsychotics for CUD with comorbid schizophrenia showed none better than any other.. Further research is needed to confirm the efficacy of gabapentin for withdrawal and gabapentin and N-acetylcysteine for CUD and to develop new medications for all 3 cannabis-related disorders.

Topics: Acetylcysteine; Amines; Animals; Cannabis; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Humans; Marijuana Abuse

Although cannabis is widely used, it remains unclear which consumption patterns are more likely to produce future consequences (risky/hazardous use) or current damage (problematic/harmful use). This unresolved issue contributes to cannabis public health implications. In order to facilitate further consensus, this review analyzes previously used definitions in the literature.. This systematic review was performed following the PRISMA guidelines. Articles published before October 2015 in the Medline, Scopus-Elsevier, ISI-Web of Knowledge and Cochrane databases and fulfilling a-priori decided criteria were retrieved. Definitions in preselected websites of national and international organizations addressing drug problems were also included.. Definitions identified in articles (n = 46) and official websites (n = 3) widely varied from each other. Weekly cannabis use was mostly considered risky. Problematic cannabis use was mostly described with the Cannabis Abuse and Screening Test. Evidence-based definitions as well as information on quantities consumed, time-frames and special considerations for risky groups were very limited.. Working on official definitions is highly necessary as criteria used remain incomplete, leading to increased confusion in the field. Recommendations to improve existing definitions are given.

Topics: Cannabis; Humans; Marijuana Abuse; Risk Factors; Substance-Related Disorders

Now that the consumption of natural and synthetic cannabinoids is becoming more widespread, the specific treatment of cannabis-related disturbances is an increasingly important matter. There are many therapeutic options, and it is not always clear which ones are evidence-based and appropriate for use in a given clinical situation.. This review is based on reports of pertinent randomized and controlled trials (RCTs) that were retrieved by a selective search in the PubMed and Cochrane databases.. Cognitive behavior therapy (CBT) combined with other techniques has been found to have a moderate to large effect (Cohen's d = 0.53-0.9) on the amount of cannabis consumed as well as on the level of psychosocial functioning or the dependence syndrome. Systemic multidimensional family therapy (MDFT) has been found beneficial for younger adolescents who consume large amounts of cannabis and have psychiatric comorbidities. Short-term interventions with motivational talk therapy have been found effective for patients with or without an initial desire to achieve cannabis abstinence. All of these psychotherapeutic interventions are effective at evidence level Ia. The administration of gabapentin had a weak effect (d = 0.26) on the quantity consumed and on abstinence (evidence level Ib). Withdrawal symptoms can be alleviated with cannabinoid-receptor antagonists (d = 0.223 and 0.481) (evidence level Ib). On the other hand, there is evidence that serotonergic antidepressants can worsen withdrawal manifestations and increase the likelihood of relapse.. Psychotherapeutic techniques remain the foundation of treatment for cannabis dependence. No drug has yet been approved for the treatment of cannabis dependence because of the lack of scientific evidence. The rates of abstinence that are currently achieved, even with psychotherapy, are still only moderate. Further clinical studies are needed for the evaluation of combinations of various treatments that can meet the needs of individual patients.

Topics: Adolescent; Cannabinoids; Cannabis; Cognitive Behavioral Therapy; Humans; Marijuana Abuse; Psychotherapy; Randomized Controlled Trials as Topic

Marijuana use can cause concerning physical, psychomotor, cognitive, and psychiatric effects, not to mention a near-doubling of car accidents.

Topics: Cannabinoids; Cannabis; Humans; Illicit Drugs; Marijuana Abuse; Marijuana Smoking; United States

Cannabis has been implicated as a risk factor for the development of schizophrenia, but the exact biological mechanisms remain unclear. In this review, we attempt to understand the neurobiological pathways that link cannabis use to schizophrenia. This has been an area of great debate; despite similarities between cannabis users and schizophrenia patients, the evidence is not sufficient to establish cause-and-effect. There have been advances in the understanding of the mechanisms of cannabis dependence as well as the role of the cannabinoid system in the development of psychosis and schizophrenia. The neurobiological mechanisms associated with the development of psychosis and effects from cannabis use may be similar but remain elusive. In order to better understand these associations, this paper will show common neurobiological and neuroanatomical changes as well as common cognitive dysfunction in cannabis users and patients of schizophrenia. We conclude that epidemiologic evidence highlights potential causal links; however, neurobiological evidence for causality remains weak.

Topics: Cannabinoids; Cannabis; Cognition Disorders; Humans; Marijuana Abuse; Psychotic Disorders; Risk Factors

Cannabis is the world's most popular illicit drug, and around half of all Danes have tried it at least once. In this paper we review the pharmacodynamic and pharmacokinetic properties of cannabis. We also discuss the treatment of cannabis intoxication and present data from The Danish Poison Information Center.

Topics: Age Distribution; Cannabinoids; Cannabis; Denmark; Drug Interactions; Humans; Illicit Drugs; Marijuana Abuse; Poison Control Centers; Substance Withdrawal Syndrome

Topics: Cannabis; Humans; Marijuana Abuse; Organic Chemicals; Primary Health Care

This study examined whether brief motivational interventions (BMIs) designed for reducing heavy drinking among college students have secondary effects on reducing marijuana use.. The data came from Project INTEGRATE, which combined data from 24 independent trials of BMIs and other individual-focused interventions designed to reduce heavy drinking and related problems among college students. We analyzed data from 10 samples across nine studies that used random assignment of participants into either a BMI or a control group and assessed marijuana use outcomes (N = 6,768; 41.5% men; 73.2% White; 57.7% first-year students; 19.2% current marijuana users at baseline). We derived three marijuana use groups within studies by cross-tabulating baseline and follow-up data: Nonusers, Reducers, and Stayers/Increasers.. Peto's one-step odds ratio analyses for meta-analysis revealed no significant intervention effects on marijuana use at either short-term (1-3 month) or long-term (6-12 month) follow-up. Subsequent exploratory analyses showed that those who reduced drinking were more likely to be a marijuana Reducer or Nonuser, compared with a Stayer/Increaser, at both follow-ups.. The BMIs to reduce heavy drinking evaluated in this study did not reduce marijuana use. However, our exploratory results suggest that if we can develop interventions for college students that effectively reduce drinking, we may also reduce their marijuana use. Furthermore, as recreational use of marijuana becomes legal or decriminalized and marijuana becomes more readily available, it may be necessary to develop interventions specifically targeting marijuana use among college students.

Topics: Alcohol Drinking; Cannabis; Humans; Male; Marijuana Abuse; Marijuana Smoking; Motivation; Psychotherapy, Brief; Randomized Controlled Trials as Topic; Students

There is extensive research on the safety, toxicology, potency, and therapeutic potential of cannabis. However, uncertainty remains facilitating continued debate on medical and recreational cannabis policies at the state and federal levels. This review will include a brief description of cannabinoids and the endocannabinoid system; a summary of the acute and long-term effects of cannabis; and a discussion of the therapeutic potential of cannabis. The conclusions about safety and efficacy will then be compared with the current social and political climate to suggest future policy directions and general guidelines.

Topics: Animals; Cannabinoids; Cannabis; Health Policy; Humans; Marijuana Abuse; Toxicology

The persons with marijuana abuse tend to be increasing in Japan, although illegal drugs use in lifetime is remarkably lower than other advanced countries, Europe and USA. In addition, there have been many methamphetamine users in Japan. As use of methamphetamine induces psychotic states, we recognize them as one of the key illegal drugs for clinical psychiatrists. Regarding to diagnosis of methamphetamine psychosis, there is a large difference between Japanese psychiatrists and other advanced countries' ones. The former considers that they have persistent symptoms. In contrast, the latter embraces it as the model of acute toxicosis. The Japanese government has been based on a full commitment to the crackdown on drug problems. However, they will execute the new law in 2016, in which some persons charged with violating the methamphetamine control law will be adapted to partially probation on drug charges. Then, we have to improve our therapeutic and recovery supports to charged illegal drug users as rapidly as possible.

Topics: Cannabis; Humans; Japan; Marijuana Abuse; Methamphetamine; Psychoses, Substance-Induced; Substance-Related Disorders

Cannabis is the most widely used illegal drug in European countries. In countries with repressive cannabis policies, prevalence is not lower than in those with tolerant laws. Repressive policies not only have uncertain benefits but they are also expensive. Economists tend to believe that good public policies minimize social costs; that is, they help to improve collective wellbeing at a lower cost.. The paper draws on a review of international literature on cannabis legislative models around the world. After a description of some of the fundamental concepts of a market economy, several existing policy scenarios will be presented and analyzed from an economic perspective. Strength and weaknesses will be summarized for each alternative.. In addition to consumption tolerance in countries such as the Netherlands, recent decriminalization of domestic markets in the Unites States and Uruguay present alternatives to reduce the negative impact of cannabis on society. Earlier initiation age and rise in consumption are unintended potential consequences of decriminalization that need to be addressed by public authorities when designing a liberalized cannabis policy environment. Price is a key variable that needs to be addressed to prevent a rise in consumption.. Repressive cannabis policies are expensive and have limited impact on consumption. Consumption legalization significantly reduces expenses for repression and law enforcement, allowing for the allocation of more resources to other targets such as education and prevention. With legalization of supply along with consumption, repression and law enforcement costs are reduced even further. Moreover, a legal market would create employment and generate tax revenues that could be allocated to the prevention of increased consumption. Legalizing cannabis would not lead to a sudden rise in consumption, providing the duty imposed by the state kept the product at its current price.

Topics: Cannabis; Commerce; Cross-Cultural Comparison; Drug and Narcotic Control; Europe; Health Policy; Humans; Illicit Drugs; Law Enforcement; Male; Marijuana Abuse; Public Policy

Cannabis is the most widely used illicit drug in the world. The medicinal value of cannabis as an antiemetic is well known by the medical fraternity. A less well-recognised entity is the potential for certain chronic users to develop hyperemesis. We describe the case of a young man who presented to us with features of cannabinoid hyperemesis syndrome. We review the current literature on this condition, its pathogenesis and management.

Topics: Adult; Antiemetics; Cannabinoids; Cannabis; Disease Management; Dronabinol; Humans; Male; Marijuana Abuse; Metoclopramide; Nausea; Receptors, Cannabinoid; Syndrome; Vomiting; Young Adult

Cannabinoids (Δ9-tetrahydrocannabinol) are the active ingredient of marijuana (cannabis) which is the most commonly abused illicit drug in the USA. In addition to being known and used as recreational drugs, cannabinoids are produced endogenously by neurons in the brain (endocannabinoids) and serve as important signaling molecules in the nervous system and the rest of the body. Cannabinoids have been implicated in bodily processes both in health and disease. Recent pharmacological and physiological experiments have described novel aspects of classic brain signaling mechanisms or revealed unknown mechanisms of cellular communication involving the endocannabinoid system. While several forms of signaling have been described for endocannabinoids, the most distinguishing feature of endocannabinoids is their ability to act as retrograde messengers in neural circuits. Neurons in the main olfactory bulb express high levels of cannabinoid receptors. Here, we describe the cellular mechanisms and function of this novel brain signaling system in regulating neural activity at synapses in olfactory circuits. Results from basic research have the potential to provide the groundwork for translating the neurobiology of drug abuse to the realm of the pharmacotherapeutic treatment of addiction, specifically marijuana substance use disorder.

Topics: Brain; Cannabinoid Receptor Modulators; Cannabis; Endocannabinoids; Humans; Marijuana Abuse; Neurons; Receptors, Cannabinoid; Signal Transduction; Smell; United States

Smokeable herbal mixtures containing synthetic agonists of cannabinoid receptors, known under brand names such as Spice, K2 and Kronic, represent a relatively new type of designer psychoactive drugs that has recently emerged on the recreational drug market. Although the Spice packages are labelled 'not for human consumption' or 'for aromatherapy only' and declared to be purely herbal, these herbal mixtures produce cannabis-like effects after smoking. This review surveys the current state of knowledge regarding the pharmacological properties of synthetic cannabimimetics and the prevalence and pattern of their use. Special emphasis is given to the negative consequences of using these products, including, among others, hallucinations, psychoses with delusions, seizures, cardiovascular symptoms and acute kidney injury.

Topics: Cannabinoids; Cannabis; Designer Drugs; Humans; Marijuana Abuse

To review and summarise the literature reporting on cannabis use within western communities with specific reference to patterns of use, the pharmacology of its major psychoactive compounds, including placental and fetal transfer, and the impact of maternal cannabis use on pregnancy, the newborn infant and the developing child. Review of published articles, governmental guidelines and data and book chapters. Although cannabis is one of the most widely used illegal drugs, there is limited data about the prevalence of cannabis use in pregnant women, and it is likely that reported rates of exposure are significantly underestimated. With much of the available literature focusing on the impact of other illicit drugs such as opioids and stimulants, the effects of cannabis use in pregnancy on the developing fetus remain uncertain. Current evidence indicates that cannabis use both during pregnancy and lactation, may adversely affect neurodevelopment, especially during periods of critical brain growth both in the developing fetal brain and during adolescent maturation, with impacts on neuropsychiatric, behavioural and executive functioning. These reported effects may influence future adult productivity and lifetime outcomes. Despite the widespread use of cannabis by young women, there is limited information available about the impact perinatal cannabis use on the developing fetus and child, particularly the effects of cannabis use while breast feeding. Women who are using cannabis while pregnant and breast feeding should be advised of what is known about the potential adverse effects on fetal growth and development and encouraged to either stop using or decrease their use. Long-term follow-up of exposed children is crucial as neurocognitive and behavioural problems may benefit from early intervention aimed to reduce future problems such as delinquency, depression and substance use.

Topics: Adult; Breast Feeding; Cannabis; Child; Female; Fetal Development; Fetus; Humans; Infant; Infant, Newborn; Marijuana Abuse; Pregnancy; Prenatal Exposure Delayed Effects; Risk Factors

Cannabis remains one of the world's most widely used substance of abuse amongst pregnant women. Trends of the last 50 years show an increase in popularity in child-bearing women together with a constant increase in cannabis potency. In addition, potent herbal "legal" highs containing synthetic cannabinoids that mimic the effects of cannabis with unknown pharmacological and toxicological effects have gained rapid popularity amongst young adults. Despite the surge in cannabis use during pregnancy, little is known about the neurobiological and psychological consequences in the exposed offspring. In this review, we emphasize the importance of maternal programming, defined as the intrauterine presentation of maternal stimuli to the foetus, in neurodevelopment. In particular, we focus on cannabis-mediated maternal adverse effects, resulting in direct central nervous system alteration or sensitization to late-onset chronic and neuropsychiatric disorders. We compare clinical and preclinical experimental studies on the effects of foetal cannabis exposure until early adulthood, to stress the importance of animal models that permit the fine control of environmental variables and allow the dissection of cannabis-mediated molecular cascades in the developing central nervous system. In sum, we conclude that preclinical experimental models confirm clinical studies and that cannabis exposure evokes significant molecular modifications to neurodevelopmental programs leading to neurophysiological and behavioural abnormalities.

Topics: Animals; Brain; Cannabis; Developmental Disabilities; Endocannabinoids; Female; Fetus; Humans; Marijuana Abuse; Maternal Exposure; Maternal-Fetal Exchange; Mental Disorders; Pregnancy; Prenatal Exposure Delayed Effects; Signal Transduction

Cannabis consumption can cause abuse and dependence and increase risk of developing psychiatric and somatic disorders. Several literature reviews explored the link between cannabis consumption and schizophrenia but none summarized the rich literature on cannabis and psychometric schizotypy. The aim of our review is to synthesize data from studies that explored the association between cannabis consumption and schizoptypal dimensions. A systematic review of the literature and, when needed, contact with the authors, allowed us to gather data from 29 cross-sectional studies. We compared schizotypy scores between subjects that never used cannabis and subjects that used it at least once ("never vs. ever") and between current users and subjects that do not use cannabis currently ("current vs. other"). We conducted separate analyses for total schizotypy score and each of the three classical schizotypal dimensions (positive, negative, disorganized). For all eight comparisons, the cannabis group ("ever" or "current") had higher schizotypy scores. Differences were in the small or medium range and, with the exception of the negative score in the current vs. other comparison, statistically significant. Cannabis consumption is associated with increased schizotypal traits. More research, using different approaches (e.g. longitudinal studies) is needed to explore the cause of this association.

Topics: Cannabis; Cross-Sectional Studies; Female; Humans; Marijuana Abuse; Marijuana Smoking; Psychometrics; Schizotypal Personality Disorder

Cannabis is the most commonly abused drug among patients with bipolar disorder. Available data has shown that the risk of psychotic disorders increases with the frequency and intensity of cannabis abuse. The present purpose was to review relevant studies to investigate whether cannabis use can be linked to the onset of mania in bipolar disorder.. Articles published between 1972 and December 2013 were searched on Medline and PsychInfo using the following keywords: first manic episode, or onset mania, or bipolar disorder and cannabis. Relevant papers cited in the references of selected articles were further considered for inclusion into the review.. Lifetime use of cannabis among bipolar patients appears to be around 70% and approximately 30% of patients with a bipolar disorder present a comorbidity of cannabis abuse or dependence. Cannabis use is associated with younger age at onset of first mania and with more frequent depressive or manic episodes, although the evidence is somewhat inconsistent. Likewise cannabis consumption is related to poorer outcome and an increased risk of rapid cycling or mixed episodes. In contrast, neuro-cognitive functioning seems to be positively affected in patients with psychiatric comorbidity. While cannabis use often precedes first manic episodes, the causal direction remains to be determined.. Variations in definition of cannabis use/dependence. Lack of controlled studies limiting definite conclusions about a putative causal relationship between cannabis and onset of mania.. Further investigations are needed to clarify the relationships between cannabis use and first manic episode.

Topics: Adult; Aged; Bipolar Disorder; Cannabis; Female; Humans; Male; Marijuana Abuse; Middle Aged

The aim of the current study was to investigate the association between anxiety and cannabis use/cannabis use disorders in the general population.. A total of N = 267 studies were identified from a systematic literature search (any time- March 2013) of Medline and PsycInfo databases, and a hand search. The results of 31 studies (with prospective cohort or cross-sectional designs using non-institutionalised cases) were analysed using a random-effects meta-analysis with the inverse variance weights. Lifetime or past 12-month cannabis use, anxiety symptoms, and cannabis use disorders (CUD; dependence and/or abuse/harmful use) were classified according to DSM/ICD criteria or scores on standardised scales.. There was a small positive association between anxiety and either cannabis use (OR = 1.24, 95% CI: 1.06-1.45, p = .006; N = 15 studies) or CUD (OR = 1.68, 95% CI: 1.23-2.31, p = .001; N = 13 studies), and between comorbid anxiety + depression and cannabis use (OR = 1.68, 95% CI: 1.17-2.40, p = .004; N = 5 studies). The positive associations between anxiety and cannabis use (or CUD) were present in subgroups of studies with ORs adjusted for possible confounders (substance use, psychiatric illness, demographics) and in studies with clinical diagnoses of anxiety. Cannabis use at baseline was significantly associated with anxiety at follow-up in N = 5 studies adjusted for confounders (OR = 1.28, 95% CI: 1.06-1.54, p = .01). The opposite relationship was investigated in only one study. There was little evidence for publication bias.. Anxiety is positively associated with cannabis use or CUD in cohorts drawn from some 112,000 non-institutionalised members of the general population of 10 countries.

Topics: Adolescent; Adult; Anxiety Disorders; Cannabis; Comorbidity; Cross-Sectional Studies; Depression; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Prospective Studies; Young Adult

Topics: Accidents, Traffic; Adolescent; Adult; Age Factors; Brain; Cannabinoids; Cannabis; Dronabinol; Humans; Lung Diseases; Marijuana Abuse; Marijuana Smoking; United States

A health policy for the prevention and treatment of cannabis-related disorders is urgently needed in France, given the high prevalence of cannabis use among children and adolescents. Such a policy will require a better understanding of the endo-cannabinoid system and the impact of exogenous cannabinoids in this fragile population. The brain continues to undergo significant development until the age of about 25 years, and cannabis consumption by young people therefore carries specific risks of dependence (frequency and intensity), and of neuroanatomical, cognitive and emotional damage. This article summarizes the available data and offers a medical view of the risks and consequences of cannabis use by children and adolescents.

Topics: Adolescent; Adult; Brain; Cannabis; Child; France; Humans; Marijuana Abuse; Prevalence; Substance-Related Disorders; Young Adult

The amphetamine derivative 3, 4 Methylenedioxymethanphetamine (MDMA) is a powerful central nervous system stimulant that displays numerous pharmacological effects, including neurotoxicity. MDMA, or ecstasy, acts by inducing the release of different neurotransmitters depending on the animal species and, in particular, it produces the release of serotonin and dopamine. MDMA induces rewarding and reinforcing effects in rodents, primates and humans, and is currently consumed as an illicit psychostimulant among young people. One of the most reported side effects is the hyperthermic effect and the neurotoxicity on central serotonergic and dopaminergic neurons, depending on the species of animal. It seems that MDMA may also produce neurotoxic effects in humans. To date, the most consistent findings associated to MDMA consumption in humans relate to cognitive deficits in heavy users. MDMA when consumed as an illicit psychostimulant is commonly co-used with other abusers, being frequently associated with cannabinoids. The interaction between MDMA and cannabis effects is complex. Cannabis derivatives act on endocannabinoid system. Thus, at cellular levels, cannabinoids acting through CB1 cannabinoid receptors display opposite effects to those induced by MDMA, and they have been reported to develop neuroprotective actions, including the blockage of MDMA induced neurotoxicity, in laboratory animals. However, cannabis use is a recognized risk factor in the presentation and development of neuropsychiatric disorders, and also contributes to the development of psychological problems and cognitive failures observed in MDMA users. This paper represents a brief overview of the pharmacological interaction between MDMA and cannabis derivatives acting in the endocannabinoid system. We have evaluated recent findings in the literature of the most representative pharmacological effects displayed by both types of drugs. We analyze both, the synergic and opposite effects produced by these two compounds and we have found a gap regarding the negative consequences of long-term human consumption of MDMA alone or in combination with cannabis.

Topics: Amphetamine-Related Disorders; Animals; Cannabinoids; Cannabis; Cognition Disorders; Endocannabinoids; Humans; Marijuana Abuse; N-Methyl-3,4-methylenedioxyamphetamine; Reinforcement, Psychology; Reward; Time Factors

This article reviews the literature for the most pressing diagnostic and treatment challenges faced in working with adolescents. Diagnosing the treatment interventions required for this population involve psychoeducation, engagement of the patient and family in the treatment process, and use of antipsychotic medications. Cannabis may be a causal risk factor in psychotic illness, and data support recommendations to reduce or cease cannabis use in this population. Treatment strategies are discussed that are effective in adult patients and that may be efficacious for youth to abstain from substances after the resolution of psychotic symptoms.

Topics: Adolescent; Adolescent Development; Antipsychotic Agents; Cannabis; Diagnosis, Differential; Diagnosis, Dual (Psychiatry); Disease Susceptibility; Humans; Interview, Psychological; Marijuana Abuse; Patient Compliance; Psychoses, Substance-Induced; Risk Factors; Secondary Prevention; Young Adult

Cannabis is widely used in adolescence; however, the effects of cannabis on the developing brain remain unclear. Cannabis might be expected to have increased effects upon brain development and cognition during adolescence. There is extensive re-organisation of grey (GM) and white matter (WM) at this time, while the endocannabinoid (eCB) system, which is involved in the normal physiological regulation of neural transmission, is still developing. In healthy adolescent cannabis users there is a suggestion of greater memory loss and hippocampal volume changes. Functional studies point to recruitment of greater brain areas under cognitive load. Structural and DTI studies are few, and limited by comorbid drug and alcohol use. The studies of cannabis use in adolescent-onset schizophrenia (AOS) differ, with one study pointing to extensive GM and WM changes. There is an intriguing suggestion that the left parietal lobe may be more vulnerable to the effects of cannabis in AOS. As in adult schizophrenia cognition does not appear to be adversely affected in AOS following cannabis use. Given the limited number of studies it is not possible to draw firm conclusions. There is a need for adequately powered, longitudinal studies.

Topics: Adolescent; Brain; Cannabis; Cognition; Dronabinol; Health; Humans; Marijuana Abuse; Nerve Fibers, Myelinated; Nerve Fibers, Unmyelinated; Neuropsychological Tests; Parietal Lobe; Psychometrics; Schizophrenia; Sex Characteristics

Estimate the prevalence of cannabis dependence and its contribution to the global burden of disease.. Systematic reviews of epidemiological data on cannabis dependence (1990-2008) were conducted in line with PRISMA and meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Culling and data extraction followed protocols, with cross-checking and consistency checks. DisMod-MR, the latest version of generic disease modelling system, redesigned as a Bayesian meta-regression tool, imputed prevalence by age, year and sex for 187 countries and 21 regions. The disability weight associated with cannabis dependence was estimated through population surveys and multiplied by prevalence data to calculate the years of life lived with disability (YLDs) and disability-adjusted life years (DALYs). YLDs and DALYs attributed to regular cannabis use as a risk factor for schizophrenia were also estimated.. There were an estimated 13.1 million cannabis dependent people globally in 2010 (point prevalence0.19% (95% uncertainty: 0.17-0.21%)). Prevalence peaked between 20-24 yrs, was higher in males (0.23% (0.2-0.27%)) than females (0.14% (0.12-0.16%)) and in high income regions. Cannabis dependence accounted for 2 million DALYs globally (0.08%; 0.05-0.12%) in 2010; a 22% increase in crude DALYs since 1990 largely due to population growth. Countries with statistically higher age-standardised DALY rates included the United States, Canada, Australia, New Zealand and Western European countries such as the United Kingdom; those with lower DALY rates were from Sub-Saharan Africa-West and Latin America. Regular cannabis use as a risk factor for schizophrenia accounted for an estimated 7,000 DALYs globally.. Cannabis dependence is a disorder primarily experienced by young adults, especially in higher income countries. It has not been shown to increase mortality as opioid and other forms of illicit drug dependence do. Our estimates suggest that cannabis use as a risk factor for schizophrenia is not a major contributor to population-level disease burden.

Topics: Age Factors; Cannabis; Comorbidity; Disabled Persons; Female; Geography, Medical; Global Health; Humans; Male; Marijuana Abuse; Prevalence; Risk Factors; Schizophrenia; Sex Factors

Cannabis is by far the most common illicit drug in France. Among 15-64 years, 32.1% have already experienced it and 8.4% declare they have used it at least once during the past twelve months. In Europe, France is one of the countries with the highest prevalence. Males are markedly more often cannabis users than females and this gender gap tends to increase with the level of use. During the last two decades, the part of the population having tried cannabis did not stop increasing, under the influence of a generalization of the cannabis experience among young people. However, cannabis last year prevalence is rather stable since 2000. Cannabis lifetime use is very rare at the beginning of middle school (1.5% in sixth grade at age 11) but increases in the following years (11% of the pupils of the eighth grade, 24% of the pupils of the ninth grade). Cannabis use at a younger age is related to subsequent onset of cannabis related problems. Adolescent and young adults from high socioeconomic status (SES) more often try cannabis than young people from lower SES. However, cannabis regular use is associated with bad school results, truancy and early school leaving, and with a lower SES. Young people from high SES indeed dispose of greater sociocultural resources to master and regulate their consumption and are more often conscious of their interest not to be tipped over in problematic use.

Topics: Adolescent; Adult; Cannabis; Female; France; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Young Adult

Cannabis is the most widely used illicit substance, especially among young people. Cannabis use is extremely commonplace and frequently comorbid with psychiatric disorders that raise questions about the etiology. The use of cannabis is an aggravating factor of all psychiatric disorders. Psychiatric complications are related to the age of onset, duration of exposure and individual risk factors of the individual (mental and social health). The panic attack is the most common complication. The link with psychosis is narrow that leads to increased prevention for vulnerable populations. Cannabis is also an indicator of increased depressive vulnerability and an aggravating factor for bipolar disorder.

Topics: Anxiety Disorders; Cannabis; Humans; Marijuana Abuse; Mood Disorders; Psychotic Disorders

Topics: Cannabis; Cognition Disorders; Humans; Marijuana Abuse; Observer Variation

Topics: Cannabis; Child; Cognitive Behavioral Therapy; Female; Humans; Infant, Newborn; Marijuana Abuse; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects

Adolescence is a period of confrontation and initiation to psychoactives drugs. Teenager's substance disorder remains an important concern for families and public authorities. The seriousness of consequences due to cannabis use, both on the health and social points, depends on the age of first use, the duration of use and the user himself. Teenagers, who do not often request to be taken care, are a population who has difficulty to access to medical treatment, even if the offer of medical treatment has increased. It is necessary to develop an early detection among vulnerable populations like teenagers, to train first aid operators to early detection strategies, as well as to increase the knowledge of the care system to improve teenagers' orientation in the care system.

Topics: Adolescent; Algorithms; Cannabis; Health Services Needs and Demand; Humans; Marijuana Abuse; Marijuana Smoking; Substance Abuse Detection

Topics: Cannabis; Humans; Marijuana Abuse; Substance Withdrawal Syndrome

The growing concern about cannabis use, the most commonly used illicit drug worldwide, has led to a significant increase in the number of human studies using neuroimaging techniques to determine the effect of cannabis on brain structure and function. We conducted a systematic review to assess the evidence of the impact of chronic cannabis use on brain structure and function in adults and adolescents.. Papers published until August 2012 were included from EMBASE, Medline, PubMed and LILACS databases following a comprehensive search strategy and pre-determined set of criteria for article selection. Only neuroimaging studies involving chronic cannabis users with a matched control group were considered.. One hundred and forty-two studies were identified, of which 43 met the established criteria. Eight studies were in adolescent population. Neuroimaging studies provide evidence of morphological brain alterations in both population groups, particularly in the medial temporal and frontal cortices, as well as the cerebellum. These effects may be related to the amount of cannabis exposure. Functional neuroimaging studies suggest different patterns of resting global and brain activity during the performance of several cognitive tasks both in adolescents and adults, which may indicate compensatory effects in response to chronic cannabis exposure.. However, the results pointed out methodological limitations of the work conducted to date and considerable heterogeneity in the findings.. Chronic cannabis use may alter brain structure and function in adult and adolescent population. Further studies should consider the use of convergent methodology, prospective large samples involving adolescent to adulthood subjects, and data-sharing initiatives.

Topics: Adolescent; Adult; Cannabinoids; Cannabis; Cerebellum; Cognition; Databases, Bibliographic; Female; Frontal Lobe; Humans; Male; Marijuana Abuse; Neuroimaging; Neuropsychological Tests; Temporal Lobe

For 5 millennia, Cannabis sativa has been used throughout the world medically, recreationally, and spiritually. From the mid-19th century to the 1930s, American physicians prescribed it for a plethora of indications, until the federal government started imposing restrictions on its use, culminating in 1970 with the US Congress classifying it as a Schedule I substance, illegal, and without medical value. Simultaneous with this prohibition, marijuana became the United States' most widely used illicit recreational drug, a substance generally regarded as pleasurable and relaxing without the addictive dangers of opioids or stimulants. Meanwhile, cannabis never lost its cachet in alternative medicine circles, going mainstream in 1995 when California became the first of 16 states to date to legalize its medical use, despite the federal ban. Little about cannabis is straightforward. Its main active ingredient, δ-9-tetrahydrocannabinol, was not isolated until 1964, and not until the 1990s were the far-reaching modulatory activities of the endocannabinoid system in the human body appreciated. This system's elucidation raises the possibility of many promising pharmaceutical applications, even as draconian federal restrictions that hamstring research show no signs of softening. Recreational use continues unabated, despite growing evidence of marijuana's addictive potential, particularly in the young, and its propensity for inducing and exacerbating psychotic illness in the susceptible. Public approval drives medical marijuana legalization efforts without the scientific data normally required to justify a new medication's introduction. This article explores each of these controversies, with the intent of educating physicians to decide for themselves whether marijuana is panacea, scourge, or both. PubMed searches were conducted using the following keywords: medical marijuana, medical cannabis, endocannabinoid system, CB1 receptors, CB2 receptors, THC, cannabidiol, nabilone, dronabinol, nabiximols, rimonabant, marijuana legislation, marijuana abuse, marijuana dependence, and marijuana and schizophrenia. Bibliographies were hand searched for additional references relevant to clarifying the relationships between medical and recreational marijuana use and abuse.

Topics: Adolescent; Adult; Cannabinoids; Cannabis; Drug and Narcotic Control; Evidence-Based Medicine; Federal Government; Government Regulation; Health Services Accessibility; Humans; Legislation, Drug; Marijuana Abuse; Marijuana Smoking; Middle Aged; Patient Advocacy; Plant Preparations; Public Policy; United States; United States Food and Drug Administration; Young Adult

To develop effective interventions for people with coexisting mental disorders (MD) and substance use, it may be beneficial to understand their attitudes and perceptions of substances.. A systematic literature search regarding attitudes and perceptions towards tobacco, alcohol or cannabis among people with MD was conducted. Studies' methodological quality was assessed using the Newcastle-Ottawa Scale.. Twenty-one papers were included in the review and found to have generally low methodological quality. Papers investigated reasons for substance use, substance use expectancies, substances' perceived effects and reasons for quitting. People with psychotic disorders reported using substances primarily for relaxation and pleasure. Among people with mood disorders, alcohol was used primarily for social motives and tobacco for negative affect reduction.. For substance use interventions among people with MD to be more effective, it may be necessary to tailor interventions specifically for this population and customize by substance type. Gaps in the literature regarding attitudes and perceptions towards substance use among people with MD were identified, which future research should aim to address. These include designing and conducting methodologically rigorous research, investigating perceived harmfulness and knowledge of substances, and broadening recruitment of participants to include people with MD other than psychosis.

Topics: Alcoholic Beverages; Alcoholism; Attitude to Health; Cannabis; Humans; Marijuana Abuse; Mental Disorders; Nicotiana; Substance-Related Disorders; Tobacco Use Disorder

Marijuana is one of the most commonly used psychoactive substances in society, mainly among youths. Its use has been consistently associated with several health problems, many of which have in common an impairment in the cognitive processes of behavior, including the memory, attention, emotion and decision making. There is evidence suggesting that cannabinoids, marijuana's primary psychoactive substance, have a negative effect in short-term memory, working memory, and decision making. It has also been found that cannabinoids affect attention and the interaction between cognitive events and emotion. This information can be used as an argument of biological plausibility to assess clinical and epidemiological research findings that show that marijuana`s use is associated to problems such as traffic accidents, psychosis, depression and poor academic records, among others.

Topics: Cannabis; Cognition; Emotions; Humans; Marijuana Abuse; Memory; Nervous System

Although cannabis use disorder is strongly related to schizophrenia and treatment of patients with double diagnosis provides serious problem, specific pharmacological, molecular and therapeutical data on this subgroup are poorly available. In this paper we present a critical review on psychopharmacological boundaries of schizophrenia with concurrent cannabis use. The relevant data available in the literature suggest that a weaker compliance, poorer therapy response and higher sensitivity for extrapyramidal side effects are key features of schizophrenia and comorbid cannabis use disorder and represent a clinical challenge. Because of paucity of available research in the field there is not enough evidence to clearly depict the exact psychopharmacological profile of cannabis related schizophrenia. Further investigations are needed to assess phenotypic characteristics of this entity and to tailor effective treatment options accordingly.

Topics: Antipsychotic Agents; Cannabis; Humans; Marijuana Abuse; Psychopharmacology; Schizophrenia

Cannabis is the most prevalent illicit substance used among schizophrenia patients. The effects of cannabis are mediated through the endocannabinoid system, which is a major regulator of neurotransmission and may be disturbed in schizophrenia. Though cognitive impairment in schizophrenia is well established, the effects of cannabis on cognition in schizophrenia patients are still unclear. This paper reviews 19 studies that examine the cognitive effects of cannabis on schizophrenia by comparing cognitive functioning of cannabis-using and non-using schizophrenia patients across a vast range of domains (memory, attention and processing speed, executive functions, visuospatial, psychomotor and language). Of the studies included in the review, 11 reported better cognitive functions among cannabis-using schizophrenia patients compared to non-users, 5 found minimal or no difference between the groups and 3 found poorer cognitive functions among cannabis-using schizophrenia patients compared to non-users. The inconsistencies in the studies reviewed may stem from significant methodological variance between the studies regarding patient selection, adequate controls, cognitive measures used, measures of cannabis use, additional drugs used, and clinical aspects of schizophrenia. These methodological issues are discussed, as well as possible explanations for the results presented and suggestions for future research in this field.

Topics: Cannabis; Humans; Marijuana Abuse; Schizophrenia; Schizophrenic Psychology

Marijuana has been used medically since antiquity. In recent years there has been a resurgence of interest in medical applications of various cannabis preparations. These drugs have been cited in the medical literature as potential secondary treatment agents for severe pain, muscle spasticity, anorexia, nausea, sleep disturbances, and numerous other uses. This article reviews the research literature related to medical applications of various forms of cannabis. Benefits related to medical use of cannabinoids are examined and a number of potential risks associated with cannabis use, both medical and recreational, are considered. There is a clearly identified need for further research to isolate significant benefits from the medical application of cannabinoids and to establish dosage levels, appropriate delivery mechanisms and formulations, and to determine what role, if any, cannabinoids might play in legitimate medical applications. It is also imperative to determine if reported dangers pose a significant health risks to users.

Topics: Cannabinoids; Cannabis; Clinical Trials as Topic; Dronabinol; Humans; Marijuana Abuse; Muscle Spasticity; Nausea; Pain; Quality of Life; United States

Numerous studies have shown that patients with psychosis are more likely to use illicit drugs than the general population, with cannabis being the most popular. There exists overwhelming evidence that cannabis use can contribute to the onset of schizophrenia and poor outcome in patients with established psychosis. Therefore, understanding why patients use cannabis and whether they are motivated to change their habits is important. The evidence is that patients with psychosis use cannabis for the same reasons the general population does, to 'get high', relax and have fun. There is little support for the 'self-medication' hypothesis, while the literature points more towards an 'alleviation of dysphoria' model. There is a lack of research reporting on whether psychotic patients are ready to change their use of cannabis, which has obvious implications for identifying which treatment strategies are likely to be effective.

Topics: Cannabis; Comorbidity; Humans; Marijuana Abuse; Models, Theoretical; Psychoses, Substance-Induced; Psychotic Disorders; Risk Factors; Schizophrenia; Self Medication; Self Report

There are many factors that impact substance use in young people in the Pacific Island Countries and Territories (PICTs). However, the extent and nature of substance use by young people in the PICTs is not clear because of a lack of data on this group.. A desk-based review (including both white and grey literature) was conducted to explore substance use among young people in the Western Pacific region. This paper presents findings from the PICTs.. Prevalence of alcohol, cannabis and amphetamine-type stimulants use by young people is reported from various sources--primarily based on data derived from the Youth Risk Behaviour and the Second Generation Behaviour Surveillance Surveys.. There appear to be evidence of risky alcohol consumption and higher levels of cannabis and amphetamine-type stimulants use in some PICTs compared with Australia and New Zealand. However, data are generally unavailable to establish any trends. Regular, reliable and routine monitoring of patterns and trends in substance use among young people in the PICTs can assist in identifying concerns and developing evidence-informed interventions to prevent, contain and treat current and any emerging issues.

Topics: Adolescent; Alcohol Drinking; Amphetamine; Amphetamine-Related Disorders; Cannabis; Child; Female; Humans; Male; Marijuana Abuse; Native Hawaiian or Other Pacific Islander; Risk-Taking; Substance-Related Disorders; Young Adult

Topics: Administration, Inhalation; Cannabis; Cardiovascular Diseases; Evoked Potentials; Humans; Marijuana Abuse; Nicotiana; Nitrous Oxide; Perioperative Care; Pulmonary Disease, Chronic Obstructive; Smoking

Cannabis (marijuana) is the most widely used illicit drug globally. Given the prevalence of nonprescription illicit drug abuse, there is a growing interest in the study of its potential effects on male sexual health. In this review, we discuss the effects of cannabis on male sexual health.. In this review, we discuss the effects of cannabis on male sexual health. METHODS AND MAIN OUTCOME MEASURE: Critical review of scientific literature examining the impact of cannabis use on male sexual health.. Studies examining the effects of cannabis use on male sexual function have been limited in both quality and quantity. Most results of these studies are conflicting and contradictory. While some did outline the beneficial effects of cannabis in enhancing erectile function, others did not. However, recent animal and in vitro studies have identified potential links between cannabis and sexual health. It appears that cannabis may actually have peripheral antagonizing effects on erectile function by stimulating specific receptors in the cavernous tissue.. Given the prevalence of cannabis use, and the potential relationships between use and the development of potentially hazardous effects on male sexual function, we encourage renewed use of research resources to determine in-depth mechanistic knowledge, and new clinically oriented studies examining the effect of cannabis on male sexual function.

Topics: Cannabis; Erectile Dysfunction; Humans; Illicit Drugs; Male; Marijuana Abuse; Prevalence; Risk Assessment; Sexual Behavior; Substance-Related Disorders

Cannabis, Cannabis sativa L., is used to produce a resin that contains high levels of cannabinoids, particularly delta9-tetrahydrocannabinol (THC), which are psychoactive substances. Although cannabis use is illegal in France and in many other countries, it is widely used for its relaxing or euphoric effects, especially by adolescents and young adults. What are the adverse effects of cannabis on health? During consumption? And in the long term? Does cannabis predispose users to the development of psychotic disorders? To answer these questions, we reviewed the available evidence using the standard Prescrire methodology. The long-term adverse effects of cannabis are difficult to evaluate. Since and associated substances, with or without the user's knowledge. Tobacco and alcohol consumption, and particular lifestyles and behaviours are often associated with cannabis use. Some traits predispose individuals to the use of psychoactive substances in general. The effects of cannabis are dosedependent.The most frequently report-ed adverse effects are mental slowness, impaired reaction times, and sometimes accentuation of anxiety. Serious psychological disorders have been reported with high levels of intoxication. The relationship between poor school performance and early, regular, and frequent cannabis use seems to be a vicious circle, in which each sustains the other. Many studies have focused on the long-term effects of cannabis on memory, but their results have been inconclusive. There do not * About fifteen longitudinal cohort studies that examined the influence of cannabis on depressive thoughts or suicidal ideation have yielded conflicting results and are inconclusive. Several longitudinal cohort studies have shown a statistical association between psychotic illness and self-reported cannabis use. However, the results are difficult to interpret due to methodological problems, particularly the unknown reliability of self-reported data. It has not been possible to establish a causal relationship in either direction, because of these methodological limitations. In Australia, the marked increase in cannabis use has not been accompanied by an increased incidence of schizophrenia. On the basis of the available data, we cannot reach firm conclusions on whether or not cannabis use causes psychosis. It seems prudent to inform apparently vulnerable individuals that cannabis may cause acute psychotic decompensation, especially at high doses. Users can feel dependent on

Topics: Adolescent; Cannabis; Dronabinol; France; Humans; Marijuana Abuse; Marijuana Smoking; Time Factors; Young Adult

This article reviews neuropsychological performance in frequent users of cocaine, (meth)amphetamines, ecstasy, opiates, alcohol, and cannabis. We searched the scientific literature published in the last five years, focusing on studies that required at least 2 weeks of abstinence from drug use, and included a control group. All substances of abuse, except cannabis, were associated with sustained deficits in executive functioning, especially inhibition. In addition, verbal memory decrements were consistently found in cocaine, (meth)amphetamines and ecstasy users, but not in heroin or cannabis users. More specific executive functioning deficits were reported depending on the substance of abuse. Cocaine was associated with diminished cognitive flexibility, whereas (meth)amphetamines were associated with worse cognitive planning functions compared to controls. Opiate studies showed lower scores on verbal fluency in opiate dependent subjects compared to controls. Working memory and visuospatial abilities were compromised in alcohol abusers. In ecstasy users, inconsistent findings have been reported across neuropsychological domains, with the exception of inhibition and verbal memory. There was little evidence for sustained cognitive impairments in adult abstinent cannabis users. Recognition of neuropsychological problems related to different substances can help to select subjects that will benefit most from treatment. Furthermore, a better understanding of the neuropsychological impairments in drug abusing individuals could help to explain the remitting course of substance abuse disorders and to improve psychological interventions.

Topics: Alcoholism; Amphetamine-Related Disorders; Cannabis; Central Nervous System Stimulants; Cocaine; Cocaine-Related Disorders; Drug Users; Hallucinogens; Heroin Dependence; Humans; Marijuana Abuse; Memory Disorders; Methadone; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; Neuropsychological Tests; Opioid-Related Disorders; Psychomotor Performance; Recognition, Psychology; Substance-Related Disorders; Verbal Behavior

The illicit use of the three main forms of cannabis-marijuana, hash, hash oil-pose certain obstacles and challenges to the dental professional. There are a number of systemic, as well as oral/head and neck manifestations, associated with cannabis use. Dentists need to be aware of these manifestations in order to take whatever precautions and/or modifications to the proposed treatment that might be necessary.

Topics: Abnormalities, Drug-Induced; Bronchitis; Cannabis; Dental Care for Chronically Ill; Gingival Diseases; Humans; Immune System; Leukoplakia, Oral; Marijuana Abuse; Marijuana Smoking; Mental Disorders; Mouth Neoplasms; Tachycardia; Xerostomia

Prenatal cannabis exposure can complicate in utero development of the nervous system. Cannabis impacts the formation and functions of neuronal circuitries by targeting cannabinoid receptors. Endocannabinoid signaling emerges as a signaling cassette that orchestrates neuronal differentiation programs through the precisely timed interaction of endocannabinoid ligands with their cognate cannabinoid receptors. By indiscriminately prolonging the 'switched-on' period of cannabinoid receptors, cannabis can hijack endocannabinoid signals to evoke molecular rearrangements, leading to the erroneous wiring of neuronal networks. Here, we formulate a hierarchical network design necessary and sufficient to describe the molecular underpinnings of cannabis-induced neural growth defects. We integrate signalosome components, deduced from genome- and proteome-wide arrays and candidate analyses, to propose a mechanistic hypothesis of how cannabis-induced ectopic cannabinoid receptor activity overrides physiological neurodevelopmental endocannabinoid signals, affecting the timely formation of synapses.

Topics: Animals; Cannabinoid Receptor Modulators; Cannabis; Female; Humans; Marijuana Abuse; Maternal-Fetal Exchange; Models, Molecular; Neurons; Pregnancy; Receptors, Cannabinoid; Signal Transduction

For centuries Cannabis sativa and cannabis extracts have been used in natural medicine. Delta(9)-tetrahydrocannabinol (THC) is the main active ingredient of Cannabis. THC seems to be responsible for most of the pharmacological and therapeutic actions of cannabis. In a few countries THC extracts (i.e. Sativex) or THC derivatives such as nabilone, and dronabinol are used in the clinic for the treatment of several pathological conditions like chemotherapy-induced nausea and vomiting, multiple sclerosis and glaucoma. On the other hand the severe side effects and the high abuse liability of these agents represent a serious limitation in their medical use. In addition, diversion in the use of these active ingredients for recreational purpose is a concern. Over recent years, alternative approaches using synthetic cannabinoid receptor agonists or agents acting as activators of the endocannabinoid systems are under scrutiny with the hope to develop more effective and safer clinical applications. Likely, in the near future few of these new molecules will be available for clinical use. The present article review recent study and patents with focus on the cannabinoid system as a target for the treatment of central nervous system disorders with emphasis on agonists.

Topics: Animals; Cannabinoid Receptor Modulators; Cannabinoids; Cannabis; Central Nervous System Diseases; Endocannabinoids; Humans; Learning; Marijuana Abuse; Patents as Topic; Phytotherapy; Receptor, Cannabinoid, CB1

To investigate the hypothesis that cases of arteritis similar to thromboangiitis obliterans (TAO) and associated with the use of cannabis were caused by cannabis or THC (dronabinol), or that cannabis use is a co-factor of TAO.. A systematic review on case reports and the literature on so-called cannabis arteritis, TAO, and cardiovascular effects of cannabinoids was conducted.. Fifteen reports with 57 cases of an arteritis associated with the use of cannabis and two additional case series of TAO, in which some patients also used cannabis, were identified. Clinical and pathological features of cannabis-associated arteritis do not differ from TAO and the major risk factor of TAO, tobacco use, was present in most, if not in all of these cases. The proposed pathophysiological mechanisms for the development of an arteritis by cannabis use are not substantiated.. The hypothesis of cannabis being a causative factor or co-factor of TAO or an arteritis similar to TAO is not supported by the available evidence. The use of the term cannabis arteritis should be avoided until or unless more convincing scientific support is forthcoming.

Topics: Arteritis; Cannabis; Humans; Marijuana Abuse; Thromboangiitis Obliterans

Topics: Adolescent; Adult; Cannabis; Dopamine; Dronabinol; Female; Humans; Male; Marijuana Abuse; Middle Aged; Nucleus Accumbens; Psychotherapy; Young Adult

Evidence that cannabis use impairs cognitive function in humans has been accumulating in recent decades. The purpose of this overview is to update knowledge in this area with new findings from the most recent literature.. Literature searches were conducted using the Web of Science database up to February 2010. The terms searched were: "cannabi*" or "marijuana", and "cogniti*" or "memory" or "attention" or "executive function", and human studies were reviewed preferentially over the animal literature.. Cannabis use impairs memory, attention, inhibitory control, executive functions and decision making, both during the period of acute intoxication and beyond, persisting for hours, days, weeks or more after the last use of cannabis. Pharmacological challenge studies in humans are elucidating the nature and neural substrates of cognitive changes associated with various cannabinoids. Long-term or heavy cannabis use appears to result in longer-lasting cognitive abnormalities and possibly structural brain alterations. Greater adverse cognitive effects are associated with cannabis use commencing in early adolescence.. The endogenous cannabinoid system is involved in regulatory neural mechanisms that modulate processes underlying a range of cognitive functions that are impaired by cannabis. Deficits in human users most likely therefore reflect neuroadaptations and altered functioning of the endogenous cannabinoid system.

Topics: Animals; Cannabis; Cognition Disorders; Humans; Marijuana Abuse; Time Factors

General population epidemiological studies have consistently found that cannabis use increases the risk of developing psychotic disorders in a dose-dependent manner. While the epidemiological signal between cannabis and psychosis has gained considerable attention, the biological mechanism whereby cannabis increases risk for psychosis remains poorly understood. Animal research suggests that delta-9-tetrahydrocannabinol (THC, the main psychoactive component of cannabis) increases dopamine levels in several regions of the brain, including striatal and prefrontal areas. Since dopamine is hypothesized to represent a crucial common final pathway between brain biology and actual experience of psychosis, a focus on dopamine may initially be productive in the examination of the psychotomimetic effects of cannabis. Therefore, this review examines the evidence concerning the interactions between THC, endocannabinoids and dopamine in the cortical as well as subcortical regions implicated in psychosis, and considers possible mechanisms whereby cannabis-induced dopamine dysregulation may give rise to delusions and hallucinations. It is concluded that further study of the mechanisms underlying the link between cannabis and psychosis may be conducted productively from the perspective of progressive developmental sensitization, resulting from gene-environment interactions.

Topics: Animals; Cannabis; Cerebral Cortex; Dopamine; Dronabinol; Humans; Marijuana Abuse; Neural Pathways; Psychotic Disorders

Cannabis use during adolescence increases the risk of developing psychotic disorders later in life. However, the neurobiological processes underlying this relationship are unknown. This review reports the results of a literature search comprising various neurobiological disciplines, ultimately converging into a model that might explain the neurobiology of cannabis-induced schizophrenia. The article briefly reviews current insights into brain development during adolescence. In particular, the role of the excitatory neurotransmitter glutamate in experience-dependent maturation of specific cortical circuitries is examined. The review also covers recent hypotheses regarding disturbances in strengthening and pruning of synaptic connections in the prefrontal cortex, and the link with latent psychotic disorders. In the present model, cannabis-induced schizophrenia is considered to be a distortion of normal late postnatal brain maturation. Distortion of glutamatergic transmission during critical periods may disturb prefrontal neurocircuitry in specific brain areas. Our model postulates that adolescent exposure to Δ9-tetrahydrocannabinol (THC), the primary psychoactive substance in cannabis, transiently disturbs physiological control of the endogenous cannabinoid system over glutamate and GABA release. As a result, THC may adversely affect adolescent experience-dependent maturation of neural circuitries within prefrontal cortical areas. Depending on dose, exact time window and duration of exposure, this may ultimately lead to the development of psychosis or schizophrenia. The proposed model provides testable hypotheses which can be addressed in future studies, including animal experiments, reanalysis of existing epidemiological data, and prospective epidemiological studies in which the role of the dose-time-effect relationship should be central.

Topics: Adolescent; Brain; Cannabinoid Receptor Modulators; Cannabis; Dronabinol; Humans; Marijuana Abuse; Models, Neurological; Nerve Net; Neurobiology; Neurotransmitter Agents; Receptors, AMPA; Receptors, N-Methyl-D-Aspartate; Risk Factors; Schizophrenia; Synapses

Evaluate the relationship between acute and chronic use of cannabis and mood changes.. Articles were selected by electronic search in PubMed. Chapters in books and reference lists of selected articles were also reviewed. As the research did not involve humans, there was no evaluation by a Research Ethics Committee.. High rates of comorbidity between use/abuse/dependence of cannabis and affective disorders in longitudinal studies and in clinical samples were observed. Longitudinal studies indicate that, in long-term, the higher use of cannabis is associated with an increased risk of developing bipolar disorder, and probably, major depression in subjects initially without affective disorder, but was not found increased risk of cannabis use among those initially only with mania or depression. Another important observation is that substance abuse in bipolar patients may be associated with a number of negative characteristics, such as difficulty in recovering the affective symptoms, more hospitalizations, poor compliance with treatment, increased risk of suicide, aggression and a poor response to lithium. Psychosocial and pharmacological treatments are indicated for the management of comorbidity between cannabis and affective disorders.. The relationship between cannabis use and mood changes are observed both in the epidemiological research and in the clinical settings.

Topics: Bipolar Disorder; Cannabis; Depression; Dose-Response Relationship, Drug; Humans; Marijuana Abuse; Marijuana Smoking; Mood Disorders

Cannabis is a widely used substance that may be becoming more socially accepted, legally tolerated, and utilized by younger individuals. This review explores the relationship between cannabis and the onset of psychosis as well as the policy ramifications of current research.. This article synthesizes published work that was considered by the author to be relevant to the discussion of cannabis and the onset of psychosis.. The evidence suggests that, along with other harms, cannabis is a significant risk factor in the etiology of psychosis. Adolescents are more vulnerable to using cannabis, and because of their stage of mental development, the cognitive effects are more pronounced. The mechanism for this change is thought to be neuro-chemical with a stronger effect in those with a diathesis for psychosis.. The risk that cannabis poses to adolescent health should not be neglected. Policy measures should use a multifaceted and strategic perspective in order to prevent adolescents from using this drug.

Topics: Adolescent; Adolescent Behavior; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Psychoses, Substance-Induced; Risk Factors

Impaired cognitive functioning, including deficits in working memory, is considered to be a core and disabling feature of schizophrenia that is difficult to treat. Deficits in working memory in schizophrenia are attributable, at least in part, to specific pathological alterations in the neuronal circuitry of the dorsolateral prefrontal cortex that involve, but are not restricted to, disturbances in glutamate, GABA, and dopamine neurotransmission. Cannabis use provides an example of an environmental exposure that may have a deleterious impact on these neurotransmitter systems and thereby contribute to worsening of cognitive functioning in schizophrenia. Increasing knowledge of the nature of the molecular alterations in these cortical circuits may lead to the development of new pathophysiologically informed treatment options for cognitive deficits in schizophrenia.

Topics: Animals; Cannabis; Cognition Disorders; Humans; Marijuana Abuse; Models, Neurological; Nerve Net; Neurons; Prefrontal Cortex; Schizophrenia

The topic of drug addiction or misuse of drugs has numerous far-reaching ramifications into areas such as neuroscience, medicine and therapeutics, toxicology, epidemiology, national and international economics and politics, and the law. The general principles of drug addiction are first summarised. A recurring and intrinsic problem is lack of adequate characterisation of the independent variable, namely the drug taken. Secondly, it is not feasible to allocate subjects randomly to treatments. Thirdly, the heterogeneity of different forms of addiction precludes facile generalisations. "A problem drug user is anyone who experiences social, psychological, physical, or legal problems related to intoxication, and/or regular excessive consumption, and/or dependence as a consequence of their use of drugs" (UK Advisory Council on Misuse of Drugs, 1982). Cannabis is a genus of flowering plants whose products are used as recreational drugs. Claims have been made for a range of therapeutic properties. Its two main active principles are delta9 - tetrahydrocannabinol (THC) and cannabidiol (CBD). These compounds have contrasting pharmacological properties. THC is suspected of causing psychotic phenomena, but CBD seems more sedative and may even be antipsychotic. The past use of cannabis, particularly the concentrations of THC and CBD, can be monitored with hair analysis. Recent studies involving the administration of THC and CBD to human subjects are reviewed. Suggestions are made for further research into the pharmacology and toxicology of CBD. Such data may also point to a more rational evidence-based approach to the legal control of cannabis preparations.

Topics: Cannabis; Drug and Narcotic Control; Humans; Marijuana Abuse; Phytotherapy; Plant Preparations; Psychotic Disorders

Stroke associated with drug abuse has been frequently reported, particularly in young patients. The most commonly implicated drugs include cocaine, heroine, and amphetamines. Despite its widespread abuse, cannabis associated stroke is only infrequently reported. The cause and effect association between cannabis use and stroke is not firmly established. Presuming that cannabis may cause stroke, potential pathophysiologic mechanisms are not known. In this paper, we shall review the literature linking cannabis use and stroke and possible mechanisms supporting this link.

Topics: Acute Disease; Cannabinoids; Cannabis; Chronic Disease; Humans; Hypertension; Marijuana Abuse; Stroke; Vasoconstriction; Vasospasm, Intracranial

This paper provides an overview of the epidemiology of cannabis use, cannabis use disorders and its treatment. Cannabis is the most commonly used illicit drug internationally. While use is decreasing in the developed world, it appears to be stable or increasing in developing countries and some indigenous communities. Early initiation and regular adolescent use have been identified as particular risk factors for later problematic cannabis (and other drug) use, impaired mental health, delinquency, lower educational achievement, risky sexual behaviour and criminal offending in a range of studies. It is estimated that approximately one in ten people who had ever used cannabis will become dependent with risk increasing markedly with frequency of use. There has been an increase in the proportion of treatment provided for cannabis use. There are as yet no evidence-based pharmacotherapies available for the management of cannabis withdrawal and craving. Relatively brief cognitive behavioural therapy and contingency management have the strongest evidence of success, and structured, family-based interventions, provide potent treatment options for adolescents. With criminally involved young people and those with severe, persistent mental illness, longer and more intensive therapies provided by interdisciplinary teams may be required.

Topics: Adolescent; Adolescent Behavior; Cannabis; Cognitive Behavioral Therapy; Humans; Juvenile Delinquency; Marijuana Abuse; Mental Disorders; Treatment Outcome

Cannabis use disorders have been recently identified as a relevant clinical issue: a subset of cannabis smokers seeks treatment for their cannabis use, yet few succeed in maintaining long-term abstinence. The rewarding and positive reinforcing effects of the primary psychoactive component of smoked cannabis, delta-9-tetrahydrocannabinol (THC) are mediated by the cannabinoid CB1 receptor. The CB1 receptor has also been shown to mediate cannabinoid dependence and expression of withdrawal upon cessation of drug administration, a phenomenon verified across species. This paper will review findings implicating the CB1 receptor in the behavioural effects of exogenous cannabinoids with a focus on cannabinoid dependence and reinforcement, factors that contribute to the maintenance of chronic cannabis smoking despite negative consequences. Opioidergic modulation of these effects is also discussed.

Topics: Animals; Cannabis; Dronabinol; Humans; Marijuana Abuse; Marijuana Smoking; Receptor, Cannabinoid, CB1; Reinforcement, Psychology

Recent advances in knowledge about cannabinoid receptor function have renewed interest in the association between cannabis and psychosis. Case series, autobiographical accounts, and surveys of cannabis users in the general population suggest an association between cannabis and psychosis. Cross-sectional studies document an association between cannabis use and psychotic symptoms, and longitudinal studies suggest that early exposure to cannabis confers a close to two-fold increase in the risk of developing schizophrenia. Pharmacological studies show that cannabinoids can induce a full range of transient positive, negative, and cognitive symptoms in healthy individuals that are similar to those seen in schizophrenia. There is considerable evidence that in individuals with an established psychotic disorder such as schizophrenia, exposure to cannabis can exacerbate symptoms, trigger relapse, and worsen the course of the illness. Only a very small proportion of the general population exposed to cannabis develop a psychotic illness. It is likely that cannabis exposure is a 'component cause' that interacts with other factors to 'cause' schizophrenia or other psychotic disorder, but is neither necessary nor sufficient to do so alone. Further work is necessary to identify the factors that underlie individual vulnerability to cannabinoid-related psychosis and to elucidate the biological mechanisms underlying this risk.

Topics: Animals; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Psychotic Disorders; Receptors, Cannabinoid; Risk Factors; Schizophrenia

The association between cannabis use and psychosis has long been recognized. Recent advances in knowledge about cannabinoid receptor function have renewed interest in this association. Converging lines of evidence suggest that cannabinoids can produce a full range of transient schizophrenia-like positive, negative, and cognitive symptoms in some healthy individuals. Also clear is that in individuals with an established psychotic disorder, cannabinoids can exacerbate symptoms, trigger relapse, and have negative consequences on the course of the illness. The mechanisms by which cannabinoids produce transient psychotic symptoms, while unclear may involve dopamine, GABA, and glutamate neurotransmission. However, only a very small proportion of the general population exposed to cannabinoids develop a psychotic illness. It is likely that cannabis exposure is a "component cause" that interacts with other factors to "cause" schizophrenia or a psychotic disorder, but is neither necessary nor sufficient to do so alone. Nevertheless, in the absence of known causes of schizophrenia, the role of component causes remains important and warrants further study. Dose, duration of exposure, and the age of first exposure to cannabinoids may be important factors, and genetic factors that interact with cannabinoid exposure to moderate or amplify the risk of a psychotic disorder are beginning to be elucidated. The mechanisms by which exposure to cannabinoids increase the risk for developing a psychotic disorder are unknown. However, novel hypotheses including the role of cannabinoids on neurodevelopmental processes relevant to psychotic disorders are being studied.

Topics: Association; Cannabis; Cognition Disorders; Humans; Marijuana Abuse; Neurotransmitter Agents; Psychotic Disorders; Schizophrenia

Cannabis abuse and endocannabinoids are associated to schizophrenia.. It is important to discern the association between schizophrenia and exogenous Cannabis sativa, on one hand, and the endogenous cannabinoid system, on the other hand.. On one hand, there is substantial evidence that cannabis abuse is a risk factor for psychosis in genetically predisposed people, may lead to a worse outcome of the disease, or it can affect normal brain development during adolescence, increasing the risk for schizophrenia in adulthood. Regarding genetic predisposition, alterations affecting the cannabinoid CNR1 gene could be related to schizophrenia. On the other hand, the endogenous cannabinoid system is altered in schizophrenia (i.e., increased density of cannabinoid CB1 receptor binding in corticolimbic regions, enhanced cerebrospinal fluid anandamide levels), and dysregulation of this system can interact with neurotransmitter systems in such a way that a "cannabinoid hypothesis" can be integrated in the neurobiological hypotheses of schizophrenia. Finally, there is also evidence that some genetic alterations of the CNR1 gene can act as a protectant factor against schizophrenia or can induce a better pharmacological response to atypical antipsychotics.. Cannabis abuse is a risk factor for psychosis in predisposed people, it can affect neurodevelopment during adolescence leading to schizophrenia, and a dysregulation of the endocannabinoid system can participate in schizophrenia. It is also worth noting that some specific cannabinoid alterations can act as neuroprotectant for schizophrenia or can be a psychopharmacogenetic rather than a vulnerability factor.

Topics: Adolescent; Animals; Cannabinoid Receptor Modulators; Cannabis; Endocannabinoids; Genetic Predisposition to Disease; Humans; Marijuana Abuse; Receptor, Cannabinoid, CB1; Risk Factors; Schizophrenia

Anxiety reactions and panic attacks are the acute symptoms most frequently associated with cannabis use. Understanding the relationship between cannabis and anxiety may clarify the mechanism of action of cannabis and the pathophysiology of anxiety. Aims of the present study were to review the nature of the relationship between cannabis use and anxiety, as well as the possible clinical, diagnostic and causal implications.. Systematic review of the Medline, PsycLIT and EMBASE literature.. Frequent cannabis users consistently have a high prevalence of anxiety disorders and patients with anxiety disorders have relatively high rates of cannabis use. However, it is unclear if cannabis use increases the risk of developing long-lasting anxiety disorders. Many hypotheses have been proposed in an attempt to explain these relationships, including neurobiological, environmental and social influences.. The precise relationship between cannabis use and anxiety has yet to be established. Research is needed to fully clarify the mechanisms of such the association.

Topics: Animals; Anxiety; Cannabis; Databases, Bibliographic; Humans; Marijuana Abuse

Cannabis is the most widely consumed illicit drug in the United States. Its use, particularly in early initiates, is associated with subsequent development of other drug and alcohol use disorders.. The authors examined the prevalence of cannabis use and the association between cannabis use and aberrant opioid-related behaviors in patients prescribed chronic opioid therapy for persistent pain.. PubMed was queried for studies of chronic opioid therapy in which aberrant opioid-related behaviors were quantitatively examined and in which cannabis use data (as determined by cannabinoid-positive urine drug tests) were extricable from that of other substances of abuse.. The prevalence of cannabis use among patients prescribed chronic opioid therapy in these studies ranged from 6.2% to 39%, compared with 5.8% in the general United States population. Furthermore, cannabis use in chronic opioid patients shows statistically significant associations with present and future aberrant opioid-related behaviors.. Cannabis use is prevalent in patients prescribed chronic opioid therapy and is associated with opioid misuse. Further research is necessary to clarify the strength and the nature of the association between cannabis use and opioid misuse, and to address additional questions about the consequences of cannabis use in the context of chronic opioid therapy.

Topics: Analgesics, Opioid; Cannabis; Chronic Disease; Comorbidity; Drug Prescriptions; Humans; Marijuana Abuse; Opioid-Related Disorders; Pain, Intractable; Prevalence; United States

For over two decades, cannabis, commonly known as marijuana, has been the most widely used illicit drug by young people in high-income countries, and has recently become popular on a global scale. Epidemiological research during the past 10 years suggests that regular use of cannabis during adolescence and into adulthood can have adverse effects. Epidemiological, clinical, and laboratory studies have established an association between cannabis use and adverse outcomes. We focus on adverse health effects of greatest potential public health interest-that is, those that are most likely to occur and to affect a large number of cannabis users. The most probable adverse effects include a dependence syndrome, increased risk of motor vehicle crashes, impaired respiratory function, cardiovascular disease, and adverse effects of regular use on adolescent psychosocial development and mental health.

Topics: Accidents, Traffic; Adolescent; Adult; Cannabis; Cardiovascular Diseases; Central Nervous System; Dronabinol; Humans; Lung Diseases; Marijuana Abuse; Marijuana Smoking; Mental Disorders; Psychotropic Drugs; Young Adult

Cannabis is the most consumed illicit drug. For a number of years it was thought to be not very toxic, although this idea has no scientific backup. The object of much controversy, it is a public health problem for the most vulnerable populations, adolescents, subjects with evolutive psychopathologies and certain highly cognitive situations: driving a car, the professional environment and students. Cannabis breeds, in international classifications of mental disorders, intoxication charts, abuse and dependence, although this last could have been challenged. The complications are basically anxious and psychotic. It is the object of a number of debates associated with schizophrenic disorders, where it seems to be a risk factor where there is a large consumption before the age of fourteen. Like all psychoactive substances, it is an aggravating factor in all evolutive psychopathologies.

Topics: Adolescent; Adult; Anxiety; Cannabis; Humans; Marijuana Abuse; Mental Disorders; Psychoses, Substance-Induced; Schizophrenia; Young Adult

Cannabis consumption has varying effects over the whole life span, especially on achievements in the areas of schooling, professional life and performance in a social environment. Data from studies on remission from neurocognitive deficits following chronic cannabis consumption are ambiguous. The outcome range included everything from complete remission over considerable lasting deficits up to even chronic psychotic disorders. The data seem to be consistent however, when a differentiation between early begin of consumption (before the age of 16) and late begin of consumption is taken into account. Mainly those cannabis users with an early begin of consumption are prone to developing lasting neurocognitive deficits and even a decrease in grey substance volume, as well as an increase in the risk of psychosis. The correlation of this outcome with cannabis consumption during a phase of brain development that includes the consolidation of higher cognitive functions, awareness of social cues, planning of concepts and motivation as well as tools of functional control, is highly convincing. The endocannabinoid system reaches the point of highest receptor density during this age of 16/17 years, and many of the above-mentioned developmental processes are modulated by this system. A chronic damage to this system (e.g., down-regulation or desensitisation of CB1 receptors by exogenous cannabinoids) therefore holds the potential for permanent neurophysiological as well as neurocognitive deficits, and also for the development of psychotic disorders.

Topics: Brain Diseases; Cannabis; Causality; Comorbidity; Humans; Illicit Drugs; Incidence; Internationality; Marijuana Abuse; Psychoses, Substance-Induced; Risk Assessment; Risk Factors

Marijuana is the number one illicit drug of abuse worldwide and a major public health problem, especially in the younger population. The objective of this article is to update and review the state of the science and treatments available for marijuana dependence based on a pre-meeting workshop that was presented at ISAM 2006. At the workshop, several papers were presented addressing the neurobiology and pharmacology of marijuana and treatment approaches, both psychotherapy and medications, for marijuana withdrawal. Medicolegal and ethical issues concerning marijuana medical use were also discussed. Concise summaries of these presentations are incorporated in this article, which is meant to be an updated review of the state of the science. Major advances have been made in understanding the underpinning of marijuana dependence and the role of the CNS cannabinoid system, which is a major area for targeting medications to treat marijuana withdrawal and dependence, as well as other addictions. Behavioral therapies are efficacious for facilitating abstinence from marijuana. Nefazadone, Marinol, and buspirone are showing early positive signals for efficacy in ameliorating marijuana withdrawal symptoms. Effective psychotherapeutic approaches are available and promising medications studies need to be confirmed in outpatient trials. The next few years looking promising for translational research efforts to make treatment widely accessible to patients with marijuana dependence.

Topics: Brain; Buspirone; Cannabis; Cognitive Behavioral Therapy; Dronabinol; Humans; Marijuana Abuse; Narcotic Antagonists; Piperazines; Social Facilitation; Triazoles

This review explores what is known about the association of cannabis with schizophrenia, its effects on the brain, and whether the brain changes known to be present in schizophrenia could be caused by cannabis and thus lead to a psychosis.. The heavy use of cannabis is known to be associated with some adverse consequences, such as the occurrence of acute psychotic episodes and the development of chronic schizophrenia in some people even after its use has terminated. Recent studies have produced controversy about whether cannabis in heavy use can cause irreversible brain damage, particularly to adolescents, and thus whether a chronic psychosis could be a result of brain changes caused by cannabis.. From the evidence that exists, it appears that the above view is unlikely and that cannabis may even have benign effects on brain structure, not producing deleterious damage. Its neurochemical interactions with the dopaminergic pathway, however, may, particularly in genetically vulnerable individuals, have adverse consequences.

Topics: Brain; Cannabis; Humans; Magnetic Resonance Imaging; Marijuana Abuse; Prevalence; Psychoses, Substance-Induced; Risk Factors; Schizophrenia

Increased potency and contamination of cannabis have been linked in the public domain to adverse mental health outcomes. This paper reviews the available international evidence on patterns of cannabis potency and contamination and potential associated harms, and discusses their implications for prevention and harm reduction measures.. A systematic literature search on cannabis potency and contamination was conducted.. Cannabis samples tested in the United States, the Netherlands, United Kingdom and Italy have shown increases in potency over the last 10 years. Some countries have not shown significant increases in potency, while other countries have not monitored potency over time. While there are some grounds to be concerned about potential contaminants in cannabis, there has been no systematic monitoring.. Increased potency has been observed in some countries, but there is enormous variation between samples, meaning that cannabis users may be exposed to greater variation in a single year than over years or decades. Claims made in the public domain about a 20- or 30-fold increase in cannabis potency and about the adverse mental health effects of cannabis contamination are not supported currently by the evidence. Systematic scientific testing of cannabis is needed to monitor current and ongoing trends in cannabis potency, and to determine whether cannabis is contaminated. Additionally, more research is needed to determine whether increased potency and contamination translates to harm for users, who need to be provided with accurate and credible information to prevent and reduce harms associated with cannabis use.

Topics: Cannabinoids; Cannabis; Drug Contamination; Evidence-Based Medicine; Humans; Marijuana Abuse; Public Health

Delta (9)-tetrahydrocannabinol (THC), the most important psychoactive substance in cannabis, is frequently detected in blood from apprehended drivers suspected for drugged driving. Both experimental and epidemiological studies have demonstrated the negative effects of THC upon cognitive functions and psychomotor skills. These effects could last longer than a measurable concentration of THC in blood. Culpability studies have recently demonstrated an increased risk of becoming responsible in fatal or injurious traffic accidents, even with low blood concentrations of THC. It has also been demonstrated that there is a correlation between the degree of impairment, the drug dose and the THC blood concentration. It is very important to focus on the negative effect of cannabis on fitness to drive in order to prevent injuries and loss of human life and to avoid large economic consequences to the society.

Topics: Accidents, Traffic; Automobile Driving; Cannabis; Central Nervous System Stimulants; Cognition; Dronabinol; Humans; Marijuana Abuse; Psychomotor Performance; Psychotropic Drugs; Risk Factors

The majority of recreational Ecstasy/MDMA users (90-98%) also take cannabis. This co-drug usage is often viewed as a methodological confound, which needs to be removed statistically. Here we take a rather different approach, and debate the potential complexities of their psychobiological interactions. The ring-substituted amphetamine derivate MDMA (3,4-methylendioxymethamphetmaine, or 'Ecstasy') is a powerful CNS stimulant, whereas cannabis is a relaxant. Their co-usage may reflect opposing effects in three psychobiological areas: arousal, body temperature, and oxidative stress. Firstly MDMA is alerting whereas cannabis is sedating. Secondly MDMA is hyperthermic whereas cannabis is hypothermic. Thirdly MDMA increases oxidative stress whereas cannabinoids are antioxidant. Hence cannabis may modulate the acute and sub-acute reactions to MDMA, reduce the acute hyperthermia induced by MDMA, and ameliorate the oxidative stress caused by MDMA. The limited empirical evidence on each topic will be critically examined. In terms of chronic effects each drug is functionally damaging, so that polydrug users generally display cumulative neurobiological impairments. However in certain aspects their neuropsychobiological effects may interactive rather than additive. In particular, the combined use of cannabis and MDMA may have rather different neuropsychobiological implications, than their separate usage. In order to investigate these potential complexities, future research will need better empirical data on the exact patterns of co-drug usage.

Topics: Animals; Cannabis; Cytoprotection; Drug Interactions; Fever; Hallucinogens; Humans; Marijuana Abuse; N-Methyl-3,4-methylenedioxyamphetamine; Neurocognitive Disorders; Oxidative Stress; Risk Factors

Cannabis has an ancient history of human use and is currently one of the most commonly used drugs worldwide. Understanding its impact on neurobehavioral functioning is of significant public health concern. In recent decades, substantial progress has been made in understanding the impact of cannabis use on neurobehavioral functioning. This has been fueled, in part, by characterization of an endocannabinoid signaling system in the brain through which cannabis exerts its psychoactive effects. Acute intoxication with cannabis causes marked changes in subjective mental status, brain functioning, and neuropsychological performance. Some of these changes are consistently detected and well characterized, yet others are not. Changes in brain functioning and neuropsychological performance are also reported after abstinence, but appear to be mild, circumscribed, and transient. On the other hand, functional neuroimaging often reveals subtle differences in the brain functioning of abstinent cannabis users compared with controls. The persistence and clinical significance of these differences, however, remains to be determined. Neuropsychological deficits and differences in brain functioning are most consistently observed only among frequent, heavy users, who are those most likely addicted to cannabis. The dire impact of drug addiction on a person's life and everyday functioning suggests that the large number of individuals addicted to cannabis experience substantial negative effects from its use. This manuscript reviews the scientific literature on the aforementioned topics in detail, providing evidence for converging findings, and highlighting areas in need of further investigation.

Topics: Animals; Brain; Cannabinoids; Cannabis; Diagnostic Imaging; Humans; Marijuana Abuse; Neuropsychological Tests; Time Factors

Growing evidence supports the hypothesis that cannabis consumption is a risk factor for the development of psychotic symptoms. Nonetheless, controversy remains about the causal nature of the association. This review takes the debate further through a critical appraisal of the evidence. An electronic search was performed, allowing to identify 622 studies published until June 1st 2005. Longitudinal studies and literature reviews were selected if they addressed specifically the issues of the cannabis/psychosis relationship or possible mechanisms involved. Ten epidemiological studies were relevant: three supported a causal relationship between cannabis use and diagnosed psychosis; five suggested that chronic cannabis intake increases the frequency of psychotic symptoms, but not of diagnosed psychosis; and two showed no causal relationship. Potential neurobiological mechanisms were also identified, involving dopamine, endocannabinoids, and brain growth factors. Although there is evidence that cannabis use increases the risk of developing psychotic symptoms, the causal nature of this association remains unclear. Contributing factors include heavy consumption, length and early age of exposure, and psychotic vulnerability. This conclusion should be mitigated by uncertainty arising from cannabis use assessment, psychosis measurement, reverse causality and control of residual confounding.

Topics: Age Factors; Cannabis; Confounding Factors, Epidemiologic; Epidemiologic Studies; Humans; Marijuana Abuse; Marijuana Smoking; Psychotic Disorders; Risk Factors; Time Factors

The acute side effects caused by cannabis use are mainly related to psyche and cognition, and to circulation. Euphoria, anxiety, changes in sensory perception, impairment of memory and psychomotor performance are common effects after a dose is taken that exceeds an individually variable threshold. Cannabis consumption may increase heart rate and change blood pressure, which may have serious consequences in people with heart disease. Effects of chronic use may be induction of psychosis and development of dependency to the drug. Effects on cognitive abilities seem to be reversible after abstinence, except possibly in very heavy users. Cannabis exposure in utero may have negative consequences on brain development with subtle impairment of cognitive abilities in later life. Consequences of cannabis smoking may be similar to those of tobacco smoking and should be avoided. Use by young people has more detrimental effects than use by adults. There appear to be promising therapeutic uses of cannabis for a range of indications. Use of moderate doses in a therapeutic context is usually not associated with severe side effects. Current prohibition on cannabis use may also have harmful side effects for the individual and the society, while having little influence on prevalence of use. Harm is greatest for seriously ill people who may benefit from a treatment with cannabis. This makes it difficult to justify criminal penalties against patients.

Topics: Animals; Blood Pressure; Cannabidiol; Cannabis; Cognition; Dronabinol; Drug Combinations; Heart Rate; Humans; Legislation, Drug; Marijuana Abuse; Plant Extracts; Psychomotor Performance; Risk Assessment

The link between cannabis use and psychosis has been studied intensively and debated hotly for decades. The authors review the research that has been done on the topic, including the studies which produced evidence of a relationship between the two phenomena, and give a detailed analysis of the hypotheses about the nature of the link (the direction of causality). According to the reviewed literature an increased prevalence of cannabis use can be found in the schizophrenic population. The use of the drug is associated with a worse prognosis and an earlier onset of schizophrenia. However, findings about the possible effect of cannabis use on the specific symptoms of schizophrenia have been contradictory. An association has also been observed between cannabis use and schizotypal personality traits, but evidence for a specific, cannabis induced functional psychosis is still lacking. Based on the data of longitudinal studies, cannabis use should be recognized as a risk factor for later psychosis. The abuse of the drug increases the likelihood of later psychotic symptoms especially among individuals with vulnerability or when the use starts in early adolescence. At the same time, the role of self-medication or a common genetic background cannot be excluded either, and a circular causality is very possible.

Topics: Age of Onset; Cannabis; Disease Susceptibility; Humans; Marijuana Abuse; Prognosis; Psychoses, Substance-Induced; Risk Factors; Schizophrenia; Self Medication

Cannabis remains the most widely used illegal drug in the United States. This update examines the available literature on neuroimaging studies of the brains of cannabis users. The majority of studies examining the acute effects of delta-9-tetrahydrocannabinol (THC) administration used PET methods and concluded that administration of THC leads to increased activation in frontal and paralimbic regions and the cerebellum. These increases in activation are broadly consistent with the behavioral effects of the drug. Although there is only equivocal evidence that chronic cannabis use might result in structural brain changes, blood-oxygenation-level-dependent-fMRI studies in chronic users consistently show alterations, or neuroadaptation, in the activation of brain networks responsible for higher cognitive functions. It is not yet certain whether these changes are reversible with abstinence. Given the high prevalence of cannabis use among adolescents, studies are needed to evaluate whether cannabis use might affect the developing brain. Considerable further work, employing longitudinal designs, is also required to determine whether cannabis use causes permanent functional alterations in the brains of adults.

Topics: Brain; Cannabis; Dronabinol; Hallucinogens; Humans; Magnetic Resonance Imaging; Marijuana Abuse; Positron-Emission Tomography

Development of a rational and enforceable basis for controlling the impact of cannabis use on traffic safety.. An international working group of experts on issues related to drug use and traffic safety evaluated evidence from experimental and epidemiological research and discussed potential approaches to developing per se limits for cannabis.. In analogy to alcohol, finite (non-zero) per se limits for delta-9-tetrahydrocannabinol (THC) in blood appear to be the most effective approach to separating drivers who are impaired by cannabis use from those who are no longer under the influence. Limited epidemiological studies indicate that serum concentrations of THC below 10 ng/ml are not associated with an elevated accident risk. A comparison of meta-analyses of experimental studies on the impairment of driving-relevant skills by alcohol or cannabis suggests that a THC concentration in the serum of 7-10 ng/ml is correlated with an impairment comparable to that caused by a blood alcohol concentration (BAC) of 0.05%. Thus, a suitable numerical limit for THC in serum may fall in that range.. This analysis offers an empirical basis for a per se limit for THC that allows identification of drivers impaired by cannabis. The limited epidemiological data render this limit preliminary.

Topics: Accidents, Traffic; Automobile Driving; Cannabis; Drug Monitoring; Humans; Marijuana Abuse; Psychomotor Disorders; Risk Factors; Risk-Taking; Substance Abuse Detection

Cannabis is the world's most widely cultivated and consumed illicit drug, but there remain major gaps in our understanding of global cannabis markets. For example, it appears that premium sinsemilla cannabis, often produced indoors in consumer countries, has become more potent in recent years and that its market share is also growing in some areas. This may be leading to greater localization of cannabis markets. It may also be responsible for the increase in the proportion of cannabis users in treatment populations at the international level. Assessing the extent and impact of this trend, however, is hampered both by a lack of international standards on issues such as terminology and by unanswered research questions. In order to arrive at accurate global estimates of the extent of production, there is a need for more scientific data on cannabis yields. On the demand side, more information is required on the question of cannabis dosage and volumes used by both occasional and regular users. Cannabis is not a uniform drug: the impact of using cannabis of differing potencies and chemical compositions needs to be researched. While issues concerning cannabis have been evaluated many times in the past, it remains a highly adaptable plant and, consequently, a dynamic drug, requiring constant reassessment.

Topics: Agriculture; Cannabis; Cost of Illness; Criminal Law; Dronabinol; Drug and Narcotic Control; Global Health; Humans; Illicit Drugs; Marijuana Abuse; Marijuana Smoking; Marketing; Morbidity; Population Surveillance; Prevalence

The demand for treatment for cannabis dependence has grown dramatically. The majority of the people who enter the treatment have difficulty in achieving and maintaining abstinence from cannabis. Understanding the impact of cannabis withdrawal syndrome on quit attempts is of obvious importance. Cannabis, however, has long been considered a 'soft' drug, and many continue to question whether one can truly become dependent on cannabis. Skepticism is typically focused on whether cannabis use can result in 'physiological' dependence or withdrawal, and whether withdrawal is of clinical importance.. The neurobiological basis for cannabis withdrawal has been established via discovery of an endogenous cannabinoid system, identification of cannabinoid receptors, and demonstrations of precipitated withdrawal with cannabinoid receptor antagonists. Laboratory studies have established the reliability, validity, and time course of a cannabis withdrawal syndrome and have begun to explore the effect of various medications on such withdrawal. Reports from clinical samples indicate that the syndrome is common among treatment seekers.. A clinically important withdrawal syndrome associated with cannabis dependence has been established. Additional research must determine how cannabis withdrawal affects cessation attempts and the best way to treat its symptoms.

Topics: Animals; Cannabis; Dogs; Humans; Marijuana Abuse; Mice; Rats; Substance Withdrawal Syndrome

Substance use by adolescents and young adults continues to be a serious problem. Marijuana remains the most commonly used illicit substance with close to 50% of high school seniors admitting use at some time. Each year 2.6 million individuals in this country become new users and most are under 19 years old. Individuals who provide health care services to this age group must have an understanding of the drug, its pharmacokinetics, and the many short- and long-term adverse effects. Familiarity with risk factors associated with initiating use can be helpful in screening older children and targeting anticipatory guidance toward those most likely to benefit. This article reviews these issues and includes commentary on a recently published review of treatment programs.

Topics: Adolescent; Adolescent Behavior; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Risk Factors; Substance Abuse Detection

Cannabis is one of the most frequently used substances. Cannabis and its constituent cannabinoids are known to impair several aspects of cognitive function, with the most robust effects on short-term episodic and working memory in humans. A large body of the work in this area occurred in the 1970s before the discovery of cannabinoid receptors. Recent advances in the knowledge of cannabinoid receptors' function have rekindled interest in examining effects of exogenous cannabinoids on memory and in understanding the mechanism of these effects.. The literature about the acute effects of cannabinoids on memory tasks in humans is reviewed. The limitations of the human literature including issues of dose, route of administration, small sample sizes, sample selection, effects of other drug use, tolerance and dependence to cannabinoids, and the timing and sensitivity of psychological tests are discussed. Finally, the human literature is discussed against the backdrop of preclinical findings.. Acute administration of Delta-9-THC transiently impairs immediate and delayed free recall of information presented after, but not before, drug administration in a dose- and delay-dependent manner. In particular, cannabinoids increase intrusion errors. These effects are more robust with the inhaled and intravenous route and correspond to peak drug levels.. This profile of effects suggests that cannabinoids impair all stages of memory including encoding, consolidation, and retrieval. Several mechanisms, including effects on long-term potentiation and long-term depression and the inhibition of neurotransmitter (GABA, glutamate, acetyl choline, dopamine) release, have been implicated in the amnestic effects of cannabinoids. Future research in humans is necessary to characterize the neuroanatomical and neurochemical basis of the memory impairing effects of cannabinoids, to dissect out their effects on the various stages of memory and to bridge the expanding gap between the humans and preclinical literature.

Topics: Animals; Cannabinoids; Cannabis; Drug Tolerance; Humans; Marijuana Abuse; Memory; Receptors, Cannabinoid; Substance Withdrawal Syndrome

When admitted in an emergency unit, young patients often present acute neurological effects of smoked marijuana. Other chronic adverse effects of marijuana are probably underestimated: postural syncope, arteritis, chronic bronchitis, amnesia. Marijuana may trigger a myocardial infarction and have a vasospastic effect. Marijuana has impairing effects on driving ability. Smoked marijuana is a potential respiratory tract carcinogen.

Topics: Accidents, Traffic; Adolescent; Adult; Automobile Driving; Cannabis; Cardiovascular Diseases; Confidence Intervals; Emergencies; Female; Health Education; Humans; Laryngeal Neoplasms; Lung Neoplasms; Male; Marijuana Abuse; Marijuana Smoking; Odds Ratio; Risk; Risk Factors; Smoking; Stroke

Cannabis, commonly known as marijuana, is the most frequently used illicit drug in Australia. Therefore, oral health care providers are likely to encounter patients who are regular users. An upward trend in cannabis use is occurring in Australia, with 40 per cent of the population aged 14 and above having used the drug. There are three main forms of cannabis: marijuana, hash and hash oil, all of which contain the main psychoactive constituent delta-9-tetrahydrocannabinol (THC). Cannabis is most commonly smoked, however it can be added to foods. THC from cannabis enters the bloodstream and exerts its effects on the body via interaction with endogenous receptors. Cannabis affects almost every system of the body, particularly the cardiovascular, respiratory and immune systems. It also has acute and chronic effects on the mental health of some users. Therefore, chronic abuse is a concern because of its negative effects on general physical and mental health. Cannabis abusers generally have poorer oral health than non-users, with an increased risk of dental caries and periodontal diseases. Cannabis smoke acts as a carcinogen and is associated with dysplastic changes and pre-malignant lesions within the oral mucosa. Users are also prone to oral infections, possibly due to the immunosuppressive effects. Dental treatment on patients intoxicated on cannabis can result in the patient experiencing acute anxiety, dysphoria and psychotic-like paranoiac thoughts. The use of local anaesthetic containing epinephrine may seriously prolong tachycardia already induced by an acute dose of cannabis. Oral health care providers should be aware of the diverse adverse effects of cannabis on general and oral health and incorporate questions about patients' patterns of use in the medical history.

Topics: Cannabis; Dental Care; Dronabinol; Humans; Marijuana Abuse; Marijuana Smoking; Mouth Diseases; Psychotropic Drugs; Tooth Diseases

A subset of marijuana smokers develop a cannabis use disorder and seek treatment for their marijuana use on their own initiative. A less well-known consequence of daily, repeated marijuana use is a withdrawal syndrome, characterized by a time-dependent constellation of symptoms: irritability, anxiety, marijuana craving, decreased quality and quantity of sleep, and decreased food intake. Treatment studies show that rates of continuous abstinence are low (comparable to relapse rates for other abused drugs), and more treatment options are needed. The objective of this review is to update clinicians on the current state of marijuana research and to describe features of marijuana withdrawal to facilitate the diagnosis and treatment of cannabis use disorders.

Topics: Anxiety; Cannabis; Eating; Humans; Irritable Mood; Marijuana Abuse; Sleep Wake Disorders; Substance Withdrawal Syndrome

Safety issues are a major barrier to the use of cannabis and cannabinoid medications for clinical purposes. Information on the safety of herbal cannabis may be derived from studies of recreational cannabis use, but cannabis exposure and effects may differ widely between medical and recreational cannabis users. Standardized, quality-controlled cannabinoid products are available in Canada, and safety profiles of approved medications are available through the Canadian formulary. In the present article, the evidence behind major safety issues related to cannabis use is summarized, with the aim of promoting informed dialogue between physicians and patients in whom cannabinoid therapy is being considered. Caution is advised in interpreting these data, because clinical experience with cannabinoid use is in the early stages. There is a need for long-term safety monitoring of patients using cannabinoids for a wide variety of conditions, to further guide therapeutic decisions and public policy.

Topics: Bronchitis; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking

Cannabis has been known as a medicine for several thousand years across many cultures. It reached a position of prominence within Western medicine in the nineteenth century but became mired in disrepute and legal controls early in the twentieth century. Despite unremitting world-wide suppression, recreational cannabis exploded into popular culture in the 1960s and has remained easily obtainable on the black market in most countries ever since. This ready availability has allowed many thousands of patients to rediscover the apparent power of the drug to alleviate symptoms of some of the most cruel and refractory diseases known to humankind. Pioneering clinical research in the last quarter of the twentieth century has given some support to these anecdotal reports, but the methodological challenges to human research involving a pariah drug are formidable. Studies have tended to be small, imperfectly controlled, and have often incorporated unsatisfactory synthetic cannabinoid analogues or smoked herbal material of uncertain composition and irregular bioavailability. As a result, the scientific evaluation of medicinal cannabis in humans is still in its infancy. New possibilities in human research have been opened up by the discovery of the endocannabinoid system, a rapidly expanding knowledge of cannabinoid pharmacology, and a more sympathetic political environment in several countries. More and more scientists and clinicians are becoming interested in exploring the potential of cannabis-based medicines. Future targets will extend beyond symptom relief into disease modification, and already cannabinoids seem to offer particular promise in the treatment of certain inflammatory and neurodegenerative conditions. This chapter will begin with an outline of the development and current status of legal controls pertaining to cannabis, following which the existing human research will be reviewed. Some key safety issues will then be considered, and the chapter will conclude with some suggestions as to future directions for human research.

Topics: Appetite; Cannabinoids; Cannabis; Cognition; Epilepsy; Glaucoma; Humans; Marijuana Abuse; Multiple Sclerosis; Nausea; Neoplasms; Neuroprotective Agents; Pain; Phytotherapy; Spinal Cord Injuries; Vomiting

Actually, guidelines for treatment of substance-related disorders were written under the overall control of the DG-Sucht e. V. and the DGPPN e. V. This appears within the framework of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaft (AWMF). The leading objective of these guidelines is the description of the current scientifically proven and evidence-based medicine in addiction to derive recommendations to therapy. In this context, the guideline for treatment of cannabis-related disorders is introduced.

Topics: Cannabis; Drug Interactions; Evidence-Based Medicine; Humans; Marijuana Abuse; Mental Disorders; Psychoses, Substance-Induced; Recurrence

Recent research has clarified a number of important questions concerning adverse effects of cannabis on health. A causal role of acute cannabis intoxication in motor vehicle and other accidents has now been shown by the presence of measurable levels of Delta(9)-tetrahydrocannabinol (THC) in the blood of injured drivers in the absence of alcohol or other drugs, by surveys of driving under the influence of cannabis, and by significantly higher accident culpability risk of drivers using cannabis. Chronic inflammatory and precancerous changes in the airways have been demonstrated in cannabis smokers, and the most recent case-control study shows an increased risk of airways cancer that is proportional to the amount of cannabis use. Several different studies indicate that the epidemiological link between cannabis use and schizophrenia probably represents a causal role of cannabis in precipitating the onset or relapse of schizophrenia. A weaker but significant link between cannabis and depression has been found in various cohort studies, but the nature of the link is not yet clear. A large body of evidence now demonstrates that cannabis dependence, both behavioral and physical, does occur in about 7-10% of regular users, and that early onset of use, and especially of weekly or daily use, is a strong predictor of future dependence. Cognitive impairments of various types are readily demonstrable during acute cannabis intoxication, but there is no suitable evidence yet available to permit a decision as to whether long-lasting or permanent functional losses can result from chronic heavy use in adults. However, a small but growing body of evidence indicates subtle but apparently permanent effects on memory, information processing, and executive functions, in the offspring of women who used cannabis during pregnancy. In total, the evidence indicates that regular heavy use of cannabis carries significant risks for the individual user and for the health care system.

Topics: Accidents, Traffic; Automobile Driving; Cannabis; Cardiovascular Diseases; Cognition Disorders; Cohort Studies; Dronabinol; Humans; Longitudinal Studies; Marijuana Abuse; Marijuana Smoking; Neurotoxicity Syndromes; Psychomotor Performance; Public Health; Respiratory Tract Diseases; Risk; Schizophrenia

This review covers published information on psychoactive drugs, particularly cannabis, in Papua New Guinea. Legal drugs are mentioned to place the illegal drugs into a broader public health context. Although a number of psychoactive drugs were used traditionally (and are used now), cannabis is the only illicit drug for which prevalence of use is currently not negligible. Very little epidemiology research on cannabis use and its individual and public health sequelae has been conducted, although a fuller criminology literature on the topic exists. The published cannabis use prevalence studies are limited in scope, and the most-cited one is of questionable accuracy. The complex interactions between the health of individuals and their social environments are highlighted by the destructive impacts that cannabis cultivation, trafficking and use are having in contemporary PNG.

Topics: Cannabinoids; Cannabis; Drug and Narcotic Control; Humans; Illicit Drugs; Marijuana Abuse; Medicine, Traditional; Papua New Guinea; Phytotherapy; Prevalence

A high incidence of positive cases for cannabinoids, in analyses for doping control in sports, has been observed since the International Olympic Committee (IOC) included them in the 1989 list of prohibited drugs under the title of classes of prohibited substances in certain circumstances. Where the rules of sports federations so provide, tests are conducted for marijuana, hashish or any other cannabis product exposure by means of urinalysis of 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (carboxy-THC) the main metabolite of delta-9-tetrahydrocannabinol (THC). Concentrations >15 ng/mL (cut-off value) in confirmatory analytical procedures are considered doping. Cannabis is an illicit drug in several countries and has received much attention in the media for its potential therapeutic uses and the efforts to legalise its use. Studies have demonstrated that the use of cannabinoids can reduce anxiety, but it does not have ergogenic potential in sports activities. An increase in heart rate and blood pressure, decline of cardiac output and reduced psychomotor activity are some of the pharmacological effects of THC that will determine a decrease in athletic performance. An ergolytic activity of cannabis products has been observed in athletes of several different sport categories. In Brazil, analyses for doping control in sports, performed in our laboratories, have detected positive cases for carboxy-THC in urine samples of soccer, volleyball, cycling and other athletes. It is our intention to discuss in this article some points that may discourage individuals from using cannabis products during sports activities, even in the so-called permitted circumstances defined by the IOC and some sports federations.

Topics: Cannabinoids; Cannabis; Competitive Behavior; Doping in Sports; Humans; Marijuana Abuse; Task Performance and Analysis

The active compound in herbal cannabis, Delta(9)-tetrahydrocannabinol, exerts all of its known central effects through the CB(1) cannabinoid receptor. Research on cannabinoid mechanisms has been facilitated by the availability of selective antagonists acting at CB(1) receptors and the generation of CB(1) receptor knockout mice. Particularly important classes of neurons that express high levels of CB(1) receptors are GABAergic interneurons in hippocampus, amygdala and cerebral cortex, which also contain the neuropeptides cholecystokinin. Activation of CB(1) receptors leads to inhibition of the release of amino acid and monoamine neurotransmitters. The lipid derivatives anandamide and 2-arachidonylglycerol act as endogenous ligands for CB(1) receptors (endocannabinoids). They may act as retrograde synaptic mediators of the phenomena of depolarization-induced suppression of inhibition or excitation in hippocampus and cerebellum. Central effects of cannabinoids include disruption of psychomotor behaviour, short-term memory impairment, intoxication, stimulation of appetite, antinociceptive actions (particularly against pain of neuropathic origin) and anti-emetic effects. Although there are signs of mild cognitive impairment in chronic cannabis users there is little evidence that such impairments are irreversible, or that they are accompanied by drug-induced neuropathology. A proportion of regular users of cannabis develop tolerance and dependence on the drug. Some studies have linked chronic use of cannabis with an increased risk of psychiatric illness, but there is little evidence for any causal link. The potential medical applications of cannabis in the treatment of painful muscle spasms and other symptoms of multiple sclerosis are currently being tested in clinical trials. Medicines based on drugs that enhance the function of endocannabinoids may offer novel therapeutic approaches in the future.

Topics: Animals; Brain; Cannabinoid Receptor Modulators; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Mental Disorders; Mice; Phytotherapy; Receptors, Cannabinoid; Receptors, Drug

Topics: Candidiasis, Oral; Cannabis; Humans; Leukoedema, Oral; Marijuana Abuse; Mouth Diseases; Mouth Neoplasms; Papilloma; Smoking; Stomatitis; Xerostomia

During the late 1960s, cannabis emerged from relative obscurity to become the most common illicit drug used in the United States, and has remained so ever since. From an epidemiological perspective, three major waves of successively younger new users can be identified during the past 40 years. Contrary to popular opinion, cannabis use can be problematic for many people (particularly adolescents). Moreover, the drug has become increasingly more potent. Cannabis is currently one of the leading substances reported in arrests, emergency room admissions, autopsies and treatment admissions. Like alcohol and tobacco, the need for effective approaches to treating cannabis use disorders transcends debates about whether it should be legal. Moreover, the costs to society are continuing to mount from past neglect of this continuing public health problem. This paper provides background on the need to develop effective models for treating cannabis use disorders.

Topics: Adolescent; Adolescent Behavior; Adult; Age of Onset; Attitude to Health; Cannabis; Child; Crime; Female; Humans; Male; Marijuana Abuse; Mental Disorders; Patient Acceptance of Health Care; United States

In 1984, I published in this journal a review entitled "Marijuana: A Crude Drug With a Spectrum of Underappreciated Toxicity." In the introduction to that article, I disclosed that our son Keith, who was 15 years old at the time, was in a long-term, modified outpatient adolescent drug and alcohol rehabilitation program because he had become dependent on marijuana with its associated behavioral, interpersonal, scholastic, and antisocial problems. Keith and most of his friends had experimented several times with LSD, beer, and several other drugs but never used injection drugs. Marijuana was clearly Keith's drug of choice and the only drug he used with regularity. Approximately 1 year later, Keith graduated from the treatment program. He completed the early aftercare component, relapsed several times, and completed a 4-month refresher drug rehabilitation program in another state. Nine years after admission to the first rehabilitation program, Keith finally attained some adult goals. Now 34 years old, he has been drug-free for 10 years. He is the president and owner of a successful discount cellular phone business that he started. More important, a decade ago, he reestablished an excellent and close relationship with his parents. As far as I can tell, Keith remains drug-free except for an occasional beer.

Topics: Adolescent; Adult; Cannabis; Dronabinol; Drug and Narcotic Control; Humans; Internet; Male; Marijuana Abuse; Memory Disorders; Memory, Short-Term; Phytotherapy; United States

Increasing prevalence of recreational cannabis use among the young population has stimulated debate on the possible effects of acute and longterm use.. To highlight recent knowledge of mechanisms of action, effects on psychomotor and cognitive performance, and health risks associated with cannabis consumption.. A brief review of recent literature on the prevalence of recreational cannabis use, the potency of modern cannabis preparations and the pharmacological actions of cannabis.. Cannabinoids derived from herbal cannabis interact with endogenous cannabinoid systems in the body. Actions on specific brain receptors cause dose-related impairments of psychomotor performance with implications for car and train driving, aeroplane piloting and academic performance. Other constituents of cannabis smoke carry respiratory and cardiovascular health risks similar to those of tobacco smoke.. Cannabis is not, as widely perceived, a harmless drug but poses risks to the individual and to society.

Topics: Cannabinoids; Cannabis; Cognition Disorders; Female; Humans; Male; Marijuana Abuse; Prevalence; Psychotropic Drugs; Respiratory Tract Diseases

Cannabis is commonly regarded as an innocuous drug and the prevalence of lifetime and regular use has increased in most developed countries. However, accumulative evidence highlights the risks of dependence and other adverse effects, particularly among people with pre-existing psychiatric disorders.. To re-evaluate the adverse effects of cannabis in the general population and among vulnerable individuals, including those with serious psychiatric disorders.. A wide-ranging review of the topics related to these issues. Results and conclusions An appreciable proportion of cannabis users report short-lived adverse effects, including psychotic states following heavy consumption, and regular users are at risk of dependence. People with major mental illnesses such as schizophrenia are especially vulnerable in that cannabis generally provokes relapse and aggravates existing symptoms. Health workers need to recognise, and respond to, the adverse effects of cannabis on mental health.

Topics: Affective Symptoms; Cannabis; Cognition Disorders; Female; Humans; Male; Marijuana Abuse; Psychoses, Substance-Induced; Psychotic Disorders; Psychotropic Drugs; Risk Factors; Substance Withdrawal Syndrome

Marihuana (Cannabis sativa, the hemp plant) is one of the most widely used illicit drugs all over the world. Cannabis products are usually smoked. The plant contains chemicals called cannabinoids. One of these, 1-delta-9-tetrahydro-cannabinol (THC) is believed be responsible for most of the characteristic psychoactive (euphoria) and cardiovascular (tachycardia, conjuctivitis) effects. Although some clinical studies suggest the medical utility of marihuana (i.e. on the basis of its antiemetic, anticonvulsive and analgesic effect)--the scientific evidence is weak. Therefore the complete legalization of the drug is strongly opposed.

Topics: Analgesics, Opioid; Animals; Anticonvulsants; Antiemetics; Cannabis; Humans; Marijuana Abuse; Phytotherapy

Topics: Cannabis; Humans; Marijuana Abuse

Acute intoxication with cannabis clearly produces cognitive impairment, but it is less clear how long cognitive deficits persist after an individual stops regular cannabis use. Numerous methodologic difficulties confront investigators in the field attempting to assess the residual neuropsychologic effects of cannabis among heavy users, and these must be understood to properly evaluate available studies. At present, it appears safe to conclude that deficits in attention and memory persist for at least several days after discontinuing regular heavy cannabis use. Some of these deficits may be caused or exacerbated by withdrawal effects from the abrupt discontinuation of cannabis; these effects typically peak after 3 to 7 days of abstinence. It is less clear, however, whether heavy cannabis use can cause neurotoxicity that persists long after discontinuation of use. It seems likely that such long-term effects, if they exist, are subtle and not clinically disabling--at least in the majority of cases.

Topics: Attention; Brain; Cannabis; Cognition Disorders; Humans; Marijuana Abuse

Topics: Automobile Driving; Cannabis; Health Policy; Humans; Marijuana Abuse; Phytotherapy

In response to public pressure to allow the medical use of marijuana, the Office of National Drug Control Policy, Washington, DC, funded a study by the Institute of Medicine evaluating the scientific evidence for benefits and risks of using marijuana as a medicine. The report used scientific reviews, public hearings, and reports from other agencies, and was evaluated by knowledgeable advisors and reviewers. It called for heavier investment in research on the biology of cannabinoid systems, careful clinical studies of cannabinoids in clinical syndromes, analysis of cannabinoids' psychological effects on symptoms, and evaluations of the health consequences of heavy marijuana use; recommends against the use of smoked marijuana in medicine and for the development of a medical cannabinoid inhaler; and recommends that compassionate use of marijuana be considered under carefully reviewed protocols. Finally, the report evaluates the abuse potential, tolerance, withdrawal, and gateway risks of medical use of cannabinoid drugs.

Topics: Cannabinoids; Cannabis; Drug and Narcotic Control; Feeding and Eating Disorders; Humans; Marijuana Abuse; National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; Nausea; Pain; Phytotherapy; Practice Patterns, Physicians'; Risk Assessment; Risk Factors; United States; Vomiting; Wasting Syndrome

Several publications have recently suggested a relationship between cannabis use and certain types of cancer. We gathered information on the latest findings on the subject. A manual and computerized bibliographic search on cannabis and cancer was conducted. In users under 40 years of age, cannabis is suspected to increase the risk of squamous-cell carcinoma of the upper aerodigestive tract, particularly of the tongue and larynx, and possibly of lung. Other tumours being suspected are non-lymphoblastic acute leukaemia and astrocytoma. In head and neck cancer, carcinogenicity was observed for regular (i.e. more than once a day for years) cannabis smokers. Moreover, cannabis increases the risk of head and neck cancer in a dose-response manner for frequency and duration of use. Interaction was observed with cigarette smoking and alcohol use. Delta9-THC seems to have a specific carcinogenic effect different from that of the pyrolysis products. Epidemiological studies are needed as soon as possible to provide data on the European and French situation. Information on the possible risks of a regular use of cannabis should be a priority.

Topics: Adolescent; Adult; Animals; Cannabis; Carcinogenicity Tests; Carcinoma, Squamous Cell; Case-Control Studies; Cricetinae; Dronabinol; Female; Head and Neck Neoplasms; Humans; Incidence; Infant, Newborn; Leukemia; Lung Neoplasms; Male; Marijuana Abuse; Mice; Middle Aged; Mutagenicity Tests; Neoplasms, Experimental; Pregnancy; Psychotropic Drugs; Rats; Retrospective Studies; Risk Factors; Time Factors

Nicotine in tobacco, tetrahydrocannabinol (delta 9-THC) in marijuana and morphine in opium are well known as drugs associated with dependence or addiction. Endogenous active substances that mimic the effects of the natural drugs and their respective receptors have been found in the mammalian central nervous system (CNS). Such active substances and receptors include acetylcholine (ACh) and the nicotinic ACh receptor (nAChR) for nicotine, anandamide and CB1 for delta 9-THC, and endomorphins (1 and 2) and the mu (OP3) opioid receptor for morphine, respectively. Considerable progress has been made in studies on neurotoxicity, in terms of the habituation, dependence and withdrawal phenomena associated with these drugs and with respect to correlations with endogenous active substances and their receptors. In this article we shall review recent findings related to the neurotoxicity of tobacco, marijuana and opium, and their toxic ingredients, nicotine, delta 9-THC and morphine in relation to their respective endogenous agents and receptors in the CNS.

Topics: Acetylcholine; Arachidonic Acids; Brain Chemistry; Cannabis; Dronabinol; Endocannabinoids; Endorphins; Humans; Marijuana Abuse; Morphine; Morphine Dependence; Nicotine; Opium; Polyunsaturated Alkamides; Receptors, Cannabinoid; Receptors, Drug; Receptors, Nicotinic; Receptors, Opioid; Tobacco Use Disorder

The recent discovery of arachidonylethanolamide (anandamide), an endogenous ligand for cannabinoid receptors, and the synthesis of SR141716A, a cannabinoid antagonist selective for brain cannabinoid (CB1) receptors, have provided new tools to explore the mechanisms underlying cannabis abuse and dependence. Drug discrimination is the animal model with the most predictive validity and specificity for investigation of the psychoactive effects of cannabinoids related to their abuse potential, because, unlike many other drugs of abuse, delta9-tetrahydrocannabinol (delta9-THC), the major psychoactive ingredient of marijuana, is not self-administered by animals. Results of delta9-THC discrimination studies have revealed that the subjective effects of cannabis intoxication are pharmacologically selective for centrally active cannabinoid compounds, and that cannabis action at CB1 receptors is involved in medication of these effects. Less clear is the role of endogenous cannabinoid system(s) in cannabis intoxication. Anandamide, named for a Sanskrit word for "internal bliss," unreliably substitutes for delta9-THC. Further, substitution, when it is observed, occurs only at doses that also significantly decrease response rates. In contrast, delta9-THC and other structurally diverse cannabinoids fully substitute for delta9-THC at doses that do not substantially affect response rates. Attempts to train animals to discriminate anandamide (or SR141716A) have so far been unsuccessful. Preliminary evidence from drug discrimination studies with more metabolically stable anandamide analogs have suggested that these differences in the discriminative stimulus effects of delta9-THC and anandamide-like cannabinoids are not entirely due to pharmacokinetic factors, but the exact role of "internal bliss" in cannabis intoxication and dependence is still not completely understood.

Topics: Arachidonic Acids; Cannabinoids; Cannabis; Discrimination, Psychological; Endocannabinoids; Humans; Marijuana Abuse; Polyunsaturated Alkamides; Receptors, Cannabinoid; Receptors, Drug

Over 50 percent of people will use marijuana sometime in their life. While intoxication lasts two to three hours, the active ingredient in marijuana, delta-9-tetrahydro-cannabinol, can accumulate in fatty tissues, including the brain and testes. Adverse effects from marijuana use include decreased coordination, epithelial damage to the lungs, increased risk of infection, cardiovascular effects and cognitive deficits. Unexplained behavior changes, altered social relationships and poor performance at school or work can signify a drug problem. Treatment requires a combination of education, social support, drug monitoring and attention to comorbid medical and psychiatric conditions.

Topics: Cannabis; Humans; Marijuana Abuse; Patient Education as Topic; Substance Withdrawal Syndrome; Teaching Materials

Topics: Anesthesia; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Mental Processes; Nausea; Pain; United Kingdom; Vomiting

Topics: Cannabinoids; Cannabis; Glaucoma; Humans; Marijuana Abuse; Marijuana Smoking; Nausea; Phytotherapy; Plant Preparations

Daily marijuana smoking has been clearly shown to have adverse effects on pulmonary function and produce respiratory symptomatology (cough, wheeze, and sputum production) similar to that of tobacco smokers. Based on the tobacco experience, decrements in pulmonary function may be predictive of the future development of chronic obstructive pulmonary disease (COPD). However, in the absence of alpha-1-antitrypsin deficiency, the habitual marijuana-only smoker would likely have to smoke 4-5 joints per day for a span of at least 30 yr in order to develop overt manifestations of COPD. The mutagenic/carcinogenic properties of marijuana smoke are also well-established. The potential for induction of laryngeal, oropharyngeal, and possibly bronchogenic carcinoma from marijuana has been documented by several case reports and observational series. Despite this, a relative risk ratio for the development of these tumors has not yet been quantified. Based on a higher frequency of case reports for upper airway cancer compared to bronchogenic carcinoma, marijuana smoking may have a more deleterious effect on the upper respiratory tract. However, this hypothesis remains speculative at best, pending confirmation by longitudinal studies.

Topics: Cannabis; Humans; Lung Diseases; Marijuana Abuse; Marijuana Smoking; Smoke

The usual phenomena of cannabis intoxication include experiences which in a non-intoxicated state would be considered as psychiatric symptoms. These can be distinguished from adverse reactions to cannabis, the commonest of which is an acute anxiety state. Acute psychotic episodes can also follow ingestion of the drug but are infrequent. These can be classified as acute confusional states and episodes occurring in clear consciousness. Neither presentation consistently shows enough specific features to warrant the diagnosis of 'cannabis psychosis' as a distinct clinical entity. The evidence that cannabis has a causative role in chronic psychotic or affective disorders is not convincing, although the drug may modify the course of an already established illness. Further controlled studies would be required to clarify the aetiological significance of the drug in these conditions.

Topics: Anxiety; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Mood Disorders; Motivation; Psychotic Disorders; Schizophrenia

Marijuana is a crude, intoxicating drug that has become much more potent in the past decade. Adolescents intoxicated from marijuana suffer from impairment of short-term memory and automobile driving skills. The drug is easily detected in users by means of immunoassay analysis of urine specimens. Frequent use by young adolescents can impede normal maturation and cause or contribute to an amotivational syndrome.

Topics: Adolescent; Adult; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Substance-Related Disorders

Topics: Adolescent; Alcohol Drinking; Animals; Biological Availability; Brain; Cannabinoids; Cannabis; Child; Cognition; Dronabinol; Drug Interactions; Female; Fetus; France; Humans; Immune System; Infant, Newborn; Lung; Male; Marijuana Abuse; Pregnancy; Psychotic Disorders; Reproduction; Scotland; Substance-Related Disorders; United States

This paper examines the research evidence relating sustained use of marijuana to chronic cerebral impairment. Evidence from both American and cross-cultural studies is reviewed, with a particular emphasis on methodological problems in the research. The focus of this paper is on neurological findings while another paper focuses on neuropsychological findings. On the basis of available research, it was concluded that there is no evidence that marijuana produces gross structural cerebral changes and little evidence that it leads to functional impairment, although subtle impairment cannot be ruled out.

Topics: Atrophy; Brain; Cannabis; Cross-Cultural Comparison; Dronabinol; Electroencephalography; Humans; Marijuana Abuse; Mental Disorders; Mental Status Schedule; Neuropsychological Tests; Radiography; Research Design; Substance-Related Disorders; United States

This paper examines the research evidence on the question of whether sustained use of marijuana may produce chronic cerebral impairment as measured by neuropsychological measures. Evidence from both American and cross-cultural studies suggests that marijuana probably does not produce chronic cerebral impairment, although subtle impairment cannot be ruled out. Several suggestions for new lines of research are discussed including prospective studies, effects of cannabis use on later aging processes, and true experimental studies.

Topics: Aging; Brain; Cannabis; Cross-Cultural Comparison; Humans; India; Intelligence; Marijuana Abuse; Prospective Studies; Psychological Tests; Research Design; United States; Visual Perception

The adolescent marijuana literature is reviewed. Studies show that the prevalence of marijuana use is generally quite low in elementary schools. In junior and senior high samples, findings vary greatly from place to place. The prevalence of use increased dramatically during the 1970s although the use patterns may have peaked already in some areas. The use of marijuana increases with age, but some evidence suggests that a slight drop-off in use occurs near the end of high school. Female use seems to be increasing more than male use. Use seems to be somewhat more prevalent in middle- and upper-middle-class homes and in broken homes. Mixed support has been found for the hypothesis that marijuana users have parents that are more permissive. Parents of marijuana users are generally characterized as being less warm and supportive, and more inclined toward the use of drugs themselves. Peer and sibling use of marijuana seem to be particularly important predictors of adolescent marijuana use. Findings on personality characteristics of marijuana users are not extensive and are somewhat contradictory. There is some evidence that users tend to be somewhat alienated, external in their locus of control, and possibly higher on anxiety. Users are also characterized by a higher value on independence vs achievement and more positive attitudes toward marijuana use. Behavioral correlates of marijuana use include greater use of alcohol and other drugs, and poorer school performance.

Topics: Adolescent; Adolescent Behavior; Age Factors; Canada; Cannabis; Child Rearing; Female; Humans; Internal-External Control; Male; Marijuana Abuse; Models, Psychological; Peer Group; Religion; Self Concept; Sex Factors; Sibling Relations; Socioeconomic Factors; United States; White People

Topics: Activities of Daily Living; Cannabidiol; Cannabis; Chemical Phenomena; Chemistry; Chromatography, Thin Layer; Dose-Response Relationship, Drug; Dronabinol; Gas Chromatography-Mass Spectrometry; Humans; Marijuana Abuse; Radioimmunoassay

The author reviews the literature on the dependence potential of cannabis. Case studies and experiments of tolerance to cannabis as well as psychological and physical dependence on cannabis are presented in man and in laboratory animals. Some effects common to both species are also recorded. Although the addictive potential of cannabis is often compared with the addictive potential of alcohol and tobacco, the author concludes that the characteristics of cannabis tolerance are similar to those of opiate dependence.

Topics: Adolescent; Adult; Animals; Cannabis; Dronabinol; Drug Tolerance; Haplorhini; Humans; Marijuana Abuse; Rats; Substance Withdrawal Syndrome; Substance-Related Disorders

In this eighth edition of the Marihuana and Health Report several areas of recent developments in marijuana research are highlighted together with a summary of the scientific research accumulated through the end of 1979 concerning the drug's possible health implications.

Topics: Alcohol Drinking; Attitude; Cannabis; Drug Interactions; Female; Humans; Male; Marijuana Abuse; Mental Disorders; Reproduction; Time Factors; United States

Chronic 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.. We 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.. Cognition 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.. Seventy 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).. In 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.. The trial was registered with ClinicalTrials.gov (NCT02044809) and the EU Clinical Trials Register (2013-000,361-36).

Topics: Cannabidiol; Cannabis; Cognition; Double-Blind Method; Hallucinogens; Humans; Marijuana Abuse; Substance-Related Disorders

Substance use disorders and affective disturbances often covary. Even momentary experiences of negative affect (NA) appear linked with substance use. While strong evidence of these relations exists, NA might bias endorsements of substance use due to hindered recall and reporting processes. This hypothesis warrants further research, as accurate assessment of substance-related variables is crucial in both research and treatment settings. The present study examined the influence of NA on reporting of cannabis variables using an affect-induction paradigm. Over 700 individuals recruited from Amazon's MTurk participated. After reporting demographics and baseline affect, participants were randomly assigned to either a NA induction or control condition. Follow-up measures assessed post-induction affect and cannabis-related variables. Results revealed that the NA induction task significantly increased NA and decreased positive affect relative to the control condition. Participants assigned to the NA induction reported greater negative cannabis expectancies and more cannabis problems, even after controlling for age and educational attainment. Cannabis use and cannabis problems appeared positively related. Future research should continue to assess for the influence of NA in reporting of cannabis variables. Should subsequent work find differences in reporting of substance use that appear to covary with negative affect, clinicians and researchers alike should be mindful of the implications of potentially biased reporting on assessment, intervention, and research outcomes.

Topics: Affect; Cannabis; Humans; Marijuana Abuse; Self Report

As greater numbers of states in the United States and countries in the world continue to legalize cannabis for medical use, it has become increasingly important to assess patterns of cannabis use in individuals using cannabis for medical symptoms over time. A public health concern is that, like recreational cannabis, some individuals using cannabis for medical reasons may develop detrimental patterns of use, leading to the development of a cannabis use disorder (CUD).. In a 9-month longitudinal cohort study following a 12-week randomized, waitlist-controlled trial in 149 adults who used cannabis to alleviate insomnia, pain, depressed mood, or anxiety (RCT: NCT03224468), we assessed whether patterns of cannabis use for the 9 months following the RCT were associated with the development of CUD.. We identified five unique trajectories of use; 31 participants (21%) had low stable or no use, 50 (34%) had medium stable use, 19 (13%) had high stable use, 26 (17%) showed de-escalating and 23 (15%) showed escalating use over 9 months following the RCT. Of 149 participants enrolled, 19 (13%) met diagnostic criteria for CUD at 12 months. Only the escalating cannabis use pattern predicted significantly higher rates of CUD compared to the low or no use category (OR = 4.29, 95% CI = 1.21 to 10.87, p = 0.02).. These data indicate that most individuals using cannabis for medical symptoms have a stable pattern of use over the first year. Escalation of use may be a detrimental pattern that warrants further concern.

Topics: Adult; Anxiety Disorders; Cannabis; Humans; Longitudinal Studies; Marijuana Abuse; Substance-Related Disorders; United States

Cannabidiol (CBD) has shown promise in treating psychiatric disorders, including cannabis use disorder - a major public health burden with no approved pharmacotherapies. However, the mechanisms through which CBD acts are poorly understood. One potential mechanism of CBD is increasing levels of anandamide, which has been implicated in psychiatric disorders including depression and cannabis use disorder. However, there is a lack of placebo-controlled human trials investigating this in psychiatric disorders. We therefore assessed whether CBD affects plasma anandamide levels compared to placebo, within a randomised clinical trial of CBD for the treatment of cannabis use disorder. Individuals meeting criteria for cannabis use disorder and attempting cannabis cessation were randomised to 28-day administration with placebo (n = 23), 400 mg CBD/day (n = 24) or 800 mg CBD/day (n = 23). We estimated the effects of each CBD dose compared to placebo on anandamide levels from baseline to day 28. Analyses were conducted both unadjusted and adjusted for cannabis use during the trial to account for effects of cannabis on the endocannabinoid system. We also investigated whether changes in plasma anandamide levels were associated with clinical outcomes relevant for cannabis use disorder (cannabis use, withdrawal, anxiety, depression). There was an effect of 800 mg CBD compared to placebo on anandamide levels from baseline to day 28 after adjusting for cannabis use. Pairwise comparisons indicated that anandamide levels unexpectedly reduced from baseline to day 28 in the placebo group (-0.048, 95% CI [-0.089, -0.007]), but did not change in the 800 mg CBD group (0.005, 95% CI [-0.036, 0.047]). There was no evidence for an effect of 400 mg CBD compared to placebo. Changes in anandamide levels were not associated with clinical outcomes. In conclusion, this study found preliminary evidence that 28-day treatment with CBD modulates anandamide levels in individuals with cannabis use disorder at doses of 800 mg/day but not 400 mg/day compared to placebo.

Topics: Cannabidiol; Cannabis; Double-Blind Method; Dronabinol; Endocannabinoids; Hallucinogens; Humans; Marijuana Abuse

Treatments for cannabis use disorder (CUD) have limited efficacy and little is known about who responds to existing treatments. Accurately predicting who will respond to treatment can improve clinical decision-making by allowing clinicians to offer the most appropriate level and type of care. This study aimed to determine whether multivariable/machine learning models can be used to classify CUD treatment responders versus non-responders.. This secondary analysis used data from a National Drug Abuse Treatment Clinical Trials Network multi-site outpatient clinical trial in the United States. Adults with CUD (n = 302) received 12 weeks of contingency management, brief cessation counseling and were randomized to receive additionally either (1) N-Acetylcysteine or (2) placebo. Multivariable/machine learning models were used to classify treatment responders (i.e. two consecutive negative urine cannabinoid tests or a 50% reduction in days of use) versus non-responders using baseline demographic, medical, psychiatric and substance use information.. Prediction performance for various machine learning and regression prediction models yielded area under the curves (AUCs) >0.70 for four models (0.72-0.77), with support vector machine models having the highest overall accuracy (73%; 95% CI = 68-78%) and AUC (0.77; 95% CI = 0.72, 0.83). Fourteen variables were retained in at least three of four top models, including demographic (ethnicity, education), medical (diastolic/systolic blood pressure, overall health, neurological diagnosis), psychiatric (depressive symptoms, generalized anxiety disorder, antisocial personality disorder) and substance use (tobacco smoker, baseline cannabinoid level, amphetamine use, age of experimentation with other substances, cannabis withdrawal intensity) characteristics.. Multivariable/machine learning models can improve on chance prediction of treatment response to outpatient cannabis use disorder treatment, although further improvements in prediction performance are likely necessary for decisions about clinical care.

Topics: Acetylcysteine; Adult; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Research Design; Substance-Related Disorders

Cannabis is increasingly consumed and increasingly perceived as harmless. Among those whose use develops into a cannabis use disorder (CUD), <5% initiate and engage in treatment. Thus, novel options for low-barrier, appealing treatments are needed to foster engagement in care.. We conducted an open trial of a telehealth-delivered multicomponent behavioral economic intervention for non-treatment-engaged adults with CUD. Participants with CUD were recruited from a health system and screened for eligibility. Participants completed behavioral economic indices (cannabis demand, proportionate cannabis-free reinforcement), measures of cannabis use and mental health symptoms, and provided open-ended feedback on the intervention experience.. Of the 20 participants who enrolled and engaged in the initial intervention session, 70% (14 out of 20) completed all intervention components. All participants were satisfied/very satisfied with the intervention and 85.7% reported the telehealth delivery made it at least slightly easier/more likely for them to receive substance use care. Baseline to immediate post-treatment, behavioral economic cannabis demand decreased (intensity: Hedges' g = 0.14, maximum total expenditure: Hedges' g = 0.53, maximum expenditure for a single hit: Hedges' g = 0.10) and proportionate cannabis-free reinforcement (Hedges' g = 0.12) increased. Past-month total cannabis use decreased by 8.9% from baseline to post-treatment (Hedges' g = 0.39), along with decreases in recent depression (Hedges' g = 0.50) and anxiety symptoms (Hedges' g = 0.29).. These preliminary findings suggest that this behavioral economic intervention was highly acceptable and feasible for adults with untreated CUD. Changes in potential mechanisms of behavior change (cannabis demand, proportionate cannabis-free reinforcement) were consistent with reduced frequency of cannabis use and improved mental health outcomes.

Topics: Adult; Cannabis; Economics, Behavioral; Humans; Marijuana Abuse; Pilot Projects; Telemedicine

Cannabis use disorder (CUD) is widespread, and there is no pharmacotherapy to facilitate its treatment. AEF0117, the first of a new pharmacological class, is a signaling-specific inhibitor of the cannabinoid receptor 1 (CB

Topics: Animals; Cannabis; Double-Blind Method; Dronabinol; Hallucinogens; Marijuana Abuse; Mice; Randomized Controlled Trials as Topic; Substance Withdrawal Syndrome

The prevalence of cannabis use in the US has increased within the past two decades. Moreover, cannabis use disorder (CUD) is associated with significant disability, but the underlying neural mechanisms of CUD are unclear. Distress intolerance (DI), a psychological risk factor for CUD, may confer risk in part via impaired inhibitory control (IC) capacity during acute stress. DI and cannabis use problems have been associated with altered N2 amplitude, an IC-related event-related potential, in prior cross-sectional studies, but whether altered N2 is a state marker of CUD severity, a pathoplastic factor responsive to intervention and predictive of CUD symptom change over time, or an enduring trait-like vulnerability is unclear. In this secondary analysis, we tested the impact of a DI-targeted intervention on acute stress-related modulation of the N2 and whether pre-intervention N2 predicted CUD symptom change through follow-up.. Sixty participants were randomly assigned to a DI-targeted or control intervention. Participants completed an IC task before and after a stress induction at pre- and post-intervention lab visits while EEG activity was recorded.. The DI intervention did not alter the N2 compared to a control intervention. Pre-intervention post-stress IC-related N2 was associated with worse CUD severity but did not predict changeover time.. Findings are consistent with blunted N2 after acute stress acting as a stable marker of CUD severity rather than a pathoplastic factor predictive of CUD trajectory. Future research should investigate whether stress-related blunting of N2 is a consequence of severe CUD or a pre-existing vulnerability.

Topics: Cannabis; Cross-Sectional Studies; Evoked Potentials; Humans; Marijuana Abuse; Substance-Related Disorders

Withdrawal from cannabis use is associated with sleep disturbances, often leading to resumption of use. Less is known about the impact of abstinence on sleep in adolescence, a developmental window associated with high rates of sleep disturbance. This study investigated effects of sustained abstinence on self-reported sleep quality and disturbance in adolescents reporting frequent cannabis use.. Non-treatment seeking adolescents, recruited from school screening surveys and the community, with frequent cannabis use (M. Participants in CB-Abst reported higher overall PSQI scores than those in CB-Mon (M=1.06, p=0.01) indicating worse sleep during the four-week trial. Sleep disruptions in CB-Abst increased during Week 1 of abstinence (d=0.34, p=0.04), decreased during Week 2 (d=0.36, p=0.04), and remained constant for the rest of the trial. At Week 4, sleep was comparable to baseline levels for those in CB-Abst (p=0.87). Withdrawal-associated sleep disruption in the CB-Abst group was circumscribed to increases in sleep latency (b=0.35; p=0.05).. Cannabis abstinence in adolescents was associated with transient delayed onset of sleep initiation falling asleep during the first week of abstinence. Findings highlight withdrawal-associated changes in sleep latency as an intervention target for supporting adolescents attempting abstinence. Future research should use objective measures of sleep and focus on elucidating mechanisms underlying sleep disturbances with cannabis use and withdrawal.

Topics: Adolescent; Behavior Therapy; Cannabis; Female; Humans; Male; Marijuana Abuse; Sleep; Sleep Latency; Substance Withdrawal Syndrome

Cannabis use disorder (CUD) is a growing public health concern, and is highly comorbid with negative affective conditions such as anxiety and depression. Late adolescence and early adulthood represents a time of rapid emotion regulation development, as well as the onset of anxiety, mood, and substance use disorders, especially CUD. Maladaptive cognitive, behavioral, and emotional responding to one's own negative affect (in an effort to eliminate it) is associated with substance use, and represents a novel treatment target to improve outcomes of treatment for substance misuse.. After development of a manual for a novel intervention, Affect Management Treatment (AMT) for CUD, a pilot randomized clinical trial was conducted in 18-25 year-old participants with CUD to evaluate the impact of this approach on negative affect, constructs (e.g., distress intolerance) representing maladaptive reactivity to negative affect, and cannabis use. Participants (N = 52) received either 12 sessions of standard cognitive behavioral therapy (CBT) for CUD or 12 sessions of AMT and were assessed on measures of negative affect, reactivity to negative affect, cannabis use, and cannabis use problems at baseline, throughout treatment, post-treatment, and 6-mo follow-up.. AMT outperformed CBT in reducing negative affect and reactivity to negative affect, and it had a significant impact on cannabis use and cannabis use problems. There were no statistically significant between-group differences on cannabis outcomes.. AMT offers a novel, successful approach to the treatment of CUD.

Topics: Adolescent; Adult; Anxiety Disorders; Cannabis; Cognitive Behavioral Therapy; Humans; Marijuana Abuse; Substance-Related Disorders; Young Adult

Topics: Cannabinoids; Cannabis; Humans; Marijuana Abuse; Self Report

Given increasing rates of daily cannabis use and Cannabis Use Disorder (CUD) in the United States, it is imperative to understand CUD mechanisms in high-risk groups. Cannabis users with high distress intolerance (DI) are at elevated risk for severe and chronic CUD, but neural mechanisms linking CUD and DI are unknown. Cross-sectional data suggests that acute stress modulation of the cannabis and threat cue-elicited late positive potential (LPP), a neurophysiological marker of motivated attention, are possible mechanisms. However, longitudinal research is needed to clarify the roles of these elicited LPPs in CUD maintenance.. Sixty cannabis users with high DI were randomized a brief computerized intervention targeting DI or a control intervention. Elicited LPPs were measured before and after a stressor at baseline and postintervention. Intervention effects on stress modulation of the cannabis and threat LPPs, as well as their prospective associations with CUD, were assessed.. Elicited LPPs did not significantly change in either intervention group. Acute stress enhancement of the cannabis LPP predicted more severe CUD and greater chronicity at 4-month follow-up.. Cannabis and threat LPPs were not altered by a brief DI intervention despite improvement in DI and cannabis use outcomes. Given that acute stress enhancement of the cannabis LPP predicted poorer CUD outcome, it may be a fruitful intervention target in distress intolerant cannabis users. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Topics: Attention; Cannabis; Cross-Sectional Studies; Cues; Humans; Marijuana Abuse; United States

Mood, sleep and pain problems are common comorbidities among treatment-seeking cannabis-dependent patients. There is limited evidence suggesting treatment for cannabis dependence is associated with their improvement. This study explored the impact of cannabis dependence treatment on these comorbidities.. This is a secondary analysis from a 12-week double-blind placebo-controlled trial testing the efficacy of a cannabis agonist (nabiximols) against placebo in reducing illicit cannabis use in 128 cannabis-dependent participants. Outcome measurements including DASS-21 (Depression, Anxiety, and Stress subscales); Insomnia Severity Index (ISI); and Brief Pain Inventory (BPI), were performed at weeks 0, 4, 8, 12 and 24. Each was analysed as continuous outcomes and as binary cases based on validated clinical cut-offs.. Among those whose DASS and ISI scores were in the moderate to severe range at baseline, after controlling for cannabis use, there was a gradual decrease in severity of symptoms over the course of the trial. BPI decreased significantly until week 12 and then rose again in the post-treatment period during weeks 12-24. Neither pharmacotherapy type (nabiximols vs placebo) nor number of counselling sessions contributed significant explanatory power to any of the models and were excluded from the final analyses for both continuous and categorical outcomes.. Participants in this trial who qualified as cases at baseline had elevated comorbidity symptoms. There was no evidence that nabiximols treatment is a barrier to achieving reductions in the comorbid symptoms examined. Cannabis dependence treatment reduced illicit cannabis use and improved comorbidity symptoms, even when complete abstinence was not achieved.

Topics: Analgesics; Cannabidiol; Cannabinoid Receptor Agonists; Cannabis; Comorbidity; Double-Blind Method; Dronabinol; Drug Combinations; Hallucinogens; Humans; Marijuana Abuse; Medical Marijuana; Pain; Sleep; Treatment Outcome

Prevalence rates for lifetime cannabis use and cannabis use disorder are much higher in people with attention deficit/hyperactivity disorder than in those without. CANreduce 2.0 is an intervention that is generally effective at reducing cannabis use in cannabis misusers. This self-guided web-based intervention (6-week duration) consists of modules grounded in motivational interviewing and cognitive behavioral therapy.. We aimed to evaluate whether the CANreduce 2.0 intervention affects cannabis use patterns and symptom severity in adults who screen positive for attention deficit/hyperactivity disorder more than in those who do not.. We performed a secondary analysis of data from a previous study with the inclusion criterion of cannabis use at least once weekly over the last 30 days. Adults with and without attention deficit/hyperactivity disorder (based on the Adult Attention deficit/hyperactivity disorder Self-Report screener) who were enrolled to the active intervention arms of CANreduce 2.0 were compared regarding the number of days cannabis was used in the preceding 30 days, the cannabis use disorder identification test score (CUDIT) and the severity of dependence scale score (SDS) at baseline and the 3-month follow-up. Secondary outcomes were Generalized Anxiety Disorder score, Center for Epidemiological Studies Depression scale score, retention, intervention adherence, and safety.. Both adults with (n=94) and without (n=273) positive attention-deficit/hyperactivity disorder screening reported significantly reduced frequency (reduction in consumption days: with: mean 11.53, SD 9.28, P<.001; without: mean 8.53, SD 9.4, P<.001) and severity of cannabis use (SDS: with: mean 3.57, SD 3.65, P<.001; without: mean 2.47, SD 3.39, P<.001; CUDIT: with: mean 6.38, SD 5.96, P<.001; without: mean 5.33, SD 6.05, P<.001), as well as anxiety (with: mean 4.31, SD 4.71, P<.001; without: mean 1.84, SD 4.22, P<.001) and depression (with: mean 10.25, SD 10.54; without: mean 4.39, SD 10.22, P<.001). Those who screened positive for attention deficit/hyperactivity disorder also reported significantly decreased attention deficit/hyperactivity disorder scores (mean 4.65, SD 4.44, P<.001). There were no significant differences in change in use (P=.08), dependence (P=.95), use disorder (P=.85), attention deficit/hyperactivity disorder status (P=.84), depression (P=.84), or anxiety (P=.26) between baseline and final follow-up, dependent on positive attention-deficit/hyperactivity disorder screening. Attention deficit/hyperactivity disorder symptom severity at baseline was not associated with reduced cannabis use frequency or severity but was linked to greater reductions in depression (Spearman ρ=.33) and anxiety (Spearman ρ=.28). Individuals with positive attention deficit/hyperactivity disorder screening were significantly less likely to fill out the consumption diary (P=.02), but the association between continuous attention deficit/hyperactivity disorder symptom severity and retention (Spearman ρ=-0.10, P=.13) was nonsignificant. There also was no significant intergroup difference in the number of completed modules (with: mean 2.10, SD 2.33; without: mean 2.36, SD 2.36, P=.34), and there was no association with attention deficit/hyperactivity disorder symptom severity (Spearman ρ=-0.09; P=.43). The same was true for the rate of adverse effects (P=.33).. Cannabis users screening positive for attention deficit/hyperactivity disorder may benefit from CANreduce 2.0 to decrease the frequency and severity of cannabis dependence and attenuate symptoms of depression and attention deficit/hyperactivity disorder-related symptoms. This web-based program's advantages include its accessibility for remote users and a personalized counselling option that may contribute to increased adherence and motivation to change among program users.. International Standard Randomized Controlled Trial Number (ISRCTN) 11086185; http://www.isrctn.com/ISRCTN11086185.

Topics: Adult; Anxiety Disorders; Attention Deficit Disorder with Hyperactivity; Cannabis; Cognitive Behavioral Therapy; Humans; Marijuana Abuse; Substance-Related Disorders; Treatment Outcome

Cannabis is the most-frequently used illicit drug in Europe. Over the last few years in Spain, treatment demand has increased, yet most cannabis users do not seek treatment despite the related problems. A web-based self-help tool, like CANreduce 2.0, could help these users to control their consumption.. This study protocol describes a three-arm randomized controlled trial (RCT) comparing the effectiveness of three approaches, in terms of reducing cannabis use among problematic cannabis users, the first two treatment arms including the Spanish version of CANreduce 2.0 (an adherence-focused, guidance-enhanced, web-based self-help tool) (1) with and (2) without psychological support; and the third group (3) treatment as usual (TAU). Study hypotheses will be tested concerning the primary outcome: change in the number of days of cannabis use over the previous week, comparing assessments at 6 weeks and 3 and 6 months follow-up between groups and against baseline. Secondary outcomes related to cannabis use will be tested similarly. Mental disorders will be explored as predictors of adherence and outcomes. Analyses will be performed on an intention-to-treat basis, then verified by complete case analyses.. This study will test how effective the Spanish version of CANreduce 2.0 (CANreduce-SP) is at reducing both the frequency and quantity of cannabis use in problematic users and whether adding psychological support increases its effectiveness.. This trial is registered with the Clinical Trials Protocol Registration and Results System (PRS) number: NCT04517474 . Registered 18 August 2020, (Archived by archive.is https://archive.is/N1Y64 ). The project commenced in November 2020 and recruitment is anticipated to end by November 2022.

Topics: Cannabis; Counseling; Health Behavior; Humans; Internet; Marijuana Abuse; Mental Disorders; Patient Acceptance of Health Care; Randomized Controlled Trials as Topic; Treatment Outcome

Attenuating enzymatic degradation of endocannabinoids (eCBs) by fatty acid amide hydrolase (FAAH) reduces cannabis withdrawal symptoms in preclinical and clinical studies. In mice, blocking cyclooxygenase-2 (COX-2) activity increases central eCB levels by inhibiting fatty acid degradation. This placebo-controlled study examined the effects of the FDA-approved COX-2 selective inhibitor, celecoxib, on cannabis withdrawal, 'relapse', and circulating eCBs in a human laboratory model of cannabis use disorder. Daily, nontreatment-seeking cannabis smokers (12M, 3F) completed a crossover study comprising two 11-day study phases (separated by >14 days for medication clearance). In each phase, the effects of daily BID placebo (0 mg) or celecoxib (200 mg) on cannabis (5.3% THC) intoxication, withdrawal symptoms (4 days of inactive cannabis self-administration) and 'relapse' (3 days of active cannabis self-administration following abstinence) were assessed. Outcome measures included mood, cannabis self-administration, sleep, food intake, cognitive performance, tobacco cigarette use and circulating eCBs and related lipids. Under placebo maintenance, cannabis abstinence produced characteristic withdrawal symptoms (negative mood, anorexia and dreaming) relative to cannabis administration and was associated with increased OEA (a substrate of FAAH) and oleic acid (metabolite of OEA), with no change in eCB levels. Compared to placebo, celecoxib improved subjective (but not objective) measures of sleep and did not affect mood or plasma levels of eCBs or associated lipids and increased cannabis craving. The overall absence of effects on cannabis withdrawal symptoms, self-administration or circulating eCBs relative to placebo, combined with an increase in cannabis craving, suggests celecoxib does not show promise as a potential pharmacotherapy for CUD.

Topics: Cannabinoid Receptor Agonists; Cannabis; Celecoxib; Cross-Over Studies; Cyclooxygenase 2; Dronabinol; Endocannabinoids; Humans; Marijuana Abuse; Recurrence; Smokers; Substance Withdrawal Syndrome

There is increasing interest and evidence for the use of cannabinoid medications in the treatment of cannabis use disorder, but little examination of the correlates of successful treatment. This paper is a secondary analysis of a randomised placebo-controlled trial of nabiximols for the treatment of cannabis use disorder (CUD), aiming to identify which client and treatment characteristics impact treatment engagement and outcomes.. Bayesian multiple regression models were used to examine the impact of age, gender, duration of regular cannabis use, daily quantity of cannabis, cannabis use problems, self-efficacy for quitting, sleep, mental health, pain measures, and treatment group upon treatment engagement (retention, medication dose, and counselling participation) and treatment outcomes (achieving end-of-study abstinence, and a 50% or greater reduction in cannabis use days) among the 128 clients participating in the 12-week trial.. Among the treatment factors, greater counselling attendance was associated with greater odds of abstinence and ≥ 50% reduction in cannabis use; nabiximols with greater odds of ≥ 50% reduction and attending counselling, and reduced hazard of treatment dropout; and higher dose with lower odds of ≥ 50% reduction. Among the client factors, longer duration of regular use was associated with higher odds of abstinence and 50% reduction, and lower hazard of treatment dropout; greater quantity of cannabis use with reduced hazard of dropout, greater odds of attending counselling, and higher average dose; greater pain at baseline with greater odds of ≥ 50% reduction and higher average dose; and more severe sleep issues with lower odds of ≥ 50% reduction. Males had lower odds of attending counselling.. These findings suggest that counselling combined with agonist pharmacotherapy may provide the optimal treatment for cannabis use disorder. Younger clients, male clients, and clients with sleep issues could benefit from extra support from treatment services to improve engagement and outcomes.. Australian New Zealand Clinical Trials Registry (ACTRN12616000103460) https://www.anzctr.org.au.

Topics: Australia; Bayes Theorem; Cannabidiol; Cannabinoids; Cannabis; Dronabinol; Drug Combinations; Humans; Male; Marijuana Abuse; Pain; Substance-Related Disorders

Topics: Calcium Channels, L-Type; Cannabinoid Receptor Agonists; Cannabinoids; Cannabis; Double-Blind Method; Dronabinol; Female; Gabapentin; Hallucinogens; Humans; Ligands; Male; Marijuana Abuse; Pregabalin

Abstinence is rarely achieved in clinical trials for cannabis use disorder (CUD). Cannabis reduction is associated with functional improvement, but reduction endpoints have not been established, indicating a need to identify and validate clinically meaningful reduction endpoints for assessing treatment efficacy.. Data from a 12-week double-blind randomized placebo-controlled medication trial for cannabis cessation (NCT01675661) were analyzed. Participants (. Cannabis risk levels were sensitive to reductions in use from BL to EOT for frequency- (. Cannabis use risk levels, as operationalized in this study, captured reductions in use during a clinical trial. Risk level reduction was associated with functional improvement suggesting that identifying risk levels and measuring the change in levels over time may be a viable and clinically meaningful endpoint for determining treatment efficacy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Topics: Adult; Cannabis; Child; Double-Blind Method; Female; Humans; Male; Marijuana Abuse; Risk Reduction Behavior; Treatment Outcome

Cannabis is the most commonly used illicit drug in the world. However, because of a changing legal landscape and rising interest in therapeutic utility, there is an increasing trend in (long-term) use and possibly cannabis impairment. Importantly, a growing body of evidence suggests that regular cannabis users develop tolerance to the impairing, as well as the rewarding, effects of the drug. However, the neuroadaptations that may underlie cannabis tolerance remain unclear. Therefore, this double-blind, randomized, placebo-controlled, cross-over study assessed the acute influence of cannabis on the brain and behavioral outcomes in two distinct cannabis user groups. Twelve occasional and 12 chronic cannabis users received acute doses of cannabis (300-μg/kg delta-9-tetrahydrocannabinol) and placebo and underwent ultrahigh field functional magnetic resonance imaging and magnetic resonance spectroscopy. In occasional users, cannabis induced significant neurometabolic alterations in reward circuitry, namely, decrements in functional connectivity and increments in striatal glutamate concentrations, which were associated with increases in subjective high and decreases in performance on a sustained attention task. Such changes were absent in chronic users. The finding that cannabis altered circuitry and distorted behavior in occasional, but not chronic users, suggests reduced responsiveness of the reward circuitry to cannabis intoxication in chronic users. Taken together, the results suggest a pharmacodynamic mechanism for the development of tolerance to cannabis impairment, of which is important to understand in the context of the long-term therapeutic use of cannabis-based medications, as well as in the context of public health and safety of cannabis use when performing day-to-day operations.

Topics: Attention; Brain; Cannabis; Cognition; Cross-Over Studies; Double-Blind Method; Dronabinol; Drug Tolerance; Female; Humans; Magnetic Resonance Imaging; Male; Marijuana Abuse; Neuropsychological Tests; Psychomotor Performance; Reward

Pharmacotherapy for cannabis use disorder (CUD) is an important unmet public health need.. In a 12-week randomized double-blind placebo-controlled trial, the efficacy of quetiapine (300 mg nightly) for the treatment of CUD was tested in 130 outpatients. Weekly cannabis use was categorized into three groups: heavy use (5-7 days), moderate use (2-4 days) and light use (0-1 days).. At baseline both groups were considered heavy users (using days per week: median = 7.0; interquartile range (IQR): 6.5-7.0; daily dollar value: median = $121.4; IQR: 73.8-206.3). The week-by-treatment interaction was marginally significant (χ. The use of quetiapine to treat CUD was associated with an increased likelihood of heavy frequency use transitioning to moderate use, but not light use. The clinical significance of reductions in cannabis use, short of abstinence warrants further study.

Topics: Adult; Antipsychotic Agents; Cannabis; Double-Blind Method; Female; Hallucinogens; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Outpatients; Quetiapine Fumarate; Substance Withdrawal Syndrome; Treatment Outcome

Time from first cannabis use to cannabis dependence (latency) may be an important prognostic indicator of cannabis-related problems and treatment outcomes. Gender differences in latency have been found; however, research in this general area is limited. As cannabis use increases and perceived risk declines, a better understanding of how these factors interact in predicting treatment outcomes is critical.. A secondary data analysis of a randomized, double-blind, placebo-controlled pharmacotherapy trial for cannabis dependence (N = 302) examined the associations between age of cannabis use onset, time to cannabis dependence (latency), and gender on cannabis use during the trial. Mediation analysis tested whether the association between age of onset and cannabis use during the trial was mediated by latency to cannabis dependence differentially for men and women.. Age of use initiation was inversely correlated with latency to dependence prior to treatment [HR(95% CI) = 1.18 (1.06, 1.30); p = .002] and cannabis use during treatment (β=-1.27; SE = 0.37; p < .001). There was a significant mediation effect between age of onset, latency, and cannabis use that varied by gender. Earlier age of onset predicted longer latency, and subsequently, greater cannabis use during the trial in men (21.4% mediated; p < .05), but not women. Other substance use, race, and past psychiatric diagnosis did not predict latency either independently or in interaction models.. Findings support existing evidence that early cannabis use onset is associated with worse outcomes and add new knowledge on the differential associations between age of onset, latency to cannabis dependence, and treatment outcomes for men and women.

Topics: Adult; Age Factors; Cannabis; Cognition; Double-Blind Method; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Sex Characteristics; Sex Factors; Substance-Related Disorders; Treatment Outcome

Prevalence of regular cannabis use and cannabis use disorder (CUD) have increased in the past two decades, but treatment-seeking is low and extant brief interventions do not target causal risk factors implicated in etiological models of addiction. Elevated distress intolerance (DI) is one risk factor that has been empirically linked with greater CUD severity and maintenance in regular users, but, to our knowledge, research has never targeted it in a brief intervention among cannabis users with CUD or at high risk. The current RCT evaluated the impact of a DI intervention (i.e., Distress Tolerance Intervention [DTI]) compared to a healthy habits control intervention (i.e., Healthy Video Control [HVC]) on DI and cannabis use outcomes.. We randomized cannabis users with high DI (N = 60) to the DTI or HVC condition and they received two computerized intervention sessions. We assessed relief cannabis craving at pre- and post-treatment; and we assessed DI, cannabis use coping motives, use-related problems, and use frequency at pre- and post-treatment as well as one- and four-month follow-ups. We assessed CUD symptoms via interviews at pre-treatment and four-month follow-up.. Significant, durable reductions in DI and all cannabis use outcomes occurred in both conditions. Compared to the HVC condition, the DTI led to greater reductions in use frequency during the treatment period. Reductions in self-reported DI were correlated with reductions in coping motives and CUD symptoms.. The DTI's impact on all outcomes was largely comparable to the control condition, though it may have utility as an adjunctive intervention.

Topics: Adaptation, Psychological; Adult; Cannabis; Craving; Female; Humans; Male; Marijuana Abuse; Motivation; Psychological Distress; Stress, Psychological; Treatment Outcome

People who use cocaine experience numerous sleep problems and often use cannabis to mitigate these problems. However, co-using cocaine and cannabis may result in worse sleep outcomes when compared to using cocaine only. The current study examined group differences in subjective sleep outcomes among people who use cocaine and people who co-use cocaine and cannabis.. Participants were 82 individuals with cocaine use disorder who were enrolled in a randomized clinical trial for cocaine treatment. Sleep outcomes, assessed at baseline prior to treatment, were measured with the Saint Mary's Hospital Sleep Questionnaire and included total sleep time, perceived sleep quality, difficulty falling asleep, and daytime alertness. Analysis of covariance and Kruskal-Wallis tests were used to compare sleep outcomes between participants with urine samples that tested positive for both cocaine and cannabis at baseline, those who tested positive for cocaine only, and those who tested negative for all drugs.. Total reported sleep time was highest among those with a drug negative urine, followed by those with a cocaine positive urine and those who tested positive for cocaine and cannabis. There were no differences in perceived sleep quality, difficulty falling asleep, or daytime alertness between groups.. People who co-use cocaine and cannabis may report reduced sleep time relative to those who only use cocaine. Co-use of cannabis may exacerbate sleep difficulties in people who use cocaine by decreasing total sleep time, although it is important to note that the groups each reported similar sleep quality. Implications for treatment and directions for future research are discussed.

Topics: Adult; Aged; Cannabinoids; Cannabis; Cocaine; Cocaine-Related Disorders; Female; Humans; Male; Marijuana Abuse; Middle Aged; Plant Extracts; Sleep; Sleep Wake Disorders; Substance Abuse Detection; Surveys and Questionnaires; Young Adult

Illicit drug use can cause a variety of effects including alterations in the immune system. The aim of this study was to investigate the effects of illicit drugs on circulating lipopolysaccharide (LPS), systemic inflammation and oxidative stress markers in drug users. We evaluated the levels of soluble CD14 (sCD14), LPS, inflammatory (TNF-α and IL-6) and regulatory (IL-10) cytokines, as well as C-reactive protein (CRP), lipid peroxidation (TBARS) and total thiols in the peripheral blood of 81 men included in groups of cannabis (n = 21), cocaine (n = 12), cannabis-plus-cocaine users (n = 27), and non-drug users (n = 21). The use of cannabis plus cocaine leads to higher systemic levels of LPS, CRP, IL-6 and higher IL-6/IL-10 ratio, characterizing a proinflammatory profile. In contrast, a regulatory profile as viewed by lower systemic TNF-α and IL-6 levels and lower TNF-α/IL-10 ratio were observed in cannabis users compared to the control group. Moreover, cocaine users presented a lower content of non-enzymatic antioxidant thiol compared to control group, cannabis group and cannabis plus cocaine group. In conclusion, our results indicate that the use of cannabis contributes to an anti-inflammatory/or regulatory profile while the concomitant cannabis plus cocaine consumption coexists with increased circulating amounts of LPS and proinflammatory status.

Topics: Adult; C-Reactive Protein; Cannabis; Cocaine; Cocaine-Related Disorders; Cytokines; Drug Users; Humans; Inflammation; Lipopolysaccharides; Male; Marijuana Abuse

Despite increasing demand for treatment among cannabis users in many countries, most users are not in treatment. Internet-based self-help offers an alternative for those hesitant to seek face-to-face therapy, though low effectiveness and adherence issues often arise.. Through adherence-focused guidance enhancement, we aimed to increase adherence to and the effectiveness of internet-based self-help among cannabis users.. From July 2016 to May 2019, cannabis users (n=775; male: 406/575, 70.6%, female: 169/575, 29.4%; age: mean 28.3 years) not in treatment were recruited from the general population and were randomly assigned to (1) an adherence-focused guidance enhancement internet-based self-help intervention with social presence, (2) a similar intervention with an impersonal service team, and (3) access to internet as usual. Controls who were placed on a waiting list for the full intervention after 3 months underwent an assessment and had access to internet as usual. The primary outcome measurement was cannabis-use days over the preceding 30 days. Secondary outcomes included cannabis-dependence severity, changes in common mental disorder symptoms, and intervention adherence. Differences between the study arms in primary and secondary continuous outcome variables at baseline, posttreatment, and follow-up were tested using pooled linear models.. All groups exhibited reduced cannabis-use days after 3 months (social presence: -8.2 days; service team: -9.8 days; internet as usual: -4.2 days). The participants in the service team group (P=.01, d=.60) reported significantly fewer cannabis-use days than those in the internet as usual group; the reduction of cannabis use in the social presence group was not significant (P=.07, d=.40). There was no significant difference between the 2 intervention groups regarding cannabis-use reduction. The service team group also exhibited superior improvements in cannabis-use disorder, cannabis-dependence severity, and general anxiety symptoms after 3 months to those in the internet as usual group.. The adherence-focused guidance enhancement internet-based self-help intervention with an impersonal service team significantly reduced cannabis use, cannabis-use disorder, dependence severity, and general anxiety symptoms.. ISRCTN Registry ISRCTN11086185; http://www.isrctn.com/ISRCTN11086185.

Topics: Adult; Anxiety; Cannabis; Health Behavior; Humans; Internet; Internet-Based Intervention; Marijuana Abuse

Some adult cannabis users report negative consequences of use but do not seek treatment. Nonjudgmental, brief interventions incorporating motivational interviewing techniques may be able to reach users who otherwise would not seek treatment and increase their motivation to change use. Previous studies have shown brief interventions with this population are efficacious in reducing use, but the absolute amount of change has not clearly translated into meaningful reductions in associated negative consequences. The current study used a marijuana check-up (MCU) model to attract nontreatment-seeking adults who used cannabis at levels that may have caused negative consequences. The study randomly assigned participants to 2-session (n = 93) and 6-session (n = 93) versions of the intervention and followed them for 12 months. The study designed the extended 6-session condition to build on the efficacy of the previously tested 2-session intervention. The study hypothesized that the opportunity to continue to consider the consequences of cannabis use would have the greatest impact on those who were in earlier stages of readiness for change. We used cognitive behavioral techniques to assist with change efforts when indicated. Results showed significant reductions in the frequency and daily duration of cannabis use at all follow-ups in both intervention conditions. The extended 6-session condition produced greater change only on a measure of the number of periods of the day in which cannabis was used. Reductions in dependence symptoms and problems related to cannabis use occurred in both conditions, but there was no effect of intervention condition. Participants who were less ready to make changes at the outset decreased use and negative consequences the least. Results suggested that some benefit of the extended session format of the check-up in reducing daily use, but the lack of a corresponding reduction in consequences suggested that the original 2-session MCU may be more cost effective.

Topics: Adult; Cannabis; Humans; Marijuana Abuse; Motivation; Primary Health Care

Theoretical models of behavior change argue that youth should decrease their time with cannabis-using friends and increase their time with non-using friends during treatment. Informed by behavior-change models of recovery and socialization and selection peer-influence models, the current study examined whether combining evidence-based psychosocial treatment with adjunctive pharmacotherapy helps youth decrease their affiliations with cannabis-using friends and increase their affiliations with non-using friends during cannabis misuse treatment.. Youth ages 15-24 years (51 % male), participated in a double-blind randomized clinical trial that tested the effects of motivational enhancement and cognitive behavioral therapy (MET-CBT) plus topiramate (N = 39) or placebo (N = 26) on cannabis craving and use. Ecological momentary assessment data, collected via smartphones throughout the six-week intervention, assessed youths' time with cannabis-using and non-using friends, cannabis use, and craving in daily life. Multiple group multilevel structural equation modeling tested study hypotheses.. Across the topiramate (48 % completion rate) and placebo (77 % completion rate) conditions, greater time spent with cannabis-using friends promoted greater next day cannabis use and craving (socialization effect). In turn, cannabis craving, but not use, promoted continued selection of cannabis-using friends. This indirect effect was only supported in the placebo condition due to the selection piece of this cycle not being significant for youth who received topiramate. Neither cannabis craving nor use were associated with time with non-using friends the next day.. MET-CBT and adjunctive topiramate pharmacotherapy interrupted youth selection processes. This finding suggests that changing peer affiliations could be one mechanism by which treatments can work.

Topics: Adolescent; Adult; Cannabis; Friends; Humans; Marijuana Abuse; Motivational Interviewing; Topiramate; Young Adult

Marijuana use may increase schizophrenia risk, and this effect may be genetically moderated. We investigated how hypothetical genetic test results indicating the presence or absence of heightened schizophrenia risk in reaction to marijuana use would affect attitudes toward marijuana use. In two experiments, participants were randomized to hypothetical scenarios in which genetic testing showed the presence or absence of a predisposition for marijuana use to increase their schizophrenia risk, or to a control condition with no mention of genetic testing. Experiment 1 used a sample of 801 U.S. young adults recruited via Amazon.com's Mechanical Turk platform. Experiment 2 replicated the same procedures with a nationally representative sample of 800 U.S. adults aged 18-30. In Experiment 1, those in the predisposition condition, compared to the control condition, rated the likelihood and importance of their avoiding marijuana as significantly higher, whereas those in the no-predisposition condition rated both as significantly lower. In experiment 2, these findings were largely replicated for the predisposition condition but not the no-predisposition condition, and prior marijuana use was a significant moderator, with the effects of the predisposition condition confined to participants who reported having used marijuana. If these results are predictive of responses to actual genetic testing, they suggest that genetic test results indicating that marijuana use will increase one's schizophrenia risk may incentivize abstinence, especially for those with prior marijuana use. Future research could further investigate whether genetic test results indicating the absence of such a predisposition might disincentivize abstinence from marijuana use.

Topics: Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Schizophrenia; Substance-Related Disorders; Young Adult

There are a wide variety of methods for using combustible cannabis which may impact an individual's pattern of use as well as their response to cannabis use disorder (CUD) treatment. Previous research has noted racial/ethnic differences in cannabis users' preferred method of use.. The current study examined data from a randomized placebo-controlled trial of a pharmacological intervention for adults with CUD. Latent profile analysis classified participants (N = 302) based on their primary method of combustible cannabis use.. A four profile solution emerged which identified participants who demonstrated 1) Primarily Joint (n = 50), 2) Primarily Blunt (n = 106), 3) Mixed MoU (n = 30), and 4) Primarily Pipe (i.e., pipe or bong; n = 116) use. Profiles were compared on socio-demographic characteristics and racial differences were found among the four latent profiles as well as differences in their level of use. Cannabis users with a preference for joints were more likely to be White as compared to other racial groups. In contrast, a greater proportion of participants with a preference for blunts were African American. The Primarily Joint profile was found to have the highest cannabis relapse rate at 1-month follow-up (94%) which was significantly greater than the Mixed MoU (74%, x. Findings suggest that treatment-seeking individuals who primarily use joints or blunts may face unique challenges that may impact cannabis abstinence. Along with other cannabis-related characteristics, an individual's preferred method of use may represent an important factor to consider in the treatment of CUD.

Topics: Adult; Cannabis; Humans; Marijuana Abuse; Racial Groups; Substance-Related Disorders; Treatment Outcome

Depression is common among individuals with cannabis use disorder (CUD), particularly individuals who present to CUD treatment. Treatments that consider this comorbidity are essential.. The goal of this secondary analysis was to examine whether N-acetylcysteine (NAC) reduced depressive symptoms among adults (age 18-50) with CUD (N = 302) and whether the effect of NAC on cannabis cessation varied as a result of baseline levels of depression. Bidirectional associations between cannabis use amount and depression were also examined.. Data for this secondary analysis were from a National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) multi-site clinical trial for CUD. Adults with CUD (N = 302) were randomized to receive 2400 mg of NAC daily or matched placebo for 12 weeks. All participants received abstinence-based contingency management. Cannabis quantity was measured by self-report, and weekly urinary cannabinoid levels (11-nor-9-carboxy-Δ9-tetrahydrocannabinol) confirmed abstinence. Depressive symptoms were measured by the Hospital Anxiety and Depression Scale.. Depressive symptoms did not differ between the NAC and placebo groups during treatment. There was no significant interaction between treatment and baseline depression predicting cannabis abstinence during treatment. Higher baseline depression was associated with decreased abstinence throughout treatment and a significant gender interaction suggested that this may be particularly true for females. Cross-lagged panel models suggested that depressive symptoms preceded increased cannabis use amounts (in grams) during the subsequent month. The reverse pathway was not significant (i.e., greater cannabis use preceding depressive symptoms).. Results from this study suggest that depression may be a risk factor for poor CUD treatment outcome and therefore should be addressed in the context of treatment. However, results do not support the use of NAC to concurrently treat co-occurring depressive symptoms and CUD in adults.. Clinicaltrials.gov: NCT01675661.

Topics: Acetylcysteine; Adult; Cannabis; Comorbidity; Depression; Double-Blind Method; Dronabinol; Female; Free Radical Scavengers; Humans; Male; Marijuana Abuse; Motivation; Treatment Outcome; Young Adult

Previous studies suggest cannabinoid agonist treatment is effective in reducing cannabis use in dependent treatment seekers, however few studies have reported on post-treatment outcomes. We examine cannabis use outcomes 12 weeks after cessation of treatment from a randomised placebo-controlled trial of nabiximols for the treatment of cannabis dependence.. 128 participants received either nabiximols (n = 61) or placebo (n = 67) for 12 weeks, in combination with psychosocial interventions. Self-reported number of days of cannabis use in the previous 28 days was measured at baseline, 4, 8, and 12 weeks (end of treatment) and again at 24 weeks (3 months after treatment ceased). Urinalysis was used to confirm self-report data at Week 24 interview.. A factorial mixed-effects model for repeated measures regression revealed that the nabiximols group used cannabis on 6.8 fewer days in the previous 28 days at week 12 (end of treatment) than the placebo group (p = 0.002, CI: 2.1,11.4), and 6.7 fewer days in the previous 28 days at the week-24 follow-up than the placebo group (p = 0.006, CI: 1.4,12.1). A significantly higher proportion of the nabiximols group (14/61; 23 %) than the placebo group (6/67; 9%) reported abstinence from cannabis in the previous 28 days at the week-24 research interview OR=3.0, CI: 1.1, 9.1; p=0.035, NNT=8, CI: 4, 71).. The benefits of treatment incorporating nabiximols with psychosocial interventions in reducing cannabis use appears to persist for up to 3 months after the cessation of treatment. A stepped care model of treatment is proposed.. Australian New Zealand Clinical Trials Registry (ACTRN12616000103460) https://www.anzctr.org.au.

Topics: Australia; Cannabidiol; Cannabinoid Receptor Agonists; Cannabis; Dronabinol; Drug Combinations; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Substance-Related Disorders; Treatment Outcome

Cannabis use disorder (CUD) and depression frequently co-occur in youth. How depressive symptoms change over the course of CUD treatment and how they impact substance use treatment outcomes is unknown. In the current study, we examine the temporal relationships between cannabis use and depression in adolescents receiving evidence-based treatments for CUD as part of a multisite clinical trial.. Six hundred adolescents (age 12-18) with a CUD were randomly assigned to substance use treatment from one of five evidence-based psychosocial interventions. We assessed self-reported cannabis use frequency and depressive symptoms at baseline (BL) and again at 3-, 6-, 9, and 12-months. A bivariate latent change model assessed bidirectional effects of baseline levels and time-lagged changes in depressive symptoms and cannabis use on depression and cannabis use outcomes.. Depressive symptoms (72%) and major depressive disorder (MDD) (18%) were common at BL. Both depression and cannabis use decreased over time and change in cannabis use was significantly associated with change in depressive symptoms (b = 1.22, p = .003). Time-lag analyses showed that within-subject change in depression (from one time point to the next) was predicted by previous depression (b = -0.71, p < .001) but not cannabis use (p = .068), and change (decrease) in cannabis use was predicted by previous (greater) depressive symptoms (b = -1.47, p < .001) but not cannabis use (p = .158), respectively.. These findings indicate an enduring relationship between decreasing cannabis use and decreasing depression among adolescents lasting for 9-months after receiving psychosocial interventions for CUD. The presence of depressive symptoms did not appear to interfere with substance use treatment or attenuate improvements in cannabis use frequency. A decrease in cannabis use was not contingent upon a reduction in depressive symptoms. These findings are limited by the possibility of regression to the mean for both cannabis use and depressive symptoms, and the lack of a nonintervention control group.

Topics: Adolescent; Cannabis; Child; Depression; Depressive Disorder, Major; Humans; Marijuana Abuse

Research has demonstrated that motivational enhancement (MET) and cognitive behavioral therapy (CBT) are some of the most effective interventions for adults with cannabis use disorder (CUD). As few as two sessions of combined MET and CBT has produced abstinence and reductions in cannabis use greater than delayed treatment controls. Despite their efficacy, outcomes in previous studies yielded abstinence rates from cannabis in the range of 20-30% at follow-ups of 6 to 12 months, and CUD remained a chronic condition for many. Additional models of providing treatment "as needed" (PRN), rather than as a single fixed-dose, are necessary to meet the different needs of adults with CUD and reengage those who do not respond to treatment initially or who relapse later. In the current study, 87 adults who met DSM-IV criteria for cannabis dependence were randomly assigned to receive either a fixed-dose of nine sessions of MET/CBT or to a PRN condition that provided a smaller initial dose of treatment, but allowed repeated access to treatment for 28 months. Cannabis use and associated problems were assessed every six months throughout a 34-month period. More than one-third of participants in the PRN condition accessed additional treatment episodes, but the total number of treatment sessions that participants utilized was comparable across conditions. Both treatments yielded significant reductions in cannabis use and associated problems at each follow-up. Contrary to hypotheses, the PRN condition did not yield better outcomes at the longer-term follow-ups. The fixed-dose condition produced greater rates of abstinence at the first follow-up, but otherwise there were no between group differences in outcomes. Future studies should test active approaches to reengaging participants with treatment when initial outcomes are less than optimal.

Topics: Adult; Cannabis; Cognitive Behavioral Therapy; Follow-Up Studies; Humans; Marijuana Abuse; Treatment Outcome

Cannabis is the most commonly used illicit substance and many users report difficulty quitting. Situations involving stress and negative affect are the most difficult in which to abstain during quit/reduction attempts. Further, cannabis users with elevated social anxiety experience greater cannabis-related impairment than individuals with more normative levels of social anxiety. Yet, although most persons with cannabis-related problems are interested in quitting and endorse negative emotional symptoms, the vast majority do not seek in-person treatment. Thus, the current study tested the utility of an online personalized feedback intervention (PFI) that integrates feedback regarding cannabis with strategies to manage negative affect (PFI-NAC). Current (past month) cannabis using undergraduates (who used cannabis weekly, on average) were randomly assigned to the 1-session PFI-NAC (n = 37) or an assessment-only control (n = 26) and completed a 2-week follow-up assessment. After controlling for baseline negative affect and cannabis use frequency, social anxiety interacted with condition to predict follow-up cannabis use frequency. Specifically, among those with moderate or high levels of social anxiety, those in PFI-NAC reported less use at follow up than controls; this was not the case among those with lower social anxiety. Results of this pilot study indicate a 1-session intervention that teaches simultaneously teaching skills to manage negative affect and cannabis may benefit some cannabis users with moderate to high social anxiety. Future work with larger samples and a wider range of cannabis users, with longer follow-up assessments, are important next steps. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Topics: Adolescent; Adult; Affect; Anxiety; Cannabis; Feedback, Psychological; Female; Humans; Internet; Male; Marijuana Abuse; Marijuana Smoking; Pilot Projects; Students; Young Adult

Cannabis is one of the most widely used drugs worldwide. Cannabis use disorder is characterised by recurrent use of cannabis that causes significant clinical and functional impairment. There are no approved pharmacological treatments for cannabis use disorder. One approach is to potentiate endocannabinoid signalling by inhibiting fatty acid amide hydrolase (FAAH), the enzyme that degrades the endocannabinoid anandamide. We aimed to test the efficacy and safety of the FAAH-inhibitor PF-04457845 in reduction of cannabis withdrawal and cannabis use in men who were daily cannabis users.. We did a double-blind, placebo-controlled, parallel group phase 2a trial at one site in men aged 18-55 years with cannabis dependence according to DSM-IV criteria (equivalent to cannabis use disorder in DSM-5). After baseline assessments, participants were randomly assigned (2:1) to receive PF-04457845 (4 mg per day) or placebo using a fixed block size of six participants, stratified by severity of cannabis use and desire to quit. Participants were admitted to hospital for 5 days (maximum 8 days) to achieve abstinence and precipitate cannabis withdrawal, after which they were discharged to continue the remaining 3 weeks of treatment as outpatients. The primary endpoints were treatment-related differences in cannabis withdrawal symptoms during hospital admission, and week 4 (end of treatment) self-reported cannabis use and urine THC-COOH concentrations in the intention-to-treat population. The study is registered at ClinicalTrials.gov, number NCT01618656.. PF-04457845, a novel FAAH inhibitor, reduced cannabis withdrawal symptoms and cannabis use in men, and might represent an effective and safe approach for the treatment of cannabis use disorder.. United States National Institute of Drug Abuse (NIDA).

Topics: Adolescent; Adult; Amidohydrolases; Cannabis; Double-Blind Method; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Pyridazines; Substance Withdrawal Syndrome; Treatment Outcome; Urea; Young Adult

Quantifying cannabis use is complex due to a lack of a standardized packaging system that contains specified amounts of constituents. A laboratory procedure has been developed for estimating physical quantity of cannabis use by utilizing a surrogate substance to represent cannabis, and weighing the amount of the surrogate to determine typical use in grams.. This secondary analysis utilized data from a multi-site, randomized, controlled pharmacological trial for adult cannabis use disorder (N=300), sponsored by the National Drug Abuse Treatment Clinical Trials Network, to test the incremental validity of this procedure. In conjunction with the Timeline Followback, this physical scale-based procedure was used to determine whether average grams per cannabis administration predicted urine cannabinoid levels (11-nor-9-carboxy-Δ9-tetrahydrocannabinol) and problems due to use, after accounting for self-reported number of days used (in the past 30 days) and number of administrations per day in a 12-week clinical trial for cannabis use disorder.. Likelihood ratio tests suggest that model fit was significantly improved when grams per administration and relevant interactions were included in the model predicting urine cannabinoid level (X. This study provides support for the use of a scale-based method for quantifying cannabis use in grams. This methodology may be useful when precise quantification is necessary (e.g., measuring reduction in use in a clinical trial).

Topics: Adolescent; Adult; Biomarkers; Cannabinoids; Cannabis; Dronabinol; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Predictive Value of Tests; Reproducibility of Results; Self Report; Young Adult

Individuals with alcohol use disorder (AUD) do not always respond to currently available treatments, and evaluation of new candidate pharmacotherapies is indicated. N-acetylcysteine (NAC), an over-the-counter supplement, has shown promise in treating a variety of substance use disorders, but little research has evaluated its merits as a treatment for AUD. This secondary analysis from the National Drug Abuse Treatment Clinical Trials Network examined the effects of NAC versus placebo on alcohol use among participants with cannabis use disorder (CUD) enrolled in a 12-week, multi-site cannabis cessation trial.. Participants (N = 302, ages 18-50) were randomized to double-blind NAC (1200 mg, twice daily) or placebo. Neither alcohol use nor desire for alcohol cessation were requirements for participation. Participants that returned for at least one treatment visit and had recorded alcohol use data (i.e., total drinks per week, drinking days per week, and binge drinking days per week) were included in the analysis (n = 277).. Compared to the placebo group, participants in the NAC group had increased odds of between-visit alcohol abstinence [OR = 1.37; 95% CI = 1.06-1.78; p = 0.019], fewer drinks per week [RR = 0.67; 95% CI = 0.48-0.99; p = 0.045], and fewer drinking days per week [RR = 0.69; 95% CI = 0.51-0.92; p = 0.014]. Changes in concurrent cannabis use amounts were not correlated to any of the alcohol use variables.. These findings indicate that NAC may be effective at reducing consumption of alcohol by ∼30% among treatment-seeking adults with CUD, suggesting a need for further trials focused on the effects of NAC on alcohol consumption among individuals seeking treatment for AUD.

Topics: Acetylcysteine; Adolescent; Adult; Alcohol Drinking; Alcoholism; Cannabis; Double-Blind Method; Female; Humans; Male; Marijuana Abuse; Middle Aged; Treatment Outcome; Young Adult

Approximately 1.8 million young adults aged 18 to 25 had a Cannabis Use Disorder (CUD) in the past year. Unfortunately, engaging young adults in treatment is very challenging. Creative approaches to treat cannabis disorders such as integrating mobile technology with evidence-based treatments are warranted. In light of these challenges, we developed a text message-delivered version of Peer Network Counseling (PNC-txt), which is a substance use intervention that focuses on peer relations. PNC-txt engages participants in 16 automated, personalized text interactions over 4weeks. We conducted a randomized controlled trial to test the efficacy of PNC-txt against a waitlist control group with 30 treatment seeking young adults (ages 18-25) who met DSM-5 criteria for CUD. Self-report and urine analyses were used to test outcomes at the three-month follow-up. The PNC-txt group significantly reduced their cannabis use related problems as well as cannabis cravings, compared to the control group. PNC-txt participants also had a significantly greater percentage with urines negative for cannabis metabolites compared to controls. Moderation analysis showed that CUD severity level moderated treatment, suggesting that PNC-txt is more effective for participants with medium and high levels of CUD severity. All effect sizes ranged from medium to large. Results from this pilot trial are promising and warrant further research on PNC-txt for addressing cannabis use disorder.

Topics: Adult; Cannabis; Counseling; Female; Humans; Male; Marijuana Abuse; Peer Group; Pilot Projects; Self Report; Text Messaging; Treatment Outcome; Young Adult

Digital interventions show promise in reducing problematic cannabis use. However, little is known about the effect of moderators in such interventions. The therapist-guided internet intervention Quit the Shit provides 50 days of chat-based (synchronous) and time-lagged (asynchronous) counseling.. In the study, we examined whether the effectiveness of Quit the Shit is reduced by shortening the program or by removing the chat-based counseling option.. We conducted a purely Web-based randomized experimental trial using a two-factorial design (factor 1: real-time-counseling via text-chat: yes vs no; factor 2: intervention duration: 50 days vs 28 days). Participants were recruited on the Quit the Shit website. Follow-ups were conducted 3, 6, and 12 months after randomization. Primary outcome was cannabis-use days during the past 30 days using a Timeline Followback procedure. Secondary outcomes were cannabis quantity, cannabis-use events, cannabis dependency (Severity of Dependence Scale), treatment satisfaction (Client Satisfaction Questionnaire), and working alliance (Working Alliance Inventory-short revised).. In total, 534 participants were included in the trial. Follow-up rates were 47.2% (252/534) after 3 months, 38.2% (204/534) after 6 months, and 25.3% (135/534) after 12 months. Provision of real-time counseling (factor 1) was not significantly associated with any cannabis-related outcome but with higher treatment satisfaction (P=.001, d=0.34) and stronger working alliance (P=.008, d=0.22). In factor 2, no significant differences were found in any outcome. The reduction of cannabis use among all study participants was strong (P<.001, d≥1.13).. The reduction of program length and the waiver of synchronous communication have no meaningful impact on the effectiveness of Quit the Shit. It therefore seems tenable to abbreviate the program and to offer a self-guided start into Quit the Shit. Due to its positive impact on treatment satisfaction and working alliance, chat-based counseling nevertheless should be provided in Quit the Shit.. International Standard Randomized Controlled Trial Number ISRCTN99818059; http://www.isrctn.com/ISRCTN99818059 (Archived by WebCite at http://www.webcitation.org/6uVDeJjfD).

Topics: Adult; Cannabis; Counseling; Female; Humans; Internet; Male; Marijuana Abuse; Research Design

No medications are approved for cannabis use disorder (CUD). Gamma-aminobutyric acid (GABA) reuptake is modulated by cannabinoid (CB) receptor agonists, and there are shared effects between CB agonists and the GABA reuptake inhibitor tiagabine. This overlapping neuropharmacology suggested that tiagabine might be useful for CUD. The study determined the ability of tiagabine maintenance to reduce cannabis self-administration using a placebo-controlled, double-blind, counterbalanced, within-subjects design. Nontreatment-seeking daily cannabis users (N = 12; 3 female, 9 male) completed two 12-day outpatient maintenance phases (0 or 12 mg of tiagabine/day). Each phase consisted of a safety session, 7 maintenance days, and 4 experimental sessions. During experimental sessions, maintenance continued and participants completed two 2-day blocks of sampling and self-administration sessions to determine the reinforcing effects of smoked cannabis (0% and 5.9% Δ9-tetrahydrocannabinol). Naturalistic cannabis use, the subjective, performance and physiological response to cannabis, as well as side effects, sleep quality, craving, other self-reported substance use, and observer ratings were also measured. Cannabis functioned as a reinforcer and produced prototypical effects (e.g., increased heart rate and ratings of "high"), but tiagabine generally did not impact the effects of cannabis, or alter naturalistic use. Furthermore, tiagabine produced small, but significant, increases on 2 subscales of a Marijuana Craving Questionnaire, and reductions in both the amount of time slept in the past 24 hr and ratings of positive mood upon awakening. These human laboratory results from a sample of nontreatment-seeking cannabis users do not support the potential efficacy of 12 mg of tiagabine as a stand-alone pharmacotherapy for CUD. (PsycINFO Database Record

Topics: Adult; Affect; Cannabinoid Receptor Agonists; Cannabis; Craving; Double-Blind Method; Dronabinol; Female; GABA Uptake Inhibitors; Hallucinogens; Humans; Male; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Reinforcement, Psychology; Self Administration; Sleep; Surveys and Questionnaires; Tiagabine

Cannabis use rates are increasing among adults in the United States (US) while the perception of harm is declining. This may result in an increased prevalence of cannabis use disorder and the need for more clinical trials to evaluate efficacious treatment strategies. Clinical trials are the gold standard for evaluating treatment, yet study samples are rarely representative of the target population. This finding has not yet been established for cannabis treatment trials. This study compared demographic and cannabis use characteristics of a cannabis cessation clinical trial sample (run through National Drug Abuse Treatment Clinical Trials Network) with three nationally representative datasets from the US; 1) National Survey on Drug Use and Health, 2) National Epidemiologic Survey on Alcohol and Related Conditions-III, and 3) Treatment: Episodes Data Set - Admissions.. Comparisons were made between the clinical trial sample and appropriate cannabis using sub-samples from the national datasets, and propensity scores were calculated to determine the degree of similarity between samples.. showed that the clinical trial sample was significantly different from all three national datasets, with the clinical trial sample having greater representation among older adults, African Americans, Hispanic/Latinos, adults with more education, non-tobacco users, and daily and almost daily cannabis users.. These results are consistent with previous studies of other substance use disorder populations and extend sample representation issues to a cannabis use disorder population. This illustrates the need to ensure representative samples within cannabis treatment clinical trials to improve the generalizability of promising findings.

Topics: Adolescent; Adult; Age Factors; Black or African American; Cannabis; Databases, Factual; Female; Hispanic or Latino; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Patient Acceptance of Health Care; United States; Young Adult

Cannabis use disorder (CUD) is a prevalent and impairing condition, and established psychosocial treatments convey limited efficacy. In light of recent findings supporting the efficacy of N-acetylcysteine (NAC) for CUD in adolescents, the objective of this trial was to evaluate its efficacy in adults.. In a 12-week double-blind randomized placebo-controlled trial, treatment-seeking adults ages 18-50 with CUD (N=302), enrolled across six National Drug Abuse Treatment Clinical Trials Network-affiliated clinical sites, were randomized in a 1:1 ratio to a 12-week course of NAC 1200mg (n=153) or placebo (n=149) twice daily. All participants received contingency management (CM) and medical management. The primary efficacy measure was the odds of negative urine cannabinoid tests during treatment, compared between NAC and placebo participants.. There was not statistically significant evidence that the NAC and placebo groups differed in cannabis abstinence (odds ratio=1.00, 95% confidence interval 0.63-1.59, p=0.984). Overall, 22.3% of urine cannabinoid tests in the NAC group were negative, compared with 22.4% in the placebo group. Many participants were medication non-adherent; exploratory analysis within medication-adherent subgroups revealed no significant differential abstinence outcomes by treatment group.. In contrast with prior findings in adolescents, there is no evidence that NAC 1200mg twice daily plus CM is differentially efficacious for CUD in adults when compared to placebo plus CM. This discrepant finding between adolescents and adults with CUD may have been influenced by differences in development, cannabis use profiles, responses to embedded behavioral treatment, medication adherence, and other factors.

Topics: Acetylcysteine; Adolescent; Adult; Cannabis; Double-Blind Method; Female; Free Radical Scavengers; Humans; Male; Marijuana Abuse; Marijuana Smoking; Medication Adherence; Sulpiride; Treatment Outcome; Young Adult

Limited data exist regarding the neonatal and neurodevelopmental outcomes of infants exposed to marijuana (MJ) in-utero, particularly among preterm infants. We hypothesized that MJ-exposed preterm infants would have worse neonatal and childhood developmental outcomes compared to MJ-unexposed infants.. Secondary analysis of multicenter randomized-controlled trial of antenatal magnesium sulfate for the prevention of cerebral palsy was conducted. Singleton nonanomalous infants delivered <35 weeks exposed to MJ in-utero were compared to MJ-unexposed. Primary neonatal outcome was death, grade 3/4 intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, and/or stage II/III necrotizing enterocolitis before discharge. Primary childhood outcome was death, moderate/severe cerebral palsy, or/and Bayley II Scales <70 at age 2. Backward-stepwise regression used to estimate odds of primary outcomes.. 1867 infants met inclusion criteria; 135(7.2%) were MJ-exposed. There were no differences in neonatal (20% vs. 26%, p = 0.14) or childhood (26% vs. 21%, p = 0.21) outcomes in MJ-exposed infants compared to MJ-unexposed infants. In adjusted models, MJ-exposure was not associated with adverse neonatal outcomes (aOR 0.83 95% CI 0.47,1.44) or early childhood outcomes (aOR 1.47, 95% CI 0.97,2.23).. Among infants born <35 weeks of gestation, MJ-exposure was not associated with adverse neonatal or childhood outcomes. Long-term follow-up studies are needed to assess later childhood neurodevelopmental outcomes following MJ-exposure.

Topics: Cannabis; Cerebral Palsy; Child Development; Child, Preschool; Developmental Disabilities; Female; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Magnesium Sulfate; Male; Marijuana Abuse; Morbidity; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Risk Factors

Previous studies have shown brief online self-help interventions to be a useful method of treating cannabis use and related problems; however, no studies have compared the effects of brief versus extended feedback for online brief intervention programs.. The current study was a two arm randomised trial aimed at testing the short term effectiveness of a brief and extended feedback version of Grassessment, a brief online intervention for cannabis users that provides individualised feedback regarding use, motives, and harms.. Participants (n=287) reporting at least one symptom of DSM IV cannabis abuse or dependence were recruited using online and offline advertising methods. Participants were randomised to receive either a brief or extended feedback version of the Grassessment program and were required to complete a one month follow up questionnaire.. One hundred and ninety four participants completed the one month follow up. Wilcoxon analyses showed a significant decrease in past month quantity and frequency of cannabis use (ps<0.001; r=-0.41 and -0.40 respectively) and lower severity of dependence scores (p=0.002; r=-0.31) among those in the brief feedback condition. Participants in the extended feedback group also demonstrated significant decreases in patterns of use (ps<0.002; r=-0.39 and -0.33) but not severity of dependence (p=0.09; r=0.18). A Generalized Estimating Equation (GEE) analysis showed no significant interaction between length of feedback received and past month cannabis use frequency (p=0.78), quantity (p=0.73), or severity of dependence (p=0.47).. This study adds support for the use of brief online self-complete interventions to reduce cannabis use and related problems in the short term. The findings suggest that in the case of the brief online screening and feedback program Grassessment, extended feedback does not lead to superior outcomes over brief feedback.

Topics: Adolescent; Adult; Aged; Cannabis; Feedback, Psychological; Female; Health Behavior; Humans; Internet; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Motivation; Treatment Outcome; Young Adult

The dopamine β-hydroxylase (DβH) enzyme transforms dopamine into noradrenaline. We hypothesized that individuals with low activity DBH genotypes (rs1611115 CT/TT) are more sensitive to the influence of cannabis and cocaine on cognitive impulse control and functional connectivity in the limbic 'reward' circuit because they experience a drug induced hyperdopaminergic state compared to individuals with high activity DBH genotypes (rs1611115 CC). Regular drug users (N = 122) received acute doses of cannabis (450 μg/kg THC), cocaine HCl 300 mg and placebo. Cognitive impulse control was assessed by means of the Matching Familiar Figures Test (MFFT). Resting state fMRI was measured in a subset of participants to determine functional connectivity between the nucleus accumbens (NAc) and (sub)cortical areas. The influence of cannabis and cocaine on impulsivity and functional connectivity significantly interacted with DBH genotype. Both drugs increased cognitive impulsivity in participants with CT/TT genotypes but not in CC participants. Both drugs also reduced functional connectivity between the NAc and the limbic lobe, prefrontal cortex, striatum and thalamus and primarily in individuals with CT/TT genotypes. Correlational analysis indicated a significant negative association between cognitive impulsivity and functional connectivity in subcortical areas of the brain. It is concluded that interference of cannabis and cocaine with cognitive impulse control and functional corticostriatal connectivity depends on DBH genotype. The present data provide a neural substrate and behavioral mechanism by which drug users can progress to drug seeking and may also offer a rationale for targeted pharmacotherapy in chronic drug users with high risk DBH genotypes.

Topics: Brain; Brain Mapping; Cannabis; Cocaine; Cocaine-Related Disorders; Cognition; Cross-Over Studies; Dopamine beta-Hydroxylase; Double-Blind Method; Dronabinol; Executive Function; Female; Humans; Impulsive Behavior; Magnetic Resonance Imaging; Male; Marijuana Abuse; Neural Pathways; Neuropsychological Tests; Psychotropic Drugs; Rest; Young Adult

The Moti-4 intervention, in which motivational interviewing, self-monitoring, and strengthening behavioral control are used, was developed in the Netherlands in response to several rapid assessments of problematic use of cannabis among vulnerable adolescents. The main goal of the study reported in this article was to determine whether the Moti-4 intervention was able to reduce two outcome measures pertaining to the level of cannabis use; the amount of Euros spent a week on cannabis and the mean number of cannabis joints (cigarettes) smoked in a week. In a randomized controlled trial (RCT) with a 6-month follow-up, 27 trained Dutch prevention workers recruited 71 Moti-4 participants and 60 controls assigned to usual care. Participants were Dutch youth aged 14-24 years who had used cannabis during the preceding month. At baseline (T0), post-test (T1) and 6-month follow-up (T2), participants completed a questionnaire with 51 items. The 27 prevention workers also completed a checklist to assess the fidelity of delivering each item to each participant in the Moti-4 protocol. Multilevel and binary logistic regression was used to assess the impact of the prevention worker and 14 participant variables on the likelihood of drop-out. Mean scores for cannabis use outcome measures by Moti-4 participants and controls at baseline, T1 and T2 were compared using paired sample t-tests. Top-down multiple regression was used to assess relationships between Moti-4 and 13 other variables on the one hand and changes in weekly cannabis use at T1 and T2 on the other. The Moti-4 experimental condition had a significant and positive influence in reducing the level of expenditure on cannabis (p<0.05). There was no significant difference in outcome, neither for the 4 participating institutes nor for the professionals implementing the intervention. Baseline cannabis use was the strongest predictor (p<0.001) of weekly cannabis expenditure at posttest and 6-month follow-up. This effect was still present at T2. Being female, having two Dutch parents and perceived behavioral control also made significant positive contributions (p<0.05). Attitude at baseline was only related to cannabis expenditure after 6months (p=0.005). At T2 Moti-4 participants were found to have a significant reduction in the number of joints smoked weekly compared to T0 (on the average 4 joints). The study demonstrated that Moti-4 is an effective intervention to reduce cannabis use in youth.

Topics: Adolescent; Cannabis; Female; Humans; Male; Marijuana Abuse; Motivational Interviewing; Netherlands; Sex Factors; Surveys and Questionnaires; Young Adult

There is currently no pharmacological treatment approved for cannabis dependence. In this proof of concept study, we assessed the feasibility/effects of fixed and self-titrated dosages of Sativex (1:1, Δ(9)-tetrahydrocannabinol (THC)/cannabidiol (CBD)) on craving and withdrawal from cannabis among nine community-recruited cannabis-dependent subjects.. Participants underwent an 8-week double-blind placebo-controlled trial (an ABACADAE design), with four smoke as usual conditions (SAU) (A) separated by four cannabis abstinence conditions (B-E), with administration of either self-titrated/fixed doses of placebo or Sativex (up to 108 mg THC/100 mg CBD). The order of medication administration during abstinence conditions was randomized and counterbalanced. Withdrawal symptoms and craving were assessed using the Cannabis Withdrawal Scale (CWS), Marijuana Withdrawal Checklist (MWC) and Marijuana Craving Questionnaire (MCQ). Medication use was assessed during the study by means of self-reports, vial weight control, toxicology and metabolite analysis. Cannabis use was assessed by means of self-reports.. High fixed doses of Sativex were well tolerated and significantly reduced cannabis withdrawal during abstinence, but not craving, as compared to placebo. Self-titrated doses were lower and showed limited efficacy as compared to high fixed doses. Participants reported a significantly lower "high" following Sativex or placebo as compared to SAU conditions. Cannabis/medication use along the study, as per self-reports, suggests compliance with the study conditions.. The results found in this proof of concept study warrant further systematic exploration of Sativex as a treatment option for cannabis withdrawal and dependence.

Topics: Adult; Cannabidiol; Cannabis; Craving; Double-Blind Method; Dronabinol; Drug Combinations; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Plant Extracts; Substance Withdrawal Syndrome; Substance-Related Disorders; Treatment Outcome; Young Adult

Anecdotally, both acute and chronic cannabis use have been associated with apathy, amotivation, and other reward processing deficits. To date, empirical support for these effects is limited, and no previous studies have assessed both acute effects of Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), as well as associations with cannabis dependence.. The objectives of this study were (1) to examine acute effects of cannabis with CBD (Cann + CBD) and without CBD (Cann-CBD) on effort-related decision-making and (2) to examine associations between cannabis dependence, effort-related decision-making and reward learning.. In study 1, 17 participants each received three acute vaporized treatments, namely Cann-CBD (8 mg THC), Cann + CBD (8 mg THC + 10 mg CBD) and matched placebo, followed by a 50 % dose top-up 1.5 h later, and completed the Effort Expenditure for Rewards Task (EEfRT). In study 2, 20 cannabis-dependent participants were compared with 20 non-dependent, drug-using control participants on the EEfRT and the Probabilistic Reward Task (PRT) in a non-intoxicated state.. Cann-CBD reduced the likelihood of high-effort choices relative to placebo (p = 0.042) and increased sensitivity to expected value compared to both placebo (p = 0.014) and Cann + CBD (p = 0.006). The cannabis-dependent and control groups did not differ on the EEfRT. However, the cannabis-dependent group exhibited a weaker response bias than the control group on the PRT (p = 0.007).. Cannabis acutely induced a transient amotivational state and CBD influenced the effects of THC on expected value. In contrast, cannabis dependence was associated with preserved motivation alongside impaired reward learning, although confounding factors, including depression, cannot be disregarded. This is the first well powered, fully controlled study to objectively demonstrate the acute amotivational effects of THC.

Topics: Administration, Inhalation; Adult; Cannabidiol; Cannabinoid Receptor Agonists; Cannabis; Choice Behavior; Decision Making; Depression; Double-Blind Method; Dronabinol; Female; Humans; Learning; Male; Marijuana Abuse; Marijuana Smoking; Motivation; Reward; Young Adult

Findings are unclear as to whether cannabis use is associated with better cognitive functioning in individuals with psychosis.. To elucidate the association between cannabis use, neurocognition and social cognition in first-episode psychosis (FEP).. Secondary data analysis was conducted on data from 133 FEP participants who had enrolled in a randomized controlled trial of a vocational intervention. Participants completed a neurocognitive and social cognitive battery and characteristics of cannabis use were documented (disorder, recency, frequency and dose). Principal axis factor analysis was used to determine the underlying structure of the cognitive batteries. Regression techniques were used to examine cognitive predictors of current cannabis use disorder (CUD), and recency and frequency of cannabis use. Bivariate correlations were used to examine associations between cognition and dose of cannabis consumption.. Male gender (p=.037) was the only significant predictor of having a current CUD. Better processing speed (p=.022) and social cognition (p=.039), male gender (p<.001), and fewer negative symptoms (p=.036) predicted recency of cannabis use. Faster processing speed (p=.007) and male gender (p=.006) also predicted frequency of cannabis use. No variables were significantly associated with dose of cannabis consumption.. Better social cognition and processing speed abilities predicting recency and frequency of cannabis use are consistent with cannabis users having higher cognitive abilities. A positive relationship between cannabis use and cognition may be the result of more drug taking opportunities in less cognitively impaired individuals with psychosis.

Topics: Cannabis; Cognition; Female; Humans; Male; Marijuana Abuse; Prognosis; Psychiatric Status Rating Scales; Psychotic Disorders; Regression Analysis; Rehabilitation, Vocational; Sex Factors; Social Perception; Young Adult

Cannabis has been suggested to impair the capacity to recognize discrepancies between expected and executed actions. However, there is a lack of conclusive evidence regarding the acute impact of cannabis on the neural correlates of error monitoring. In order to contribute to the available knowledge, we used a randomized, double-blind, between-groups design to investigate the impact of administration of a low (5.5 mg THC) or high (22 mg THC) dose of vaporized cannabis vs. placebo on the amplitudes of the error-related negativity (ERN) and error positivity (Pe) in the context of the Flanker task, in a group of frequent cannabis users (required to use cannabis minimally 4 times a week, for at least 2 years). Subjects in the high dose group (n=18) demonstrated a significantly diminished ERN in comparison to the placebo condition (n=19), whereas a reduced Pe amplitude was observed in both the high and low dose (n=18) conditions, as compared to placebo. The results suggest that a high dose of cannabis may affect the neural correlates of both the conscious (late), as well as the initial automatic processes involved in error monitoring, while a low dose of cannabis might impact only the conscious (late) processing of errors.

Topics: Brain; Cannabis; Dose-Response Relationship, Drug; Double-Blind Method; Dronabinol; Electroencephalography; Female; Hallucinogens; Humans; Male; Marijuana Abuse; Mental Processes; Nebulizers and Vaporizers; Neuropsychological Tests; Reaction Time; Young Adult

Cannabis users frequently report concurrent tobacco use, and tobacco use is associated with poorer outcomes during treatment for cannabis use disorders (CUD). Interventions that simultaneously target both tobacco and cannabis use disorders may enhance cessation outcomes for either or both substances.. This study evaluated an intervention integrating highly effective treatments for cannabis and tobacco use disorders. Thirty-two participants meeting diagnostic criteria for CUD and reporting daily tobacco use were enrolled in a 12-week computer-assisted behavioral treatment for CUD. Participants were encouraged to participate in a tobacco intervention that included a computer-assisted behavioral treatment tailored for tobacco and cannabis co-users, and nicotine-replacement therapy (NRT). Cannabis and tobacco outcomes were evaluated using descriptive statistics and were compared to a historical control group that received treatment for CUD but not tobacco.. Participants achieved 3.6±4.3 consecutive weeks of cannabis abstinence, which was comparable to the historical control group (3.1±4.4). A majority of the sample (78%) completed at least one tobacco module and 44% initiated NRT. Over half (56%) initiated tobacco quit attempts, and 28% were tobacco abstinent for at least two consecutive weeks. Participants showed greater reduction in tobacco use (cigarettes per day) than the historical control group, but differences in tobacco abstinence rates during the final month of treatment were not statistically significant (12.5% vs. 4%).. Findings suggest that providing a tobacco intervention during treatment for CUD is feasible and may positively impact tobacco use without negatively affecting cannabis use outcomes.

Topics: Adolescent; Adult; Behavior Therapy; Cannabis; Female; Humans; Male; Marijuana Abuse; Middle Aged; Patient Acceptance of Health Care; Smoking Cessation; Therapy, Computer-Assisted; Tobacco Use Disorder; Treatment Outcome; Young Adult

US-based trials have shown that Multidimensional Family Therapy (MDFT) not only reduces substance abuse among adolescents, but also decreases mental and behavioural disorder symptoms, most notably externalising symptoms. In the INCANT trial, MDFT decreased the rate of cannabis dependence among Western European youth. We now focus on other INCANT outcomes, i.e., lessening of co-morbidity symptoms and improvement of family functioning.. INCANT was a randomised controlled trial comparing MDFT with individual therapy (IP) at and across sites in Berlin, Brussels, Geneva, The Hague, and Paris. We recruited 450 boys and girls aged 13 up to 18 years with a cannabis use disorder, and their parent(s), and followed them for 12 months. Mental and behavioural characteristics (classified as 'externalising' or 'internalising') and family conflict and cohesion were assessed.. From intake through 12 months, MDFT and IP groups improved on all outcome measures. Models including treatment, site, and referral source showed that MDFT outperformed IP in reducing externalising symptoms.Adolescents were either self-referred to treatment (mostly on the initiative from people close to the teen) or referred under some measure of coercion by an external authority. These two groups reacted equally well to treatment.. Both MDFT and IP reduced the rate of externalising and internalising symptoms and improved family functioning among adolescents with a cannabis use disorder. MDFT outperformed IP in decreasing the rate of externalising symptoms. Contrary to common beliefs among therapists in parts of Western Europe, the 'coerced' adolescents did at least as well in treatment as the self-referred adolescents.MDFT shows promise as a treatment for both substance use disorders and externalising symptoms.. ISRCTN51014277.

Topics: Adolescent; Cannabis; Europe; Family Relations; Family Therapy; Female; Humans; Male; Marijuana Abuse; Parents; Treatment Outcome

Cannabis is among the most frequently abused substances in the United States. Cognitive control is a contributory factor in the maintenance of substance-use disorders and may relate to treatment response. Therefore, we assessed whether cognitive-control-related neural activity before treatment differs between treatment-seeking cannabis-dependent and healthy individuals and relates to cannabis-abstinence measures during treatment and 1-year follow-up. Cannabis-dependent males (N=20) completed a functional magnetic resonance imaging (fMRI) cognitive-control (Stroop) task before a 12-week randomized controlled trial of cognitive-behavioral therapy and/or contingency management. A healthy-comparison group (N=20) also completed the fMRI task. Cannabis use was assessed by urine toxicology and self-report during treatment, and by self-report across a 1-year follow-up period (N=18). The cannabis-dependent group displayed diminished Stroop-related neural activity relative to the healthy-comparison group in multiple regions, including those strongly implicated in cognitive-control and addiction-related processes (eg, dorsolateral prefrontal cortex and ventral striatum). The groups did not differ significantly in response times (cannabis-dependent, N=12; healthy-comparison, N=14). Within the cannabis-dependent group, greater Stroop-related activity in regions including the dorsal anterior cingulate cortex was associated with less cannabis use during treatment. Greater activity in regions including the ventral striatum was associated with less cannabis use during 1-year posttreatment follow-up. These data suggest that lower cognitive-control-related neural activity in classic 'control' regions (eg, dorsolateral prefrontal cortex and dorsal anterior cingulate) and classic 'salience/reward/learning' regions (eg, ventral striatum) differentiates cannabis-dependent individuals from healthy individuals and relates to less abstinence within-treatment and during long-term follow-up. Clinically, results suggest that treatment development efforts that focus on enhancing cognitive control in addition to abstinence may improve treatment outcomes in cannabis dependence.

Topics: Adult; Brain; Brain Mapping; Cannabis; Follow-Up Studies; Humans; Illicit Drugs; Magnetic Resonance Imaging; Male; Marijuana Abuse; Reaction Time; Self Report; Stroop Test; Treatment Outcome

Active marijuana produces significant subjective, psychomotor, and physiological effects relative to inactive marijuana, yet demonstrating that these effects are dose-dependent has proven difficult. This within-subject, double-blind study was designed to develop a smoking procedure to obtain a marijuana dose-response function. In four outpatient laboratory sessions, daily marijuana smokers (N = 17 males, 1 female) smoked six 5-s puffs from 3 marijuana cigarettes (2 puffs/cigarette). The number of puffs from active (≥5.5% Δ⁹-tetrahydrocannabinol/THC) and inactive (0.0% THC) marijuana varied according to condition (0, 2, 4, or 6 active puffs); active puffs were always smoked before inactive puffs. Subjective, physiological, and performance effects were assessed prior to and at set time points after marijuana administration. Active marijuana dose-dependently increased heart rate and decreased marijuana craving, despite evidence (carbon monoxide expiration, weight of marijuana cigarettes post-smoking) that participants inhaled less of each active marijuana cigarette than inactive cigarettes. Subjective ratings of marijuana "strength," "high," "liking," "good effect," and "take again" were increased by active marijuana compared with inactive marijuana, but these effects were not dose-dependent. Active marijuana also produced modest, non-dose-dependent deficits in attention, psychomotor function, and recall relative to the inactive condition. In summary, although changes in inhalation patterns as a function of marijuana strength likely minimized the difference between dose conditions, dose-dependent differences in marijuana's cardiovascular effects and ratings of craving were observed, whereas subjective ratings of marijuana effects did not significantly vary as a function of dose.

Topics: Adult; Behavior; Breath Tests; Cannabis; Carbon Monoxide; Dose-Response Relationship, Drug; Double-Blind Method; Dronabinol; Female; Heart Rate; Humans; Inhalation; Male; Marijuana Abuse; Marijuana Smoking; Memory; Middle Aged; Plant Leaves; Psychomotor Performance; Psychotropic Drugs; Reproducibility of Results; Young Adult

Prior studies have separately examined the effects of dronabinol (oral THC) on cannabis withdrawal, cognitive performance, and the acute effects of smoked cannabis. A single study examining these clinically relevant domains would benefit the continued evaluation of dronabinol as a potential medication for the treatment of cannabis use disorders.. Thirteen daily cannabis smokers completed a within-subject crossover study and received 0, 30, 60 and 120mg dronabinol per day for 5 consecutive days. Vital signs and subjective ratings of cannabis withdrawal, craving and sleep were obtained daily; outcomes under active dose conditions were compared to those obtained under placebo dosing. On the 5th day of medication maintenance, participants completed a comprehensive cognitive performance battery and then smoked five puffs of cannabis for subjective effects evaluation. Each dronabinol maintenance period occurred in a counterbalanced order and was separated by 9 days of ad libitum cannabis use.. Dronabinol dose-dependently attenuated cannabis withdrawal and resulted in few adverse side effects or decrements in cognitive performance. Surprisingly, dronabinol did not alter the subjective effects of smoked cannabis, but cannabis-induced increases in heart rate were attenuated by the 60 and 120mg doses.. Dronabinol's ability to dose-dependently suppress cannabis withdrawal may be therapeutically beneficial to individuals trying to stop cannabis use. The absence of gross cognitive impairment or side effects in this study supports safety of doses up to 120mg/day. Continued evaluation of dronabinol in targeted clinical studies of cannabis treatment, using an expanded range of doses, is warranted.

Topics: Adolescent; Adult; Cannabis; Cross-Over Studies; Dose-Response Relationship, Drug; Dronabinol; Drug Administration Schedule; Eating; Female; Heart Rate; Humans; Male; Marijuana Abuse; Middle Aged; Sleep; Substance Withdrawal Syndrome

The present study assessed psychomotor function in chronic, daily cannabis smokers during 3 weeks continuously monitored abstinence on a secure research unit. We hypothesized that psychomotor performance would improve during abstinence of chronic, daily cannabis smokers.. Performance on the critical tracking (CTT) and divided attention (DAT) tasks was assessed in 19 male chronic, daily cannabis smokers at baseline and after 8, 14-16 and 21-23 days of continuously monitored abstinence. Psychomotor performance was compared to a control group of non-intoxicated occasional drug users. Critical frequency (λ(c)) of the CTT and tracking error and control losses of the DAT were the primary outcome measures. Results showed that chronic cannabis smokers' performance on the CTT (p<0.001) and the DAT (p<0.001) was impaired during baseline relative to the comparison group. Psychomotor performance in the chronic cannabis smokers improved over 3 weeks of abstinence, but did not recover to equivalent control group performance.. Sustained cannabis abstinence moderately improved critical tracking and divided attention performance in chronic, daily cannabis smokers, but impairment was still observable compared to controls after 3 weeks of abstinence. Between group differences, however, need to be interpreted with caution as chronic smokers and controls were not matched for education, social economic status, life style and race.

Topics: Adult; Attention; Cannabis; Case-Control Studies; Cognition; Dronabinol; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Psychomotor Performance; Reproducibility of Results; Time Factors; Young Adult

There are no FDA-approved pharmacotherapies for cannabis dependence. Cannabis is the most widely used illicit drug in the world, and patients seeking treatment for primary cannabis dependence represent 25% of all substance use admissions. We conducted a phase IIa proof-of-concept pilot study to examine the safety and efficacy of a calcium channel/GABA modulating drug, gabapentin, for the treatment of cannabis dependence. A 12-week, randomized, double-blind, placebo-controlled clinical trial was conducted in 50 unpaid treatment-seeking male and female outpatients, aged 18-65 years, diagnosed with current cannabis dependence. Subjects received either gabapentin (1200 mg/day) or matched placebo. Manual-guided, abstinence-oriented individual counseling was provided weekly to all participants. Cannabis use was measured by weekly urine toxicology and by self-report using the Timeline Followback Interview. Cannabis withdrawal symptoms were assessed using the Marijuana Withdrawal Checklist. Executive function was measured using subtests from the Delis-Kaplan Executive Function System. Relative to placebo, gabapentin significantly reduced cannabis use as measured both by urine toxicology (p=0.001) and by the Timeline Followback Interview (p=0.004), and significantly decreased withdrawal symptoms as measured by the Marijuana Withdrawal Checklist (p<0.001). Gabapentin was also associated with significantly greater improvement in overall performance on tests of executive function (p=0.029). This POC pilot study provides preliminary support for the safety and efficacy of gabapentin for treatment of cannabis dependence that merits further study, and provides an alternative conceptual framework for treatment of addiction aimed at restoring homeostasis in brain stress systems that are dysregulated in drug dependence and withdrawal.

Topics: Adolescent; Adult; Amines; Calcium Channel Blockers; Cannabis; Counseling; Cyclohexanecarboxylic Acids; Double-Blind Method; Executive Function; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Male; Marijuana Abuse; Middle Aged; Substance Withdrawal Syndrome; Treatment Outcome

Sativex(®), a cannabis extract oromucosal spray containing Δ(9)-tetrahydrocannabinol (THC) and cannabidiol (CBD), is currently in phase III trials as an adjunct to opioids for cancer pain treatment, and recently received United Kingdom approval for treatment of spasticity. There are indications that CBD modulates THC's effects, but it is unclear if this is due to a pharmacokinetic and/or pharmacodynamic interaction.. Cannabis smokers provided written informed consent to participate in this randomized, controlled, double-blind, double-dummy institutional review board-approved study. Participants received 5 and 15 mg synthetic oral THC, low-dose (5.4 mg THC and 5.0 mg CBD) and high-dose (16.2 mg THC and 15.0 mg CBD) Sativex, and placebo over 5 sessions. CBD, THC, 11-hydroxy-THC, and 11-nor- 9-carboxy-THC were quantified in plasma by 2-dimensional GC-MS. Lower limits of quantification were ≤0.25 μg/L.. Nine cannabis smokers completed all 5 dosing sessions. Significant differences (P < 0.05) in maximum plasma concentrations (C(max)) and areas under the curve from 0-10.5 h postdose (AUC(0→10.5)) for all analytes were found between low and high doses of synthetic THC and Sativex. There were no statistically significant differences in C(max), time to maximum concentration or in the AUC(0→10.5) between similar oral THC and Sativex doses. Relative bioavailability was calculated to determine the relative rate and extent of THC absorption; 5 and 15 mg oral THC bioavailability was 92.6% (13.1%) and 98.8% (11.0%) of low- and high-dose Sativex, respectively.. These data suggest that CBD modulation of THC's effects is not due to a pharmacokinetic interaction at these therapeutic doses.

Topics: Adult; Cannabidiol; Cannabis; Double-Blind Method; Dronabinol; Drug Combinations; Female; Humans; Male; Marijuana Abuse; Mouth Mucosa; Plant Extracts; Young Adult

Cannabis dependence is a significant public health problem. Because there are no approved medications for this condition, treatment must rely on behavioral approaches empirically complemented by such lifestyle change as exercise.. To examine the effects of moderate aerobic exercise on cannabis craving and use in cannabis dependent adults under normal living conditions.. Participants attended 10 supervised 30-min treadmill exercise sessions standardized using heart rate (HR) monitoring (60-70% HR reserve) over 2 weeks. Exercise sessions were conducted by exercise physiologists under medical oversight.. Sedentary or minimally active non-treatment seeking cannabis-dependent adults (n = 12, age 25±3 years, 8 females) met criteria for primary cannabis dependence using the Substance Abuse module of the Structured Clinical Interview for DSM-IV (SCID).. Self-reported drug use was assessed for 1-week before, during, and 2-weeks after the study. Participants viewed visual cannabis cues before and after exercise in conjunction with assessment of subjective cannabis craving using the Marijuana Craving Questionnaire (MCQ-SF).. Daily cannabis use within the run-in period was 5.9 joints per day (SD = 3.1, range 1.8-10.9). Average cannabis use levels within the exercise (2.8 joints, SD = 1.6, range 0.9-5.4) and follow-up (4.1 joints, SD = 2.5, range 1.1-9.5) periods were lower than during the run-in period (both P<.005). Average MCQ factor scores for the pre- and post-exercise craving assessments were reduced for compulsivity (P  = .006), emotionality (P  = .002), expectancy (P  = .002), and purposefulness (P  = .002).. The findings of this pilot study warrant larger, adequately powered controlled trials to test the efficacy of prescribed moderate aerobic exercise as a component of cannabis dependence treatment. The neurobiological mechanisms that account for these beneficial effects on cannabis use may lead to understanding of the physical and emotional underpinnings of cannabis dependence and recovery from this disorder.. ClinicalTrials.gov NCT00838448].

Topics: Adolescent; Adult; Cannabis; Child; Exercise; Exercise Therapy; Female; Humans; Male; Marijuana Abuse; Patient Compliance; Self Report

To meet the treatment needs of the growing number of adolescents who seek help for cannabis use problems, new or supplementary types of treatment are needed. We investigated whether multidimensional family therapy (MDFT) was more effective than cognitive behavioral therapy (CBT) in treatment-seeking adolescents with a DSM-IV cannabis use disorder in The Netherlands.. One hundred and nine adolescents participated in a randomized controlled trial, with study assessments at baseline and at 3, 6, 9 and 12 months following baseline. They were randomly assigned to receive either outpatient MDFT or CBT, both with a planned treatment duration of 5-6 months. Main outcome measures were cannabis use, delinquent behavior, treatment response and recovery at one-year follow-up, and treatment intensity and retention.. MDFT was not found to be superior to CBT on any of the outcome measures. Adolescents in both treatments did show significant and clinically meaningful reductions in cannabis use and delinquency from baseline to one-year follow-up, with treatment effects in the moderate range. A substantial percentage of adolescents in both groups met the criteria for treatment response at month 12. Treatment intensity and retention was significantly higher in MDFT than in CBT. Post hoc subgroup analyses suggested that high problem severity subgroups at baseline may benefit more from MDFT than from CBT.. The current study indicates that MDFT and CBT are equally effective in reducing cannabis use and delinquent behavior in adolescents with a cannabis use disorder in The Netherlands.

Topics: Adolescent; Cannabis; Cognitive Behavioral Therapy; Dronabinol; Family Therapy; Female; Follow-Up Studies; Humans; Juvenile Delinquency; Male; Marijuana Abuse; Netherlands; Psychiatric Status Rating Scales; Psychotropic Drugs; Research Design; Self Report; Time Factors; Treatment Outcome

The present study investigated the potential efficacy of buspirone for treating marijuana dependence. Participants received either buspirone (maximum 60mg/day) (n=23) or matching placebo (n=27) for 12 weeks, each in conjunction with motivational interviewing. In the modified intention-to-treat analysis, the percentage of negative UDS results in the buspirone-treatment group was 18 percentage points higher than the placebo-treatment group (95% CI: -2% to 37%, p=0.071). On self-report, participants receiving buspirone reported not using marijuana 45.2% of days and participants receiving placebo reported not using 51.4% of days (p=0.55). An analysis of participants that completed the 12-week trial showed a significant difference in the percentage negative UDS (95% CI: 7-63%, p=0.014) and a trend for participants randomized to the buspirone-treatment group who completed treatment to achieve the first negative UDS result sooner than those participants treated with placebo (p=0.054). Further study with buspirone in this population may be warranted; however, strategies to enhance study retention and improve outcome measurement should be considered in future trials.

Topics: Adult; Anti-Anxiety Agents; Anxiety; Buspirone; Cannabinoids; Cannabis; Double-Blind Method; Female; Humans; Male; Marijuana Abuse; Motivation; Psychiatric Status Rating Scales; Sample Size; Substance Withdrawal Syndrome; Surveys and Questionnaires; Treatment Outcome

Pain, spasticity, tremor, spasms, poor sleep quality, and bladder and bowel dysfunction, among other symptoms, contribute significantly to the disability and impaired quality of life of many patients with multiple sclerosis (MS). Motor symptoms referable to the basal ganglia, especially paroxysmal dystonia, occur rarely and contribute to the experience of distress. A substantial percentage of patients with MS report subjective benefit from what is often illicit abuse of extracts of the Cannabis sativa plant; the main cannabinoids include delta-9-tetrahydrocannabinol (delta9-THC) and cannabidiol. Clinical trials of cannabis plant extracts and synthetic delta9-THC provide support for therapeutic benefit on at least some patient self-report measures. An illustrative case is presented of a 52-year-old woman with MS, paroxysmal dystonia, complex vocal tics, and marijuana dependence. The patient was started on an empirical trial of dronabinol, an encapsulated form of synthetic delta9-THC that is usually prescribed as an adjunctive medication for patients undergoing cancer chemotherapy. The patient reported a dramatic reduction of craving and illicit use; she did not experience the "high" on the prescribed medication. She also reported an improvement in the quality of her sleep with diminished awakenings during the night, decreased vocalizations, and the tension associated with their emission, decreased anxiety and a decreased frequency of paroxysmal dystonia.

Topics: Adult; Cannabis; Dronabinol; Female; Hallucinogens; Humans; Male; Marijuana Abuse; Multiple Sclerosis; Nocturnal Paroxysmal Dystonia; Phytotherapy; Tics

Cannabis use is a major problem in inner cities and has been causally implicated in psychosis. Very few of the available hospital-based studies of the implications of cannabis usage have involved psychiatric intensive care units (PICU); but PICU receive many of the most challenging and resource-hungry-and incompletely understood-patients in the mental health system.. To study the clinical impact of cannabis abuse in a PICU, and to compare the use of atypical and typical antipsychotics in this setting.. 115 patients admitted to a PICU consented to take part in an open label naturalistic study. BPRS, TCI-240, weight, length of admission and routine bloods were evaluated in all participants.. There was a high rate of cannabis abuse (71.3%) in the PICU population. Patients who abused cannabis spent longer in PICU because their psychoses were more severe. They were younger at first hospital admission. Cannabis also had metabolic implications, with higher blood glucose levels at admission and greater weight increase. Atypical antipsychotics were effective in treating psychosis inpatients positive to cannabis at admission.. Our findings suggest that cannabis abusers had a more severe psychotic illness, especially in schizophrenia. There are additional complications in terms of weight gain for cannabis users.

Topics: Adult; Antipsychotic Agents; Cannabis; Critical Care; Female; Humans; London; Male; Marijuana Abuse; Prospective Studies; Psychiatric Status Rating Scales; Psychotic Disorders; Risk Assessment; Substance Abuse Detection

The increasing demand for cannabis dependence treatment has led to the identification of significant gaps in the knowledge of effective interventions. A randomized controlled trial of brief cognitive-behavioral interventions (CBT) for cannabis dependence was undertaken to address this issue. A total of 229 participants were assessed and allocated to either a 6-session CBT program, a single-session brief intervention, or a delayed-treatment control group. This paper demonstrates that individuals with cannabis use disorder will present for a brief intervention program. While they report similar patterns of cannabis use to nontreatment samples, they report a range of serious health and psychosocial consequences. While they appear relatively socially stable, they typically demonstrated severe cannabis dependence and significantly elevated levels of psychological distress, with the most commonly cited reason for cannabis use being stress relief. There were clinically relevant gender differences among the sample. This study provides more evidence of the demand for, and nature of issues relevant to, interventions for cannabis use disorders, and supports the need for further research into how best to assist individuals with these disorders.

Topics: Adolescent; Adult; Cannabis; Cognitive Behavioral Therapy; Female; Humans; Male; Marijuana Abuse; Middle Aged; New South Wales; Psychiatric Status Rating Scales; Psychotherapy, Brief; Secondary Prevention; Severity of Illness Index; Treatment Outcome

Commercially available snack bars and other foodstuffs prepared from pressed hemp seeds were ingested by volunteers. Urine specimens were collected for 24 h after ingestion of the foodstuffs containing hemp seeds and tested for marijuana using an EMIT immunoassay and gas chromatography-mass spectrometry (GC-MS). Specimens from individuals who ate one hemp seed bar demonstrated little marijuana immunoreactivity, and only one specimen screened positive at a 20-ng/mL cutoff. Specimens from individuals who ate two hemp seed bars showed increased immunoreactivity, and five specimens screened positive at a 20-ng/mL cutoff. A single specimen yielded a quantitative GC-MS value (0.6 ng/mL), but it failed to meet reporting criteria. Several specimens from individuals who ate three cookies made from hemp seed flour and butter screened positive at both 50- and 20-ng/mL cutoffs. Two specimens produced quantitative GC-MS values (0.7 and 3.1 ng/mL), but they failed to meet reporting criteria. Several specimens also tested positive with an FDA-approved on-site marijuana-screening device. Hemp seeds similar to those used in the foodstuffs did not demonstrate the presence of marijuana when tested by GC-MS. In this study, ingestion of hemp seed food products resulted in urine specimens that screened positive for marijuana. No specimens gave a GC-MS quantitative value above the limit of detection for marijuana.

Topics: Adult; Cannabis; Dronabinol; Enzyme Multiplied Immunoassay Technique; Female; Food; Gas Chromatography-Mass Spectrometry; Hallucinogens; Humans; Immunoassay; Male; Marijuana Abuse; Middle Aged; Seeds; Substance Abuse Detection

Plasma prolactin levels were determined in 23 adult males prior to and following administration of delta 9-tetrahydrocannabinol (THC) (17.5 mg orally), a synthetic cannabis compound, Nabilone (2 mg orally), a 1-g marihuana cigarette containing 1.83% THC, smoked under controlled conditions and placebo capsules and cigarettes for each of the active cannabis compounds. In order to control for possible influence of previous cannabis use history on prolactin response, three groups of subjects were studied--regular (daily) marihuana users, intermittent (weekly) marihuana users, and occasional (monthly) marihuana users. Each subject served as his own control for each drug condition. Double blind studies were conducted on a residential research ward. All baseline prolactin values were within the normal range for healthy adult males. There were no statistically significant differences in plasma prolactin levels among the three subject groups prior to administration of THC, Nabilone, marihuana or their respective placebos. There were no statistically significant changes in prolactin levels following TCH, Nabilone or marihuana smoking. Only placebo administration to regular and occasional marihuana users was followed by a significant increase in plasma prolactin levels. These findings indicate that acute administration of cannabis compounds, either orally or via smoking, does not significantly affect plasma prolactin levels in adult human males.

Topics: Adult; Antiemetics; Cannabis; Dronabinol; Humans; Male; Marijuana Abuse; Prolactin

Morning cannabis use is associated with heavier, frequent cannabis use and more cannabis-related negative consequences, yet little empirical research has examined its predictors. Using 24 months of longitudinal data, the present study tested demographic, psychosocial, and behavioral predictors of morning cannabis use among young adults at the monthly- and person-levels. Young adults (N = 778) were part of a larger study on substance use and social role transitions; participants completed a baseline survey and up to 24 consecutive monthly surveys. Hypotheses were tested using logistic multilevel models to estimate odds ratios for any vs. no morning use in a given month. At the monthly level, social anxiety motives and cannabis use frequency on a given month were positively associated with morning cannabis use. At the person level, typical coping motives, average cannabis use frequency, and male sex were positively associated with morning cannabis use. Findings advance our understanding of individual and psychosocial predictors of morning cannabis use among young adults. Notably, social anxiety motives may represent a malleable target for intervention efforts that could reduce risky use patterns associated with morning use. Such efforts may be especially prudent for young men, as our findings indicated morning cannabis use probabilities were much higher for men than women.

Topics: Adaptation, Psychological; Cannabis; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Motivation; Young Adult

Topics: Cannabinoid Receptor Agonists; Cannabis; Decision Making; Hallucinogens; Humans; Marijuana Abuse; Motivation; Reward; Students

The present study was aimed to compare the grip/pinch strengths and manual dexterity of individuals with and without the use of cannabis and its derivatives.. A cross-sectional prospective study was conducted with 66 individuals, including 33 cases with the use of cannabis (and its derivatives) and 33 age- and sex-matched controls. Grip and pinch strengths were evaluated with a dynamometer. The Nine-Hole Peg Test (9HPT), Minnesota Manual Dexterity Test (MMDT), and Michigan Hand Outcomes Questionnaire (MHQ) were used to assess the hand function.. The hand grip strength and dominant hand 2-point pinch (2PP) grip strength were less in individuals with substance use disorder (SUD) (p < 0.05). The 9HPT duration of the SUD patients was higher (p < 0.05). On the other hand, the MMDT insertion and rotation test results were different between the groups (p < 0.05). Grip strength was related with the MMDT insertion and rotation tests (r =  -0.411 to -0.480). There was significant correlation between grip strength with dominant hand 9HPT (r =  -0.370) and between dominant hand 3-point pinch (3PP) strength with MMDT insertion (r =  -0.378). In addition, dominant hand 2PP strength was correlated with overall hand function of MHQ (r = 0.382).. The individuals with cannabis use disorder showed reduced grip strength on both sides and decreased 2PP strength on the dominant side compared to healthy individuals. In addition, there is a decrease in the hand skills of individuals with cannabis use disorder. Decreased grip strength of individuals with cannabis use disorder affected their hand skills negatively.

Topics: Cannabis; Cross-Sectional Studies; Hand; Hand Strength; Humans; Marijuana Abuse; Prospective Studies

Cannabis demand (i.e., reinforcing value) can be assessed using a marijuana purchase task (MPT; assesses hypothetical purchasing of cannabis at escalating prices) and has been related to use frequency, problems, and cannabis use disorder symptoms in adults. Cannabis demand has yet to be studied in adolescents, which can inform prevention and intervention efforts to reduce cannabis-related risks. The present study sought to validate the MPT with a sample of late adolescent lifetime cannabis users. Participants aged 15-18 years old (

Topics: Adolescent; Adult; Cannabis; Commerce; Craving; Humans; Marijuana Abuse; Marijuana Smoking

Cannabis is one of the most widely used substances in the world, with usage trending upward in recent years. However, although the psychiatric burden associated with maladaptive cannabis use has been well established, reliable and interpretable biomarkers associated with chronic use remain elusive. In this study, we combine large-scale functional magnetic resonance imaging with machine learning and network analysis and develop an interpretable decoding model that offers both accurate prediction and novel insights into chronic cannabis use.. Chronic cannabis users (n = 166) and nonusing healthy control subjects (n = 124) completed a cue-elicited craving task during functional magnetic resonance imaging. Linear machine learning methods were used to classify individuals into chronic users and nonusers based on whole-brain functional connectivity. Network analysis was used to identify the most predictive regions and communities.. We obtained high (∼80% out-of-sample) accuracy across 4 different classification models, demonstrating that task-evoked connectivity can successfully differentiate chronic cannabis users from nonusers. We also identified key predictive regions implicating motor, sensory, attention, and craving-related areas, as well as a core set of brain networks that contributed to successful classification. The most predictive networks also strongly correlated with cannabis craving within the chronic user group.. This novel approach produced a neural signature of chronic cannabis use that is both accurate in terms of out-of-sample prediction and interpretable in terms of predictive networks and their relation to cannabis craving.

Topics: Brain; Cannabis; Craving; Humans; Marijuana Abuse

Topics: Adolescent; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking

Cannabis use is increasing among Andalusian adolescents, causing health, social and financial problems. School nurses visit schools and provide health promotion to adolescents in Andalusia. In order to better tailor health promotion programs, it is important to understand the sociodemographic and motivational factors related to cannabis use in Andalusian adolescents.. In this cross-sectional study, 369 students (aged 15-18 years) from secondary schools in Andalusia were involved. An anonymous questionnaire based on the I-Change Model was self-administered during school hours. Cannabis users were compared with non-cannabis users regarding sociodemographic and motivational factors. Contingency tables, mean comparison tests, and logistic regression analyses were conducted.. The prevalence of cannabis use in the last year was 21.6%. Non-cannabis users had a few positive beliefs toward cannabis use (e.g. the ability to relax or medical benefits), as well as users. Users recognized some disadvantages of cannabis use but played down their importance and mentioned more advantages. Moreover, social influence, especially from peers, plays a critical role in cannabis use. Specific social situations and moods seemed to be special risk factors for cannabis use, such as being at a celebration or feeling good. Results of regression analysis showed that cannabis use is mainly associated with age, low family function, low family affluence, high pocket money, perceiving few disadvantages of cannabis use, much social modeling of cannabis use, social norm and pressure favoring cannabis, low self-efficacy to resist using cannabis and positive intentions to use cannabis.. Based on our results, prevention programmes lead by nurses can be tailored to the factors important to prevent cannabis use, focusing on outlining the disadvantages of cannabis use, alternatives for using cannabis when feeling good, increasing salience of healthy social influences and reinforcing self-efficacy to resist temptations to use cannabis are recommended.. Nurses need to know the sociodemographic factors and motivations associated with the use of cannabis in adolescents in order to establish effective preventive interventions at school.

Topics: Adolescent; Cannabis; Cross-Sectional Studies; Humans; Marijuana Abuse; Motivation; Surveys and Questionnaires

Cannabis represents the most used substance in the young population after alcohol and tobacco. The consumption of the substance undoubtedly represents an emerging public health issue, and the regulatory aspects are quite heterogeneous. Alternatives to drug prohibition, such as legalization or decriminalization, are a topic of growing debate among researchers, policy makers and the public. Limiting harmful use and combating illicit trafficking are the main objectives of legalization for recreational purposes, although liberalization raises critical issues that have not yet been resolved despite the experience gained in many countries. In the context of legalization, it is essential to allow the lawful production of cannabis, guarantee a supply of controlled quality cannabis, and ensure that the population understands the risks associated with the consumption of the substance. At the same time, it is essential to protect the safety and health of the population by limiting access to cannabis and preventing accidental exposure to fragile categories and children. Incomplete knowledge of law enforcement can create further complications. Incomplete knowledge of the implementation of the laws can create further complications; therefore adequate information must be favored. Scientific evidence helps to understand the potential harms and benefits of cannabis, but the impact of legalization - even in terms of reducing consumption - is not clearly documented. So, far more efforts need to be made in the future to broaden awareness of the general population on the recreational use of cannabis.

Topics: Cannabinoid Receptor Agonists; Cannabis; Child; Hallucinogens; Humans; Marijuana Abuse; Public Health; Public Opinion

Deregulation of cannabis use has raised concerns regarding its potential effects on health, particularly in adolescents and young adults. Here, we extracted data from the Global Burden of Disease database to estimate the long-term effect (> 5 years) of medical marijuana laws (MML) on 2019 cannabis use disorders Disability Adjusted Life Years (2019 CUD DALYs) in US male and female adolescents (15-19 years old) and young adults (20-24 years old). Socio-cultural, demographic and economic characteristics were used as baseline covariates. To improve the robustness of estimation, we took advantage of machine learning techniques. We found no significant effect of MML on 2019 CUD DALYS in each of our four age/sex groups. Estimates from a marginal structural model taking into account age and sex strata in the same model were also non-significant. Our findings suggest that MML may have a negligible effect (if any) on cannabis use disorders in this population group.

Topics: Adolescent; Adult; Cannabis; Female; Hallucinogens; Humans; Male; Marijuana Abuse; Medical Marijuana; Substance-Related Disorders; Young Adult

The association between physical inactivity and substance use throughout adolescence was prospectively investigated in relation to developing cannabis use disorder (CUD). Physical inactivity and substance use in males (N = 462) and females (N = 178) were measured at 12-14, 16, 19, and 22 years of age in a repeated measures design. A structured diagnostic interview was administered to formulate current CUD diagnosis at 22 years of age. Mixture modeling path analysis evaluated the association between physical inactivity, substance use, and CUD. Males: Slope of physical inactivity increase spanning 12-22 years of age mediates the association between number of parents with substance use disorder (SUD) and rate of increase in substance use frequency (prodrome) which mediates the association between physical inactivity (hypothesized vulnerability) and CUD. Females: Number of SUD parents predicts slope of physical inactivity increase in daughters throughout adolescence which covaries with slope of increasing substance use frequency culminating in CUD. The association between parental SUD load (number of SUD affected parents) and CUD was found to not be mediated by physical inactivity. Rate of increase in physical inactivity during adolescence in males and females is a facet of the vulnerability for CUD. These results have ramifications for prevention considering that numerous cognitive, behavior, and emotion features of CUD vulnerability are attenuated by exercise. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Topics: Adolescent; Cannabis; Emotions; Female; Humans; Male; Marijuana Abuse; Parents; Sedentary Behavior; Substance-Related Disorders

Topics: Cannabinoid Receptor Agonists; Cannabis; Cities; Hallucinogens; Marijuana Abuse

To determine the differences in internalizing symptoms between those who met criteria for Cannabis Use Disorder (CUD) and those who did not in young adults attending a Historically Black College or University (HBCU).. The sample included 619 undergraduate students, with 110 (18%) who met criteria for CUD.. Participants completed an online survey, which included demographic, anxious and depressive symptomatology, and substance use assessment.. Those who met CUD criteria reported more depressive symptoms (M = 22.83 ± 10.74) and anxiety symptoms (M = 45.70 ± 12.82) than their non-CUD counterparts (M = 19.17 ± 10.58; M = 40.57 ± 14.11, respectively).. Differences between those who met criteria for CUD and those who did not are consistent with previous literature and may aid in characterizing internalizing behaviors in HBCU students with CUD. Future research should examine the subgroups that may cycle through withdrawal symptoms, despite not having severe CUD. This subgroup may be at higher risk for psychopathology than their severe counterparts.

Topics: Anxiety; Cannabis; Humans; Marijuana Abuse; Students; Substance-Related Disorders; Universities; Young Adult

Cannabis use disorder (CUD) is one of the main reasons for seeking substance use treatment. It is thus important to monitor and increase knowledge of individuals with CUD utilizing healthcare. We aimed to examine the number of CUD diagnoses over time, compare individuals with CUD with those without and identify subgroups based on CUD diagnosis, sex, birth year, socioeconomic factors and psychiatric comorbidity.. A Swedish, population-based study with 3,307,759 individuals, born in 1970-2000, with register data extending to 2016. K-mode cluster analysis was used to identify potential subgroups.. The number of individuals with a CUD diagnosis was 14,046 (0.42%). CUD diagnoses increased over time (born 1990-1994: 61 per 100,000, born 1995-2000: 107 per 100,000, by 2016). A majority of those with a CUD had another psychiatric diagnosis (80%, compared with 19% for those without CUD). Four clusters were identified. Cluster 1 comprised mainly men with low income and substance use disorders, clusters 2, 3 and 4 comprised mainly women with higher proportions of mood-related, neurotic and stress-related and behavioural disorders.

Topics: Cannabis; Cluster Analysis; Comorbidity; Female; Humans; Male; Marijuana Abuse; Middle Aged; Socioeconomic Factors; Substance-Related Disorders

Cognitive and motivational processes are thought to underlie cannabis use disorder (CUD), but research assessing how cognitive processes [e.g. interference control (IC)] interact with implicit [e.g. attentional bias (AB)] and explicit motivation (i.e. craving) is lacking. We assessed the presence of AB in cannabis users with varying use severity and tested models of moderation, mediation and moderated mediation to assess how AB, craving and IC interact in their association with measures of cannabis use.. A cross-sectional study design was used.. Eight studies performed by our laboratory in the Netherlands including never-sporadic, occasional (≤ 1/month) and regular cannabis users (≥ 2/week), and individuals in treatment for CUD were combined (n = 560; 71% male).. Studies included a classic Stroop task (IC), a cannabis Stroop task (AB) and measures of session-induced and average session craving. Both heaviness of cannabis use (grams/week) and severity of use related problems were included.. Only those in treatment for CUD showed an AB to cannabis (P = 0.019) and group differences were only observed when comparing CUD with never-sporadic users (P = 0.007). In occasional and regular users, IC was negatively associated with heaviness (β = 0.015, P < 0.001), but not severity of use. Average session craving (exploratory), but not session-induced craving (confirmatory), mediated this association between AB and heaviness (β = 0.050, P = 0.011) as well as severity of use (β = 0.083, P = 0.009); higher AB was associated with heavier use and more severe problems through increased craving.. Attentional bias only appears to be present in cannabis users with the most severe problems and craving appears to mediate the association between attentional bias and both heaviness and severity of use in occasional and regular users. The association of interference control with heaviness but not severity of use may point to subacute intoxication effects of cannabis use on interference control.

Topics: Attentional Bias; Cannabis; Craving; Cross-Sectional Studies; Cues; Female; Humans; Male; Marijuana Abuse

Many individuals diagnosed with cannabis use disorder (CUD) report a desire to quit using cannabis due to problems associated with use. Yet, successful abstinence is difficult for a large subset of this population. Thus, the present study sought to elucidate potential risk factors for cannabis use problems, perceived barriers for quitting, and diminished self-efficacy for remaining abstinent. Specifically, this investigation examined cigarette user status, anxiety sensitivity, and the interplay between these individual difference factors in terms of cannabis-related problems, perceived barriers for cannabis cessation, and self-efficacy for quitting cannabis use. The sample consisted of 132 adult cannabis users who met criteria for CUD and were interested in quitting (38 % female; 63.6 % Black; M

Topics: Adult; Anxiety; Cannabis; Female; Hallucinogens; Humans; Male; Marijuana Abuse; Self Efficacy; Substance-Related Disorders; Tobacco Products

Topics: Australia; Cannabis; Female; Humans; Marijuana Abuse; Marijuana Smoking; Pregnancy; Prenatal Exposure Delayed Effects; Substance-Related Disorders

Individuals with elevated social anxiety are particularly susceptible to cannabis problems, and sex differences in factors underlying this relation have been identified - e.g., among those with elevated social anxiety, men may use cannabis to cope with negative affect (NA) generally whereas women may use to cope with social anxiety specifically. This study examined the relations between social anxiety and cannabis-related behaviors by sex among 401 (75.3% female) undergraduates who endorsed past-month cannabis use. Among both sexes, social anxiety was related to more cannabis problems and coping (to decrease NA generally) and social anxiety (to manage NA in social situations) motives. Among men (not women), social anxiety was related to less frequent cannabis use and more conformity (to fit in with others) motives. Among women (not men), social anxiety was related to more enjoyment, experimentation, boredom alleviation, altered perceptions (to modulate perceptual experiences), and relatively low risk (perceived low risk) motives. The relation between social anxiety and cannabis problems occurred indirectly via coping motives for both sexes, and among men (not women) via conformity motives. Among women (not men), social anxiety was indirectly related to cannabis problems via enjoyment, experimentation, boredom, altered perceptions, and social anxiety motives. Findings suggest that among those with elevated social anxiety, men and women appear to use cannabis for different reasons, and that these reasons may play different roles in cannabis problem risk among men and women. Data highlight the importance of considering sex in efforts to understand the role of social anxiety in cannabis-related behaviors.

Topics: Adaptation, Psychological; Anxiety; Cannabis; Female; Humans; Male; Marijuana Abuse; Motivation

Understanding how recreational cannabis legalization may impact cannabis use disorder (CUD) among adolescents and young adults is key to developing an appropriate public health response. This research investigates whether associations among adolescent and young adult perception of risk of harm from cannabis use, prevalence of past-month cannabis use, and rate of CUD treatment admissions changed following recreational cannabis legalization in the US, 2008-2019.. Data from the NSDUH and TEDS-A datasets are employed in difference-in-differences models of the effect of recreational legalization on perception of risk, cannabis use prevalence, and CUD treatment admissions. Moderated models test whether associations among variables changed following recreational legalization.. Following recreational legalization: 1) adolescent and young adult past-month cannabis use prevalence increased; 2) among both adolescents and young adults, the association of lower perception of risk of harm with higher cannabis use prevalence was strengthened; 3) among adolescents, the association of higher cannabis use prevalence with higher CUD treatment admissions was suppressed; and 4) among young adults, an association of higher cannabis use prevalence with lower CUD treatment admissions emerged.. Recreational legalization is likely to increase cannabis use among adolescents and young adults who perceive cannabis as less harmful, while at the same time reduce rates of CUD treatment utilization. These trends portend an increase in unmet need for CUD treatment for age groups particularly vulnerable to the development and negative consequences of CUD.

Topics: Adolescent; Cannabis; Humans; Legislation, Drug; Marijuana Abuse; Perception; Substance-Related Disorders; Young Adult

Adolescent health surveillance systems are critical for understanding patterns of cannabis use; however, their limitations underscore the need for studies that generate new insights, particularly from individuals who are most impacted by negative outcomes. Our objectives were to learn about youths' cannabis use and their perceptions of their peers' cannabis use; their perspectives about trajectories of cannabis use over time and factors that influence trajectories; and perceived risks and benefits associated with cannabis use.. A group model building approach was used to gather data about cannabis use from a sample of urban, Black youth. Information about participants' cannabis use was assessed on eligibility screener, enrollment survey, and through structured activities over the course of four group model building workshops.. Participants [(n = 20) mean age 18; 35% male and 95% Black] exclusively used the terms weed and blunts for cannabis. Youth who consume peers' blunts would not characterize themselves as cannabis users. Collectively, youth estimated the majority of Baltimore youth used cannabis by age 16 and that most used daily. Youth described cannabis as more beneficial than harmful. There were no gender differences in prevalence of use, but there were gender dynamics to shared use.. Participatory research with urban, Black youth suggests youths' perceptions are misaligned with the ways that researchers conceptualize cannabis use. To better understand the scope of youth cannabis use and its harms, it is critical to leverage input from youth with lived experience to ensure survey tools adequately capture the way youth see themselves using cannabis.

Topics: Adolescent; Black People; Cannabis; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Surveys and Questionnaires

Topics: Adult; Cannabinoid Receptor Agonists; Cannabis; Humans; Marijuana Abuse; Surveys and Questionnaires

Excessive cannabis use may lead to lower educational attainment. However, this association may be due to confounders and reverse causality. We tested the potential causal relationship between cannabis use disorder (CUD) or life-time cannabis use (LCU) and educational attainment.. Bidirectional two-sample Mendelian randomization (MR) study was conducted. Our primary method was inverse-variance weighted (IVW) MR, with a series of sensitivity analyses. Multivariable MR (MVMR) was performed to estimate any direct effect independent of intelligence, smoking initiation or attention deficit hyperactivity disorder (ADHD).. European ancestry individuals. The sample sizes of the genome-wide association study ranged from 55 374 to 632 802 participants.. Genetic variants of CUD, LCU or educational attainment.. Genetic liability to cannabis use disorder may lead to lower educational attainment. Genetic liability to higher educational attainment may also lead to higher life-time cannabis use risk and lower cannabis use disorder risk. However, the bidirectional effect between cannabis use disorder and educational attainment may be due to shared risk factors (e.g. attention-deficit hyperactivity disorder).

Topics: Cannabinoid Receptor Agonists; Cannabis; Educational Status; Genome-Wide Association Study; Hallucinogens; Humans; Marijuana Abuse; Mendelian Randomization Analysis; Polymorphism, Single Nucleotide

Childhood and adolescent misuse and abuse exposures remain a serious public health challenge in the United States. This study aimed to describe recent trends and patterns of intentional substance misuse and abuse exposures among school-aged children and adolescents in the United States.. This study was a retrospective cohort study of intentional misuse and abuse exposures in children 6 through 18 years reported to the National Poison Data System (NPDS) from January 1, 2000, through December 31, 2020. Demographic trends, reported clinical effects, treatments, management sites, and health outcomes were assessed overall and within four age categories: 6-9, 10-12, 13-15, and 16-18.. Between 2000 and 2020, there were 338,727 cases regarding intentional misuse and abuse exposures for children ages 6 through 18 years old. Overall, misuse/abuse ingestions fluctuated over time, with a peak in 2011. The majority of intentional misuse/abuse ingestions occurred in males (58.3%), and more than 80% of all reported exposure cases occurred in youth aged 13 to 18. 32.6% of ingestions resulted in worse than minor clinical outcomes. Older age groups had a greater number of severe medical outcomes compared to younger age groups. Major or life-threatening exposures (including those resulting in death) were more common in males. Overall, deaths were rare (. With over 330,000 poison center cases reported during the 20-year study period, intentional substance misuse and abuse exposures substantially impact the pediatric population. The substances most commonly misused/abused are more widely available substances such as over-the-counter medications, household products and pharmaceuticals commonly prescribed to youth. Differences in age and sex were evident, with males and adolescents more likely to abuse and misuse substances. Our study describes an upward trend in marijuana misuse/abuse exposures among youth, especially those involving edible products. These findings highlight an ongoing concern about the impact of rapidly evolving cannabis legalization on this vulnerable population.

Topics: Adolescent; Aged; Cannabis; Child; Eating; Humans; Male; Marijuana Abuse; Poison Control Centers; Poisons; Retrospective Studies; United States

To determine the risk factors for cannabis use disorders and cannabis psychosis in Japan based on a 2021 online survey among Japanese users of social network services.. The 3142 respondents who had used cannabis within the preceding year were categorized into two groups based on the development of cannabis use disorder and/or cannabis psychosis. Analyses were performed to determine these conditions' risk factors.. Multivariate analysis revealed that factors significantly associated with cannabis use disorders were "cannabis-use initiation at a young age" (p = 0.004, OR: 0.951, 95% CI [0.920-0.984]), "family history of mental health problems" (p < 0.001, OR: 1.988, 95% CI [1.545-2.556]), "psychiatric disorders preceding cannabis use" (p = 0.039, OR: 1.672, 95% CI [1.026-2.722]), and "use of cannabis products other than dry flower" (p < 0.001, OR: 2.725, 95% CI [1.844-4.026]). Factors significantly associated with cannabis psychosis were "cannabis-use initiation at a young age" (p = 0.011, OR: 0.888, 95% CI [0.811-0.973]) and "family history of mental health problems" (p = 0.002, OR: 2.531, 95% CI [1.400-4. 576]).. Risk factors for problematic cannabis use were cannabis initiation at a young age, pre-cannabis psychiatric disorders, family history of mental health problems, and the use of cannabis products other than dry flower. However, the causal relationship among these factors remains ambivalent.

Topics: Cannabis; Humans; Japan; Marijuana Abuse; Psychotic Disorders; Risk Factors; Substance-Related Disorders; Surveys and Questionnaires

While cannabis use in women is increasing worldwide, research into gender differences in cannabis use disorder (CUD) symptomology is lacking. In response to limited effectiveness of addiction treatment, research focus has been shifting from clinical diagnoses towards interactions between symptoms, as patterns of symptoms and their interactions could be crucial in understanding etiological mechanisms in addiction. The aim of this study was to evaluate the CUD symptom network and assess whether there are gender differences therein.. A total of 1257 Dutch individuals reporting weekly cannabis use, including 745 men and 512 women, completed online questionnaires assessing DSM-5 CUD symptoms and additional items on plans to quit or reduce use, cigarette use, and the presence of psychological diagnoses. Gender differences were assessed for all variables and an Ising model estimation method was used to estimate CUD symptom networks in men and women using network comparison tests to assess differences.. There were gender differences in the prevalence of 6 of the 11 symptoms, but symptom networks did not differ between men and women. Cigarette use appeared to only be connected to the network through withdrawal, indicating a potential role of cigarette smoking in enhancing cannabis withdrawal symptoms. Furthermore, there were gender differences in the network associations of mood and anxiety disorders with CUD symptoms.. The association between smoking and withdrawal as well as gender differences in the role of comorbidities in the CUD network highlight the value of using network models to understand CUD and how symptom interactions might affect treatment.

Topics: Anxiety Disorders; Cannabis; Female; Hallucinogens; Humans; Male; Marijuana Abuse; Sex Factors; Substance Withdrawal Syndrome

Topics: Cannabinoid Receptor Agonists; Cannabis; Hallucinogens; Marijuana Abuse; United States

Cannabis use is rising globally, underscoring the importance of understanding contextual factors related to cannabis use. Although much work has retrospectively examined cannabis use patterns and effects, fewer studies have evaluated cannabis use in natural environments.. The present study used ecological momentary assessment (EMA) to examine the subjective experience of cannabis use (i.e., positive and negative affect) and how cannabis' mood effects are modified by the social context, defined as being alone or with others, in which use occurs. Associations between cannabis' mood effects and cannabis use disorder symptomatology were additionally examined. Participants (N = 200) completed baseline assessments and two 7-day waves of EMA data collection. Mixed-effects models examined between- and within-subject effects for positive and negative affect at cannabis use and nonuse times and interactions between cannabis use and social context.. Positive affect was elevated at cannabis use times, compared to nonuse times, regardless of social context. The relationship between cannabis use and negative affect was moderated by social context, such that negative affect was elevated at cannabis use times when participants were alone and reduced at cannabis use times when participants were with others. Higher levels of cannabis use disorder symptomatology and cannabis use frequency were both associated with lower negative affect at cannabis use times.. These results suggest that elevated positive affect is consistent across cannabis use times regardless of social context, but negative affect may vary more by the presence of others.

Topics: Affect; Cannabis; Ecological Momentary Assessment; Humans; Marijuana Abuse; Retrospective Studies; Social Environment

There is an increase in the medical use of cannabis. However, the safety of medical cannabis, particularly for mental health conditions, has not yet been clearly established. Thus, this study assessed the risk of emergency department (ED) visits and hospitalization for depressive disorders among medical cannabis users. We conducted a retrospective longitudinal cohort study of patients who received medical authorization to use cannabis from 2014 to 2019 in Ontario, matched (1:3 ratio) to population-based controls using propensity scores. Conditional Cox regressions were used to assess the association between cannabis authorization and the outcome. A total of 54,006 cannabis-authorized patients and 161,265 controls were analyzed. Approximately 39% were aged under 50 years, 54% were female, and 16% had a history of anxiety or mood disorders. The adjusted hazard ratio (aHR) for depressive disorders was 2.02 (95%CI: 1.83-2.22). The aHR was 2.23 (1.95-2.55) among subjects without prior mental health disorders. The interaction between sex (or age) and exposure was not significant. In conclusion, medical cannabis authorization was associated with an increased risk of depressive disorders. This finding highlights the need for a careful risk-benefit assessment when authorizing cannabis, particularly for patients who seek cannabis to treat a depressive condition.

Topics: Aged; Cannabinoid Receptor Agonists; Cannabis; Cohort Studies; Depressive Disorder; Female; Hallucinogens; Humans; Longitudinal Studies; Male; Marijuana Abuse; Medical Marijuana; Propensity Score; Retrospective Studies

While men show greater prevalence of cannabis use disorder (CUD) than women, whether cannabis use frequency drives this difference is unknown, and little is known about sex differences in problems associated with CUD. We therefore assessed the association of CUD with sex, adjusted for frequency of use, and compared the association of psychosocial and health-related problems with CUD between men and women. We included US adults age ≥ 18 who reported past-year cannabis use in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 3701). Cannabis use frequency, DSM-5 CUD and problems (interpersonal, financial, legal, health-related) were assessed. Associations between psychosocial problems, sex and DSM-5 CUD were assessed using prevalence differences (PD) and 95% confidence intervals (CI) from logistic regression models, controlling for demographics and cannabis use frequency, and effect modification by sex was assessed. We found that the prevalence of CUD among men versus women was not significantly greater after adjusting for use frequency. Women had significantly higher prevalence of interpersonal, financial and health-related problems than men, adjusting for frequency of use. Women showed significantly greater association of CUD with interpersonal problems with a boss or co-workers (p < 0.05) and a neighbor, relative or friend (p < 0.05) compared to men. Lack of sex differences in CUD after adjusting for frequency of use suggests use frequency may be an important target of CUD prevention efforts. CUD showed stronger associations for interpersonal problems among women than men, suggesting the need for particular emphasis on treating interpersonal problems related to cannabis use among women.

Topics: Adult; Cannabis; Female; Humans; Male; Marijuana Abuse; Prevalence; Sex Characteristics; Substance-Related Disorders

A major concern with cannabis-based medicines (CbM) and medical cannabis (MC) is the risk of abuse and dependence. The face validity of the International Classification of Diseases (ICD-10) criteria for cannabis dependence in patients prescribed CbM for chronic pain has not been assessed.. Physicians from Canada, Germany and Israel were recruited via the mailing lists of national pain societies. To be eligible, physicians had to have prescribed CbM for chronic pain treatment in the past 12 months. Participants were asked to rate the appropriateness of items adapted from the substance use module of the Composite International Diagnostic Interview Version 3.0 to assess dependence in the context of chronic pain treatment with CbM and the appropriateness of two additional items. In case of disagreement, participants were asked to give reasons. Furthermore, they were asked to suggest potential additional criteria.. On average 69.0% of 178 participating physicians indicated agreement with the appropriateness of the ICD-10 criteria, while 20.6% indicated disagreement. The highest disagreement rate was observed for the item on repeated use despite legal problems (35.4% disagreement or strong disagreement). Reasons for disagreement were summarized into six content categories using qualitative methods of analysis. Additional criteria suggested by participants were summarized into 10 content categories.. A collaboration of psychiatrists and pain physicians is required to define criteria and develop instruments to capture abuse and dependence of CbM in chronic pain patients.. Sixty-nine per cent of 178 pain medicine physicians in Canada, Germany and Israel who participated in a survey on the appropriateness of the ICD-10 criteria for cannabis abuse and dependence for patients prescribed cannabis-derived products for chronic pain assessed the criteria as appropriate, whereas 20.6% deemed the criteria as not appropriate.

Topics: Analgesics; Cannabinoid Receptor Agonists; Cannabis; Chronic Pain; Germany; Humans; International Classification of Diseases; Israel; Marijuana Abuse; Reproducibility of Results; Substance-Related Disorders

The objective of this cross-sectional study was to identify cannabis-related features and other characteristics predictive of violence using a data-driven approach in patients with severe mental disorders (SMDs). A Least Absolute Shrinkage and Selection Operator regularization regression model was used on the database consisting of 97 patients with SMD who completed questionnaires measuring substance use and violence. Cannabis use, particularly related to patients' decision to consume or time spent using, was a key predictor associated with violence. Other patterns of substance use and personality traits were identified as strong predictors. Regular patterns of cannabis use and interpersonal issues related to cannabis/stimulant abuse were inversely correlated to violence. This study identified the effect of several predictors correlated to violence in patients with SMD using a regularization regression model. Findings open the door to better identify the profiles of patients that may be more susceptible to perpetrate violent behaviors.

Topics: Cannabis; Cross-Sectional Studies; Humans; Independent Living; Machine Learning; Marijuana Abuse; Mental Disorders; Substance-Related Disorders; Violence

Cannabis use disorder (CUD) is one of the main reasons for seeking substance treatment in the Nordic countries, but there are few studies on readmission to care. We aimed to characterize CUD readmission and estimate the magnitude of how socio-economic factors and psychiatric comorbidity influence the risk of CUD readmission.. This was a nation-wide cohort study carried out between 2001 and 2016 in Sweden. The participants were individuals with CUD, aged 17 years and above (n = 12 143).. Information on predictors was obtained from registers and included education, income and psychiatric comorbidity assessed by six disease groups. The outcome measure was readmission, defined as a CUD visit to health-care at least 6 months after initial CUD diagnosis. Hazard ratios (HR) were estimated using Cox survival analyses and flexible parametric survival analyses to assess risk of readmission and how the risk varied with age.. The vast majority of CUD visits took place in outpatient care (~80%). Approximately 23% of the included individuals were readmitted to care during follow-up. The fully adjusted model showed an increased risk of readmission among those with schizophrenia and other psychotic disorders [HR = 1.54, 95% confidence interval (CI) = 1.29-1.84], low education (HR = 1.40, 95% CI = 1.24-1.57), personality disorders (HR = 1.27, 95% CI = 1.05-1.54) or mood disorders (HR = 1.27, 95% CI = 1.12-1.45). Flexible parametric modeling revealed increased risk of readmission mainly in individuals aged 18-35 years.. The risk of readmission was highest among those with low education, schizophrenia and other psychotic disorders, mood-related disorders or personality disorders. Individuals aged 18-35 years showed the highest risk of readmission. Our findings highlight individuals with complex health-care needs.

Topics: Cannabis; Cohort Studies; Comorbidity; Humans; Marijuana Abuse; Patient Readmission; Substance-Related Disorders

Topics: Adolescent; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Marijuana Smoking

Rates of cannabis use disorder (CUD) are higher in people with schizophrenia than in the general population. Irrespective of psychiatric diagnosis, tobacco co-use is prevalent in those with CUD and leads to poor cannabis cessation outcomes. The cannabis withdrawal syndrome is well-established and increases cannabis relapse risk. We investigated whether cannabis withdrawal severity differed as a function of high versus no/low tobacco dependence and psychiatric diagnosis in individuals with CUD.. Men with CUD (N = 55) were parsed into four groups according to schizophrenia diagnosis and tobacco dependence severity using the Fagerstrom Test for Nicotine Dependence (FTND): men with schizophrenia with high tobacco dependence (SCT+, n = 13; FTND ≥ 5) and no/low tobacco dependence (SCT-, n = 22; FTND ≤ 4), and nonpsychiatric controls with high (CCT+, n = 7; FTND ≥ 5) and no/low (CCT-, n = 13; FTND ≤ 4) tobacco dependence. Participants completed the Marijuana Withdrawal Checklist following 12-h of cannabis abstinence.. There was a significant main effect of tobacco dependence on cannabis withdrawal severity (p < .001). Individuals with high tobacco dependence had significantly greater cannabis withdrawal severity (M = 13.85 [6.8]) compared to individuals with no/low tobacco dependence (M = 6.49, [4.9]). Psychiatric diagnosis and the interaction effects were not significant. Lastly, cannabis withdrawal severity positively correlated with FTND (r = .41, p = .002).. Among individuals with CUD and high tobacco dependence, cannabis withdrawal severity was elevated twofold, irrespective of diagnosis, relative to individuals with CUD and no/low tobacco dependence. Findings from this study emphasize the importance of addressing tobacco co-use when treating CUD.

Topics: Cannabis; Humans; Male; Marijuana Abuse; Schizophrenia; Substance Withdrawal Syndrome; Substance-Related Disorders; Tobacco Use Disorder

For people with psychotic disorders, the negative outcomes associated with continuing cannabis use would suggest that discontinuing such use may be beneficial for their symptomatic and functional recovery. However, existing evidence that discontinuation is associated with better clinical outcomes is inconsistent and it remains unclear whether discontinuing use is associated with improvements in outcomes for people with an established psychotic disorder. In this 3-5-year longitudinal study we examined baseline and follow-up symptomatic and functional profiles of 371 people with an established psychotic disorder, comparing those who continued to use cannabis with those who discontinued use after baseline assessment. At follow-up, one third (33.3 %) of baseline cannabis users had discontinued use. Discontinuation was associated with significantly lower odds of past-year hallucinations and a mean improvement in level of functioning (Personal and Social Performance Scale) compared to a decline in functioning in continuing users. No significant differences in severity of negative symptoms were observed. With few longitudinal studies examining symptomatic and functional outcomes for people with established psychotic disorders who continue to use cannabis compared to those who discontinue use, our findings that discontinuing cannabis was associated with significant clinical improvements fill gaps in the evidence-base.

Topics: Cannabis; Humans; Longitudinal Studies; Marijuana Abuse; Psychotic Disorders

Cannabis use disorder (CUD) is increasing among US adults. Few national studies have addressed the role of medical cannabis laws (MCLs) and recreational cannabis laws (RCLs) in these increases, particularly in patient populations with high rates of CUD risk factors.. To quantify the role of MCL and RCL enactment in the increases in diagnosed CUD prevalence among Veterans Health Administration (VHA) patients from 2005 to 2019.. Staggered-adoption difference-in-difference analyses were used to estimate the role of MCL and RCL in the increases in prevalence of CUD diagnoses, fitting a linear binomial regression model with fixed effects for state, categorical year, time-varying cannabis law status, state-level sociodemographic covariates, and patient age group, sex, and race and ethnicity. Patients aged 18 to 75 years with 1 or more VHA primary care, emergency department, or mental health visit and no hospice/palliative care within a given calendar year were included. Time-varying yearly state control covariates were state/year rates from American Community Survey data: percentage male, Black, Hispanic, White, 18 years or older, unemployed, income below poverty threshold, and yearly median household income. Analysis took place between February to December 2022.. As preplanned, International Classification of Diseases, Clinical Modification, ninth and tenth revisions, CUD diagnoses from electronic health records were analyzed.. The number of individuals analyzed ranged from 3 234 382 in 2005 to 4 579 994 in 2019. Patients were largely male (94.1% in 2005 and 89.0% in 2019) and White (75.0% in 2005 and 66.6% in 2019), with a mean (SD) age of 57.0 [14.4] years. From 2005 to 2019, adjusted CUD prevalences increased from 1.38% to 2.25% in states with no cannabis laws (no CLs), 1.38% to 2.54% in MCL-only enacting states, and 1.39% to 2.56% in RCL-enacting states. Difference-in-difference results indicated that MCL-only enactment was associated with a 0.05% (0.05-0.06) absolute increase in CUD prevalence, ie, that 4.7% of the total increase in CUD prevalence in MCL-only enacting states could be attributed to MCLs, while RCL enactment was associated with a 1.12% (95% CI, 0.10-0.13) absolute increase in CUD prevalence, ie, that 9.8% of the total increase in CUD prevalence in RCL-enacting states could be attributed to RCLs. The role of RCL in the increases in CUD prevalence was greatest in patients aged 65 to 75 years, with an absolute increase of 0.15% (95% CI, 0.13-0.17) in CUD prevalence associated with RCLs, ie, 18.6% of the total increase in CUD prevalence in that age group.. In this study of VHA patients, MCL and RCL enactment played a significant role in the overall increases in CUD prevalence, particularly in older patients. However, consistent with general population studies, effect sizes were relatively small, suggesting that cumulatively, laws affected cannabis attitudes diffusely across the country or that other factors played a larger role in the overall increases in adult CUD. Results underscore the need to screen for cannabis use and CUD and to treat CUD when it is present.

Topics: Adult; Aged; Cannabis; Hallucinogens; Humans; Male; Marijuana Abuse; Medical Marijuana; Substance-Related Disorders; United States; Veterans Health

Cannabis is used for medical and recreational purposes and may result in cannabis use disorder (CUD). This study explored the prevalence of cannabis use disorder and other psychiatric comorbidities among inpatients undergoing treatment for substance use disorder who reported medical cannabis use at admission.. We assessed CUD and other substance use disorders based on DSM-5 symptoms, anxiety with the Generalized Anxiety Disorder scale (GAD-7), depression with the Patient Health Questionnaire (PHQ-9), and post-traumatic stress disorder with the PTSD Checklist for DSM-5 (PCL-5). We compared the prevalence of CUD and other psychiatric comorbidities between inpatients who endorsed the use of cannabis for medical purposes only vs those endorsing use for medical and recreational purposes.. Among 125 inpatients, 42% reported medical use only, and 58% reported medical and recreational use (dual motives). For CUD, 28% of Medical-Only and 51% of Dual-Use motives patients met the diagnostic criteria for CUD (p = 0.016). High psychiatric comorbidities were present: 79% and 81% screened positive for an anxiety disorder, 60% and 61% screened positive for depression, and 66% and 57% screened positive for PTSD for the Medical-Only and Dual-Use inpatients, respectively.. Many treatment-seeking individuals with substance use disorder who report medical cannabis use meet criteria for CUD, particularly those reporting concurrent recreational use.

Topics: Cannabis; Hallucinogens; Humans; Inpatients; Marijuana Abuse; Medical Marijuana; Prevalence; Substance-Related Disorders

Although there is momentum towards legalising adult recreational cannabis use worldwide, the extent of youth cannabis-related harm associated with legalisation is still uncertain. The current study aimed to assess whether the initial implementation of Canada's cannabis legalisation (via the Cannabis Act) on 17 October 2018 might be associated with youth harm, as assessed by emergency department visits for cannabis-related disorders/poisoning.. We used Ontario and Alberta, Canada emergency department data from 1 April 2015 to 31 December 2019. We identified all cannabis-related disorders/poisoning (ICD-10 CA: F12.X, T40.7) emergency department visits of youth (n = 13,615), defined as patients younger than the minimum legal cannabis sales age (18 years, Alberta; 19 years, Ontario). Seasonal Autoregressive Integrated Moving Average (SARIMA) models were employed to assess the impact of legalisation on weekly counts of cannabis-related harms.. The final SARIMA intervention (step) parameter indicated a post-legalisation increase of 14.7 (95% confidence interval [CI] 5.0; 24.3, p < 0.01) weekly youth cannabis-related disorder/poisoning presentations to Ontario/Alberta emergency department settings, equivalent to an increase of 20.0% (95% CI 6.2%; 33.9%). There was no evidence of associations between cannabis legalisation and comparison series of youth alcohol, opioid or appendicitis emergency department episodes.. Our findings require replication and extension but are consistent with the possibility that the implementation of the Cannabis Act was associated with an increase in youth cannabis-related presentations to Ontario/Alberta emergency departments.

Topics: Adolescent; Adult; Alberta; Cannabis; Emergency Service, Hospital; Hallucinogens; Humans; Marijuana Abuse; Ontario

This Viewpoint proposes a model of cannabis use disorder diagnosis in the context of cannabis for therapeutic purposes that is based on DSM-5 model of diagnosing substance use disorder in the context of prescribed medication use.

Topics: Cannabinoid Receptor Agonists; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Substance-Related Disorders

In the United States, recreational and medicinal cannabis use has continually increased in recent years, including in patients undergoing bariatric surgery. However, the effects of cannabis use on morbidity and mortality after bariatric surgery are uncertain, and the literature is limited by a paucity of studies. This study intends to evaluate the effects of cannabis use disorder on outcomes in patients undergoing bariatric surgery.. The National Inpatient Sample 2016-2019 was queried for patients ≥ 18 years who underwent roux-en-y gastric bypass (RYGB), vertical sleeve gastrectomy (VSG), or adjustable gastric band (AGB) surgery. Cannabis use disorder was identified using ICD-10 coding. Three outcomes were evaluated: medical complications, in-hospital mortality, and length of stay. Logistic regression was used to evaluate effects of cannabis use disorder on medical complications and in-hospital mortality, and linear regression for length of stay. All models controlled for race, age, sex, income, procedure type, and various medical comorbidities.. A total of 713,290 patients were included in this study, with 1,870 (0.26%) having cannabis use disorder. Cannabis use disorder was associated with medical complications (OR: 2.24; 95% CI: 1.31-3.82; P = 0.003) and longer lengths of stay (β: 1.3; SE: 0.297; P < 0.001), but not in-hospital mortality (OR: 3.29; CI: 0.94-11.5); P = 0.062).. Severe cannabis use was associated with higher risk for complications and extended length of stay. Future investigations are needed to better elucidate the relationship between cannabis use and bariatric surgery, including effects of dosage, chronicity, and method of ingestion.

Topics: Bariatric Surgery; Cannabis; Gastrectomy; Gastric Bypass; Humans; Length of Stay; Marijuana Abuse; Obesity, Morbid; Retrospective Studies; Treatment Outcome; United States

Sexual minority women and gender diverse (SMWGD) individuals are at elevated risk for alcohol and cannabis use disorders compared with cisgender, heterosexual women. This has been attributed to the unique stressors that SMWGD experience (i.e., sexual minority stress); however, recent studies have found mixed evidence for a link between sexual minority stress and substance use. The current manuscript introduces and tests a novel theoretical model derived from integrating minority stress theory and the multistage model of drug addiction to explain these mixed findings. We used data from a 30-day ecological momentary assessment (EMA) study of substance use among SMWGD to determine whether event-level associations between enacted stigma (bias from others) and same-/next-day alcohol and cannabis use are dependent on an individual's typical pattern of substance use (e.g., frequency, quantity, motives, and substance use disorder [SUD] symptoms). Findings indicate that enacted stigma predicted an increased likelihood of alcohol and cannabis use among those who used frequently and those who had a probable alcohol or cannabis use disorder and predicted a decreased likelihood of use among those who used less frequently. Enacted stigma also predicted cannabis (but not alcohol) use among those who reported high coping motives for use. Findings provide initial evidence in support of an integrated model of minority stress theory and the multistage model of drug addiction. Findings suggest that alcohol and cannabis use disorder interventions for SMWGD would benefit from addressing sexual minority stress and coping skill-building. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Topics: Adaptation, Psychological; Cannabis; Female; Humans; Marijuana Abuse; Sexual and Gender Minorities; Substance-Related Disorders

Cannabis concentrate products contain more of the intoxicating cannabinoid, tetrahydrocannabinol, than flower products and, thus, may produce greater harm. Indeed, concentrate use is associated with greater cannabis dependence and problems (e.g., anxiety) than flower use. Given this, continued examination of concentrate versus flower use differences on associations with various cannabis measures may be useful. These measures include behavioral economic demand for cannabis (i.e., its subjective reinforcing value), use frequency, and dependence.. In the present study of 480 cannabis users, those who were frequent concentrate users (. Two previously observed latent factors emerged, based on confirmatory factor analysis:. Findings continue to indicate that the demand metrics, although distinct, can be parsimoniously condensed into two factors. In addition, method of administration (i.e., concentrate vs. flower use) may affect how demand for cannabis relates to frequency of use. Associations were notably stronger with frequency relative to dependence.

Topics: Cannabinoids; Cannabis; Dronabinol; Flowers; Hallucinogens; Humans; Marijuana Abuse

Cannabis is the most widely used psychoactive substance in the United States (US), with reported use patterns increasing among adults in recent years. Cannabinoid hyperemesis syndrome (CHS) has been one concern related to increased cannabis use patterns. US emergency departments have reported an increase of CHS cases over the last decade, yet little is known about CHS. This study explores the experiences of people with chronic cannabis use and cyclic vomiting and their perceptions of CHS.. Semi-structured interviews were conducted with 24 people recruited from a prospective cohort of patients presenting to Rhode Island emergency departments with symptomatic cyclic vomiting and chronic cannabis use. Data were analyzed thematically using NVivo.. Participants characterized their cyclic vomiting as related to food and alcohol consumption patterns, stress, and existing gastrointestinal issues. Despite recurrent episodes of cyclic vomiting, nausea, and abdominal pain, many participants remained uncertain whether their symptoms were driven by cannabis. Many participants relied on at-home research to assess their symptoms and seek out management approaches. Clinical treatment recommendations focused on cannabis cessation. However, most participants felt clinical recommendations failed to consider the complexity and challenge of stopping cannabis use given the chronicity of use and therapeutic benefits some perceived cannabis to have.. Although cannabis cessation is the only reported CHS cure to date, additional clinical and non-clinical treatment approaches are needed to better support people with chronic cannabis use and cyclic vomiting to meet their ongoing needs.

Topics: Adult; Cannabinoid Receptor Agonists; Cannabinoids; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Prospective Studies; Syndrome; Vomiting

Given increasing rates of Cannabis Use Disorder (CUD), objective measures are needed that can reliably index risk and track cannabis use progression. Based on incentive sensitization models, neurophysiological reactivity to cannabis cues, measured with the electroencephalography-recorded late positive potential (LPP), may be a candidate biomarker. To serve as such, the cannabis cue-elicited LPP must demonstrate adequate retest reliability and sensitivity to cannabis use change. Moreover, incentive sensitization theory suggests that state-level contextual variables, such as acute stress, can impact drug cue reactivity. Therefore, the present study evaluated the three-month retest reliability of the cannabis cue-elicited LPP, recorded before and after a laboratory stress induction, as well as its sensitivity to cannabis use change.. Cannabis and neutral cue-elicited LPPs were measured in 102 adults reporting frequent cannabis use (86 % with current CUD) before and after an acute stress induction at two lab visits three-months apart. Physiological and subjective stress reactivity were also measured.. Manipulation checks confirmed expected cannabis cue and acute stress effects. Cannabis cue-elicited LPP amplitudes showed significant three-month retest reliability of poor-to-fair through moderate-to-good size. Change in cannabis use frequency significantly predicted change in cannabis cue-elicited LPP amplitudes, particularly at post-stress.. Consistent with incentive sensitization models of addiction, the cannabis cue-elicited LPP demonstrated trait-like, moderate three-month stability and responsivity to change in cannabis use behavior. Greater predictive validity of the post-stress LPP may arise through kindling effects of acute stress on incentive salience-related neural activity, which should be explored in future studies.

Topics: Adult; Cannabis; Cues; Humans; Marijuana Abuse; Motivation; Reproducibility of Results

Cannabis use disorder (CUD) among pregnant women is on the rise in the United States. The American College of Obstetricians and Gynecologists have recommended against the use of cannabis during pregnancy and breastfeeding. However, limited research exists on CUD treatment in this vulnerable population. The purpose of this study was to examine factors that influence CUD treatment completion in pregnant women. Data from the 2010-2019 Treatment Episode Data Set-Discharges (TEDS-D) were used (n = 7,319 pregnant women who reported CUD and had no prior treatment history). Descriptive statistics, logistic regression, and classification tree analyses were conducted to assess treatment outcomes. Only 30.3% of the sample completed CUD treatment. Length of stay between 4 and 12 months was associated with a higher likelihood of CUD treatment completion. The odds of treatment completion were higher if the referral source was alcohol/drug use care provider (AOR = 1.60, 95% CI [1.01, 2.54]), other community referral (AOR = 1.65, 95% CI [1.38, 1.97]), and the court/criminal justice (AOR = 2.29, 95% CI [1.92, 2.72]) relative to being referred by individual/self. A relatively high proportion of CUD treatment completion (52%) was observed among pregnant women who had > 1 month of CUD treatment and were referred to the treatment program by the criminal justice system. For pregnant women, referrals from the justice system, community, and healthcare providers can increase the likelihood of successful CUD treatment outcomes. Developing targeted CUD treatments for pregnant populations is crucial due to increasing CUD rates, cannabis accessibility, and potency.

Topics: Cannabis; Female; Humans; Marijuana Abuse; Pregnancy; Pregnant Women; Substance-Related Disorders; Treatment Outcome; United States

While evidence strongly supports a causal effect of cannabis on psychosis, it is less clear whether the symptom pattern, clinical course, and outcomes differ in cases of schizophrenia with and without a background of cannabis use.. Analysis of medical records from a longitudinal follow-up of Swedish conscripts with data on cannabis use in adolescence and subsequent incidence of schizophrenia. One hundred sixty patients with schizophrenia were assessed using the OPCRIT protocol. Cases were validated for diagnosis schizophrenia according to OPCRIT.. Patients with a cannabis history (n = 32), compared to those without (n = 128), had an earlier age at onset, a higher number of hospital admissions and a higher total number of hospital days. There was no significant difference in type of onset and clinical symptom profiles between the groups.. Our findings indicate that the disease burden of schizophrenia is greater in individuals who use cannabis during adolescence. Strengthening evidence on causality and teasing out long-term effects of pre-illness cannabis use from continued post-illness has clinical implications for improving schizophrenia outcomes.

Topics: Adolescent; Cannabis; Causality; Humans; Marijuana Abuse; Psychotic Disorders; Schizophrenia

Topics: Adult; Cannabis; Humans; Male; Marijuana Abuse; Prospective Studies; Psychoses, Substance-Induced; Psychotic Disorders; Young Adult

Cannabis potency (concentration of Δ-9-Tetrahydrocannabinol) has been associated with risks of adverse mental health outcomes and addiction but no studies have triangulated evidence from self-report and objective measures of cannabis potency. We hypothesised that users of high potency cannabis would have higher levels of (a) anxiety, (b) depression and (c) psychosis-like symptoms (d) cannabis dependence than users of lower potency cannabis.. A cross-sectional study of 410 participants donated a sample of cannabis for analysis of THC concentration and reported their cannabis potency preference. These two exposure measures were investigated for their association with cannabis dependence, depression, anxiety, and psychosis-like symptoms in separate linear/logistic regression models.. High potency cannabis preference was associated with a slight increased risk of cannabis dependence after adjusting for confounding, with the exception of cannabis use frequency (OR = 1.16, 95% CI 1.04-1.28). No association was found between THC concentration in cannabis and cannabis dependence. There was weak evidence of a small association between cannabis potency and depression and anxiety. There was no association between high potency cannabis preference or THC concentration in cannabis and psychosis-like symptoms.. Users of cannabis who preferred high potency types might be at increased risk of problematic cannabis use. This should be considered with caution as we were not able to triangulate these results with an objective measure of cannabis potency. More research is needed to understand the association between high potency cannabis use and depression and anxiety.

Topics: Cannabis; Cross-Sectional Studies; Dronabinol; Hallucinogens; Humans; Marijuana Abuse; Mental Health

Few studies examine the utility of the Cannabis Use Disorder Identification Test - Revised (CUDIT-R) in relation to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) criteria for cannabis use disorder (CUD). This study assesses the performance of the CUDIT-R among a sample of Veterans with and without medical cannabis use.. We approached and consented primary care patients presenting to one of three Department of Veterans Affairs (VA) Medical Centers. Veterans with at least monthly cannabis use and complete CUD data at baseline were included in this analysis (n=234). CUDIT-R scores were compared against Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (DSM-5) CUD as the standard to calculate measures of validity (sensitivity, specificity), identify optimal CUDIT-R cutoff values, and assess the diagnostic proficiency of the CUDIT-R using receiver operating characteristic (ROC) curves. We further stratified analyses by active medical cannabis card holder status and DSM-5 CUD severity (any, moderate, and severe).. Among the entire sample, 38.9% qualified for any DSM-5 CUD, with 10.7% and 3.0% meeting criteria for moderate and severe CUD, respectively. We identified optimal CUDIT-R scores at 10 for any DSM-5 CUD (sensitivity=0.58; specificity=0.80), at 12 for moderate CUD (sensitivity=0.72; specificity=0.82), and at 14 for severe CUD (sensitivity=0.71; specificity=0.87). ROC curves showed higher CUDIT-R validity among non-card holders compared with medical cannabis card holders.. The present study identified optimal CUDIT-R cutoff scores for Veterans who use cannabis. Varying DSM-5 validity measures inform the need for population-specific CUDIT-R cutoff values.

Topics: Cannabinoid Receptor Agonists; Cannabis; Humans; Marijuana Abuse; ROC Curve; Substance-Related Disorders; Veterans

Cannabis use is increasingly viewed by adolescents as not harmful. Youths with cannabis use disorder (CUD) are recognized by clinicians as being at risk for adverse outcomes, yet little is known about the associations between subclinical cannabis use (ie, nondisordered cannabis use [NDCU]) and adverse psychosocial events.. To describe the prevalence and demographics of NDCU and to compare associations of cannabis use with adverse psychosocial events among adolescents with no cannabis use, NDCU, and CUD.. This cross-sectional study used a nationally representative sample derived from the 2015 to 2019 National Survey on Drug Use and Health. Participants were adolescents aged 12 to 17 years, separated into 3 distinct groups: nonuse (no recent cannabis use), NDCU (recent cannabis use below diagnostic threshold), and CUD. Analysis was conducted from January to May 2022.. CUD, NDCU, or cannabis nonuse. NDCU was defined as endorsing recent cannabis use but not meeting the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) CUD criteria. CUD was defined using DSM-5 criteria.. The main outcomes were prevalence of adolescents meeting criteria for NDCU and associations between adverse psychosocial events and NDCU, adjusted for sociodemographic characteristics.. The 68 263 respondents (mean [SD] age, 14.5 [1.7] years; 34 773 [50.9%] males) included in the analysis represented an estimated yearly mean of 25 million US adolescents during 2015 to 2019. Among respondents, 1675 adolescents (2.5%) had CUD, 6971 adolescents (10.2%) had NDCU, and 59 617 adolescents (87.3%) reported nonuse. Compared with nonusers, individuals with NDCU had approximately 2 to 4 times greater odds of all adverse psychosocial events examined, including major depression (adjusted odds ratio [aOR], 1.86; 95% CI, 1.67-2.08), suicidal ideation (aOR, 2.08; 95% CI, 1.88-2.29), slower thoughts (aOR, 1.76; 95% CI, 1.58-1.96), difficulty concentrating (aOR, 1.81; 95% CI, 1.65-2.00), truancy (aOR, 1.90; 95% CI, 1.67-2.16), low grade point average (aOR, 1.80; 95% CI, 1.62-2.00), arrest (aOR, 4.15; 95% CI, 3.17-5.43), fighting (aOR, 2.04; 95% CI, 1.80-2.31), and aggression (aOR, 2.16; 95% CI, 1.79-2.62). Prevalence of adverse psychosocial events was greatest for adolescents with CUD (range, 12.6% to 41.9%), followed by NDCU (range, 5.2% to 30.4%), then nonuse (range, 0.8% to 17.3%).. In this cross-sectional study of US adolescents, past-year NDCU was approximately 4 times as prevalent as past-year CUD. A stepwise gradient association was observed for odds of adverse psychosocial events between adolescent NDCU and CUD. In the context of US normalization of cannabis use, prospective research into NDCU is necessary.

Topics: Adolescent; Cannabis; Cross-Sectional Studies; Depressive Disorder, Major; Female; Humans; Male; Marijuana Abuse; Prospective Studies; Substance-Related Disorders

In the United States, cannabis is increasingly used to manage chronic pain. Veterans Health Administration (VHA) patients are disproportionately affected by pain and may use cannabis for symptom management. Because cannabis use increases the risk of cannabis use disorders (CUDs), we examined time trends in CUD among VHA patients with and without chronic pain, and whether these trends differed by age. From VHA electronic health records from 2005 to 2019 (∼4.3-5.6 million patients yearly), we extracted diagnoses of CUD and chronic pain conditions ( International Classification of Diseases [ ICD ]- 9-CM , 2005-2014; ICD-10-CM , 2016-2019). Differential trends in CUD prevalence overall and age-stratified (<35, 35-64, or ≥65) were assessed by any chronic pain and number of pain conditions (0, 1, or ≥2). From 2005 to 2014, the prevalence of CUD among patients with any chronic pain increased significantly more (1.11%-2.56%) than those without pain (0.70%-1.26%). Cannabis use disorder prevalence increased significantly more among patients with chronic pain across all age groups and was highest among those with ≥2 pain conditions. From 2016 to 2019, CUD prevalence among patients age ≥65 with chronic pain increased significantly more (0.63%-1.01%) than those without chronic pain (0.28%-0.47%) and was highest among those with ≥2 pain conditions. Over time, CUD prevalence has increased more among VHA patients with chronic pain than other VHA patients, with the highest increase among those age ≥65. Clinicians should monitor symptoms of CUD among VHA patients and others with chronic pain who use cannabis, and consider noncannabis therapies, particularly because the effectiveness of cannabis for chronic pain management remains inconclusive.

Topics: Cannabis; Chronic Pain; Humans; Marijuana Abuse; Substance-Related Disorders; United States; Veterans

Little is known about inhaled flavored cannabis use. This study aimed to investigate the prevalence and patterns of flavored cannabis use and cannabis-tobacco co-use.. This study surveyed adult past 30-day cannabis users in U.S. states and districts that have legalized cannabis for nonmedical/adult use (n=9) (November 2018; n=2,978). By product/behavior (any cannabis, cannabis extract vaporizers, mixed cannabis-nicotine vaporizers, blunts, chasing), the association between flavored (versus non-flavored) use and sociodemographic characteristics, cannabis use disorder symptoms, and tobacco use was estimated using weighted multivariable logistic regression in January 2022.. Almost half of adult cannabis users reported using at least one flavored cannabis product (46.5%). Flavored cannabis use was more likely among respondents who were female (AOR=1.2, CI=1.0, 1.4), were Black (ref: White; AOR=2.2, CI=1.5, 3.1), were Hispanic/Latino/a/x (ref: White; AOR=1.6, CI=1.2, 1.9), had cannabis use disorder symptoms (AOR=2.0, CI=1.6, 2.4), or were currently using tobacco (AOR=2.4, CI=2.1, 2.9). Use was less likely among middle-aged/older adults (ref: ages 21-34 vs 35-49 years; AOR=0.6, CI=0.5, 0.7).. Observed differences in flavored cannabis use are concerning if flavors raise appeal or dependence. Integrating flavored cannabis and tobacco research and practice is warranted.

Topics: Aged; Cannabis; Female; Humans; Male; Marijuana Abuse; Middle Aged; Nicotiana; Nicotine; Tobacco Use

The relationship between psychotic disorders and cannabis use is heavily debated. Shared underlying genetic risk is one potential explanation. We investigated the genetic association between psychotic disorders (schizophrenia and bipolar disorder) and cannabis phenotypes (lifetime cannabis use and cannabis use disorder).. We used genome-wide association summary statistics from individuals with European ancestry from the Psychiatric Genomics Consortium, UK Biobank, and International Cannabis Consortium. We estimated heritability, polygenicity, and discoverability of each phenotype. We performed genome-wide and local genetic correlations. Shared loci were identified and mapped to genes, which were tested for functional enrichment. Shared genetic liabilities to psychotic disorders and cannabis phenotypes were explored using causal analyses and polygenic scores, using the Norwegian Thematically Organized Psychosis cohort.. Psychotic disorders were more heritable than cannabis phenotypes and more polygenic than cannabis use disorder. We observed positive genome-wide genetic correlations between psychotic disorders and cannabis phenotypes (range 0·22-0·35) with a mixture of positive and negative local genetic correlations. Three to 27 shared loci were identified for the psychotic disorder and cannabis phenotype pairs. Enrichment of mapped genes implicated neuronal and olfactory cells as well as drug-gene targets for nicotine, alcohol, and duloxetine. Psychotic disorders showed a causal effect on cannabis phenotypes, and lifetime cannabis use had a causal effect on bipolar disorder. Of 2181 European participants from the Norwegian Thematically Organized Psychosis cohort applied in polygenic risk score analyses, 1060 (48·6%) were females and 1121 (51·4%) were males (mean age 33·1 years [SD 11·8]). 400 participants had bipolar disorder, 697 had schizophrenia, and 1044 were healthy controls. Within this sample, polygenic scores for cannabis phenotypes predicted psychotic disorders independently and improved prediction beyond the polygenic score for the psychotic disorders.. A subgroup of individuals might have a high genetic risk of developing a psychotic disorder and using cannabis. This finding supports public health efforts to reduce cannabis use, particularly in individuals at high risk or patients with psychotic disorders. Identified shared loci and their functional implications could facilitate development of novel treatments.. US National Institutes of Health, the Research Council Norway, the South-East Regional Health Authority, Stiftelsen Kristian Gerhard Jebsen, EEA-RO-NO-2018-0535, European Union's Horizon 2020 Research and Innovation Programme, the Marie Skłodowska-Curie Actions, and University of Oslo Life Science.

Topics: Animals; Bipolar Disorder; Cannabis; Genetic Predisposition to Disease; Genome-Wide Association Study; Marijuana Abuse; Schizophrenia; Substance-Related Disorders

Thailand was the first country in Asia to legalize the use and purchase of cannabis leaves in February 2021 and the whole plant in June 2022 after the 2019 allowance for medical purposes. The study explored trends in cannabis use in Thailand before and after the recreational cannabis allowance was imposed.. Cannabis and other variables of substance use, cannabis use disorder, and attitude towards cannabis of the Thai population aged 18 to 65 years in 2019 (n = 5,002), 2020 (n = 5,389) and 2021 (n = 5,669) were obtained from annual surveys conducted in the last two months of each year by the Centre for Addiction Studies. The surveys were repeat cross-sectional surveys of the general population of Thailand. Repeated variables from at least two annual surveys were included for analysis using the Chi-square test and the t-test.. The prevalence of cannabis use in the past year had increased from 2.2% in 2019 to 2.5% and 4.2% in 2020 and 2021 respectively, while those of methamphetamine, alcohol, and tobacco use had decreased. Trends in past-year drinking/eating cannabis products had increased, especially among the middle age group (40-49 years) from 2.1% (95% confidence interval (CI): 1.3, 3.1) in 2019 and 1.1% (95% CI: 0.6, 1.9) in 2020 to 3.8% (95% CI: 2.8, 5.0) in 2021. The younger population aged 18-19 had an increase in cannabis smoking from 0.9% (95% CI: 0.1, 3.3) in 2019 to 2.0% (95% CI: 0.5, 5.1) and 2.2% (95% CI: 0.7, 5.1) in 2020 and 2021 respectively. Symptoms of cannabis use disorder among cannabis users increased from 2019 to 2020 and then reversed afterwards in 2021. Thais had greater health knowledge about the benefits and harms of cannabis and had attitudes toward more harm of cannabis in 2021; however, 35.6% or a third of the sample in 2021 truly believed that cannabis was a cure for cancer, and 23.2% or one-fourth were uncertain or did not believe that cannabis was addictive.. Although most of the substances had a lower prevalence of use during the COVID-19 pandemic in Thailand, cannabis had a higher use after legalization. Thai youth had a growing trend to smoke cannabis.

Topics: Adolescent; Cannabis; COVID-19; Cross-Sectional Studies; Developing Countries; Humans; Marijuana Abuse; Middle Aged; Pandemics; Substance-Related Disorders; Thailand

The DSM-5 criteria for cannabis use disorder (CUD) combine DSM-IV dependence and abuse criteria (without legal problems) and new withdrawal and craving criteria. Information on dimensionality, internal reliability, and differential functioning of the DSM-5 CUD criteria is lacking. Additionally, dimensionality of the DSM-5 withdrawal items is unknown. This study examined the psychometric properties of the DSM-5 CUD criteria among adults who used cannabis in the past 7 days (N = 5,119). Adults with frequent cannabis use were recruited from the US general population through social media and filled in a web-based survey about demographics and cannabis use behaviors. Factor analysis was used to assess dimensionality, and item response theory analysis models were used to explore relationships between the criteria and the underlying latent trait (CUD), and whether each criterion and the criteria set functioned differently by demographic and clinical characteristics: sex, age, state-level cannabis laws, reasons for cannabis use, and frequency of use. The DSM-5 CUD criteria showed unidimensionality and provided information about the CUD latent trait across the severity spectrum. The cannabis withdrawal items indicated one underlying latent factor. While some CUD criteria functioned differently in specific subgroups, the criteria set as a whole functioned similarly across subgroups. In this online sample of adults with frequent cannabis use, evidence supports the reliability, validity, and utility of the DSM-5 CUD diagnostic criteria set, which can be used for determining a major risk of cannabis use, i.e., CUD, to inform cannabis policies and public health messaging, and for developing intervention strategies.

Topics: Adult; Cannabis; Diagnostic and Statistical Manual of Mental Disorders; Hallucinogens; Humans; Marijuana Abuse; Reproducibility of Results; Substance-Related Disorders

Marijuana consumption is growing up becoming very common especially between young people. 9-THC, the main psychoactive compound in cannabis, acts on the endocannabinoid system having different cardiovascular effects, including arrhythmias, acute coronary syndrome, and sudden cardiac death. We present the case of a young man from Gambia with no cardiovascular risk factors, marijuana consumer, presenting to the emergency department with ST-elevation myocardial infarction. At coronary angiography, thrombotic left anterior descending coronary artery subocclusion was documented. We also describe the association between acute coronary syndrome and cannabis abuse.

Topics: Acute Coronary Syndrome; Adolescent; Cannabis; Coronary Angiography; Coronary Thrombosis; Coronary Vessels; Humans; Male; Marijuana Abuse; ST Elevation Myocardial Infarction

Cannabis legislation and attitudes towards use are changing. Given that evidence from cultural neuroscience research suggests that culture influences the neurobiological mechanisms underlying behaviour, it is of great importance to understand how cannabis legislation and attitudes might affect the brain processes underlying cannabis use disorder. Brain activity of 100 dependent cannabis users and 84 controls was recorded during an N-back working memory (WM) task in participants from the Netherlands (NL; users = 60, controls = 52) and Texas, USA (TX; users = 40, controls = 32). Participants completed a cannabis culture questionnaire as a measure of perceived benefits (positive) and perceived harms (negative) of cannabis from their personal, friends-family's and country-state's perspectives. Amount of cannabis use (grams/week), DSM-5 CUD symptoms and cannabis use-related problems were assessed. Cannabis users self-reported more positive and less negative (personal and friends-family) cannabis attitudes than controls, with this effect being significantly larger in the TX cannabis users. No site difference in country-state attitudes was observed. TX cannabis users, compared with NL cannabis users, and those cannabis users perceiving more positive country-state attitudes showed a more positive association between grams/week and WM-related activity in the superior parietal lobe. NL cannabis users, compared with TX cannabis users, and those cannabis users with less positive personal attitudes showed a more positive association between grams/week and WM-load-related activity in the temporal pole. Both site and cultural attitudes moderated the association of quantity of cannabis use with WM- and WM-load-related activity. Importantly, differences in legislation did not align with perceived cannabis attitudes and appear to be differentially associated with cannabis use-related brain activity.

Topics: Brain; Cannabis; Cross-Cultural Comparison; Humans; Magnetic Resonance Imaging; Marijuana Abuse; Memory, Short-Term; Substance-Related Disorders

Cannabis use and cannabis use disorder (CUD) are associated with mental health disorders, however the extent of this matter among pregnant and recently postpartum (e.g., new moms) women in the US is unknown. Associations between cannabis use, DSM-5 CUD and DSM-5 mental health disorders (mood, anxiety, personality and post-traumatic stress disorders) were examined among a nationally representative sample of pregnant and postpartum women.. The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III was used to examine associations between past-year cannabis use, CUD and mental health disorders. Weighted logistic regression models were used to estimate unadjusted and adjusted odds ratios (aORs). The sample (N=1316) included 414 pregnant and 902 postpartum women (pregnant in the past year), aged 18-44 years old.. The prevalence of past-year cannabis use and CUD was 9.8% and 3.2%, respectively. The odds of cannabis use (aORs range 2.10-3.87, p-values<0.01) and CUD (aORs range 2.55-10.44, p-values< 0.01) were higher among women with versus without any past-year mood, anxiety or posttraumatic stress disorders or any lifetime personality disorder. aORs for the association of cannabis use with specific mood, anxiety or personality disorders ranged from 1.95 to 6.00 (p-values<0.05). aORs for the association of CUD with specific mood, anxiety or personality disorders ranged from 2.36 to 11.60 (p-values<0.05).. From pregnancy up to one year postpartum is a critical period where women may be particularly vulnerable to mental health disorders, cannabis use and CUD. Treatment and prevention are essential.

Topics: Adolescent; Adult; Cannabis; Female; Humans; Marijuana Abuse; Mental Health; Postpartum Period; Pregnancy; Prevalence; Substance-Related Disorders; Young Adult

Cannabis use disorder (CUD) and frequency of use are highly related to social anxiety disorder (SAD). With updates to diagnostic criteria of psychiatric disorders and recent changes in cannabis laws, the present study sought to explore the relationships between cannabis use, CUD, and social anxiety in a large nationally representative sample of individuals with lifetime (N = 1255) and past-year SAD (N = 980). Notably, we found that at the symptom level, at least weekly cannabis use was significantly related to fear or avoidance of social situations interfering with relationships in both samples. Weekly + cannabis use and CUD were significantly associated with lifetime SAD symptom severity, but only weekly + cannabis use was related to SAD severity in the past-year sample. We also found that weekly + cannabis use but not CUD was related to greater odds of seeking treatment for SAD and suicide attempt history. Overall, these data provide an updated examination of cannabis use and SAD using DSM-5 criteria and a large nationally representative sample and also highlight the importance of weekly + cannabis use as a marker of severity and suicide risk in individuals with SAD.

Topics: Cannabis; Comorbidity; Humans; Marijuana Abuse; Phobia, Social; Prevalence; Substance-Related Disorders

Rates of cannabis use are elevated in early psychosis populations, rendering it difficult to determine if an episode of psychosis is related to cannabis use (e.g., cannabis-induced psychosis), or if substance use is co-occurring with a primary psychotic disorder (e.g., schizophrenia). Clinical presentations of these disorders are often indistinguishable, hindering assessment and treatment. Despite substantial research identifying cognitive deficits, eye movement abnormalities and speech impairment associated with primary psychotic disorders, these neuropsychological features have not been explored as targets for diagnostic differentiation in early psychosis.. Eighteen participants with cannabis-induced psychosis (M. Relative to individuals with primary psychosis, individuals with cannabis-induced psychosis demonstrated significantly better performance on the pro-saccade task, faster RT on pro- and anti-saccade tasks, better premorbid adjustment, and a higher degree of insight into their illness. There were no significant differences between groups on psychiatric symptoms, premorbid intellectual functioning, or problems related to cannabis use.. In early stages of illness, reliance on traditional diagnostic tools or clinical interviews may be insufficient to distinguish between cannabis-induced and primary psychosis. Future research should continue to explore neuropsychological differences between these diagnoses to improve diagnostic accuracy.

Topics: Adult; Cannabis; Humans; Male; Marijuana Abuse; Psychotic Disorders; Schizophrenia; Substance-Related Disorders; Young Adult

Use rates of cannabis, a substance associated with a host of comorbid physical and mental health concerns, continue to rise for military veterans. Despite this prevalence, descriptive patterns of use among veterans and research on treatment factors that predict cannabis outcomes are lacking. This study aimed to conduct a descriptive profile of veterans who endorse cannabis use, compare veterans endorsing cannabis use to those who do not endorse use, and investigate what factors (other substance use, psychiatric symptoms, and treatment outcomes) predicted return to cannabis use following residential treatment.. The study was a secondary data analysis of a longitudinal sample of U.S. military veterans (N = 200, 193 males, Mage = 50.14, SD = 9) participating in residential substance use disorder treatment through a Veterans Affairs medical center. Interview, survey, and electronic health data were collected over 12 months. Analyses included descriptive and frequency statistics to identify patterns in cannabis use behaviors and motives, independent t-tests to examine differences between the cannabis-using group and non-using group, and a series of univariate logistic regressions to examine potential predictors for cannabis use after treatment discharge.. Lifetime cannabis use was common among veterans (77.5%), and 29.5% reported use during the study. On average, veterans had made one quit attempt before treatment entry. Veterans who endorsed cannabis use consumed more alcohol in the past 30 days at baseline and reported less impulse control and less confidence in maintaining abstinence at discharge. Length of stay in the residential program and no diagnosis of Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV cannabis use disorder criteria predicted post-treatment cannabis use such that veterans who remained in the program longer were more likely to abstain from cannabis use following treatment, and those who did not meet DSM-IV cannabis use disorder criteria were more likely to use following treatment.. Identification of relevant risk factors and treatment processes, such as impulse control, confidence in treatment, and length of stay in treatment, provides practical recommendations for future intervention efforts. This study calls for further examination of cannabis use outcomes among veterans, particularly those participating in substance use treatment.

Topics: Cannabis; Comorbidity; Humans; Male; Marijuana Abuse; Residential Treatment; Substance-Related Disorders; Veterans

Topics: Adolescent; Cannabis; Humans; Marijuana Abuse; Pneumonia

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

Topics: Adult; Cannabis; Female; Humans; Male; Marijuana Abuse; Young Adult

Hedonic dysregulation is a core mechanism of addiction. There is a dearth of research on hedonic dysregulation in cannabis use disorder (CUD). The current study tested whether personalized scripted imagery may be an efficacious approach to remediate reward functioning in adults with CUD.. Adults with CUD (n=10) and non-CUD controls (n=12) completed a single session personalized scripted imagery procedure. Non-drug (i.e. natural) reward and neutral scripts were transcribed and participants listened to the scripts in counterbalanced order. Primary outcomes included positive affect (PA), galvanic skin response (GSR), and cortisol and were assessed at four timepoints. Mixed effects models were used to compare between and within subject effects.. Mixed effects models revealed a Condition (reward vs. neutral) X Group (CUD vs. control) interaction (p=0.01) on PA response, indicating blunted PA response to the neutral script relative to the reward script in CUD participants. Likewise, GSR response in CUD participants was decreased in response to the neutral script relative to the reward script (p=0.034; interaction n.s.). An interaction effect of Group X PA on cortisol response was found (p=.036) indicating that cortisol was positively correlated with PA in healthy control participants, but not CUD participants.. Adults with CUD may demonstrate acute deficits in hedonic tone under neutral conditions relative to healthy controls. Personalized scripted imagery may be an efficacious tool to remediate hedonic dysregulation in CUD. Cortisol may play a role in healthy positive affect regulation warranting further investigation.

Topics: Adult; Cannabis; Humans; Hydrocortisone; Marijuana Abuse; Pilot Projects; Reward; Substance-Related Disorders

Young adults' cannabis and alcohol use patterns have changed after state recreational cannabis legalization according to studies based on college samples but not nationally representative samples. Associations between recreational cannabis legalization and changes in cannabis and alcohol use outcomes among young adults were examined, including differences by college enrollment and minor status (ages 18-20 vs 21-23 years).. Repeated cross-sectional data (2008-2019) were collected from college-eligible participants aged 18-23 years in the National Survey on Drug Use and Health. Self-reported past-month cannabis use and frequent use (≥20 days) and a proxy for past-year DSM-5 cannabis use disorder were primary outcomes; past-month frequent alcohol use and binge drinking were secondary outcomes. Multilevel logistic regression models quantified changes in outcome prevalence from the study years before to after recreational cannabis legalization, adjusting for secular trends. Analyses were conducted on March 22, 2022.. Prevalence increased from before to after recreational cannabis legalization for past-month cannabis use (from 21% to 25%) and past-year proxy cannabis use disorder (from 11% to 13%); the increases were statistically significant [adjusted odds ratio (95% CI) = 1.20 (1.08-1.32) and 1.14 (1.003-1.30), respectively]. Increases were detected for young adults who were not in college and who were aged 21-23 years. Recreational cannabis legalization impacts were not detected for secondary outcomes.. Some young adults appear sensitive to state recreational cannabis legalization, including in terms of cannabis use disorder risk. Additional prevention efforts should be directed to young adults who are not in college and timed to occur before age 21 years.

Topics: Alcohol Drinking; Cannabis; Cross-Sectional Studies; Humans; Marijuana Abuse; Prevalence; Young Adult

The 2018 Cannabis Act legalizing the production, sale, and use of cannabis for non-medical purposes renewed interest in the importance of ongoing and more detailed monitoring of cannabis consumption and consequences. Some cannabis users will experience impaired control over their use of cannabis, putting them at risk for cannabis use disorder (CUD, sometimes called addiction) and other harms. Including the Severity of Dependence Scale (SDS) in the annual Canadian Community Health Survey (CCHS) would allow for monitoring of one of the more harmful consequences of cannabis use in the post-legalization period.. Data from the nationally representative 2019-2020 CCHS were used to examine cannabis consumers with and without impaired control. Respondents who used cannabis in the past year were categorized according to their SDS scores: those with impaired control (SDS ≥ 4) versus those without impaired control (SDS < 4). Cross-tabulations were used to examine the sociodemographic, mental health, health behaviour and cannabis exposure characteristics of those with impaired control. Multivariable logistic regression models assessed associations between these characteristics and the risk of impaired control. The prevalence of self-reported cannabis-related problems experienced by consumers-with and without impaired control-is also presented.. In 2019-2020, 4.7% of past-year cannabis consumers scored ≥ 4 on the SDS and were considered to have impaired control. Multivariable logistic regression suggested that the odds of having impaired control remained higher for people who were male, were aged 18 to 24 years, were single or never married, were from lower-income households, were diagnosed with an anxiety or a mood disorder, started consuming cannabis at age ≤ 15, and consumed at least monthly.. A better understanding of the characteristics of cannabis consumers experiencing impaired control (a correlate of future CUD or addiction) could help with the development of more effective education, prevention and treatment strategies.

Topics: Anxiety; Canada; Cannabis; Female; Humans; Male; Marijuana Abuse; Substance-Related Disorders

Frontotemporal disorders (FTD) are the consequence of impairment to neurons in the frontal and temporal lobes of the brain. Also, no definitive treatment has been found for FTD. Cannabinoid products can be used to manage treatment-resistant behavioral variants of Frontotemporal dementia (bvFTD).. We describe the case of 34 years old male with two years of marijuana abuse. At first, he presented with symptoms of apathy and bizarre behavior, which became more severe, and led to disinhibition. The clinical symptoms and imaging findings made FTD probable for him, which was very interesting to report.. While cannabis has demonstrated potential in managing behavioral and mental symptoms of dementia, the presented case highlights the profound impact of cannabis consumption on brain structure and chemistry, including the potential for neurodegenerative disorders like FTD.

Topics: Adult; Apathy; Cannabis; Frontotemporal Dementia; Humans; Male; Marijuana Abuse; Temporal Lobe

Cannabis is the most widely used illicit drug in the world. It is consumed by age groups, the main ones being adolescents and young adults. Its consumption leads to somatic, psychiatric and social complications. Data in our context are scarce. The purpose of our work was to describe the epidemiological and clinical profile of patients with cannabis addiction at the Centre for Care, Support and Prevention of the Laquintinie Hospital in Douala. We conducted a retrospective cross-sectional study of patients followed from March 2021 to July 2022 for cannabis addiction at the Addiction Care, Support and Prevention Center of the Laquintinie Hospital in Douala. The diagnosis of use disorder was based on a dependency syndrome related to cannabis use (single event usage). Data entry and analysis were performed using SPSS version 7.1 software. Of the 45 cases of cannabis addiction, 44 (98%) were male patients with an average age of 21,97 years. The most affected age group was between 20 and 24 years (28/44 or 63%); 49% of consumers were students, 62% of mothers accompanying patient to the consultation. The age of cannabis use initiation was 16 years (31%), the most commonly used form of cannabis was herbal (100%) and 100% of patients used inhalation (smoking). The most common complication was amotivational syndrome (31%). Cannabis use initiation occurs at an early age. The most commonly used form of cannabis is herbal administered through inhalation (smoking). The most common complications are amotivational syndrome, cognitive disorders, sleep disorders and withdrawal syndrome.

Topics: Adolescent; Adult; Behavior, Addictive; Cameroon; Cannabis; Cross-Sectional Studies; Female; Humans; Male; Marijuana Abuse; Retrospective Studies; Young Adult

Topics: Cannabis; Humans; Legislation, Drug; Marijuana Abuse; Public Policy

Cannabis use disorder (CUD) is a growing public health problem. Early identification of adolescents and young adults at risk of developing CUD in the future may help stem this trend. A logistic regression model fitted using a Bayesian learning approach was developed recently to predict the risk of future CUD based on seven risk factors in adolescence and youth. A nationally representative longitudinal dataset, Add Health was used to train the model (henceforth referred as Add Health model).. We validated the Add Health model on two cohorts, namely, Michigan Longitudinal Study (MLS) and Christchurch Health and Development Study (CHDS) using longitudinal data from participants until they were approximately 30 years old (to be consistent with the training data from Add Health). If a participant was diagnosed with CUD at any age during this period, they were considered a case. We calculated the area under the curve (AUC) and the ratio of expected and observed number of cases (E/O). We also explored recalibrating the model to account for differences in population prevalence.. The cohort sizes used for validation were 424 (53 cases) for MLS and 637 (105 cases) for CHDS. AUCs for the two cohorts were 0.66 (MLS) and 0.73 (CHDS) and the corresponding E/O ratios (after recalibration) were 0.995 and 0.999.. The external validation of the Add Health model on two different cohorts lends confidence to the model's ability to identify adolescent or young adult cannabis users at high risk of developing CUD in later life.

Topics: Adolescent; Adult; Bayes Theorem; Cannabis; Humans; Longitudinal Studies; Marijuana Abuse; Risk Factors; Substance-Related Disorders; Young Adult

Topics: Cannabis; Causality; Humans; Marijuana Abuse; Psychotic Disorders; Risk Factors

The objectives of this study were to characterize the detailed cannabis use patterns (eg, frequency, mode, and product) and determine the differences in the whole-blood cannabinoid profiles during symptomatic versus asymptomatic periods of participants with suspected cannabinoid hyperemesis syndrome recruited from the emergency department (ED) during a symptomatic episode.. This is a prospective observational cohort study of participants with symptomatic cyclic vomiting onset after chronic cannabis use. Standardized assessments were conducted to evaluate for lifetime and recent cannabis use, cannabis use disorder, and cannabis withdrawal symptoms. Quantitative whole-blood cannabinoid testing was performed at 2 times, first when symptomatic (ie, baseline) and at least 2 weeks after the ED visit when asymptomatic. The differences in cannabinoid concentrations were compared between symptomatic and asymptomatic testing. The study was conducted from September 2021 to August 2022.. There was a difference observed between delta-9-tetrahydrocannabinol metabolites, but not the parent compound during symptomatic episodes and asymptomatic periods. Most participants (84%) reported using cannabis > once per day (median 3 times per day on weekdays, 4 times per day on weekends). Hazardous cannabis use was universal among participants; the mean cannabis withdrawal discomfort score was 13, indicating clinically significant rates of cannabis withdrawal symptoms with cessation of use. Most participants (79%) previously tried to stop cannabis use, but a few (13%) of them had sought treatment.. Patients presenting to the ED with cannabinoid hyperemesis syndrome have high cannabis use disorder scores. Further studies are needed to better understand the influence of THC metabolism and concentrations on symptomatic cyclic vomiting.

Topics: Cannabinoids; Cannabis; Cohort Studies; Emergency Service, Hospital; Humans; Marijuana Abuse; Substance Withdrawal Syndrome; Vomiting

Cannabis use disorder (CUD) remains a significant public health issue globally, affecting up to one in five adults who use cannabis. Despite extensive research into the molecular underpinnings of the condition, there are no effective pharmacological treatment options available. Therefore, we sought to further explore genetic analyses to prioritise opportunities to repurpose existing drugs for CUD. Specifically, we aimed to identify druggable genes associated with the disorder, integrate transcriptomic/proteomic data and estimate genetic relationships with clinically actionable biochemical traits. Aggregating variants to genes based on genomic position, prioritised the phosphodiesterase gene PDE4B as an interesting target for drug repurposing in CUD. Credible causal PDE4B variants revealed by probabilistic finemapping in and around this locus demonstrated an association with inflammatory and other substance use phenotypes. Gene and protein expression data integrated with the GWAS data revealed a novel CUD associated gene, NPTX1, in whole blood and supported a role for hyaluronidase, a key enzyme in the extracellular matrix in the brain and other tissues. Finally, genetic correlation with biochemical traits revealed a genetic overlap between CUD and immune-related markers such as lymphocyte count, as well as serum triglycerides.

Topics: Cannabis; Drug Repositioning; Marijuana Abuse; Precision Medicine; Proteomics; Substance-Related Disorders

Women experiencing intimate partner violence (IPV) are at increased risk for developing hazardous patterns of cannabis use. Research suggests that women experiencing IPV use cannabis to cope with posttraumatic stress disorder (PTSD) symptoms. To advance research, we used experience sampling methods to explicate the within-day concurrent and proximal relations between PTSD symptom clusters and cannabis use among women experiencing IPV.. Participants were 145 community women (M age = 40.66, 41.6% white, 31.4% Black, 10.9% Hispanic or Latina, 8% American Indian/Alaska Native, 5.8% Bi-/multi-racial) experiencing IPV and using substances who completed three surveys a day for 30 days.. Externalizing behavior (OR = 1.37, 95% CI [1.15, 1.65], p < 0.001) and dysphoric arousal (OR = 1.27, 95% CI [1.09, 1.49], p = 0.002) PTSD symptom clusters were associated with cannabis use reported in the same survey period. Results from the lagged models found no proximal associations between PTSD symptom clusters and cannabis use.. Results highlight the acute effects of externalizing behavior and dysphoric arousal PTSD symptoms on cannabis use among women experiencing IPV. These findings may inform prevention and intervention efforts for cannabis use in this population.

Topics: Adult; Cannabis; Female; Hispanic or Latino; Humans; Intimate Partner Violence; Marijuana Abuse; Stress Disorders, Post-Traumatic; Syndrome

According to the literature, early initiation to cannabis use and a dependent pattern of use are important risk factors for the development of mental health disorders. However, there are few cohort studies which look at the development of mental health disorders associated with cannabis use among young people with cannabis use disorder (CUD). The aim of the study was to determine the cumulative incidence of mental health disorders and the risk of developing mental health disorders among minors who commenced treatment for CUD in Catalonia during 2015-2019.. This was a retrospective fixed cohort study, matched for confounding variables, based on data from the Catalan Health Surveillance System. The exposed cohort comprised young people who entered treatment for CUD during 2015-2019 (n = 948) and who were minors on the date of commencing treatment. Matching was done with a paired cohort (n = 4,737), according to confounding variables. Individuals with a diagnosis of a mental health disorder prior to the study period were excluded. The cumulative incidence was calculated for mental health disorders for the exposed and the paired cohorts and stratified by type of mental disorder. Incidence rate ratios were estimated using the conditional Poisson model with robust variance, stratified by sex.. The cumulative incidence for development of a mental health disorder was 19.6% in the exposed cohort and 3.1% in the paired cohort; with higher incidence among females (females 32.7%; males 15.8%). The exposed cohort had an 8.7 times increased risk of developing a mental health disorder than the paired cohort. The most frequent diagnoses were reaction to severe stress, adjustment disorder, and personality disorders.. This study confirmed that the exposed cohort was at increased risk of developing mental health disorders compared to the paired cohort. To date, few studies have analyzed the association between cannabis use and the development of mental health disorders, considering cannabis dependence. Further studies should be undertaken considering CUD. In addition, more studies are needed to understand the factors that determine the development of CUD. Further research in these areas would contribute to the design of prevention strategies aimed at those young individuals with a higher risk of developing cannabis dependence and suffering its consequences.

Topics: Adolescent; Cannabis; Cohort Studies; Female; Humans; Male; Marijuana Abuse; Mental Disorders; Mental Health; Retrospective Studies; Substance-Related Disorders

Cannabis use disorder (CUD) prevalence has increased, while perceived risks of cannabis use and CUD treatment need have decreased. Chronic cannabis use may also impair the neural and behavioral mechanisms of insight, further hampering treatment-seeking. This study aimed to measure whether CUD is characterized by reduced self-monitoring in drug-related contexts (objectively-assessed insight), subserved by functional neural abnormalities in error-processing and manifested clinically as decreased awareness of the need to change.. Case-control laboratory study was used.. University setting was in Alabama, USA.. There were 42 CUD participants and 47 age-, sex-, and nicotine use-matched controls.. Participants completed a probabilistic choice task, adapted for the first time for CUD, in which they selected pleasant, unpleasant, neutral, and cannabis-related images according to their preference. Reduced versus accurate insight was operationalized as the correspondence between self-reported and actual most chosen image type. Neurophysiological error-processing during an inhibitory control task was recorded using electroencephalography. Participants with CUD completed measures of cannabis problem recognition and motivation to change.. Compared with controls, the CUD group made significantly more cannabis selections on the choice task (mean difference [MD] = 8.11, 95% confidence interval [CI] [4.88 11.35], p < 0.001) and had significantly reduced insight into cannabis choice (odds ratio [OR] = 9.69, 95% CI [1.06 88.65], p = 0.04). CUD participants with reduced insight on the choice task had significantly decreased neurophysiological reactivity to errors on the inhibitory control task (error-related negativity) compared with CUD participants with accurate insight (MD = 2.64 μV, 95% CI [0.74 μV 4.54 μV], p = 0.008) and controls (MD = 4.05 μV, 95% CI [1.29 μV 6.80 μV], p = 0.005). Compared with CUD participants with accurate insight on the choice task, CUD participants with reduced insight reported significantly less agreement that they had a cannabis problem (MD = -5.06, 95% CI [-8.49-1.62], p = 0.003).. People with CUD who show reduced insight on a drug-related choice task may also have decreased early neural error-processing and less cannabis problem recognition.

Topics: Cannabis; Case-Control Studies; Emotions; Humans; Marijuana Abuse; Motivation

Medical and nonmedical cannabis use and cannabis use disorders (CUD) have increased with increasing cannabis legalization. However, the prevalence of CUD among primary care patients who use cannabis for medical or nonmedical reasons is unknown for patients in states with legal recreational use.. To estimate the prevalence and severity of CUD among patients who report medical use only, nonmedical use only, and both reasons for cannabis use in a state with legal recreational use.. This cross-sectional survey study took place at an integrated health system in Washington State. Among 108 950 adult patients who completed routine cannabis screening from March 2019 to September 2019, 5000 were selected for a confidential cannabis survey using stratified random sampling for frequency of past-year cannabis use and race and ethnicity. Among 1688 respondents, 1463 reporting past 30-day cannabis use were included in the study.. Patient survey-reported reason for cannabis use in the past 30 days: medical use only, nonmedical use only, and both reasons.. Patient responses to the Composite International Diagnostic Interview-Substance Abuse Module for CUD, corresponding to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition CUD severity (0-11 symptoms) were categorized as any CUD (≥2 symptoms) and moderate to severe CUD (≥4 symptoms). Adjusted analyses were weighted for survey stratification and nonresponse for primary care population estimates and compared prevalence of CUD across reasons for cannabis use.. Of 1463 included primary care patients (weighted mean [SD] age, 47.4 [16.8] years; 748 [weighted proportion, 61.9%] female) who used cannabis, 42.4% (95% CI, 31.2%-54.3%) reported medical use only, 25.1% (95% CI, 17.8%-34.2%) nonmedical use only, and 32.5% (95% CI, 25.3%-40.8%) both reasons for use. The prevalence of CUD was 21.3% (95% CI, 15.4%-28.6%) and did not vary across groups. The prevalence of moderate to severe CUD was 6.5% (95% CI, 5.0%-8.6%) and differed across groups: 1.3% (95% CI, 0.0%-2.8%) for medical use, 7.2% (95% CI, 3.9%-10.4%) for nonmedical use, and 7.5% (95% CI, 5.7%-9.4%) for both reasons for use (P = .01).. In this cross-sectional study of primary care patients in a state with legal recreational cannabis use, CUD was common among patients who used cannabis. Moderate to severe CUD was more prevalent among patients who reported any nonmedical use. These results underscore the importance of assessing patient cannabis use and CUD symptoms in medical settings.

Topics: Adult; Cannabinoid Receptor Agonists; Cannabis; Cross-Sectional Studies; Female; Hallucinogens; Humans; Male; Marijuana Abuse; Middle Aged; Prevalence; Substance-Related Disorders

Brief cannabis screening followed by standardized assessment of symptoms may support diagnosis and treatment of cannabis use disorder (CUD). This study tested whether the probability of a medical provider diagnosing and treating CUD increased with the number of substance use disorder (SUD) symptoms documented in patients' EHRs.. This observational study used EHR and claims data from an integrated healthcare system. Adult patients were included who reported daily cannabis use and completed the Substance Use Symptom Checklist, a scaled measure of DSM-5 SUD symptoms (0-11), during routine care 3/1/2015-3/1/2021. Logistic regression estimated associations between SUD symptom counts and: 1) CUD diagnosis; 2) CUD treatment initiation; and 3) CUD treatment engagement, defined based on Healthcare Effectiveness Data and Information Set (HEDIS) ICD-codes and timelines. We tested moderation across age, gender, race, and ethnicity.. Patients (N=13,947) were predominantly middle-age, male, White, and non-Hispanic. Among patients reporting daily cannabis use without other drug use (N=12,568), the probability of CUD diagnosis, treatment initiation, and engagement increased with each 1-unit increase in Symptom Checklist score (p's<0.001). However, probabilities of diagnosis, treatment, and engagement were low, even among those reporting ≥2 symptoms consistent with SUD: 14.0% diagnosed (95% CI: 11.7-21.6), 16.6% initiated treatment among diagnosed (11.7-21.6), and 24.3% engaged in treatment among initiated (15.8-32.7). Only gender moderated associations between Symptom Checklist and diagnosis (p=0.047) and treatment initiation (p=0.012). Findings were similar for patients reporting daily cannabis use with other drug use (N=1379).. Despite documented symptoms, CUD was underdiagnosed and undertreated in medical settings.

Topics: Adult; Cannabis; Female; Hallucinogens; Humans; Male; Marijuana Abuse; Middle Aged; Primary Health Care; Risk Factors; Substance-Related Disorders

Adverse childhood experiences (ACEs), social-emotional impairments (SEIs), and neurodevelopmental disorders (NDs) are frequent in psychiatric disorders, including substance-use disorders. We aimed to determine the prevalence of ACE, SEI, or ND in individuals with cannabis-use disorder (CUD). We compared individuals with preCUD-onset ACE, SEI, or ND to those without.. We crosssectionally studied 323 inpatients or outpatients with a history of past or current CUD, aged 12-35 years (mean age 22.94 ± 4.79), 64.5% of whom were male. The sample was divided into two groups: the non-premorbid (N = 52) and the premorbid ACE/SEI/ND group (N = 271). Within the premorbid group, further subgroups were based on ACEs, SEI, and NDs. We also analyzed other substance use and psychiatric symptoms/diagnoses based on the non-premorbid-premorbid dichotomy in the CUD sample.. Pre-CUD ACE-SEI-ND had higher prevalence of bipolar, schizoaffective, borderline personality, and attention-deficit/hyperactivity disorders, and a history of agitation, hallucinations, and self-injury. The ACE group had higher rates of agitation, depression, delusions, hallucinations, eating disorders, and use of cocaine, amphetamines, and hallucinogens than the SEI or ND. Patients in the premorbid group initiated cannabis use at an earlier age, experienced the first comorbid psychiatric episode earlier, and were hospitalized earlier than those in the non- premorbid ACE-SEI-ND group.. PreCUD-onset ACE, SEI, or ND conditions in individuals with CUDare linked to earlier onset of comorbid mental illness. Furthermore, ACEs contribute to significant and potentially severe clinical symptoms, as well as the use of substances other than cannabis.

Topics: Adolescent; Adult; Adverse Childhood Experiences; Cannabis; Female; Hallucinations; Humans; Male; Marijuana Abuse; Neurodevelopmental Disorders; Substance-Related Disorders; Young Adult

Cannabis use disorder (CUD) presents differently in men and women, particularly in symptoms of cannabis withdrawal. Novel pharmacotherapeutic interventions for CUD, such as those that target the endocannabinoid (eCB) system, must be developed in a manner consistent with these sex differences. The present pilot study sought to prospectively assess sex differences in cannabis withdrawal in a small sample of adults with moderate-to-severe CUD and to determine if withdrawal was associated with peripheral eCB and eCB congener tone. Men and women (n = 5/sex) completed 2 weeks of study participation separated by 1 month; in the latter week, participants abstained from cannabis use. Each week, participants attended in-person laboratory visits during which blood was drawn repeatedly to assess plasma eCB and eCB congener tone. Participants also completed multiple daily ambulatory assessments to assess cannabis use and withdrawal symptoms. As anticipated, women reported a greater increase in withdrawal symptoms during the abstinent week [Δ = 9.4 (SE = 1.1); p < 0.001] than men [Δ = 1.2 (SE = 1.2); p = 0.35]. Sex differences in levels of the eCB N-arachidonoylethanolamide (AEA), as well as the eCB congeners stearoylethanolamide (SEA) and linoleylethanolamide (LEA), were evident during abstinence at the morning time point only (p's < 0.05). LEA was associated with withdrawal symptom expression in both sexes [β = 0.16 (SE = 0.09)] and palmitoylethanolamide (PEA) [β = 0.22 (SE = 0.13)] and 2-arachidonoylglycerol (2-AG) [β = 0.32 (SE = 0.15)] were associated with withdrawal symptoms in women only. Pharmacotherapeutic development for CUD should consider evident sex differences in eCB and eCB congener tone during abstinence and their associations with cannabis withdrawal, as eCB-based interventions may produce differential effects by sex.

Topics: Adult; Caffeine; Cannabinoid Receptor Agonists; Cannabis; Endocannabinoids; Female; Humans; Male; Marijuana Abuse; Pilot Projects; Sex Characteristics; Substance Withdrawal Syndrome; Substance-Related Disorders

Cannabis use disorder is associated with considerable comorbidity and impairment in functioning, and prevalence is increasing among adults with chronic pain. We aimed to assess the effect of introduction of medical cannabis laws (MCL) and recreational cannabis laws (RCL) on the increase in cannabis use disorder among patients in the US Veterans Health Administration (VHA).. Data from patients with one or more primary care, emergency, or mental health visit to the VHA in 2005-19 were analysed using 15 repeated cross-sectional VHA electronic health record datasets (ie, one dataset per year). Patients in hospice or palliative care were excluded. Patients were stratified as having chronic pain or not using an American Pain Society taxonomy of painful medical conditions. We used staggered-adoption difference-in-difference analyses to estimate the role of MCL and RCL enactment in the increases in prevalence of diagnosed cannabis use disorder and associations with presence of chronic pain, accounting for the year that state laws were enacted. We did this by fitting a linear binomial regression model stratified by pain, with time-varying cannabis law status, fixed effects for state, categorical year, time-varying state-level sociodemographic covariates, and patient covariates (age group [18-34 years, 35-64 years, and 65-75 years], sex, and race and ethnicity).. Between 2005 and 2019, 3 234 382-4 579 994 patients were included per year. Among patients without pain in 2005, 5·1% were female, mean age was 58·3 (SD 12·6) years, and 75·7%, 15·6%, and 3·6% were White, Black, and Hispanic or Latino, respectively. In 2019, 9·3% were female, mean age was 56·7 (SD 15·2) years, and 68·1%, 18·2%, and 6·5% were White, Black, and Hispanic or Latino, respectively. Among patients with pain in 2005, 7·1% were female, mean age was 57·2 (SD 11·4) years, and 74·0%, 17·8%, and 3·9% were White, Black, and Hispanic or Latino, respectively. In 2019, 12·4% were female, mean age was 57·2 (SD 13·8) years, and 65·3%, 21·9%, and 7·0% were White, Black, and Hispanic or Latino, respectively. Among patients with chronic pain, enacting MCL led to a 0·135% (95% CI 0·118-0·153) absolute increase in cannabis use disorder prevalence, with 8·4% of the total increase in MCL-enacting states attributable to MCL. Enacting RCL led to a 0·188% (0·160-0·217) absolute increase in cannabis use disorder prevalence, with 11·5% of the total increase in RCL-enacting states attributable to RCL. In patients without chronic pain, enacting MCL and RCL led to smaller absolute increases in cannabis use disorder prevalence (MCL: 0·037% [0·027-0·048], 5·7% attributable to MCL; RCL: 0·042% [0·023-0·060], 6·0% attributable to RCL). Overall, associations of MCL and RCL with cannabis use disorder were greater in patients with chronic pain than in patients without chronic pain.. Increasing cannabis use disorder prevalence among patients with chronic pain following state legalisation is a public health concern, especially among older age groups. Given cannabis commercialisation and widespread public beliefs about its efficacy, clinical monitoring of cannabis use and discussion of the risk of cannabis use disorder among patients with chronic pain is warranted.. NIDA grant R01DA048860, New York State Psychiatric Institute, and the VA Centers of Excellence in Substance Addiction Treatment and Education.

Topics: Adolescent; Adult; Aged; Cannabis; Chronic Pain; Cross-Sectional Studies; Female; Humans; Male; Marijuana Abuse; Medical Marijuana; Middle Aged; United States; Veterans Health; Young Adult

Topics: Cannabis; Humans; Marijuana Abuse; Medication Adherence; Psychotic Disorders

Precise crop fertilization requires an in-depth understanding of plant uptake and utilisation to optimise sustainable production. This study investigated the influence of nitrogen (N) nutrition and pruning on the cannabinoid concentrations and biomass of a commercial cannabis cultivar; the rationale for this study is how N supply and pruning affect cannabinoid yields and concentration in a commercial setting. Clones of a Cannabis sativa L. (CBD-type) were grown in a controlled-environment glasshouse in pots with coarse sand. After five weeks of vegetative growth under 210 mg/L N and an 18 h light regime, rates of 30, 60, 210, and 500 mg/L N were applied to plants for twelve weeks and a light regime set at 12 h. Double stem pruning was applied as an additional treatment to investigate efficacy on biomass increase. Biomass, N concentrations, and cannabinoid concentrations were measured after the final harvest. Pruning treatment did not increase cannabinoid concentrations or affect biomass. It was coincidentally found that plants on the glasshouse edge with higher exposure to sunlight developed more biomass and higher cannabinoid concentrations. Only biomass in leaves was increased significantly via higher nitrogen nutrition. Cannabinoid concentration, as well as cannabinoid yield per plant were decreased with the increase in N supply. High rates of fertilizer are not recommended because of reduced cannabinoid concentration and biomass yield: the ideal N supply is likely to be between 60 and 210 mg/L. This research will benefit growers and advisors in understanding the complexity of effects of nitrogen fertiliser and pruning practices on plant biomass and secondary metabolite production in medicinal cannabis.

Topics: Biomass; Cannabinoids; Cannabis; Fertilizers; Marijuana Abuse; Nitrogen

Topics: Cannabis; Humans; Marijuana Abuse; Psychotic Disorders

The endocannabinoid system has been associated with various psychiatric disorders, such as schizophrenia or addictive disorders. Recent studies have found that some polymorphisms in the cannabinoid receptor type 2 (CNR2), cannabinoid receptor type 1 (CNR1) and fatty acid amide hydrolase (FAAH) genes could play an important role as risk factors in the etiology of these diseases. We analysed different cannabinoid gene polimorphisms from non-substance using patients diagnosed with schizophrenia (n = 379), schizophrenic patients with cannabis use disorders (n = 124), cannabis users who did not have psychoses (n = 71), and 316 controls from various Spanish hospitals and health centres. We found a statistical association between polymorphisms rs35761398 and rs12744386 in the CNR2 gene and comorbidity of schizophrenia and cannabis dependence, as well as an association between loss of heterozygosity (overdominance) for polymorphism rs324420 in the FAAH gene and cannabis dependence in a Spanish population sample. The rs35761398 and rs12744386 polymorphisms in the CNR2 gene are genetic risk factors for schizophrenia in cannabis-dependent subjects. Loss of heterozygosity for polymorphism rs324420 in the FAAH gene is a genetic risk factor for cannabis dependence in this population.. El sistema cannabinoide se ha asociado con varios trastornos psiquiátricos como la esquizofrenia y las adicciones. Diversos estudios han observado que algunos polimorfismos del receptor cannabinoide tipo 2 (CNR2), del receptor cannabinoide tipo 1 (CNR1) y del gen de la enzima amido hidrolasa de ácidos grasos (FAAH) pueden ser factores de riesgo de estos trastornos. Hemos analizado diversos polimorfismos del sistema cannabinoide en pacientes diagnosticados de esquizofrenia sin trastorno por uso de sustancias (n = 379), esquizofrenia con trastorno por uso de cannabis (n = 124), dependientes de cannabis sin psicosis asociada (n = 71) y un grupo de control (316) procedentes de diversos hospitales y centros de asistencia sanitaria españoles. Hemos encontrado una asociación entre los polimorfismos rs35761398 y rs12744386 del CNR2 con la presencia de esquizofrenia y trastorno por uso de cannabis comórbido y una pérdida de heterocigosidad en el polimorfismo rs324420 del gen FAAH con la dependencia de cannabis en población española. Los polimorfismos rs35761398 y rs12744386 en CNR2 son factores de riesgo para esquizofrenia en sujetos dependientes de cannabis. La pérdida de heterocigosidad en el polimorfismo rs324420 en el gen FAAH es un factor de riesgo para la dependencia de cannabis.

Topics: Cannabis; Comorbidity; Humans; Marijuana Abuse; Polymorphism, Single Nucleotide; Receptors, Cannabinoid; Schizophrenia

Cannabis use is highly common among military combat veterans, who are also inclined toward developing Cannabis Use Disorder (CUD). The present study examined the association between Moral Injury (MI), which may occur following combat-related acts that violate one's deep moral beliefs, and CUD, as well as the mediating role of depression and the moderating role of perceived social support.. Participants were 215 Israel Defense Forces male combat veterans discharged from military service within the past five years, who reported using cannabis regularly (≥3 days weekly) during the past six months. Participants completed a set of validated self-report questionnaires assessing MI, CUD, depression and perceived social support.. Results indicated that MI-perpetration by self and MI-betrayal were positively associated with CUD. Additionally, serial mediation analyses indicated that the associations between MI-self and betrayal and CUD were mediated by depression (direct effect: β = 0.13, p = 0.1, and β = 0.20, p = .04, respectively). Furthermore, moderation analyses indicated that the association between MI and CUD was significant only among participants with average or high levels of perceived social support (for support by a significant other: b = 0.13, p = .006 and b = 0.22, p < .001 for MI-self and betrayal, respectively; for support by family: b = 0.13, p = .009 for MI-betrayal; and for support by friends: b = 0.1, p = .044 for MI-self).. MI and its association with CUD should be addressed in clinical settings when working with combat veterans.

Topics: Cannabis; Depression; Humans; Marijuana Abuse; Social Support; Stress Disorders, Post-Traumatic; Veterans

Topics: Cannabis; Hallucinogens; Humans; Marijuana Abuse; Psychotic Disorders; Risk Factors

Initial use of drugs such as tobacco and alcohol may lead to subsequent more problematic drug use-the 'gateway' hypothesis. However, observed associations may be due to a shared underlying risk factor, such as trait impulsivity. We used bidirectional Mendelian randomization (MR) to test the gateway hypothesis.. Our main method was inverse-variance weighted (IVW) MR, with other methods included as sensitivity analyses (where consistent results across methods would raise confidence in our primary results). MR is a genetic instrumental variable approach used to support stronger causal inference in observational studies.. Genome-wide association summary data among European ancestry individuals for smoking initiation, alcoholic drinks per week, cannabis use and dependence, cocaine and opioid dependence (n = 1749-1 232 091).. Genetic variants for exposure.. We found evidence of causal effects from smoking initiation to increased drinks per week [(IVW): β = 0.06; 95% confidence interval (CI) = 0.03-0.09; P = 9.44 × 10. Bidirectional Mendelian randomization testing of the gateway hypothesis reveals that smoking initiation may lead to increased alcohol consumption, cannabis use and cannabis dependence. Cannabis use may also lead to smoking initiation and opioid dependence to alcohol consumption. However, given that tobacco and alcohol use typically begin before other drug use, these results may reflect a shared risk factor or a bidirectional effect for cannabis use and opioid dependence.

Topics: Alcohol Drinking; Cannabis; Genome-Wide Association Study; Humans; Marijuana Abuse; Mendelian Randomization Analysis; Nicotiana; Opioid-Related Disorders; Polymorphism, Single Nucleotide; Smoking

In non-pregnant populations, cannabis use and cannabis use disorder (CUD) have been linked to tobacco use and less successful quit attempts. We compared perinatal cigarette use in women across 3 groups: never used cannabis (No CU group); used cannabis but did not meet CUD criteria (CU group); history of CUD (CUD group).. Interviews with 257 pregnant women with overweight/obesity (M age = 28 years; 52% white) were conducted for a study of eating behavior in Western Pennsylvania from 2012-2016. Tobacco use was assessed early in pregnancy (< 20 weeks gestation), late in pregnancy (34-38 weeks gestation) and 6 months postpartum. CUD was measured with the Structured Clinical Interview for DSM-IV (SCID). Data relevant to the proposed analyses were available for 252 women. Generalized mixed effect models were used to predict perinatal cigarette use based on cannabis use group, time and their interaction, adjusting for age, race, education, income, parity, and mood/anxiety disorder.. Forty-eight percent of participants reported prior cannabis use and 15% were diagnosed with lifetime CUD. History of cannabis use predicted cigarette smoking in early pregnancy (OR 11.12, CI 3.27-37.85), late pregnancy (OR 6.55, CI 1.70-25.27), and 6 months postpartum (OR 7.57, CI 2.72-21.07), regardless of CUD.. A history of CUD did not appear to confer additional risk for perinatal cigarette use. Given increasing rates of cannabis use among pregnant women, these results highlight the importance of addressing history of cannabis use in conjunction with tobacco use to improve smoking cessation efforts.

Topics: Adult; Cannabis; Cohort Studies; Female; Humans; Marijuana Abuse; Obesity; Overweight; Pregnancy; Tobacco Products

Given the increased prevalence of cannabis use in Ireland and increase in cannabis potency, this study aimed to estimate the size of the potential population in Ireland that may be in need of cannabis treatment and the percentage of people with cannabis use disorder (CUD) who actually access treatment. We also compared the profile of those with CUD in the general population to those who receive treatment for their cannabis use to explore whether certain subgroups are more or less likely to enter treatment.. This was a retrospective, multi-source database study. Data were obtained from (1) Ireland's 2014/2015 national general population survey (GPS) on drug use and (2) treatment data from the Irish National Drug Treatment Reporting System (NDTRS) for 2015. The profiles of GPS cases with CUD and NDTRS cases were compared using 2-sided t tests designed for independent samples.. The prevalence of last year cannabis use among adults aged 15 and older was 6.5% and the prevalence of CUD was 2.6%, representing 94,515 of the Irish population. A total of 4,761 cases entered treatment for problem cannabis use. NDTRS treatment cases were significantly more likely than GPS cases to be unemployed (63.7% vs. 26.6%) and have no or primary level only educational attainment (56.3% vs. 21.2%). Over half (53.3%) of NDTRS cases first used cannabis before the age of 15 years, compared to 14.7% of CUD cases in the population.. Our findings suggest that earlier users and those with more complex or disadvantaged lives are more likely to seek treatment. A broad population health approach that engages multiple sectors such as health, social welfare, and education is recommended to ensure that there is increased opportunity for people with CUD to be identified and signposted towards treatment.

Topics: Adolescent; Adult; Cannabis; Humans; Marijuana Abuse; Medical Marijuana; Retrospective Studies; Substance-Related Disorders

The authors sought to determine the association of cannabis indicators with self-reported psychotic disorders in the U.S. general population.. Participants were from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002; N=43,093) and NESARC-III (2012-2013; N=36,309). Logistic regression was used to estimate standardized prevalences of past-year self-reported psychotic disorders within each survey and to evaluate the association of past-year self-reported psychotic disorders with indicators of nonmedical cannabis use (any use; frequent use [at least three times/week], daily/near-daily use, and DSM-IV cannabis use disorder) compared with those with no past-year nonmedical cannabis use. Whether the strength of associations differed between surveys was indicated by difference-in-difference tests (between-survey contrasts) and ratios of odds ratios between surveys.. Self-reported psychotic disorders were significantly more prevalent among participants with any nonmedical cannabis use than those without (2001-2002: 1.65% compared with 0.27%; 2012-2013: 1.89% compared with 0.68%). In 2001-2002, self-reported psychotic disorders were unrelated to either frequent use or daily/near-daily use. However, in 2012 - 2013, compared with nonusers, self-reported psychotic disorders were more common among participants with frequent use and those with daily/near-daily nonmedical cannabis use (2012-2013: 2.79% and 2.52%, respectively, compared with 0.68% among nonusers). Self-reported psychotic disorders were significantly more prevalent among participants with cannabis use disorder than nonusers in both surveys (2001-2002: 2.55% compared with 0.27%; 2012 - 2013: 3.38% compared with 0.68%). The strength of these associations did not change over time.. Data from the U.S. general population, especially more recent data, suggest associations between self-reported psychotic disorder and frequent nonmedical cannabis use and cannabis use disorder. Clinicians and policy makers should consider these relationships when monitoring patients and formulating programs.

Topics: Adult; Cannabis; Diagnostic and Statistical Manual of Mental Disorders; Humans; Marijuana Abuse; Psychotic Disorders; Self Report; Substance-Related Disorders

Topics: Adolescent; Cannabinoid Receptor Agonists; Cannabis; Cotinine; Cross-Sectional Studies; Hallucinogens; Humans; Marijuana Abuse; Sleep; Sleep Initiation and Maintenance Disorders; Substance Withdrawal Syndrome; Young Adult

There are few studies in Spain on cannabinoid hyperemesis syndrome (CHS), as well as on the use of topical capsaicin as a treatment.. Retrospective study of patients over 14 years of age seen in a hospital emergency department during 2018 and 2019 with a diagnosis of CHS based on the following criteria: compatible clinical picture, cannabis use less than 48h and positive urine cannabis test. Epidemiological and clinical variables, attendance times and treatment (including use of topical capsaicin 0.075%) were collected.. Fifty-nine attendances were studied, from 29 patients (4.4 cases/10,000 visits, 95% CI 2.8-4.7). Fifty per cent returned for CHS, differing only in more tobacco (P=.01) and cocaine (P=.031) use. Capsaicin was used in 74.6% of visits. The mean time to resolution of vomiting after application was 17.87min.. Although probably underdiagnosed, CHS has a low incidence in the emergency department in Spain, with high patient recurrence. The use of capsaicin ointment is efficient and safe.

Topics: Cannabinoids; Cannabis; Capsaicin; Humans; Incidence; Marijuana Abuse; Retrospective Studies; Syndrome; Vomiting

Topics: Cannabis; Emergency Service, Hospital; Humans; Hypnotics and Sedatives; Marijuana Abuse; Psychotropic Drugs

Topics: Attitude of Health Personnel; Cannabis; Diagnosis, Differential; Humans; Marijuana Abuse; Mental Disorders

Medication nonadherence among bipolar disorder (BD) is often linked with comorbid substance use disorders. This study aims to investigate cannabis use disorder (CUD) association with medication noncompliance in hospitalized BD patients.. Using data on 266,303 BD hospitalizations between 2010 and 2014 from the US Nationwide Inpatient Sample database, we obtained medication noncompliance rates stratified by demographics and CUD. Logistic regression was used to evaluate factors associated with medication noncompliance.. Overall mean age, the prevalence of CUD, and medication nonadherence were 41.58 (± 0.11) years, 15.0% and 16.1%, respectively. There were 56.6% females in the overall population. There was a significant difference in the characteristics of those in the medication nonadherence vs adherence groups, including age, sex, race, comorbid substance use, income, insurance type, hospital region, and hospital teaching status (p < 0.001). After adjusting for other variables using multivariate analysis, there remained a statistically significant association of medication nonadherence in BD hospitalization and CUD (OR 1.42, 95% CI 1.36-1.48).. Confounding multiple substance use could not be accounted for, and the retrospective nature of the database which includes only inpatients is prone to possible selection and reporting bias.. CUD statistically predicts increased rates of medication nonadherence among patients with BD. Given the possible association of CUD with medication nonadherence among BD patients, collaborative work between general adult psychiatry and addiction services is imperative in improving the management outcome of patients with BD and comorbid CUD.

Topics: Adult; Bipolar Disorder; Cannabis; Female; Humans; Inpatients; Male; Marijuana Abuse; Medication Adherence; Retrospective Studies

France accounts for one of the highest levels of recreational cannabis use, with almost 40% of youth aged 17 reporting having experimented with cannabis. We investigated the impact of early cannabis experimentation (defined as first-time use ≤ 16 years) on future probability of unemployment in young to mid-adulthood using a longitudinal, community sample over the span of 9 years.. Data were obtained from the French TEMPO Cohort study, set up in 2009 among young adults aged 22-25 years old. Participants who reported information on age of cannabis experimentation and employment status in at least one study wave (2009, 2011, 2015 and 2018) were included in the statistical analyses (N = 1487, 61.2% female).. In A-IPW-adjusted analyses, early cannabis experimenters (≤ 16 years) had 1.71 (95% CI: 1.46-2.02) times higher odds of experiencing unemployment compared to late cannabis experimenters (> 16 years) and 2.40 (95% CI: 2.00 - 2.88) times higher odds of experiencing unemployment compared to non-experimenters. Late cannabis experimenters experienced 1.39 (95% CI: 1.17-1.68) times higher odds of being unemployed compared to non-experimenters, and early cannabis experimenters experienced 3.84 (95%CI: 2.73-5.42) times higher odds of experiencing long-term unemployment (defined as unemployed at least twice) compared to non-experimenters.. Participants who ever used cannabis, especially at or before the age of 16, had higher odds of experiencing unemployment, even when accounting for many psychological, academic and family characteristics which preceded cannabis initiation.

Topics: Adolescent; Adult; Cannabis; Cohort Studies; Cyclic N-Oxides; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Unemployment; Young Adult

Topics: Cannabis; Causality; Humans; Marijuana Abuse; Psychotic Disorders

Topics: Adolescent; Cannabis; COVID-19; Humans; Marijuana Abuse; Pandemics; SARS-CoV-2; Vomiting

Cannabis legalization in many jurisdictions worldwide has raised concerns that such legislation might increase the burden of transient and persistent psychotic illnesses in society. Our study aimed to address this issue.. Implementation of Canada's cannabis legalization framework was not associated with evidence of significant changes in cannabis-induced psychosis or schizophrenia ED presentations. Given the potentially idiosyncratic rollout of Canada's cannabis legalization, further research will be required to establish whether study results generalize to other settings.

Topics: Alberta; Amphetamines; Canada; Cannabis; Cross-Sectional Studies; Education, Medical, Graduate; Emergency Service, Hospital; Fellowships and Scholarships; Female; Humans; Internship and Residency; Marijuana Abuse; Ontario; Psychotic Disorders; Radiography; Radiology; United States

Cannabis has been implicated as both a potential cause and adverse prognostic factor in psychotic disorders. Investigating the contributory role of cannabis toward the overall burden of psychotic illnesses may represent an important step toward psychosis prevention and treatment. The current study samples consecutive admissions (N = 246) to two community based first-episode psychosis services to characterize timing of cannabis use relative to psychosis and attenuated symptom onset, differences between those with and without cannabis exposure, and the association of age at first cannabis exposure with clinical and demographic variables. Both cannabis exposure (78%) and cannabis use disorders (47%) were highly prevalent at admission. In 94% of participants, cannabis use preceded the onset of both attenuated and full-threshold psychosis symptoms by several years. Earlier age at first exposure to cannabis was associated with younger age at prodrome and psychosis onset, worse premorbid functioning, and greater severity of cannabis use disorder at admission. The timing of first exposure to cannabis may have individual prognostic as well as public health significance. Documenting the prevalence and impact of cannabis use in early psychosis samples, as well as the overall incidence of psychotic disorders, will be of vital public health significance as the United States enacts cannabis legalization and cannabis products become more widely available.

Topics: Age of Onset; Cannabis; Humans; Marijuana Abuse; Prognosis; Psychotic Disorders

Topics: Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Psychotic Disorders

In recent decades, cannabis has been widely used around the world for medical and recreational purposes, both legally and illegally. Aside from its therapeutic benefits, cannabis exhibits many adverse effects. Psychosis is one of the potentially harmful effects of cannabis.. A 23-year-old Thai man, who reported cannabis use for 2 years and discontinued for 3 months, restarted smoking two bongs (2 g equivalence) of cannabis. Two hours later, he had a penile erection, felt a severe persistent sharp pain in his penis, and reported that his glans looked distorted. Intending to eradicate the pain, he decided to trim the penile skin several times and completely amputated his penis himself using scissors. Cannabis-induced psychosis was diagnosed because symptoms began after cannabis use, without evidence of other substance abuse. To confirm the cannabis exposure, his urine immunoassay was positive for delta-9-tetrahydrocannabinol (Δ. Cannabis-induced psychosis is an adverse effect of cannabis, which may lead to impaired judgement unexpected self-harm. A multidisciplinary team approach, including a primary care physician, an emergency physician, a urologist, and a psychiatrist, is essential when dealing with a patient with cannabis-induced psychosis and a urogenital injury.

Topics: Adult; Amputation, Surgical; Cannabis; Humans; Male; Marijuana Abuse; Penis; Psychotic Disorders; Young Adult

A growing body of research has reported on the potential opioid-sparing effects of cannabis and cannabinoids, but less is known about specific mechanisms. The present research examines cannabis-related posts in two large online communities on the Reddit platform ("subreddits") to compare mentions of naturalistic cannabis use by persons self-identifying as actively using opioids versus persons in recovery. We extracted all posts mentioning cannabis-related keywords (e.g., "weed", "cannabis", "marijuana") from December 2015 through August 2019 from an opioid use subreddit and an opioid recovery subreddit. To investigate how cannabis is discussed at-scale, we identified and compared the most frequent phrases in cannabis-related posts in each subreddit using term-frequency-inverse document frequency (TF-IDF) weighting. To contextualize these findings, we also conducted a qualitative content analysis of 200 random posts (100 from each subreddit). Cannabis-related posts were about twice as prevalent in the recovery subreddit (n = 908; 5.4% of 16,791 posts) than in the active opioid use subreddit (n = 4,224; 2.6% of 159,994 posts, p < .001). The most frequent phrases from the recovery subreddit referred to time without using opioids and the possibility of using cannabis as a "treatment." The most frequent phrases from the opioid subreddit referred to concurrent use of cannabis and opioids. The most common motivations for using cannabis were to manage opioid withdrawal symptoms in the recovery subreddit, often in conjunction with anti-anxiety and GI-distress "comfort meds," and to enhance the "high" when used in combination with opioids in the opioid subreddit. Despite limitations in generalizability from pseudonymous online posts, this examination of reports of naturalistic cannabis use in relation to opioid use identified withdrawal symptom management as a common motivation. Future research is warranted with more structured assessments that examines the role of cannabis and cannabinoids in addressing both somatic and affective symptoms of opioid withdrawal.

Topics: Analgesics, Opioid; Cannabinoid Receptor Agonists; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Narcotics; Opioid-Related Disorders; Social Media; Social Support; Substance Withdrawal Syndrome

Despite the growing prevalence of cannabis use and associated consequences among U.S. young adults, relatively little is known about precisely what level of marijuana involvement may be problematic.. With this study we sought to identify empirically-derived cut-scores for the Marijuana Consequences Questionnaire (MACQ) that would distinguish among levels of cannabis risk in a sample of young adult college students (N = 496). We also examined how these levels of cannabis risk corresponded to a variety of indicators of cannabis involvement, including frequency of use, intoxication, other measures of cannabis consequences, and indicators of more severe cannabis involvement (e.g., physiological dependence, loss of control over use, cannabis use disorder).. Receiver operating characteristic analyses yielded cutoffs that distinguished among three distinct levels of risk, "Low", "Moderate", and "High". These empirically derived cut scores showed strong overall differentiation among classifications, with good sensitivity and specificity. MACQ-based risk levels were validated across several indices of cannabis involvement. Cutoffs differed across genders.. Findings offer a new application for the MACQ, allowing for the identification of those at greatest risk. As such, this measure may be used to facilitate appropriately targeted intervention.

Topics: Cannabis; Female; Hallucinogens; Humans; Male; Marijuana Abuse; Sensitivity and Specificity; Students; Surveys and Questionnaires; Young Adult

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

Topics: Adolescent; Adult; Anxiety; Anxiety Disorders; Cannabis; Humans; Marijuana Abuse; Substance-Related Disorders; Young Adult

Topics: Cannabis; Hallucinogens; Harm Reduction; Humans; Marijuana Abuse; Parents; Universities

Prior research has examined the prevalence and correlates of cannabis use disorder (CUD) in people who use cannabis; however, these are poorly described for people using cannabis for medical reasons.. Data came from a 2018 to 2019 online, anonymous, cross-sectional survey of Australians reporting using either illicit or licit cannabis for medical reasons within the past year. Included were questions on demographics, current and lifetime patterns of cannabis use, clinical conditions for which medical cannabis was used, and individual criteria for CUD and cannabis withdrawal syndrome. Bayesian Horseshoe logistic regression models were used to identify covariates associated with meeting CUD DSM-5 conditions for any-CUD (≥2/11 criteria) and moderate-severe-CUD (≥4/11).. A total of 905 participants were included in the analysis. The majority (98%) used illicit cannabis products. Criteria for any-CUD criteria were met by 290 (32.0%), and 117 (12.9%) met criteria for moderate-severe-CUD. Tolerance (21%) and withdrawal (35%) were the most commonly met criteria. Correlates with the strongest association with CUD were inhaled route of administration [odds ratio (OR) = 2.96, 95% credible interval 1.11, 7.06], frequency of cannabis use (OR = 1.24, 1.11-1.35), proportion of cannabis for medical reasons (OR = 0.83, 0.74, 0.94), frequency of tobacco use (OR = 1.10, 1.03, 1.17), age (OR = 0.75, 0.64, 0.90) and pain as main clinical indication (OR = 0.58, 0.36, 1.00).. Prevalence of CUD in medical cannabis users appears comparable to 'recreational' users, with many similar correlates. CUD was associated with using cannabis to treat mental health rather than pain conditions and inhaled over other routes of administration.

Topics: Analgesics; Australia; Bayes Theorem; Cannabis; Cross-Sectional Studies; Hallucinogens; Humans; Marijuana Abuse; Medical Marijuana; Pain; Prevalence; Substance-Related Disorders

Many people across the world use potentially addictive legal and illegal substances, but evidence suggests that not all use leads to heavy use and dependence, as some substances are used moderately for long periods of time. Here, we empirically examine, the stability of and transitions between three substance use states: zero-use, moderate use, and heavy use. We investigate two large datasets from the US and the Netherlands on yearly usage and change of alcohol, nicotine, and cannabis. Results, which we make available through an extensive interactive tool, suggests that there are stable moderate use states, even after meeting criteria for a positive diagnosis of substance abuse or dependency, for both alcohol and cannabis use. Moderate use of tobacco, however, was rare. We discuss implications of recognizing three states rather than two states as a modeling target, in which the moderate use state can both act as an intervention target or as a gateway between zero use and heavy use.

Topics: Behavior, Addictive; Cannabis; Humans; Marijuana Abuse; Substance-Related Disorders; Tobacco Use

The high prevalence rates of cannabis use in adolescents and its early onset constitutes a major public health problem, raising the need for its early detection. The availability of validated tools to analyze early cannabis use is essential to detect problematic use at an early age. The Cannabis Abuse Screening Test (CAST) (Legleye et al., 2007) is widely applied in Europe; however, the CAST cut-off scores vary according to the setting, the screening objective, and the correction version (CAST-f or CAST-b), creating therefore confusion in its application. Moreover, the psychometric properties of the CAST as a tool for detecting problematic cannabis use are understudied. To fill this gap, such psychometric properties have been analyzed in a sample of Spanish adolescents while using different cut-off scores for CAST-f and CAST-b. Based on our findings, the optimal cut-off scores are 2 points for CAST-b and 4 points for CAST-f. The internal reliability of CAST-f (α = 0.83) and CAST-b (KR-20 = 0.80) are satisfactory. Factorial analysis suggested the assumption of a one-dimension model. The CAST seems to be a valid and reliable tool for early screening of problematic cannabis use in Spanish adolescents.

Topics: Adolescent; Cannabis; Humans; Marijuana Abuse; Prevalence; Psychometrics; Reproducibility of Results

Topics: Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Psychotic Disorders

Confirming the existence and composition of the shared genetic basis of Schizophrenia and cannabis and cigarette smoking has critical values for the clinical prevention and intervention of psychosis.. To achieve this goal, we leveraged Genome-Wide summary statistics of Schizophrenia (n = 99,934), cigarette smoking (n = 518,633) and cannabis usage (n = 162,082). We applied Causal Analysis Using Summary Effect Estimates (CAUSE) and genomic structural equation modeling (GenomicSEM) to quantify the contribution of a common genetic factor of cannabis and cigarette smoking and schizophrenia (referred to as SCZ_SMO), then identified genome-wide loci that made up SCZ_SMO.. Our result provided new evidence on the shared genetic basis model for the association between Schizophrenia and smoking and provided genetic and biological insights into their shared mechanism.

Topics: Cannabis; CD56 Antigen; Cigarette Smoking; Genetic Predisposition to Disease; Genome-Wide Association Study; Humans; Marijuana Abuse; Neurons; Polymorphism, Single Nucleotide; Schizophrenia

Cannabis use is increasing among midlife and older adults. This study tested the hypotheses that long-term cannabis use is associated with cognitive deficits and smaller hippocampal volume in midlife, which is important because midlife cognitive deficits and smaller hippocampal volume are risk factors for dementia.. Participants are members of a representative cohort of 1,037 individuals born in Dunedin, New Zealand, in 1972-1973 and followed to age 45, with 94% retention. Cannabis use and dependence were assessed at ages 18, 21, 26, 32, 38, and 45. IQ was assessed at ages 7, 9, 11, and 45. Specific neuropsychological functions and hippocampal volume were assessed at age 45.. Long-term cannabis users showed IQ decline from childhood to midlife (mean=-5.5 IQ points), poorer learning and processing speed relative to their childhood IQ, and informant-reported memory and attention problems. These deficits were specific to long-term cannabis users because they were either not present or were smaller among long-term tobacco users, long-term alcohol users, midlife recreational cannabis users, and cannabis quitters. Cognitive deficits among long-term cannabis users could not be explained by persistent tobacco, alcohol, or other illicit drug use, childhood socioeconomic status, low childhood self-control, or family history of substance dependence. Long-term cannabis users showed smaller hippocampal volume, but smaller hippocampal volume did not statistically mediate cannabis-related cognitive deficits.. Long-term cannabis users showed cognitive deficits and smaller hippocampal volume in midlife. Research is needed to ascertain whether long-term cannabis users show elevated rates of dementia in later life.

Topics: Aged; Cannabis; Child; Cognition; Cognitive Reserve; Dementia; Hippocampus; Humans; Marijuana Abuse; Middle Aged; Neuropsychological Tests

Topics: Cannabinoid Receptor Agonists; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Reproducibility of Results; Schizophrenia; Self Report

Tobacco and cannabis use in pregnancy are associated with increased adverse perinatal and long-term offspring outcomes. Products for both have evolved with various forms available on the market, challenging accurate counseling of risks and quantification of tobacco and cannabis usage during the perinatal period. Health care providers are recommended to screen for any type of use, provide consistent messaging of harms of tobacco and cannabis use in pregnancy, and offer individualized interventions. The journey to cessation can be complicated by barriers and triggers, lack of social supports, and mental health challenges that should be addressed to prevent relapse and withdrawals.

Topics: Cannabis; Female; Humans; Marijuana Abuse; Nicotiana; Pregnancy; Smoking Cessation; Substance-Related Disorders

A growing number of US states have legalized marijuana use in the past decade. We examined if marijuana legalization is associated with increased marijuana-related admissions to substance use treatment facilities between 2000 and 2017.. Data from the Treatment Episode Data Set-Admissions were used to examine the relationship between marijuana-related admissions among adults aged ≥18 by year and legalization status (i.e., fully legalized, medical use only [partially legalized], and illegal) (N = 35,457,854). Using interaction analyses, we further examined whether certain patient characteristics were associated with residence in states that legalized marijuana use as compared to those in which marijuana remained illegal.. Overall, the proportion of marijuana-related admissions in states with legalization decreased by 2.3% from 31.7% in 2000-2005 to 29.4% in 2012-2017 (odds ratio [OR], 0.90; 95% confidence intervals [CI], 0.89-0.90) with little difference from states where marijuana use remained illegal, in which marijuana use as any reason for admissions decreased by 0.3% from 39.8% in 2000-2005 to 39.5% in 2012-2017 (OR, 0.99; 95% CI, 0.98-0.99). We did not find any striking patient characteristics (e.g., referral by the police) associated with admissions in states that legalized compared to those that had not.. While earlier studies suggested that marijuana legalization is associated with increased levels of use, emergency department visits, and traffic fatalities, our findings suggest that marijuana legalization did not increase marijuana-related treatment use in the United States.. This is the first study to examine the association of marijuana legalization with marijuana-related treatment use.

Topics: Adult; Cannabis; Hallucinogens; Humans; Legislation, Drug; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Substance-Related Disorders; United States

This commentary suggests that neuroscience research on young healthy heavy cannabis users and patients with cannabis-induced psychosis using multimodal assessment of sensorimotor dysfunction (e.g. neuroimaging, clinical rating scales, and instrumental assessments) may help to identify both biological resistance and vulnerability without constraints and confounder factors imposed by antipsychotic treatment or disease chronicity.

Topics: Antipsychotic Agents; Cannabis; Humans; Marijuana Abuse; Neuroimaging; Psychotic Disorders

This study aimed to leverage human genetic data to investigate whether cannabis use causally affects periodontitis.. Data were obtained from summary statistics of genome-wide association studies of lifetime cannabis use (N = 184,765), cannabis use disorder (17,068 cases; 357,219 controls), and periodontitis (17,353 cases; 28,210 controls). We performed two-sample Mendelian randomization (MR) analysis using 6 genetic variants as instrumental variables for lifetime cannabis use and 11 variants as instruments for cannabis use disorder to estimate associations with periodontitis.. There was no evidence for an association between genetic liability for lifetime cannabis use or cannabis use disorder with periodontitis. The estimates from the primary analyses were supported in multivariable MR analysis, which considered potential pleiotropic pathways and in weak instrument analyses.. This study provides little evidence to support a detrimental effect of genetic liability for cannabis use on periodontal health.

Topics: Cannabis; Genome-Wide Association Study; Humans; Marijuana Abuse; Mendelian Randomization Analysis; Periodontitis; Polymorphism, Single Nucleotide

Researchers have traditionally studied the effects of psychoactive drugs such as Cannabis in controlled laboratory settings or relied on retrospective self-reports to measure impairment. However, advances in technology afford opportunities to conduct assessments remotely.. We considered whether objective click-stream data (time and number of clicks spent on a webpage) during an online survey could supplement self-reports of substance use problems.. The clickstream data of participants (n = 236) were examined as they completed an online study which included validated psychometric tests (Cannabis Use Disorders Identification Test-Revised, Grit-O, Kessler Psychological Distress Scale, and Brief Self Control Scale). Clickstream data were compared to self-reported Cannabis use.. People reporting Cannabis use within the last 4 weeks required more time and more clicks to complete the online survey, and this was specifically associated with reported frequency of use, duration of impairment, and problems with memory and concentration. Longer amounts of time and more clicks on the online questionnaire were associated with more recent Cannabis use rather than demographic factors or stimulant use.. These results imply clickstream data remotely detected indecision or other deficits associated with previous Cannabis use.

Topics: Analgesics; Cannabinoid Receptor Agonists; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Retrospective Studies; Self Report; Substance-Related Disorders

Approximately 3.8% of adults worldwide have used cannabis in the past year. Understanding how cannabis use is associated with other health conditions is crucial for healthcare providers seeking to understand the needs of their patients, and for health policymakers. This paper analyzes the relationship between documented cannabis use disorders (CUD), cannabis use (CU) and other health diagnoses among primary care patients during a time when medical use of marijuana was permitted by state law in California, United States of America.. The study utilized primary care electronic health record (EHR) data from an academic health system, using a case-control design to compare diagnoses among individuals with CUD/CU to those of matched controls, and those of individuals with CUD diagnoses with individuals who had CU otherwise documented. Associations of documented CU and CUD with general medical conditions and health conditions associated with cannabis use (both medical and behavioral) were analyzed using conditional logistic regression.. Of 1,047,463 patients with ambulatory encounters from 2013-2017, 729 (0.06%) had CUD diagnoses and 3,731 (0.36%) had CU documented in their EHR. Patients with documented CUD and CU patients had significantly (p < 0.01) higher odds of most medical and behavioral diagnoses analyzed. Compared to matched controls, CUD-documented patients had highest odds of other substance use disorders (OR = 21.44: 95% CI 9.43-48.73), any mental health disorder (OR = 6.99; 95% CI 5.03-9.70) social anxiety disorder (OR = 13.03; 95% CI 2.18-77.94), HIV/AIDS (OR = 7.88: 95% CI 2.58-24.08), post-traumatic stress disorder (OR = 7.74: 95% CI 2.66-22.51); depression (OR = 7.01: 95% CI 4,79-10.27), and bipolar disorder (OR = 6.49: 95% CI 2.90-14.52). Compared to matched controls, CU-documented patients had highest odds of other substance use disorders (OR = 3.64; 95% CI 2.53-5.25) and post-traumatic stress disorder (OR = 3.41; 95% CI 2.53-5.25). CUD-documented patients were significantly more likely than CU-documented patients to have HIV/AIDS (OR = 6.70; 95% CI 2.10-21.39), other substance use disorder (OR = 5.88; 95% CI 2.42-14.22), depression (OR = 2.85; 95% CI 1.90-4.26), and anxiety (OR = 2.19: 95% CI 1.57-3.05) diagnoses.. The prevalence of CUD and CU notation in EHR data from an academic health system was low, highlighting the need for improved screening in primary care. CUD and CU documentation were associated with increased risk for many health conditions, with the most elevated risk for behavioral health disorders and HIV/AIDS (among CUD-documented, but not CU-documented patients). Given the strong associations of CUD and CU documentation with health problems, it is important for healthcare providers to be prepared to identify CU and CUD, discuss the pros and cons of cannabis use with patients thoughtfully and empathically, and address cannabis-related comorbidities among these patients.

Topics: Adult; Cannabis; Case-Control Studies; Comorbidity; Electronic Health Records; HIV Infections; Humans; Marijuana Abuse; Medical Marijuana; Primary Health Care; Substance-Related Disorders; United States

African American/Black individuals experience significant health disparities, particularly as it relates to cannabis use. As such, there is a need to identify intrapersonal factors related to more severe patterns of use among this subpopulation. Worry about quitting or reducing cannabis as a result of the anticipated anxiety-related states during deprivation (i.e., abstinence phobia) is one factor that is theoretically important in the context of cannabis-related disparities.. Cannabis abstinence phobia was associated with greater severity of cannabis use problems, more perceived barriers for quitting cannabis use, and more severe cannabis withdrawal symptoms.. Abstinence phobia may represent an underrecognized intervention target for addressing cannabis use problems and quit success.

Topics: Adult; Analgesics; Black or African American; Cannabis; Cross-Sectional Studies; Female; Hallucinogens; Humans; Male; Marijuana Abuse; Phobic Disorders; Substance Withdrawal Syndrome

Topics: Atherosclerosis; Cannabinoid Receptor Agonists; Cannabis; Genotype; Humans; Marijuana Abuse; Polymorphism, Single Nucleotide; Receptor, Cannabinoid, CB1

The prevalence of cannabis use disorder (CUD) has been increasing recently and is expected to increase further due to the rising trend of cannabis legalization. To help stem this public health concern, a model is needed that predicts for an adolescent or young adult cannabis user their personalized risk of developing CUD in adulthood. However, there exists no such model that is built using nationally representative longitudinal data.. We use a novel Bayesian learning approach and data from Add Health (n = 8712), a nationally representative longitudinal study, to build logistic regression models using four different regularization priors: lasso, ridge, horseshoe, and t. The models are compared by their prediction performance on unseen data via 5-fold-cross-validation (CV). We assess model discrimination using the area under the curve (AUC) and calibration by comparing the expected (E) and observed (O) number of CUD cases. We also externally validate the final model on independent test data from Add Health (n = 570).. Our final model is based on lasso prior and has seven predictors: biological sex; scores on personality traits of neuroticism, openness, and conscientiousness; and measures of adverse childhood experiences, delinquency, and peer cannabis use. It has good discrimination and calibration performance as reflected by its respective AUC and E/O of 0.69 and 0.95 based on 5-fold CV and 0.71 and 1.10 on validation data.. This externally validated model may help in identifying adolescent or young adult cannabis users at high risk of developing CUD in adulthood.

Topics: Adolescent; Adult; Bayes Theorem; Cannabis; Humans; Longitudinal Studies; Marijuana Abuse; Substance-Related Disorders; Young Adult

Although several recent studies have examined psychosocial and demographic correlates of cannabis use disorder (CUD) in adults, few, if any, recent studies have evaluated the performance of machine learning methods relative to standard logistic regression for identifying correlates of CUD. The present study used pooled data from the 2015-2018 National Survey on Drug Use and Health to evaluate psychosocial and demographic correlates of CUD in adults. In addition, we compared the performance of logistic regression, classification trees, and random forest methods in classifying CUD. When comparing the performance of each method on the test data set, classification trees (AUC = 0.84, 95%CI: 0.82, 0.85) and random forest (AUC = 0.83, 95%CI: 0.82, 8.05) performed similarly and superior to logistic regression (AUC = 0.77, 95%CI: 0.74, 0.79). Results of the random forests reveal that marital status, risk propensity, age, and cocaine dependence variables contributed most to node purity, whereas model accuracy would decrease significantly if county type, income, race, and education variables were excluded from the model. One possible approach to improving the efficiency, interpretability, and clinical insights of CUD correlates is the employment of machine learning techniques.

Topics: Adult; Cannabis; Cocaine-Related Disorders; Humans; Logistic Models; Marijuana Abuse; Substance-Related Disorders; United States

Cannabis is the most commonly used regulated drug by European youths. Yet, few cannabis-specific interventions have been examined in Europe. The Cannabis Cessation Program (CCP) was developed in Sweden in the 1990s and has been implemented in some Norwegian municipalities. The present study aimed to examine outcomes of this intervention in the Norwegian setting.. The respondents (N = 102) were recruited in four community-based CCPs in Norway. We examined their changes in cannabis use, other substance use, mental distress, well-being, sense of coherence (SoC), and social networks, from baseline (T0) to post-treatment (T1) and up to a 3-month follow-up period (T2). Changes were evaluated with pair-wise t-tests.. Seventy-six participants (75%) completed the 8-week program, according to plan. All participants reported a significant reduction in cannabis use at T1 (average reduction ~16 days per month) and at T2 (N = 59; ~13 days per month). Among those that completed the program, 67% was abstinent from cannabis at T1 and 37% was abstinent at T2. An intention-to-treat analysis showed that 50% (51/102) and 22% (22/102) were abstinent from cannabis use at T1 and T2, respectively. In parallel to abstinence, we observed a substantial reduction in mental distress and an increase in well-being and SoC. Respondents socialized with fewer friends with current substance use, but drug-free social networks were not expanded.. Our findings suggested that the CCP was a valuable, low-threshold manual-based intervention for cannabis use disorders. It showed considerable potential for reducing individuals' cannabis use.. Clinicaltrials.gov no. NCT04989205. Registered 12 July 2021, i.e., the study was retrospectively registered.

Topics: Adolescent; Cannabis; Hallucinogens; Health Behavior; Humans; Marijuana Abuse; Substance-Related Disorders

The prevalence of prenatal cannabis use has nearly doubled in the U.S. from 2002 to 2017. As cannabis legalization continues to expand, this study aimed to estimate the recent trends in the prevalence of cannabis use, cannabis dependence, and cannabis risk perceptions among U.S. pregnant people.. The National Survey on Drug Use and Health (2002-2019) was designed to be representative of the U.S. civilian non-institutionalized population. The study sample included pregnant participants (aged 12-44 years; n=15,109). Cannabis consumption was defined as using cannabis at least once in the 30 days before assessment. Past 12‒month cannabis dependence was defined on the basis of the DSM-IV. Joinpoint regression was used to test for significant changes in the trends while controlling for age, race/ethnicity, and family income. Analyses were conducted between August 2021 and April 2022.. No evidence of change in the prevalence of prenatal cannabis use was detected between 2016-2017 (5.8%) and 2018-2019 (4.7%) (prevalence difference= -1.1; 95% CI= -2.9, 0.7). The prevalence of cannabis dependence did not change significantly among pregnant people from 2002 to 2019. The percentage of pregnant people perceiving regular cannabis use (1-2 times/week) as a great risk remained stable from 2002 to 2007 (∼53%) and declined sharply after (27%).. Three of 4 pregnant people in the U.S. do not characterize regular cannabis use as a great risk. As cannabis legalization increases, public health efforts are needed to raise awareness of the possible harms associated with cannabis use.

Topics: Cannabis; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Marijuana Abuse; Pregnancy; Prevalence; Substance-Related Disorders

(1) Background: During the SARS-CoV-2 (COVID-19) pandemic, cannabis use increased relative to pre-pandemic levels, while forced home confinement frequently caused sleep/wake cycle disruptions, psychological distress, and maladaptive coping strategies with the consequent appearance of anxiety symptoms and their potential impact on substance use problems. (2) Aim: Long-acting trazodone (150 mg or 300 mg daily) has a potential benefit as monotherapy in patients with cannabis use disorder. The present work aims to investigate the effectiveness of trazodone in optimizing the condition of people with cannabis dependence under pandemic conditions. (3) Methods: All cases with cannabis use disorder were uniformly treated with long-acting trazodone 150 mg or 300 mg/day; their craving and clinical status were monitored through appropriate psychometric scales. Side effects were recorded as they were reported by patients. We described the cases of three young patients-one man and two women-who were affected by chronic cannabis use disorder and who experienced lockdown-related psychological distress and sought psychiatric help. (4) Results: The described cases highlight that the once-a-day formulation of trazodone seems to have a therapeutic role in patients with cannabis use disorder and to guarantee tolerability and efficacy over time. No significant side effects emerged. (5) Conclusions: The use of long-acting trazodone (150 mg or 300 mg daily) has a potential benefit as monotherapy in patients with cannabis use disorder. Trazodone deserves to be studied in terms of its efficacy for cannabis use disorder.

Topics: Cannabis; Communicable Disease Control; COVID-19; COVID-19 Drug Treatment; Female; Hallucinogens; Humans; Male; Marijuana Abuse; Pandemics; SARS-CoV-2; Substance-Related Disorders; Trazodone

Topics: Cannabis; Hallucinogens; Humans; Marijuana Abuse

Topics: Adolescent; Aged; Cannabis; Humans; Marijuana Abuse; Psychotropic Drugs

Topics: Analgesics; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Syndrome; Vomiting

Topics: Analgesics; Cannabinoids; Cannabis; Humans; Marijuana Abuse; Syndrome; Vomiting

Topics: Cannabis; Hallucinogens; Humans; Magnetic Resonance Imaging; Marijuana Abuse; Psychotic Disorders; Schizophrenia

As medical cannabis use increases in North America, establishing its safety profile is a priority. The objective of this study was to assess rates of emergency department (ED) visits and hospitalizations due to poisoning by cannabis, and cannabis-related mental health disorders among medically authorized cannabis patients in Ontario, Canada, between 2014 and 2017.. This is a retrospective cohort study of patients who received medical cannabis authorization in Ontario, Canada, using data collected in participating cannabis clinics. Outcomes included ED visit/hospitalization with a main diagnosis code for: cannabis/cannabinoid poisoning; and mental/behavioral disorders due to cannabis use. Cox proportional hazard regressions were utilized to analyze the data.. From 29,153 patients who received medical authorization, 23,091 satisfied the inclusion criteria. During a median follow-up of 240 days, 14 patients visited the ED or were hospitalized for cannabis poisoning-with an incidence rate of 8.06 per 10,000 person-years (95% CI: 4.8-13.6). A total of 26 patients visited the ED or were hospitalized for mental and behavioral disorders due to cannabis use-with an incidence rate of 15.0 per 10,000 person-years (95% CI: 10.2-22.0). Predictors of cannabis-related mental and behavioral disorders include prior substance use disorders, other mental disorders, age, diabetes, and chronic obstructive pulmonary disease.. The results suggest that the incidence of cannabis poisoning or cannabis-related mental and behavioral disorders was low among patients who were authorized to use cannabis for medical care. Identified predictors can help to target patients with potential risk of the studied outcomes.

Topics: Cannabis; Cohort Studies; Emergency Service, Hospital; Hospitalization; Humans; Incidence; Marijuana Abuse; Medical Marijuana; Mental Disorders; Ontario; Retrospective Studies

Topics: Brazil; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Mental Disorders

In the United States, adult cannabis use has increased over time, but less information is available on time trends in cannabis use disorder. The authors used Veterans Health Administration (VHA) data to examine change over time in cannabis use disorder diagnoses among veterans, an important population subgroup, and whether such trends differ by age group (<35 years, 35-64 years, ≥65 years), sex, or race/ethnicity.. VHA electronic health records from 2005 to 2019 (range of Ns per year, 4,403,027-5,797,240) were used to identify the percentage of VHA patients seen each year with a cannabis use disorder diagnosis (ICD-9-CM, January 1, 2005-September 30, 2015; ICD-10-CM, October 1, 2015-December 31, 2019). Trends in cannabis use disorder diagnoses were examined by age and by race/ethnicity and sex within age groups. Given the transition in ICD coding, differences in trends were tested within two periods: 2005-2014 (ICD-9-CM) and 2016-2019 (ICD-10-CM).. In 2005, the percentages of VHA patients diagnosed with cannabis use disorder in the <35, 35-64, and ≥65 year age groups were 1.70%, 1.59%, and 0.03%, respectively; by 2019, the percentages had increased to 4.84%, 2.86%, and 0.74%, respectively. Although the prevalence of cannabis use disorder was consistently higher among males than females, between 2016 and 2019, the prevalence increased more among females than males in the <35 year group. Black patients had a consistently higher prevalence of cannabis use disorder than other racial/ethnic groups, and increases were greater among Black than White patients in the <35 year group in both periods.. Since 2005, diagnoses of cannabis use disorder have increased substantially among VHA patients, as they have in the general population and other patient populations. Possible explanations warranting investigation include decreasing perception of risk, changing laws, increasing cannabis potency, stressors related to growing socioeconomic inequality, and use of cannabis to self-treat pain. Clinicians and the public should be educated about the increases in cannabis use disorder in general in the United States, including among patients treated at the VHA.

Topics: Adult; Cannabis; Female; Humans; Male; Marijuana Abuse; Substance-Related Disorders; United States; United States Department of Veterans Affairs; Veterans; Veterans Health

The nature of the robust association between cannabis use and schizophrenia remains undetermined. Plausible hypotheses explaining this relationship include the premise that cannabis use causes schizophrenia, increased liability for schizophrenia increases the risk of cannabis use initiation (eg, self-medication), or the bidirectional causal hypothesis where both factors play a role in the development of the other. Alternatively, factors that confound the relationship between schizophrenia and cannabis use may explain their association. Externalizing behaviors are related to both schizophrenia and cannabis use and may influence their relationship.. This study aimed to evaluate whether externalizing behaviors influence the genetic relationship between cannabis use and schizophrenia. We conducted a multivariate genome-wide association analysis of 6 externalizing behaviors in order to construct a genetic latent factor of the externalizing spectrum. Genomic structural equation modeling was used to evaluate the influence of externalizing behaviors on the genetic relationship between cannabis use and schizophrenia.. We found that externalizing behaviors partially explained the association between cannabis use and schizophrenia by up to 42%.. This partial explanation of the association by externalizing behaviors suggests that there may be other unidentified confounding factors, alongside a possible direct association between schizophrenia and cannabis use. Future studies should aim to identify further confounding factors to accurately explain the relationship between cannabis use and schizophrenia.

Topics: Cannabis; Genome-Wide Association Study; Humans; Marijuana Abuse; Risk Factors; Schizophrenia

Topics: Cannabis; Hallucinogens; Harm Reduction; Humans; Marijuana Abuse; Psychotic Disorders

In the context of changing cannabis and other drug policy and regulation, concerns may arise regarding drug treatment access and use. We assessed cannabis/cocaine-related dependence and treatment in Argentina, Chile, and Uruguay.. Nationally representative cross-sectional household surveys of people ages 15-64 in Argentina (4 surveys, 2006-2017), Chile (7 surveys, 2006-2018), and Uruguay (4 surveys, 2006-2018) were harmonized. We estimated weighted prevalences of cannabis or cocaine-related (cocaine or cocaine paste) dependence, based on meeting 3+ past-year ICD-10 dependence criteria. We estimated weighted prevalences of past-year alcohol/drug treatment use (Argentina, Chile) or use/seeking (Uruguay) among people with past-year cannabis/cocaine-related dependence. We tested model-based prevalence trends over time and described individual-level treatment correlates by country.. Cannabis/cocaine dependence prevalence increased in the region starting in 2010-2011, driven by cannabis dependence. Adjusted cannabis dependence prevalence increased from 0.7% in 2010 to 1.5% in 2017 in Argentina (aPD=0.8, 95% CI= 0.3, 1.2), from 0.8% in 2010 to 2.8% in 2018 in Chile (aPD=2.0, 95% CI= 1.4, 2.6), and from 1.4% in 2011 to 2.4% in 2018 in Uruguay (aPD=0.9, 95% CI= 0.2, 1.6). Cocaine-related dependence increased in Uruguay, decreased in Argentina, and remained stable in Chile. Among people with past-year cannabis/cocaine dependence, average alcohol/drug treatment use prevalence was 15.3% in Argentina and 6.0% in Chile, while treatment use/seeking was 14.7% in Uruguay. Alcohol/drug treatment prevalence was lower among people with cannabis dependence than cocaine-related dependence. Treatment correlates included older ages in all countries and male sex in Argentina only.. Alcohol/drug treatment use among people with cannabis/cocaine-related dependence remained low, signaling an ongoing treatment gap in the context of growing cannabis dependence prevalence in the region. Additional resources may be needed to increase treatment access and uptake. Future studies should assess contributors of low treatment use, including perceived need, stigma, and service availability.

Topics: Adolescent; Adult; Argentina; Cannabis; Chile; Cocaine; Cocaine-Related Disorders; Cross-Sectional Studies; Ethanol; Hallucinogens; Humans; Male; Marijuana Abuse; Middle Aged; Substance-Related Disorders; Uruguay; Young Adult

Since the release of the DSM-V, CUD has been understood as a unidimensional construct. However, continued research has identified separate symptom clusters relating to consumption, loss of control, and withdrawal within substance use disorder criteria that may pose separate risk factors and functional difficulties. The current study aims to examine how symptom clusters commonly manifest in young adults that use cannabis using a latent class analysis (LCA) and explore how these clusters are related to co-occurring psychological constructs.. 1174 (aged 18-34) participants completed a battery of assessments on substance use and other psychological constructs. LCA was conducted on 17 symptoms corresponding with DSM-V CUD criteria. Multinomial regressions were used to examine class membership and commonly co-occurring psychopathology and psychological constructs.. LCA results identified a 'No problems' class, a 'Moderate consumption' class characterized by moderate probability of endorsing consumption items, a 'Consumption with Moderate Loss of Control' class, characterized by endorsing consumption and loss of control items but minimal endorsement of withdrawal items, a 'Consumption with Moderate Withdrawal' class characterized by moderate probability of endorsing all item types, and 'High Consumption, Loss of Control, Withdrawal' class characterized by high probability of endorsing all items. Multinomial regressions indicated some class differences in psychological constructs.. Symptom clusters differed in terms of CUD criteria, especially for those in our sample with moderate/severe problems. Findings suggest intervention efforts may benefit from treatment targeted at various presentations of CUD.

Topics: Cannabis; Diagnostic and Statistical Manual of Mental Disorders; Humans; Marijuana Abuse; Substance-Related Disorders; Syndrome; Young Adult

Topics: Adolescent; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Marijuana Smoking; Substance Withdrawal Syndrome; Substance-Related Disorders

Compared to other addictive substances, patients with cannabis addiction are significantly outnumbered by those who report dependence on other, more addictive substances. Unfortunately, most cannabis addiction goes untreated, and among those who choose treatment, the requirements are much higher for adolescents and young adults.. To examine the relationship of cannabinoid dependency in the genetic context-the association between the rs1799732 polymorphism of the. The study group consisted of 515 male volunteers. Of these, 214 patients were diagnosed with cannabis addiction and 301 were non-addicted. Patients were diagnosed with NEO Five-Factor Personality Inventory (NEO-FFI), and State-Trait Anxiety Inventory (STAI) questionnaires. The interactions between personality traits and polymorphisms in the. Compared to the control group, the case group obtained significantly higher scores on the STAI State, STAI Trait, Neuroticism and Openness scales, as well as lower scores on the Extraversion, Agreeableness, and Conscientiousness scales. There was no statistically significant difference between addicts and the control group in the frequency of genotypes, but there was a statistically significant difference between addicts and the control group in the frequency of the. Studying homogeneous subgroups-as in our study-seems reasonable, particularly when combined with genetic determinants and psychological traits. In multigenic and multifactorial entities, such a strategy has a future.

Topics: Adolescent; Cannabis; Dopamine; Humans; Male; Marijuana Abuse; Personality; Personality Inventory; Receptors, Dopamine; Receptors, Dopamine D2; Young Adult

Cannabis Use Disorder (CUD) has been linked to a complex set of neuro-behavioral risk factors. While many studies have revealed sex and gender differences, the relative importance of these risk factors by sex and gender has not been described. We used an "explainable" machine learning approach that combined decision trees [gradient tree boosting, XGBoost] with factor ranking tools [SHapley's Additive exPlanations (SHAP)] to investigate sex and gender differences in CUD. We confirmed that previously identified environmental, personality, mental health, neurocognitive, and brain factors highly contributed to the classification of cannabis use levels and diagnostic status. Risk factors with larger effect sizes in men included personality (high openness), mental health (high externalizing, high childhood conduct disorder, high fear somaticism), neurocognitive (impulsive delay discounting, slow working memory performance) and brain (low hippocampal volume) factors. Conversely, risk factors with larger effect sizes in women included environmental (low education level, low instrumental support) factors. In summary, environmental factors contributed more strongly to CUD in women, whereas individual factors had a larger importance in men.

Topics: Cannabis; Child; Female; Humans; Machine Learning; Male; Marijuana Abuse; Personality Disorders; Sex Factors

Topics: Cannabis; Humans; Marijuana Abuse; Substance-Related Disorders

Using cannabis in solitary contexts is associated with greater cannabis use problems than using cannabis in social contexts. However, it remains unclear why solitary use predicts greater problems. Consistent with a social learning perspective, the current study examined whether cannabis use motives mediated the association between context of cannabis use and negative consequences. We also examined whether cannabis type (concentrates vs. flower) moderated the relation between context of use and motives.. Recreational college cannabis users (. Solitary cannabis use was associated with greater global negative consequences through coping motives (β = 0.26, SE = 0.10, 95% CI [0.10, 0.43]). Cannabis type did not moderate relations between context and motives, despite concentrate users reporting more frequent cannabis use, more frequent solitary use, and greater consequences than flower users.. Frequent cannabis use in solitary contexts was associated with greater negative cannabis consequences, both directly and indirectly via coping motives. Efforts to reduce frequent use of cannabis in solitary contexts, particularly for the purpose of coping, may be beneficial in reducing negative consequences.

Topics: Adaptation, Psychological; Cannabis; Humans; Marijuana Abuse; Motivation; Smoking

Research has established associations between regular cannabis use and psychotic symptomatology in young people. However, there has been little previous research on whether the experience of psychotic symptomatology differs between non-users and regular users of cannabis.. Data were from the Christchurch Health and Development Study (CHDS), a longitudinal cohort born in 1977. Data on frequency of cannabis use and (past month) psychotic symptomatology were obtained at the age 18, 21 and 25 waves of assessment. Symptoms were rank ordered by the number of affirmative responses over the three assessments, and the symptom profile of non-users and regular users were compared using a non-parametric Mann-Whitney U test.. Among non-users and regular users, the commonly reported symptoms of psychosis were those that would be considered "mild". More severe symptoms were not commonly reported. A comparison of the symptom profile across the two groups showed no significant differences.. There was no evidence of qualitative differences in the pattern of psychotic symptomatology reported by non-cannabis users and regular cannabis users. Although regular cannabis users tend to report a greater number of symptoms, these symptoms did not tend to be severe, and were unlikely to be indicative of psychotic illness.

Topics: Adolescent; Birth Cohort; Cannabis; Humans; Marijuana Abuse; Middle Aged; New Zealand; Psychotic Disorders

We examined group differences in cortical thickness and surface-parameters among age and handedness--matched persons with cannabis-induced psychosis (CIP), schizophrenia with heavy cannabis use (SZC), and healthy controls (HC).. We recruited 31 men with SZC, 28 with CIP, and 30 with HC. We used the Psychiatric Research Interview for Substance and Mental Disorders to differentiate between CIP and SZC. We processed and analyzed T1 MR images using the Surface-based Brain Morphometry (SBM) pipeline of the CAT-12 toolbox within the statistical parametric mapping. After pre-processing, volumes were segmented using surface and thickness estimation for the analysis of the region of interest. We used the projection-based thickness method to assess the cortical thickness and Desikan-Killiany atlas for cortical parcellation.. We observed the lowest cortical thickness, depth, and gyrification in the SZC, followed by CIP and the control groups. The differences were predominantly seen in frontal cortices, with limited parietal and temporal regions involvement. After False Discovery Rate (FDR) corrections and post-hoc analysis, SZC had reduced cortical thickness than HC in the middle and inferior frontal, right entorhinal, and left postcentral regions. Cortical thickness of SZC was also significantly lower than CIP in bilateral postcentral and right middle frontal regions. We found negative correlations (after FDR corrections) between the duration of cannabis use and cortical thickness in loci of parietal and occipital cortices.. Our study suggested cortical structural abnormalities in schizophrenia, in reference to healthy controls and cannabis-induced psychosis, indicating different pathophysiology of SZC and CIP.

Topics: Brain; Cannabis; Cerebral Cortex; Magnetic Resonance Imaging; Marijuana Abuse; Psychotic Disorders; Schizophrenia

Cannabis is the most widely used drug worldwide. Data about the association of cannabis use with aggression is heterogeneous. The objective of the current study was to assess the nature of the association between cannabis use disorder (CUD) and self-directed, other-directed, and combined aggression. We used data from the National Survey on Drug Use and Health across 2008 to -2014, with a pooled sample of 270,227 adult respondents. We used regression models to estimate the odds ratios (ORs) for those having CUD perpetrating each form of aggression compared with no aggression and other-directed compared with self-directed aggression. CUD was associated with significantly increased odds of committing other-directed (adjusted OR [aOR] = 1.42, 95 percent CI = 1.26-1.60) and combined aggression (aOR = 2.11, 95 percent CI = 1.36-3.26) compared with no aggression. CUD was associated with a nonstatistically significant risk of other-directed compared with self-directed aggression (aOR = 1.29, 95 percent CI = .97-1.69). In those 18 to 25 years old, CUD was significantly associated with an increased differential risk of other-directed versus self-directed aggression (aOR = 1.29, 95 percent CI = 1.03-1.62). Cannabis use disorder seems to increase the risk of other-directed aggression compared with self-directed aggression, especially among youths.

Topics: Adolescent; Adult; Aggression; Cannabis; Humans; Marijuana Abuse; Substance-Related Disorders; Young Adult

Topics: Analgesics, Opioid; Cannabis; Humans; Marijuana Abuse; Mindfulness; Opioid-Related Disorders; Pain

Topics: Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Substance-Related Disorders; Veterans; Veterans Health

Young adults experiencing a first episode of psychosis (FEP) have high rates of cannabis use and cannabis use disorder (CUD). No evidence-based practice effectively treats CUD for people with FEP, and little is known about factors that influence intentions to reduce or stop using. A critical inquiry was conducted to identify salient factors contributing to intentions of young adults with FEP to reduce or discontinue cannabis use, guided by theory of planned behavior (TPB).. Online focus groups (. Participants identified benefits of cannabis reduction and cessation for pursuing life goals, but most maintained regular use. Participants perceived cannabis as a facilitator of social interactions, enjoyable activities, and improved mental health (and reduced dysthymia). Many were concerned about reducing or discontinuing cannabis without replacement strategies to compensate for its benefits.. In spite of life goals incompatible with cannabis use, cessation was not favored given the perceived benefits of cannabis and participants' lack of replacement strategies to facilitate social interactions, enjoyable activities, and euthymia. Interventions may be improved by addressing motivations for use and by teaching skills to build positive social support, schedule enjoyable activities, and ameliorate dysthymia. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Topics: Adult; Cannabis; Humans; Intention; Marijuana Abuse; Psychotic Disorders; Substance-Related Disorders; Theory of Planned Behavior; Young Adult

Cannabis is often characterised as a young person's drug. However, people who began consuming cannabis in the 1970s and 1980s are no longer young and some have consumed it for many years. This study tested the preregistered hypothesis that long-term cannabis users show accelerated biological ageing in midlife and poorer health preparedness, financial preparedness, and social preparedness for old age.. In this longitudinal study, participants comprised a population-representative cohort of 1037 individuals born in Dunedin, New Zealand, between April, 1972, and March, 1973, and followed to age 45 years. Cannabis, tobacco, and alcohol use and dependence were assessed at ages 18 years, 21 years, 26 years, 32 years, 38 years, and 45 years. Biological ageing and health, financial, and social preparedness for old age were assessed at age 45 years. Long-term cannabis users were compared using independent samples t tests with five groups: lifelong cannabis non-users, long-term tobacco users, long-term alcohol users, midlife recreational cannabis users, and cannabis quitters. In addition, regression analyses tested dose-response associations for continuously measured persistence of cannabis dependence from age 18 years to 45 years, with associations adjusted for sex, childhood socioeconomic status, childhood IQ, low childhood self-control, family substance dependence history, and persistence of alcohol, tobacco, and other illicit drug dependence.. Of 997 cohort members still alive at age 45 years, 938 (94%) were assessed at age 45 years. Long-term cannabis users showed statistically significant accelerated biological ageing and were less equipped to manage a range of later-life health, financial, and social demands than non-users. Standardised mean differences between long-term cannabis users and non-users were large: 0·70 (95% CI 0·46 to 0·94; p<0·0001) for biological ageing, -0·72 (-0·96 to -0·49, p<0·0001) for health preparedness, -1·08 (-1·31 to -0·85; p<0·0001) for financial preparedness, and -0·59 (-0·84 to -0·34, p<0·0001) for social preparedness. Long-term cannabis users did not fare better than long-term tobacco or alcohol users. Tests of dose-response associations suggested that cannabis associations could not be explained by the socioeconomic origins, childhood IQ, childhood self-control, and family substance-dependence history of long-term cannabis users. Statistical adjustment for long-term tobacco, alcohol, and other illicit drug dependence suggested that long-term cannabis users' tendency toward polysubstance dependence accounted for their accelerated biological ageing and poor financial and health preparedness, although not for their poor social preparedness (β -0·10, 95% CI -0·18 to -0·02; p=0·017).. Long-term cannabis users are underprepared for the demands of old age. Although long-term cannabis use appears detrimental, the greatest challenge to healthy ageing is not use of any specific substance, but rather the long-term polysubstance use that characterises many long-term cannabis users. Substance-use interventions should include practical strategies for improving health and building financial and social capital for healthy longevity.. The National Institute on Aging and the UK Medical Research Council. The Dunedin Research Unit is supported by the New Zealand Health Research Council and the New Zealand Ministry of Business, Innovation and Employment.

Topics: Adolescent; Cannabis; Child; Hallucinogens; Healthy Aging; Humans; Illicit Drugs; Longitudinal Studies; Marijuana Abuse; Middle Aged; Substance-Related Disorders

Background and Objectives: With the growing recreational cannabis use and recent reports linking it to hypertension, we sought to determine the risk of hypertensive crisis (HC) hospitalizations and major adverse cardiac and cerebrovascular events (MACCE) in young adults with cannabis use disorder (CUD+). Material and Methods: Young adult hospitalizations (18−44 years) with HC and CUD+ were identified from National Inpatient Sample (October 2015−December 2017). Primary outcomes included prevalence and odds of HC with CUD. Co-primary (in-hospital MACCE) and secondary outcomes (resource utilization) were compared between propensity-matched CUD+ and CUD- cohorts in HC admissions. Results: Young CUD+ had higher prevalence of HC (0.7%, n = 4675) than CUD- (0.5%, n = 92,755), with higher odds when adjusted for patient/hospital-characteristics, comorbidities, alcohol and tobacco use disorder, cocaine and stimulant use (aOR 1.15, 95%CI:1.06−1.24, p = 0.001). CUD+ had significantly increased adjusted odds of HC (for sociodemographic, hospital-level characteristics, comorbidities, tobacco use disorder, and alcohol abuse) (aOR 1.17, 95%CI:1.01−1.36, p = 0.034) among young with benign hypertension, but failed to reach significance when additionally adjusted for cocaine/stimulant use (aOR 1.12, p = 0.154). Propensity-matched CUD+ cohort (n = 4440, median age 36 years, 64.2% male, 64.4% blacks) showed higher rates of substance abuse, depression, psychosis, previous myocardial infarction, valvular heart disease, chronic pulmonary disease, pulmonary circulation disease, and liver disease. CUD+ had higher odds of all-cause mortality (aOR 5.74, 95%CI:2.55−12.91, p < 0.001), arrhythmia (aOR 1.73, 95%CI:1.38−2.17, p < 0.001) and stroke (aOR 1.46, 95%CI:1.02−2.10, p = 0.040). CUD+ cohort had fewer routine discharges with comparable in-hospital stay and cost. Conclusions: Young CUD+ cohort had higher rate and odds of HC admissions than CUD-, with prevalent disparities and higher subsequent risk of all-cause mortality, arrhythmia and stroke.

Topics: Adult; Cannabis; Cocaine; Female; Hospitalization; Humans; Hypertension; Male; Marijuana Abuse; Stroke; Substance-Related Disorders; Tobacco Use Disorder; Young Adult

Cannabis use disorder is frequent in schizophrenia patients, and it is associated with an earlier age of onset and poor schizophrenia prognosis. Serotonin 2A receptors (5-HT2AR) have been involved in psychosis and, like Akt kinase, are known to be modulated by THC. Likewise, endocannabinoid system dysregulation has been suggested in schizophrenia. The presence of these molecules in blood makes them interesting targets, as they can be evaluated in patients by a minimally invasive technique. The aim of the present study was to evaluate 5-HT2AR protein expression and the Akt functional status in platelet homogenates of subjects diagnosed with schizophrenia, cannabis use disorder, or both conditions, compared with age- and sex-matched control subjects. Additionally, endocannabinoids and pro-inflammatory interleukin-6 (IL-6) levels were also measured in the plasma of these subjects. Results showed that both platelet 5-HT2AR and the active phospho (Ser473)Akt protein expression were significantly increased in schizophrenia subjects, whereas patients with a dual diagnosis of schizophrenia and cannabis use disorder did not show significant changes. Similarly, plasma concentrations of anandamide and other lipid mediators such as PEA and DEA, as well as the pro-inflammatory IL-6, were significantly increased in schizophrenia, but not in dual subjects. Results demonstrate that schizophrenia subjects show different circulating markers pattern depending on the associated diagnosis of cannabis use disorder, supporting the hypothesis that there could be different underlying mechanisms that may explain clinical differences among these groups. Moreover, they provide the first preliminary evidence of peripherally measurable molecules of interest for bigger prospective studies in these subpopulations.

Topics: Biomarkers; Cannabinoid Receptor Agonists; Cannabis; Humans; Interleukin-6; Marijuana Abuse; Prospective Studies; Proto-Oncogene Proteins c-akt; Schizophrenia

Topics: Adolescent; Analgesics; Arrhythmias, Cardiac; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Young Adult

Cannabis use is prevalent and increasing, and frequent use intensifies the risk of cannabis use disorder (CUD). CUD is underrecognized in medical settings, but a validated single-item cannabis screen could increase recognition.. To evaluate the Single-Item Screen-Cannabis (SIS-C), administered and documented in routine primary care, compared with a confidential reference standard measure of CUD.. This diagnostic study included a sample of adult patients who completed routine cannabis screening between January 28 and September 12, 2019, and were randomly selected for a confidential survey about cannabis use. Random sampling was stratified by frequency of past-year use and race and ethnicity. The study was conducted at an integrated health system in Washington state, where adult cannabis use is legal. Data were analyzed from May 2021 to March 2022.. The SIS-C asks about frequency of past-year cannabis use with responses (none, less than monthly, monthly, weekly, daily or almost daily) documented in patients' medical records.. The Diagnostic and Statistical Manual, Fifth Edition (DSM-5) Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM) for past-year CUD was completed on a confidential survey and considered the reference standard. The SIS-C was compared with 2 or more criteria on the CIDI-SAM, consistent with CUD. All analyses were weighted, accounting for survey design and nonresponse, to obtain estimates representative of the health system primary care population.. Of 5000 sampled adult patients, 1688 responded to the cannabis survey (34% response rate). Patients were predominantly middle-aged (weighted mean [SD] age, 50.7 [18.1]), female or women (weighted proportion [SE], 55.9% [4.1]), non-Hispanic (weighted proportion [SE], 96.7% [1.0]), and White (weighted proportion [SE], 74.2% [3.7]). Approximately 6.6% of patients met criteria for past-year CUD. The SIS-C had an area under receiver operating characteristic curve of 0.89 (95% CI, 0.78-0.96) for identifying CUD. A threshold of less than monthly cannabis use balanced sensitivity (0.88) and specificity (0.83) for detecting CUD. In populations with a 6% prevalence of CUD, predictive values of a positive screen ranged from 17% to 34%, while predictive values of a negative screen ranged from 97% to 100%.. In this diagnostic study, the SIS-C had excellent performance characteristics in routine care as a screen for CUD. While high negative predictive values suggest that the SIS-C accurately identifies patients without CUD, low positive predictive values indicate a need for further diagnostic assessment following positive results when screening for CUD in primary care.

Topics: Adult; Cannabis; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Marijuana Abuse; Mass Screening; Middle Aged; Substance-Related Disorders

Two major theories aid in explaining the association between anxiety and cannabis use: a symptom-driven pathway (heightened anxiety precedes greater cannabis use) and a substance-induced pathway (greater use precedes heightened anxiety). Although the co-occurrence of cannabis use and anxiety symptomology is well-established, less is known about the temporal sequence of cannabis use and anxiety symptomology over the course of young adult development METHODS: Data are from an ongoing, longitudinal, cohort study. All prospective analyses used data from wave 8, when participants were between the ages of 17 and 20, through wave 13, when participants are between ages 21 and 24 (N = 2995). Data were set up in accelerated longitudinal design in which we estimated a series of latent difference score models between anxiety and cannabis use from 17 to 24 years old. Models were estimated for men and women, separately.. For the overall sample and men, greater cannabis use predicted greater subsequent increases in anxiety; however, greater anxiety symptoms were associated with decreasing cannabis use. For women, results were more complex. A positive association was noted between prior, trait-like levels of anxiety predicting greater change (increasing) in anxiety symptomology. However, when change is predicted by prior change we see that cannabis use decreases among women who have recently experienced an increase in anxiety CONCLUSION: The nuanced set of results from this study support a dynamic interplay between anxiety symptoms and cannabis use, with important sex differences observed. Overall, our results pave the way for rethinking our guiding theories to include a more robust, flexible, and dynamic model for understanding associations between substance use and mental health symptomology during a key period of development.

Topics: Adolescent; Adult; Anxiety; Cannabis; Cohort Studies; Female; Humans; Longitudinal Studies; Male; Marijuana Abuse; Prospective Studies; Young Adult

Approximately 80% of people with a substance use disorder (SUD) are smokers. Starting SUD treatment offers the opportunity to also quit smoking. The ACT-ATAC project aims to identify the predictors associated with smoking cessation among persons treated for alcohol and/or cannabis use disorder in Barcelona. This manuscript reports its methodology and the experience of carrying it out during the COVID-19 pandemic.. Mixed methods project with three substudies. Substudy 1 (S1) comprises heterogeneous discussion groups among clinicians. S2 has two prospective cohorts composed of smokers under treatment for alcohol and/or cannabis use disorder and the clinicians in charge of these patients. Participating smokers will be followed for 12 months and interviewed about their substance use and the tobacco cessation services received using the Spanish version of the users' Knowledge, Attitudes, and Services (S-KAS) scale. The clinicians will be asked about their self-reported practices in smoking cessation using the Knowledge, Attitudes, and Practices (S-KAP) scale. S3 comprises heterogeneous discussion groups with smokers. Data will be triangulated using qualitative and quantitative analyses. To facilitate the recruitment process, the researchers have introduced several strategies (design clear protocols, set monthly online meetings, extend the project, provide gift cards, etc.).. The results of S1 were used to develop the questionnaires. S2 required some adjustments due to the COVID-19 pandemic, particularly the follow-up interviews being conducted by phone instead of face-to-face, and the recruitment rhythm was lower than expected. Recruitment will last until reaching at least 200-250 users. The fieldwork could not have been possible without the collaboration of the ACT-ATAC team and the introduction of several strategies. Trial registration The ACT-ATAC project has been successfully registered at Clinicaltrials.gov [NCT04841655].

Topics: Cannabis; COVID-19; Ethanol; Humans; Marijuana Abuse; Pandemics; Pilot Projects; Prospective Studies; Smokers; Substance-Related Disorders; Tobacco Use Cessation

Substance use disorders (SUDs) are increasing in the obstetric population, vary with demographic characteristics, and are associated with adverse pregnancy outcomes. Cannabis use disorder and opioid use disorder are two of the most common SUDs during pregnancy.. This study had two objectives. The first objective was to assess trends in any SUD diagnosis during delivery hospitalizations from 2000 to 2018 by maternal age, ZIP code income quartile, and hospital location and teaching status. The second objective was to determine risk for adverse pregnancy outcomes during delivery hospitalizations specifically in the presence of cannabis and opioid use disorder diagnoses.. We conducted a serial cross-sectional analysis of the 2000-2018 National Inpatient Sample. Delivery hospitalizations to women aged 15-54 years with substance use disorder diagnoses were identified. SUD included (i) cannabis use disorder; (ii) opioid use disorder; (iii) alcohol use disorder; and (iv) other drug use disorder. We used joinpoint regression to estimate the average annual percent change (AAPC) in any substance use disorder diagnoses with 95% confidence intervals (CIs) by (i) ZIP code income quartile, (ii) hospital location and teaching status, and (iii) maternal age. We used unadjusted and adjusted log-linear regression to evaluate the relationship between cannabis use disorder and opioid use disorder several adverse maternal outcomes. We report unadjusted and adjusted risk ratios (aRRs) as measures of effect.. From 2000 to 2018, trends analyses broadly demonstrated increasing risk for SUD across demographic categories. In trends analyses stratified by ZIP code-income quartile, the proportion of deliveries with any SUD diagnosis increased across each income quartile with significant increases in the lowest income quartile (AAPC 4.6%, 95% CI 0.4%, 8.9%), second lowest quartile (AAPC 6.3%, 95% CI 5.3%, 7.4%), second highest quartile (AAPC 5.4%, 95% CI 4.1%, 6.8%), and highest quartile (AAPC 4.4%, 95% CI 2.1%, 6.8%). A larger increasing AAPC for SUD was present for deliveries in rural hospitals (AAPC 12.3%, 95% CI 9.8%, 14.9%) as compared to teaching (AAPC 5.7%, 95% CI 5.2%, 6.3%) and non-teaching urban hospitals (AAPC 7.0%, 95% CI 5.9%, 8.1%). By maternal age group, there was a significant larger AAPC for SUD for women aged 15-19 years (AAPC 8.5%, 95% CI 6.6%, 10.4%), 20-24 years (AAPC 9.0%, 95% CI 6.9%, 11.1%) and 25-29 years (AAPC 9.8%, 95% CI 9.1%, 10.6%) than women ≥30 years of age. Cannabis use disorder was associated with increased adjusted risk for preterm delivery (aRR 1.44, 95% CI 1.43, 1.45) and abruption and antepartum hemorrhage (aRR 1.77, 95% CI 1.75, 1.80). Opioid use disorder was associated with risk for non-transfusion severe maternal morbidity (aRR 1.73, 95% CI 1.67, 1.79), preterm delivery (aRR 1.75, 95% CI 1.74, 1.77), and abruption and antepartum hemorrhage (aRR 2.15, 95% CI 2.11, 2.19).. While substance use disorders are increasing in pregnancy across rural and urban settings, age groups, and income quartiles, several populations are associated with higher increased risks and trends. These findings support that SUDs are likely to continue to be of public health significance in diverse geographic and demographic settings.

Topics: Adult; Cannabis; Child; Cross-Sectional Studies; Demography; Female; Hemorrhage; Humans; Infant, Newborn; Marijuana Abuse; Opioid-Related Disorders; Pregnancy; Premature Birth

Topics: Cannabis; Hospitalization; Humans; Incidence; Inpatients; Marijuana Abuse; Switzerland

Whilst the cannabis-cancer link has been traditionally described as controversial recent whole nation and whole continent studies have demonstrated that well documented laboratory-based multimodal cannabinoid genotoxicity is indeed reflected in numerous cancer types in larger epidemiological series. A recent longitudinal human sperm epigenome-wide DNA methylation screen in both cannabis dependence and cannabis withdrawal has revealed remarkable insights into the manner in which widespread perturbations of DNA methylation may lead to cancerogenic changes in both the exposed and subsequent generations as a result of both cannabis exposure and withdrawal. These results therefore powerfully strengthen and further robustify the causal nature of the relationship between cannabinoid exposure and cancerous outcomes well beyond the previously published extensive mechanistic literature on cannabinoid genotoxicity. The reported epigenomic results are strongly hypothesis generating and call powerfully for further work to investigate oncogenic mechanisms in many tissues, organs and preclinical models. These epigenomic results provide an extraordinarily close

Topics: Cannabinoids; Cannabis; Epigenome; Hallucinogens; Humans; Male; Marijuana Abuse; Neoplasms; Seeds

Topics: Cannabis; Humans; Male; Marijuana Abuse; Substance-Related Disorders

Posttraumatic stress disorder (PTSD) is the most highly co-occurring psychiatric disorder among veterans with cannabis use disorder (CUD). Despite some evidence that cannabis use prospectively exacerbates the course of PTSD, which in turn increases the risk for CUD, the causal nature of the relationship between cannabis and psychiatric comorbidity is debated. The longitudinal relationship between PTSD diagnosis and traumatic intrusion symptoms with cannabis use and CUD was examined using cross-lagged panel model (CLPM) analysis.. Prospective data from a longitudinal observational study of 361 veterans deployed post-9/11/2001 included PTSD and CUD diagnoses, cannabis use, and PTSD-related traumatic intrusion symptoms from the Inventory of Depression and Anxiety Symptoms.. A random intercept CLPM analysis that leveraged three waves (baseline, 6 months and 12 months) of cannabis use and PTSD-related intrusion symptoms to account for between-person differences found that baseline cannabis use was significantly positively associated with 6-month intrusion symptoms; the converse association was significant but reduced in magnitude (baseline use to 6-month intrusions: β = 0.46, 95% CI 0.155-0.765; baseline intrusions to 6-month use: β = 0.22, 95% CI -0.003 to 0.444). Results from the two-wave CLPM reveal a significant effect from baseline PTSD to 12-month CUD (β = 0.15, 95% CI 0.028-0.272) but not from baseline CUD to 12-month PTSD (β = 0.12, 95% CI -0.022 to 0.262).. Strong prospective associations capturing within-person changes suggest that cannabis use is linked with greater severity of trauma-related intrusion symptoms over time. A strong person-level directional association between PTSD and CUD was evident. Findings have significant clinical implications for the long-term effects of cannabis use among individuals with PTSD.

Topics: Cannabis; Humans; Longitudinal Studies; Marijuana Abuse; Stress Disorders, Post-Traumatic; Veterans

Cannabis use has been increasing in the United States and throughout the world. It is derived from one of the earliest plants cultivated by humans - Cannabis sativa. Cannabis (also called marijuana) is the most commonly used psychoactive substance worldwide. The cannabis plant has more than 400 chemicals, of which more than 100 cannabinoids (such as cannabigerol, cannabidiol, and cannabinol) have been identified. The endocannabinoid system (ECS) plays an essential role in the effects of cannabis on end organs. Although cannabis use has been reported for many decades, some of its unique adverse effects of nausea, vomiting, and abdominal pain, termed as cannabis hyperemesis syndrome (CHS), were noted recently. The legal status of cannabis in the United States has been rapidly changing from state to state. The incidence of CHS is expected to rise with rising access to cannabis in the United States. Furthermore, CHS is frequently underdiagnosed due to a lack of uniform criteria, subjective nature of symptoms, and overlap with cyclical vomiting syndrome (CVS). Understanding the ECS and its role in biphasic response (proemetic and antiemetic) of CHS is critical to explain its pathophysiology. As the use of cannabis increases globally, awareness of CHS is warranted for early recognition and prompt treatment to avoid complications. We describe the putative mechanism of CHS with an overview of the clinical features in these patients. Furthermore, we highlight the differences between CHS and CVS with important differentials to consider. We provide a narrative update on the current evidence on CHS pathophysiology, diagnosis, treatment, and identifying research gaps.

Topics: Analgesics; Cannabis; Endocannabinoids; Humans; Marijuana Abuse; Nausea; Syndrome; Vomiting

Although cannabis may worsen nausea and vomiting for patients with gastroparesis, it may also be an effective treatment for gastroparesis-related abdominal pain. Given conflicting data and a lack of current epidemiological evidence, we aimed to investigate the association of cannabis use on relevant clinical outcomes among hospitalized patients with gastroparesis.. Patients with a diagnosis of gastroparesis were reviewed from the National Inpatient Sample (NIS) database between 2008 and 2014. Gastroparesis was identified by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes with patients classified based on a diagnosis of cannabis use disorder. Demographics, comorbidities, socioeconomic status, and outcomes were compared between cohorts using χ2 and analysis of variance. Logistic regression was then performed and annual trends also evaluated.. A total of 1,473,363 patients with gastroparesis were analyzed [n=33,085 (2.25%) of patients with concomitant cannabis use disorder]. Patients with gastroparesis and cannabis use disorder were more likely to be younger and male gender compared with nonusers (36.7±18.8 vs. 51.9±16.8; P<0.001 and 52.9% vs. 33.5%; P<0.001, respectively). Race/ethnicity was different between groups (P<0.001). Cannabis users had a lower median household income and were more likely to have Medicaid payor status (all P<0.001). Controlling for confounders, length of stay, and mortality were significantly decreased for patients with gastroparesis and cannabis use (all P<0.001).. While patients with gastroparesis and cannabis use disorder were younger, with a lower socioeconomic status, and disproportionately affected by psychiatric diagnoses, these patients had better hospitalization outcomes, including decreased length of stay and improved in-hospital mortality.

Topics: Analgesics; Cannabis; Gastroparesis; Humans; Income; Inpatients; Length of Stay; Male; Marijuana Abuse; Substance-Related Disorders; Treatment Outcome; United States

Chronic pain is associated with mental and physical health difficulties and is prevalent among veterans. Cannabis has been put forth as a treatment for chronic pain, and changes in laws, attitudes, and use patterns have occurred over the past 2 decades. Differences in prevalence of nonmedical cannabis use and cannabis use disorder (CUD) were examined across 2 groups: veterans or nonveterans and those reporting or not reporting recent pain. Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013; n = 36,309) were analyzed using logistic regression. Prevalence differences (PDs) for 3 cannabis outcomes (1) past-year nonmedical cannabis use, (2) frequent (≥3 times a week) nonmedical use, and (3) DSM-5 CUD were estimated for those reporting recent moderate to severe pain (veterans or nonveterans) and veterans reporting or not reporting recent pain. Difference in differences was calculated to investigate PDs on outcomes associated with residence in a state with medical cannabis laws (MCLs). Associations between physical and mental health and cannabis variables were tested. The results indicated that the prevalence of recent pain was greater among veterans (PD = 7.25%, 95% confidence interval (CI) [4.90-9.60]). Among veterans, the prevalence of frequent cannabis use was greater among those with pain (PD = 1.92%, 98% CI [0.21-3.63]), and among veterans residing in a state with MCLs, the prevalence of CUD was greater among those reporting recent pain (PD = 3.88%, 98% CI [0.36-7.39]). Findings failed to support the hypothesis that cannabis use improves mental or physical health for veterans with pain. Providers treating veterans with pain in MCL states should monitor such patients closely for CUD.

Topics: Cannabis; Chronic Pain; Humans; Marijuana Abuse; Medical Marijuana; Mental Health; United States; Veterans

Although poor decision-making (DM) has been correlated with problematic cannabis use (CU), cross-sectional designs make it difficult to determine whether poor DM represents an antecedent and/or consequence of CU. The current study measured bidirectional associations between CU and DM among adolescents over 2 years and compared these findings to those observed with episodic memory, which is consistently reported as a consequence of CU. We also measured the role of DM as a risk factor for cannabis use disorder (CUD) onset.. Two-year longitudinal study with five bi-annual assessments.. Participants were 401 adolescents aged 14-17 years at baseline.. Miami, Florida, USA.. CU frequency and CUDs were assessed at each time-point through the Drug Use History Questionnaire and Structured Clinical Interview for DSM-IV, respectively. Neurocognition was assessed at odd time-points throughout the Iowa Gambling Task, Game of Dice Task and Cups Task [decision-making (DM)] and the Wechsler Memory Scale IV and California Verbal Learning Test II (episodic memory). We used latent growth curve modeling to examine bidirectional influences between CU and neurocognition over time. We applied discrete time survival analyses to determine whether baseline DM predicted CUD onset.. Greater lifetime CU frequency was associated with poorer episodic memory at baseline (bs = -14.84, -16.44, Ps = 0.038, 0.021). Greater CU escalation predicted lesser gains in immediate episodic memory (b = -0.05, P = 0.020). Baseline DM did not predict CU escalation (b = 0.07, P = 0.421), nor did escalation in CU predict changes in DM (b = 0.02, P = 0.352). Baseline DM also did not predict CUD onset (adjusted OR = 1.01, 95% confidence interval = 0.98-1.06).. This study replicates findings that poorer episodic memory in adolescents appears to be a consequence of cannabis use, even among adolescents at earlier stages of use. Poor decision-making does not appear to be either a consequence of or a risk factor for escalating cannabis use or onset of cannabis use disorder among adolescents.

Topics: Adolescent; Cannabis; Cross-Sectional Studies; Decision Making; Gambling; Humans; Longitudinal Studies; Marijuana Abuse

Cannabis use disorder (CUD) is the most common non-alcohol related substance use disorder (SUD) in the United States and is especially prevalent among returning veterans. The long-term mental health correlates of CUD remain unknown, which is significant given the rise in legalization and also recreational and medicinal cannabis use nationally.. Using a gender-balanced, national sample of 1,649 veterans (n = 115 with CUD; 75.2% White; M age = 37.49, SD = 9.88), we used latent growth curve modeling to examine posttraumatic stress disorder (PTSD) symptom severity, depressive symptoms, generalized anxiety, alcohol use, and psychosocial functioning between veterans with versus without a prior diagnosis of CUD over five time points, spanning an average of 7 years.. Returning veterans with CUD compared to those without reported higher alcohol use, depression, anxiety, PTSD symptom severity, and worse psychosocial functioning at baseline. We observed nonlinear change across each outcome. We also found that CUD moderated change in alcohol use (quadratic: b = -.129, p < .001) and PTSD symptoms (quadratic: b = -.280, p = .019), such that individuals with CUD evidenced decelerated change and worse outcomes relative to veterans without a previously documented CUD diagnosis. Trajectories of depression, anxiety, and psychosocial functioning were similar across individuals with versus without CUD.. In the first long-term and longitudinal evaluation of mental health and alcohol use course among returning veterans, CUD was associated with worse and more persistent alcohol use and PTSD symptom severity over time. These data have implications for clinical assessment, case conceptualization, and treatment of veterans and may inform efforts to offset risk for hazardous drinking and PTSD following a diagnosis of CUD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Topics: Adult; Cannabis; Comorbidity; Humans; Marijuana Abuse; Mental Health; Stress Disorders, Post-Traumatic; Substance-Related Disorders; United States; Veterans

Despite the significant societal and personal burden of cannabis use, the impact of long-term use and Cannabis Use Disorder (CUD) on white matter microstructure is still unclear. Previous studies show inconsistent findings, in part due to heterogeneity in methodology, variable severity of cannabis use, and potential confounding effects of other mental health issues and substance use. The goal of this diffusion tensor imaging (DTI) study was to compare whole-brain white matter microstructure between 39 near daily cannabis users and 28 controls closely matched on age, sex, alcohol use, cigarette use and mental health. Within the group of cannabis users, associations between white matter microstructure and recent cannabis use, dependence severity, and age of onset and duration of weekly use were investigated. White matter microstructure did not differ between cannabis users and controls and did not covary with recent cannabis use, dependence severity, or duration of use. Earlier onset of weekly cannabis use was related to lower fractional anisotropy (FA) in various sections of the right inferior longitudinal fasciculus and uncinate fasciculus. These findings suggest that long-term near-daily cannabis use does not necessarily affect white matter microstructure, but vulnerability may be higher during adolescence. These findings underscore the importance of sample composition and warrant further studies that investigate the moderating role of age of onset in the impact of cannabis on the brain.

Topics: Adolescent; Adult; Anisotropy; Cannabis; Diffusion Tensor Imaging; Female; Humans; Male; Marijuana Abuse; Neuropsychological Tests; White Matter; Young Adult

The authors sought to estimate the prevalence of past-12-month and lifetime cannabis use and cannabis use disorder among U.S. veterans; to describe demographic, substance use disorder, and psychiatric disorder correlates of nonmedical cannabis use and cannabis use disorder; and to explore differences in cannabis use and cannabis use disorder prevalence among veterans in states with and without medical marijuana laws.. Participants were 3,119 respondents in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) who identified as U.S. veterans. Weighted prevalences were calculated. Logistic regression analyses tested associations of nonmedical cannabis use and cannabis use disorder with demographic and clinical correlates and examined whether prevalence differed by state legalization status.. The prevalences of any past-12-month cannabis use and cannabis use disorder were 7.3% and 1.8%, respectively. Lifetime prevalences were 32.5% and 5.7%, respectively. Past-12-month and lifetime cannabis use disorder prevalence estimates among nonmedical cannabis users were 24.4% and 17.4%, respectively. Sociodemographic correlates of nonmedical cannabis use and use disorder included younger age, male gender, being unmarried, lower income, and residing in a state with medical marijuana laws. Nonmedical cannabis use and use disorder were associated with most psychiatric and substance use disorders examined.. Among veterans, the odds of nonmedical cannabis use and use disorder were elevated among vulnerable subgroups, including those with lower income or psychiatric disorders and among survey participants residing in states with medical marijuana laws. The study findings highlight the need for clinical attention (e.g., screening, assessment) and ongoing monitoring among veterans in the context of increasing legalization of cannabis.

Topics: Alcohol-Related Disorders; Cannabis; Ethanol; Hallucinogens; Humans; Male; Marijuana Abuse; Medical Marijuana; Prevalence; Substance-Related Disorders; United States; Veterans

Topics: Analgesics; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Pharmaceutical Preparations

Topics: Adult; California; Cannabinoids; Cannabis; COVID-19; Female; Humans; Marijuana Abuse; Pregnancy; Pregnant Women

Marijuana is the most common illicit substance globally. The rate of marijuana use is increasing in young adults in the US. The current environment of legalizing marijuana use is further contributing to an increase of users. The purpose of this study was to explore the characteristics of adults who abuse marijuana (20-49 years old) and analyze behavior and social relation variables related to depression and suicide risk using machine-learning algorithms. A total of 698 participants were identified from the 2019 National Survey on Drug Use and Health survey as marijuana dependent in the previous year. Principal Component Analysis and Chi-square were used to select features (variables) and mean imputation method was applied for missing data. Logistic regression, Random Forest, and K-Nearest Neighbor machine-learning algorithms were used to build depression and suicide risk prediction models. The results showed unique characteristics of the group and well-performing prediction models with influential risk variables. Identified risk variables were aligned with previous studies and suggested the development of marijuana abuse prevention programs targeting 20-29 year olds with a regular depression and suicide screening. Further study is suggested for identifying specific barriers to receiving timely treatment for depression and suicide risk.

Topics: Adult; Cannabis; Humans; Machine Learning; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Middle Aged; Young Adult

The extent to which child traffic injuries may be attributed to parents who use cannabis before driving is unknown. We investigated whether prenatal cannabis use disorders may predict future road traffic injuries in children. We conducted a cohort study of 792,082 children in Quebec, Canada with 6,280,663 years of follow-up between 2006 and 2019. The main exposure measure was maternal cannabis use disorder before or during pregnancy. The main outcome measure was future hospitalizations for transport-related injuries in children after birth. Using Cox proportional hazards regression models adjusted for potential confounders, we estimated hazard ratios and 95% confidence intervals (CI) for the association of prenatal cannabis use disorders with transport-related injuries in children. Maternal cannabis use disorders before birth were associated with 5.64 times the risk of hospitalization for future motor vehicle crash injuries in children (95% CI 2.61-12.21). The risk increased with the child's age. Prenatal cocaine, opioid, and other drug use disorders were not associated with pediatric transport-related injuries. Maternal cannabis use disorders before birth may be an early predictor of childhood injuries from motor vehicle crashes.

Topics: Accidents, Traffic; Canada; Cannabis; Child; Cohort Studies; Female; Humans; Marijuana Abuse; Pregnancy; Substance-Related Disorders

Cannabis is the most used recreational drug worldwide. Its use can increase the risk of developing psychotic disorders and exacerbate their course. However, the relationship between cannabis use and dissociative symptoms has been scarcely investigated.. To examine differences in psychotic and dissociative symptoms, and in functioning in first-episode psychotic patients (FEPp) using cannabis compared with those not using cannabis.. Between January 2014 and December 2019, seventy FEPp with cannabis use disorder (N = 35) and without it (N = 35) were recruited in psychiatric inpatient facilities in the Italian regions of Lazio and Piemonte. All subjects were assessed at FEP, after 4 and 8 months, using the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF) scale and the Dissociative Experiences Scale - II (DES-II). Detailed information on the pattern of cannabis and other substance use were collected.. FEP using cannabis showed higher levels of positive symptomatology, dissociative experiences and worse functioning than their non-user counterpart, despite a comparable antipsychotic treatment. At an eight-month prospective evaluation, FEP using cannabis still showed higher levels of positive symptomatology and dissociation. Moreover, global functioning worsened over time in FEPp using cannabis, whereas it improved those not using it.. Our findings suggest that a greater degree of dissociation and positive symptoms at FEPp and their persistence over time may characterise cannabis-associated psychosis. Both these factors might explain the overall functioning worsening over time that we observed in the cannabis-user group compared to the functioning improvement in the non-user group.

Topics: Antipsychotic Agents; Cannabis; Humans; Marijuana Abuse; Prospective Studies; Psychotic Disorders

As 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.. Data 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.. Between 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]).. CUD 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.

Topics: Adolescent; Adult; Cannabis; Child; Diagnostic and Statistical Manual of Mental Disorders; Humans; Marijuana Abuse; Substance-Related Disorders; Surveys and Questionnaires; United States; Young Adult

This study measured emergency department (ED) use and hospitalization for medical reasons among patients with substance-related disorders (SRD), comparing four subgroups: cannabis-related disorders, drug-related disorders other than cannabis, alcohol-related disorders and polysubstance-related disorders, controlling for various clinical, sociodemographic and service use variables.. Clinical administrative data for a cohort of 22,484 patients registered in Quebec (Canada) addiction treatment centers in 2012-13 were extracted for the years 2009-10 to 2015-16. Using negative binomial models, risks of frequent ED use and hospitalization were calculated for a 12-month period (2015-16).. Patients with polysubstance-related disorders used ED more frequently than other groups with SRD. They were hospitalized more frequently than patients with cannabis or other drug-related disorders, but less frequently than those with alcohol-related disorders. Patients with alcohol-related disorders used ED more frequently than those with cannabis-related disorders and underwent more hospitalizations than both patients with cannabis-related and other drug-related disorders. Co-occurring SRD-mental disorders or SRD-chronic physical illnesses, more years with SRD, being women, living in rural territories, more frequent consultations with usual general practitioner or outpatient psychiatrist, and receiving more interventions in community healthcare centers increased frequency of ED use and hospitalization, whereas both adverse outcomes decreased with high continuity of physician care. Behavioral addiction, age less than 45 years, living in more materially deprived areas, and receiving 1-3 interventions in addiction treatment centers increased risk of frequent ED use, whereas living in semi-urban areas decreased ED use. Patients 25-44 years old receiving 4+ interventions in addiction treatment centers experienced less frequent hospitalization.. Findings showed higher risk of ED use among patients with polysubstance-related disorders, and higher hospitalization risk among patients with alcohol-related disorders, compared with patients affected by cannabis and other drug-related disorders. However, other variables contributed substantially more to the frequency of ED use and hospitalization, particularly clinical variables regarding complexity and severity of health conditions, followed by service use variables. Another important finding was that high continuity of physician care helped decrease the use of acute care services. Strategies like integrated care and outreach interventions may enhance SRD services.

Topics: Adult; Alcohol-Related Disorders; Cannabis; Emergency Service, Hospital; Female; Hospitalization; Humans; Male; Marijuana Abuse; Middle Aged; Referral and Consultation; Substance-Related Disorders

The aim of this study is to evaluate the associations between alcohol-cannabis use and forensic/stressful events with the risk of incident clinical psychosis during follow-up.. A community-based sample (n: 2142) was screened for clinical psychosis (schizophrenia and other psychotic disorders, affective disorders with psychotic features) at baseline and follow-up. Thus, incident clinical psychosis cases to develop during follow-up (individuals with no clinical psychosis at the baseline assessment and with clinical psychosis at the follow-up assessment) were detected (n: 27). These cases and the controls who did not report any psychotic symptoms at the follow-up assessment (n: 1691) were compared for exposure to environmental risk factors during follow-up (total n: 1718).. Individuals reporting heavy alcohol drinking or cannabis use during follow-up had significantly higher risk of incident clinical psychosis. The monthly frequency of drinking and cannabis use was also associated with the risk. Higher number of stressful life events exposed predicted higher risk of incident clinical psychosis. The risk of incident clinical psychosis was significantly higher in case of coexistence of two risk factors (heavy drinking, cannabis use, ≥3 stressful events), in comparison with the existence of a single risk factor (17.7 vs. 1.6%, p<0.001).. Heavy drinking, cannabis use, forensic events and stressful events were associated with the risk of incident clinical psychosis. The coexistence of multiple stressful events and disorders related to abuse of alcohol/cannabis should be considered as a warning for the development of clinical psychosis.

Topics: Cannabis; Humans; Marijuana Abuse; Prospective Studies; Psychotic Disorders; Risk Factors; Schizophrenia

Worldwide, cannabis is the most used illegal substance, and the use of cannabis has increased over the years. An increase in the level of tetrahydrocannabinol (THC) in cannabis has also been seen. It is currently unclear whether this has led to an increase in the incidence of cannabis-induced psychosis. We aimed to investigate (1) the development of incidence of cannabis-induced psychosis over time compared with other substance-induced psychoses and (2) the development of incident cases of cannabis-induced psychosis over time compared with dual diagnosis defined as schizophrenia and a cannabis use disorder.. Data on psychiatric diagnoses were extracted from the Danish Psychiatric Central Research Register and summarized per year as both absolute incidence (number of cases) and incidence rates per 100 000 person years.. The incidence rate of cannabis-induced psychosis increased steadily from 2.8 per 100 000 person years in 2006 to 6.1 per 100 000 person years in 2016. There was a corresponding increase in dual diagnosis with schizophrenia and cannabis use disorder, but a decrease in alcohol-induced psychosis. The data showed no trend in the other substance-induced psychosis investigated in this thesis.. The increase in cannabis-induced psychosis follows both the increase in the level of THC in cannabis, and the increase in cannabis use. The change in diagnostic practice does not appear to explain the increase in incidence of cannabis-induced psychosis.

Topics: Adult; Cannabis; Denmark; Diagnosis, Dual (Psychiatry); Humans; Incidence; Marijuana Abuse; Middle Aged; Psychoses, Substance-Induced; Psychotic Disorders; Schizophrenia; Young Adult

Topics: Cannabis; Female; Hallucinogens; Harm Reduction; Humans; Infant, Newborn; Marijuana Abuse; Pregnancy; Self Report

Daily use of high-potency cannabis has been reported to carry a high risk for developing a psychotic disorder. However, the evidence is mixed on whether any pattern of cannabis use is associated with a particular symptomatology in first-episode psychosis (FEP) patients.. We analysed data from 901 FEP patients and 1235 controls recruited across six countries, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. We used item response modelling to estimate two bifactor models, which included general and specific dimensions of psychotic symptoms in patients and psychotic experiences in controls. The associations between these dimensions and cannabis use were evaluated using linear mixed-effects models analyses.. In patients, there was a linear relationship between the positive symptom dimension and the extent of lifetime exposure to cannabis, with daily users of high-potency cannabis having the highest score (. Our findings provide the first large-scale evidence that FEP patients with a history of daily use of high-potency cannabis present with more positive and less negative symptoms, compared with those who never used cannabis or used low-potency types.

Topics: Cannabis; Case-Control Studies; Gene-Environment Interaction; Humans; Marijuana Abuse; Psychotic Disorders; Schizophrenia

Cannabis is one of the world's most widely used recreational drugs and the second most commonly smoked substance. Research on cannabis and the lungs has been limited by its illegal status, the variability in strength and size of cannabis cigarettes (joints), and the fact that most cannabis users also smoke tobacco, making the effects difficult to separate. Despite these difficulties, the available evidence indicates that smoking cannabis causes bronchitis and is associated with changes in lung function. The pattern of effects is surprisingly different from that of tobacco. Whereas smoking cannabis appears to increase the risk of severe bronchitis at quite low exposure, there is no convincing evidence that this leads to chronic obstructive pulmonary disease. Instead, cannabis use is associated with increased central airway resistance, lung hyperinflation and higher vital capacity with little evidence of airflow obstruction or impairment of gas transfer. There are numerous reports of severe bullous lung disease and pneumothorax among heavy cannabis users, but convincing epidemiological data of an increased risk of emphysema or alveolar destruction are lacking. An association between cannabis and lung cancer remains unproven, with studies providing conflicting findings.

Topics: Cannabis; Humans; Lung; Lung Diseases; Marijuana Abuse; Marijuana Smoking; Risk Factors

Cannabis use disorder (CUD) is frequent in adolescence and often goes into remission towards adulthood. This study aimed to estimate trajectories of CUD severity (CUDS) in Swiss men aged from 20 to 25 years and to identify prospective predictors of these trajectories.. Latent class growth analysis of self-reported CUDS in a cohort study with three data collection waves.. A general population sample of young Swiss men.. A total of 5987 Swiss men assessed longitudinally at the mean ages of 20, 21.5 and 25 years.. Latent CUDS in the last 12 months was measured at each wave with the Cannabis Use Disorders Identification Test-Revised (CUDIT-R). Predictors of CUDS trajectories, measured at age 20, were from six domains: factors related to cannabis use, family, peers, other substance use, mental health and personality.. We distinguished four CUDS trajectories: stable-low (88.2%), decreasing (5.2%), stable-high (2.6%) and increasing (4.0%). Predictors were generally associated with higher odds of membership in the decreasing and stable-high trajectory (versus the stable-low), and to a lesser degree with higher odds of membership in the increasing trajectory. Bivariate predictors of persistent high CUDS (stable-high versus decreasing trajectory) were major depression severity [odds ratio (OR) = 1.19, 95% confidence interval (CI) = 1.01, 1.40], attention deficit hyperactivity disorder severity (OR = 1.25, 95% CI = 1.04, 1.51), antisocial personality disorder severity (OR = 1.18, 95 % CI = 1.04, 1.34), relationship with parents (OR = 0.74, 95% CI = 0.63, 0.88), number of friends with drug problems (OR = 1.33, 95% CI = 1.11, 1.60) and the personality dimensions neuroticism-anxiety (OR = 1.35, 95% CI = 1.11, 1.65) and sociability (OR = 0.78, 95% CI = 0.62, 0.97).. Factors associated with persistent cannabis use disorder in young Swiss men include cannabis use, cannabis use disorder severity, mental health problem severity, relationship with parents (before the age of 18), peers with drug problems and the personality dimensions neuroticism-anxiety and sociability at or before age 20. Effect sizes may be small, and predictors are mainly associated with persistence via higher severity at age 20 years.

Topics: Adolescent; Adult; Cannabis; Cohort Studies; Depressive Disorder, Major; Humans; Infant, Newborn; Marijuana Abuse; Switzerland; Young Adult

Cannabis use is considered an established risk factor for psychosis development. Differentiating between cannabis-induced disorders and schizophrenia is useful for prognostic and therapeutic purposes. Three inpatients groups were differentiated: cannabis-induced psychosis (CIP) (n = 69; mean age = 27.4, SD = 6.5; 82.6% males), schizophrenia with cannabis abuse or dependence (SZ + CB) (n = 57; mean age = 31.9, SD = 10.1; 94.7% males) and schizophrenia without cannabis abuse or dependence (SZ) (n = 181; mean age = 41.8, SD = 13.3; 54.1% males). The Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) scale was used to differentiate induced psychosis. The CIP group presented lower mean scores on the negative PANSS subscale (M = 12.9, SD = 5.9; F = 32.24, p < 0.001), fewer auditory hallucinations (60.3%; X² = 6.60, p = 0.037) and greater presence of mania (26.1% vs. 12.3%; X² = 32.58, p < 0.001) than the SZ + CB group. There were few clinical differences between patients with schizophrenia, regardless of previous cannabis use. The age of first admission due to psychosis was lower in both psychotic inpatients groups with cannabis use (M = 26.1, SD = 6.4 in CIP and M = 25.3, SD = 6.2 in SZ + CB; X² = 20.02, p < 0,001). A clinical pattern characteristic of cannabis-induced psychosis was not observed, but the precipitating role of cannabis in the appearance of psychotic symptoms was demonstrated, given the lower age of first admission due to psychosis in cannabis user groups.. El consumo de cannabis se considera un factor de riesgo establecido para el desarrollo de psicosis. Diferenciar los trastornos inducidos por cannabis de la esquizofrenia resulta útil desde el punto de vista pronóstico y terapéutico. Se diferenciaron tres grupos de pacientes hospitalizados: psicosis inducida por cannabis (PIC) (n = 69; Media de edad = 27,4, DE = 6,5; 82,6 % varones), esquizofrenia con abuso o dependencia de cannabis (EZ + CB) (n = 57; Media de edad = 31,9, DE = 10,1; 94,7% varones) y esquizofrenia sin abuso o dependencia de cannabis (EZ) (n = 181; Media de edad = 41,8, DE = 13,3; 54,1% varones). Se utilizó la escala Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) para la diferenciación de cuadros inducidos. El grupo PIC presentó puntaciones inferiores en la subescala PANSS negativa (M = 12,9, DE = 5,9; F = 32,24; p < 0,001), menos alucinaciones auditivas (60,3%; X²  = 6,60; p = 0,037) y mayor presencia de manía (26,1% vs. 12,3%; X² = 32,58; p < 0,001) en comparación con el grupo EZ + CB. Hubo pocas diferencias clínicas entre los pacientes con esquizofrenia, independientemente del consumo de cannabis. La edad del primer ingreso por psicosis fue menor en ambos grupos de psicóticos consumidores (M = 26,1, DE = 6,4 en PIC y M = 25,3, DE = 6,2 en EZ + CB; X² = 20,02; p < 0,001). No se observó un patrón clínico característico de las psicosis inducidas por cannabis, aunque sí se demostró el papel precipitante del cannabis en la aparición de psicosis, dada la menor edad de ingreso en los consumidores.

Topics: Adult; Cannabis; Humans; Marijuana Abuse; Psychotic Disorders; Risk Factors; Schizophrenia

Topics: Brain; Cannabis; Drug-Related Side Effects and Adverse Reactions; Marijuana Abuse

Accidental pediatric cannabis poisonings are an incidental effect of cannabis use. The average THC content of cannabis resin and the number of consumers are rising sharply in the USA and in most European countries. The objective is to study the evolution of prevalence and severity of pediatric exposures to cannabis in France.. This is a retrospective observational study of cases detected by French poison centers between January 1. A total of 965 cases of poisoning were covered. The annual average number of cases was 93 between 2010 and 2014 and 167 between 2015 and 2017. The median age was 15 months (range, 6 months-10 years) and the sex ratio was 1:1. The form of cannabis ingested was mainly resin (75%). During the period covered by the study, 26.1% of children (. The data indicates a significant increase in the number of cases of pediatric exposure to cannabis and a rise in the seriousness of poisonings between 2010 and 2017.

Topics: Cannabis; Child; Child, Preschool; Emergency Service, Hospital; Female; France; Humans; Infant; Length of Stay; Male; Marijuana Abuse; Prevalence; Retrospective Studies

Topics: Adult; Age Factors; Aged; Cannabis; Female; Humans; Incidence; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; United States

To examine whether moderate adolescent cannabis use has neurocognitive effects that are unexplained by familial confounds, which prior family-controlled studies may not have identified.. A quasi-experimental, sibling-comparison design was applied to a prospective, observational study of adolescents with moderate cannabis use. Participants were recruited from 2001 to 2006 (mean age = 17 years). A second wave of data was collected from 2008 to 2013 (mean age = 24 years).. Two US metropolitan communities.. A total of 1192 adolescents from 596 families participated in this study. Participants were primarily male (64%) and racially and ethnically diverse (non-Hispanic white = 45%). A sibling in each family was a clinical proband identified due to delinquent behaviors. Whereas prior family-controlled studies have used samples of primarily infrequent cannabis users (mean = 1-2 days/month), participants here endorsed levels of cannabis use comparable to findings from epidemiological cohort studies (mean = 7-9 days/month).. Semi-structured clinical interviews assessed drug use, and a neuropsychological battery assessed cognitive abilities. Covariates included age at assessment, gender and alcohol use.. After correcting for multiple testing, a greater frequency and earlier onset of regular cannabis use were associated with poorer cognitive performance, specifically on tests of verbal memory. Further, after accounting for familial factors shared by siblings and alcohol use, poorer verbal memory performance was still associated with greater life-time frequency of cannabis use at wave 1 [b = -0.007 (-0.002, -0.012), adjusted P = 0.036]; earlier cannabis use at wave 2 [b = -0.12 (-0.05, -0.19), adjusted P = 0.006; b = -0.14 (-0.06, -0.23), adjusted P = 0.006]; and greater frequency of past 6 months use at wave 2 [b = -0.02 (-0.01, -0.03), adjusted P = 0.002; b = -0.02 (-0.01, -0.03), adjusted P = 0.008].. Moderate adolescent cannabis use may have adverse effects on cognitive functioning, specifically verbal memory, that cannot be explained by familial factors.

Topics: Adolescent; Adult; Cannabis; Cognition; Humans; Infant, Newborn; Marijuana Abuse; Neuropsychological Tests; Prospective Studies; Siblings; Young Adult

Longitudinal studies of cannabis exposure during early adolescence in the general population frequently report an increased risk of subsequently developing psychotic symptoms or a psychotic illness. However, there is a dearth of knowledge about the effects of early cannabis exposure on psychosis in homeless and precariously housed adults, who represent a population afflicted with high rates of psychosis. The aim of the present study was to examine how early cannabis exposure (by age 15) compared to later first use (after age 15) affected the expression of adult psychosis in this population. Secondary measures of psychopathology, drug use, cognition and brain structure were also collected. 437 subjects were recruited from single room occupancy hotels in the urban setting of the Downtown Eastside of Vancouver, Canada. Psychiatric diagnoses were determined, and psychotic symptom severity was measured with the 5-factor PANSS. Participants completed a battery of neurocognitive tests, and brain structure was assessed using structural and diffusion tensor imaging MRI scans. Results indicated that early cannabis exposure was associated with an increased risk (OR = 1.09, p < .05) of developing substance induced psychosis, whereas later first use increased risk (OR = 2.19, p < .01) of developing schizophrenia or schizoaffective disorder. There was no group difference in neurocognitive function, although differences were observed in the lateral orbitofrontal cortex and white matter tract diffusivity. These findings indicate that early cannabis exposure in this population may increase the risk of developing drug associated psychoses, which could potentially be mediated in part through altered neurodevelopmental brain changes.

Topics: Adolescent; Adolescent Behavior; Adult; Age Factors; British Columbia; Cannabis; Female; Housing Instability; Humans; Ill-Housed Persons; Male; Marijuana Abuse; Middle Aged; Neuropsychological Tests; Psychoses, Substance-Induced; Psychotic Disorders; Young Adult

People living with HIV (PLWH) report higher rates of cannabis use than the general population, a trend likely to continue in light of recent policy changes and the reported therapeutic benefits of cannabis for PLWH. Therefore, it is important to better understand cannabis-associated effects on neurocognition, especially as PLWH are at heightened risk for neurocognitive impairment. This study aimed to elucidate the effects of a past cannabis use disorder on current neurocognition in a diverse sample of PLWH. This cross-sectional study included 138 PLWH (age M(SD) = 47.28(8.06); education M(SD) = 12.64(2.73); 73% Male; 71% Latinx) who underwent neuropsychological, DSM-diagnostic, and urine toxicology evaluations. One-way ANCOVAs were conducted to examine effects of a past cannabis use disorder (CUD+) on tests of attention/working memory, processing speed, executive functioning, verbal fluency, learning, memory, and motor ability. Compared to the past CUD- group, the past CUD+ group performed significantly better on tests of processing speed, visual learning and memory, and motor ability (

Topics: Cannabis; Cross-Sectional Studies; HIV Infections; Humans; Marijuana Abuse; Neuropsychological Tests

Regular cannabis use and cannabis use disorder (CUD) have become increasingly prevalent in the United States over the past two decades. Theory and empirical data suggest that the incentive salience of cannabis cues is important to the development and chronicity of CUD. Cannabis cue incentive salience is often assessed with a cannabis cue reactivity paradigm wherein cannabis-related and neutral images are presented. However, prior cannabis cue reactivity studies have been limited by the use of heterogeneous stimuli that were not properly characterized across motivational/affective characteristics, physical image attributes, or non-cannabis-related salient image features (e.g., human presence, face visibility). In order to increase standardization and flexibility of future cannabis cue reactivity tasks, the aim of the present study was to develop and validate a cannabis cue and matched neutral image database comprised of motivational/affective ratings as well as physical image attributes. 234 regular cannabis users varying in primary use method (i.e., bowl, blunt/joint, bong, vaporizer) made motivational (i.e., urge to smoke cannabis) and affective (i.e., arousal, valence) ratings of cannabis-related and neutral images matched on salient, non-cannabis-related features. Physical features (hue, saturation, value) of each image were also analyzed. Motivational/affective ratings of cannabis-related and neutral images differed as expected, and cannabis use frequency and cannabis craving correlations with cannabis image ratings generally supported stimulus validity. Motivational/affective ratings did not significantly differ across cannabis use method-specific images. This database may be a useful tool for future behavioral and neuroscience research on cannabis cue reactivity.

Topics: Cannabis; Craving; Cues; Humans; Marijuana Abuse; Motivation

This study employed taxometric procedures to replicate a previous report of the dimensional structure of problems related to cannabis consumption.

Topics: Cannabis; Hallucinogens; Humans; Marijuana Abuse; Substance-Related Disorders

The ongoing opioid overdose crisis is driven largely by exposure to illicitly-manufactured fentanyl. Preliminary observational and experimental research suggests that cannabis could potentially play a role in reducing use of prescription opioids among individuals with chronic pain. However, there is limited data on the effects of cannabis on illicit opioid consumption, particularly fentanyl, especially among individuals on opioid agonist therapy (OAT). We sought to assess the longitudinal association between cannabis use and exposure to fentanyl among people on OAT.. Data were drawn from two community-recruited prospective cohorts of people who use drugs in Vancouver, Canada. We used generalized linear mixed-effects modeling, adjusted by relevant confounders, to investigate the relationship between cannabis use and recent fentanyl exposure (both assessed by urine drug testing) among participants on OAT between 2016 and 2018.. Among the 819 participants on OAT who contributed 1989 observations over the study period, fentanyl exposure was common. At the baseline interview, fentanyl was detected in a majority of participants (431, 53 %), with lower prevalence among individuals with urine drug tests positive for tetrahydrocannabinol (47 vs. 56 %, p = 0.028). Over all study interviews, cannabis use was independently associated with reduced likelihood of being recently exposed to fentanyl (Adjusted Prevalence Ratio = 0.91, 95 % Confidence Interval: 0.83 - 0.99).. Participants on OAT using cannabis had significantly lower risk of being exposed to fentanyl. Our findings reinforce the need for experimental trials to investigate the potential benefits and risks of controlled cannabinoid administration for people on OAT.

Topics: Adult; Analgesics, Opioid; Canada; Cannabis; Drug Overdose; Female; Fentanyl; Humans; Longitudinal Studies; Male; Marijuana Abuse; Middle Aged; Opiate Substitution Treatment; Prescriptions; Prevalence; Prospective Studies; Substance Abuse Detection; Substance-Related Disorders

Topics: Adolescent; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Prevalence

Topics: Cannabis; Data Collection; Humans; Marijuana Abuse; Nicotiana; Tobacco Use

Cannabis markets are evolving in terms of greater diversity and potency of products. The current study examined changes in cannabis use and modes of consumption among 16- to 19-year-olds in three markets with different regulatory frameworks: England, Canada, and the United States (US).. Repeat cross-sectional online surveys were conducted in 2017, 2018, and 2019, with samples of 16- to 19-year-olds recruited from commercial panels in Canada (n = 11,779), England (n = 11,117), and the US (n = 11,869). Regression models examined changes in the prevalence of any cannabis use and use of seven modes of consumption, across the countries.. Cannabis use among youth was more prevalent among respondents in Canada and the US than in England in all years and increased to a greater extent between 2017 and 2019 (p < .001 for all contrasts). Among past 30-day cannabis consumers, the prevalence of vaping oils/liquids and the use of cannabis extracts (oil, wax and shatter) increased in all countries, and was significantly higher in Canada and US. For example, the prevalence of vaping oils/liquids increased from 24.2 % in 2017 to 52.1 % in 2019 among past 30-day cannabis consumers in the US (AOR = 3.46, 95 %CI = 2.57-4.66).. Prevalence is increasing for the most potent categories of cannabis products, particularly among youth in Canada and the US. Future research should examine the potential risks of these products and whether shifts in modes of cannabis reflect recent permissive changes to cannabis policy.

Topics: Adolescent; Canada; Cannabis; Cross-Sectional Studies; England; Female; Food; Humans; Male; Marijuana Abuse; Marijuana Smoking; Prevalence; Substance-Related Disorders; Surveys and Questionnaires; United States; Vaping

Despite medicalization and legalization of marijuana use, factors influencing demand for marijuana among persons living with HIV (PLWH) are incompletely understood. This knowledge gap undermines effective clinical management and policies. This study used demand curve simulation methods to address these issues.. Marijuana-using PLWH (N = 119) completed experimental tasks to simulate amount of marijuana purchasing/use across different costs (money or time), and likelihood of reselling marijuana or marijuana therapeutic-use registration card in relation to profits. Additional simulations assessed purchasing of marijuana relative to other drug and non-drug goods.. Simulated marijuana use decreased as money and time costs increased. Consumption was greater for participants with more severe Cannabis Use Disorder (CUD) and anxiety, intermediate pain levels, and past 90-day opioid use. Whereas few participants chose to sell their registration card, marijuana resale (diversion) steeply increased with profit. Likelihood of seeking marijuana therapeutic-use certification decreased in relation to registration card money cost, having to visit more physicians to get a signature, and delay to receiving the card, and increased with duration of certification. Participants who reported recent opioid use were more likely to seek certification. Consumption of several commodities assessed was independent of marijuana.. Simulated marijuana use was related to participants' clinical profile (CUD, anxiety and pain symptoms, recent opioid use), and unrelated to purchasing other goods. Likelihood of seeking marijuana therapeutic-use registration was affected by several types of costs and recent opioid use. Participants were unlikely to divert registration cards. We discuss clinical and policy implications of these findings.

Topics: Adult; Anxiety; Cannabis; Female; Hallucinogens; HIV Infections; Humans; Male; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Medical Marijuana; Opioid-Related Disorders; Pain; Surveys and Questionnaires

Cannabis use is highly prevalent among people with a psychotic disorder. They often report sociality, coping with unpleasant affect and having positive experiences as important reasons for cannabis use, suggesting that cannabis improves their quality of life (QoL) and psychosocial functioning. However, based on previous studies we hypothesize that cannabis use is negatively associated with long-term subjective QoL and psychosocial functioning in people with a psychotic disorder.. We included 2994 people with a psychotic disorder (36.4% female), mean age 44.4 (SD 11.9), mean illness duration 17.2 years (SD 11.1), who participated in two yearly routine outcome assessments between 2014 and 2018 (interval 9-15 months) from the naturalistic PHAMOUS cohort study. Linear regression analyses were used to examine whether first assessment cannabis use was associated with QoL (ManSA) and psychosocial functioning (HoNOS). Changes in outcomes between assessments were analyzed with AN(C)OVA, to examine differences between continuers (n = 255), discontinuers (n = 85), starters (n = 83) and non-users (n = 2571).. At first assessment, 11.4% was using cannabis. They had lower QoL (B = -2.93, p < 0.001) and worse psychosocial functioning (B = 1.03, p = 0.002) than non-users. After one year, changes in QoL and psychosocial functioning were not significantly different between continuers, starters, discontinuers and non-users.. Cannabis users were less satisfied with their family relations and financial situation and showed more aggressive and disruptive behavior and self-harm than non-users. These differences are likely the result of patients having used cannabis for many years. Starting or discontinuing cannabis did not lead to changes in QoL and psychosocial functioning within one year.

Topics: Cannabis; Child, Preschool; Cohort Studies; Female; Humans; Male; Marijuana Abuse; Psychosocial Functioning; Psychotic Disorders; Quality of Life

A significant proportion of individuals aged 50+ in the U.S. use cannabis for medical or recreational purposes, sometimes with adverse effects. Given differences in cannabis use among men and women, we examined sex differences in (1) cannabis forms used, (2) exposure reasons, and (3) medical outcomes in older-adult poison control center (PCC) cases.. Data came from the American Association of Poison Control Centers' National Poison Data System, 2009-2019. We focused on the 3633 cases aged 50+ in which plant and other non-synthetic cannabinoid cannabis forms were the only or primary substance. Logistic regression was used to examine associations of sex with cannabis forms. Multinomial logistic regression models were fit to examine associations of sex with exposure reasons (therapeutic errors/adverse reactions, intentional misuse/abuse, other) and medical outcomes (no-to-minimal, moderate, or major effects).. Females constituted 57.4% of cases. In multivariable analyses, female cases had 1.20 (95% CI = 1.01-1.43) greater odds of involving cannabis forms other than plant forms and 1.93 greater odds (95% CI = 1.66-2.24) of therapeutic errors/adverse effects compared to intentional misuse/abuse. Older age and occurrence in recreational-cannabis-legal states were positively associated with other cannabis forms. Older age, recreational and/or medical cannabis-legal states, CBD, pharmaceuticals, concentrated extracts, and chronic exposure were associated with higher odds of therapeutic errors/adverse effects. Sex was not significantly associated with medical outcomes.. Female cases compose a large share of PCC cases aged 50+ and are associated with higher odds of involving cannabis forms other than plants and therapeutic errors/adverse reactions compared to intentional misuse/abuse.

Topics: Aged; Aged, 80 and over; Cannabinoids; Cannabis; Drug-Related Side Effects and Adverse Reactions; Female; Forecasting; Humans; Male; Marijuana Abuse; Middle Aged; Poison Control Centers; Sex Factors; United States

To assess changes in cannabis use in young adults as a function of psychotic-like experiences.. Participants were initially recruited at age 14 in high schools for the longitudinal IMAGEN study. All measures presented here were assessed at follow-ups at age 19 and at age 22, respectively. Perceived stress was only assessed once at age 22. Ever users of cannabis (N = 552) gave qualitative and quantitative information on cannabis use and psychotic-like experiences using the Community Assessment of Psychic Experiences (CAPE). Of those, nearly all n = 549 reported to have experienced at least one psychotic experience of any form at age 19.. Mean cannabis use increased from age 19 to 22 and age of first use of cannabis was positively associated with a change in cannabis use between the two time points. Change in cannabis use was not significantly associated with psychotic-like experiences at age 19 or 22. In exploratory analysis, we observed a positive association between perceived stress and the experience of psychotic experiences at age 22.. Age of first use of cannabis influenced trajectories of young cannabis users with later onset leading to higher increase, whereas the frequency of psychotic-like experiences was not associated with a change in cannabis use. The observed association between perceived stress and psychotic-like experiences at age 22 emphasizes the importance of stress experiences in developing psychosis independent of cannabis use.

Topics: Adolescent; Adult; Cannabis; Humans; Longitudinal Studies; Marijuana Abuse; Psychotic Disorders; Young Adult

Veterans have high rates of cannabis use, and rates of cannabis use disorder (CUD) are rising among this population. These rising rates are particularly true for veterans with post-traumatic stress disorder (PTSD), which is common among veterans of recent conflicts, Operations Enduring Freedom, Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND). Although prior work has documented links between PTSD and cannabis use, a better understanding of the intersection among CUD, PTSD, and other disorders in real-world clinical practice can inform prevention and treatment efforts. This study examined the prevalence and comorbidities of CUD and PTSD in OFE/OIF/OND veterans.. The study analyzed data from the Veterans Affairs Corporate Data Warehouse (2010-2016) for returning war veterans who were diagnosed with CUD (N = 46,268). The study determined prevalence of PTSD, and examined additional differences in comorbidities.. The prevalence of a comorbid PTSD diagnosis among OEF/OIF/OND veterans with a CUD diagnosis was 72.3%. Further analysis revealed additional co-occurring disorders. Veterans with a diagnosis of CUD and PTSD were more likely to have a comorbid diagnosis of depression (odds ratio, 1.69; 95% CI, 1.62-1.71), panic disorder (odds ratio; 1.58; 95% CI, 1.43-1.75), alcohol use disorder (odds ratio; 1.30; 95% CI, 1.24-1.35), opioid use disorder (odds ratio; 1.52; 95% CI, 1.43-1.62), and insomnia (odds ratio; 1.74; 95% CI, 1.65-1.84) than veterans without a PTSD diagnosis.. Findings highlight that the majority of returning war veterans with CUD are highly complex. Our findings substantiate the need for urgent, comprehensive care for veterans with co-occurring CUD and PTSD, including integrated and transdiagnostic treatment approaches.

Topics: Afghan Campaign 2001-; Cannabis; Comorbidity; Humans; Iraq War, 2003-2011; Marijuana Abuse; Prevalence; Stress Disorders, Post-Traumatic; United States; Veterans

To estimate associations between both current- and prior-year medical cannabis dispensary densities and hospitalizations for cannabis use disorder in California, USA between 2013 and 2016.. Spatial analysis of ZIP code-level hospitalization discharge data using Bayesian Poisson hierarchical space-time models over 4 years.. California, USA from 2013 to 2016 (6832 space-time ZIP code units).. We assessed associations of annual hospitalizations for cannabis use disorder [assignment of a primary or secondary code for cannabis abuse and/or dependence using ICD-9-CM or ICD-10-CM (outcome)] with the total number of medical cannabis dispensaries per square mile in a ZIP code as well as dispensary temporal and spatial lags (primary exposures). Other exposure covariates included alcohol outlet densities, manual labor and retail sales densities and ZIP code-level economic and demographic conditions.. One additional dispensary per square mile was associated with a median risk ratio of 1.021 (95% credible interval 1.001, 1.041). Prior-year dispensary density did not appear to be associated with hospitalizations (median risk ratio = 1.006, 95% CrI = 0.986, 1.026). Higher median household income, higher unemployment, greater off-premises alcohol outlet density and lower on-premises alcohol outlet density and poverty were all associated with decreased ZIP code-level risk of cannabis abuse/dependence hospitalizations.. In California, USA, the increasing density of medical cannabis dispensaries appears to be positively associated with same-year but not next-year hospitalizations for cannabis use disorder.

Topics: Bayes Theorem; California; Cannabis; Hospitalization; Humans; Marijuana Abuse; Medical Marijuana

The principal objective of our study was to document the short-term impact of the legalization of recreational cannabis on active cannabis use, cannabis use disorder, and various psychotic disorders.. We carried out a retrospective observational study of patients who were at least 12 years old and who had visited a psychiatrist in the emergency unit of the. We examined consultations in patients over 18 years old in prelegalization (. Although an affirmative conclusion is tentative, the current findings suggest a first link between the legalization of cannabis in Canada and increased diagnoses of cannabis use disorder, as well as cannabis use in general among patients in a university hospital psychiatric emergency department.

Topics: Adolescent; Adult; Cannabis; Child; Humans; Legislation, Drug; Marijuana Abuse; Prevalence; Psychotic Disorders; Young Adult

The Protective Behavioral Strategies for Marijuana Scale (PBSM), a 17-item scale targeting strategies for mitigating the negative consequences of cannabis use, highlights a range of behaviors that can reduce harm beyond straightforward decreases in quantity or frequency. The 17-item scale's factor structure remains under-examined but could reveal meaningful distinctions among strategies. This study aimed to confirm the factor structure of the short form of the PBSM.. A confirmatory factor analysis demonstrated poor fit for the one-factor model of the PBSM, prompting an exploratory factor analysis. Analyses revealed two internally reliable factors: a "Quantity" factor, strategies specific to mitigating overuse and limiting amounts consumed and an "Context" factor loosely related to troubles with others. This two-factor model accounted for over half of the total variance; invariance testing indicated reduced fit as models became more restrictive. Though each of the factors covaried negatively with both days of use and problems, Context had a stronger relation to both variables compared to Quantity. Only Context predicted fewer cannabis problems and use.. The two-factor solution suggests further work on the psychometric properties of the scale could provide heuristic information to allow for more nuanced approaches in clinical and research settings. Theoretically, each factor might have novel links to some constructs but not others in ways that could assist harm-reduction strategies and treatment.

Topics: Adult; Cannabis; Factor Analysis, Statistical; Female; Harm Reduction; Humans; Male; Marijuana Abuse; Psychometrics; Students; Young Adult

Cannabis is among the most widely used drugs, with the literature demonstrating that cannabis use disorder (CUD) may be more prevalent than previously thought. Research should explore novel approaches to behavioral support to meet treatment need, including computer-assisted therapies such as Breaking Free Online (BFO). This study aimed to understand how participants' baseline sociodemographic and clinical characteristics are associated with engagement with BFO, and how both participants' characteristics and their engagement may be associated with cannabis use and biopsychosocial functioning at follow-up.. An observational study with 1830 individuals presenting to UK-based publicly funded treatment services who reported cannabis as their primary problem substance and engaged with BFO as a self-directed intervention.. Moderate-severe depression/anxiety (51%) and elevated severity of cannabis dependence scores (39%) characterized the baseline sample. Women demonstrated greater clinical complexity at baseline than men. Baseline mental health and biopsychosocial functioning were associated with whether participants completed a follow-up assessment. Among 460 participants who completed a follow-up assessment, intervention engagement was positively associated with self-reported quality of life and biopsychosocial functioning at follow-up.. Cannabis users demonstrated substantial clinical complexity at baseline, with depression/anxiety and biopsychosocial functioning being associated with BFO engagement. Greater BFO engagement was also associated with better quality of life and biopsychosocial functioning at follow-up. Some groups, including those with greater mental health and biopsychosocial impairment at baseline and women, may require support to engage with BFO to maximize clinical benefits.

Topics: Cannabis; Female; Humans; Male; Marijuana Abuse; Quality of Life; Substance-Related Disorders; United Kingdom

Knowledge of factors relating to patterns of cannabis use is important for informing drug policy. This study determined factors associated with recent and current cannabis use. In addition, we explored factors related to having a cannabis use disorder (CUD)-defined using the Diagnostic and Statistical Manual of Psychiatric Disorders-among current users.. We analyzed data from Ireland's 2010-11 and 2014-15 National Drug Prevalence Surveys, which recruited 5134 and 7005 individuals respectively, aged 15 years or more, living in private households. Multinomial logistic regression was used to identify factors associated with recent (last year) and current (last month) cannabis use compared to experiential use. Binary logistic regression was used to determine factors related to CUD among current users.. The weighted prevalence of experiential cannabis use was 18.3%, with 3.0% and 3.3% of participants indicating recent or current use, respectively; 41.3% of current users indicated having a CUD. Factors associated with both recent or current cannabis use included younger age, not being married or cohabiting, having no dependent children and current use of tobacco or alcohol. Male gender, younger age and lower educational levels were significantly related to CUD among current users.. Males, adolescents/young adults and individuals with lower educational levels are more likely to be current users of cannabis and are at a greater risk of having a CUD. Health professionals should be aware of these factors to improve detection and prevention of CUD.

Topics: Adolescent; Cannabis; Child; Diagnostic and Statistical Manual of Mental Disorders; Humans; Ireland; Male; Marijuana Abuse; Prevalence; Young Adult

Topics: Cannabis; Humans; Marijuana Abuse

Stimulants such as cocaine and amphetamines are well-established risk factors for acute aortic dissection. Despite the fact that marijuana is the most commonly used illicit drug in the United States, its relationship to acute aortic syndromes has not been well studied.. A comprehensive retrospective review was undertaken of all consecutive patients who presented with acute Stanford type A aortic dissection from January 2017 to December 2019. Of 152 patients identified, 51 (33.6%) underwent comprehensive urine toxicology screening at clinical presentation. The characteristics and outcomes of the patients with urine results positive for tetrahydrocannabinol (THC) (n = 9, 17.6%) were compared with the 42 patients who had no evidence of recent marijuana consumption.. Of the 51 dissection patients who underwent broad-spectrum urine toxicology screening upon presentation, 9 (17.6%) returned positive results for THC, a proportion higher than would be expected for the general population. All THC patients were male; 3 concurrently tested positive for cocaine, and 3 others had evidence of recent amphetamine use. The THC patients were significantly younger than the non-THC patients (mean ± standard deviation age 48 ± 11.3 versus 61.4 ± 12.3 years, respectively, P = .004). A greater proportion of the THC cohort had a known diagnosis of aortic aneurysm before the dissection (44.4% versus 4.8%, P = .006). All patients underwent expeditious surgical repair. Thirty-day mortality for the entire cohort of 51 patients was 19.6% (10 deaths); for the THC group, it was 11.1% (1 death). There was no difference in the incidence of major postoperative complications between the 2 groups.. Marijuana is the third most commonly used substance in the United States, after alcohol and tobacco. Although marijuana use is understudied, our results suggest that marijuana may be a contributing risk factor for acute type A aortic dissection, particularly in patients with other predisposing risk factors. Given the recent national trend to legalize marijuana, with the concomitant potential for exponential increases in its consumption, we suggest that the diagnosis of aortic dissection be considered earlier in any younger patient who presents with suggestive symptoms, especially if there is a history of recent marijuana use.

Topics: Acute Disease; Aortic Aneurysm, Thoracic; Aortic Dissection; Cannabis; Female; Follow-Up Studies; Humans; Incidence; Male; Marijuana Abuse; Middle Aged; Prognosis; Retrospective Studies; United States; Vascular Surgical Procedures

Given the constant high prevalence of cannabis use and cannabis dependence, it is important to determine protective behaviors on the individual level, which buffer the effects of risk factors. Protective Behavioral Strategies for Marijuana (PBSM) have been identified to play an important role for harm reduction in adolescent and young adult users. In the present study, we analyzed if PBSM moderate the effects of use motives (captured by the Marijuana Motives Measure, MMM) on the severity of dependence beyond the effects of age, gender, education and cannabis use frequency. We used confirmatory factor analysis (CFA) to validate the German versions of PBSM and MMM. Data was gathered in an online survey distributed to randomly chosen households in the city of Bern in the German speaking part of Switzerland. The final sample comprised 362 past-month users. Results showed negative correlations between PBSM and cannabis use frequency and severity of dependence. The only motives being correlated with severity of dependence were coping and routine, beyond frequency of use. PBSM significantly moderated the effect only of routine motives on the severity of dependence. However, only a few cases who used PBSM extensively were affected. PBSM appear to be an important factor to reduce harm among past-month users but not among those with dependent use patterns, e.g. coping and routine users. Clinical implications are discussed. The routine factor adds significantly to the MMM and should be implemented and improved in future studies. PBSM as well as the MMM can be used in future studies in German speaking populations.

Topics: Adaptation, Psychological; Adolescent; Adult; Aged; Cannabis; Factor Analysis, Statistical; Female; Germany; Harm Reduction; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Motivation; Protective Factors; Psychometrics; Risk Factors; Students; Surveys and Questionnaires

Sub-Saharan Africa is one of the top three regions with the highest rates of opioid-related premature mortality. Nyaope is the street name for what is believed to be a drug cocktail in South Africa although recent research suggests that it is predominantly heroin. Nyaope powder is most commonly smoked together with cannabis, a drug-use pattern unique to the region. Due to the increasing burden of this drug in low-income communities and the absence of human structural neuroimaging data of combination heroin and cannabis use disorder, we initiated an important cohort study in order to identify neuroanatomical sequelae. Twenty-eight male nyaope users and thirty healthy, matched controls were recruited from drug rehabilitation centers and the community, respectively. T1-weighted MRI images were obtained using a 3 T General Electric Discovery and cortical thickness was examined and compared. Nyaope users displayed extensive grey matter atrophy in the right hemispheric medial orbitofrontal, rostral middle frontal, superior temporal, superior frontal, and supramarginal gyri (two-sided t-test, p < 0.05, corrected for multiple comparisons). Our findings indicate cortical abnormality in nyaope users in regions involved in impulse control, decision making, social- and self-perception, and working memory. Importantly, affected brain regions show large overlap with the pattern of cortical abnormalities shown in heroin use disorder.

Topics: Adult; Atrophy; Cannabis; Case-Control Studies; Cerebral Cortex; Cohort Studies; Gray Matter; Heroin; Heroin Dependence; Humans; Illicit Drugs; Magnetic Resonance Imaging; Male; Marijuana Abuse; Neuroimaging; South Africa

Alcohol and cannabis are commonly used by adolescents in the United States. Both alcohol use disorder (AUD) and cannabis use disorder (CUD) have been associated with an increased risk of aggression. One form of aggression seen during retaliation is reactive aggression to social provocation. This study investigated the association between AUD and CUD symptom severity and recruitment of neural regions implicated in retaliation.. In this study, 102 youths aged 13-18 years (67 male; 84 in residential care) completed self-report measures of aggression-related constructs and participated in a retaliation task during functional magnetic resonance imaging to investigate the association between relative severity of AUD/CUD and atypical recruitment of regions implicated in retaliation.. AUD Identification Test scores were positively associated with irritability and reactive aggression scores. CUD Identification Test scores were positively associated with callous-unemotional traits and both proactive and reactive aggression scores. In functional magnetic resonance imaging analyses, only AUD Identification Test (not CUD Identification Test) scores were associated with an exaggerated recruitment of regions implicated in retaliation (dorsomedial frontal, anterior insula cortices, caudate, and, to a lesser extent, periaqueductal gray).. These data suggest that relative severity of AUD is associated with a disinhibited, exaggerated retaliation response that relates to an increased risk for reactive aggression. Similar findings were not related to severity of CUD.

Topics: Adolescent; Aggression; Alcoholism; Cannabis; Humans; Magnetic Resonance Imaging; Male; Marijuana Abuse; United States

Cannabis is an increasingly common recreational substance used by teenagers. However, there is limited data probing association of cardiac arrhythmias with marijuana use in this population.. We provide prevalence trends, disease burden and healthcare utilization of cardiac arrhythmias associated with cannabis use disorder (CUD) in hospitalized teenagers (13-20 years) using a large national administrative database in the United States from 2003-2016. We used partial least square regression analysis for assessing trends in prevalence of cardiac arrhythmias and multiple logistic regression to elucidate independent predictors of arrhythmias associated with CUD. Among all CUD related hospitalizations (n = 876, 431), 0.5% had arrhythmias. Prevalence trends of arrhythmias among CUD increased six-fold during the study period (P < 0.001). CUD was more prevalent in males and older teens (both P < 0.001). There was a significant risk for mortality when CUD was associated with arrhythmia (7.4% vs. 0.1%, P < 0.001). While mean length-of-stay (LOS) was shorter (4.4 vs. 5.4 days, P < 0.001) for patients with CUD, they incurred three times higher mean hospitalization charges when compared to CUD patients without arrhythmia ($45 959 vs. $18 986, P < 0.001). Both LOS and hospitalization charges showed an uptrend during the study period (P < 0.001). Congenital heart disease, congestive heart failure, hypertension, and obesity independently predicted arrhythmias in CUD while other substance abuse did not change the risk of arrhythmia in CUD.. Arrhythmia burden is increasing among teenagers with CUD, and co-occurrence of arrhythmia and CUD worsens hospital outcomes.

Topics: Adolescent; Arrhythmias, Cardiac; Cannabis; Hospitalization; Humans; Marijuana Abuse; Prevalence; United States

Topics: Adult; Cannabis; Cytochrome P-450 CYP2C19; Cytochrome P-450 CYP2C9; Humans; Male; Marijuana Abuse; Pharmacogenomic Variants; Syndrome; Vomiting

Two of the most commonly used illegal substances by adolescents are alcohol and cannabis. Alcohol use disorder (AUD) and cannabis use disorder (CUD) are associated with poorer decision-making in adolescents. In adolescents, level of AUD symptomatology has been negatively associated with striatal reward responsivity. However, little work has explored the relationship with striatal reward prediction error (RPE) representation and the extent to which any augmentation of RPE by novel stimuli is impacted. One-hundred fifty-one adolescents participated in the Novelty Task while undergoing functional magnetic resonance imaging (fMRI). In this task, participants learn to choose novel or non-novel stimuli to gain monetary reward. Level of AUD symptomatology was negatively associated with both optimal decision-making and BOLD response modulation by RPE within striatum and regions of prefrontal cortex. The neural alterations in RPE representation were particularly pronounced when participants were exploring novel stimuli. Level of CUD symptomatology moderated the relationship between novelty propensity and RPE representation within inferior parietal lobule and dorsomedial prefrontal cortex. These data expand on an emerging literature investigating individual associations of AUD symptomatology levels versus CUD symptomatology levels and RPE representation during reinforcement processing and provide insight on the role of neuro-computational processes underlying reinforcement learning/decision-making in adolescents.

Topics: Adolescent; Alcoholism; Cannabis; Depressive Disorder, Major; Female; Humans; Magnetic Resonance Imaging; Male; Marijuana Abuse; Reward; Underage Drinking

Topics: Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Suicidal Ideation

Topics: Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Suicidal Ideation

Cannabis use disorder (CUD) during pregnancy has increased dramatically in the United States (US). This study examined the associations between prenatal CUD and adverse neonatal outcomes and heterogeneities in the associations by mothers' tobacco use status and race/ethnicity.. Population-based, retrospective cohort study.. California, USA.. A total of 4.83 million mothers who delivered a live singleton birth during 2001 to 2012 and their paired infants. Data were obtained from mother-infant linked hospital discharge records and birth and death certificates. Identified by ICD-9 codes recorded at delivery, 20 237 mothers had prenatal CUD.. Neonatal outcomes included length of gestation, preterm birth, birth weight, admission into neonatal intensive care unit, hospitalization within 1 year of birth, and death within 1 year of birth. Propensity score matching was used to balance maternal, paternal, and infant characteristics in the comparisons between infants exposed and unexposed to prenatal CUD.. CUD increased from 2.8 to 6.9 per 1000 deliveries during 2001 to 2012. Multivariable regressions in matched samples estimated that prenatal CUD was associated with greater odds of being small for gestational age (OR = 1.13, 95% CI = 1.08, 1.18), preterm birth (OR = 1.06, 95% CI = 1.01, 1.12), low birth weight (OR = 1.13, 95% CI = 1.07, 1.20), and death within 1 year of birth (OR = 1.35, 95% CI = 1.12, 1.62). Compared with infants whose mothers were tobacco non-users, infants whose mothers were tobacco users had greater odds of preterm birth, low birth weight, hospitalization, and death in association with prenatal CUD. Compared with infants whose mothers were non-Hispanic White, infants whose mothers were Hispanic had greater odds of hospitalization and death and infants whose mothers were non-Hispanic Black had greater odds of being small for gestational age in association with prenatal CUD.. Prenatal cannabis use disorder appears to be associated with escalated odds of major adverse neonatal outcomes, with heterogeneities in the associations by mothers' tobacco use status and race/ethnicity.

Topics: Cannabis; Humans; Infant, Newborn; Marijuana Abuse; Mothers; Pregnancy; Premature Birth; Retrospective Studies

An association has been found between cannabis use disorder (CUD) and violence in several clinical populations, including veterans with posttraumatic stress disorder (PTSD), and there is evidence that CUD has been increasing among veterans since September 11, 2001. There is also evidence that some veterans may be attempting to self-medicate psychological problems including PTSD and aggression with cannabis, despite the lack of safety and efficacy data supporting this use. To date, however, the association between CUD and aggression has yet to be examined in a large, non-clinic sample of veterans. The present study examined the association between cannabis use disorder, anger, aggressive urges, and difficulty controlling violence in a large sample of Iraq/Afghanistan-era veterans (N = 3028). Results of multivariate logistic regressions indicated that current CUD was significantly positively associated with difficulty managing anger (OR = 2.93, p < .05), aggressive impulses/urges (OR = 2.74, p < .05), and problems controlling violence in past 30 days (OR = 2.71, p < .05) even accounting for demographic variables, comorbid symptoms of depression and PTSD, and co-morbid alcohol and substance use disorders. Lifetime CUD was also uniquely associated with problems controlling violence in the past 30 days (OR = 1.64, p < .05), but was not significantly associated with difficulty managing anger or aggressive impulses/urges. Findings indicated that the association between CUD and aggression needs to be considered in treatment planning for both CUD and problems managing anger and aggressive urges, and point to a critical need to disentangle the mechanism of the association between CUD and violence in veterans.

Topics: Afghanistan; Anger; Cannabis; Humans; Iraq; Iraq War, 2003-2011; Marijuana Abuse; Stress Disorders, Post-Traumatic; Veterans; Violence

Sensorimotor dysfunction has been previously reported in persons with cannabis dependence. Such individuals can exhibit increased levels of neurological soft signs (NSS), particularly involving motor coordination and sensorimotor integration. Whether such abnormalities may also apply to non-dependent individuals with heavy cannabis use (HCU) is unknown, as much as the neural correlates underlying such deficits. In this study, we investigated associations between NSS and gray matter volume (GMV) in males with HCU and male controls. Twenty-four persons with HCU and 17 controls were examined using standardized assessment of NSS and structural magnetic resonance imaging (MRI) at 3 T. GMV was calculated using voxel-based morphometry algorithms provided by the Computational Anatomy Toolbox (CAT12). Individuals with HCU showed higher NSS total scores compared to controls. In particular, significant NSS-subdomain effects were found for "motor coordination" (MoCo), "complex motor tasks" (CoMT), and "hard signs" (HS) expression in HCU (p < 0.05, Bonferroni-corrected). Compared to controls, persons with HCU showed significant NSS/GMV interactions in putamen and inferior frontal cortex (MoCo), right cerebellum (CoMT) and middle and superior frontal cortices, and bilateral precentral cortex and thalamus (HS). In between-group analyses, individuals with HCU showed lower GMV in the right anterior orbital and precentral gyrus, as well as higher GMV in the right superior frontal gyrus and left supplementary motor cortex compared to controls. The data support the notion of abnormal sensorimotor performance associated with HCU. The data also provide a neuromechanistic understanding of such deficits, particularly with respect to aberrant cortical-thalamic-cerebellar-cortical circuit.

Topics: Adolescent; Adult; Brain; Cannabis; Cerebellum; Gray Matter; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Marijuana Abuse; Motor Cortex; Prefrontal Cortex; Psychomotor Performance; Young Adult

Males and females show different patterns of cannabis use and related psychosocial outcomes. However, the neuroanatomical substrates underlying such differences are poorly understood. The aim of this study was to map sex differences in the neurobiology (as indexed by brain volumes) of dependent and recreational cannabis use. We compared the volume of a priori regions of interest (i.e., amygdala, hippocampus, nucleus accumbens, insula, orbitofrontal cortex (OFC), anterior cingulate cortex and cerebellum) between 129 regular cannabis users (of whom 70 were recreational users and 59 cannabis dependent) and 114 controls recruited from the ENIGMA Addiction Working Group, accounting for intracranial volume, age, IQ, and alcohol and tobacco use. Dependent cannabis users, particularly females, had (marginally significant) smaller volumes of the lateral OFC and cerebellar white matter than recreational users and controls. In dependent (but not recreational) cannabis users, there was a significant association between female sex and smaller volumes of the cerebellar white matter and OFC. Volume of the OFC was also predicted by monthly standard drinks. No significant effects emerged the other brain regions of interest. Our findings warrant future multimodal studies that examine if sex and cannabis dependence are specific key drivers of neurobiological alterations in cannabis users. This, in turn, could help to identify neural pathways specifically involved in vulnerable cannabis users (e.g., females with cannabis dependence) and inform individually tailored neurobiological targets for treatment.

Topics: Amygdala; Cannabis; Female; Hippocampus; Humans; Magnetic Resonance Imaging; Male; Marijuana Abuse

Topics: Adolescent; Aggression; Alcohol-Related Disorders; Alcoholism; Cannabis; Humans; Marijuana Abuse

Cognitive impairment is among the core features of schizophrenia. In a healthy population, the cognitive deficit is often linked with cannabis abuse, and although the same would be expected in patients with schizophrenia, research has presented contradictory results.. Participants were patients with first-episode schizophrenia (FES) spectrum disorder who had been lifetime cannabis users (. FES patients using cannabis showed less impaired cognitive functioning with the most prominent difference in visual memory compared to FES non-users. However, they differed neither in the clinical assessment of general psychopathology, positive and negative symptoms, nor in medication from the patient's non-users. A comparison of the HC who used cannabis, and those who did not, revealed no sizeable differences in cognitive performance between the groups.. The results delivered supporting evidence for the trend of superior neurocognitive performance in FES patients with a lifetime history of cannabis use compared to non-using patients.

Topics: Cannabis; Cognition; Cognition Disorders; Humans; Marijuana Abuse; Schizophrenia

In the United States, 15 states and the District of Columbia have implemented recreational cannabis laws (RCLs) legalizing recreational cannabis use. We aimed to estimate the association between RCLs and street prices, potency, quality and law enforcement seizures of illegal cannabis, methamphetamine, cocaine, heroin, oxycodone, hydrocodone, morphine, amphetamine and alprazolam.. We pooled crowdsourced data from 2010-19 Price of Weed and 2010-19 StreetRx, and administrative data from the 2006-19 System to Retrieve Information from Drug Evidence (STRIDE) and the 2007-19 National Forensic Laboratory Information System (NFLIS). We employed a difference-in-differences design that exploited the staggered implementation of RCLs to compare changes in outcomes between RCL and non-RCL states.. Eleven RCL and 40 non-RCL US states.. The primary outcome was the natural log of prices per gram, overall and by self-reported quality. The primary policy was an indicator of RCL implementation, defined using effective dates.. The street price of cannabis decreased by 9.2% [β = -0.092; 95% confidence interval (CI) = -0.15-, -0.03] in RCL states after RCL implementation, with largest declines among low-quality purchases (β = -0.195; 95% CI = -0.282, -0.108). Price declines were accompanied by a 93% (β = -0.93; 95% CI = -1.51, -0.36) reduction in law enforcement seizures of cannabis in RCL states. Among illegal opioids, including heroin, oxycodone and hydrocodone, street prices increased and law enforcement seizures decreased in RCL states.. Recreational cannabis laws in US states appear to be associated with illegal drug market responses in those states, including reductions in the street price of cannabis. Changes in the street prices of illegal opioids analyzed may suggest that in states with recreational cannabis laws the markets for other illegal drugs are not independent of legal cannabis market regulation.

Topics: Cannabis; Heroin; Humans; Illicit Drugs; Legislation, Drug; Marijuana Abuse; United States

From a secondary prevention perspective, it is useful to know who is at greatest risk of progressing from substance initiation to riskier patterns of future use. Therefore, the aim of this study was to determine relationships between age at first use of alcohol, tobacco and cannabis and patterns of cannabis use, frequency of use and whether age of substance use onset is related to having a cannabis use disorder (CUD).. We analysed data from Ireland's 2010/11 and 2014/15 National Drug Prevalence Surveys, which recruited 5134 and 7005 individuals respectively, aged 15 years and over, living in private households. We included only those people who reported lifetime cannabis use. Multinomial, linear and binary logistic regression analyses were used to determine relationships between age of substance use onset and patterns of cannabis use, frequency of use and having a CUD.. When compared to former users, the odds of being a current cannabis user were found to be reduced by 11% (OR = 0.89; 95% CI: 0.83, 0.95) and 4% (OR = 0.96; 95% CI: 0.92, 1.00) for each year of delayed alcohol and cannabis use onset, respectively. Among current users, significant inverse linear relationships were noted, with increasing age of first use of tobacco (β = - 0.547; P < .001) and cannabis (β = - 0.634; P < .001) being associated with a decreased frequency of cannabis use within the last 30 days. The odds of having a CUD were found to be reduced by 14% (OR = 0.86; 95% CI: 0.78, 0.94) and 11% (OR = 0.89; 95% CI: 0.82, 0.98) for each year of delayed tobacco and cannabis use onset respectively in analyses which examined survey participants aged 15-34 years.. Among people who report past cannabis use, it is those with a more precocious pattern of early use of substances, including alcohol, and especially tobacco and cannabis, who are more likely to report ongoing, heavy and problematic cannabis use. Secondary prevention initiatives should prioritise people with a pattern of very early onset substance use.

Topics: Cannabis; Humans; Longitudinal Studies; Marijuana Abuse; Prevalence; Substance-Related Disorders

Alcohol and cannabis co-use is a between-group risk factor for heavier drinking and negative consequences, but only one study has tested links between co-use and AUD. In addition, few studies focus on risk profiles within co-users, despite heterogeneity in levels of co-use. The current study tested between-group (co-users vs. alcohol-/cannabis-only users) and within-group (patterns of co-use) risk profiles for AUD and CUD in a large, nationally representative sample.. Data from the 2002-2019 National Study on Drug Use and Health (NSDUH) were used for analyses (N = 1,005,421). Analyses tested 1) whether co-users had greater odds of AUD/CUD than alcohol- and cannabis-only users, respectively, 2) whether there were latent profiles of co-use patterns within co-users, and 3) whether profile membership conferred within-group risk for AUD/CUD.. Co-users were at 3.38 greater odds of having an AUD, but co-use did not confer risk for CUD. Within co-users, five latent profiles emerged: weekly alcohol/cannabis use, weekly alcohol/monthly cannabis, weekly cannabis/occasional alcohol, weekly alcohol/occasional cannabis, and occasional use of both. Multiple comparisons suggested that, generally as frequency of each substance use increased, odds of both AUD and CUD became greater.. Primary alcohol users who also use cannabis are at risk for AUD, but the opposite effect was not observed in primary cannabis users. Higher frequency of each substance also conferred risk within co-users for both AUD and CUD. Findings add novel contributions that should be considered within both alcohol and cannabis use interventions. Future studies using prospective data are needed.

Topics: Alcoholism; Cannabis; Humans; Marijuana Abuse; Prospective Studies; Substance-Related Disorders

Abstinence remains a standard outcome for potential treatment interventions for Cannabis Use Disorder (CUD). However, there needs to be validation of non-abstinent outcomes. This study explores reductions in self-reported days of use as another viable outcome measure using data from three completed randomized placebo-controlled clinical trials of pharmacological interventions for CUD.. The three trials tested the effect of quetiapine (QTP, n = 113); dronabinol (DRO, n = 156); and lofexidine + dronabinol (LFD, n = 122). Self-reported cannabis use was categorized into three use-groups/week: heavy (5-7 days/week), moderate (2-4 days/week) and light use (0-1 days/week). Multinomial logistic regressions analyzed the treatment by time effect on the likelihood of light and moderate use compared to heavy use in each study.. Across the three trials, there was no significant overall time-by-treatment interaction (QTP: p = .06; DRO: p = .15; LFD: p = .21). However, the odds of moderate compared to heavy use were significantly higher in treatment than in placebo groups starting around the midpoint of each trial. No treatment differences were found between the odds of light compared to heavy use.. While study-end abstinence rates have been a standard treatment outcome for CUD trials, reduction from heavy to moderate use has not been standardly assessed. During the last several weeks of each trial, those on active medication were more likely to move from heavy to moderate use, which suggests that certain medications may be more impactful than previously assessed. Future studies should determine if this pattern is associated with less CUD severity and/or improved quality of life.

Topics: Cannabis; Dronabinol; Humans; Marijuana Abuse; Quality of Life; Treatment Outcome

Topics: Adolescent; Adult; Cannabis; Emergency Service, Hospital; Female; Humans; Male; Marijuana Abuse; Marijuana Use; Michigan; Retrospective Studies; Syndrome; Vomiting; Young Adult

Screening, brief intervention, and referral to treatment (SBIRT) can reduce substance use, but receipt of these services by those who use cannabis frequently and have cannabis use disorder (CUD) remains unexplored. We examined cannabis use frequency and CUD's associations with the odds of receiving a substance use screening and a healthcare professional discussion among those who used healthcare services.. Data came from the 2015-2019 National Survey on Drug Use and Health (N = 214,505 aged 18+). Among adults who used cannabis and attended healthcare settings in the past year (N = 36,374), multivariable logistic regression analysis was used to examine associations of cannabis use frequency and CUD with receiving a substance use screen and substance use discussion by a healthcare professional.. Cannabis use frequency was associated with higher odds of receiving a screen (adjusted odds ratio [AOR] = 1.27, 95% confidence interval [CI] = 1.14-1.41 for 300+ days of use) and a discussion among those screened (AOR = 1.83, 95% CI = 1.60-2.09 for 300+ days of use). CUD was not associated with receiving a screen, but it was positively associated with receiving a discussion among those screened (AOR = 1.22, 95% CI = 1.08-1.39). Nonmedical users were less likely to have a discussion among those screened and not screened.. Findings indicate disparities in screening and discussion of substance use with patients, especially between medical and nonmedical users.. Study findings provide novel insight into differences in the reach of SBIRT services among adult cannabis users.

Topics: Adult; Cannabis; Delivery of Health Care; Hallucinogens; Humans; Marijuana Abuse; Substance-Related Disorders

Persons with severe opioid or cocaine use disorders are particularly vulnerable to morbidity and mortality. Heaviest use of mu-opioid receptor agonists and cocaine typically commences in early adulthood and is preceded by substantial adolescent exposure to cannabis and/or alcohol. Little information exists on the age trajectories of exposure to cannabis or alcohol in persons diagnosed with severe opioid or cocaine use disorders, compared to persons diagnosed with other substance use disorders (unrelated to opioids or cocaine).. This observational study had n = 854 volunteers (male = 581, female = 273; ≥18 years of age at the time of interview) and examined the ages of onset of heaviest use of cannabis and alcohol in persons diagnosed by DSM-IV criteria with opioid dependence (OD), both opioid and cocaine dependence (OD + CD) and cocaine dependence (CD). These age trajectory measures were compared to persons with other substance use disorders (primarily cannabis and alcohol use disorders, termed "Any Other Diagnoses").. Unadjusted survival analyses showed persons diagnosed with either OD + CD or CD had earlier onset of heaviest use of cannabis (mean ages of 16.2 and 17.8, respectively) compared to the "Any Other Diagnoses" reference group (mean age = 19.5). A multivariate logistic regression showed that later onset of heaviest use of cannabis was associated with lower odds of being in the OD + CD or CD groups, when compared to the reference group.. Persons diagnosed with severe cocaine use disorders or dual opioid and cocaine use disorders exhibit a pattern of heavy and especially early adolescent exposure to cannabis, compared to persons with other substance use disorders.

Topics: Adolescent; Adult; Age of Onset; Alcoholism; Analgesics, Opioid; Cannabis; Cocaine; Humans; Marijuana Abuse; Opioid-Related Disorders; Substance-Related Disorders; Young Adult

Regular cannabis use, even without cannabis use disorder (CUD), is associated with numerous biopsychosocial problems. Biopsychosocial risk factors that precede regular use and CUD might reflect broader pre-existing risk factors rather than the consequence of cannabis use. We aimed to (1) replicate prior work differentiating psychosocial problems associated with regular cannabis use with or without CUD relative to no-use in adulthood, and (2) test if these use groups differed in biopsychosocial functioning in early and middle childhood.. Biopsychosocial characteristics of individuals at-risk for substance use problems (n = 402) reporting no-use, regular use without CUD, and regular use with CUD by young adulthood were prospectively compared during early childhood (ages 3-5), middle childhood (ages 9-11) and young adulthood (ages 18-25).. Regular use (vs. no-use) was associated with more health problems (mean d = |0.57|), psychopathology (mean d = |0.72|), social and family environment risk (mean d = |0.88|) in childhood and adulthood and comorbid substance use in adulthood (mean d = |1.25|). Regular use with and without CUD was linked to similar, developmentally-persistent patterns of problems across domains.. We found that childhood risk factors present many years prior to cannabis initiation (as early as age 3) differentiated patterns of adult cannabis use and CUD status in adulthood. Therefore, biopsychosocial impairments associated with regular cannabis use in adulthood is not solely attributable to cannabis exposure but can be traced back to early and persistent biopsychosocial risk that may benefit from early behavioral intervention, irrespective of CUD diagnosis.

Topics: Adolescent; Adult; Cannabis; Child; Child, Preschool; Family; Humans; Interpersonal Relations; Marijuana Abuse; Substance-Related Disorders; Young Adult

Research exploring patterns and predictors of problematic cannabis use behaviors among young adults is limited. This knowledge is essential for intervening to prevent abuse and dependence outcomes.. Young adult cannabis users (Mage = 19.2[SD = 0.8]) in Southern California (N = 1007) were classified by patterns of problematic cannabis use from the Cannabis Abuse Screening Test, using Latent Class Analysis. Multinomial regression evaluated the association of frequency of use (no past 30 day use, infrequent [use on 1-2 of past 30 days], semi-frequent [use on 3-9 of the past 30 days], and frequent [use on 10 or more of the past 30 days]) for each cannabis product type (combustible, edible, vaporized, concentrate, blunt) with class membership.. Four distinct classes of cannabis-related problems were identified: "non-symptomatic" (no problems; 33.8 %), "non-recreational use" (before noon and when alone; 34.5 %), "moderate use problems" (before noon, alone, and memory problems; 8.0 %), and "severe cannabis problems" (all 6 problems; 23.7 %). Semi-frequent (AOR range: 1.85-4.63;ps<0.05) and frequent (AOR range: 9.18-24.2;ps<0.05) use of combustible and vaporized cannabis, frequent blunt use (AORs range: 4.03-10.3;ps<0.05), and semi-frequent, but not frequent edible use (AOR range: 2.57-2.73;ps<0.05) was associated with higher odds of classification in any problematic use class (vs. non-symptomatic).. Differences in cannabis use problems across these classes and their predictors reveal the heterogeneity in cannabis-related problems experienced by young people. Combustible cannabis, vaporized cannabis, and blunt cannabis use may confer the most risk for cannabis abuse and dependency outcomes, with more frequent days of use contributing to increased patterns of risk.

Topics: Adolescent; Cannabis; Humans; Latent Class Analysis; Marijuana Abuse; Young Adult

Cannabis use is associated with relative cognitive weaknesses as observed by cross-sectional as well as longitudinal research. Longitudinal studies, controlling for relevant confounds, are necessary to differentiate premorbid from post-initiation contributions to these effects.. We followed a sample of adolescents and young adults across ten years. Participants provided neurocognitive data and substance use information at two-year intervals. Participants who initiated cannabis and/or alcohol use were identified (n = 86) and split into alcohol-only initiators (n = 39) and infrequent (n = 29) and moderately frequent (n = 18) cannabis initiators. Participants completed the Rey Auditory Verbal Learning Task (RAVLT) and the Iowa Gambling Task (IGT). Group differences before and after substance use initiation and the extent to which alcohol, nicotine, and cannabis use frequencies contributed to cognitive functions over time were examined.. After controlling for parental education, RAVLT new learning was worse in moderately frequent cannabis users prior to use initiation. RAVLT total learning and delayed recall showed significant declines from pre- to post-initiation in moderately frequent cannabis users. Regression analyses confirmed that frequencies of cannabis, but not alcohol, use contributed to post-initiation variations. Nicotine use showed an independent negative association with delayed memory. Findings for the IGT were not significant.. Verbal learning and memory may be disrupted following the initiation of moderately frequent cannabis use while decreased new learning may represent a premorbid liability. Our use of a control group of alcohol-only users adds interpretive clarity to the findings and suggests that future studies should carefully control for comorbid substance use.

Topics: Adolescent; Adult; Cannabis; Cognition; Cross-Sectional Studies; Humans; Marijuana Abuse; Neuropsychological Tests; Verbal Learning; Young Adult

Topics: Analgesics; Cannabis; Hallucinogens; Humans; Marijuana Abuse

This short communication reports on the association of annual measures of young adult (age 18-24) past month cannabis use with cannabis use disorder (CUD) treatment admissions by state in the U.S. from 2008 to 2017.. Annual data on percentage of past month cannabis use and the total number of CUD treatment admissions among young adults were acquired for each state from SAMHSA NSDUH and TEDS-A data sets. For each state, the correlation over time between cannabis use and treatment admissions rate was calculated and visualized in a choropleth map. Fixed-effects regression, where effects are fixed by state, was used to investigate the association of cannabis use with treatment admissions rate.. In 38 out of 50 states, including seven out of the eight states legalizing recreational cannabis during the study period, as young adult cannabis use increased, treatment admissions declined. Cannabis use is significantly and negatively associated with treatment admissions (β = -7.21, 95% CI = -11.88, -2.54), even after controlling for health insurance coverage, criminal justice referral, treatment center availability, and cannabis legalization status.. While it is possible that across the U.S. more young adults are using cannabis without developing CUD, we speculate that increasing social acceptance of cannabis use, and declining perception of harm, may influence treatment seeking behavior, potentially resulting in growing unmet need for CUD treatment among young adults. Monitoring state-level trends in cannabis use, CUD prevalence, and treatment admissions is key to developing CUD prevention and treatment policies targeted to timely, state-specific conditions.

Topics: Adolescent; Adult; Cannabis; Hallucinogens; Humans; Legislation, Drug; Marijuana Abuse; Medical Marijuana; United States; Young Adult

Epidemiological studies show that the use of cannabis is related to the use of other illicit drugs, including stimulants such as cocaine and ecstasy. However, few studies have examined how patterns of cannabis use relate to the use of stimulants. In this research we determined relationships between patterns of cannabis use and recent stimulant use, drawing on data from two large nationally representative surveys. We also explored how frequency of cannabis use relates to stimulant use and whether subjects with a cannabis use disorder (CUD)-defined as cannabis abuse or dependence-are more likely to be recent users of cocaine or ecstasy.. We analysed data from Ireland's 2010/11 and 2014/15 National Drug Prevalence Surveys,which recruited 5,134 and 7,005 individuals respectively, aged 15 years and over, living in private households. We included only those people who reported some past cannabis use. Multivariable logistic regression analysis was used to examine associations between patterns of cannabis use and recent stimulant use.. Among survey participants who had used cannabis in the last month, 17.9% reported recent cocaine use, while almost one-quarter (23.6%) reported recent ecstasy use. There was a significant linear relationship between patterns of cannabis use and recent use of cocaine, ecstasy or any stimulant, with last month cannabis users displaying greater odds (OR = 12.03, 95% CI: 8.15-17.78) of having recent stimulant use compared to last year (OR = 4.48, 95% CI: 2.91-6.91) and former (reference) cannabis users. Greater frequency of cannabis use in the last 30 days was also significantly related to the use of stimulants. In addition, results demonstrated an association between CUD and recent use of cocaine or ecstasy (OR = 2.28, 95% CI: 1.55-3.35).. Findings from this study suggest a relationship between patterns and frequency of cannabis use and recent use of stimulants and an association between CUD and stimulant use. As the use of cannabis with stimulants may increase the risk of negative health consequences, education in community and medical settings about polydrug use and its increased risks may be warranted.

Topics: Adolescent; Adult; Cannabis; Central Nervous System Stimulants; Cocaine; Cocaine-Related Disorders; Female; Hallucinogens; Humans; Ireland; Male; Marijuana Abuse; Marijuana Smoking; Young Adult

Topics: Aging; Analgesics; Cannabis; Hallucinogens; Humans; Infant; Marijuana Abuse

To investigate the differences in negative coping styles used by individuals with cannabis use disorder and non-users.. The quantitative cross-sectional study was conducted from November, 2016 to August 2017 at Foundation University, Rawalpindi, Pakistan, and comprised individuals aged 15-34 years. Data was collected from drug rehabilitation and university students of Rawalpindi and Islamabad. The sample was divided into groups of cannabis users and non-users. Data was collected using the brief version of the Coping Orientation to Problems Experienced inventory and the Diagnostic and Statistical Manual of Mental Disorders version 5. Data was analysed using SPSS 21.. Of the 204 participants, 104(51%) were users with a mean age of 27±5.37 years and 100(49%) were non-users with a mean age of 25±5.65 years. The users scored higher at active avoidance coping compared to the non-users (p<0.05). The differences were non-significant in case of denial and religious coping (p>0.05). Active avoidance coping differed across individuals with mild, moderate and severe cannabis use disorder (p<0.05), while religious and denial coping did not (p>0.05).. Active avoidance coping was found to be an important characteristic in relation to cannabis use disorder.

Topics: Adaptation, Psychological; Adult; Cannabis; Cross-Sectional Studies; Humans; Marijuana Abuse; Universities; Young Adult

Recent observations indicate that cannabis use can result in cardiovascular complications including arrhythmias. We studied the relationship between cannabis use disorder (CUD) and arrhythmia hospitalization.. We conducted a retrospective analysis of the Nationwide Inpatient Sample (2010-2014). Patients (age 15-54) with a primary diagnosis for arrhythmia (N = 570,556) were compared with non-arrhythmia (N = 67,662,082) inpatients for odds ratio (OR) of CUD by the logistic regression model, adjusted for demographics and comorbid risk factors.. The incidence of CUD in arrhythmia inpatients was 2.6%. Among cannabis users, the most prevalent arrhythmia was atrial fibrillation (42%), followed by other arrhythmias (24%) and atrial flutter (8%). Patients with CUD were younger (15-24 years, OR: 4.23), male (OR: 1.70), and African American (OR: 2.70). CUD was associated with higher odds of arrhythmia hospitalization in the young population, 1.28 times in 15-24 years (95% confidence interval [CI]: 1.229-1.346) and 1.52 times in 25-34 years (95% CI: 1.469-1.578).. With the growing legalization in the United States, there is an increased use of medicinal/recreational cannabis. This is the first national study to our knowledge that found that CUD is associated with a 47%-52% increased likelihood of arrhythmia hospitalization in the younger population and the risk of association was controlled for potential confounders including other substances. The fact that atrial fibrillation is the most prevalent arrhythmia is of special concern since it can result in stroke and other embolic events. Physicians need to familiarize themselves with cannabis abuse or dependence as a risk factor for arrhythmia.

Topics: Adolescent; Adult; Arrhythmias, Cardiac; Cannabis; Hospitalization; Humans; Marijuana Abuse; Middle Aged; Prevalence; Retrospective Studies; United States; Young Adult

Systematic screening of problematic cannabis use does not include the motivations that lead to consumption, although from a person-centered perspective this is fundamental. The present study explores the motivations for cannabis use in adults and its relationship with cannabis use patterns and problematic use.. Adult cannabis users (previous 60 days) were recruited in the province of Barcelona (n = 468). Information on their sociodemographic data, cannabis use pattern, Cannabis Abuse Screening Test (CAST) and the main motivation for use were collected. Motivations were categorized a posteriori according to the Marijuana Motives Measures (MMM). A descriptive and inferential analysis was carried out to link the motivations to sociodemographic variables, consumption pattern and probability of suffering problematic cannabis use (CAST).. Using cannabis to heighten positive feelings (35%), out of habit (29%) and to cope with negative feelings (25%) were the most frequent motivations. In comparison to other motivations, coping is related to a greater quantity of cannabis used (4 vs 3 joints per day, p = 0.005), higher probability of problematic cannabis use (77% vs 64%, p = 0.05), and greater social vulnerability (unemployment 56% vs 37%, p = 0.001; and low educational level 14% vs 8%, p = 0.042).. Coping as a motivation for cannabis use is present in one out of four users and is a marker of social vulnerability, greater quantity of cannabis used and higher risk of problematic use. Patient-centered care together with preventive (emotional and social education) and clinical strategies (psychotherapy) can be useful for this population at higher risk.. Introducción. El cribado sistemático del consumo problemático de cannabis no incluye las motivaciones que llevan al consumo, aunque desde una perspectiva de atención centrada en la persona, este dato sea fundamental. El presente estudio explora las motivaciones de consumo de cannabis en adultos y su relación con el patrón de consumo y consumo problemático.  Método. Consumidores adultos de cannabis (en los últimos 60 días) fueron reclutados en la provincia de Barcelona (n=468). Se pasó un cuestionario para explorar datos sociodemográficos, patrón de uso, la Cannabis Abuse Screening Test (CAST) y la motivación principal para el consumo. Los motivos de consumo se categorizaron a posteriori según la Marijuana Motives Measures (MMM). Se realizó un análisis descriptivo e inferencial para explorar la relación entre la motivación categorizada y variables sociodemográficas, patrón de consumo y puntuaciones de la CAST.Resultados. Consumir cannabis para mejorar las emociones positivas (35%), por costumbre (29%) y para afrontar emociones negativas (25%) fueron las motivaciones más frecuentes. Respecto a otras motivaciones, el “afrontamiento” se relaciona con mayor cantidad consumida (4 vs 3 porros/día, p = 0,005), mayor probabilidad de tener un consumo problemático (77% vs 64%, p = 0,05), y mayor vulnerabilidad social (desempleo 56% vs 37%, p = 0,001; y bajo nivel de estudios (14% vs 8%, p = 0,042)). Conclusiones. El afrontamiento está presente en uno de cada cuatro usuarios de cannabis, es un marcador de vulnerabilidad social y de mayor cantidad de consumo de cannabis y probabilidad de consumo problemático. Una atención centrada en la persona junto con estrategias preventivas (educación emocional y social) y clínicas (psicoterapia) pueden ser de utilidad en esta población de mayor riesgo.

Topics: Adaptation, Psychological; Adolescent; Adult; Cannabis; Educational Status; Female; Humans; Male; Marijuana Abuse; Motivation; Patient-Centered Care; Spain; Surveys and Questionnaires; Unemployment; Young Adult

Cannabis use has been associated with adverse mental health outcomes, the neurochemical underpinnings of which are poorly understood. Although preclinical evidence suggests glutamatergic dysfunction following cannabis exposure in several brain regions including the hippocampus, evidence from human studies have been inconsistent. We investigated the effect of persistent cannabis use on the brain levels of N-acetyl aspartate (NAA) and myoinositol, the metabolite markers of neurons and glia, the site of the main central cannabinoid CB1 receptor, and the levels of glutamate, the neurotransmitter directly affected by CB1 modulation. We investigated cannabis users (CUs) who started using during adolescence, the period of greatest vulnerability to cannabis effects and focused on the hippocampus, where type 1 cannabinoid receptors (CBR1) are expressed in high density and have been linked to altered glutamatergic neurotransmission. Twenty-two adolescent-onset CUs and 21 nonusing controls (NU), completed proton magnetic resonance spectroscopy, to measure hippocampal metabolite concentrations. Glutamate, NAA, and myoinositol levels were compared between CU and NU using separate analyses of covariance. CU had significantly lower myoinositol but not glutamate or NAA levels in the hippocampus compared with NU. Myoinositol levels in CU positively correlated with glutamate levels, whereas this association was absent in NU. Altered myoinositol levels may be a marker of glia dysfunction and is consistent with experimental preclinical evidence that cannabinoid-induced glial dysfunction may underlie cannabinoid-induced memory impairments. Future studies using appropriate imaging techniques such as positron emission tomography should investigate whether glial dysfunction associated with cannabis use underlies hippocampal dysfunction and memory impairment in CUs.

Topics: Adult; Alcohol Oxidoreductases; Aspartic Acid; Biomarkers; Cannabis; Female; Glutamic Acid; Hippocampus; Humans; Inositol; Male; Marijuana Abuse; Neuroglia; Neurons; Young Adult

Topics: Cannabis; Cohort Studies; Colorado; Emergency Service, Hospital; Female; Humans; Male; Marijuana Abuse; Medical Records; Patient Education as Topic; Retrospective Studies; Surveys and Questionnaires; Young Adult

Topics: Adult; Cannabis; Female; Humans; Male; Marijuana Abuse; Marijuana Use; Mindfulness; Young Adult

As new cannabis products and administration methods proliferate, patterns of use are becoming increasingly heterogeneous. However, few studies have explored different profiles of cannabis use and their association with problematic use.. Latent class analysis (LCA) was used to identify subgroups of past-year cannabis users endorsing distinct patterns of use from a large international sample (n = 55 240). Past-12-months use of six different cannabis types (sinsemilla, herbal, hashish, concentrates, kief, edibles) were used as latent class indicators. Participants also reported the frequency and amount of cannabis used, whether they had ever received a mental health disorder diagnosis and their cannabis dependence severity via the Severity of Dependence Scale (SDS).. LCA identified seven distinct classes of cannabis use, characterised by high probabilities of using: sinsemilla & herbal (30.3% of the sample); sinsemilla, herbal & hashish (20.4%); herbal (18.4%); hashish & herbal (18.8%); all types (5.7%); edibles & herbal (4.6%) and concentrates & sinsemilla (1.7%). Relative to the herbal class, classes characterised by sinsemilla and/or hashish use had increased dependence severity. By contrast, the classes characterised by concentrates use did not show strong associations with cannabis dependence but reported greater rates of ever receiving a mental health disorder diagnosis.. The identification of these distinct classes underscores heterogeneity among cannabis use behaviours and provides novel insight into their different associations with addiction and mental health.

Topics: Adolescent; Adult; Cannabis; Cross-Sectional Studies; Female; Humans; Latent Class Analysis; Linear Models; Male; Marijuana Abuse; Mental Disorders; Self Report; Severity of Illness Index; Young Adult

Topics: Analgesics; Cannabis; Developed Countries; Female; Humans; Marijuana Abuse; Pregnancy; Prevalence

The literature on psychosis-relevant outcomes in cannabis users does not adequately address the confounding effects of other substance use/misuse and psychiatric disorders.. We studied a unique population for whom cannabis use is central and necessary to their way of life. They are forbidden from using other substances, including tobacco and alcohol. Their use of cannabis is heavy, chronic, and begins early. The cases were compared with matched controls who did not use cannabis, alcohol, or drugs. The controls were from the same location and shared similar beliefs and lifestyle, except for cannabis use. Attenuated psychosis-relevant phenomena were assessed with the Schizotypal Personality Questionnaire (SPQ) and cognitive functioning with a culture-neutral computerized cognitive battery.. Fifteen cases and 12 matched controls were studied. The cases averaged >30 000 lifetime cannabis exposures. Relative to controls, the cases had significantly higher mean (s.d.) SPQ scores 24 (14.32) v. 13 (8.92), p = 0.031; and poorer cognitive performance, reflected by a lower mean (s.d.) composite cognitive score -0.23 (0.32) v. +0.28 (0.52), p = 0.03. Moderate to large effect sizes were noted for differences in tests of attention, psychomotor speed, working memory, cognitive flexibility, visuo-spatial processing, and verbal memory. A subsample of cases had higher SPQ scores and worse cognitive performance than their siblings not using cannabis.. Heavy, chronic, and early cannabis use that is not confounded by other drug use is associated with psychosis-relevant phenomena and cognitive deficits. The findings are relevant to the evolving attitudes and laws about cannabis.

Topics: Adult; Cannabis; Case-Control Studies; Cognition; Cognition Disorders; Female; Humans; Male; Marijuana Abuse; Memory, Short-Term; Middle Aged; Neuropsychological Tests; Psychiatric Status Rating Scales; Psychotic Disorders; Siblings; Surveys and Questionnaires; Young Adult

We examined the frequency of diabetic ketoacidosis (DKA) in cannabis users compared with nonusers in the T1D Exchange clinic registry (T1DX).. The association between cannabis use by total substance score for cannabis (TSC) and DKA in the past 12 months was examined using a logistic regression model adjusted for potential confounders among adults in the T1DX.. Of 932 adults with type 1 diabetes, 61 had a TSC >4, which classified them as moderate cannabis users. Adjusting for sex, age at study visit, and HbA. Cannabis use was associated with an increased risk for DKA among adults in the T1DX. Providers should inform their patients of the potential risk of DKA with cannabis use.

Topics: Adolescent; Adult; Cannabis; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Registries; Risk Factors; Young Adult

Women who use psychoactive substances could have higher levels of unplanned pregnancy and of difficulties accessing long-term contraceptive methods than those who do not use these substances. General population data on this topic are rare, particularly in France.. This study is based on data from the French Health Survey 2016, collected from women aged 15 to 49 years and living in the Great Paris region (N=1626). Use of illegal psychoactive substances (cannabis, substances used via intranasal or intravenous administration) were evaluated over the lifecourse and, for cannabis, over the 12 months preceding the study. Unplanned pregnancies were ascertained over the preceding 5 years, emergency contraception, abortion, and the experience of sexual violence during the lifecourse. We also studied the number of sexual partners in the preceding 12 months, as well as current contraception. Data were analyzed using weighted logistic regression models, adjusted for participants' sociodemographic characteristics and tobacco use.. Women who use illegal substances have a higher probability than non-users to experience an unplanned pregnancy in the preceding 5 years (OR associated with lifecourse cannabis use: 1.61, 95% CI 1.00-2.58), to have used emergency contraception (ORs between 2.20 to 2.90), to have had an abortion (OR associated with lifecourse cannabis use: 1.77, 95% CI 1.26-2.49), and to have experienced sexual violence (ORs between 1.87 to 3.14). They also had more sexual partners than non-users, but did not differ in terms of contraception.. In the general population, there is a relationship between women's use of illegal substances and their probability of experiencing sexual violence. These results should be brought to the attention of health professionals in contact with women, to help identify those who have addictive behaviors and identify their sexual and reproductive health needs.

Topics: Adolescent; Adult; Cannabis; Contraception Behavior; Databases, Factual; Female; Humans; Illicit Drugs; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Paris; Pregnancy; Pregnancy, Unplanned; Sex Offenses; Substance-Related Disorders; Young Adult

Illicit drug use contributes to substantial morbidity and mortality. Drug scheduling, a legal measure in drug enforcement, is often structured as a hierarchy based on addiction tendency, abuse trends, and harm, but may lack data-driven evidence when classifying substances. Our study aims to measure addiction tendency and use trends based on real-world data. We used the open access database of National Police Agency, Ministry of the Interior in Taiwan and analyzed all daily criminal cases of illicit drugs from 2013 to 2017 and monthly illicit drug enforcement data from the same database from 2002 to 2017. We hypothesized that repeat and frequent use despite legal consequence may be a reflection of addictive behavior, and empirical mode decomposition was applied in analysis to calculate addiction tendency indices and intrinsic 15-year use trends. Our analysis showed heroin has the highest addiction index, followed by methamphetamine. 3,4-Methyl enedioxy methamphetamine, marijuana, and ketamine had lower addictive propensities. This result is consistent with most drug scheduling hierarchies. 15-year use trends of substances were consistent with previous epidemiological studies.

Topics: Amphetamine-Related Disorders; Anesthetics, Dissociative; Cannabis; Central Nervous System Stimulants; Crime; Databases, Factual; Hallucinogens; Heroin; Humans; Illicit Drugs; Ketamine; Marijuana Abuse; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Opioid-Related Disorders; Psychiatric Status Rating Scales; Substance-Related Disorders; Taiwan

Topics: Bias; Cannabis; Female; Hallucinogens; Humans; Marijuana Abuse; Medical Marijuana; Pregnancy

Understanding the potential impact of cannabis use on cardiovascular health is increasingly important as cannabis use rises in the U.S. Objectives: This study evaluated the associations between regular cannabis use, with and without tobacco co-use, and cardiovascular outcomes.. Analysis of a limited dataset obtained through IBM Watson Health Explorys, a platform integrating electronic health record data. Matched controls using Mahalanobis distance within propensity score calipers were defined for: 1) cannabis-using patients (n = 8,944; 43% female); and subgroups of cannabis-using patients: 2) with an encounter diagnosis for tobacco use disorder (TUD; n = 4,682); and 3) without a TUD diagnosis (non-TUD; n = 4,262). Patients had ≥1 blood pressure measurement and blood chemistry lab result in the MetroHealth System (Cleveland, Ohio). Cannabis-using patients had an encounter diagnosis of cannabis abuse/dependence and/or ≥2 cannabis-positive urine drug screens. Control patients, with no cannabis-use-documentation, were matched to the cannabis-using patients on demographics, residential zip code median income, body mass index, and, for the total sample, TUD-status. Outcomes were encounter diagnosis (yes/no) of cerebrovascular accident (CVA), heart arrhythmia, myocardial infarction, subarachnoid hemorrhage (SAH), and all-cause mortality.. TUD-patients had the greatest prevalence of cardiovascular disease, regardless of cannabis-use indication. In the total sample and non-TUD subgroup, regular cannabis use was significantly associated with greater risk for CVA, arrhythmia, SAH, and mortality. In the TUD subgroup, regular cannabis use was significantly associated with greater risk for arrhythmia and SAH.. Cannabis use is associated with significantly greater risk of adverse cardiovascular diagnoses and overall death, particularly in non-tobacco users.

Topics: Adult; Cannabis; Cardiovascular Diseases; Electronic Health Records; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Nicotiana; Ohio; Prevalence; Tobacco Use; Tobacco Use Disorder

The burden of cannabis and other illicit drug use among youth represent a serious public health problem. The aim of the present study is to explore factors associated with cannabis and other illicit drug use among Nigerian secondary school adolescents of the six geopolitical zones of the country.. A total sample of 4078 secondary school adolescents of 32 schools from the six geopolitical zones of Nigeria participated in a cross-sectional survey in December 2015-January 2016. The association of sociodemographic characteristics, parental smoking, parental permissiveness to drink, friends' marijuana or other drugs use, risk perceptions and beliefs with the risk of lifetime cannabis and other illicit drugs use was examined through multilevel logistic regression models.. The mean age of the students involved in the study was 14.7 years. Older age, living in one-parent or family structures different from both parents household, parental smoking, parental permissiveness to drink alcohol, friends' use of marijuana or other drugs, low risk perception of harmful effects, and positive beliefs on marijuana or drugs use were associated with the risk of cannabis and illicit drugs use. The indicator of socioeconomic status was associated to the risk of using cannabis, but not to the risk of using illicit drugs.. The present study highlights some correlates that influence the uptake of cannabis and drugs among Nigerian adolescents. Preventive programs addressing these factors could help to reduce the burden of the problem. Specific attention should be given to interventions to contrast the incorrect beliefs and perceptions.

Topics: Adolescent; Adolescent Behavior; Cannabis; Cross-Sectional Studies; Female; Humans; Illicit Drugs; Logistic Models; Male; Marijuana Abuse; Nigeria; Schools; Social Class; Students; Substance-Related Disorders

Topics: Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Risk

With legalization efforts across the United States, cannabis use is becoming increasingly mainstream. Various studies have documented the effects of acute and chronic cannabis use on brain structure and cognitive performance, including within the frontal executive control network, but little attention has been given to the effects on the cerebellum. Recent evidence increasingly points to the role of the cerebellum in various nonmotor networks, and the cerebellum's expression of cannabinoid receptors may pose particular vulnerabilities to the consequences of cannabis use. Using a combined approach of resting-state functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), the present study aims to assess how cannabis use relates to the cerebellum's intrinsic functional connectivity and underlying white matter structure and whether these properties are associated with craving or severity of cannabis use. Resting-state fMRI and DTI data, as well as self-reports of substance use history, were analyzed from a sample of 26 adults at risk for cannabis use disorder (CUD) and an age- and sex-matched comparison group of 25 cannabis-naïve adults (control). Results demonstrated that individuals at risk for a CUD showed key differences in cerebellar functional connectivity, with specific impacts on the dorsal attention and default mode networks. In addition, group differences in white matter were localized to the middle cerebellar peduncle (MCP), with a relationship between lower MCP diffusivity and higher levels of self-reported craving. These findings lend further support to the cerebellum's role in key cognitive networks and potential consequences for substance use disorders.

Topics: Adult; Cannabis; Cerebellum; Diffusion Tensor Imaging; Executive Function; Female; Humans; Magnetic Resonance Imaging; Male; Marijuana Abuse; Neural Pathways; Risk; Surveys and Questionnaires; White Matter; Young Adult

An association between first-episode presentation of bipolar mania and concurrent cannabis use disorder has been well established in the current literature (Bally et al., 2014, Baethge et al., 2008). Previous studies have shown that 30-70% of patients admitted for a first manic episode had concurrent cannabis use (Bally et al., 2014). The exact mechanism of this association has yet to be confirmed.. We aim to evaluate the prevalence of cannabis use in patients with bipolar disorder (BD) admitted to UTHealth Harris County Psychiatric Center (HCPC) for a first manic episode.. In this retrospective cohort study, 15,969 inpatient records of patients admitted to HCPC between 2012-2013 were examined to identify patients admitted with a first manic episode according to ICD-9 criteria (single episode mania). The prevalence of multiple sociodemographic and clinical variables including cannabis positivity in urine drug screening (UDS) were examined.. Twenty patients were admitted for a first manic episode. Half of the patients were females; mean age was 28.65 ± 10.56 years and mean length of stay (LOS) was 7.15 ± 3.72 days. Fifteen patients received a UDS. Of these fifteen, seven were positive for cannabinoids (47%). One patient was positive for phencyclidine (in addition to cannabis) and one patient was positive for amphetamine (but not cannabis).. The prevalence of cannabis use was higher in first-episode mania patients compared to the general population. The influence of cannabis on the first episode of mania requires additional study.

Topics: Adolescent; Adult; Bipolar Disorder; Cannabis; Female; Humans; International Classification of Diseases; Mania; Marijuana Abuse; Retrospective Studies; Young Adult

This population-based study showed that maternal opioid plus marijuana use during pregnancy was associated with increased odds of prematurity and low birth weight but lower odds of neonatal abstinence syndrome and prolonged hospitalization compared with opioid exposure without marijuana use. Further research should evaluate the biologic mechanisms responsible for these outcomes.

Topics: Adolescent; Adult; Analgesics, Opioid; Cannabis; Child; Data Collection; Databases, Factual; Female; Hospitalization; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Male; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Massachusetts; Neonatal Abstinence Syndrome; Opioid-Related Disorders; Outcome Assessment, Health Care; Pregnancy; Pregnancy Complications; Young Adult

Topics: Cannabinoids; Cannabis; Humans; Marijuana Abuse; Vomiting

Cannabis use is increasing worldwide despite the various health effects of this substance.. We report 2 cases of acute hippocampal encephalopathy in heavy cannabis users (>10 joints/d).. In both male patients, acute encephalitis was suspected. Brain magnetic resonance imaging (MRI) diffusion-weighted sequences showed bilateral high signal abnormalities in hippocampal regions. Patients had renal dysfunction, rhabdomyolysis, and inflammatory syndrome. Investigations showed no evidence of infectious or autoimmune encephalitides. Repeated electroencephalograms revealed no epileptic activity. Clinical, biological, and magnetic resonance imaging acute abnormalities improved within weeks. New exposure to cannabis yielded a new episode of encephalopathy. In both patients, severe long-lasting episodic memory impairment associated with hippocampal atrophy were observed several months later.. Health professionals should be aware of this cannabis-related syndrome given its severe and long-lasting effects.

Topics: Adult; Brain Diseases; Cannabis; Electroencephalography; Hippocampus; Humans; Magnetic Resonance Imaging; Male; Marijuana Abuse; Neuropsychological Tests

To compare birth and early developmental screening outcomes for infants with and without in utero cannabis exposures.. Observational cohort of women receiving prenatal care within a large health system, live birth between October 1, 2015 and December 1, 2017, and at least one infant visit. Cannabis exposure was through routine urine toxicology screen. Preterm birth, small for gestational age (SGA) birth, birth defects, and early developmental screening outcomes were assessed from birth and electronic health record data.. Of 3435 women, 283 (8.2%) had a positive urine toxicology screen. In utero cannabis exposure was associated with SGA birth, adjusted rate ratio (aRR) 1.69 (95% confidence interval [CI]: 1.22-2.34). Abnormal 12-month developmental screens occurred in 9.1% of infants with in utero cannabis exposure vs. 3.6% of those with negative maternal screens, aRR 1.90 (95% CI: 0.92-3.91). Additional birth outcomes were not associated with in utero cannabis exposure.. Exposure to cannabis during pregnancy may adversely impact fetal growth.

Topics: Cannabis; Cohort Studies; Electronic Health Records; Female; Fetal Development; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Small for Gestational Age; Male; Marijuana Abuse; Pregnancy; Premature Birth; Prenatal Care

Topics: Adolescent; Brain; Cannabinoids; Cannabis; Cognitive Dysfunction; Humans; Marijuana Abuse

Topics: Cannabis; Humans; Marijuana Abuse

Whether cannabis use worsens outcomes in coronary heart disease is unknown and no previous study has evaluated the outcomes for patients who undergo percutaneous coronary intervention (PCI) according to cannabis use.. We analysed patients in the National Inpatient Sample between 2004 and 2014 who underwent PCI and evaluated rates, predictors and outcomes of patients according to cannabis misuse defined by cannabis abuse or dependence.. A total of 7 306 012 patients were included and 32 765 cannabis misusers (0.4%). Cannabis misusers were younger (49.5 vs 64.6 years, P < .001) and were more likely to be male (82.7% vs 66.3%, P < .001). There was also a greater proportion of patients who were of black ethnicity in the cannabis misuse group (27.7% vs 7.9%, P < .001) and fewer elective admissions (7.8% vs 27.6%, P < .001). There was no difference in in-hospital mortality (OR 1.06 95% CI 0.80-1.40, P = .67), bleeding (OR 0.94 95% CI 0.77-1.15, P = .55) and stroke/transient ischaemic attack (OR 1.19 95% CI 0.98-1.45, P = .084) compared with non-cannabis misusers. Cannabis misusers had significantly lower odds of in-hospital vascular complications (OR 0.73 95% CI 0.58-0.90, P = .004).. Our results suggest that cannabis misusers are more likely to be male, of black ethnicity and from the lowest quartile of income, but there was no evidence that cannabis misuse is associated with worse periprocedural outcomes following PCI when controlling for key proxies of health status.

Topics: Adult; Age Factors; Aged; Cannabis; Ethnicity; Female; Hemorrhage; Humans; Inpatients; Male; Marijuana Abuse; Middle Aged; Myocardial Infarction; Percutaneous Coronary Intervention; Retrospective Studies; Stroke; Treatment Outcome

To estimate the proportion of cannabis consumed in Australia by daily cannabis users.. Monte Carlo simulation using parameters estimated from nationally representative and repeated cross-sectional household surveys in 2007, 2010, 2013 and 2016.. Australia PARTICIPANTS: Adult samples (mean age = 49.9; 55% females) from four National Drug Strategy Household Surveys (n = 92 243).. Frequency of cannabis use (daily/weekly/about once a month/every few months/once or twice a year). The weighted estimated prevalence of users in each of these frequency levels was multiplied by population size to estimate the total number of users. Quantity of cannabis use was measured as number of joints consumed. The consumption of those who reported using bongs was converted into joints based on the bong to joint ratio estimated from the survey data. We estimated the proportion of cannabis consumed by daily users by Monte Carlo simulation using parameters estimated from the household surveys. We conducted 10 000 simulation trials, and in each trial we [1] simulated the number of users at each consumption level (stratum) based on estimated prevalence and population size[2], for each simulated individual, we simulated the number of days of cannabis use in a year based on frequency data[3], for each consumption day, we simulated the quantity consumed [4] and lastly we calculated the total joints consumed at each consumption level and estimated the proportion of joints consumed by daily users out of the total consumption.. The prevalence of past-year cannabis use increased from 8.9% [95% confidence interval (CI) = 8.5-9.4] in 2007 to 10.5% (95% CI = 10.0-11.1) in 2016, 16% of whom were daily users. Between 2007 and 2016, daily users accounted for between 81.6 and 85.7% of all cannabis consumed. Weekly users accounted for an additional 12.1-15.9%.. Between 2007 and 2016, only one in six Australian cannabis users were daily users, but they accounted for more than 80% of the estimated cannabis consumed in Australia.

Topics: Adult; Australia; Cannabis; Computer Simulation; Cross-Sectional Studies; Female; Health Surveys; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Monte Carlo Method; Prevalence; Surveys and Questionnaires; Young Adult

Topics: Adult; Cannabis; Humans; Marijuana Abuse; Prazosin; Psychotic Disorders; Randomized Controlled Trials as Topic; Stress Disorders, Post-Traumatic; Vaping

Historically, cannabis researchers have assumed a single mode and product of cannabis (e.g., smoking plant). However, patterns of use, products (e.g., concentrates, edibles), and modes (e.g. blunts, vaporizers) are diversifying. This study sought to: 1) classify cannabis users into groups based on their use of the full range of cannabis products, and 2) examine user group differences on demographics, cannabis consequences and cannabis use disorder (CUD) symptomatology.. In a sample of college students (data collected in Fall 2017), who used cannabis in the past year (N = 1390), latent class analysis (LCA) was used to characterize cannabis users. We then added demographic characteristics, cannabis consequences, and CUD symptomatology scores separately to LCA models to examine class differences.. Five unique classes emerged: high-frequency all-product users, high-frequency plant/moderate-frequency edible and concentrate users, low-frequency plant users, moderate-frequency plant and edible users, and low-frequency edible users. Demographic characteristics, cannabis consequences, and CUD symptomatology differed across classes characterized by frequency as well as product.. Results reflect the increasing variety of cannabis products, modes, and use patterns among college students. In this sample, frequency of use remains a strong predictor of cannabis-related consequences, in addition to type of product. As variation in cannabis use patterns continue to evolve, it is essential for researchers to conduct comprehensive assessments.

Topics: Adolescent; Cannabis; Drug Users; Female; Humans; Latent Class Analysis; Male; Marijuana Abuse; Marijuana Use; Students; United States; Universities; Young Adult

Topics: Analgesics, Opioid; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Medical Marijuana

Topics: Cannabis; Humans; Legislation, Drug; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Students

To examine the association between cannabis use and subsequent other illicit drug use and drug use disorders (harmful use and dependence).. We used survey data from a population-based cohort in Stockholm County (collected 1998-2000), with linkage to the National Patient Register. The study base comprised participants aged 20-64 years (N = 10 345), followed-up until 2014. Cox and logistic regression analyses were conducted to test associations between self-reported cannabis use and risk of subsequent other illicit drug use (three-year follow-up) and drug use disorders (16-year follow-up).. The odds ratio (OR) for other illicit drug use onset at three-year follow-up for lifetime cannabis users was 7.00 (4.47-10.35, 95% CI) and for recent cannabis users 34.41 (19.14-61.88, 95% CI). Adjusting for age and AUDIT score attenuated the association, for lifetime users: OR = 5.48 (3.69-8.13, 95% CI) and OR = 5.65 (3.80-8.41, 95% CI), and for recent users: OR = 18.32 (9.88-33.99, 95% CI) and OR = 20.88 (11.19-38.95, 95% CI). For cannabis users only, the hazard ratio (HR) for drug use disorders at 16-year follow-up was 0.89 (0.31-2.61, 95%CI). For cannabis and other illicit drug users, the corresponding HR was 7.27 (3.85-13.75, 95% CI).. There was no independent association between cannabis use and subsequent drug use disorders. The association with subsequent drug use disorders was rather explained by other illicit drug use, which cannabis users were at higher risk of at the three-year follow-up.

Topics: Adult; Cannabis; Follow-Up Studies; Humans; Illicit Drugs; Marijuana Abuse; Middle Aged; Substance-Related Disorders; Sweden; Young Adult

Rates of problematic cannabis use have nearly doubled over the last decade, and peak onset for cannabis use disorders occurs during young adulthood. Craving for cannabis is hypothesized to be an important factor that maintains cannabis use among people who desire to stop or reduce their use, including many young adults. Previous studies that used single timepoint assessment methods to demonstrate a link between craving and cannabis use have found mixed predictive utility of measurements. The impermanent, or time-varying nature of craving may be responsible for mixed findings, leading to inaccuracies in retrospective recall and greater difficulty measuring craving and detecting its association with cannabis use. The current study compared intensive longitudinal assessments and single timepoint assessments predicting cannabis use among young adults with problematic cannabis use who reported a desire to reduce their use. Participants (N = 80) completed a baseline craving questionnaire and intensive longitudinal assessments of momentary craving and cannabis use up to four times per day for 14 days. Results suggested that averaged momentary craving predicted cannabis use above-and-beyond craving measured at baseline. An increase of one SD above the sample-mean for averaged momentary craving increased the probability of cannabis use by 367 %, while a one SD increase in baseline craving was only associated with a 49 % increase. Findings suggest that asking young adults who want to cut back on their cannabis use about their craving at a single timepoint may not be as clinically useful as tracking cravings repeatedly in near real-time and in ecologically valid contexts.

Topics: Adult; Cannabis; Craving; Ecological Momentary Assessment; Female; Humans; Male; Marijuana Abuse; Prospective Studies; Retrospective Studies; Young Adult

The treatment of adolescents with Cannabis Use Disorder (CUD) presents a variety of challenges. The identification of a patient's treatment goal might be an important predictor of cannabis consumption and a key factor when designing the intervention. This paper aims to present the psychometric properties of the Spanish version of the Adolescent Substance Abuse Goal Commitment (ASAGC) questionnaire in adolescent consumers of cannabis and to report the association of goal commitment with the treatment outcome.. A sample of 115 adolescents between 13 and 18 years old with CUD in outpatient treatment were evaluated. Psychometric properties including exploratory and confirmatory factor analysis, predictive validity, reliability and stability over time were analyzed.. ASAGC shows good psychometric properties, with excellent reliability (Cronbach's α of >0.95 for both subscales, Abstinence and Harm Reduction) at baseline and 3 and 6 months (>0.95 for both subscales) and good stability at 3 and 6 months (K = 0.572 and 0.659). Higher scores in Commitment to abstinence at baseline are associated with lower scores of THC in urine at 3 and 6 months (p < .001).. The ASAGC is a useful tool to study treatment commitment in adolescents that present a CUD. Abstinence commitment is a reliable prognostic factor. However, adolescents committed to HR remain a therapeutic challenge.

Topics: Adolescent; Cannabis; Goals; Humans; Marijuana Abuse; Motivation; Psychometrics; Reproducibility of Results; Surveys and Questionnaires

There is concern that recreational marijuana legalization (RML) may lead to increased cannabis use disorder (CUD) among youth due to increased marijuana use. This study investigates whether adolescent substance use disorder treatment admissions for marijuana use increased in Colorado and Washington following RML.. Annual data on 2008-2017 treatment admissions for marijuana use from the SAMHSA TEDS-A dataset for adolescents age 12-17 were used to model state treatment admissions trends. Difference-in-differences models were used to investigate whether treatment admissions increased following RML in Colorado/Washington compared to non-RML states, after adjusting for socioeconomic characteristics and treatment availability.. Over all states in the analysis, the rate of adolescent treatment admissions for marijuana use declined significantly over the study period (β=-3.375, 95 % CI=-4.842, -1.907), with the mean rate falling nearly in half. The decline in admissions rate was greater in Colorado and Washington compared to non-RML states following RML, though this difference was not significant (β=-7.671, 95 % CI=-38.798, 23.456).. Adolescent treatment admissions for marijuana use did not increase in Colorado and Washington following RML. This may be because youth marijuana use did not increase, CUD did not increase (even if use did increase), or treatment seeking behaviors changed due to shifts in attitudes and perceptions of risk towards marijuana use.

Topics: Adolescent; Adolescent Behavior; Cannabis; Child; Colorado; Female; Hospitalization; Humans; Legislation, Drug; Male; Marijuana Abuse; Marijuana Use; Patient Admission; United States; United States Substance Abuse and Mental Health Services Administration; Washington

The notion that smoking cannabis may damage the respiratory tract has been introduced in recent years but there is still a paucity of studies on this subject. The aim of this study was to investigate the relationship between cannabis smoking, pneumothorax and bullous lung disease in a population of operated patients.. We performed a retrospective study on patients operated on for spontaneous pneumothorax. Patients were divided into three groups according to their smoking habit: cannabis smokers, only-tobacco smokers and nonsmokers. Cannabis lifetime exposure was expressed in dose-years (1d/y = 1 gram of cannabis/week for one year). Clinical, radiological and perioperative variables were collected. The variables were analyzed to find associations with smoking habit. The impact of the amount of cannabis consumption was also investigated by ROC curves analysis. Of 112 patients, 39 smoked cannabis, 23 smoked only tobacco and 50 were nonsmokers. Median cannabis consumption was 28 dose/years, median tobacco consumption was 6 pack/years. Cannabis smokers presented with more severe chronic respiratory symptoms and bullous lung disease and with a higher incidence of tension pneumothorax than both tobacco smokers and nonsmokers. Cannabis smokers also developed a larger pneumothorax, experienced prolonged postoperative stay and demonstrated a higher incidence of pneumothorax recurrence after the operation than nonsmokers did. The risk of occurrence of chronic respiratory symptoms and bullous lung disease in cannabis smokers was dose-related.. Cannabis smoking seems to increase the risk of suffering from respiratory complaints and can have detrimental effects on lung parenchyma, in a dose-dependent manner. Cannabis smoking also negatively affected the outcome of patients operated for spontaneous pneumothorax. A history of cannabis abuse should always be taken in patients with pneumothorax. There may be need for a specific treatment for pneumothorax in cannabis smokers.

Topics: Adult; Blister; Cannabis; Female; Hallucinogens; Humans; Lung; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Pneumothorax; Pulmonary Emphysema; Respiratory System; Severity of Illness Index; Smokers; Tobacco Smoking; Tomography, X-Ray Computed; Young Adult

Four states have legalized medical cannabis for the purpose of treating opioid use disorder. It is unclear whether cannabinoids improve or exacerbate opioid withdrawal. A more thorough examination of cannabis and its impact on specific symptoms of opioid withdrawal is warranted.. Two hundred individuals recruited through Amazon Mechanical Turk with past month opioid and cannabis use and experience of opioid withdrawal completed the survey. Participants indicated which opioid withdrawal symptoms improved or worsened with cannabis use and indicated the severity of their opioid withdrawal on days with and without cannabis.. 62.5% (n = 125) of 200 participants had used cannabis to treat withdrawal. Participants most frequently indicated that cannabis improved: anxiety, tremors, and trouble sleeping. A minority of participants (6.0%, n = 12) indicated cannabis worsened opioid withdrawal, specifically symptoms of yawning, teary eyes, and runny nose. Across all symptoms, more participants indicated that symptoms improved with cannabis compared to those that indicated symptoms worsened with cannabis. Women reported greater relief from withdrawal with cannabis use than men.. These results show that cannabis may improve opioid withdrawal symptoms and that the size of the effect is clinically meaningful. It is important to note that symptoms are exacerbated with cannabis in only a minority of individuals. Prospectively designed studies examining the impact of cannabis and cannabinoids on opioid withdrawal are warranted.

Topics: Analgesics, Opioid; Cannabis; Female; Humans; Male; Marijuana Abuse; Narcotics; Self Report; Substance Withdrawal Syndrome

Topics: Automobile Driving; Canada; Cannabis; Driving Under the Influence; Humans; Marijuana Abuse

This study prospectively investigates behavioural and social antecedents of different patterns of adolescent cannabis use, specifically, early adolescent onset cannabis use and late onset occasional use.. The sample comprised 852 adolescents (53% female) drawn from the Australian arm of the International Youth Development Study. Data were collected via self-report surveys. Risk and protective factors from a modified version of the Communities That Care youth survey were measured in fifth grade (mean [M] = 10.9 years, SD = 0.4). Frequency of cannabis use was measured at six time-points throughout adolescence (ages 12-19 years).. Early adolescent onset cannabis use (10.7% of the sample [n = 91]) was predicted by childhood family-related factors including poor family management, family history of antisocial behaviour and attachment to parents. Cigarette use and drinking until drunk were the strongest predictors of early adolescent onset cannabis use. Cumulative risks associated with community, family, peer/individual environments and early substance use (cigarettes, alcohol) in childhood were predictive of early adolescent onset cannabis use (e.g. relative risk ratio = 2.64; 95% confidence interval 1.40-4.97 for early substance use). Family and early substance use-related cumulative risks were predictive of late adolescent onset occasional cannabis use (n = 231; 27%). Cumulative early substance use risk was the strongest independent predictor of both early adolescent onset and late adolescent onset occasional cannabis use.. Primary prevention efforts should focus on reducing exposure and access to licit substances during late childhood and delaying the onset of use. Prevention and intervention targeted toward the family environment also appears likely to be important in the prevention of early adolescent onset cannabis use.

Topics: Adolescent; Adolescent Behavior; Cannabis; Child; Child Behavior; Female; Health Behavior; Humans; Male; Marijuana Abuse; Risk Factors; Social Environment; Surveys and Questionnaires

Cannabis use is consistently linked to poorer mental health outcomes, and there is evidence that use of higher-potency cannabis increases these risks. To date, no studies have described the association between cannabis potency and concurrent mental health in a general population sample or addressed confounding using longitudinal data.. To explore the association between cannabis potency and substance use and mental health outcomes, accounting for preceding mental health and frequency of cannabis use.. This cohort study used data from the Avon Longitudinal Study of Parents and Children, a UK birth cohort of participants born between April 1, 1991, and December 31, 1992. Present data on outcomes and exposures were collected between June 2015 and October 2017 from 1087 participants at 24 years of age who reported recent cannabis use.. Self-reported type of cannabis most commonly used in the past year, coded to a binary exposure of use of high-potency cannabis or lower-potency cannabis.. Outcomes were reported frequency of cannabis use, reported cannabis use problems, recent use of other illicit drugs, tobacco dependence, alcohol use disorder, depression, generalized anxiety disorder, and psychotic-like experiences. The study used secondary data; consequently, the hypotheses were formulated after data collection.. Past-year cannabis use was reported by 1087 participants (580 women; mean [SD] age at onset of cannabis use, 16.7 [3.0] years). Of these, 141 participants (13.0%) reported the use of high-potency cannabis. Use of high-potency cannabis was associated with increased frequency of cannabis use (adjusted odds ratio [AOR], 4.38; 95% CI, 2.89-6.63), cannabis problems (AOR, 4.08; 95% CI, 1.41-11.81), and increased likelihood of anxiety disorder (AOR, 1.92; 95% CI, 1.11-3.32). Adjustment for frequency of cannabis use attenuated the association with psychotic experiences (AOR 1.29; 95% CI, 0.67-2.50), tobacco dependence (AOR, 1.42; 95% CI, 0.89-2.27), and other illicit drug use (AOR, 1.29; 95% CI, 0.77-2.17). There was no evidence of association between the use of high-potency cannabis and alcohol use disorder or depression.. To our knowledge, this study provides the first general population evidence suggesting that the use of high-potency cannabis is associated with mental health and addiction. Limiting the availability of high-potency cannabis may be associated with a reduction in the number of individuals who develop cannabis use disorders, the prevention of cannabis use from escalating to a regular behavior, and a reduction in the risk of mental health disorders.

Topics: Adolescent; Cannabis; Cohort Studies; Comorbidity; Correlation of Data; Dose-Response Relationship, Drug; Female; Humans; Longitudinal Studies; Male; Marijuana Abuse; Mental Disorders; Risk Factors; Substance-Related Disorders; United Kingdom; Young Adult

Topics: Cannabis; Comorbidity; Humans; Marijuana Abuse; Schizophrenia; Schizophrenic Psychology; Stereotyping

Little is known regarding trends in cannabis use among justice-involved youth. We hypothesize that cannabis use will be higher over time among justice-involved youth who, on average, are more likely to be exposed to and seek out cannabis.. The present study compares trends in cannabis use among justice-involved youth (past year) with youth in the general population age 12-17 who have not been arrested in the past year.. Public-use data as part of the 2002-2017 National Survey on Drug Use and Health (NSDUH), which does not include state-level identifiers, was used. Males constitute 51% of the total sample. Among justice-involved youth, 66.4% were males. We employed logistic regression analyses with survey year as an independent variable and past-year cannabis use as the dependent variable. A series of logistic regressions examined the association between cannabis use and psychosocial and behavioral factors.. The prevalence of past-year cannabis use among justice-involved youth (3.09% of the sample) steadily increased from 54% in 2002 to 58% in 2017 (AOR = 1.018, 95% CI = 1.004-1.034), while the concurrent prevalence of cannabis use among youth with no past year arrests decreased from a high of 14% in 2002 to 12% in 2017 (AOR = 0.993, 95% CI = 0.990-0.997).. Study findings suggest that cannabis use is increasing among justice-involved youth.

Topics: Adolescent; Cannabis; Child; Female; Health Surveys; Humans; Juvenile Delinquency; Logistic Models; Male; Marijuana Abuse; Marijuana Smoking; Prevalence; United States

This study describes the events and circumstances preceding children aged 16 years or younger being treated for cannabis poisoining in the emergency department (ED) of a Canadian pediatric hospital.. We extracted cannabis poisoning treated in the ED at British Columbia Children's Hospital (BCCH) between 1 January, 2016 and 31 December, 2018, from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database. The poisonings were distinguished by the inadvertent or intentional ingestion of cannabis. We reviewed the hospital's electronic health information system and the patients' health records to obtain additional information on the context, including spatial and temporal characteristics.. Of the 911 poisonings treated at BCCH, 114 were related to intentional cannabis use (12.5%). Fewer than 10 poisonings resulted from inadvertent ingestions by children and the median age for these was 3 years. All inadvertent ingestion occurred at home and involved cannabis belonging to the patient's family. The vast majority of poisonings resulted from the intentional use of cannabis only (28.9%) or cannabis use with other psychoactive substances (co-ingestions; 71.1%). The median patient age was 15 years. Most patients reported consuming cannabis through inhalation with peers. Cannabis and co-ingestion poisonings were more often reported on weekdays than weekends. The consumption of cannabis leading to poisoning more often occurred in private residences. Patients with cannabis poisoning more often sought medical treatment themselves or were helped by their family.. The characteristics of cannabis poisonings among children are described for the three-year period prior to recreational cannabis legalization in Canada in order to set a baseline for future comparisons. Implications for improving injury prevention initiatives and policies are discussed.. Cette étude décrit les événements et les circonstances à l’origine des admissions de jeunes de 16 ans et moins au service des urgences d’un hôpital pédiatrique canadien pour une intoxication au cannabis.. Nous avons extrait de la base de données du Système canadien hospitalier d’information et de recherche en prévention des traumatismes (SCHIRPT) les cas d’intoxication au cannabis ayant été traités au service des urgences de l’Hôpital pour enfants de la Colombie­Britannique (HECB) entre le 1er janvier 2016 et le 31 décembre 2018. Nous avons examiné le système électronique d’information sur la santé de l’hôpital ainsi que le dossier médical des patients pour obtenir plus de renseignements sur le contexte des cas, notamment les caractéristiques spatiales et temporelles.. Des 911 cas d’intoxication traités à l’HECB, 114 étaient liés à la consommation intentionnelle de cannabis (12,5 %). Moins de 10 concernaient des enfants ayant ingéré du cannabis par inadvertance, avec un âge médian pour ces cas de 3 ans. Toutes les ingestions accidentelles sont survenues à la maison et, dans tous les cas, le cannabis appartenait à un membre de la famille du patient. La vaste majorité des intoxications étaient dues à une consommation intentionnelle soit de cannabis seul (28,9 %) soit de cannabis avec d’autres substances psychoactives (co­ingestion, 71,1 %). L’âge médian des patients était de 15 ans. La plupart des patients ont déclaré avoir consommé le cannabis par inhalation et en groupe. Les intoxications au cannabis seul et au cannabis co­ingéré avec d’autres substances étaient plus fréquentes les jours de semaine que les fins de semaine. Dans la plupart des cas d’intoxication au cannabis, le cannabis avait été consommé dans une résidence privée. La majorité des victimes d’intoxication au cannabis ont obtenu des soins médicaux par elles­mêmes ou ont été aidées par leur famille.. Les caractéristiques des cas d’intoxication pédiatrique au cannabis portent sur les trois ans précédant la légalisation de la consommation de cannabis à des fins récréatives au Canada, de manière à établir une base de référence pour des comparaisons futures. Nous abordons aussi la question de l’amélioration des initiatives et des politiques de prévention à la lumière de ces résultats.. Few pediatric poisonings involved the inadvertent ingestion of cannabis; in these cases, patients consumed cannabis found in their home. The vast majority of pediatric cannabis poisonings resulted from intentional use. Of these, more poisonings resulted from cannabis co-ingestions with alcohol as compared to cannabis only. Cannabis was most often intentionally consumed in the company of peers and in private residences. Cannabis-only and cannabis co-ingestion poisonings were more often reported on weekdays than on weekends. A higher proportion of patients with cannabis poisoning sought medical treatment themselves or were helped by family members, rather than being helped by a bystander.. Peu d’intoxications pédiatriques étaient dues à une ingestion accidentelle de cannabis et, dans ces cas, le patient avait consommé du cannabis trouvé à la maison. La vaste majorité des intoxications pédiatriques au cannabis sont survenues à la suite d’une consommation intentionnelle. Dans ces cas, l’intoxication découlait plus souvent d’une co­ingestion de cannabis et d’alcool que d’une consommation de cannabis seul. Le cannabis était généralement consommé intentionnellement en groupe et dans une résidence privée. Les intoxications au cannabis seul et au cannabis co­ingéré avec d’autres substances étaient plus nombreuses les jours de semaine que les fins de semaine. La majorité des patients victimes d’intoxication au cannabis ont consulté un médecin d’eux­mêmes ou avec l’aide de leur famille plutôt que de demander l’aide d’un témoin.

Topics: Adolescent; Canada; Cannabis; Child Health; Child, Preschool; Emergency Service, Hospital; Family Health; Female; Hospitals, Pediatric; Humans; Legislation, Drug; Male; Marijuana Abuse; Needs Assessment; Poisoning

Topics: Adolescent; Canada; Cannabis; Female; Humans; Male; Marijuana Abuse; Surveys and Questionnaires

Cannabis contains over a hundred of different cannabinoids, of which Δ

Topics: Adolescent; Adult; Cannabidiol; Cannabis; Commerce; Dronabinol; Female; Health Status; Humans; Male; Marijuana Abuse; Marijuana Use; Prevalence; United States; Vulnerable Populations; Young Adult

Although evidence from psychosis patients demonstrates the adverse effects of cannabis use (CU) at a young age and that the rate of CU is high in subgroups of young violent patients with psychotic disorders, little is known about the possible effect of the age of onset of CU on later violent behaviors (VB). So, we aimed to explore the impact of age at onset of CU on the risk of displaying VB in a cohort of early psychosis patients.. Data were collected prospectively over a 36-month period in the context of an early psychosis cohort study. A total of 265 patients, aged 18-35 years, were included in the study. Logistic regression was performed to assess the link between age of onset of substance use and VB.. Among the 265 patients, 72 had displayed VB and 193 had not. While violent patients began using cannabis on average at age 15.29 (0.45), nonviolent patients had started on average at age 16.97 (0.35) (p = 0.004). Early-onset CU (up to age 15) was a risk factor for VB (odds ratio = 4.47, confidence interval [CI]: 1.13-20.06) when the model was adjusted for age group, other types of substance use, being a user or a nonuser and various violence risk factors and covariates. History of violence and early CU (until 15) were the two main risk factors for VB.. Our results suggest that early-onset CU may play a role in the emergence of VB in early psychosis.

Topics: Adolescent; Adult; Age of Onset; Cannabis; Cohort Studies; Female; Humans; Logistic Models; Male; Marijuana Abuse; Odds Ratio; Psychotic Disorders; Risk Factors; Violence; Young Adult

Topics: Adolescent; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Prodromal Symptoms; Psychotic Disorders

Cannabis use and cannabis use disorder are more prevalent in U.S. states with medical marijuana laws (MMLs), as well as among individuals with elevated psychological distress. We investigated whether adults with moderate and serious psychological distress experienced greater levels of cannabis use and/or disorder in states with MMLs compared to states without MMLs.. National Survey of Drug Use and Health data (2013-2017) were used to compare past-month cannabis use, daily cannabis use, and cannabis use disorder prevalence among adults with moderate and serious psychological distress in states with versus without MMLs. We executed pooled multivariable logistic regression analyses to test main effects of distress, MMLs and their interaction, after adjustment.. Compared to states without MMLs, states with MMLs had higher adjusted prevalence of past-month use (11.1 % vs. 6.8 %), daily use (4.0 % vs. 2.2 %), and disorder (1.7 % vs. 1.2 %). Adults with moderate and serious psychological distress had greater adjusted odds of any use (AORs of 1.72 and 2.22, respectively) and of disorder (AORs of 2.17 and 2.94, respectively), compared to those with no/mild distress. We did not find evidence of an interaction between MMLs and distress category for any outcome.. Associations between elevated distress and cannabis use patterns are no greater in states with MML. However, cannabis use is more prevalent in MML states. Thus, higher base rates of cannabis use and disorder among adults with elevated distress are proportionally magnified in these states.

Topics: Adolescent; Adult; Cannabis; Female; Hallucinogens; Humans; Male; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Middle Aged; Prevalence; Psychological Distress; Substance-Related Disorders; United States; Young Adult

Marijuana is one of the most commonly consumed psychotropic drugs in the world. It has been associated with adverse cardiovascular reactions including acute coronary syndrome, but this information is not widely known among emergency medicine clinicians. This article describes cannabis use as a contributing factor to acute myocardial infarction in a young woman with chest pain.

Topics: Acute Coronary Syndrome; Adult; Cannabis; Chest Pain; Drug-Eluting Stents; Electrocardiography; Endovascular Procedures; Female; Humans; Marijuana Abuse; Myocardial Infarction; Patient Compliance; Patient Education as Topic

Topics: Cannabis; Humans; Marijuana Abuse

Topics: Cannabis; Humans; Marijuana Abuse

Because cannabis use in children can have negative consequences, the recent legalization of recreational cannabis for adults in Canada creates an urgent need for youth education.. A multidisciplinary clinical rotation was developed wherein nursing and pharmacy students collaborated with youth (grades 7 through 10) to construct an educational program about cannabis. Four schools participated, representing a variety of socioeconomic demographics. Feedback was solicited from students and stakeholders. The purpose of this project was to create REACH (Real Education About Cannabis and Health), a toolkit and curriculum resource that includes lesson plans for teachers covering the science of cannabis, social science implications, peer pressure, decision making and harm reduction, videos featuring youth testimonials, and supplemental resources.. Preliminary feedback suggests the materials are engaging and informative.. A collaboration of health science students with youth in schools resulted in an authentic and relatable educational program about cannabis. Future studies will evaluate REACH's effectiveness in seventh- and ninth-grade students. [J Nurs Educ. 2020;59(8):465-469.].

Topics: Adolescent; Canada; Cannabis; Child; Curriculum; Health Education; Humans; Marijuana Abuse; Schools; Students

Cannabis use in pregnancy has increased

Topics: Adolescent; Adult; Autism Spectrum Disorder; Canada; Cannabis; Case-Control Studies; Child; Child, Preschool; Developmental Disabilities; Female; Humans; Incidence; Infant, Newborn; Male; Marijuana Abuse; Neurodevelopmental Disorders; Pregnancy; Prenatal Exposure Delayed Effects; Retrospective Studies; Risk Factors; Young Adult

The effect of concomitant cocaine and cannabis use on monocyte activation and inflammation in patients with alcohol use disorder (AUD) is unknown.. To analyze the impact of cocaine and cannabis use on levels of markers of monocyte activation (sCD163 and sCD14) and systemic inflammation (interleukin-6 [IL-6]) in AUD patients admitted for hospital treatment between 2013 and 2018. Clinical and laboratory parameters were obtained upon admission. IL-6, sCD163, and sCD14 were measured in frozen plasma samples. We performed logistic regression to detect associations between cocaine and cannabis use and markers of monocyte activation and inflammation in the highest quartile.. In this series of AUD patients the concomitant use of cannabis use was associated with sCD163 levels that were in the highest quartile, consistent with monocyte activation.

Topics: Adult; Alcohol Drinking; Alcoholism; Biomarkers; Cannabis; Female; Humans; Inflammation; Interleukin-6; Lipopolysaccharide Receptors; Male; Marijuana Abuse; Middle Aged; Monocytes; Substance-Related Disorders

The smell of cannabis is a cue with universal relevance to cannabis users. However, most cue reactivity imaging studies have solely utilized visual images, auditory imagery scripts, or tactile cues in their experiments. This study introduces a multimodal cue reactivity paradigm that includes picture, odor, and bimodal picture + odor cues.. Twenty-eight adults at risk for cannabis use disorder (CUD; defined as at least weekly use and Substance Involvement Score of ≥4 on the Cannabis sub-test of the Alcohol, Smoking and Substance Involvement Screening Test) and 26 cannabis-naive controls were exposed to cannabis and floral cues during event-related fMRI. Between-group differences in fMRI activation and correlations were tested using FMRIB's Local Analyses of Mixed Effects and corrected for multiple comparisons using a voxelwise threshold of z > 2.3 and a corrected cluster threshold of p < .05.. Both visual and olfactory modalities resulted in significant activation of craving and reward systems, with cannabis odor cues eliciting a significantly greater response in regions mediating anticipation and reward (nucleus accumbens, pallidum, putamen, and anterior insular cortex, supplementary motor area, angular gyrus and superior frontal gyrus) and cannabis picture cues eliciting a significantly greater response in the occipital cortex and amygdala. Furthermore, the CUD group showed significantly increased activation in the ventral tegmental area (VTA), the insula, and the pallidum compared to controls. Within the CUD group, activation in the insula, anterior cingulate, and occipital cortex to bimodal cannabis cues was significantly correlated with self-reported craving.. Our multimodal cue reactivity paradigm is sensitive to neural adaptations associated with problematic cannabis use.

Topics: Adult; Brain; Cannabis; Cues; Humans; Magnetic Resonance Imaging; Marijuana Abuse; Odorants

Topics: Adolescent; Adolescent Behavior; Cannabis; Child; Chile; Cross-Sectional Studies; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Parent-Child Relations; Parenting; Parents; Risk Factors; Schools; Students; Young Adult

Topics: Cannabis; Female; Humans; Male; Marijuana Abuse; Prevalence; Psychotic Disorders

Topics: Biomedical Research; Canada; Cannabis; England; Humans; Illicit Drugs; Marijuana Abuse; Marijuana Use; National Institute on Drug Abuse (U.S.); Recreational Drug Use; United States

Topics: Adolescent; Analgesics; Behavior Therapy; Cannabis; Humans; Marijuana Abuse; Substance-Related Disorders

Topics: Adolescent; Adult; Aged; Cannabis; Female; Frustration; Humans; Male; Marijuana Abuse; Middle Aged; Parent-Child Relations; Parents; Surveys and Questionnaires

As cannabis use becomes more widely accepted, there is growing interest in its effects on brain function, specifically how it may impact daily functional activities such as driving, operating machinery, and other safety-related tasks. There are currently no validated methods for quantifying impairment from acute cannabis intoxication. The objective of this study was to identify neurophysiological correlates associated with driving simulator performance in subjects who were acutely intoxicated with cannabis. These signatures could help create an EEG-based profile of impairment due to acute cannabis intoxication.. Each subject completed a three-visit study protocol. Subjects were consented and screened on the first visit. On the second and third visits, subjects were administered either 500 mg of cannabis with 6.7% delta-9-tetrahydrocannabinol (THC) or placebo using a Volcano© Digit Vaporizer in a counterbalanced fashion. EEG was acquired from subjects as they performed a series of neurocognitive tasks and an approximately 45-minute simulated drive that included a rural straight-away absent of any other cars or obstacles during the final 10 minutes.EEG data was acquired using a STAT X24 wireless sensor headset during a simulated driving scenario from 10 subjects during the THC and placebo visits. Metrics of driving performance were extracted from the driving simulator and synchronized with EEG data using a common clock.. A within-subjects analysis showed that the standard deviation of lane position (SDLP) was significantly worse and heart rate was elevated during the dosed visit compared to the placebo visit. Consistent with our prior findings, EEG power in the Theta frequency band (4-7 Hz) in the dosed condition was significantly decreased from the placebo condition. Theta power was negatively correlated with the SDLP driving performance metric, while there were no significant correlations between any EEG measure and SDLP in the placebo condition.. These results, in combination with prior work on the effect of cannabis intoxication during neurocognitive tasks, suggest that neurophysiological signatures associated with acute cannabis intoxication are robust and consistent across tasks, and that these signatures are significantly correlated with impaired performance in a driving simulator. Taken together, EEG data acquired during a short neurocognitive testbed and during a simulated drive may provide specific profiles of impairment associated with acute cannabis intoxication. Further research is needed to establish the impaired cognitive processes associated with these EEG biomarkers.

Topics: Biomarkers; Cannabis; Computer Simulation; Driving Under the Influence; Electroencephalography; Female; Humans; Male; Marijuana Abuse; Psychomotor Performance; Young Adult

The associations between cannabis use and anxiety or depression remain unclear. If cannabis affects these conditions, it is of interest to examine possible changes in cannabis use over time, in relation to anxiety and depression, as cannabis potency has increased in recent decades.. Cohorts from the Women and Alcohol in Gothenburg study (n = 1 100), from three time periods were used to examine associations over time between cannabis use and anxiety and depression. Logistic regression analyses were used and relative excess risk due to interaction (RERI) was calculated to examine potential additive interactions between period of cannabis use, cannabis use, and anxiety or depression.. Cannabis use was associated with anxiety in the oldest cohort (examined 1986-1992, born 1955/65), OR = 5.14 (1.67-15.80, 95 % CI), and with both anxiety and depression in the youngest cohort (examined 2000-2015, born 1980/93), OR = 1.66 (1.00-2.74, 95 % CI) and 2.37 (1.45-3.86, 95 % CI), respectively. RERI was significant between cannabis use and depression in the youngest cohort when compared with older cohorts (1.68 (0.45-2.92, 95 % CI)).. Cross-sectional data prevent statements on causality, though between-cohort comparisons are possible.. The association between cannabis use and depression becomes more pronounced when adding the effect of period of use rather than looking at the effect of cannabis use itself. This study provides clinicians and public health workers with scientifically underpinned knowledge regarding the link between cannabis use and depression, of particular importance given increasing cannabis potency.

Topics: Adolescent; Adult; Aged; Anxiety; Cannabis; Cohort Studies; Cross-Sectional Studies; Depression; Female; Humans; Marijuana Abuse; Middle Aged; Sweden; Young Adult

Topics: Cannabis; Genome-Wide Association Study; Humans; Legislation, Drug; Marijuana Abuse; Policy

This study aims to find the prevalence of medication non-compliance among schizophrenia inpatients and to compare the relative risks of medication non-compliance with cannabis use disorders (CUDs) versus without CUDs. In addition, this study also examines the odds of medication non-compliance in schizophrenia inpatients with CUDs.. This is a retrospective cross-sectional analysis of the nationwide inpatient sample. This sample includes 1,030,949 inpatients (age 18 to 65 years) from 2010 to 2014 with primary ICD-9 diagnoses of schizophrenia and other psychotic disorders, that were further sub grouped based on medication non-compliance. CUDs were recognized using the ICD-9 codes.. The prevalence of medication non-compliance was 26% among schizophrenia inpatients. Multivariable analysis revealed that CUD comorbidity was a significant risk factor for medication non-compliance among schizophrenia patients when unadjusted (OR 1.49, 95%CI 1.469-1.503), and association remained significant even after adjusting for covariates (adjusted OR 1.38, 95%CI 1.268-1.489). Comorbid CUD was seen in young adults (18-35 years, 62.4%), males (80.5%), African Americans (54.1%) and low-income families below 25th percentile (48.6%) with personality disorders (10.5%).. Medication compliance is a challenge among schizophrenia patients, which has a significant adverse impact on the course of illness. CUD Comorbidity increases the risk of medication non-compliance significantly among schizophrenia patients. In addition to case management, an integrated treatment model to address both substance use disorders and psychosis will translate into better long-term outcomes in schizophrenia patients.

Topics: Adolescent; Adult; Aged; Cannabis; Comorbidity; Cross-Sectional Studies; Humans; Inpatients; Male; Marijuana Abuse; Medication Adherence; Middle Aged; Retrospective Studies; Schizophrenia; United States; Young Adult

Cannabis addiction is worldwide one of the most prevalent addictions, without any effective pharmacotherapeutic options. Nabiximols spray, consisting of 2.7 mg tetrahydrocannabinol (THC) and 2.5 mg cannabidiol (CBD), could serve as an effective substitution therapy for cannabis addiction. Researchers reported that patients who were treated for 12 weeks with nabiximols significantly reduced the number of days on which they used cannabis (18.6 days less compared to placebo users; 95% CI: 3.5-33.7). There was no difference between groups regarding general health, the use of other substances, cannabis craving, withdrawal symptoms or achieving abstinence.

Topics: Analgesics; Cannabidiol; Cannabis; Clinical Trials as Topic; Dronabinol; Drug Combinations; Female; Humans; Male; Marijuana Abuse; Nasal Sprays; Substance Withdrawal Syndrome

Topics: Analgesics; Cannabis; Hallucinogens; Humans; Marijuana Abuse

Topics: Adolescent; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking

The increase in cannabis use coincides with the proliferation of small-scale cannabis cultivation. These crops facilitate substance availability and increased use. Some investigations have studied the characteristics of small-scale cultivators; however, it is not known whether their profiles differ by gender. The aim of the present study was to analyse differences among growers regarding sociodemographic variables, patterns of use and health problems from a gender perspective. A descriptive observational study was designed with a sample of 219 cultivators (157 men and 62 women), aged between 18 and 34. Problematic use of cannabis (CPQ), cannabis dependence (SDS), patterns of abuse (CAST), risky alcohol use (AUDIT), nicotine dependence (FTND) and sociodemographic variables (ad hoc questionnaire) were analysed. The results showed convergence between men and women in some indicators: early onset and daily cannabis use, psychosocial problems deriving from use, a similar number of problematic use and cannabis dependence cases, as well as a polydrug trend. Conversely, men reported greater physical problems and more intensive use of cannabis and alcohol. Women cannabis growers presented a similar profile to their male counterparts, whereas studies of the general population have shown cannabis use to be higher among men than women. This fact supports the relevance of researching specific risk factors related to gender, which can exert a differential influence on the intensity of use, and their relationship with small-scale cultivation. Implications of these results for planning preventive strategies and treatment are discussed from a gender perspective.. El incremento en el consumo de cannabis coincide con la proliferación del cultivo de cannabis a pequeña escala. Estos cultivos favorecen la disponibilidad de la sustancia e incrementan su consumo. Investigaciones previas han dejado entrever las características definitorias de poblaciones de cultivadores, pero se desconoce si su perfil difiere en función del género. El objeto del presente estudio fue analizar las diferencias de género en autocultivadores en relación con variables sociodemográficas, patrones de consumo y problemáticas de salud. Se diseñó un estudio observacional descriptivo, con una muestra de 219 cultivadores (157 hombres y 62 mujeres), con edades entre 18 y 34 años. Se analizaron problemas de consumo (CPQ), dependencia del cannabis (SDS), patrones de abuso(CAST), consumo de riesgo de alcohol (AUDIT), dependencia de la nicotina (FTND) y variables sociodemográficas (cuestionario ad hoc). Los resultados mostraron convergencia entre hombres y mujeres en los indicadores: inicio temprano y consumo diario de cannabis, problemáticas psicosociales derivadas del consumo, un número similar de casos de consumo problemático y dependencia del cannabis y tendencia al policonsumo. Contrariamente, los varones refirieron mayores problemas físicos, consumo intensivo de cannabis y de alcohol. A diferencia de los estudios en población general, donde el consumo de cannabis es mayor en hombres que en mujeres, las mujeres autocultivadoras presentan un perfil similar a los autocultivadores hombres. Este hecho sugiere la necesidad de investigar sobre los factores de riesgo específicos al género que pueden estar influyendo diferencialmente en el consumo intensivo y su relación con el autocultivo. Se discuten las implicaciones de los resultados en la planificación de estrategias preventivas y de tratamiento, desde una perspectiva de género.

Topics: Adult; Alcohol Drinking; Cannabis; Commerce; Female; Humans; Male; Marijuana Abuse; Motivation; Risk Assessment; Risk Factors; Sex Characteristics; Sex Distribution; Socioeconomic Factors; Spain; Surveys and Questionnaires; Young Adult

Although cannabis use is still illegal in most places around the world, it remains a widely used drug. The recreational use of cannabis has been linked to multiple mental wellbeing issues, including psychosis, depression and anxiety. The objective of this study was to investigate the temporal dynamics of cannabis use in relation to mental health issues.. The current research uses a novel methodological approach, behaviour sequence analysis, to understand the temporal relationship between recreational cannabis use and surrounding issues related to mental wellbeing, in a sample of 61 participants who had written autobiographical accounts online.. The results indicated a bi-directional temporal ordering between cannabis use and mood disorders. Cannabis use preceded psychosis and can also exacerbate symptoms of psychosis, depression and anxiety. Findings also suggested that low self-esteem may be a predictor of future cannabis use.. Research shows a link between mood disorders and recreational cannabis use. The BSA method can be used in applied settings to map pathways in individuals' life histories. SO WHAT?: The current study shows the sequential links between cannabis use and psychosis, depression and anxiety. Results show there is no single clear pathway and clinical practitioners should focus on a wider range of factors in individual's case histories.

Topics: Australia; Cannabis; Female; Humans; Male; Marijuana Abuse; Mood Disorders

Cannabis consumption during adolescence has been reported as a risk factor for psychotic-like experiences (PLEs) and schizophrenia. However, brain developmental processes associated with cannabis-related PLEs are still poorly described.. A total of 706 adolescents from the general population who were recruited by the IMAGEN consortium had structural magnetic resonance imaging scans at both 14 and 19 years of age. We used deformation-based morphometry to map voxelwise brain changes between the two time points, using the pairwise algorithm in SPM12b. We used an a priori region-of-interest approach focusing on the hippocampus/parahippocampus to perform voxelwise linear regressions. Lifetime cannabis consumption was assessed using the European School Survey Project on Alcohol and other Drugs (ESPAD), and PLEs were assessed with the Comprehensive Assessment Psychotic-like experiences (CAPE) tool. We first tested whether hippocampus/parahippocampus development was associated with PLEs. Then we formulated and tested an a priori simple mediation model in which uncus development mediates the association between lifetime cannabis consumption and PLEs.. We found that PLEs were associated with reduced expansion within a specific region of the right hippocampus/parahippocampus formation, the uncus (p = .002 at the cluster level, p = .018 at the peak level). The partial simple mediation model revealed a significant total effect from lifetime cannabis consumption to PLEs (b = 0.069, 95% CI = 0.04-0.1, p =2 × 10. We show here that the uncus development is involved in the cerebral basis of PLEs in a population-based sample of healthy adolescents.

Topics: Adolescent; Cannabis; Humans; Marijuana Abuse; Parahippocampal Gyrus; Psychotic Disorders; Risk Factors; Surveys and Questionnaires

Acute consumption of cannabis or its primary psychoactive ingredient ∆. We aim to develop and validate a prototype for a mobile phone application to measure ∆. We conducted two double-blind, within-subjects studies examining impairments after oral doses of ∆. ∆. The phone tasks were brief, to facilitate use in a non-laboratory setting, but it is likely that this made them less sensitive to the impairing effects of ∆

Topics: Adolescent; Adult; Attention; Cannabis; Cell Phone; Cognition; Cognitive Dysfunction; Double-Blind Method; Dronabinol; Female; Hallucinogens; Humans; Male; Marijuana Abuse; Marijuana Smoking; Memory, Short-Term; Psychomotor Performance; Reaction Time; Young Adult

Growing numbers of older adult marijuana users make understanding the marijuana-related treatment needs and treatment-related characteristics of this age group increasingly important. In this study, we examined four types of marijuana-involved admissions (marijuana as the only substance; marijuana as the primary substance with other secondary/tertiary substances; marijuana as the secondary substance; and marijuana as the tertiary substance) by treatment setting.. Data came from the 2012-2017 Treatment Episode Data Set-Admissions (TEDS-A), which includes 851,652 admissions by those aged 55+. Using multinomial logistic regression analysis, we focused on the 120,286 marijuana-involved admissions to test the hypothesis that polysubstance use would be associated with a higher likelihood of using detoxification and rehabilitation settings than ambulatory/outpatient settings.. Of all marijuana-involved admissions, 7.5% were marijuana-only, 12.7% were marijuana-primary, 58.4% were marijuana-secondary, and 21.4% were marijuana-tertiary admissions. Compared to marijuana-only admissions, admissions involving other substances were associated with a higher likelihood of detoxification and rehabilitation than ambulatory/outpatient treatment (e.g., RRR = 5.79, 95% CI = 5.08-6.61 for detoxification and RRR = 3.19, 95% CI = 2.89-3.52 for rehabilitation among marijuana-tertiary admissions). Referral source, first age of marijuana use, race/ethnicity, and homelessness were significant covariates.. Given increasing numbers of older-adult marijuana users, healthcare providers should screen older adults for marijuana and other substance use, and substance abuse treatment programs should become more responsive to older adults' needs.

Topics: Aged; Alcoholism; Cannabis; Female; Hospitalization; Humans; Male; Marijuana Abuse; Middle Aged; Opiate Alkaloids; Substance Abuse Treatment Centers; Substance-Related Disorders

Topics: Adolescent; Analgesics; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking

Topics: Cannabidiol; Cannabis; Cues; Heroin; Humans; Marijuana Abuse

Using a nationally representative longitudinal cohort, we examine how cognitive aptitude in early adolescence is associated with heterogeneous pathways of marijuana use from age sixteen through young adulthood. We also examine whether this relationship can be explained by the role of cognitive aptitude in the social organization of peer group deviance.. Using the National Longitudinal Survey of Youth 1997, we identified 5 latent trajectories of frequency of marijuana use between ages 16 and 26: abstainers, dabblers, early heavy quitters, consistent users, and persistent heavy users. Multinomial regression assessed the relationship of cognitive aptitude in early adolescence with these latent trajectories, including the role of peer group substance use in this relationship.. A one decile increase in cognitive aptitude in early adolescence is associated with greater relative risk of the dabbler trajectory (RR = 1.048; p < .001) and consistent user trajectory (RR = 1.126; p < .001), but lower relative risk of the early heavy quitter trajectory (RR = 0.917; p < .05) in comparison with the abstainer trajectory. There was no effect for the persistent heavy user trajectory. The inclusion of peer group substance use-either via illegal drugs or smoking-had no effect on these relationships.. Adolescents who rate higher in cognitive aptitude during early adolescence may be more likely to enter into consistent but not extreme trajectories of marijuana use as they age into young adulthood. Cognition may not influence patterns of marijuana use over time via the organization of peer groups.

Topics: Adolescent; Adult; Aptitude; Cannabis; Cognition; Female; Humans; Male; Marijuana Abuse; Marijuana Use; Peer Group; Risk Factors; Substance-Related Disorders; Young Adult

With the increasing consumption of hemp seed products, it is important to establish whether biological samples from consumers contain trace cannabinoids that could mistakenly be attributed to cannabis abuse. Thus, we analyzed whether the cannabinoids, 11-nor-9-carboxy-tetrahydrocannabinol, cannabidiol, and cannabinol, can be detected in the urine of short-term (1 week) and long-term (12 weeks) consumers of hemp seed products. Using three hemp seed products that have recently been highly distributed in Korea, subjects consumed 30 g of hemp seeds (Group A, 53.1 (±0.5) μg THC and Group B, 124.81 (±1.5) μg THC) or 2 capsules of hemp seed oil (Group C, 11.1 μg THC) once a day at 10am. In the short-term study, the hemp seed product was consumed for 7 days, after which a single urine sample was collected. In the long-term study, the hemp seed product was consumed for 12 weeks, and urine samples were collected at 7 day intervals. For screening of the urine samples, we used COBAS C311, and for the confirmatory analysis we used gas chromatography/mass spectrometry. In the screening, all 64 samples from the short-term study were below the detection cutoff level of 25 ng/mL. In the long-term study, out of the 480 samples, 3 samples from 2 participants were above the cutoff level, but these samples were all negative in screening. In conclusion, our study demonstrated that when hemp seed products sold in Korea are consumed in normal quantities over the short- or long-term, urine samples do not test positive for cannabinoids.

Topics: Adult; Cannabinoids; Cannabis; Case-Control Studies; Female; Gas Chromatography-Mass Spectrometry; Humans; Limit of Detection; Male; Marijuana Abuse; Middle Aged; Seeds; Substance Abuse Detection; Urinalysis; Young Adult

Topics: Cannabinoids; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Mental Disorders

Cannabis, the most widely used illicit drug, can induce hallucinations. Our understanding of the biology of cannabis-induced hallucinations (Ca-HL) is limited. We used the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) to identify cannabis-induced hallucinations (Ca-HL) among long-term cannabis users (used cannabis ≥1 year and ≥100 times). A genome-wide association study (GWAS) was conducted by analyzing European Americans (EAs) and African Americans (AAs) in Yale-Penn 1 and 2 cohorts individually, then meta-analyzing the two cohorts within population. In the meta-analysis of Yale-Penn EAs (n = 1917), one genome-wide significant (GWS) signal emerged at the CHRM3 locus, represented by rs115455482 (P = 1.66 × 10

Topics: Alleles; Animals; Black or African American; Cannabis; Female; Genetic Predisposition to Disease; Genome-Wide Association Study; Hallucinations; Humans; Male; Marijuana Abuse; Mice; Polymorphism, Single Nucleotide; Receptor, Muscarinic M3; White People

Cannabis currently leads to intensive, and sometimes highly emotional discussions like no other drug. What are the health and social risks, if the substance is used recreationally? This article describes the most important cannabinoids, the endogenous cannabinoid system and possible risks of cannabis if used as drug. Psychotherapeutic treatment options of cannabis abuse and dependence are shown.. Keine Droge führt derzeit zu so intensiven, teilweise leidenschaftlich geführten Diskussionen wie Cannabis. Welche gesundheitlichen und sozialen Risiken birgt die Substanz, wenn sie zu Rauschzwecken gebraucht wird? Dieser Beitrag beschreibt die wichtigsten Cannabinoide, das endogene Cannabissystem sowie mögliche kurzund langfristige Risiken. Er zeigt zudem psychotherapeutische Behandlungsoptionen von Cannabismissbrauch und -abhängigkeit auf.

Topics: Cannabinoids; Cannabis; Endocannabinoids; Hallucinogens; Humans; Marijuana Abuse

The α2a-adrenergic agonist, lofexidine, reduced cannabis withdrawal-related sleep disruption in the laboratory, but side effects (e.g. fatigue, hypotension) limit its utility as a treatment for cannabis use disorder. This study tested the potential efficacy and tolerability of a daily bedtime administration of the FDA-approved α2a-adrenergic agonist, guanfacine, in a human laboratory model of cannabis use disorder. Daily, nontreatment-seeking cannabis smokers (13M, 2F) completed a within-subject study comprising two 9-day inpatient study phases. Each phase tested the effects of daily placebo or immediate-release guanfacine (2 mg) on cannabis intoxication (5.6 percent THC; 2 days), withdrawal (4 days of abstinence) and subsequent 'relapse' (3 days of cannabis self-administration). Ratings of mood, sleep, cardiovascular effects, food intake, psychomotor performance and cannabis self-administration were assessed. An outpatient phase preceded each inpatient phase for medication clearance or dose induction. Under placebo medication conditions, cannabis abstinence produced significant withdrawal, including irritability, sleep disruption and anorexia. Guanfacine reduced ratings of irritability and improved objective measures of sleep during cannabis withdrawal relative to placebo but did not reduce cannabis self-administration. Guanfacine was well tolerated with little evidence of fatigue and only small decreases in blood pressure: no dose was held due to hypotension. Thus, a single daily administration of guanfacine at bedtime improved sleep and mood during cannabis withdrawal relative to placebo. This positive signal supports further studies varying the guanfacine dose, formulation or frequency of administration, or combining it with other medications to increase the likelihood of having an impact on cannabis use.

Topics: Adrenergic alpha-2 Receptor Agonists; Adult; Affect; Anorexia; Blood Pressure; Cannabis; Feeding Behavior; Female; Guanfacine; Humans; Irritable Mood; Male; Marijuana Abuse; Psychomotor Performance; Self Administration; Sleep; Substance Withdrawal Syndrome; Young Adult

Decreased white matter (WM) integrity in patients with psychotic disorder has been a consistent finding in diffusion tensor imaging (DTI) studies. However, the contribution of environmental risk factors to these WM alterations is rarely investigated. The current study examines whether individuals with (increased risk for) psychotic disorder will show increased WM integrity change over time with increasing levels of childhood trauma and cannabis exposure.. DTI scans were obtained from 85 patients with a psychotic disorder, 93 non-psychotic siblings and 80 healthy controls, of which 60% were rescanned 3 years later. In a whole-brain voxel-based analysis, associations between change in fractional anisotropy (ΔFA) and environmental exposures as well as interactions between group and environmental exposure in the model of FA and ΔFA were investigated. Analyses were adjusted for a priori hypothesized confounding variables: age, sex, and level of education.. At baseline, no significant associations were found between FA and both environmental risk factors. At follow-up as well as over a 3-year interval, significant interactions between group and, respectively, cannabis exposure and childhood trauma exposure in the model of FA and ΔFA were found. Patients showed more FA decrease over time compared with both controls and siblings when exposed to higher levels of cannabis or childhood trauma.. Higher levels of cannabis or childhood trauma may compromise connectivity over the course of the illness in patients, but not in individuals at low or higher than average genetic risk for psychotic disorder, suggesting interactions between the environment and illness-related factors.

Topics: Adult; Adult Survivors of Child Adverse Events; Anisotropy; Cannabis; Case-Control Studies; Cross-Sectional Studies; Diffusion Tensor Imaging; Female; Humans; Longitudinal Studies; Male; Marijuana Abuse; Neuroimaging; Psychotic Disorders; Risk Factors; White Matter

The legalization of non-medical cannabis use and supply is impending in Canada. This constitutes a major policy change with the declared objective of improving public health outcomes, which requires rigorous monitoring and evaluation. While numerous different aspects associated with legalization will be examined, a focused perspective is required for effective policy evaluation purposes. To these ends, we have identified a set of 10 core indicators associated with cannabis-related risk/harm outcomes-based on current best evidence-that are expected to measure the primary impacts of legalization on public health outcomes. We briefly review these indicators, and their respective data availability in Canada. As ideally an integrated outcome assessment of cannabis legalization's impact on public health will be available, we further propose options to merge the individual indicators into an integrated, weighted 'index', considering their expected relative impact for public health. One possible approach to undertake this is 'multi-criteria decision analysis' as a method to weight the relative indicator impact on public health; alternative approaches are proposed. The integrated 'public health index' for cannabis legalization will allow for scientifically comprehensive, while focused, monitoring and evaluation of the effects of legalization in Canada for the benefits of science and evidence-based policy alike.

Topics: Canada; Cannabis; Hospitalization; Humans; Legislation, Drug; Marijuana Abuse; Marijuana Smoking; Prevalence; Public Health

Due to the recentness of changes to marijuana policies in a number of states, the effect on adolescent use and perceptions is not yet well understood. This study examines change in adolescent marijuana use and related perceptions in Colorado, before and after the implementation of legal commercial sale of recreational marijuana for adults starting on January 1, 2014. The data are from a repeated cross-sectional survey of a representative sample of Colorado high school students, with separately drawn samples surveyed in fall 2013 (prior to implementation) and fall 2015 (18 months after implementation). We examined change in the prevalence of adolescent marijuana use, measured by lifetime use, past 30-day use, frequent use, and use on school property. To consider the possibility of heterogeneity in the change in marijuana use, we examined change in past 30-day marijuana use by demographic characteristics (sex, grade, race/ethnicity), school characteristics (poverty, percent minority), urbanicity of the school district, and whether the city or county permitted retail marijuana stores. There was an absence of significant effects for change in lifetime or past 30-day marijuana use. Among those reporting past 30-day use, frequent use and use on school property declined. There was a significant decline in the perceived harm associated with marijuana use, but we did not find a significant effect for perceived wrongfulness, perceived ease of access, or perceived parental disapproval. We did not find significant variability in past 30-day use by demographic characteristics or by school and community factors from 2013 to 2015. We did not find a significant effect associated with the introduction of legal sales of recreational marijuana to adults in Colorado on adolescent (illegal) use, but ongoing monitoring is warranted, including consideration of heterogeneity in the effects of marijuana policies.

Topics: Adolescent; Adolescent Behavior; Adult; Cannabis; Colorado; Cross-Sectional Studies; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Social Perception; Students; Surveys and Questionnaires

Cannabis withdrawal syndrome (CWS) was newly added to the Diagnostic and Statistical Manual of Mental Disorders in its most recent edition, DSM-5. With cannabis use increasing among U.S. adults, information is needed about the prevalence and correlates of DSM-5 CWS in the general population. This study presents nationally representative findings on the prevalence, sociodemographic and clinical correlates of DSM-5 CWS among U.S. adults.. Participants ≥18 years were interviewed in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) in 2012-2013. Among the sub-sample of frequent cannabis users in the prior 12 months (≥3 times a week; N = 1527), the prevalence and demographic and clinical correlates of DSM-5 CWS were examined.. In frequent cannabis users, the prevalence of CWS was 12.1%. The most common withdrawal symptoms among those with CWS were nervousness/anxiety (76.3%), hostility (71.9%), sleep difficulty (68.2%) and depressed mood (58.9%). CWS was associated with significant disability (p < 0.001), and with mood disorders (adjusted odds ratios [aOR] = 1.9-2.6), anxiety disorders (aOR = 2.4-2.5), personality disorders (aOR = 1.7-2.2) and family history of depression (aOR = 2.5) but not personal history of other substance use disorders or family history of substance use problems.. CWS is highly comorbid and disabling. Its shared symptoms with depressive and anxiety disorders call for clinician awareness of CWS and the factors associated with it to promote more effective treatment among frequent cannabis users.

Topics: Adolescent; Adult; Aged; Anxiety Disorders; Cannabis; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; Female; Health Surveys; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Personality Disorders; Substance Withdrawal Syndrome; United States; Young Adult

To determine if higher potency cannabis is associated with earlier progression to regular cannabis use, daily cannabis use, and cannabis use disorder symptom onset.. Data sources were the Michigan Longitudinal Study, an ongoing prospective, high-risk family study investigating the course and predictors for substance use disorders among youth beginning prior to school entry and time-parallel national average trends in delta-9-tetrahydrocannabinol (i.e., psychoactive compound in cannabis). The national average trends in delta-9-tetrahydrocannabinol were used to estimate potency level for the individual. Only cannabis users were included in analyses (n = 527).. Cox regression showed an increased risk of progression from cannabis initiation to cannabis use disorder symptom onset by 1.41 times (p < .001) for each unit increase in national average delta-9-tetrahydrocannabinol as compared to those not endorsing CUD symptom onset, adjusting for sex, regular use, and cohort effects. Accounting for regular use, individuals initiating cannabis at national average 4.9% delta-9-tetrahydrocannabinol were at 1.88 times (p = .012) higher risk for cannabis use disorder symptom onset within one year compared to those who did not endorse CUD symptom onset, while those initiating cannabis at national average 12.3% delta-9-tetrahydrocannabinol were at 4.85 times (p = .012) higher risk within one year.. This study provides prospective evidence suggesting higher potency cannabis, on average in the U.S., increases risk for onset of first cannabis use disorder symptom. Development of guidelines regarding cannabis potency is critical for reducing the costs associated with negative health outcomes.

Topics: Adolescent; Adult; Cannabis; Child; Disease Progression; Dronabinol; Female; Hallucinogens; Humans; Longitudinal Studies; Male; Marijuana Abuse; Marijuana Smoking; Michigan; Prospective Studies; United States; Young Adult

Although epidemiological data suggest that repeated use of cannabis during adolescence may increase the risk for psychosis, its precise molecular mechanisms remain undetermined. In this study, we examined whether brain-derived neurotrophic factor (BDNF) and its receptor TrkB signaling plays a role in the risk for psychosis after exposure of cannabinoid (CB) receptor agonist during adolescence. Repeated administration of the CB receptor agonist WIN55,212-2 (2 mg/kg/day) during adolescence (P35 - P45) significantly increased methamphetamine (METH: 1 mg/kg)-induced hyperlocomotion in adulthood (P70 - P74) compared with vehicle-treated mice. Western blot analysis showed that BDNF-TrkB signaling in the nucleus accumbens (NAc) of WIN55,212-2-treated mice were significantly higher than that of vehicle-treated mice. Interestingly, an increase in the METH-induced locomotion in WIN55,212-2-treated mice was significantly attenuated by subsequent repeated administration of the TrkB antagonist ANA-12 (0.5 mg/kg/day from P70 to P83). Furthermore, increased BDNF-TrkB signaling in the NAc from WIN55,212-2-treated mice was also significantly attenuated after subsequent repeated administration of ANA-12. These findings suggest that increased BDNF-TrkB signaling in the NAc plays an important role in the increase in METH-induced locomotion in adulthood after repeated WIN55,212-2 administration during adolescence. Therefore, TrkB antagonists would be potential prophylactic and therapeutic drugs for psychosis in adult with cannabis use during adolescence.

Topics: Animals; Azepines; Behavior, Animal; Benzamides; Benzoxazines; Brain-Derived Neurotrophic Factor; Cannabinoid Receptor Agonists; Cannabinoids; Cannabis; Central Nervous System Stimulants; Dentate Gyrus; Locomotion; Male; Marijuana Abuse; Membrane Glycoproteins; Methamphetamine; Mice; Mice, Inbred C57BL; Morpholines; Naphthalenes; Nucleus Accumbens; Prefrontal Cortex; Protein-Tyrosine Kinases; Psychoses, Substance-Induced; Risk

Cannabis is illegal in France but, as in many countries, legalization is under debate. In the United States, an increase of emergency department (ED) visits related to cannabis exposure (CE) in infants and adults was reported. In France, a retrospective observational study also suggested an increase of CE in children under 6 years old. This study only included toddlers and the data sources used did not allow repeated analysis for monitoring.. Our study aimed to evaluate the trend in visits for CE in ED in patients younger than 27 years old in Southern France. A cross-sectional study using the Electronic Emergency Department Abstracts (EEDA) included in the national Syndromic Surveillance System. CE visits were defined using International Classification of Disease (ICD-10).. From 2009 to 2014, 16 EDs consistently reported EEDA with <5% missing diagnosis code. Seven hundred and ninety seven patients were admitted for CE including 49 (4.1%) children under 8 years old. From 2009-11 to 2012-14, the rate of CE visits increased significantly across all age groups. The highest increase was in the 8-14 years old (+144%; 1.85-4.51, P < 0.001) and was also significant in children under 8 (0.53-1.06; P = 0.02). Among children under 8, hospitalization rate (75.5% vs. 16.8%; P < 0.001) and intensive care unit admissions (4.1% vs. 0.1%; P < 0.001) were higher compared with patients older than 8 years.. These trends occurred despite cannabis remaining illegal. EEDA could be useful for monitoring CE in EDs.

Topics: Adolescent; Adult; Age Factors; Cannabis; Child; Child, Preschool; Cross-Sectional Studies; Emergency Service, Hospital; Female; France; Hospitalization; Humans; Infant; Infant, Newborn; Male; Marijuana Abuse; Retrospective Studies; Sentinel Surveillance; Young Adult

Medical cannabis laws (MCL) have received increased attention as potential drivers of cannabis use (CU), but little work has explored how the broader policy climate, independent of MCL, may impact CU outcomes. We explored the association between state-level policy liberalism and past-year cannabis use (CU) and cannabis use disorder (CUD).. We obtained state-level prevalence of past-year CU and CUD among past year cannabis users for ages 12-17, 18-25, and 26+ from the 2004-2006 and 2010-2012 National Surveys on Drug Use and Health. States were categorized as liberal, moderate, or conservative based on state-level policy liberalism rankings in 2005 and 2011. Linear models with random state effects examined the association between policy liberalism and past-year CU and CUD, adjusting for state-level social and economic covariates and medical cannabis laws.. In adjusted models, liberal states had higher average past-year CU than conservative states for ages 12-17 (+1.58 percentage points; p = 0.03) and 18-25 (+2.96 percentage points; p = 0.01) but not for 26+ (p = 0.19). CUD prevalence among past year users was significantly lower in liberal compared to conservative states for ages 12-17 (-2.87 percentage points; p = 0.045) and marginally lower for ages 26+ (-2.45 percentage points; p = 0.05).. Liberal states had higher past-year CU, but lower CUD prevalence among users, compared to conservative states. Researchers and policy makers should consider how the broader policy environment, independent of MCL, may contribute to CU outcomes.

Topics: Adolescent; Adult; Aged; Cannabis; Cross-Sectional Studies; Female; Humans; Legislation, Drug; Male; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Middle Aged; Policy; Politics; United States

Topics: Cannabis; Hallucinogens; Humans; Marijuana Abuse; Self Report

Topics: Canada; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Self Report

Cannabis use has been linked to impaired driving and fatal accidents. Prior evidence suggests the potential for population-wide effects of the annual cannabis celebration on April 20th ('4/20'), but evidence to date is limited.. We used data from the Fatal Analysis Reporting System for the years 1975-2016 to estimate the impact of '4/20' on drivers involved in fatal traffic crashes occurring between 16:20 and 23:59 hours in the USA. We compared the effects of 4/20 with those for other major holidays, and evaluated whether the impact of '4/20' had changed in recent years.. Between 1992 and 2016, '4/20' was associated with an increase in the number of drivers involved in fatal crashes (IRR 1.12, 95% CI 0.97 to 1.28) relative to control days 1 week before and after, but not when compared with control days 1 and 2 weeks before and after (IRR 1.05, 95% CI 0.92 to 1.28) or all other days of the year (IRR 0.98, 95% CI 0.88 to 1.10). Across all years we found little evidence to distinguish excess drivers involved in fatal crashes on 4/20 from routine daily variations.. There is little evidence to suggest population-wide effects of the annual cannabis holiday on the number of drivers involved in fatal traffic crashes.

Topics: Accidents, Traffic; Cannabis; Female; Holidays; Humans; Male; Marijuana Abuse; Regression Analysis; United States

A 70-year-old man with known coronary artery disease presented with crushing chest pain, diaphoresis, and pallor after consuming a marijuana lollipop; the pain began within 30 minutes of consumption. His troponin T increased from 94 ng/L to 216 ng/L, with slight ST changes but no gross ST elevations. Discharge diagnosis was non-ST-elevation myocardial infarction, and subsequent nuclear medicine wall motion studies showed worsening ejection fraction (40% to 31%). He also described worsening functional status and exercise capacity after the event. The outcome of this case is important with new marijuana legalization-hopefully with marijuana use no longer criminalized, more research into the cardiovascular side effects will emerge.

Topics: Aged; Cannabis; Electrocardiography; Humans; Male; Marijuana Abuse; Non-ST Elevated Myocardial Infarction; Troponin T

Given the increase in cannabis availability and use in North America, identification of risk factors for cannabis use and dependence is paramount. One factor that may be associated with various cannabis-related adverse outcomes is the context in which it is used. This secondary analysis study sought to examine the extent to which the social context of cannabis use is related to patterns of use and associated harms.. One hundred and eighty-eight adult cannabis users were community-recruited in Halifax, Canada. Participants took part in a face-to-face structured interview where they provided information about the social context of their most recent cannabis-using occasion and about their patterns of, and motives for, cannabis use.. Compared to individuals reporting their most recent cannabis-using occasion as social, solitary users (n = 55) were significantly more likely to screen positive for psychosis, endorse more symptoms of cannabis abuse/dependence, report using cannabis to cope, and use cannabis on more days within the previous 30 days. On the other hand, social users were significantly more likely to report using alcohol in addition to cannabis during their most recent cannabis-using occasion (all P < 0.05).. Results suggest that solitary cannabis use may be associated with specific motives for use and future adverse consequences. Findings from this study serve as a guide for future investigations which could ultimately inform public policy and the development of targeted harm-reduction strategies.

Topics: Adult; Canada; Cannabis; Female; Humans; Male; Marijuana Abuse; Middle Aged; Social Behavior; Young Adult

Topics: Cannabis; Hallucinogens; Humans; Marijuana Abuse; Self Report

Data on associations between cannabis use and psychopathology, cognition and functional impairment in schizophrenia spectrum disorders (SSD) is controversial.. To examine the effect of cannabis on psychopathology, cognition and real-world functioning in SSD patients.. Naturalistic cross-sectional study, 123 clinically stable SSD outpatients.. demographic and clinical data, psychometric evaluation: Positive and Negative Syndrome, Hamilton Depression Rating, Clinical Global Impression (CGI), Personal and Social Performance and Screen for Cognitive Impairment in Psychiatry (SCIP) scales. Patients were classified as cannabis user patients (CUP) and non cannabis user patients (NCUP) according to self-report, both lifetime and last year.. chi-square, Student t test, ANOVA (Duncan post hoc), and general linear model analysis for adjusting for antipsychotic doses.. Mean age 40.75, 66.7% male, single (66.7%), prior hospital admissions 2.75, mean length of illness 13.85 years. 53.7% were lifetime cannabis users and 8.9% last year users. Lifetime CUP had more hospitalizations (p = 0.013) at a younger age (p = 0.002), and showed better cognitive functioning globally (CGI-C: p = 0.045) and on working memory and processing speed (SCIP-2: p = 0.039; SCIP-5: p = 0.033) and worse functioning in socially useful activities (p = 0.014) than NCUP. All these differences remained after adjusting for antipsychotic doses. Last year cannabis users had worse mood (Hamilton Depression Rating Scale 9.66 vs. 5.64; p = 0.002), but this difference disappears when adjusting for antipsychotic doses.. Lifetime cannabis use is associated with better working memory and processing speed and worse real-world functioning in the area of socially useful activities in patients with schizophrenia-related disorders. Clinicians should, therefore, be aware of it to provide patient-centred care in their daily clinical practice.

Topics: Adult; Cannabis; Cognition; Cross-Sectional Studies; Female; Humans; Male; Marijuana Abuse; Neuropsychological Tests; Schizophrenia

Topics: Cannabis; Case-Control Studies; Europe; Humans; Incidence; Marijuana Abuse; Psychotic Disorders

Topics: Acute Disease; Analgesics; Cannabis; Emergency Service, Hospital; Humans; Marijuana Abuse

Topics: Cannabis; Humans; Marijuana Abuse

Topics: Cannabis; Female; Humans; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Pregnancy; Public Health

Topics: Cannabis; Female; Humans; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Pregnancy; Public Health

Topics: Adolescent; Cannabis; Humans; Latent Class Analysis; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Young Adult

The marijuana arteriopathy should be considered in young patients with peripheral arterial disease with no risk factors for atherosclerosis. It was described for the first time in 1960 and since then there have been about 100 cases published in the literature. Although it tends to be considered as an independent entity of thromboangiitis obliterans or Leo Buerger's disease, in the light of the last findings it is possible to consider it within the spectrum of the latter. We present two cases of young patients with peripheral vascular disease associated with marijuana use where other associated illnesses had been excluded and where the mainstay of treatment has been the cessation of marijuana consumption. It is essential to assess drug use in young patients presenting with peripheral arterial disease.. La arteriopatía por marihuana debe ser considerada en pacientes jóvenes con arteriopatía periférica sin factores de riesgo para ateroesclerosis. Se ha descrito por primera vez en 1960 y existen más de 100 casos en la literatura. Si bien se tiende a considerar como una entidad independiente de la tromboangeítis obliterante o enfermedad de Leo Buerger, debido a los hallazgos la consideramos dentro del espectro de esta última. Presentamos dos casos de pacientes jóvenes con enfermedad vascular periférica asociada al consumo de marihuana, luego de excluir otras enfermedades. El tratamiento es el cese del consumo. Es indispensable valorar el uso de drogas en pacientes jóvenes que se presentan con arteriopatía periférica.

Topics: Adult; Cannabis; Humans; Male; Marijuana Abuse; Peripheral Arterial Disease; Risk Factors; Thromboangiitis Obliterans; Treatment Outcome

Topics: Cannabis; Europe; Hallucinogens; Humans; Marijuana Abuse; Public Health

Topics: Adolescent; Brain; Cannabis; Cognition; Humans; Marijuana Abuse; Psychotic Disorders

Topics: Cannabis; Female; Humans; Marijuana Abuse; Marijuana Smoking; Pregnancy; Self Report; United States

Topics: Adolescent; Cannabis; Employment; Humans; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Socioeconomic Factors; Washington

Topics: Cannabis; Female; Humans; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Pregnancy; Self Report

Topics: Cannabis; Health Knowledge, Attitudes, Practice; Humans; Marijuana Abuse; Marijuana Use; New Zealand; Psychotic Disorders; Violence

Cannabis can be prescribed for posttraumatic stress disorder (PTSD) and chronic pain, and comorbid cannabis use disorder (CUD) can occur in both conditions. Research demonstrates that PTSD and chronic pain commonly co-occur.. Data were acquired from the National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 36,309). Past-year CUD and PTSD were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Past-year physician-confirmed chronic pain was self-reported and classified as musculoskeletal (e.g., arthritis), digestive (e.g., pancreatitis), and nerve (e.g., reflex sympathetic dystrophy) pain. Weighted cross-tabulations assessed sociodemographic, psychiatric, and chronic pain condition variables among those with PTSD versus no PTSD, among the entire sample and among those with CUD and chronic pain. Multiple logistic regressions examined the relationship between PTSD and chronic pain with CUD. CUD characteristics were also evaluated across PTSD and chronic pain groups.. Rates of CUD were elevated in PTSD (9.4%) compared to those without (2.2%). The odds of CUD were greater for PTSD+digestive pain, PTSD+nerve pain, and PTSD+any chronic pain compared to having neither PTSD nor chronic pain (odds ratio range: 1.88-2.32). PTSD with and without comorbid chronic pain was associated with overall elevated rates of adverse CUD characteristics, including earlier age of onset, greater usage, and greater CUD severity.. PTSD with and without chronic pain is associated with elevated rates and severity of CUD. These results may have implications for prescribing practices and understanding individuals at risk for developing CUD.

Topics: Adolescent; Adult; Cannabis; Chronic Pain; Comorbidity; Female; Humans; Logistic Models; Male; Marijuana Abuse; Stress Disorders, Post-Traumatic; United States; Young Adult

Marijuana use is disproportionately prevalent among HIV-infected individuals. The strongest neurocognitive effect of marijuana use is impairment in the domain of memory. Memory impairment is also high among HIV-infected persons. The present study examined 69 HIV-infected individuals who were stratified by age of regular marijuana initiation to investigate how marijuana use impacts neurocognitive functioning. A comprehensive battery assessed substance use and neurocognitive functioning. Findings indicated early onset marijuana users (regular use prior to age 18), compared to non-marijuana users and late onset marijuana users (regular use at age 18 or later), were over 8 times more likely to have learning impairment and nearly 4 times more likely to have memory impairment. A similar pattern of early onset marijuana users performing worse in learning emerged when examining domain deficit scores. The potential for early onset of regular marijuana use to exacerbate already high levels of memory impairment among HIV-infected persons has important clinical implications, including increased potential for medication non-adherence and difficulty with independent living.

Topics: Adolescent; Adult; Cannabis; Cognition; Cognitive Dysfunction; Female; HIV Infections; Humans; Learning; Male; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Memory Disorders; Memory, Short-Term; Middle Aged; Neuropsychological Tests; Substance-Related Disorders

Schizophrenia (SZ) and bipolar disorder (BD) are heritable, polygenic disorders with shared clinical and genetic components, suggesting a psychosis continuum. Cannabis use is a well-documented environmental risk factor in psychotic disorders. In the current study, we investigated the relationship between SZ genetic load and cannabis use before illness onset in SZ and BD spectrums. Since frequent early cannabis use (age <18 years) is believed to increase the risk of developing psychosis more than later use, follow-up analyses were conducted comparing early use to later use and no use.. We assigned a SZ-polygenic risk score (PGRS) to each individual in our independent sample (N = 381 SZ spectrum cases, 220 BD spectrum cases and 415 healthy controls), calculated from the results of the Psychiatric Genomics Consortium (PGC) SZ case-control study (N = 81 535). SZ-PGRS in patients who used cannabis weekly to daily in the period before first illness episode was compared with that of those who never or infrequently used cannabis.. Patients with weekly to daily cannabis use before illness onset had the highest SZ-PGRS (p = 0.02, Cohen's d = 0.33). The largest difference was found between patients with daily or weekly cannabis use before illness onset <18 years of age and patients with no or infrequent use of cannabis (p = 0.003, Cohen's d = 0.42).. Our study supports an association between high SZ-PGRS and frequent cannabis use before illness onset in psychosis continuum disorders.

Topics: Adolescent; Adult; Bipolar Disorder; Cannabis; Case-Control Studies; Female; Genetic Predisposition to Disease; Humans; Male; Marijuana Abuse; Multifactorial Inheritance; Norway; Psychiatric Status Rating Scales; Risk Factors; Schizophrenia; Young Adult

Cannabis use disorders are frequently comorbid in patients with a psychotic disorder and are associated with worse outcomes. To date there are no proven effective strategies to achieve cannabis abstinence in this population. An alternative for abstinence might be harm reduction, i.e. replacing the use of street cannabis with high tetrahydrocannabinol and low cannabidiol levels by medicinal cannabis variants with relatively low tetrahydrocannabinol and relatively high cannabidiol levels, thereby reducing the psychosis inducing effects of cannabis and enhancing the antipsychotic effects of cannabis. Here we present the data of a case series with seven inpatients diagnosed with a psychotic disorder and a treatment-resistant cannabis use disorder who received substitution therapy with a low tetrahydrocannabinol medicinal cannabis variant (Bedrolite). The results suggest that the low tetrahydrocannabinol medicinal cannabis variant Bedrolite is not effective in the treatment of inpatients with a psychotic disorder and comorbid cannabis use disorder. Bedrolite is thus not very likely to become an effective harm reduction strategy in these patients.

Topics: Adult; Antipsychotic Agents; Cannabidiol; Cannabis; Comorbidity; Dronabinol; Female; Humans; Inpatients; Male; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Middle Aged; Psychotic Disorders; Young Adult

Major Depressive Disorder (MDD) and Bipolar Disorder (BPD) are the most severe mood disorders globally. Previous reports indicate high co-occurrence of cannabis use and cannabis use disorders (CUDs) associated with both disorders, yet studies comparing patterns of cannabis use between individuals with MDD and BPD are scarce.. Data were drawn from Wave 1 (2001-2002) of the National Epidemiologic survey on Alcohol and Related Conditions (NESARC). Cannabis users who qualified for a diagnosis of past-year MDD (N=217) were compared to those with BPD (N=168) in frequency and daily dose of cannabis use, rates of comorbid psychiatric disorders including specific criteria of CUDs, treatment utilization and suicidality.. Among past-year cannabis users, individuals with BPD reported using cannabis more frequently and smoking more joints per day compared to those with MDD. They were also more likely to suffer from comorbid personality disorders and qualify for specific CUD-criteria, including use in physically hazardous situations and unsuccessful efforts to control substance use.. Our results indicate that individuals with BPD may present more intensive patterns of cannabis use compared to those with MDD. This may have potential effects on the course of BPD and should be further explored in longitudinal studies.

Topics: Adolescent; Adult; Aged; Bipolar Disorder; Cannabis; Depressive Disorder, Major; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Retrospective Studies; Surveys and Questionnaires; Young Adult

Cannabis and its principal active constituent, Δ9-tetrahydrocannabinol (THC), are increasingly available as edibles resembling commercially available food products. In this case series, we describe a population of predominantly pediatric patients who were inadvertently exposed to a THC-containing product in San Francisco.. Twelve children and 9 adults were identified, with 16 patients having detectable serum THC and THC metabolites. All patients presented to hospitals with a variety of constitutional symptoms and all were discharged home within 12 hours.. In general, pediatric patients had more severe symptoms and longer hospital length of stay, and, uniquely, a majority presented with leukocytosis and elevated lactic acid levels.. We recommend that efforts be made to increase general public awareness in regard to the potential hazards of THC-containing edibles resembling commercially available food products.

Topics: Adolescent; Adult; Candy; Cannabis; Child; Dronabinol; Female; Gas Chromatography-Mass Spectrometry; Humans; Hypnotics and Sedatives; Incidence; Male; Marijuana Abuse; Middle Aged; San Francisco; Substance Abuse Detection; Young Adult

Despite moderate heritability, only one study has identified genome-wide significant loci for cannabis-related phenotypes. We conducted meta-analyses of genome-wide association study data on 2080 cannabis-dependent cases and 6435 cannabis-exposed controls of European descent. A cluster of correlated single-nucleotide polymorphisms (SNPs) in a novel region on chromosome 10 was genome-wide significant (lowest P=1.3E-8). Among the SNPs, rs1409568 showed enrichment for H3K4me1 and H3K427ac marks, suggesting its role as an enhancer in addiction-relevant brain regions, such as the dorsolateral prefrontal cortex and the angular and cingulate gyri. This SNP is also predicted to modify binding scores for several transcription factors. We found modest evidence for replication for rs1409568 in an independent cohort of African American (896 cases and 1591 controls; P=0.03) but not European American (EA; 781 cases and 1905 controls) participants. The combined meta-analysis (3757 cases and 9931 controls) indicated trend-level significance for rs1409568 (P=2.85E-7). No genome-wide significant loci emerged for cannabis dependence criterion count (n=8050). There was also evidence that the minor allele of rs1409568 was associated with a 2.1% increase in right hippocampal volume in an independent sample of 430 EA college students (fwe-P=0.008). The identification and characterization of genome-wide significant loci for cannabis dependence is among the first steps toward understanding the biological contributions to the etiology of this psychiatric disorder, which appears to be rising in some developed nations.

Topics: Adult; Alleles; Black or African American; Cannabis; Case-Control Studies; Chromosomes, Human, Pair 10; Cohort Studies; Female; Gene Frequency; Genetic Predisposition to Disease; Genome-Wide Association Study; Genotype; Humans; Male; Marijuana Abuse; Middle Aged; Phenotype; Polymorphism, Single Nucleotide; White People; Young Adult

Studies investigating the impact of medical marijuana legalization have found no significant changes in adolescent use. In one of the few studies focused on recreational marijuana, we investigated how recreational marijuana legalization and community sales policy influenced factors that likely impact youth use (youth willingness and intent to use, parent use) as well as youth use. Legalization of recreational marijuana in Oregon coincided with our study on adolescent substance use. Cohort 1 transitioned from 8th to 9th grade prior to legalization and Cohort 2 made this transition during legalization (N = 444; 53% female). Communities were allowed to opt out of sales. Multivariate linear regression models estimated the impact of legalization and community sales policy on changes in attitudes and parent use (2 time points 1 year apart). Zero-inflated Poisson growth curve models estimated the effects on initial levels and rate of change from 8th through 9th grade (4 time points). In communities opting out of sales, the prior-to-legalization cohort was less likely to increase their willingness and intent to use marijuana, and the legalization cohort was more likely to increase intent to use. For youth who used marijuana, legalization was associated with increased use, and those in communities opting out of sales had greater growth in marijuana use. Community policy appears to impact youth attitudes toward, and use of, marijuana. Results suggest that legalization of recreational marijuana did not increase marijuana use for youth who did not use marijuana but did increase use in youth who were already using. (PsycINFO Database Record

Topics: Adolescent; Attitude; Cannabis; Commerce; Female; Humans; Intention; Legislation, Drug; Male; Marijuana Abuse; Marijuana Smoking; Oregon; Parents

Intact cognitive and emotional functioning is vital for the long-term success of addiction treatment strategies. Accumulating evidence suggests an association between chronic marijuana use and lasting alterations in cognitive brain function. Despite initial evidence for altered emotion processing in dependent marijuana users after short abstinence periods, adaptations in the domain of emotion processing after longer abstinence remain to be determined.. Using task-based and resting state fMRI, the present study investigated emotion processing in 19 dependent marijuana users and 18 matched non-using controls after an abstinence period of > 28 days.. Relative to the control subjects, negative emotional stimuli elicited increased medial orbitofrontal cortex (mOFC) activity and stronger mOFC-dorsal striatal and mOFC-amygdala functional coupling in dependent marijuana users (p < 0.022, FWE-corrected). Furthermore, mOFC-dorsal striatal functional connectivity was increased at rest in marijuana users (p < 0.03, FWE-corrected). Yet, processing of positive stimuli and subjective ratings of valence and arousal were comparable in both groups.. Together, the present findings provide the first evidence for persisting emotion processing alterations in dependent marijuana users. Alterations might reflect long-term neural adaptations as a consequence of chronic marijuana use or predisposing risk factors for the development of marijuana dependence.

Topics: Adolescent; Adult; Amygdala; Analysis of Variance; Behavior, Addictive; Brain Mapping; Cannabis; Case-Control Studies; Cerebral Cortex; Emotions; Female; Frontal Lobe; Humans; Magnetic Resonance Imaging; Male; Marijuana Abuse; Prefrontal Cortex; Visual Cortex; Young Adult

ABSTRACTBackground:Compared to their non-using age peers, older marijuana users are known to have lower marijuana risk perceptions. We examined associations of older marijuana users' risk perceptions with their marijuana use patterns and substance use disorders.. Data are from 2013 to 2015 National Survey of Drug Use and Health (N = 24,057 respondents aged 50+ years). Bivariate logistic regression was used to compare risk perceptions among never users, former users, and past-year users aged 50+ years. Multivariable logistic regression was used to test associations between risk perception and marijuana use status and between risk perception and marijuana use patterns.. Among the total sample, former (AOR = 0.30, 95% CI = 0.27-0.32) and past-year (AOR = 0.05, 95% CI = 0.04-0.06) marijuana users had significantly lower odds of moderate/great risk perception (as opposed to no/slight risk perception) than never users. Among past-year users, odds of moderate/great risk perception were lower among those who used marijuana more frequently (AOR = 0.14, 95% CI = 0.07-0.28 for 300+ days of use compared to 1-11 days of use) and who reported any medical marijuana use (AOR = 0.27, 95% CI = 0.14-0.51). However, those who had marijuana use disorder were 3.5 times more likely to report moderate/great risk perception (AOR = 3.50, 95% CI = 1.62-7.58). Those who had a college education, had higher incomes, and resided in states with medical marijuana laws also had lower risk perceptions.. Public health education on scientific evidence about marijuana's benefits and harms and age-appropriate treatment for older adults with substance use problems are needed. Research on risk perception formation using longitudinal data among older adults is also needed.

Topics: Age Factors; Aged; Aged, 80 and over; Cannabis; Female; Health Knowledge, Attitudes, Practice; Humans; Logistic Models; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Multivariate Analysis; Perception; Risk; United States

Cannabis is associated with increased risk for severe mental illness and is commonly used among individuals with schizophrenia or bipolar disorder. In this study we investigated associations between cannabis use and brain structures among patients with schizophrenia or bipolar disorders. Magnetic resonance imaging scans were obtained for 77 schizophrenia and 55 bipolar patients with a history of cannabis use (defined as lifetime use >10 times during one month or abuse/dependence), and 97 schizophrenia, 85 bipolar disorder patients and 277 healthy controls without any previous cannabis use. Cortical thickness, cortical surface area and subcortical volumes were compared between groups. Both hypothesis-driven region-of-interest analyses from 11 preselected brain regions in each hemisphere and exploratory point-by-point analyses were performed. We tested for diagnostic interactions and controlled for potential confounders. After controlling for confounders such as tobacco use and alcohol use disorders we found reduced cortical thickness in the caudal middle frontal gyrus compared to non-user patients and healthy controls. The findings were not significant when patients with co-morbid alcohol and illicit drug use were excluded from the analyses, but onset of cannabis use before illness onset was associated with cortical thinning in the caudal middle frontal gyrus. To conclude, we found no structural brain changes associated with cannabis use among patients with severe mental illness, but the findings indicate excess cortical thinning among those who use cannabis before illness onset. The present findings support the understanding that cannabis use is associated with limited brain effects in schizophrenia as well as bipolar disorder.

Topics: Adult; Bipolar Disorder; Brain; Cannabis; Cross-Sectional Studies; Female; Humans; Magnetic Resonance Imaging; Male; Marijuana Abuse; Organ Size; Schizophrenia

Topics: Adolescent; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Marijuana Smoking; Research

While cannabis has been widely used in the UK for over 50 years, it is only in recent decades that domestic cultivation has become established. Public concern, media reporting and policing policy has emphasised the role of profit motivated criminal organisations often working on a large scale and with coerced labour. However, increasingly, another population are growing for medical reasons, to help themselves and others treat or manage difficult, poorly understood, or incurable conditions. Our study sought to further understand the motives, techniques and interactions of cannabis cultivators through interviews with 48 growers and supplementary ethnographic work. As well as those motivated to grow for personal use, social and commercial supply purposes we identified a cohort growing to provide themselves and others with cannabis used for therapeutic purposes. This paper draws primarily on interviews with a sub-group of sixteen medically-motivated growers who were not only involved in treatment, but also embraced the label "activist". Rather than develop techniques of deception they were organising to effect a change in legislation. Rejecting the image of criminal perpetrators, they presented themselves as victims of unjust government policy, an indifferent medical establishment, and brutal and immoral criminal markets. Through cultivation, association, self-healing and apomedication, they have found voice and are shifting the debate over the status of growers and of cannabis itself. The ambiguity of their position as both producers and patients challenges the assumptions underlying legal distinctions between suppliers and users, with potentially profound implications for policy.

Topics: Attitude; Cannabis; Crime; Criminal Law; Drug and Narcotic Control; Government Regulation; Humans; Legislation, Drug; Marijuana Abuse; Medical Marijuana; Physicians; Surveys and Questionnaires; United Kingdom

Topics: Adolescent; Cannabis; Cognitive Dysfunction; Humans; Longitudinal Studies; Marijuana Abuse

The number of people entering specialist drug treatment for cannabis problems has increased considerably in recent years. The reasons for this are unclear, but rising cannabis potency could be a contributing factor.. Cannabis potency data were obtained from an ongoing monitoring programme in the Netherlands. We analysed concentrations of δ-9-tetrahydrocannabinol (THC) from the most popular variety of domestic herbal cannabis sold in each retail outlet (2000-2015). Mixed effects linear regression models examined time-dependent associations between THC and first-time cannabis admissions to specialist drug treatment. Candidate time lags were 0-10 years, based on normative European drug treatment data.. THC increased from a mean (95% CI) of 8.62 (7.97-9.27) to 20.38 (19.09-21.67) from 2000 to 2004 and then decreased to 15.31 (14.24-16.38) in 2015. First-time cannabis admissions (per 100 000 inhabitants) rose from 7.08 to 26.36 from 2000 to 2010, and then decreased to 19.82 in 2015. THC was positively associated with treatment entry at lags of 0-9 years, with the strongest association at 5 years, b = 0.370 (0.317-0.424), p < 0.0001. After adjusting for age, sex and non-cannabis drug treatment admissions, these positive associations were attenuated but remained statistically significant at lags of 5-7 years and were again strongest at 5 years, b = 0.082 (0.052-0.111), p < 0.0001.. In this 16-year observational study, we found positive time-dependent associations between changes in cannabis potency and first-time cannabis admissions to drug treatment. These associations are biologically plausible, but their strength after adjustment suggests that other factors are also important.

Topics: Cannabinoid Receptor Agonists; Cannabis; Dronabinol; Drug Monitoring; Humans; Marijuana Abuse; Netherlands

Topics: Cannabis; Czech Republic; Humans; Legislation, Drug; Marijuana Abuse; Public Policy

Topics: Cannabis; Cohort Effect; Humans; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Mental Health; Prevalence; Surveys and Questionnaires; United States

Cannabis legalization in Colorado resulted in increased cannabis-associated health care utilization. Our objective was to examine cooccurrence of cannabis and mental health diagnostic coding in Colorado emergency department (ED) discharges and replicate the study in a subpopulation of ED visits where cannabis involvement and psychiatric diagnosis were confirmed through medical review.. We collected statewide ED International Classification of Diseases, 9th Revision, Clinical Modification diagnoses from the Colorado Hospital Association and a subpopulation of ED visits from a large, academic hospital from 2012 to 2014. Diagnosis codes identified visits associated with mental health and cannabis. Codes for mental health conditions and cannabis were confirmed by manual records review in the academic hospital subpopulation. Prevalence ratios (PRs) of mental health ED discharges were calculated to compare cannabis-associated visits to those without cannabis. Rates of mental health and cannabis-associated ED discharges were examined over time.. Statewide data demonstrated a fivefold higher prevalence of mental health diagnoses in cannabis-associated ED visits (PR = 5.35, 95% confidence interval [CI], 5.27-5.43) compared to visits without cannabis. The hospital subpopulation supported this finding with a fourfold higher prevalence of psychiatric complaints in cannabis attributable ED visits (PR = 4.87, 95% CI = 4.36-5.44) compared to visits not attributable to cannabis. Statewide rates of ED visits associated with both cannabis and mental health significantly increased from 2012 to 2014 from 224.5 to 268.4 per 100,000 (p < 0.0001).. In Colorado, the prevalence of mental health conditions in ED visits with cannabis-associated diagnostic codes is higher than in those without cannabis. There is a need for further research determining if these findings are truly attributed to cannabis or merely coincident with concurrent increased use and availability.

Topics: Adult; Cannabis; Colorado; Cross-Sectional Studies; Emergency Service, Hospital; Female; Humans; Male; Marijuana Abuse; Marijuana Use; Middle Aged; Patient Discharge; Prevalence; Retrospective Studies

The Cannabis abuse screening test (CAST) is a short test used for screening those with problematic cannabis use. Recently, its invariance toward age was tested in an Israeli sample of cannabis users, but this study had some sample and methodological limitations: it was conducted in a volunteer sample aged 18-40 and considered the CAST items as continuous variables, although they are based on 5-point Likert scales. We thus tested the CAST invariance toward age (15-24, 25-34, and 35-64 years old) using a French probabilistic sample of 1,351 past-year cannabis users aged 15-64 and using appropriate methods for categorical items and survey weights. Factors retained (non-recreational use and problems) were the same as those mentioned in previous studies. Scalar invariance held for the "problems" factor but only partial scalar invariance was supported for the "non-recreational use" factor. Caution is thus needed when the CAST score is compared across age groups.

Topics: Adolescent; Adult; Cannabis; Female; Humans; Israel; Male; Marijuana Abuse; Middle Aged; Models, Statistical; Psychometrics; Surveys and Questionnaires

Topics: Adult; Cannabis; Causality; Comorbidity; Female; Humans; India; Male; Marijuana Abuse; Psychotic Disorders; Recurrence; Young Adult

Approximately 6%-8% of U.S. adolescents are daily/past-month users of marijuana. However, survey data may not reliably reflect the impact of legalization on adolescents. The objective was to evaluate the impact of marijuana legalization on adolescent emergency department and urgent cares visits to a children's hospital in Colorado, a state that has allowed both medical and recreational marijuana.. Retrospective review of marijuana-related visits by International Classification of Diseases codes and urine drug screens, from 2005 through 2015, for patients ≥ 13 and < 21 years old.. From 2005 to 2015, 4,202 marijuana-related visits were identified. Behavioral health evaluation was obtained for 2,813 (67%); a psychiatric diagnosis was made for the majority (71%) of these visits. Coingestants were common; the most common was ethanol (12%). Marijuana-related visits increased from 1.8 per 1,000 visits in 2009 to 4.9 in 2015. (p = < .0001) CONCLUSIONS: Despite national survey data suggesting no appreciable difference in adolescent marijuana use, our data demonstrate a significant increase in adolescent marijuana-associated emergency department and urgent cares visits in Colorado.

Topics: Adolescent; Adult; Ambulatory Care; Cannabis; Colorado; Emergency Service, Hospital; Female; Humans; Male; Marijuana Abuse; Marijuana Use; Retrospective Studies; Young Adult

To evaluate the transfer of delta-9-tetrahydrocannabinol and its metabolites into human breast milk after maternal inhalation of 0.1 g cannabis containing 23.18% delta-9-tetrahydrocannabinol.. In this pilot pharmacokinetic study, breast milk samples were collected from mothers who regularly consumed cannabis, were 2-5 months postpartum, and exclusively breastfeeding their infants. Women were anonymously recruited for the study. After discontinuing cannabis for at least 24 hours, they were directed to obtain a baseline breast milk sample, then smoke a preweighed, analyzed, standardized strain of cannabis from one preselected dispensary, and collect breast milk samples at specific time points: 20 minutes and 1, 2, and 4 hours. Quantification of delta-9-tetrahydrocannabinol and its metabolites in these collected breast milk samples was performed by high-performance liquid chromatography tandem mass spectrometry.. A total of eight women were enrolled. Most were occasional cannabis smokers and one a chronic user. Delta-9-tetrahydrocannabinol was detected at low concentrations at all the time points beyond time zero. No metabolites were detected at any time point. Delta-9-tetrahydrocannabinol was transferred into mother's milk such that exclusively breastfeeding infants ingested an estimated mean of 2.5% of the maternal dose (the calculated relative infant dose=2.5%, range 0.4-8.7%). The estimated daily infant dose was 8 micrograms per kilogram per day.. This study documents inhaled delta-9-tetrahydrocannabinol transfer into the mother's breast milk. Low concentrations of delta-9-tetrahydrocannabinol were detected. The long-term neurobehavioral effect of exposure to delta-9-tetrahydrocannabinol on the developing brain is unclear. Mothers should be cautious using cannabis during pregnancy and breastfeeding.

Topics: Adult; Breast Feeding; Cannabis; Dronabinol; Female; Food Contamination; Humans; Infant; Infant, Newborn; Male; Marijuana Abuse; Marijuana Smoking; Milk, Human; Puerperal Disorders

Topics: Cannabis; Humans; Marijuana Abuse

Neuroimaging studies have demonstrated gray matter (GM) volume abnormalities in substance users. While the majority of substance users are polysubstance users, very little is known about the relation between GM volume abnormalities and polysubstance use.. In this study we assessed the relation between GM volume, and the use of alcohol, tobacco, cocaine and cannabis as well as the total number of substances used, in a sample of 169 males: 15 non-substance users, 89 moderate drinkers, 27 moderate drinkers who also smoke tobacco, 13 moderate drinkers who also smoke tobacco and use cocaine, 10 heavy drinkers who smoke tobacco and use cocaine and 15 heavy drinkers who smoke tobacco, cannabis and use cocaine.. Regression analyses showed that there was a negative relation between the number of substances used and volume of the dorsal medial prefrontal cortex (mPFC) and the ventral mPFC. Without controlling for the use of other substances, the volume of the dorsal mPFC was negatively associated with the use of alcohol, tobacco, and cocaine. After controlling for the use of other substances, a negative relation was found between tobacco and cocaine and volume of the thalami and ventrolateral PFC, respectively.. These findings indicate that mPFC alterations may not be substance-specific, but rather related to the number of substances used, whereas, thalamic and ventrolateral PFC pathology is specifically associated with tobacco and cocaine use, respectively. These findings are important, as the differential alterations in GM volume may underlie different cognitive deficits associated with substance use disorders.

Topics: Adolescent; Adult; Alcohol Drinking; Alcoholism; Cannabis; Cocaine; Cocaine-Related Disorders; Drug Users; Ethanol; Gray Matter; Humans; Magnetic Resonance Imaging; Male; Marijuana Abuse; Middle Aged; Neuroimaging; Nicotiana; Organ Size; Self Report; Substance-Related Disorders; Tobacco Use; Tobacco Use Disorder; Young Adult

Topics: Adolescent; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Marijuana Smoking

Topics: Adolescent; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Medical Marijuana; United States

There is a lack of studies investigating the dose-response effect of childhood trauma, recent events and cannabis use on recent psychosis. This study aims to determine the relationship between the level of exposure to stress factors and cannabis use with psychosis and to determine the combination effect among these factors in predicting a psychotic disorder.. 146 recent onset psychotic (ROP) patients and 61 healthy controls were included. Childhood trauma was evaluated using the childhood trauma questionnaire (CTQ) and recent events using the Holmes-Rahe social readjustment scale. The pattern of cannabis use was assessed by a detailed interview. A hierarchical multiple regression was run in order to determine both the cumulative and independent contribution of each factor in predicting a psychotic disorder.. The highest levels of exposure to childhood trauma and cannabis were associated with psychosis while neither low nor high recent event exposure was associated. The combined effect of risk factors yielded a significant association with psychosis (×. Our study provides evidence for a cumulative and a dose-response effect of environmental factors on recent psychosis. Considering that cannabis use and stress are highly prevalent in the population with psychosis, investigations of their relationships are needed to implement targeted prevention and treatment strategies.

Topics: Adolescent; Adult; Adult Survivors of Child Abuse; Cannabis; Cross-Sectional Studies; Female; Humans; Male; Marijuana Abuse; Marijuana Use; Psychotic Disorders; Retrospective Studies; Risk Factors; Stress, Psychological; Young Adult

Rates of cannabis use and related problems continue to rise, ranking as the third most common substance use disorder in the United States, behind tobacco and alcohol use. Past work suggests that perceived distress tolerance is related to several clinically significant features of cannabis use (e.g., coping-oriented use). However, there has been little exploration of the mechanisms that may underlie relations between perceived distress tolerance and cannabis use problems, withdrawal severity, and self-efficacy for quitting. The current study sought to examine the experience of pain, which frequently co-occurs with cannabis use (Ashrafioun, Bohnert, Jannausch, & Ilgen, 2015), as an underlying factor in the relation between perceived distress tolerance and cannabis related problems among 203 current cannabis-using adults (29.2% female, M = 37.7 years, SD = 10.2, 63% African American). Results indicated that perceived distress tolerance via pain related affective distress significantly predicted the severity of cannabis use problems (Pm = 0.60), degree of cannabis withdrawal (Pm = 0.39), and lower self-efficacy for quitting cannabis (Pm = 0.36). Future work may usefully explore the role of pain-related affective distress as a mechanistic factor in the context of perceived distress tolerance-cannabis relations.

Topics: Adaptation, Psychological; Adult; Affect; Cannabis; Female; Humans; Male; Marijuana Abuse; Middle Aged; Pain; Self Efficacy; Stress, Psychological; Substance Withdrawal Syndrome

Cannabis use is increasing in the United States, as are its adverse effects. We investigated the genetics of an adverse consequence of cannabis use: cannabis-related aggression (CRA) using a genome-wide association study (GWAS) design. Our GWAS sample included 3269 African Americans (AAs) and 2546 European Americans (EAs). An additional 89 AA subjects from the Grady Trauma Project (GTP) were also examined using a proxy-phenotype replication approach. We identified genome-wide significant risk loci contributing to CRA in AAs at the serotonin receptor 2B receptor gene (HTR2B), and the lead SNP, HTR2B*rs17440378, showed nominal association to aggression in the GTP cohort of cannabis-exposed subjects. A priori evidence linked HTR2B to impulsivity/aggression but not to cannabis response. Human functional data regarding the HTR2B variant further supported our finding. Treating an Htr2b

Topics: Adult; Aggression; Alcoholism; Animals; Black or African American; Cannabis; Cohort Studies; Female; Genome-Wide Association Study; Humans; Male; Marijuana Abuse; Marijuana Smoking; Mice; Mice, Knockout; Middle Aged; Receptor, Serotonin, 5-HT2B; Risk Factors; White People

Wellens' syndrome is an electrocardiographic pattern of T-wave changes associated with critical stenosis of the proximal left anterior descending artery, signifying imminent risk of an anterior-wall myocardial infarction. The Wellens' electrocardiographic pattern can also be noted in several cardiac and non-cardiac diseases. We chronicle here a unique case of a patient who presented with atypical left chest pain and dizziness for 6 hours. His pain started after he smoked phencyclidine-laced cannabis. Cardiac panel demonstrated normal troponin T levels. Electrocardiogram showed sinus rhythm with new deep biphasic T-wave inversions in anterolateral leads. Coronary angiography showed no pathological processes. Subsequently, ECG changes resolved coincidentally with the resolution of chest pain. He was eventually diagnosed with pseudo-Wellens' syndrome. This paper illustrates that physicians should be vigilant for Wellens' syndrome mimicked by acute phencyclidine and cannabis intoxication. Additionally, we present a review of various aetiologies of pseudo-Wellens' syndrome, especially in patients with substance abuse.

Topics: Adult; Cannabis; Chest Pain; Humans; Male; Marijuana Abuse; Nifedipine; Phencyclidine; Phencyclidine Abuse; Syndrome

A prominent effect of acute cannabis use is impaired motor coordination and driving performance. However, few studies have evaluated balance in chronic cannabis users, even though density of the CB1 receptor, which mediates the psychoactive effects of cannabis, is extremely high in brain regions critically involved in this fundamental behavior. The present study measured postural sway in regular cannabis users and used rambling and trembling analysis to quantify the integrity of central and peripheral nervous system contributions to the sway signal.. Postural sway was measured in 42 regular cannabis users (CB group) and 36 non-cannabis users (N-CB group) by asking participants to stand as still as possible on a force platform in the presence and absence of motor and sensory challenges. Center of pressure (COP) path length was measured, and the COP signal was decomposed into rambling and trembling components. Exploratory correlational analyses were conducted between sway variables, cannabis use history, and neurocognitive function.. The CB group had significantly increased path length and increased trembling in the anterior-posterior (AP) direction. Exploratory correlational analyses suggested that AP rambling was significantly inversely associated with visuo-motor processing speed.. Regular cannabis use is associated with increased postural sway, and this appears to be predominantly due to the trembling component, which is believed to reflect the peripheral nervous system's contribution to the sway signal.

Topics: Adolescent; Adult; Cannabis; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Postural Balance; Young Adult

The Canadian federal government has committed to legalizing non-medical cannabis use by adults in 2018. Medical use was legalized in 2001; however, not all people reporting medical use have medical authorization. To prepare for monitoring the effects of the policy change, a greater understanding of the prevalence of cannabis use and the characteristics of all cannabis users is needed.. Data from the 2015 Canadian Tobacco, Alcohol and Drugs Survey (CTADS) were used to estimate prevalence and examine reasons for medical use and factors associated with people who reported using cannabis Non-Medically Only (NMO), compared with people who reported Self-Defined Medical and Non-Medical use (SDMNM), including use of other drugs and the non-therapeutic use of psychoactive pharmaceuticals.. In 2015, 9.5% of Canadians aged 15 and older reported NMO cannabis use, while another 2.8% reported SDMNM use. Half of Canadians reporting some self-defined medical use cited pain as the primary reason. Daily and near-daily use was significantly more common among SDMNM users (47.2%) than among individuals considered NMO users (26.4%). Past-year cannabis users of any type were more likely to be male and younger, to have used other illicit drugs and at least one of three classes of psychoactive pharmaceutical drugs non-therapeutically, and to be daily smokers or heavy drinkers. SDMNM cannabis use was more common among people reporting worse health (general and mental), use of psychoactive pharmaceuticals, and living in lower-income households.. Because non-medical cannabis use is common to both user groups analyzed, many similarities were anticipated. Nevertheless, SDMNM users also had several unique characteristics consistent with use to address medical problems. However, because the CTADS does not collect information about whether the individual has received a health care practitioner's authorization to use cannabis for a medical purpose this analysis should not be interpreted as an evaluation of people who access cannabis through Health Canada's medical access program, the Access Cannabis for Medical Purposes Regulations (ACMPR).

Topics: Adolescent; Adult; Age Factors; Aged; Canada; Cannabis; Female; Humans; Illicit Drugs; Male; Marijuana Abuse; Medical Marijuana; Middle Aged; Prevalence; Sex Factors; Surveys and Questionnaires

Cannabis concentrates, including dabs, contain extremely high levels of Δ. 4077 respondents completed a survey designed to assess the use of conventional flower cannabis relative to dabs. Individuals provided information about frequency and magnitude of use, and also completed the Marijuana Motives Measure and Severity of Dependence Scale to examine whether dab users have different motives for use and/or demonstrate more severe consequences of use compared to those who only use conventional flower products.. 58% of respondents reported they had tried dabs at least once and 36.5% endorsed regular use (once a month or more). Those who use regularly use dabs were significantly more likely to report using for experimentation (feeling "curious") relative to reasons for using conventional flower products. Interestingly, motives reflecting positive effects (i.e., coping, sleep problems, relieving social anxiety) were endorsed more highly for flower use. In addition, regular dab users reported being more worried about their use of cannabis products relative to those who had tried dabs but did not use regularly.. Results indicate that cannabis consumers do not necessarily choose dabs over flower products for positive effects, but rather appear to choose these highly potent products for experimentation. As concentrate use may lead to increased cannabis-related problems, studies directly assessing concentrate users are needed.

Topics: Adult; Anxiety; Cannabis; Diazonium Compounds; Dronabinol; Female; Humans; Male; Marijuana Abuse; Middle Aged; Sulfanilic Acids; Surveys and Questionnaires; United States

The Kreek-McHugh-Schluger-Kellogg (KMSK) scales provide a rapid assessment of maximal self-exposure to specific drugs and can be used as a dimensional instrument. This study provides a re-evaluation of the KMSK scales for cannabis, alcohol, cocaine, and heroin in a relatively large multi-ethnic cohort, and also the first systematic comparison of gender-specific profiles of drug exposure with this scale.. This was an observational study of n = 1,133 consecutively ascertained adult volunteers. The main instruments used were the SCID-I interview (DSM-IV criteria) and KMSK scales for cannabis, alcohol, cocaine, and heroin.. Participants were 852 volunteers (297 female) with specific DSM-IV abuse or dependence diagnoses, and 281 volunteers without any drug diagnoses (154 female). Receiver operating characteristic (ROC) curves were calculated for concurrent validity of KMSK scores with the respective DSM-IV dependence diagnoses. The areas under the ROC curves for men and women combined were 99.5% for heroin, 97% for cocaine, 93% for alcohol, and 85% for cannabis. Newly determined optimal KMSK "cutpoint" scores were identical for men and women for cocaine and heroin dependence diagnoses, but were higher in men than in women, for cannabis and alcohol dependence diagnoses.. This study confirms the scales' effectiveness in performing rapid dimensional analyses for cannabis, alcohol, cocaine, and heroin exposure, in a cohort larger than previously reported, with "cutpoints" changed from initial determinations, based on this larger sample. The KMSK scales also detected gender differences in self-exposure to alcohol and cannabis that are associated with the respective dependence diagnoses.

Topics: Adult; Alcoholism; Cannabis; Cocaine; Cohort Studies; Diagnostic and Statistical Manual of Mental Disorders; Female; Heroin; Heroin Dependence; Humans; Male; Marijuana Abuse; Middle Aged; ROC Curve; Sex Characteristics; Substance-Related Disorders; Young Adult

Topics: Adolescent; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Medical Marijuana

The cannabis academic literature is informed by dominant deficit, public health and harm reduction frameworks. However, a large majority of cannabis consumption appears to place outside the scope of these models that prioritise the identification and limitation of negative impacts. As such there are apparent analytical blind spots pertaining to: non-problematic use of cannabis (as defined by Global Commission on Drug Policy); the intersection of medical and recreational intents of use; and pleasure. This paper explores the academic and grey literature relating to the spectrum of wellness to assess its suitability as a framework for cannabis scholars. For millennia cannabis use has been associated with wellness models, particularly at the nexus of mind, body, and spirit. Despite this seemingly obvious match, the academic literature that incorporates cannabis consumption patterns into wellness conceptions is thin. The spectrum of wellness has both advantages and disadvantages compared to existing models and may be useful as a complementary framework that allows for broader examination of cannabis consumer activity.

Topics: Cannabis; Drug and Narcotic Control; Harm Reduction; Health Promotion; Humans; Marijuana Abuse; Marijuana Use; Pleasure; Public Health; Public Policy

To explore patterns of cannabis use for medical purposes in Australia immediately prior to the 2016 legislation for frameworks for medical cannabis use. Design, setting: Anonymous online survey with convenience sample, April-October 2016. Participants were recruited through online media and at professional and consumer forums.. Adults (at least 18 years of age) who reported using a cannabis product for self-identified medical or therapeutic reasons during the preceding 12 months.. Consumer characteristics; indications and patterns of medical cannabis use; perceived benefits and harms; views on appropriate availability of medical cannabis.. Most of the 1748 participants were men (68.1%) and employed (56.6%), with a mean age of 37.9 years (SD, 13.4 years) and mean reported period of medical cannabis use of 9.8 years (SD, 12.5 years). The most frequent reasons for medical cannabis use were anxiety (50.7%), back pain (50.0%), depression (49.3%), and sleep problems (43.5%). Respondents had used medical cannabis on a mean of 19.9 of the previous 28 days (SD, 10.0 days), spending a mean $68.60 (SD, $85.00) per week, and 83.4% had inhaled the substance. Participants reported high levels of clinical effectiveness and frequent side effects, including drowsiness, ocular irritation, lethargy and memory impairment; 17% met DSM-5 criteria for moderate or severe cannabis use disorder. Many reported harms or concerns related to the illicit status of cannabis. Participants believed that medical cannabis should be integrated into mainstream health care, and that products should be required to meet consistency and safety standards.. Illicitly sourced cannabis is used to treat a broad range of medical conditions in Australia. Future models of prescribed medical cannabis take consumer patterns of use and demand into consideration.

Topics: Adult; Australia; Cannabis; Female; Humans; Male; Marijuana Abuse; Medical Marijuana; Middle Aged; Off-Label Use; Self Medication; Surveys and Questionnaires; Treatment Outcome

Topics: Adolescent; Cannabis; Functional Neuroimaging; Humans; Marijuana Abuse; Neuropsychological Tests; Prospective Studies

Cannabis is the most commonly used illicit drug in psychosis patients and has been identified as a risk factor for relapse and subsequent hospital readmission, having substantial economic implications. To clarify the contribution of cannabis consumption to hospital readmission, a consecutive inpatient cohort of 161 early psychosis patients was included into the study. Data on cannabis use at admission and number of hospital readmissions and length of stay (LOS, number of inpatient days) in a 6-year follow-up was extracted from clinical notes. 62.4% of the patients had lifetime cannabis use. Their admission lasted on average 54.3 ± 75 days and over the following 6 years patients had 2.2 ± 2.8 hospital readmissions, for a total of 197.4 ± 331.5 days. Cannabis use significantly predicted the number of hospital readmissions and LOS in the following 6 years, the latter remaining significant after adjusting for use of other substance. Cannabis-using patients of male gender and Black ethnicity had a longer LOS at follow-up compared to female patients and other ethnic groups, respectively. Having a history of cannabis use when admitted to an early intervention inpatient unit for psychosis is associated with a higher number of subsequent hospital readmissions and a longer LOS, especially in male and Black patients.

Topics: Adolescent; Adult; Aged; Cannabis; Cohort Studies; Female; Follow-Up Studies; Humans; Inpatients; Length of Stay; Longitudinal Studies; Male; Marijuana Abuse; Middle Aged; Patient Readmission; Prospective Studies; Psychotic Disorders; Retrospective Studies; Risk Factors; Time Factors; Young Adult

Topics: Biomedical Research; Cannabis; Female; Fetal Development; Humans; Marijuana Abuse; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects

Topics: Adolescent; Ambulatory Care; Cannabis; Colorado; Humans; Marijuana Abuse; Marijuana Smoking; Marijuana Use

Previous research shows that between individuals there is a positive association between medically motivated use and cannabis use frequency and quantity. While between-subjects' analyses are useful for understanding shared vulnerabilities, research has so far not examined within-subjects' relationships which are closer to evaluating functional relationships (i.e., do individuals tend to use cannabis more heavily subsequent to elevations in pain experiences?). To better understand the association between experiences of pain and cannabis use, the current paper examines whether there is a functional within-subjects association between experiences of pain and heavy cannabis use.. 182 regular cannabis users without a medical cannabis license were asked to report momentary experiences of physical pain, whether they had used cannabis, and if so, quantity consumed five times per day over a five-day period on their smartphones. Mixed effects models examined the relations between within- and between-subjects experiences of pain and cannabis use and quantity consumed.. Elevated experiences of pain were not associated with cannabis use occasions at the within- or between-subjects level. Experiences of pain were associated with greater amount of cannabis consumed at the within-subjects level, but not at the between-subjects level.. Experiences of pain are not associated with decisions about whether or not to use cannabis. Once cannabis users are in cannabis-using situations, they tend to use larger amounts when they are experiencing elevated levels of pain. This may have implications for cannabis abuse treatment as pain may make it more difficult for users to reduce their consumption.

Topics: Adult; Cannabinoids; Cannabis; Ecological Momentary Assessment; Female; Habits; Humans; Male; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Medical Marijuana; Motivation; Pain; Young Adult

Topics: Adolescent; Ambulatory Care; Cannabis; Colorado; Humans; Legislation, Drug; Marijuana Abuse

There is evidence that regular cannabis use has negative effects on sleep health. Relative to HIV- populations, HIV + individuals consistently report greater sleep impairments. The number of HIV + individuals reporting frequent cannabis use, often to treat sleep issues, has significantly increased recently. It is unknown, however, if HIV status moderates the association between cannabis use and sleep health. The current study, therefore, examines these associations in a sample of HIV + and HIV- adults.. HIV + and HIV- (N = 107) individuals completed one laboratory visit. Participants completed a 30-day drug use history questionnaire quantifying consumption of cannabis, cigarettes, and alcohol, and a sleep health questionnaire. To verify substance use and HIV status, participants completed a urine toxicology screening and serology testing.. HIV + individuals demonstrated lower sleep health than HIV- individuals. Linear regressions indicated that HIV status moderated the association between total 30-day cannabis consumption and sleep health; cannabis consumption was negatively associated with sleep health in HIV-, but not HIV + individuals. This interactive effect was significant after examining cigarette/alcohol use, depression symptoms, and demographic variables as covariates.. These results corroborate studies demonstrating an inverse relationship between sleep health and cannabis consumption. This study also suggests that factors other than cannabis may be associated with lower sleep health in HIV + individuals. Emerging studies suggest that inflammation may mediate effects of cannabis on HIV infection. Future studies examining this mechanism are warranted to understand cannabis further and sleep in HIV + individuals.

Topics: Adolescent; Adult; Alcohol Drinking; Cannabis; Female; HIV Infections; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Sleep; Sleep Wake Disorders; Surveys and Questionnaires

Topics: Adolescent; Attitude; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Marijuana Use

Policing practices do not reflect recent decriminalization of drug possession in Mexico. We assessed knowledge of cannabis law as part of a police education program (PEP) post-drug law reform in Tijuana.. Officers took pre-/post-PEP surveys; random subsample (n = 759) received follow-up assessments. Longitudinal logistic regression (pre-, post-, 3-months post-PEP) measured knowledge of cannabis law.. PEP increased conceptual knowledge of cannabis law from baseline to post-training (AOR = 56.1, CI: 41.0-76.8) and 3 months post-PEP (AOR = 11.3, CI: 9.0-14.2).. PEPs improve police knowledge of cannabis law. Reforms should be bundled with PEPs to improve policy implementation. (Am J Addict 2018;XX:XX-XX).

Topics: Adult; Cannabis; Educational Measurement; Female; Humans; Male; Marijuana Abuse; Mexico; Police; Surveys and Questionnaires; Teaching

As the number of states legalizing marijuana for medical and/or recreational use continues to grow, there are an increasing number of children exposed to marijuana-containing products in homes and communities. Increased exposure leads to a greater probability of accidental ingestion and toxicity. Because marijuana ingestion can cause a dangerous and potentially life-threatening toxicity for children, pediatric health care providers need an increased awareness of the danger. This article describes the growing problem and outlines clinical management as well as prevention. [Pediatr Ann. 2018;47(12):e474-e476.].

Topics: Acute Disease; Adolescent; Cannabis; Child; Humans; Illicit Drugs; Marijuana Abuse; Pediatrics; United States

Cannabis legalization and commercialization have introduced novel alternative cannabis products, including edible and vaporized cannabis that might appeal to youth and be associated with polyuse (ie, use of ≥2 different products).. To investigate the prevalence, patterns, and sociodemographic correlates of cannabis product use across combustible, edible, and vaporized administration methods, including polyuse of cannabis via multiple administration methods.. This cross-sectional survey study included 10th-grade students from 10 Los Angeles, California, area high schools from January 2 through October 6, 2015. Students were recruited from respondents in the Happiness and Health Study, an ongoing prospective cohort study in the 10 high schools. Students not in school during administration of the pencil-and-paper survey completed abbreviated surveys by telephone, internet, or mail. Data were analyzed from July 17, 2017, through July 12, 2018.. Self-reported sex, race/ethnicity, and socioeconomic status (SES). Students with high SES had parents who attained college or a higher educational level and were ineligible for free or subsidized lunch; those with low SES had parents with lower educational attainment or were eligible for free or subsidized lunch.. Self-report of ever use (yes or no) and past 30-day use (yes or no) status and frequency of use (days in past 30 days) of combustible, edible, and vaporized cannabis.. The sample included 3177 tenth-grade students (93.5% of study enrollees); among these students, 1715 (54.0%) were girls and the mean (SD) age was 16.1 (0.4) years. Among those with available demographic data, respondents were diverse in race/ethnicity (537 [17.2%] Asian; 149 [4.8%] black; 1510 [48.3%] Hispanic; 507 [16.2%] white; 207 [6.6%] multiethnic/multiracial; and 216 [6.9%] other) and included 1654 (60.1%) with a low SES. Prevalence of ever use was highest for combustible products (993 [31.3%]), followed by edible (676 [21.3%]) and vaporized (333 [10.5%]) products. A similar pattern was found for past 30-day use (426 [13.4%] for combustible, 249 [7.8%] for edible, and 156 [4.9%] for vaporized cannabis). Among participants who reported using cannabis in the past 30 days, mean frequency of use of combustible cannabis was higher by 2.65 days (95% CI, 1.40-3.91 days, P = .001) than the mean frequency of use for edible cannabis and 1.75 days higher (95% CI, 0.59-2.90 days, P = .003) than frequency of use for vaporized cannabis. Most cannabis users (665 [61.7%]) used multiple administration methods, and 260 (8.2%) used all 3 methods. Boys had higher prevalence of ever use for vaporized (170 [11.6%] vs 163 [9.5%]) but not combustible (459 [31.4%] vs 534 [31.1%]) or edible (303 [20.7%] vs 373 [21.7%]) cannabis. Respondents with low SES had higher prevalence of ever use for combustible (614 [37.1%] vs 242 [22.0%]) and edible (408 [24.7%] vs 166 [15.1%]) but not vaporized (186 [11.2%] vs 93 [8.5%]) cannabis.. Among 10th-grade students in Los Angeles, use of cannabis via alternative administration methods was of appreciable prevalence, predominately reported in conjunction with other cannabis products and unequally distributed across sociodemographic strata. Prevention programs and regulatory restrictions addressing the spectrum of cannabis products might benefit pediatric public health.

Topics: Adolescent; Adolescent Behavior; Adolescent Health; Cannabis; Cross-Sectional Studies; Female; Humans; Los Angeles; Male; Marijuana Abuse; Nebulizers and Vaporizers; Prospective Studies; Risk Factors; Socioeconomic Factors; Surveys and Questionnaires

Cannabis use disorders and psychiatric comorbidities. Psychiatric disorders and personality disorders are common among patients with cannabis use disorders. Symptoms of cannabis intoxication or withdrawal need to be disentangled from symptoms of psychiatric disorders. Cannabis use disorders and psychiatric disorders worsen each other. Cannabis use disorders could induce psychiatric disorders, in particular depressive disorders and anxiety disorders. Cannabis withdrawal anxiety typically begins after cannabis use has been stopped or reduced. Patients with cannabis use disorder experience, on a daily basis, subthreshold withdrawal anxiety symptoms, characterized by irritability associated with craving for cannabis. By contrast, individuals with primary anxiety disorders have different features. Integrated approaches to treatment for patients presenting with co-occurring cannabis use disorders and psychiatric disorders are recommended, including simultaneous treatments.. Consommation de cannabis et comorbidités psychiatriques. La fréquence des troubles psychiatriques et des troubles de la personnalité est élevée chez les consommateurs réguliers de cannabis. La symptomatologie des troubles anxieux ou dépressifs primaires et celle des troubles anxieux ou dépressifs induits par la consommation de cannabis sont intriquées. Ils s’aggravent mutuellement avec le temps. La symptomatologie anxieuse ou dépressive liée au manque ou au sevrage chez les sujets dépendants au cannabis est intermittente. Elle survient après une période d’abstinence, notamment au réveil. Elle est caractérisée par l’irritabilité ou la nervosité, l’existence de craving pour le cannabis et cède à la reprise de la consommation. La prise en charge optimale des patients à double diagnostic est une prise en charge dite « intégrée », combinant simultanément les approches thérapeutiques, addictologiques et psychiatriques.

Topics: Anxiety Disorders; Cannabis; Comorbidity; Humans; Marijuana Abuse; Mental Disorders; Substance Withdrawal Syndrome

Topics: Adolescent; Brain; Cannabis; Humans; Longitudinal Studies; Marijuana Abuse; Marijuana Smoking

This study aimed to explore a dose-response relationship of delta-9-tetrahydrocannabinol (THC) in THC-naïve children after unintentional acute exposure and compare clinical outcomes with non-naïve children.. A retrospective review was performed on children aged 31 days to 20 years who presented to Children's Hospital Colorado for care related to acute THC toxicity. The children were divided into groups based on exposure: group 1 (THC naïve) and group 2 (THC non-naïve).. A total of 38 children (age, 3.5 [3] years) met inclusion for group 1 and an equal number of children (age, 15.1 [3.9] years) met the criteria for comparison in group 2. Eight naïve patients had documentation of estimated THC dose ingested (mean [SD], 7.13 [5.8] mg/kg; range, 2.9-19.5 mg/kg). A direct relationship between estimated oral THC dose, level of medical intervention required, and hospital disposition was observed. Lethargy/somnolence was more common in the naïve group (84% vs. 26%, P < 0.0001) whereas problems in cognition, perception, and behavior were more common in the non-naïve group (4% vs 11%, P = 0.01). The duration of clinical effect and length of hospital stay were longer in the naïve group (19.3 vs 5.0 hours, P < 0.0001) and (0.73 vs 0.19 days, P < 0.0001) respectively.. There seems to be a direct relationship between the estimated oral THC dose (mg/kg), hospital disposition, and level of medical intervention required. Symptoms and duration of effects after THC exposure varied based on the route of exposure, age of patient, and history of previous THC experience.

Topics: Adolescent; Cannabis; Child; Child, Preschool; Colorado; Dose-Response Relationship, Drug; Dronabinol; Female; Humans; Infant; Length of Stay; Male; Marijuana Abuse; Retrospective Studies; Young Adult

Cannabis use is observationally associated with an increased risk of schizophrenia, but whether the relationship is causal is not known. Using a genetic approach, we took 10 independent genetic variants previously identified to associate with cannabis use in 32 330 individuals to determine the nature of the association between cannabis use and risk of schizophrenia. Genetic variants were employed as instruments to recapitulate a randomized controlled trial involving two groups (cannabis users vs nonusers) to estimate the causal effect of cannabis use on risk of schizophrenia in 34 241 cases and 45 604 controls from predominantly European descent. Genetically-derived estimates were compared with a meta-analysis of observational studies reporting ever use of cannabis and risk of schizophrenia or related disorders. Based on the genetic approach, use of cannabis was associated with increased risk of schizophrenia (odds ratio (OR) of schizophrenia for users vs nonusers of cannabis: 1.37; 95% confidence interval (CI), 1.09-1.67; P-value=0.007). The corresponding estimate from observational analysis was 1.43 (95% CI, 1.19-1.67; P-value for heterogeneity =0.76). The genetic markers did not show evidence of pleiotropic effects and accounting for tobacco exposure did not alter the association (OR of schizophrenia for users vs nonusers of cannabis, adjusted for ever vs never smoker: 1.41; 95% CI, 1.09-1.83). This adds to the substantial evidence base that has previously identified cannabis use to associate with increased risk of schizophrenia, by suggesting that the relationship is causal. Such robust evidence may inform public health messages about cannabis use, especially regarding its potential mental health consequences.

Topics: Adult; Cannabis; Case-Control Studies; Female; Genetic Variation; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Polymorphism, Single Nucleotide; Random Allocation; Risk Factors; Schizophrenia; Smokers; White People

Topics: Adult; Brain; Cannabis; Cerebrovascular Circulation; Dronabinol; Female; Gas Chromatography-Mass Spectrometry; Humans; Magnetic Resonance Imaging; Male; Marijuana Abuse; Young Adult

The purpose of this study was to evaluate the extent of short-term memory impairment and schizophrenia-like symptoms in heavy and systematic cannabis users and the association between the severity of abuse and the longevity of its persistent symptoms after refraining from such use.. A complete psychiatric examination and a psychometric evaluation were performed in 48 solely cannabis users. Additionally, head hair samples were analyzed and the detected cannabinoids levels were correlated with the psychometric findings.. A total of 33.3% (n = 16) of the total examined cannabis users were currently imprisoned. The years of abuse ranged from 1 to 35 years and the median daily dose was 5.84.4 gr and 4.84.0 gr for prisoners (n = 16) and non prisoners (n = 32), respectively. A total of 39.6% of the users experienced hallucinations (mostly auditory), 54.2% experienced delusions (mostly ideas of reference and persecution), 85.4% had organic brain dysfunction in a test addressing visual-motor functioning and visual perception skills, and all users (100%) were found to have organic brain dysfunction in a test of visual memory immediate recall. The cannabinoid metabolite levels in the hair samples were consistent with the reported history of substance abuse and total grams of consumption for the participants below 35 years old (p < .001). Statistically elevated cannabinoids levels were observed in users with auditory hallucinations compared to users without any hallucinations (p = .019).. The existence of hallucinations, delusions, and organic brain dysfunction in heavy cannabis users seems to be associated with cannabinoid levels in hair. The continuation of persistent symptoms 3 months after the discontinuation of cannabis abuse, was a remarkable finding.. We provide evidence that chronic and heavy cannabis abuse results in long-lasting brain dysfunction in all users and in long-lasting schizophrenia-like psychotic symptoms in more than half of all users. These findings suggest a reevaluation of the current classification of cannabis as a "soft narcotic" which erroneously, therefore, is typically considered harmless. (Am J Addict 2017;26:335-342).

Topics: Adult; Cannabinoids; Cannabis; Female; Hair; Humans; Male; Marijuana Abuse; Memory, Short-Term; Schizophrenia; Time; Time Factors; Young Adult

Over 22 million Americans are current users of marijuana; half of US states allow medical marijuana, and several allow recreational marijuana. The objective of this study was to evaluate the impact marijuana has on hospitalizations, emergency department (ED) visits, and regional poison center (RPC) calls in Colorado, a medical and recreational marijuana state. This is a retrospective review using Colorado Hospital Association hospitalizations and ED visits with marijuana-related billing codes, and RPC marijuana exposure calls. Legalization of marijuana in Colorado has been associated with an increase in hospitalizations, ED visits, and RPC calls linked with marijuana exposure. From 2000 to 2015, hospitalization rates with marijuana-related billing codes increased from 274 to 593 per 100,000 hospitalizations in 2015. Overall, the prevalence of mental illness among ED visits with marijuana-related codes was five-fold higher (5.07, 95% CI: 5.0, 5.1) than the prevalence of mental illness without marijuana-related codes. RPC calls remained constant from 2000 through 2009. However, in 2010, after local medical marijuana policy liberalization, the number of marijuana exposure calls significantly increased from 42 to 93; in 2014, after recreational legalization, calls significantly increased by 79.7%, from 123 to 221 (p<0.0001). The age group <17years old also had an increase in calls after 2014. As more states legalize marijuana, it is important to address public education and youth prevention, and understand the impact on mental health disorders. Improvements in data collection and surveillance methods are needed to more accurately evaluate the public health impact of marijuana legalization.

Topics: Adolescent; Adult; Cannabis; Colorado; Emergency Service, Hospital; Female; Hospitalization; Humans; Legislation, Drug; Male; Marijuana Abuse; Mental Disorders; Poison Control Centers; Prevalence; Retrospective Studies

Topics: Cannabis; Female; Humans; Marijuana Abuse; Marijuana Smoking; Pregnancy

Topics: Adult; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Medical Marijuana

Cannabis use disorder (CUD) co-occurs with major depressive disorder (MDD) more frequently than would be expected by chance. However, studies to date have not produced a clear understanding of the mechanisms underlying this co-morbidity. Genetically informative studies can add valuable insight to this problem, as they allow the evaluation of competing models of co-morbidity. This study uses data from the Australian Twin Registry to compare 13 co-morbidity twin models initially proposed by Neale and Kendler (Am J Hum Genet 57:935-953, 1995). The analysis sample comprised 2410 male and female monozygotic and dizygotic twins (average age 32) who were assessed on CUD and MDD using the SSAGA-OZ interview. Data were analyzed in OpenMx. Of the 13 different co-morbidity models, two fit equally well: CUD causes MDD and Random Multiformity of CUD. Both fit substantially better than the Correlated Liabilities model. Although the current study cannot differentiate between them statistically, these models, in combination, suggest that CUD risk factors may causally influence the risk to develop MDD, but only when risk for CUD is high.

Topics: Adult; Australia; Cannabis; Comorbidity; Depression; Depressive Disorder, Major; Female; Humans; Interview, Psychological; Male; Marijuana Abuse; Marijuana Smoking; Risk Factors; Social Environment; Surveys and Questionnaires; Twins; Twins, Dizygotic; Twins, Monozygotic

Topics: Analgesics; Cannabis; Female; Humans; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Pregnancy

This study examines the relationships between trial of new marijuana or hashish products and unexpected highs, and use of edible products and unexpected highs.. We conducted an online survey of 634 adult, past-year marijuana users in Colorado. We used logistic regression models to examine the relationship between new product trial or edible use and unexpected highs.. In the first year that recreational marijuana was legal in Colorado, 71.4% of respondents tried a new marijuana or hashish product, and 53.6% used an edible product. Trial of new products was associated with greater odds of experiencing an unexpected high after controlling for age, gender, education, mental health status, current marijuana or hashish use, and mean amount of marijuana or hashish consumed in the past month (OR=2.13, p<0.001). Individuals who reported having used edibles had greater odds of experiencing an unexpected high, after controlling for the same set of variables (OR=1.56, p<0.05).. People who try new marijuana or hashish products, or use edible marijuana or hashish products, are at greater risk for an unexpected high. It is possible that some negative outcomes associated with marijuana use and unexpected highs may be averted through a better understanding of how to use product packaging to communicate with consumers.

Topics: Adolescent; Adult; Cannabinoids; Cannabis; Colorado; Drug Packaging; Female; Food Packaging; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Surveys and Questionnaires; Young Adult

Uncertainty exists whether the use of non-prescription psychoactive substances following onset of a first episode of psychosis (FEP), in particular cannabis use, affects medication adherence. Data from FEP patients (N=233) obtained through prospective assessments measured medication adherence and pattern of cannabis and other substance use in the first two years following onset of psychosis. Multiple logistic regression analyses were employed to compare the different substance use groups with regard to risk of medication non-adherence, while controlling for confounders. The proportion of non-adherent patients was higher in those who continued using high-potency forms of cannabis (skunk-like) following the onset (83%) when compared to never regular users (51%), corresponding to an Odds Ratio (OR) of 5.26[95% Confidence Interval (CI) 1.91-15.68]. No significant increases in risk were present in those who used cannabis more sporadically or used milder forms of cannabis (hash-like). Other substances did not make an independent contribution in this model, including cigarette use ([OR 0.88, 95% CI 0.41-1.89]), alcohol use ([OR 0.66, 95% CI 0.27-1.64]) or regular use of other illicit drugs ([OR 1.03, 95% CI 0.34-3.15]) following the onset. These results suggest that continued use of high-potency cannabis following the onset of psychosis may adversely affect medication adherence.

Topics: Adult; Antipsychotic Agents; Cannabis; Female; Humans; Logistic Models; Male; Marijuana Abuse; Medication Adherence; Prospective Studies; Psychotic Disorders; Time Factors

Topics: Cannabis; Female; Humans; Marijuana Abuse; Pregnancy; Pregnant Women

We created the Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQ-CU) because the current lack of psychometrically sound inventories for measuring these dimensions of cannabis use has impeded research on the effects of cannabis in humans.. A sample of 2,062 cannabis users completed the DFAQ-CU and was used to assess the DFAQ-CU's factor structure and reliability. To assess validity, a subsample of 645 participants completed additional measures of cannabis dependence and problems (Marijuana Smoking History Questionnaire [MSHQ], Timeline Followback [TLFB], Cannabis Abuse Screening Test [CAST], Cannabis Use Disorders Identification Test Revised [CUDIT-R], Cannabis Use Problems Identification Test [CUPIT], and Alcohol Use Disorder Identification Test [AUDIT]).. A six-factor structure was revealed, with factors measuring: daily sessions, frequency, age of onset, marijuana quantity, cannabis concentrate quantity, and edibles quantity. The factors were reliable, with Cronbach's alpha coefficients ranging from .69 (daily sessions) to .95 (frequency). Results further provided evidence for the factors' convergent (MSHQ, TLFB), predictive (CAST, CUDIT-R, CUPIT), and discriminant validity (AUDIT).. The DFAQ-CU is the first psychometrically sound inventory for measuring frequency, age of onset, and quantity of cannabis use. It contains pictures of marijuana to facilitate the measurement of quantity of marijuana used, as well as questions to assess the use of different forms of cannabis (e.g., concentrates, edibles), methods of administering cannabis (e.g., joints, hand pipes, vaporizers), and typical THC levels. As such, the DFAQ-CU should help facilitate research on frequency, quantity, and age of onset of cannabis use.

Topics: Adult; Cannabis; Eating; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Psychometrics; Young Adult

Topics: Cannabinoids; Cannabis; Humans; Marijuana Abuse; Psychotic Disorders; Risk Factors

Effective regulation of negative affective states has been associated with mental health. Impaired regulation of negative affect represents a risk factor for dysfunctional coping mechanisms such as drug use and thus could contribute to the initiation and development of problematic substance use. This study investigated behavioral and neural indices of emotion regulation in regular marijuana users (n = 23) and demographically matched nonusing controls (n = 20) by means of an fMRI cognitive emotion regulation (reappraisal) paradigm. Relative to nonusing controls, marijuana users demonstrated increased neural activity in a bilateral frontal network comprising precentral, middle cingulate, and supplementary motor regions during reappraisal of negative affect (P < 0.05, FWE) and impaired emotion regulation success on the behavioral level (P < 0.05). Amygdala-focused analyses further revealed impaired amygdala downregulation in the context of decreased amygdala-dorsolateral prefrontal cortex functional connectivity (P < 0.05, FWE) during reappraisal in marijuana users relative to controls. Together, the present findings could reflect an unsuccessful attempt of compensatory recruitment of additional neural resources in the context of disrupted amygdala-prefrontal interaction during volitional emotion regulation in marijuana users. As such, impaired volitional regulation of negative affect might represent a consequence of, or risk factor for, regular marijuana use. Hum Brain Mapp 38:4270-4279, 2017. © 2017 Wiley Periodicals, Inc.

Topics: Brain; Brain Mapping; Cannabis; Cognition; Craving; Emotional Intelligence; Emotions; Executive Function; Humans; Magnetic Resonance Imaging; Male; Marijuana Abuse; Neural Pathways; Neuropsychological Tests; Volition; Young Adult

Cannabinoid hyperemesis syndrome (CHS), a variant of cyclic vomiting syndrome, is an enigmatic and challenging clinical disorder. As cannabis legalization, use, and potency has increased worldwide over the past decade, so has the prevalence of CHS. These patients often require acute care and inpatient treatment for refractory emesis, electrolyte derangement, dehydration, acute renal failure, and injury to the upper gastrointestinal tract. Routinely-prescribed antiemetics are frequently associated with treatment failure in CHS, necessitating use of sedating agents such as benzodiazepines and antipsychotics. Hydrotherapy with hot water provides short-term symptomatic relief from acute episodes of CHS. The reasons for this may be from chronic and/or excessive cannabis use leading to abnormal stimulation of the hypothalamic-pituitary-adrenal axis (HPA) and sympathetic nervous system (SNS) in CHS patients. Overuse of cannabis may also lead to dysfunction of the endocannabinoid system, which is essential for allostasis of the autonomic nervous system after stress.

Topics: Acute Disease; Antiemetics; Cannabinoids; Cannabis; Gastrointestinal Tract; Humans; Hypothalamo-Hypophyseal System; Marijuana Abuse; Marijuana Smoking; Models, Theoretical; Nausea; Pituitary-Adrenal System; Sympathetic Nervous System; Syndrome; Vomiting

Marijuana is a widely used illicit drug and its consumption during pregnancy has been associated with adverse reproductive outcomes. The purpose of this study was to determine the effects of chronic intake of Δ9-tetrahydrocannabinol (THC), the major component of marijuana, on trophoblast function, placental development, and birth outcomes.. The pathological characteristics and distribution of cannabinoid receptors in placenta were observed by immunohistochemical (IHC) staining. Cell migration in response to THC was measured by transwell assays. The levels of cannabinoid receptors and Signal Transducer and Activator of Transcription 3 (STAT3) were detected by western blot.. We found the placenta expressed two main cannabinoid receptors, suggesting that THC induced biological responses in placental cells. Supporting this hypothesis, we observed dramatic alterations of placental morphology in marijuana users. Using THC and inhibitors of cannabinoid receptors, we demonstrated that THC impaired trophoblast cell migration and invasion partly via cannabinoid receptors. Additionally, pregnant mice injected with THC showed adverse reproductive events including reduced number of fetuses, lower maternal and placental weights. Mechanistically, STAT3 signaling pathway was involved in the THC-induced suppression of trophoblast cell motility and pregnancy outcomes.. Our study indicates that the STAT3 signaling pathway plays a critical role in THC-induced trophoblast dysfunction.

Topics: Adult; Animals; Birth Rate; Cannabinoids; Cannabis; Dronabinol; Female; Humans; Marijuana Abuse; Mice; Placenta; Pregnancy; Receptors, Cannabinoid; Signal Transduction; STAT3 Transcription Factor; Trophoblasts

Topics: Adult; Brain Ischemia; Cannabis; Humans; Intracranial Hemorrhages; Male; Marijuana Abuse; Stroke

Recent reports suggest an increase in use of extremely potent cannabis concentrates such as Butane Hash Oil (BHO) in some developed countries. The aims of this study were to examine the characteristics of BHO users and the effect profiles of BHO.. Anonymous online survey in over 20 countries in 2014 and 2015. Participants aged 18 years or older were recruited through onward promotion and online social networks. The overall sample size was 181,870. In this sample, 46% (N=83,867) reported using some form of cannabis in the past year, and 3% reported BHO use (n=5922).. Participants reported their use of 7 types of cannabis in the past 12 months, the source of their cannabis, reasons for use, use of other illegal substances, and lifetime diagnosis for depression, anxiety and psychosis. Participants were asked to rate subjective effects of BHO and high potency herbal cannabis.. Participants who reported a lifetime diagnosis of depression (OR=1.15, p=0.003), anxiety (OR=1.72, p<0.001), and a larger number of substance use (OR=1.29, p<0.001) were more likely to use BHO than only using high potency herbal cannabis. BHO users also reported stronger negative effects and less positive effects when using BHO than high potency herbal cannabis (p<0.001) CONCLUSION: Mental health problems and other illicit drug use were associated with use of BHO. BHO was reported to have stronger negative and weaker positive effects than high potency herbal cannabis.

Topics: Adult; Anxiety; Cannabis; Depression; Drug Users; Female; Humans; Male; Marijuana Abuse; Oils; Psychotic Disorders; Surveys and Questionnaires; Young Adult

The use of marijuana and cannabis concentrates is increasing, especially following decriminalization in several states. Psychosis and cardiotoxicity have been reported following cannabis use; however, myocardial injury from "dabbing" has not yet been reported. We report a case of hyperthermia, tachycardia, hypertension, severe agitation, neuro-, and cardiotoxicity following the use of "dabs" where there is concomitant confirmatory biological and sample testing.. A 17-year-old athletic man developed agitation requiring sedation and intubation for safety, with peak systolic blood pressures in the 190s and hyperthermia (to 102 °F). He developed elevated serum troponins with persistent tachycardia despite sedation and no clear non-intoxicant etiology. It was discovered that the patient had recently been "dabbing"; an exhaustive search of his home found a sample of the "dabs" which was analyzed along with a comprehensive urine drug screen by tandem liquid mass spectroscopy (t-LCMS) for confirmation.. Tetrahydrocannabinol (THC) has been increasingly associated with agitation and cardiotoxicity, while cannabidiol (CBD) has been associated with neuroprotective, inhibitory states. We propose that increasing concentrations of THC as well as THC:CBD ratios seen in cannabis concentrates such as "dabs" may cause agitation and end-organ damage through sympathomimetic and serotonergic pathways.

Topics: Administration, Inhalation; Adolescent; Cannabis; Cardiotoxicity; Heart Diseases; Humans; Male; Marijuana Abuse; Neurotoxicity Syndromes; Plant Extracts; Substance Abuse Detection; Tandem Mass Spectrometry; Urinalysis

Science needs to drive our thinking as we navigate a new legislative environment in which many Americans have access to marijuana for therapeutic or recreational use. With the responsibility to fund, conduct, and make use of the research on marijuana, and understand the impacts of new policies, comes the obligation of not thinking in simplistic, black-and-white terms about this substance. The drug's unique harms include neurodevelopmental impacts that may be long lasting or permanent, yet some evidence suggests the drug may benefit people with certain medical conditions (e.g., chronic pain). Marijuana use is also entangled with other substance use and should not be considered in isolation. Finally, policy options are not limited to the extremes of prohibition vs. full commercialization; a spectrum of intermediate options can and should be considered and evaluated as states create new policies around this drug.

Topics: Behavior, Addictive; Cannabis; Humans; Legislation, Drug; Marijuana Abuse; Marijuana Smoking; Public Policy; Recreation; Science; Substance-Related Disorders; United States

Specific provisions of legal cannabis legislation and regulation could influence cannabis initiation, frequency and quantity of use, and progression to cannabis use disorder. This brief essay highlights scientifically based principles and risk factors that underlie substance use and addiction that can be leveraged to inform policies that might mitigate the development and consequences of cannabis use disorder. Specifically, pharmacologic, access/availability, and environmental factors are discussed in relation to their influence on substance use disorders to illustrate how regulatory provisions can differentially affect these factors and risk for addiction. Relevant knowledge from research and experience with alcohol and tobacco regulation are also considered. Research designed to inform regulatory policy and to evaluate the impact of cannabis legislation on cannabis use and problems is progressing. However, definitive findings will come slowly, and more concerted efforts and resources are needed to expedite this process. In the meantime, policymakers should take advantage of the large body of scientific literature on substance use to foster empirically-guided, common sense approaches to cannabis policy that focus on prevention of addiction.

Topics: Behavior, Addictive; Cannabis; Humans; Legislation, Drug; Marijuana Abuse; Marijuana Smoking; Public Policy; Risk Factors

Topics: Cannabis; Humans; Marijuana Abuse; Medication Adherence; Prospective Studies; Psychotic Disorders; Recurrence

The emergency department (ED) and hospital settings represent crucial opportunities for engaging treatment for cannabis use disorder (CUD). Thus, there is a need to identify factors associated with healthcare utilization among persons with CUD to improve screening and intervention approaches. Problematic alcohol use may be a salient risk factor.. Using data from the 2005-2013 National Surveys on Drug Use and Health, we determined factors, including different patterns of alcohol use, associated with past-year ED admission and inpatient hospitalization among persons aged 12 years or older meeting criteria for CUD in the past year (N=16,757). We also determined the prevalence and correlates of problem alcohol use among persons with CUD to further inform its association with healthcare utilization.. Among persons with CUD, 40.15% and 10.04% reported past-year ED admission and inpatient hospitalization, respectively. Severe alcohol use disorder (AUD) (≥6 AUD symptoms), female sex, Black race, low income, major depressive episode (MDE), and other substance use disorders were associated with increased odds of healthcare utilization; current (i.e., last month) alcohol use patterns were not. Persons with CUD that were males, ages 18-25 (vs. ages 12-17), Hispanic (vs. White), and with low income, other drug use disorders, or MDE had increased odds of AUD.. Findings suggest that screening and intervention efforts for improving treatment initiation or engagement for CUD may target cannabis-using women, blacks, low-income adults or those with severe AUD in the past year, another substance use disorder, or MDE.

Topics: Adult; Alcoholism; Cannabis; Depressive Disorder, Major; Female; Hispanic or Latino; Humans; Male; Marijuana Abuse; Marijuana Smoking; Patient Acceptance of Health Care; Prevalence; Risk Factors; Substance-Related Disorders; United States; White People

High-potency cannabis concentrates are increasingly popular in the United States, and there is concern that use of high-potency cannabis might increase risk for cannabis-related problems. However, little is known about the potential negative consequences of concentrate use. This study reports on associations between past-year use of a high-potency cannabis concentrate, known as butane hash oil (BHO), and cannabis-related problems.. A sample of 821 college students were recruited to complete a survey about their health and behavior. Participants who had used cannabis in the past year (33%, n=273) completed questions about their cannabis use, including their use of BHO and cannabis-related problems in eight domains: physical dependence, impaired control, academic-occupational problems, social-interpersonal problems, self-care problems, self-perception, risk behavior, and blackouts.. Approximately 44% (n=121) of past-year cannabis users had used BHO in the past year. More frequent BHO use was associated with higher levels of physical dependence (RR=1.8, p<0.001), impaired control (RR=1.3, p<0.001), cannabis-related academic/occupational problems (RR=1.5, p=0.004), poor self-care (RR=1.3, p=0.002), and cannabis-related risk behavior (RR=1.2, p=0.001). After accounting for sociodemographic factors, age of onset of cannabis use, sensation seeking, overall frequency of cannabis use, and frequency of other substance use, BHO use was still associated with higher levels of physical dependence (RR=1.2, p=0.014).. BHO use is associated with greater physiological dependence on cannabis, even after accounting for potential confounders. Longitudinal research is needed to determine if cannabis users with higher levels of physiological dependence seek out BHO and/or if BHO use increases risk for physiological dependence.

Topics: Butanes; Cannabis; Humans; Marijuana Abuse; Oils; Psychotic Disorders; Self Concept; Substance-Related Disorders; United States

Substance use during adolescence is a public health concern due to associated physical and behavioral health consequences. Such consequences are amplified among concurrent substance users. Although sex and racial/ethnic differences in single-substance use have been observed, the current literature is inconclusive as to whether differences exist in the prevalence of concurrent use. The current study used data from the 2011-2014 National Survey on Drug Use and Health to examine typologies (single and concurrent patterns) of alcohol, marijuana, and cigarette use among current adolescent users age 12-18 by sex and race/ethnicity. Participants were 14,667 White, Hispanic, African American, Asian, and Native American adolescents. The most common typology was alcohol only, followed by concurrent use of alcohol and marijuana. Weighted prevalence estimates indicated that adolescent females were more likely to be current users of alcohol only, whereas male adolescents were more likely to belong to all other typologies. Compared to Whites, racial/ethnic minorities had larger proportions of marijuana only users and were generally less likely than or equally likely to be concurrent users. One exception was for African American adolescents, who were more likely to be alcohol and marijuana users than their White counterparts. Results suggest that concurrent substance use is common among U.S. adolescents, making up over 40% of past-month use, but typologies of use vary by sex and race/ethnicity. Preventive interventions should consider all typologies of use rather than only single substance exposures and address patterns of use that are most pertinent to adolescents based on sex and race/ethnicity.

Topics: Adolescent; Alcohol Drinking; Cannabis; Cigarette Smoking; Ethnicity; Female; Hispanic or Latino; Humans; Male; Marijuana Abuse; Prevalence; Racial Groups; Substance-Related Disorders; United States; White People

Topics: Cannabis; Health Promotion; Humans; Marijuana Abuse; Psychotic Disorders

Topics: Cannabis; Coronary Stenosis; Diagnosis, Differential; Electrocardiography; Humans; Marijuana Abuse; Syndrome; Young Adult

In France, cannabis consumption is illegal. The health impact of its increasing use and higher tetrahydrocannabinol (THC) concentrations is still poorly documented, particularly that of unintentional pediatric intoxications. We sought to evaluate the French national trend of admissions for unintentional cannabis intoxication in children over an 11-year period (2004-2014).. A retrospective, national, multicenter, observational study of a pediatric cohort. All children aged <6 years admitted to a tertiary-level pediatric emergency department (PED) for proven cannabis intoxication (compatible symptoms and positive toxicological screening results) during the reference period were included.. Twenty-four PEDs participated in our study; 235 children were included, and 71% of the patients were 18 months old or younger. Annual admissions increased by a factor of 13. Hashish resin was the main form ingested (72%). During the study period, the evolution was characterized by a national increase in intoxications, younger intoxicated children (1.28 ± 0.4 vs 1.7 ± 0.7 years,. Children are collateral victims of changing trends in cannabis use and a prevailing THC concentration. Intoxicated children are more frequent, are younger, and have intoxications that are more severe. This raises a real issue of public health.

Topics: Cannabis; Child; Child, Preschool; Emergency Service, Hospital; Female; France; Hospitalization; Humans; Incidence; Infant; Male; Marijuana Abuse; Retrospective Studies; Substance-Related Disorders

Consumption of natural cannabis (NC) and synthetic cannabinoids (SCs) has been associated with psychotic disorders. We compared the prevalence of use, consumer profiles, and psychosis-inducing potential of NC and SCs in a specific high-risk population.. This prospective pilot study included 332 patients (18-64 years, mean 36.83, SD 13.33). Patients' sociodemographics and medical histories as well as illicit substance use and psychiatric symptom histories were collected using a drug consumption survey that assessed the use of new psychoactive substances and the Psychotic Symptoms Interview.. In total, 7.2% of all patients, 10.6% of psychotic patients, and 4.5% of nonpsychotic patients reported SC consumption. Compared with SCs, NC was consumed much more frequently by its users (mean 222.73, SD 498.27). NC and SC use induced persistent psychosis. Psychotic symptoms were first experienced by patients with a history of NC or SC use during intoxication and persisted after cessation (>1 year) of drug use. Positive and negative symptoms tended to be more severe in SC and NC users, respectively.. NC and SCs may cause different symptom clusters. These relationships should be further evaluated.

Topics: Adult; Cannabinoids; Cannabis; Female; Hospitals, Psychiatric; Humans; Male; Marijuana Abuse; Pilot Projects; Prospective Studies; Psychotic Disorders; Substance-Related Disorders

Although there are serious negative harms associated with simultaneous alcohol and marijuana (SAM) use, little is known about the self-reported acute effects of SAM use and how they may be similar to or different than effects experienced when using alcohol or marijuana only. The current study examines the perceived acute effects of SAM use, compared to using alcohol or marijuana only, as well as demographic and substance use predictors of overall SAM effects.. Participants were a community sample of young adults ages 18-23 participating in a longitudinal study on social role transitions and substance use during young adulthood. Young adults who reported SAM use at least once in their lifetime were selected for the present analyses (N=315; mean age=21.42; 58% female) and reported the effects they experienced from typical alcohol use, marijuana use, and SAM use.. There were significant differences in the extent to which young adults perceived the effects depending on the substances used. Most effects (i.e., clumsy, confused, dizzy, difficulty concentrating) were rated strongest when engaging in SAM use, compared to typical alcohol or marijuana use alone. Feeling high and feeling marijuana effects were rated strongest when engaging in marijuana use alone compared to SAM use, but feeling drunk was greater during SAM use compared to alcohol use alone. Greater alcohol use and increased time spent high during typical SAM use were associated with greater overall SAM effects.. When young adults engage in SAM use they report experiencing greater negative physiological and cognitive effects.

Topics: Alcohol Drinking; Cannabis; Emotions; Ethanol; Female; Humans; Longitudinal Studies; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Perception; Self Report; Substance-Related Disorders; Young Adult

Topics: Adolescent; Adult; Cannabis; Hallucinogens; Humans; Marijuana Abuse; Marijuana Smoking; Nucleus Accumbens; Young Adult

In Colorado, marijuana was legalized for medical use in 2000, commercialized in 2009, and approved for recreational purposes in 2012. Little is known about the association between recent policy changes and adolescent substance treatment outcomes measured by urine drug screens (UDS). This study addressed this research gap.. Participants were youth (N = 523) aged 11-19 years who were enrolled in an outpatient motivational interviewing (MI)/cognitive behavioral therapy (CBT) plus contingency management (CM) in Denver, Colorado from October 2007 to June 2014. The measures included UDS collected during weekly treatment sessions and sent to a commercial laboratory for quantitative analysis of tetrahydrocannabinol (THC)/Creatinine (Cr). Linear regression models and logistic regression models using a Generalized Estimating Equations (GEE) approach for repeated measures were completed to answer the study aims.. Males, but not females, had a marginally significant increasing trend over time in monthly average THC/Cr (β = 1.99, p = 0.046). There was a significant increasing trend over time (per 30 days) in the odds of having a negative UDS within 6 sessions (OR = 1.02, 95%CI = 1.003-1.04, p = 0.006).. Based on these data, substance treatment outcomes from MI and CBT are mixed, but overall treatment appears to remain effective in a state with legalized marijuana. (Am J Addict 2017;26:802-806).

Topics: Adolescent; Cannabis; Child; Cognitive Behavioral Therapy; Colorado; Combined Modality Therapy; Commerce; Dronabinol; Female; Humans; Male; Marijuana Abuse; Motivational Interviewing; Sex Factors; Substance Abuse Detection; Treatment Outcome; Young Adult

With the Canadian government legalizing cannabis in the year 2018, the potential harms to certain populations-including those with opioid use disorder-must be investigated. Cannabis is one of the most commonly used substances by patients who are engaged in medication-assisted treatment for opioid use disorder, the effects of which are largely unknown. In this study, we examine the impact of baseline and ongoing cannabis use, and whether these are impacted differentially by gender.. We conducted a retrospective cohort study using anonymized electronic medical records from 58 clinics offering opioid agonist therapy in Ontario, Canada. One-year treatment retention was the primary outcome of interest and was measured for patients who did and did not have a cannabis positive urine sample in their first month of treatment, and as a function of the proportion of cannabis-positive urine samples throughout treatment.. Our cohort consisted of 644 patients, 328 of which were considered baseline cannabis users and 256 considered heavy users. Patients with baseline cannabis use and heavy cannabis use were at increased risk of dropout (38.9% and 48.1%, respectively). When evaluating these trends by gender, only female baseline users and male heavy users are at increased risk of premature dropout.. Both baseline and heavy cannabis use are predictive of decreased treatment retention, and differences do exist between genders. With cannabis being legalized in the near future, physicians should closely monitor cannabis-using patients and provide education surrounding the potential harms of using cannabis while receiving treatment for opioid use disorder.

Topics: Adult; Analgesics, Opioid; Cannabis; Demography; Female; Humans; Male; Marijuana Abuse; Ontario; Patient Dropouts; Sex Characteristics

Topics: Cannabis; Child, Preschool; Consciousness Disorders; Dronabinol; Female; Food; Humans; Marijuana Abuse; Marijuana Use; Substance Abuse Detection

One hundred and sixty-nine subjects with psychosis were recruited. AoP, defined as age of DSM-IV diagnosis was established using the Structured Clinical Interview for DSM-IV. Cannabis use data were collected using a self-report computerized questionnaire. DNA was extracted from saliva and genotyping of the. Our data are indicative of the need to further investigate the association between the

Topics: Adolescent; Adult; Age of Onset; Canada; Cannabis; Catechol O-Methyltransferase; Female; Humans; Kaplan-Meier Estimate; Male; Marijuana Abuse; Polymorphism, Single Nucleotide; Psychoses, Substance-Induced; Surveys and Questionnaires

Chronic cannabis use may cause neurocognitive deficits and increase the risk of psychosis. Nevertheless, the effects of cannabis use on neurocognitive functioning in schizophrenia have remained largely unspecified.. Here, we studied repetition suppression of auditory event-related responses in a paired-stimulus design in a mixed sample of schizophrenia patients (n = 34) and healthy control subjects (n = 45) with chronic heavy cannabis use and schizophrenia patients (n = 33) and healthy control subjects (n = 61) without cannabis use.. Repeated measures analysis yielded an overall significant reduction of P50 amplitude between first and second stimulus (p < .02), which was not different between the groups, a reduction of N100 amplitude, which was different for schizophrenia patients compared with healthy control subjects independent of cannabis use (p < .02), and a significant interaction between diagnosis and chronic cannabis use on the reduction of the P200 amplitude (p < .001). While chronic cannabis use was related with increased P200 suppression ratios in control subjects (with chronic cannabis use: 0.55 ± 0.04; without chronic cannabis use: 0.40 ± 0.03; p < .02), the reverse effect was found in schizophrenia (with chronic cannabis use: 0.36 ± 0.05; without chronic cannabis use: 0.54 ± 0.05; p < .02). This result remained significant after inclusion of potential confounders. Total lifetime cannabis use showed a significant correlation with the P200 suppression ratio in otherwise healthy control subjects (r = .28, p < .007). By contrast, the duration of time since last cannabis use was significantly correlated with the P200 suppression ratio in schizophrenia patients (r = .42, p < .002).. In aggregate, these diverging effects of chronic cannabis use on P200 repetition suppression may suggest underlying alterations in the endocannabinoid system in schizophrenia.

Topics: Acoustic Stimulation; Cannabis; Electroencephalography; Evoked Potentials, Auditory; Healthy Volunteers; Humans; Male; Marijuana Abuse; Marijuana Smoking; Schizophrenia; Sensory Gating; Young Adult

Drugs of abuse stimulate striatal dopamine release and activate reward pathways. This study examined the impact of alcohol and cannabis marketing on the reward circuit in alcohol and cannabis users while sober and intoxicated. It was predicted that alcohol and cannabis marketing would increase striatal activation when sober and that reward sensitivity would be less during alcohol and cannabis intoxication. Heavy alcohol (n = 20) and regular cannabis users (n = 21) participated in a mixed factorial study involving administration of alcohol and placebo in the alcohol group and cannabis and placebo in the cannabis group. Non-drug users (n = 20) served as between group reference. Brain activation after exposure to alcohol and cannabis marketing movies was measured using functional magnetic resonance imaging and compared between groups while sober and compared with placebo while intoxicated. Implicit alcohol and cannabis cognitions were assessed by means of a single-category implicit association test. Alcohol and cannabis marketing significantly increased striatal BOLD activation across all groups while sober. Striatal activation however decreased during intoxication with alcohol and cannabis. Implicit associations with cannabis marketing cues were significantly more positive in alcohol and cannabis users as compared with non-drug using controls. Public advertising of alcohol or cannabis use elicits striatal activation in the brain's reward circuit. Reduction of marketing would reduce brain exposure to reward cues that motivate substance use. Conversely, elevated dopamine levels protect against the reinforcing potential of marketing.

Topics: Adult; Alcoholic Beverages; Alcoholic Intoxication; Alcoholism; Brain; Cannabis; Cues; Female; Humans; Magnetic Resonance Imaging; Male; Marijuana Abuse; Marketing; Reward; Young Adult

There is substantial evidence for the assumption that particularly heavy cannabis usett is associated with a variety of psychopathologic conditions. Little is known about the relationship between cannabis and anxiety. Prior studies have concluded that cannabis use alone is not sufficient for the development of long-term anxiety, and it has been suggested that cannabis is simply a risk factor that operates in conjunction with other risk factors. One such risk factor may be an individuals' genetic vulnerability. The present study examines the relationship between cannabis use and symptoms of anxiety by taking a developmental molecular-genetic perspective with a focus on a polymorphism involved in the regulation of serotonin. Specifically, we concentrated on changes in cannabis use and symptoms of anxiety over time and differences herein for individuals with and without the short allele of the 5-HTTLPR genotype. Data were from 1424 adolescents over a period of 5 years. We used different statistical analyses to test co-development of cannabis use and symptoms of anxiety throughout adolescence and the possible role of the 5-HTTLPR genotype in this process. Results from different analyses showed that cannabis use is associated with an increase in symptoms of anxiety, but only in carriers of the short allele of the 5-HTTLPR genotype, not in non-carriers. The findings of the present study show first evidence that the links between cannabis use and symptoms of anxiety are conditional on the individuals' genetic make-up.

Topics: Adolescent; Alleles; Anxiety Disorders; Cannabis; Child; Female; Genetic Predisposition to Disease; Genotype; Humans; Male; Marijuana Abuse; Netherlands; Polymorphism, Genetic; Prospective Studies; Risk Factors; Serotonin Plasma Membrane Transport Proteins; Surveys and Questionnaires

Cannabis is widely perceived as a safe recreational drug and its use is increasing in youth. It is important to understand the implications of cannabis use during childhood and adolescence on brain development. This is the first longitudinal study that compared resting functional connectivity of frontally mediated networks between 43 healthy controls (HCs; 20 females; age M = 16.5 ± 2.7) and 22 treatment-seeking adolescents with cannabis use disorder (CUD; 8 females; age M = 17.6 ± 2.4). Increases in resting functional connectivity between caudal anterior cingulate cortex (ACC) and superior frontal gyrus across time were found in HC, but not in CUD. CUD showed a decrease in functional connectivity between caudal ACC and dorsolateral and orbitofrontal cortices across time. Lower functional connectivity between caudal ACC cortex and orbitofrontal cortex at baseline predicted higher amounts of cannabis use during the following 18 months. Finally, high amounts of cannabis use during the 18-month interval predicted lower intelligence quotient and slower cognitive function measured at follow-up. These data provide compelling longitudinal evidence suggesting that repeated exposure to cannabis during adolescence may have detrimental effects on brain resting functional connectivity, intelligence, and cognitive function.

Topics: Adolescent; Brain; Brain Mapping; Cannabis; Child; Cross-Sectional Studies; Female; Follow-Up Studies; Humans; Intelligence Tests; Interview, Psychological; Longitudinal Studies; Magnetic Resonance Imaging; Male; Marijuana Abuse; Neural Pathways; Rest; Young Adult

Heavy cannabis use is associated with reduced motivation. The basal ganglia, central in the motivation system, have the brain's highest cannabinoid receptor density. The frontal lobe is functionally coupled to the basal ganglia via segregated frontal-subcortical circuits conveying information from internal, self-generated activity. The basal ganglia, however, receive additional influence from the sensory system to further modulate purposeful behaviors according to the context. We postulated that cannabis use would impact functional connectivity between the basal ganglia and both internal (frontal cortex) and external (sensory cortices) sources of influence. Resting-state functional connectivity was measured in 28 chronic cannabis users and 29 controls. Selected behavioral tests included reaction time, verbal fluency and exposition to affective pictures. Assessments were repeated after one month of abstinence. Cannabis exposure was associated with (1) attenuation of the positive correlation between the striatum and areas pertaining to the 'limbic' frontal-basal ganglia circuit, and (2) attenuation of the negative correlation between the striatum and the fusiform gyrus, which is critical in recognizing significant visual features. Connectivity alterations were associated with lower arousal in response to affective pictures. Functional connectivity changes had a tendency to normalize after abstinence. The results overall indicate that frontal and sensory inputs to the basal ganglia are attenuated after chronic exposure to cannabis. This effect is consistent with the common behavioral consequences of chronic cannabis use concerning diminished responsiveness to both internal and external motivation signals. Such an impairment of the fine-tuning in the motivation system notably reverts after abstinence.

Topics: Adult; Basal Ganglia; Cannabis; Frontal Lobe; Humans; Magnetic Resonance Imaging; Male; Marijuana Abuse; Reaction Time; Somatosensory Cortex; Young Adult

Most drugs of abuse lead to a general blunting of dopamine release in the chronic phase of dependence, which contributes to poor outcome. To test whether cannabis dependence is associated with a similar dopaminergic deficit, we examined striatal and extrastriatal dopamine release in severely cannabis-dependent participants (CD), free of any comorbid conditions, including nicotine use. Eleven CD and 12 healthy controls (HC) completed two positron emission tomography scans with [

Topics: Adult; Amphetamine; Brain; Cannabis; Corpus Striatum; Dextroamphetamine; Dopamine; Endocannabinoids; Female; Humans; Magnetic Resonance Imaging; Male; Marijuana Abuse; Positron-Emission Tomography

Cannabis use shows a robust dose-dependent relationship with psychosis risk among the general population. Despite this, it has been difficult to link cannabis use with risk for transitioning to a psychotic disorder among individuals at ultra-high risk (UHR) for psychosis. The present study examined UHR transition risk as a function of cannabis use characteristics which vary substantially between individuals including age of first use, cannabis abuse severity and a history of cannabis-induced attenuated psychotic symptoms (APS).. Participants were 190 UHR individuals (76 males) recruited at entry to treatment between 2000 and 2006. They completed a comprehensive baseline assessment including a survey of cannabis use characteristics during the period of heaviest use. Outcome was transition to a psychotic disorder, with mean time to follow-up of 5.0 years (range 2.4-8.7 years).. A history of cannabis abuse was reported in 58% of the sample. Of these, 26% reported a history of cannabis-induced APS. These individuals were 4.90 (95% confidence interval 1.93-12.44) times more likely to transition to a psychotic disorder (p = 0.001). Greater severity of cannabis abuse also predicted transition to psychosis (p = 0.036). However, this effect was mediated by higher abuse severity among individuals with a history of cannabis-induced APS.. Findings suggest that cannabis use poses risk in a subpopulation of UHR individuals who manifest cannabis-induced APS. Whether this reflects underlying genetic vulnerability requires further study. Nevertheless, findings reveal an important early marker of risk with potentially significant prognostic utility for UHR individuals.

Topics: Adolescent; Adult; Cannabis; Disease Progression; Female; Follow-Up Studies; Humans; Male; Marijuana Abuse; Prognosis; Psychoses, Substance-Induced; Risk; Young Adult

Increased scientific attention given to cannabis in the United States has particular relevance for its domestic HIV care population, given that evidence exists for both cannabis as a therapeutic agent and cannabis use disorder (CUD) as a barrier to antiretroviral medication adherence. It is critical to identify relative risk for CUD among demographic subgroups of HIV patients, as this will inform detection and intervention efforts. A Center For AIDS Research Network of Integrated Clinical Systems cohort (N = 10,652) of HIV-positive adults linked to care at seven United State sites was examined for this purpose. Based on a patient-report instrument with validated diagnostic threshold for CUD, the prevalence of recent cannabis use and corresponding conditional probabilities for CUD were calculated for the aggregate sample and demographic subgroups. Generalized estimating equations then tested models directly examining patient demographic indices as predictors of CUD, while controlling for history and geography. Conditional probability of CUD among cannabis-using patients was 49%, with the highest conditional probabilities among demographic subgroups of young adults and those with non-specified sexual orientation (67-69%) and the lowest conditional probability among females and those 50+ years of age (42% apiece). Similarly, youthful age and male gender emerged as robust multivariate model predictors of CUD. In the context of increasingly lenient policies for use of cannabis as a therapeutic agent for chronic conditions like HIV/AIDS, current study findings offer needed direction in terms of specifying targeted patient groups in HIV care on whom resources for enhanced surveillance and intervention efforts will be most impactful.

Topics: Adolescent; Adult; Cannabis; Cohort Studies; Female; HIV Infections; Humans; Male; Marijuana Abuse; Marijuana Smoking; Medication Adherence; Middle Aged; Prevalence; United States; Young Adult

Topics: Adolescent; Cannabis; Humans; Legislation, Drug; Marijuana Abuse; Marijuana Smoking; Marijuana Use

Topics: Adolescent; Adolescent Behavior; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking

Sex with multiple partners (SMP) is one of the important contributing factors for contracting sexually transmitted infections (STIs) among adolescents and young adults, especially among Lesbian, Gay, and Bisexual (LGB) youth. Past studies mainly focus on examining associations of alcohol or club drugs use with unprotected sexual behaviors among adult homo/bisexual men, while little is known about the temporal association between marijuana use (MU) and SMP among LGB youth.. This study examined the relationship between MU and SMP among LGB adolescents and young adults. Generalized estimating equations (GEE) logistic regression analyses were utilized to analyze four waves' public-use Add Health data (N = 694, youth who reported a homo/bisexual status at any wave; Wave 1: aged 11-21; Wave 4: aged 24-32).. After adjusting for other substance use, current depression, mother-child relationship quality at Wave 1, and socioeconomic variables, past-year MU was both concurrently and prospectively associated with past-year SMP. The moderating effect of age was not found.. MU is concurrently and prospectively associated with increased odds of SMP in the adolescent sample and in the young adult sample. Findings imply that prevention/intervention on HIV risk behaviors may benefit from MU reduction not only in LGB adolescents but also in young adults.

Topics: Adolescent; Adult; Age Factors; Bisexuality; Cannabis; Child; Female; Health Surveys; HIV Infections; Homosexuality; Homosexuality, Female; Homosexuality, Male; Humans; Logistic Models; Male; Marijuana Abuse; Marijuana Smoking; Risk-Taking; Sexual and Gender Minorities; Sexual Behavior; Sexual Partners; Sexually Transmitted Diseases; United States; Young Adult

Cannabis use has been found to stimulate appetite and potentially promote weight gain via activation of the endocannabinoid system. Despite the fact that the onset of cannabis use is typically during adolescence, the association between adolescence cannabis use and long-term change in body weight is generally unknown. This study aims to examine the association between adolescence cannabis use and weight change to midlife, while accounting for the use of other substances. The study applied 20 to 22 years of follow-up data on 712 Danish adolescents aged between 15 and 19 years at baseline. Self-reported height and weight, cannabis, cigarette and alcohol use, socioeconomic status (SES) and physical activity levels were assessed in baseline surveys conducted in 1983 and 1985. The follow-up survey was conducted in 2005. In total 19.1% (n = 136) of adolescents reported having used/using cannabis. Weight gain between adolescence and midlife was not related to cannabis exposure during adolescence in either crude or adjusted models, and associations were not modified by baseline alcohol intake or smoking. However, cannabis use was significantly associated with cigarette smoking (p<0.001) and alcohol intake (p<0.001) and inversely associated with physical activity levels (p = 0.04). In conclusion, this study does not provide evidence of an association between adolescence cannabis use and weight change from adolescence to midlife.

Topics: Adolescent; Age Factors; Alcohol Drinking; Body Mass Index; Body Weight; Cannabis; Denmark; Exercise; Female; Follow-Up Studies; Humans; Male; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Population Surveillance; Risk Factors; Self Report; Smoking; Social Class; Young Adult

Topics: Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Risk

Topics: Cannabinoids; Cannabis; Humans; Marijuana Abuse; Research

Motivational enhancement therapy (MET) is efficacious in reducing cannabis use, yet benefits are generally short-lived. Oxytocin is a hypothalamic neuropeptide that promotes prosocial behaviors and plays a role in drug-related neuroadaptations; as such, oxytocin may enhance the effect of MET on cannabis outcomes. Cannabis dependent adults were randomized to receive MET plus oxytocin (n =8) or placebo (n =8). Participants receiving oxytocin showed reductions in amount of cannabis used daily and number of sessions per day. Participants receiving placebo did not evidence significant reductions. Powered clinical trials of oxytocin-enhanced MET for cannabis use disorder are warranted.

Topics: Adolescent; Adult; Cannabis; Combined Modality Therapy; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Motivational Interviewing; Oxytocics; Oxytocin; Pilot Projects; Treatment Outcome; Young Adult

Topics: Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Prescription Drugs

Cannabis use has been reported to affect the course of various psychiatric disorders, however its effect on the course of major depressive disorder (MDD) is not yet clear. We used data from Wave 1 and Wave 2 of the National Epidemiologic survey on Alcohol and Related Conditions (NESARC). Individuals with baseline MDD (N=2,348) were included in the study. Cannabis users without a Cannabis Use Disorder (CUDs) and individuals with a CUD were compared to nonusers using linear and logistic regression analyses controlling for sociodemographics, psychiatric disorders and substance use disorders at baseline. No differences were found in rates of remission between the groups. Level of cannabis use was associated with significantly more depressive symptoms at follow-up, particularly anhedonia, changes in body weight, insomnia or hypersomnia and psychomotor problems. After adjusting for baseline confounding factors, no associations were found between cannabis use and suicidality, functionality and quality of life. We conclude that many of the associations between cannabis use and a more severe course of MDD do not seem to be attributed to cannabis use itself but to associated sociodemographic and clinical factors. Further longitudinal studies using depression severity indices are required.

Topics: Adult; Cannabis; Depressive Disorder, Major; Female; Humans; Longitudinal Studies; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Quality of Life; Young Adult

This paper examined longitudinal marijuana use trajectories among drug-using youth presenting to the ED to inform intervention development.. Given interest in substance use and violence, this study oversampled those presenting with assault injuries. Assault-injured youth (ages 14-24) endorsing past 6-month drug use (n=349), and a sex and age proportionally-sampled comparison group (n=250) endorsing drug use, completed a baseline assessment and follow-ups at 6, 12, 18, and 24 months. Latent class trajectory analyses examined days of marijuana use over 2 years. Multinomial regression analyses examined baseline, 12-month and 24-month factors associated with substance use trajectory groups.. Trajectory analyses identified 5 groups: Low (Low; 28.2%; n=169); Intermittent (INT; 16.2%; n=97); Moderate Decline (MD; 12.0%; n=72); High decline (HD, 13.2%; n=79) and Chronic (C; 30.4%; n=182). At baseline, as compared to the Low group, the other trajectory groups were more likely to be male and have greater levels of physical aggression. At 12- and 24-months, negative and positive peer influences, incarceration and community violence were additional characteristics associated with the greater marijuana use trajectories (as compared to the Low group).. Interventions for drug-using youth presenting to the urban ED should address peer influences, physical aggression and community violence exposure, given the association between these characteristics and greater marijuana use trajectories.

Topics: Adolescent; Aggression; Cannabis; Emergency Service, Hospital; Female; Hospitals, Urban; Humans; Longitudinal Studies; Male; Marijuana Abuse; Marijuana Smoking; Peer Group; Risk Factors; Sex Factors; Social Facilitation; Substance-Related Disorders; Violence; Wounds and Injuries; Young Adult

Young adults with psychiatric illnesses are more likely to use cannabis and experience problems from use. It is not known whether those with a lifetime psychiatric illness experience a prolonged cannabis withdrawal syndrome with abstinence. Participants were fifty young adults, aged 18-25, recruited from the Boston-area in 2015-2016, who used cannabis at least weekly, completed the Structured Clinical Interview for DSM-IV to identify Axis I psychiatric diagnoses (PD+ vs PD-), and attained cannabis abstinence with a four-week contingency management protocol. Withdrawal symptom severity was assessed at baseline and at four weekly abstinent visits using the Cannabis Withdrawal Scale. Cannabis dependence, age of initiation, and rate of abstinence were similar in PD+ and PD- groups. There was a diagnostic group by abstinent week interaction, suggesting a difference in time course for resolution of withdrawal symptoms by group, F(4,46)=3.8, p=0.009, controlling for sex, baseline depressive and anxiety symptoms, and frequency of cannabis use in the prior 90days. In post hoc analyses, there was a difference in time-course of cannabis withdrawal. PD- had significantly reduced withdrawal symptom severity in abstinent week one [t(46)=-2.2, p=0.03], while PD+ did not report improved withdrawal symptoms until the second abstinent week [t(46)=-4.1, p=0.0002]. Cannabis withdrawal symptoms improved over four weeks in young people with and without a lifetime psychiatric diagnosis. However, those with a psychiatric illness reported one week delayed improvement in withdrawal symptom severity. Longer duration of cannabis withdrawal may be a risk factor for cannabis dependence and difficulty quitting.

Topics: Boston; Cannabis; Female; Humans; Male; Marijuana Abuse; Mental Disorders; Substance Withdrawal Syndrome; Time Factors; Young Adult

Topics: Cannabis; Dronabinol; Humans; Marijuana Abuse; Marijuana Smoking

In 2012, 10% of Canadians used cannabis and just under half of those who use cannabis were estimated to have driven under the influence of cannabis. Substantial evidence has accumulated to indicate that driving after cannabis use increases collision risk significantly; however, little is known about the extent and costs associated with cannabis-related traffic collisions. This study quantifies the costs of cannabis-related traffic collisions in the Canadian provinces.. Province and age specific cannabis-attributable fractions (CAFs) were calculated for traffic collisions of varying severity. The CAFs were applied to traffic collision data in order to estimate the total number of persons involved in cannabis-attributable fatal, injury and property damage only collisions. Social cost values, based on willingness-to-pay and direct costs, were applied to estimate the costs associated with cannabis-related traffic collisions. The 95% confidence intervals were calculated using Monte Carlo methodology.. Cannabis-attributable traffic collisions were estimated to have caused 75 deaths (95% CI: 0-213), 4407 injuries (95% CI: 20-11,549) and 7794 people (95% CI: 3107-13,086) were involved in property damage only collisions in Canada in 2012, totalling $1,094,972,062 (95% CI: 37,069,392-2,934,108,175) with costs being highest among younger people.. The cannabis-attributable driving harms and costs are substantial. The harm and cost of cannabis-related collisions is an important factor to consider as Canada looks to legalize and regulate the sale of cannabis. This analysis provides evidence to help inform Canadian policy to reduce the human and economic costs of drug-impaired driving.

Topics: Accidents, Traffic; Adolescent; Adult; Age Factors; Canada; Cannabis; Cause of Death; Costs and Cost Analysis; Cross-Sectional Studies; Driving Under the Influence; Female; Humans; Male; Marijuana Abuse; Middle Aged; Wounds and Injuries; Young Adult

Topics: Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; United Kingdom

Topics: Administration, Intravenous; Cannabis; Delirium; Dexmedetomidine; Female; Humans; Hypnotics and Sedatives; Male; Marijuana Abuse; Marijuana Smoking; Substance Withdrawal Syndrome; Young Adult

Cannabis arteritis (CA) is a major and underdiagnosed cause of peripheral arterial disease in young patients. A 34-year-old man, daily smoker of 20 cigarettes and two cannabis cigarettes for 14 years, presented with a necrotic plaque of left hallux for 3 weeks. The Doppler ultrasound and angiography were compatible with severe Buerger's disease. Submitted to a revascularisation procedure and hypocoagulation with rivaroxaban. He had ceased smoking but maintained consumption of cannabis. Owing to the persistence of distal necrosis, amputation of the hallux was performed with good evolution. CA is a subtype of Buerger's disease. It is poorly known but increasingly prevalent and manifests in cannabis users regardless of tobacco use. The drug is considered at least a cofactor of the arteriopathy. The most effective treatment is cessation of consumption. Being cannabis one of the most consumed drugs, its mandatory to ask about its use in all young patients with arteriopathy.

Topics: Adult; Amputation, Surgical; Angiography; Arteritis; Cannabis; Diagnosis, Differential; Diagnostic Imaging; Hallux; Humans; Leg; Male; Marijuana Abuse; Necrosis; Smoking

Topics: Cannabis; Humans; Marijuana Abuse; Psychotic Disorders

Topics: Acute Disease; Adult; Cannabis; Humans; Male; Marijuana Abuse; Pancreatitis

This study examines the prevalence, behaviors, and birth outcomes associated with marijuana use in pregnancy. This was a retrospective cohort from a university-based prenatal care clinic from July 1, 2009 to June 30, 2010. The primary exposure was marijuana use, defined by self-report or urine toxicology. Demographic and outcome data were determined by chart review and analyzed by chi-square test, Fisher's exact test, ANOVA, and logistic regression. Three hundred and ninety-six patients initiated prenatal care during this time frame; 116 (29.3 %) of whom screened positive for marijuana at initial visit. Patients who used marijuana were less likely to have graduated high school (p = 0.016) or be employed (p = 0.015); they were more likely to use tobacco (p < 0.001) or alcohol (p = 0.032) and report a history of abuse (p = 0.010) or depressed mood (p = 0.023). When analyzed via logistic regression, only tobacco use remained associated with marijuana use (adjusted odds ratio (OR) = 3.3; 95 % confidence interval (CI): 1.9-5.9). Birth outcomes were available for 170 (43.0 %) patients. Only 3 (1.9 %) tested positive for marijuana at the time of delivery. Marijuana use was not related to incidence of low birth weight (13.8 % vs 14.0 %, p = 1.00), preterm delivery (17.7 % vs 12.0 %, p = 0.325), or NICU admissions (25.5 % vs 15.8 %, p = 0.139). Prenatal care utilization was equal between marijuana users and non-users. Although marijuana is common among obstetric patients at prenatal care initiation, most cease use by delivery. Marijuana is strongly correlated with cigarette use. We found no differences in birth outcomes or utilization of prenatal care by marijuana exposure.

Topics: Adult; Birth Weight; Cannabis; Female; Health Services Accessibility; Humans; Logistic Models; Male; Marijuana Abuse; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Prenatal Care; Prevalence; Retrospective Studies; Young Adult

Cannabis smoking increases motor vehicle accident risk. Empirically defined cannabinoid detection windows are important to drugged driving legislation. Our aims were to establish plasma cannabinoid detection windows in frequent cannabis smokers and to determine if residual cannabinoid concentrations were correlated with psychomotor performance. Twenty-eight male chronic frequent cannabis smokers resided on a secure research unit for up to 33 days with daily blood collection. Plasma specimens were analyzed for Δ(9) -tetrahydrocannabinol (THC), 11-hydroxy-THC (11-OH-THC), and 11-nor-9-carboxy-THC (THCCOOH) by gas chromatography-mass spectrometry. Critical tracking and divided attention tasks were administered at baseline (after overnight stay to ensure lack of acute intoxication) and after 1, 2, and 3 weeks of cannabis abstinence. Twenty-seven of the twenty-eight participants were THC-positive at admission (median 4.2 µg/L). THC concentrations significantly decreased 24 h after admission, but were still ≥2 µg/L in 16 of the 28 participants 48 h after admission. THC was detected in 3 of 5 specimens on day 30. The last positive 11-OH-THC specimen was 15 days after admission. THCCOOH was measureable in 4 of 5 participants after 30 days of abstinence. Years of prior cannabis use significantly correlated with THC concentrations on admission, and days 7 and 14. Tracking error, evaluated by the Divided Attention Task, was the only evaluated psychomotor assessment significantly correlated with cannabinoid concentrations at baseline and day 8 (11-OH-THC only). Median THC was 0.3 µg/L in 5 chronic frequent cannabis smokers' plasma samples after 30 days of sustained abstinence. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

Topics: Adolescent; Adult; Aged; Automobile Driving; Cannabis; Dronabinol; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Psychomotor Performance; Psychotropic Drugs; Substance Abuse Detection; Young Adult

Long-term cannabis use may confer cognitive deficits and increased risk of psychosis. However, the relationship between cannabis use and schizophrenia is complex. In particular, little is known about the effects of chronic cannabis use on the attention-related electric brain response in schizophrenia. We investigated auditory novelty and oddball P300 evoked potentials in a mixed sample of first-episode and chronic schizophrenic patients and healthy controls with (SZCA, n = 20; COCA, n = 20, abstinence ≥28 days) or without (SZ, n = 20; CO, n = 20) chronic cannabis use. Duration of regular cannabis use was 8.3 ± 5.6 (SZCA) and 9.1 ± 7.1 (COCA) years. In general, schizophrenic patients showed reduced P300 amplitudes. Cannabis use was associated with both a reduced early and late left-hemispheric novelty P300. There was a significant 'diagnosis × cannabis' interaction for the left-hemispheric late novelty P300 in that cannabis use was associated with a reduced amplitude in the otherwise healthy but not in the schizophrenic group compared with their relative control groups (corrected p < 0.02; p > 0.9, respectively). The left-hemispheric late novelty P300 in the otherwise healthy cannabis group correlated inversely with amount and duration of cannabis use (r = -0.50, p = 0.024; r = -0.57, p = 0.009, respectively). Our study confirms attentional deficits with chronic cannabis use. However, cannabis use may lead to different cognitive sequelae in patients with schizophrenia and in healthy controls, possibly reflecting preexisting alterations in the endocannabinoid system in schizophrenia.

Topics: Adolescent; Adult; Analysis of Variance; Attention Deficit Disorder with Hyperactivity; Cannabis; Electroencephalography; Event-Related Potentials, P300; Female; Humans; Male; Marijuana Abuse; Middle Aged; Psychiatric Status Rating Scales; Schizophrenia; Substance Withdrawal Syndrome; Young Adult

There have been extensive policy shifts in the legality of recreational and therapeutic use of cannabis in the United States, as well as a steady increase in the number of people using the drug on a regular basis. Given these rapid societal changes, defining what is known scientifically about the consequences of cannabis use on mental health takes on added public health significance. The purpose of this circumspectives piece is to discuss evidence of cannabis' effects on two psychiatric conditions: post-traumatic stress disorder and psychotic disorders. Dr Haney and Dr Evins will discuss two viewpoints regarding the benefit and harm of cannabis use for these conditions, while outlining what remains unproven and requires further testing to move the field forward.

Topics: Animals; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Mental Disorders

Topics: Bipolar Disorder; Cannabis; Humans; Ketamine; Marijuana Abuse

The use of cannabis as both a therapeutic agent and recreational drug is common, and its availability is increasing as a result of legalization in many countries. Among older children, the manifestations of cannabis intoxication are numerous and include both neurological and systemic manifestations that are frequently non-specific. There have been only a few reports detailing cannabis intoxication in infants and toddlers. We describe three infants who presented to the emergency department with encephalopathic signs without prominent systemic manifestations. During the initial interview of caregivers, no history of exposure to neurotoxic agents was obtained. All three patients were subsequently diagnosed with cannabis intoxication based on urine toxic screens for delta-9-tetrahydrocannabinol (THC). The infants recovered with supportive care that included fluids and monitoring. The non-specific symptomatology of cannabis intoxication in infants together with the wide differential for unexplained acute onset encephalopathy may delay diagnosis and lead to inappropriate procedures and interventions such as antimicrobial treatments and imaging studies.. Healthcare personnel of emergency rooms, urgent care centers, and general clinics should be aware of the potential risk of cannabis ingestion in young infants. A thorough medical history and toxic screen are warranted in all infants with unexplained decreased sensorium.

Topics: Brain Diseases; Cannabis; Diagnosis, Differential; Emergency Service, Hospital; Female; Humans; Infant; Male; Marijuana Abuse

In a society highly focused on physical appearance, people are increasingly using the so-called performance and image-enhancing drugs (PIEDs) or life-style drugs as an easy way to control weight. Preliminary data from online sources (e.g. websites, drug forums, e-newsletters) suggest an increased use of cannabis amongst the general population as a PIED due to its putative weight-loss properties. The use of cannabis and/or cannabis-related products to lose weight may represent a new substance-use trend that should be carefully monitored and adequately investigated, especially in light of the well-known adverse psychiatric and somatic effects of cannabis, its possible interaction with other medications/drugs and the unknown and potentially dangerous composition of synthetic cannabimimetics preparations.

Topics: Anti-Obesity Agents; Body Image; Cannabinoids; Cannabis; Humans; Illicit Drugs; Marijuana Abuse; Self Medication; Weight Loss

Children diagnosed with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for substance abuse. Response inhibition is a hallmark of ADHD, yet the combined effects of ADHD and regular substance use on neural networks associated with response inhibition are unknown. Task-based functional Magnetic Resonance Imaging (fMRI) data from young adults with childhood ADHD with (n = 25) and without (n = 25) cannabis use ≥ monthly in the past year were compared with a local normative comparison group (LNCG) with (n = 11) and without (n = 12) cannabis use. Go/NoGo behavioral and fMRI data were evaluated for main and interaction effects of ADHD diagnosis and cannabis use. ADHD participants made significantly more commission errors on NoGo trials than controls. ADHD participants also had less frontoparietal and frontostriatal activity, independent of cannabis use. No main effects of cannabis use on response inhibition or functional brain activation were observed. An interaction of ADHD diagnosis and cannabis use was found in the right hippocampus and cerebellar vermis, with increased recruitment of these regions in cannabis-using controls during correct response inhibition. ADHD participants had impaired response inhibition combined with less fronto-parietal/striatal activity, regardless of cannabis use history. Cannabis use did not impact behavioral response inhibition. Cannabis use was associated with hippocampal and cerebellar activation, areas rich in cannabinoid receptors, in LNCG but not ADHD participants. This may reflect recruitment of compensatory circuitry in cannabis using controls but not ADHD participants. Future studies targeting hippocampal and cerebellar-dependent function in these groups may provide further insight into how this circuitry is altered by ADHD and cannabis use.

Topics: Adult; Attention Deficit Disorder with Hyperactivity; Brain; Brain Mapping; Cannabis; Female; Follow-Up Studies; Humans; Inhibition, Psychological; Longitudinal Studies; Magnetic Resonance Imaging; Male; Marijuana Abuse; Neuropsychological Tests; Self Report; Tobacco Use Disorder; Young Adult

Despite growing numbers of older-adult illicit drug users, research on this topic is rare. This study examined the relationship between marijuana and/or other illicit drug use and major depressive episode (MDE) and serious suicidal thoughts among those aged 50+ years in the USA.. The public use files of the 2008 to 2012 US National Survey on Drug Use and Health (NSDUH) provided data on 29,634 individuals aged 50+ years. Logistic regression analysis was used to test hypothesized associations between past-year marijuana and/or other illicit drug use and MDE and serious suicidal thoughts.. Nearly 6% of the 50+ years age group reported past-year marijuana and/or other illicit drug use. Compared to non-users of any illicit drug, the odds of past-year MDE among those who used marijuana only, other illicit drugs only, and marijuana and other illicit drugs were 1.54 (95% CI = 1.17-2.03), 2.75 (95% CI = 1.75-4.33), and 2.12 (95% CI = 1.45-3.09), respectively. Those who used marijuana and other drugs also had higher odds (2.44, 95% CI = 1.58-3.77) of suicidal thoughts than non-users of any illicit drug. However, among users of any illicit drug, no difference was found among users of marijuana only, marijuana and other illicit drugs, and other illicit drugs only. Among marijuana users, marijuana use frequency was a significant correlate of suicidal thoughts only among those with MDE.. Health and mental health (MH) service providers should pay close attention to the potential reciprocal effects of marijuana and other illicit drug use and MDE and suicidal thoughts among late middle-aged and older adults.

Topics: Age Distribution; Aged; Cannabis; Cross-Sectional Studies; Depression; Depressive Disorder, Major; Female; Health Surveys; Humans; Illicit Drugs; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Regression Analysis; Self Report; Substance-Related Disorders; Suicidal Ideation; Suicide, Attempted; United States

Topics: Cannabinoids; Cannabis; Humans; Marijuana Abuse; Mental Disorders; Severity of Illness Index

Case reports and hospital-based case-control studies suggest that cannabis use may increase the risk of stroke. We examined the risk of non-fatal stroke or transient ischemic attack (TIA) among cannabis users in the general community.. A general population survey of Australians aged 20-24 years (n=2,383), 40-44 years (n=2,525) and 60-64 years (n=2,547) was used to determine the odds of lifetime stroke or TIA among participants who had smoked cannabis in the past year while adjusting for other stroke risk factors.. There were 153 stroke/TIA cases (2.1%). After adjusting for age cohort, past year cannabis users (n=1,043) had 3.3 times the rate of stroke/TIA (95% CI 1.8-6.3, p<0.001). The incidence rate ratio (IRR) reduced to 2.3 after adjustment for covariates related to stroke, including tobacco smoking (95% CI 1.1-4.5). Elevated stroke/TIA was specific to participants who used cannabis weekly or more often (IRR 4.7, 95% CI 2.1-10.7) with no elevation among participants who used cannabis less often.. Heavy cannabis users in the general community have a higher rate of non-fatal stroke or transient ischemic attack than non-cannabis users.

Topics: Adult; Australia; Cannabis; Case-Control Studies; Female; Humans; Ischemic Attack, Transient; Longitudinal Studies; Male; Marijuana Abuse; Middle Aged; Regression Analysis; Risk Factors; Smoking; Stroke; Young Adult

Synthetic cannabinoid use has increased in many states, and medicinal and/or recreational marijuana use has been legalized in some states. These changes present challenges to law enforcement drug recognition experts (DREs) who determine whether drivers are impaired by synthetic cannabinoids or marijuana, as well as to clinical toxicologists who care for patients with complications from synthetic cannabinoids and marijuana. Our goal was to compare what effects synthetic cannabinoids and marijuana had on performance and behavior, including driving impairment, by reviewing records generated by law enforcement DREs who evaluated motorists arrested for impaired driving.. Data were from a retrospective, convenience sample of de-identified arrest reports from impaired drivers suspected of using synthetic cannabinoids (n = 100) or marijuana (n = 33). Inclusion criteria were arrested drivers who admitted to using either synthetic cannabinoids or marijuana, or who possessed either synthetic cannabinoids or marijuana; who also had a DRE evaluation at the scene; and whose blood screens were negative for alcohol and other drugs. Exclusion criteria were impaired drivers arrested with other intoxicants found in their drug or alcohol blood screens. Blood samples were analyzed for 20 popular synthetic cannabinoids by using liquid chromatography-tandem mass spectrometry. Delta-9-tetrahydrocannabinol (THC) and THC-COOH were quantified by gas chromatography-mass spectrometry. Statistical significance was determined by using Fisher's exact test or Student's t-test, where appropriate, to compare the frequency of characteristics of those in the synthetic cannabinoid group versus those in the marijuana group.. 16 synthetic cannabinoid and 25 marijuana records met selection criteria; the drivers of these records were arrested for moving violations. Median age for the synthetic cannabinoid group (n = 16, 15 males) was 20 years (IQR 19-23 years). Median age for the marijuana group (n = 25, 21 males) was 20 years (IQR 19-24 years) (p = 0.46). In the synthetic cannabinoid group, 94% (15/16) admitted to using synthetic cannabinoids. In the marijuana group, 96% (24/25) admitted to using marijuana. Blood was available for testing in 96% (24/25) of the marijuana group; 21 of these 24 had quantitative levels of THC (mean + SD = 10.7 + 5 ng/mL) and THC-COOH (mean + SD = 57.8 + 3 ng/mL). Blood was available for testing in 63% (10/16) of the synthetic cannabinoid group, with 80% (8/10) of these positive for synthetic cannabinoids. Those in the synthetic cannabinoid group were more frequently confused (7/16 [44%] vs. 0/25 [0%], p ≤ 0.003) and disoriented (5/16 [31%] vs. 0/25 [0%], p ≤ 0.003), and more frequently had incoherent, slurred speech (10/16 [63%] vs. 3/25 [12%], p = 0.0014) and horizontal gaze nystagmus (8/16 [50%] vs. 3/25 [12%], p = 0.01) than those in the marijuana group.. Drivers under the influence of synthetic cannabinoids were more frequently impaired with confusion, disorientation, and incoherent, slurred speech than drivers under the influence of marijuana in this population evaluated by DREs.

Topics: Automobile Driving; Cannabinoids; Cannabis; Chromatography, Liquid; Confusion; Crime; Female; Gas Chromatography-Mass Spectrometry; Humans; Male; Marijuana Abuse; Marijuana Smoking; Nystagmus, Pathologic; Plant Extracts; Predictive Value of Tests; Psychotropic Drugs; Retrospective Studies; Space Perception; Speech Intelligibility; Substance Abuse Detection; Tandem Mass Spectrometry; Young Adult

Patients with schizophrenia spectrum disorders and substance use may have an earlier onset of illness compared to those without substance use. Most previous studies have, however, too small samples to control for confounding variables and the effect of specific types of substances. The present study aimed to examine the relationship between substance use and age at onset, in addition to the influence of possible confounders and specific substances, in a large and heterogeneous multisite sample of patients with schizophrenia spectrum disorders.. The patients (N=1119) were recruited from catchment areas in Oslo, Stavanger and Bergen, Norway, diagnosed according to DSM-IV and screened for substance use history. Linear regression analysis was used to examine the relationship between substance use and age at onset of illness.. Patients with substance use (n=627) had about 3years earlier age at onset (23.0years; SD 7.1) than the abstinent group (n=492; 25.9years; SD 9.7). Only cannabis use was statistically significantly related to earlier age at onset. Gender or family history of psychosis did not influence the results.. Cannabis use is associated with 3years earlier onset of psychosis.

Topics: Adult; Age of Onset; Cannabis; Family; Female; Humans; Male; Marijuana Abuse; Norway; Psychotic Disorders; Regression Analysis; Schizophrenia; Sex Factors; Young Adult

The current study examined the independent and combined effects of HIV and marijuana (MJ) use (no use, light use, and moderate-to-heavy use) on neurocognitive functioning among a convenience sample of HIV-positive (HIV+) and HIV-negative (HIV-) individuals recruited from HIV community care clinics and advertisements in the Greater Los Angeles area. MJ users consisted of individuals who reported regular use of MJ for at least 12 months, with last reported use within the past month. Participants included 89 HIV+ (n = 55) and HIV- (n = 34) individuals who were grouped into non-users, light users, and moderate-to-heavy users based on self-reported MJ use. Participants were administered a brief cognitive test battery and underwent laboratory testing for CD4 count and viral load. HIV+ individuals demonstrated lower performance on neurocognitive testing than controls, and moderate-to-heavy MJ users performed more poorly on neurocognitive testing than light users or non-users. Moderate-to-heavy HIV+ users performed significantly lower on learning/memory than HIV- moderate-to-heavy users (MD = -8.34; 95% CI: -16.11 to -0.56) as well as all other comparison groups. In the domain of verbal fluency, HIV+ light users outperformed HIV- light users (MD = 7.28; 95% CI: 1.62-12.39), but no HIV group differences were observed at other MJ use levels. HIV+ MJ users demonstrated lower viral load (MD = -0.58; 95% CI: -1.30 to 0.14) and higher CD4 count than non-users (MD = 137.67; 95% CI: 9.48-265.85). The current study findings extend the literature by demonstrating the complex relationship between HIV status and MJ use on neurocognitive and clinical outcomes.

Topics: Adult; Cannabis; Cognition; Cognitive Dysfunction; Executive Function; Female; HIV Infections; HIV Seronegativity; Humans; Los Angeles; Male; Marijuana Abuse; Marijuana Smoking; Memory, Short-Term; Middle Aged; Viral Load

Shifting policies towards legalisation of cannabis for therapeutic and recreational use raise significant ethical issues for health-care providers seeking evidence-based recommendations. We investigated whether heavy cannabis use is associated with persistent harms to the hippocampus, if exposure to cannabidiol offers protection, and whether recovery occurs with abstinence. To do this, we assessed 111 participants: 74 long-term regular cannabis users (with an average of 15.4 years of use) and 37 non-user healthy controls. Cannabis users included subgroups of participants who were either exposed to Δ9-tetrahydrocannabinol (THC) but not to cannabidiol (CBD) or exposed to both, and former users with sustained abstinence. Participants underwent magnetic resonance imaging from which three measures of hippocampal integrity were assessed: (i) volume; (ii) fractional anisotropy; and (iii) N-acetylaspartate (NAA). Three curve-fitting models across the entire sample were tested for each measure to examine whether cannabis-related hippocampal harms are persistent, can be minimised (protected) by exposure to CBD or recovered through long-term abstinence. These analyses supported a protection and recovery model for hippocampal volume (P=0.003) and NAA (P=0.001). Further pairwise analyses showed that cannabis users had smaller hippocampal volumes relative to controls. Users not exposed to CBD had 11% reduced volumes and 15% lower NAA concentrations. Users exposed to CBD and former users did not differ from controls on any measure. Ongoing cannabis use is associated with harms to brain health, underpinned by chronic exposure to THC. However, such harms are minimised by CBD, and can be recovered with extended periods of abstinence.

Topics: Adult; Cannabidiol; Cannabis; Dronabinol; Female; Hippocampus; Humans; Magnetic Resonance Imaging; Male; Marijuana Abuse

Topics: Cannabinoids; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Psychoses, Substance-Induced; Psychotic Disorders; Risk Factors

The antiemetic properties of marijuana are well known, but there is increasing evidence of its paradoxical hyperemetic effects on the gastrointestinal tract and central nervous system, known as 'cannabinoid hyperemesis syndrome' (CHS). We report a case of CHS encountered in our outpatient clinic. We also completed a review of the literature using PubMed in patients over 18 years of age with CHS. Understanding the diagnostic criteria and risk factors associated with CHS may reduce the ordering of unnecessary and expensive investigations, and pursuing inappropriate medical and surgical treatments. Ultimately, abstaining from cannabis use leads to resolution of symptoms in the majority of patients.

Topics: Adult; Antiemetics; Cannabis; Diagnosis, Differential; Humans; Male; Marijuana Abuse; Nausea; Syndrome; Vomiting

A potential unintended consequence of legalizing recreational marijuana is increased marijuana-related driving impairment. Some states where recreational marijuana is legal have begun implementing interventions to mitigate driving under the influence (DUI) of marijuana, including media campaigns to increase knowledge about DUI laws. However, little is known about the associations between knowledge of DUI laws and marijuana DUI behavior. In this study, we provide new data from a survey of marijuana users in Colorado and Washington to examine associations between marijuana drugged driving and two potential behavioral precursors of marijuana DUI. We also explore other factors that may influence marijuana DUI.. Data are from an online survey of marijuana users in Colorado and Washington. Respondents who reported any marijuana use in the past 30 days (n = 865) served as the analytic sample. We examined prevalence of two behavioral outcomes: (1) any driving of a motor vehicle while high in the past year and (2) driving a motor vehicle within 1 hour of using marijuana 5 or more times in the past month. Additional outcomes measuring willingness to drive while high were also assessed. Logistic regressions were used to estimate each outcome as a function of two multi-item scales measuring knowledge of the legal consequences of driving high and perceptions that driving while high is not safe. Additional covariates for potential confounders were included in each model.. Prevalence of past-year driving while under the influence of marijuana was 43.6% among respondents. The prevalence of driving within 1 hour of using marijuana at least 5 times in the past month was 23.9%. Increased perception that driving high is unsafe was associated with lower odds of past-year marijuana DUI (OR = 0.31, P < 0.01) and lower past-month odds of driving 5 or more times within 1 hour of using marijuana (OR = 0.26, P < 0.01). Increased knowledge of marijuana DUI laws was also associated with lower odds of each of these outcomes (OR = 0.63, P < 0.01, OR = 0.69, P = 0.02, respectively). Post-estimation Wald tests confirmed the negative associations with marijuana DUI were greater in magnitude for safety perceptions than knowledge of DUI laws. Increased perceptions that driving while high is unsafe was associated with significantly lower willingness to drive after using marijuana while increased knowledge of marijuana DUI laws was not associated with these outcomes.. Despite recent interventions targeting public awareness of the legal consequences of marijuana DUI, our results suggest that knowledge of these laws is a weaker predictor of DUI behavior than perceptions that driving high is unsafe. In addition, safety perceptions predict decreased openness to driving high while knowledge of DUI laws was not associated with openness. These findings suggest that interventions for reducing the incidence of marijuana DUI are likely to be more successful by targeting safety perceptions related to marijuana DUI rather than knowledge of DUI laws. We caution that because these data are limited to an online convenience sample, results may not be generalizable beyond our sample.

Topics: Adolescent; Adult; Attitude; Automobile Driving; Cannabinoids; Cannabis; Colorado; Driving Under the Influence; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Middle Aged; Risk-Taking; Safety; Surveys and Questionnaires; Washington; Young Adult

Social anxiety disorder appears to be a risk factor for cannabis-related problems. Although it is presumed that increases in cannabis craving during elevated social anxiety reflect an intent to cope with greater negative affectivity, it is unclear whether increases in physiological arousal during social stress are related to cannabis craving, especially among those with social anxiety disorder. Similarly, no studies have assessed motivational reasons for cannabis use during elevated social stress. Thus, the current study tested whether increases in state social anxiety (measured subjectively and via physiological arousal) were related to greater cannabis craving among 126 current cannabis users (88.9% with cannabis use disorder, 31.7% with social anxiety disorder, 54.0% non-Hispanic Caucasian) randomly assigned to either a social interaction or reading task. As predicted, cannabis users in the social interaction condition reported greater cannabis craving than those in the reading condition. This effect was particularly evident among those with social anxiety disorder. Although physiological arousal did not moderate the relationship between condition and craving, coping motives were the most common reasons cited for wanting to use cannabis and were reported more among those in the social interaction task. These experimental results uniquely add to a growing literature suggesting the importance of elevated state social anxiety (especially among those with social anxiety disorder) in cannabis use vulnerability processes.

Topics: Adult; Anxiety; Anxiety Disorders; Cannabis; Craving; Female; Humans; Interpersonal Relations; Male; Marijuana Abuse; Marijuana Smoking; Motivation; Phobia, Social; Phobic Disorders; Stress, Psychological; Substance-Related Disorders; Young Adult

With mounting evidence that the risk of cannabis-induced psychosis may be related to both dose and potency of tetrahydrocannbinol (THC), increasing reports of psychosis associated with cannabinoids containing greater amounts of THC are anticipated. We report two cases of emergent psychosis after using a concentrated THC extract known as cannabis "wax," "oil," or "dabs" raising serious concerns about its psychotic liability. Although "dabbing" with cannabis wax is becoming increasingly popular in the US for both recreational and "medicinal" intentions, our cases raise serious concerns about its psychotic liability and highlight the importance of understanding this risk by physicians recommending cannabinoids for purported medicinal purposes.

Topics: Adolescent; Adult; Cannabis; Diagnosis, Differential; Dronabinol; Follow-Up Studies; Humans; Illicit Drugs; Male; Marijuana Abuse; Plant Extracts; Psychoses, Substance-Induced

In the general population cannabis use is associated with better cardiometabolic outcomes. Patients with severe mental illness frequently use cannabis, but also present increased cardiometabolic risk factors. We explore the association between cannabis use and cardiometabolic risk factors in patients with severe mental illness.. A total of 3169 patients with severe mental illness from a Dutch cohort were included in the study. The association of cannabis use with body mass index, waist circumference, blood pressure, cholesterol, triglycerides, glucose, glycated hemoglobin and Positive and Negative Syndrome Scale was examined with separate univariate AN(C)OVA. Changes in metabolic risk factors and Positive and Negative Syndrome Scale were examined after a follow-up interval of 9-24 months, for patients who continued, discontinued, started or were never using cannabis between the two assessments.. Cannabis users at baseline had lower body mass index, smaller waist circumference, lower diastolic blood pressure, and more severe psychotic symptoms than non-users. Patients who discontinued their cannabis use after the first assessment had a greater increase in body mass index, waist circumference, diastolic blood pressure and triglyceride concentrations than other patients, and the severity of their psychotic symptoms had decreased more compared to continued users and non-users.. Extra attention should be paid to the monitoring and treatment of metabolic parameters in patients who discontinue their cannabis use.

Topics: Adult; Blood Pressure; Body Mass Index; Cannabinoids; Cannabis; Cardiovascular Diseases; Cohort Studies; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Mental Disorders; Mental Health; Outcome Assessment, Health Care; Psychotic Disorders; Risk Factors; Substance-Related Disorders; Surveys and Questionnaires; Waist Circumference

With rising rates of marijuana use in the general population and an increasing number of states legalizing recreational marijuana use and authorizing medical marijuana programs, there are renewed clinical and policy concerns regarding the mental health effects of cannabis use.. To examine prospective associations between cannabis use and risk of mental health and substance use disorders in the general adult population.. A nationally representative sample of US adults aged 18 years or older was interviewed 3 years apart in the National Epidemiologic Survey on Alcohol and Related Conditions (wave 1, 2001-2002; wave 2, 2004-2005). The primary analyses were limited to 34 653 respondents who were interviewed in both waves. Data analysis was conducted from March 15 to November 30, 2015.. We used multiple regression and propensity score matching to estimate the strength of independent associations between cannabis use at wave 1 and incident and prevalent psychiatric disorders at wave 2. Psychiatric disorders were measured with a structured interview (Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV). In both analyses, the same set of wave 1 confounders was used, including sociodemographic characteristics, family history of substance use disorder, disturbed family environment, childhood parental loss, low self-esteem, social deviance, education, recent trauma, past and present psychiatric disorders, and respondent's history of divorce.. In the multiple regression analysis of 34 653 respondents (14 564 male [47.9% weighted]; mean [SD] age, 45.1 [17.3] years), cannabis use in wave 1 (2001-2002), which was reported by 1279 respondents, was significantly associated with substance use disorders in wave 2 (2004-2005) (any substance use disorder: odds ratio [OR], 6.2; 95% CI, 4.1-9.4; any alcohol use disorder: OR, 2.7; 95% CI, 1.9-3.8; any cannabis use disorder: OR, 9.5; 95% CI, 6.4-14.1; any other drug use disorder: OR, 2.6; 95% CI, 1.6-4.4; and nicotine dependence: OR, 1.7; 95% CI, 1.2-2.4), but not any mood disorder (OR, 1.1; 95% CI, 0.8-1.4) or anxiety disorder (OR, 0.9; 95% CI, 0.7-1.1). The same general pattern of results was observed in the multiple regression analyses of wave 2 prevalent psychiatric disorders and in the propensity score-matched analysis of incident and prevalent psychiatric disorders.. Within the general population, cannabis use is associated with an increased risk for several substance use disorders. Physicians and policy makers should take these associations of cannabis use under careful consideration.

Topics: Adult; Aged; Alcoholism; Cannabis; Evidence-Based Medicine; Female; Humans; Longitudinal Studies; Male; Marijuana Abuse; Mental Disorders; Middle Aged; Odds Ratio; Prevalence; Propensity Score; Prospective Studies; Risk; Substance-Related Disorders; United States

Cannabis use is frequent among depressed patients and may lead to the so-called "amotivational syndrome", which combines symptoms of affective flattening and loss of emotional reactivity (i.e. the so-called "negative" symptomatology). The aim of this study was to investigate the negative symptomatology in depressed patients with concomitant cannabis use disorders (CUDs) in comparison with depressed patients without CUDs.. Fifty-one patients with a diagnosis of Major Depressive Disorder (MDD) and concomitant CUD and fifty-one MDD patients were enrolled in the study. The 21-Item Hamilton Depression Rating Scale (HDRS) and the negative symptoms subscales of the Positive and Negative Syndrome Scale (PANSS) were used to assess depressive and negative symptomatology.. Patients with cannabis use disorders presented significantly more severe negative symptoms in comparison with patients without cannabis use (15.18 ± 2.25 vs 13.75 ± 2.44; t100 = 3.25 p = 0.002).. A deeper knowledge of the "negative" psychopathological profile of MDD patients who use cannabis may lead to novel etiopathogenetic models of MDD and to more appropriate treatment approaches.

Topics: Adolescent; Adult; Cannabis; Depressive Disorder, Major; Female; Humans; Male; Marijuana Abuse; Middle Aged; Young Adult

Adult attention deficit hyperactivity disorder (ADHD) shows a robust association with alcohol and cannabis misuse, and these relationships are expressed differently in males and females. Manifestation of specific ADHD symptom profiles, even in the absence of the full disorder, may also be related to problems with alcohol and cannabis, although these relationships have not been investigated in epidemiological studies. To address this question, we studied the sex-specific associations of ADHD symptomatology with problematic alcohol and cannabis use in a representative sample of adults aged 18 years and older residing in Ontario, Canada.. Data were obtained from the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, between January 2011 and December 2013. Respondents (n =  5080) reported on current ADHD symptomatology, measured using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four additional items, and alcohol and cannabis use, which were measured using the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), respectively. Logistic regression analyses were conducted in men and women to test the association of each ADHD symptom cluster (hyperactivity, inattentiveness, impulsivity) with problematic alcohol and cannabis use.. After controlling for age, education, and comorbid internalizing and externalizing psychopathology, hyperactive symptoms were associated with problematic alcohol use in both men and women and with problematic cannabis use in men. Impulsive symptoms were independently associated with problematic cannabis use in men. By contrast, inattentive symptomatology predicted problems with alcohol and cannabis only in women. In all models, age was negatively associated with substance misuse and externalizing behavior was positively correlated and the strongest predictor of hazardous alcohol and cannabis use.. ADHD symptom expression in adulthood is related to concurrent hazardous use of alcohol and cannabis. Distinctive ADHD symptom profiles may confer increased risk for substance misuse in a sex-specific manner.

Topics: Adult; Alcohol Drinking; Attention Deficit Disorder with Hyperactivity; Cannabis; Comorbidity; Cross-Sectional Studies; Female; Humans; Male; Marijuana Abuse; Middle Aged; Ontario; Self Report; Sex Distribution; Substance-Related Disorders

In this position paper, the adverse health effects of cannabis are reviewed based on the existing scientific literature; in addition possible symptom-relieving effects on some diseases are depicted. In Germany, cannabis is the most widely used illicit drug. Approximately 600,000 adult persons show abusive or addictive cannabis consumption. In 12 to 17 year old adolescents, cannabis use increased from 2011 to 2014 from 2.8 to 6.4%, and the frequency of regular use from 0.2 to 1.5%. Currently, handling of cannabinoids is much debated in politics as well as in general public. Health aspects have to be incorporated into this debate. Besides analysing mental and neurological side effects, this position paper will mainly focus on the influences on the bronchopulmonary and cardiovascular system. There is strong evidence for the induction of chronic bronchitis. Allergic reactions including asthma are known, too. Associations with other diseases like pulmonary emphysema, lung cancer and pneumonia are not sufficiently proven, however cannot be excluded either. In connection with the use of cannabis cardiovascular events such as coronary syndromes, peripheral vascular diseases and cerebral complications have been noted. Often, the evidence is insufficient due to various reasons; most notably, the overlapping effects of tobacco and cannabis use can frequently not be separated adequately. Empirically, early beginning, high-dosed, long-lasting and regular cannabis consumption increase the risk of various psychological and physical impairments and negatively affect age-based development. Concerns therefore relate especially to children and adolescents. There is only little scientific evidence for medical benefits through cannabis as a remedy; systematic research of good quality, in particular prospective, randomised, placebo-controlled double-blinded studies are rare. The medical societies signing this position paper conclude that cannabis consumption is linked to adverse health effects which have to be taken into consideration in the debate about the social attitude towards cannabinoids. The societies agree that many aspects regarding health effects of cannabis are still uncertain and need clarification, preferably through research provided by controlled studies.

Topics: Cannabis; Evidence-Based Medicine; Germany; Lung Diseases; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Practice Guidelines as Topic; Pulmonary Medicine; Risk Assessment; Treatment Outcome

Topics: Cannabis; Humans; Marijuana Abuse; Psychotic Disorders; Substance-Related Disorders

Topics: Cannabinoids; Cannabis; Humans; Marijuana Abuse; Psychotic Disorders; Risk Factors

Topics: Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Public Policy

Topics: Cannabinoids; Cannabis; Humans; Marijuana Abuse

Quantifying an illegal phenomenon like a drug market is inherently complex due to its hidden nature and the limited availability of reliable information. This article presents findings from a recent estimate of the production, consumption and export of Dutch cannabis and discusses the opportunities provided by, and limitations of, mathematical models for estimating the illegal cannabis market.. The data collection consisted of a comprehensive literature study, secondary analyses on data from available registrations (2012-2014) and previous studies, and expert opinion. The cannabis market was quantified with several mathematical models. The data analysis included a Monte Carlo simulation to come to a 95% interval estimate (IE) and a sensitivity analysis to identify the most influential indicators.. The annual production of Dutch cannabis was estimated to be between 171 and 965tons (95% IE of 271-613tons). The consumption was estimated to be between 28 and 119tons, depending on the inclusion or exclusion of non-residents (95% IE of 51-78tons or 32-49tons respectively). The export was estimated to be between 53 and 937tons (95% IE of 206-549tons or 231-573tons, respectively).. Mathematical models are valuable tools for the systematic assessment of the size of illegal markets and determining the uncertainty inherent in the estimates. The estimates required the use of many assumptions and the availability of reliable indicators was limited. This uncertainty is reflected in the wide ranges of the estimates. The estimates are sensitive to 10 of the 45 indicators. These 10 account for 86-93% of the variation found. Further research should focus on improving the variables and the independence of the mathematical models.

Topics: Adolescent; Adult; Aged; Cannabis; Commerce; Drug Trafficking; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Models, Theoretical; Netherlands; Prevalence; Time Factors; Young Adult

Topics: Cannabinoids; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Psychoses, Substance-Induced; Psychotic Disorders; Risk Factors

Specific personality traits have been linked with substance use disorders (SUDs), genetic mechanisms, and brain systems. Thus, determining the specificity of personality traits to types of SUD can advance the field towards defining SUD endophenotypes as well as understanding the brain systems involved for the development of novel treatments. Disentangling these factors is particularly important in highly co morbid SUDs, such as marijuana and nicotine use, so treatment can occur effectively for both. This study evaluated personality traits that distinguish isolated and co-morbid use of marijuana and nicotine. To that end, we collected the NEO Five Factor Inventory in participants who used marijuana-only (n=59), nicotine-only (n=27), both marijuana and nicotine (n=28), and in non-using controls (n=28). We used factor analyses to identify personality profiles, which are linear combinations of the five NEO Factors. We then conducted Receiver Operating Characteristics (ROC) curve analysis to test accuracy of the personality factors in discriminating isolated and co-morbid marijuana and nicotine users from each other. ROC curve analysis distinguished the four groups based on their NEO personality patterns. Results showed that NEO Factor 2 (openness, extraversion, agreeableness) discriminated marijuana and marijuana+nicotine users from controls and nicotine-only users with high predictability. Additional ANOVA results showed that the openness dimension discriminated marijuana users from nicotine users. These findings suggest that personality dimensions distinguish marijuana users from nicotine users and should be considered in prevention strategies.

Topics: Adolescent; Adult; Cannabis; Comorbidity; Discrimination, Psychological; Factor Analysis, Statistical; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Mexico; Personality; Personality Disorders; Personality Inventory; Personality Tests; ROC Curve; Substance-Related Disorders; Tobacco Use Disorder; Young Adult

Adolescents who regularly use marijuana may be at heightened risk of developing subclinical and clinical psychotic symptoms. However, this association could be explained by reverse causation or other factors. To address these limitations, the current study examined whether adolescents who engage in regular marijuana use exhibit a systematic increase in subclinical psychotic symptoms that persists during periods of sustained abstinence.. The sample comprised 1,009 boys who were recruited in 1st and 7th grades. Self-reported frequency of marijuana use, subclinical psychotic symptoms, and several time-varying confounds (e.g., other substance use, internalizing/externalizing problems) were recorded annually from age 13 to 18. Fixed-effects (within-individual change) models examined whether adolescents exhibited an increase in their subclinical psychotic symptoms as a function of their recent and/or cumulative history of regular marijuana use and whether these effects were sustained following abstinence. Models controlled for all time-stable factors (default) and several time-varying covariates as potential confounds.. For each year adolescent boys engaged in regular marijuana use, their expected level of subsequent subclinical psychotic symptoms rose by 21% and their expected odds of experiencing subsequent subclinical paranoia or hallucinations rose by 133% and 92%, respectively. The effect of prior regular marijuana use on subsequent subclinical psychotic symptoms persisted even when adolescents stopped using marijuana for a year. These effects were after controlling for all time-stable and several time-varying confounds. No support was found for reverse causation.. These results suggest that regular marijuana use may significantly increase the risk that an adolescent will experience persistent subclinical psychotic symptoms.

Topics: Adolescent; Cannabis; Child; Cohort Studies; Comorbidity; Humans; Illicit Drugs; Internal-External Control; Longitudinal Studies; Male; Marijuana Abuse; Pennsylvania; Psychoses, Substance-Induced; Risk Factors; Substance Withdrawal Syndrome; Substance-Related Disorders

The study assesses the degree to which individuals in different trajectories of marijuana use are similar or different in terms of unconventional behavior, sensation seeking, emotional dysregulation, nicotine dependence, alcohol dependence/abuse, children living at home, and spouse/partner marijuana use at age 43.. This study used a longitudinal design. The sample participants (N = 548) were first studied at mean age 14 and last studied at mean age 43.. Six trajectories of marijuana use were identified: chronic/heavy users (3.6 %), increasing users (5.1 %), chronic/occasional users (20 %), decreasers (14.3 %), quitters (22.5 %), and nonusers/experimenters (34.5 %). With three exceptions, as compared with being a nonuser/experimenter, a higher probability of belonging to the chronic/heavy, the increasing, or the chronic/occasional user trajectory group was significantly associated with a greater likelihood of unconventional behavior, sensation seeking, emotional dysregulation, nicotine dependence, alcohol dependence/abuse, not having children who lived at home, and having a spouse/partner who used marijuana at early midlife. In addition, compared with being a quitter, a higher probability of belonging to the chronic/heavy user trajectory group was significantly associated with a higher likelihood of unconventional behavior, sensation seeking, emotional dysregulation, alcohol dependence/abuse, and spouse/partner marijuana use. Implications for intervention are presented.. Trajectories of marijuana use, especially chronic/heavy use, increasing use, and chronic/occasional use, are associated with unconventional behavior, sensation seeking, emotional dysregulation, nicotine dependence, alcohol dependence/abuse, having children who lived at home, and spouse/partner marijuana use at age 43. The importance of the findings for prevention and treatment programs are discussed.

Topics: Adolescent; Adult; Alcohol-Related Disorders; Cannabis; Female; Human Development; Humans; Longitudinal Studies; Male; Marijuana Abuse; Marijuana Smoking; New York; Tobacco Use Disorder; Young Adult

Although there is emergent evidence illustrating neural sensitivity to cannabis cues in cannabis users, the specificity of this effect to cannabis cues as opposed to a generalized hyper-sensitivity to hedonic stimuli has not yet been directly tested. Using fMRI, we presented 53 daily, long-term cannabis users and 68 non-using controls visual and tactile cues for cannabis, a natural reward, and, a sensory-perceptual control object to evaluate brain response to hedonic stimuli in cannabis users. The results showed an interaction between group and reward type such that the users had greater response during cannabis cues relative to natural reward cues (i.e., fruit) in the orbitofrontal cortex, striatum, anterior cingulate gyrus, and ventral tegmental area compared to non-users (cluster-threshold z = 2.3, P < 0.05). In the users, there were positive brain-behavior correlations between neural response to cannabis cues in fronto-striatal-temporal regions and subjective craving, marijuana-related problems, withdrawal symptoms, and levels of THC metabolites (cluster-threshold z = 2.3, P < 0.05). These findings demonstrate hyper-responsivity, and, specificity of brain response to cannabis cues in long-term cannabis users that are above that of response to natural reward cues. These observations are concordant with incentive sensitization models suggesting sensitization of mesocorticolimbic regions and disruption of natural reward processes following drug use. Although the cross-sectional nature of this study does not provide information on causality, the positive correlations between neural response and indicators of cannabis use (i.e., THC levels) suggest that alterations in the reward system are, in part, related to cannabis use. Hum Brain Mapp 37:3431-3443, 2016. © 2016 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.

Topics: Adult; Brain; Brain Mapping; Cannabis; Craving; Cross-Sectional Studies; Cues; Female; Food Preferences; Humans; Magnetic Resonance Imaging; Male; Marijuana Abuse; Motivation; Neuropsychological Tests; Reward; Substance Withdrawal Syndrome; Visual Perception

The purpose of this study was to examine whether individuals who used medical cannabis for chronic pain were at increased risk for cannabis use problems compared with individuals who used medical cannabis for other reasons (e.g., anxiety, insomnia, and muscle spasms). An additional aim was to determine whether individuals who used cannabis for chronic pain, as well as those who reported greater within-group pain levels, demonstrated a species preference (i.e., sativa, indica, hybrids) and the extent to which species preference was associated with cannabis use problems.. Participants were 163 medical cannabis users (77% male), recruited from a medical marijuana dispensary in California, who completed assessments of medical cannabis use motives, history, preferences (species type), and problems, as well as current pain level.. Individuals who used cannabis to manage chronic pain experienced fewer cannabis use problems than those who did not use it for pain; among those who used it for pain, the average pain level in the past week was not associated with cannabis use problems. Furthermore, individuals who used cannabis for chronic pain were more likely to use indica over sativa. Preference for indica was associated with fewer cannabis use problems than preference for hybrid species.. Individuals who use cannabis to manage chronic pain may be at a lower risk for cannabis use problems, relative to individuals who use it for other indications, potentially as a function of their species preference.

Topics: Adult; Cannabis; Chronic Pain; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Middle Aged

In the 1960s and the 1970s, Morocco and Lebanon became major producers of hashish for export to markets in West and Central Europe, Africa and the Middle East. By using a comparative approach, this paper aims to evaluate changes in production in the traditional areas of cannabis cultivation in the Rif (Morocco) and the Beqaa (Lebanon) and to better understand the role that these countries play in current trends in the global cultivation and consumption of cannabis.. The comparative approach takes in account the historical and institutionnal context, and the perception of cannabis in those two country. We rely on primary field research done in the Rif (from 2002) and in the Beqaa (from 1995) in the form of interviews and observations with farmers and intermediaries. Acreage and production estimates of hashish for both countries have been triangulated from different sources.. Maghreb and Middle East have a long history of consumption, production and marketing of cannabis. Over the past 12 centuries, migration, trade and different spiritual practices and trends have led to the expansion of cannabis markets. This long period is marked by stages and rifts caused by foreign interference, a worldwide prohibition of cannabis at the beginning of the 20th century and increased global demand in the 1960s and the 1970s. Morocco and Lebanon are among the most important producers of hashish to be exported for trade for the last fifty years. The global prohibition of cannabis and the global sustained demand have created opportunities for poor farmers in the Rif and the Beqaa regions to survive and get wealthy. It is difficult to understand the reasons why areas producing cannabis are steadily increasing. If the Rif and the Beqaa share some features (such are marginalized areas of production, repressive legislation, huge international demand, range of comparable tasks and Mediterranean climate suitable for growing cannabis, etc.) then a comparison between the two countries makes it more easy to notice differences in contexts, in local and international markets (Stability in Morocco, instability in Lebanon; traditional market in Morocco, absence of local market in Lebanon, etc.) In Morocco, the stability and specialized skills among Moroccan growers of hashish have enhanced a competitive economy with various production areas, products and qualities, but also prices and strategies due to competition between Moroccan and European producers. Moreover, Morocco produces cannabis for its significant local market.. As shown by comparing Morocco and Lebanon, allows us to examine their perverse effects caused by a global prohibition. The criminalization of growers has only increased their marginalized situation. The enforced eradication of cannabis has limited the cultivation for a short time but not in any sustainable way (resumption of cannabis cultivation in a time of conflict in Lebanon; replacement of local variety by hybrids in Morocco). The cultural heritage of cannabis and its social functions should not be ignored. In the light of the new global changes in the cannabis cultivation (Import substitution, technical progress in developed countries, etc.), hashish producers in the south countries are likely to face uncertain future.

Topics: Cannabis; Commerce; Crops, Agricultural; Cultural Characteristics; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; History, Medieval; Humans; Lebanon; Marijuana Abuse; Marijuana Smoking; Morocco; Time Factors

Cannabis is the most frequently used illicit drug worldwide. Cross-sectional neuroimaging studies suggest that chronic cannabis exposure and the development of cannabis use disorders may affect brain morphology. However, cross-sectional studies cannot make a conclusive distinction between cause and consequence and longitudinal neuroimaging studies are lacking. In this prospective study we investigate whether continued cannabis use and higher levels of cannabis exposure in young adults are associated with grey matter reductions. Heavy cannabis users (N = 20, age baseline M = 20.5, SD = 2.1) and non-cannabis using healthy controls (N = 22, age baseline M = 21.6, SD = 2.45) underwent a comprehensive psychological assessment and a T1- structural MRI scan at baseline and 3 years follow-up. Grey matter volumes (orbitofrontal cortex, anterior cingulate cortex, insula, striatum, thalamus, amygdala, hippocampus and cerebellum) were estimated using the software package SPM (VBM-8 module). Continued cannabis use did not have an effect on GM volume change at follow-up. Cross-sectional analyses at baseline and follow-up revealed consistent negative correlations between cannabis related problems and cannabis use (in grams) and regional GM volume of the left hippocampus, amygdala and superior temporal gyrus. These results suggests that small GM volumes in the medial temporal lobe are a risk factor for heavy cannabis use or that the effect of cannabis on GM reductions is limited to adolescence with no further damage of continued use after early adulthood. Long-term prospective studies starting in early adolescence are needed to reach final conclusions.

Topics: Adult; Cannabis; Female; Gray Matter; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Male; Marijuana Abuse; Young Adult

Topics: Cannabis; Health Policy; Marijuana Abuse; Marijuana Smoking

Topics: Adult; Cannabis; Diagnostic and Statistical Manual of Mental Disorders; Humans; Marijuana Abuse

Synthetic cannabinoid receptor agonists (SCRAs) are heterogeneous compounds originally intended as probes of the endogenous cannabinoid system or as potential therapeutic agents. We assessed the clinical toxicity associated with recent SCRA use in a large cohort of drug overdose patients.. This subgroup analysis of a large (n = 3739) drug overdose cohort study involved consecutive ED patients at two urban teaching hospitals collected between 2009 and 2013. Clinical characteristics of patients with the exposure to SCRAs (SRCA subgroup) were compared with those from patients who smoked traditional cannabinoids (marijuana subgroup). Data included demographics, exposure details, vital signs, mental status, and basic chemistries gathered as part of routine clinical care. Study outcomes included altered mental status and cardiotoxicity.. Eighty-seven patients reported exposure to any cannabinoid, of whom 17 reported SCRAs (17 cases, 70 controls, mean age 38.9 years, 77 % males, 31 % Hispanic). There were no significant differences between SRCA and marijuana with respect to demographics (age, gender, and race/ethnicity), exposure history (suicidality, misuse, and intent), vital signs, or serum chemistries. Mental status varied between SRCA and marijuana, with agitation significantly more likely in SCRA subgroup (OR = 3.8, CI = 1.2-11.9). Cardiotoxicity was more pronounced in the SCRA subgroup with dysrhythmia significantly more likely (OR = 9.2, CI = 1.0-108).. In the first clinical study comparing the adverse effects of SCRA overdose vs. marijuana controls in an ED population, we found that SCRA overdoses had significantly pronounced neurotoxicity and cardiotoxicity compared with marijuana.

Topics: Adult; Arrhythmias, Cardiac; Biomarkers; Cannabinoid Receptor Agonists; Cannabinoids; Cannabis; Cardiotoxicity; Cohort Studies; Demography; Drug Overdose; Female; Hospitals, Urban; Humans; Intelligence Tests; Male; Marijuana Abuse; Neurologic Examination

Women represent 15% of the people living with HIV in Chile. Risk behaviors for HIV are: multiple partners, unsafe sex, and exchange of sex for drugs/money.. A correlational design was used. A sample of 203 women who were sexually active and consumed substances within the last 3-months were selected for this study.. The average age of the participants was 32.4 years (SD = 9.2) and 68.1% were housewives. The substance most commonly used was alcohol (95.1%) and marijuana (49.8%); 23.7% of the women were drunk or drugged before having sex; 74.4% had multiple sexual partners and 95.6% had unprotected sex. There is a significant correlation (p < 0.05) between substance abuse and HIV risk behaviors.. It is necessary to develop more research to understand in depth the relationship between substance use and HIV risk among Chilean women. It is important to consider the use of substances to develop and implement HIV prevention programs in the Chilean community.

Topics: Adult; Binge Drinking; Cannabis; Chile; Ethanol; Female; HIV Infections; Humans; Marijuana Abuse; Risk Factors; Risk-Taking; Sex Work; Sexual Partners; Substance-Related Disorders; Unsafe Sex; Women's Health; Young Adult

Topics: Cannabis; Conflict of Interest; Decision Making; Documentation; Drug Prescriptions; Federal Government; Governing Board; Humans; Legislation, Drug; Marijuana Abuse; Medical History Taking; Medical Marijuana; Physician-Patient Relations; Practice Guidelines as Topic; Practice Patterns, Physicians'; Professional Misconduct; Referral and Consultation; State Government; United States

This study examined the relationship between cannabis use, sex, and attentional inhibition in a sample of 325 young Australians (194 women and 131 men) aged 14 to 24 years. Participants completed an online assessment, which included self-report measures of alcohol and other drug use, psychological distress, schizotypy, and location-based negative priming. Participants who had never used cannabis (n = 163) were compared with occasional (n = 118) and frequent (n = 44) cannabis users, with frequent use being defined as having used cannabis at least weekly in the past 6 months. There was a significant interaction between sex and cannabis use, with follow-up analyses indicating that frequent cannabis use was associated with reduced negative priming among females only. This study highlights the role of sex in influencing how cannabis use interacts with cognition and suggests that females who use cannabis frequently may be more likely than males to exhibit deficits in attentional inhibition. (PsycINFO Database Record

Topics: Adult; Attention; Cannabis; Cognition; Female; Humans; Internet; Male; Marijuana Abuse; Marijuana Smoking; Repetition Priming; Self Report; Sex Factors; Surveys and Questionnaires; Young Adult

One of the major mechanisms for terminating the actions of the endocannabinoid anandamide is hydrolysis by fatty acid amide hydrolase (FAAH), and inhibitors of the enzyme were suggested as potential treatment for human cannabis dependence. However, the status of brain FAAH in cannabis use disorder is unknown.. Brain FAAH binding was measured with positron emission tomography and [. In cannabis users, FAAH binding was significantly lower by 14%-20% across the brain regions examined than in matched control subjects (overall Cohen's d = 0.96). Lower binding was negatively correlated with cannabinoid concentrations in blood and urine and was associated with higher trait impulsiveness.. Lower FAAH binding levels in the brain may be a consequence of chronic and recent cannabis exposure and could contribute to cannabis withdrawal. This effect should be considered in the development of novel treatment strategies for cannabis use disorder that target FAAH and endocannabinoids. Further studies are needed to examine possible changes in FAAH binding during prolonged cannabis abstinence and whether lower FAAH binding predates drug use.

Topics: Adult; Amidohydrolases; Amygdala; Brain; Cannabinoids; Cannabis; Carbon Radioisotopes; Dronabinol; Female; Humans; Impulsive Behavior; Male; Marijuana Abuse; Positron-Emission Tomography

The average amount of marijuana in a joint is unknown, yet this figure is a critical quantity for creating credible measures of marijuana consumption. It is essential for projecting tax revenues post-legalization, estimating the size of illicit marijuana markets, and learning about how much marijuana users are consuming in order to understand health and behavioral consequences.. Arrestee Drug Abuse Monitoring data collected between 2000 and 2010 contain relevant information on 10,628 marijuana transactions, joints and loose marijuana purchases, including the city in which the purchase occurred and the price paid for the marijuana. Using the Brown-Silverman drug pricing model to link marijuana price and weight, we are able to infer the distribution of grams of marijuana in a joint and provide a Bayesian posterior distribution for the mean weight of marijuana in a joint.. We estimate that the mean weight of marijuana in a joint is 0.32g (95% Bayesian posterior interval: 0.30-0.35).. Our estimate of the mean weight of marijuana in a joint is lower than figures commonly used to make estimates of marijuana consumption. These estimates can be incorporated into drug policy discussions to produce better understanding about illicit marijuana markets, the size of potential legalized marijuana markets, and health and behavior outcomes.

Topics: Bayes Theorem; Cannabis; Commerce; Criminals; Databases, Factual; Humans; Illicit Drugs; Marijuana Abuse; Marijuana Smoking

Psychotic and affective exacerbations associated with synthetic cannabinoid (SC) use are becoming an emerging concern in psychiatric hospitals. However, data are lacking regarding whether clinical manifestations of SC use differ from those associated with cannabis use.. Our aim was to explore the unique profile of SC users admitted to a mental health center in terms of demographic, clinical, and physiologic variables in comparison to cannabis users.. We retrieved retrospective data of patients admitted to a mental health center between October 2007 and May 2014 who self-reported recent use of SC (n = 60) and patients who were cannabis users (positive carboxy-tetrahydrocannabinol urine test at admission) without a history of SC use (n = 163). Clinical measures included hospitalization length, number of previous hospitalizations, Positive and Negative Syndrome Scale (PANSS) scores, psychiatric status at admission, and relevant physiologic and laboratory parameters.. Hospitalized SC users were younger than hospitalized cannabis users (n = 163) (30.46 ± 7.83 years versus 34.67 ± 10.07 years, U₂₂₃ = 3,781.5, P = .009, respectively). SC patients had longer hospitalizations compared to cannabis users (43.45 ± 54.02 days versus 22.91 ± 31.36 days, U₂₁₉ = 5,701.5, P = .005, respectively), had more previous hospitalizations (3.73 ± 5.05 versus 1.98 ± 5.12, U₂₂₃ = 6,284, P < .001, respectively), and were more likely to be hospitalized by criminal court order (36.7% [n = 22] versus 19.9% [n = 32], χ²₂ = 7.136, P = .028, respectively). SC patients presented with a more severe clinical picture manifested by higher total PANSS scores (82.53 ± 23.05 versus 69.98 ± 19.94, t₉₁ = -2.696, P = .008) in a subset of patients with PANSS scores assessed within a week from admission (n = 30 in the SC group and n = 63 in the cannabis group). No differences were found in physiologic or laboratory measures on admission between the SC and cannabis groups.. Patients admitted following use of SC are generally younger males who have higher severity of psychotic symptoms at admission, are more likely to be admitted by criminal court order, and require longer hospitalization periods in comparison to cannabis users.

Topics: Adult; Cannabinoids; Cannabis; Female; Hospitalization; Hospitals, Psychiatric; Humans; Male; Marijuana Abuse; Mental Disorders; Middle Aged; Psychotic Disorders; Retrospective Studies; Sex Factors; Young Adult

Topics: Brain; Cannabis; Dronabinol; Humans; Marijuana Abuse

"Dabbing" involves heating extremely concentrated forms of marijuana to high temperatures and inhaling the resulting vapor. We studied themes describing the consequences of using highly concentrated marijuana by examining the dabbing-related content on Twitter.. Tweets containing dabbing-related keywords were collected from 1/1-1/31/2015 (n=206,854). A random sample of 5000 tweets was coded for content according to pre-determined categories about dabbing-related behaviors and effects experienced using a crowdsourcing service. An examination of tweets from the full sample about respiratory effects and passing out was then conducted by selecting tweets with relevant keywords.. Among the 5000 randomly sampled tweets, 3540 (71%) were related to dabbing marijuana concentrates. The most common themes included mentioning current use of concentrates (n=849; 24%), the intense high and/or extreme effects from dabbing (n=763; 22%) and excessive/heavy dabbing (n=517; 15%). Extreme effects included both physiological (n=124/333; 37%) and psychological effects (n=55/333; 17%). The most common physiologic effects, passing out (n=46/333; 14%) and respiratory effects (n=30/333; 9%), were then further studied in the full sample of tweets. Coughing was the most common respiratory effect mentioned (n=807/1179; 68%), and tweeters commonly expressed dabbing with intentions to pass out (416/915; 45%).. This study adds to the limited understanding of marijuana concentrates and highlights self-reported physical and psychological effects from this type of marijuana use. Future research should further examine these effects and the potential severity of health consequences associated with concentrates.

Topics: Adolescent; Cannabis; Female; Humans; Intention; Marijuana Abuse; Marijuana Smoking; Random Allocation; Social Media; Young Adult

Topics: Cannabis; Eligibility Determination; Heart Transplantation; Humans; Marijuana Abuse; Marijuana Smoking

Substance use in psychosis is an important field of study given that it can be a risk factor for the development of psychosis and can give rise to psychotic symptoms. Studies of substance use in first episode psychosis patients do not frequently assess non-pathological substance consumption among patients, but rather the prevalence of substance abuse or dependence disorders. Moreover, most of these studies do not address the effects of sex in sufficient depth, and the consumption of caffeine or tobacco, which are two of the most frequently used substances, is often not assessed.. The aim of this study was to compare patterns and quantities of substance use between first episode psychosis patients and healthy controls and between men and women, and explore the potential interactive effects between group (patients or controls) and sex.. A total of 158 participants (82 first episode psychosis patients and 76 healthy controls) were included in the study. Both adults and adolescents were included in the study. Frequency and amount of use of caffeine, tobacco, alcohol, cannabis, cocaine, hallucinogens, stimulants, and opiates were gathered.. A significant main effect of sex was found for the frequency of use of tobacco (p=.050). Main effects of group were found for the quantity of tobacco (p<.001) and cannabis (p<.001) consumed, as well as main effects of sex for the quantity of alcohol (p=.003) and cannabis (p=.017) consumed. There were also interaction effects between group and sex for the frequency of use of tobacco (p=.005) and cannabis (p=.009), and for the amount of cannabis consumed (p=.049). Qualitative differences between males and females regarding combined substance use are also reported.. Among patients, men used tobacco more frequently than women, but this sex difference was not the same for the control group, in which women smoked more often than men. Regarding cannabis, men smoked cannabis more frequently and in larger amounts than women, but only in the patients group, whereas no sex differences for cannabis were found for the controls. Main effects of group and sex for tobacco and alcohol, as well as the lack of differences for the frequency and amount of use of caffeine, are also commented. This is the first study to assess the different effects of sex on substance use in first episode psychosis patients and healthy controls.

Topics: Adolescent; Adult; Alcohol Drinking; Caffeine; Cannabis; Comorbidity; Female; Humans; Illicit Drugs; Male; Marijuana Abuse; Prevalence; Psychoses, Substance-Induced; Psychotic Disorders; Recurrence; Reference Values; Risk Factors; Sex Factors; Smoking; Spain; Substance-Related Disorders; Young Adult

Evaluate magnitude and duration of subjective and physiologic responses to neutral and marijuana (MJ)-related cues in cannabis dependent volunteers.. 33 volunteers (17 male) who met DSM-IV criteria for Cannabis Abuse or Dependence were exposed to neutral (first) then MJ-related visual, auditory, olfactory and tactile cues. Mood, drug craving and physiology were assessed at baseline, post-neutral, post-MJ and 15-min post MJ cue exposure to determine magnitude of cue- responses. For a subset of participants (n=15; 9 male), measures of craving and physiology were collected also at 30-, 90-, and 150-min post-MJ cue to examine duration of cue-effects.. In cue-response magnitude analyses, visual analog scale (VAS) items craving for, urge to use, and desire to smoke MJ, Total and Compulsivity subscale scores of the Marijuana Craving Questionnaire, anxiety ratings, and diastolic blood pressure (BP) were significantly elevated following MJ vs. neutral cue exposure. In cue-response duration analyses, desire and urge to use MJ remained significantly elevated at 30-, 90- and 150-min post MJ-cue exposure, relative to baseline and neutral cues.. Presentation of polysensory MJ cues increased MJ craving, anxiety and diastolic BP relative to baseline and neutral cues. MJ craving remained elevated up to 150-min after MJ cue presentation. This finding confirms that carry-over effects from drug cue presentation must be considered in cue reactivity studies.

Topics: Adult; Affect; Anxiety; Cannabis; Craving; Cues; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Photic Stimulation; Surveys and Questionnaires; Time Factors; Volunteers; Young Adult

Head and neck cancer among marijuana users: a meta-analysis of matched case-control studies. de Carvalho MFF, Dourado MR, Fernandes IB, Araújo CTP, Mesquita AT, Ramos-Jorge ML. Arch Oral Biol 2015;60(12):1750-5.. Information not available. Systematic review with meta-analysis of data.

Topics: Cannabis; Case-Control Studies; Head and Neck Neoplasms; Humans; Marijuana Abuse; Marijuana Smoking

Topics: Cannabis; Humans; Marijuana Abuse; Psychoses, Substance-Induced; Psychotic Disorders

Synthetic cannabinoids (SC) use has had a dramatic increase in recent years, but data regarding their adverse effects on mental health is limited. In this study, we compared clinical presentations of SC users with cannabis users in a psychiatric inpatient setting.. Digital charts of all patients who were admitted to a dual diagnosis psychiatric unit in one year were reviewed. Patients who had any current substance use disorder were categorized in four groups: (1) SC use and cannabis use (SC+MJ+), (2) SC use without cannabis use (SC+MJ-), (3) cannabis use without SC use (SC-MJ+), and (4) No SC or cannabis use (SC-MJ-).. A total of 594 charts were included. SC+MJ- patients had significantly more psychotic symptoms (OR: 4.44, 95% CI: 1.98-9.94), followed by SC+MJ+ (OR: 3.61, 95% CI: 1.87-6.97) and SC-MJ+ (OR: 1.87, 95%CI: 1.33-2.64) patients. The SC+MJ- group also had more agitation and aggression was most prominent in SC+MJ+ subjects. Multivariate analyses showed that the psychiatric associations of SC and cannabis use remained significant even after controlling for potential confounds such as other substance use.. The prominent psychiatric features of SC users as compared to cannabis users in an inpatient setting are psychotic presentations and agitation, which have important treatment implications.

Topics: Adult; Cannabinoids; Cannabis; Comorbidity; Female; Humans; Male; Marijuana Abuse; Psychoses, Substance-Induced; Psychotic Disorders; Retrospective Studies; Substance-Related Disorders

Chronic cannabis users may experience cyclical episodes of nausea and vomiting and learned behavior of hot bathing. This clinical condition, known as cannabis hyperemesis syndrome, was first reported in 2004.. Our aim was to promote early recognition of this syndrome in emergency departments (EDs) and to increase referral to addiction specialists.. Cannabis abusers were admitted to the ED for vomiting or abdominal pain from June 1, 2014 to January 1, 2015 and diagnosed with cannabis hyperemesis syndrome by a specialized addiction team. Then, medical records were examined retrospectively.. Seven young adults were included. Their mean age was 24.7 years (range 17-39 years) and the majority were men (male-to-female ratio 1.2). Biological and toxicological blood samples were taken in all patients. Tetrahydrocannabinol blood level was measured in 4 patients, with a mean blood concentration of 11.6 ng/mL. Radiographic examination including abdominal computed tomography and brain imaging were negative, as was upper endoscopy. Five patients compulsively took hot baths in an attempt to decrease the symptoms. Treatment was symptomatic. Five patients have started follow-up with the specialized addiction team.. Cannabis hyperemesis syndrome is still under-diagnosed 10 years after it was first described. Physicians should be aware of this syndrome to avoid repeated hospitalizations or esophageal complications. Greater awareness should lead to prompt treatment and prevention of future recurrence through cannabis cessation. Addiction specialists, as well as medical toxicologists, are experts in the management of cannabis abusers and can help re-establish the role of medical care in this population in collaboration with emergency physicians.

Topics: Abdominal Pain; Adolescent; Adult; Cannabis; Diagnosis, Differential; Emergency Service, Hospital; Female; Humans; Male; Marijuana Abuse; Patient Care Team; Pilot Projects; Referral and Consultation; Substance-Related Disorders; Vomiting

Incentive salience is a multidimensional construct that includes craving, drug value relative to other reinforcers, and implicit motivation such as attentional bias to drug cues. Laboratory cue reactivity (CR) paradigms have been used to evaluate marijuana incentive salience with measures of craving, but not with behavioral economic measures of marijuana demand or implicit attentional processing tasks.. This within-subjects study used a new CR paradigm to examine multiple dimensions of marijuana's incentive salience and to compare CR-induced increases in craving and demand. Frequent marijuana users (N=93, 34% female) underwent exposure to neutral cues then to lit marijuana cigarettes. Craving, marijuana demand via a marijuana purchase task, and heart rate were assessed after each cue set. A modified Stroop task with cannabis and control words was completed after the marijuana cues as a measure of attentional bias.. Relative to neutral cues, marijuana cues significantly increased subjective craving and demand indices of intensity (i.e., drug consumed at $0) and Omax (i.e., peak drug expenditure). Elasticity significantly decreased following marijuana cues, reflecting sustained purchase despite price increases. Craving was correlated with demand indices (r's: 0.23-0.30). Marijuana users displayed significant attentional bias for cannabis-related words after marijuana cues. Cue-elicited increases in intensity were associated with greater attentional bias for marijuana words.. Greater incentive salience indexed by subjective, behavioral economic, and implicit measures was observed after marijuana versus neutral cues, supporting multidimensional assessment. The study highlights the utility of a behavioral economic approach in detecting cue-elicited changes in marijuana incentive salience.

Topics: Adolescent; Adult; Attentional Bias; Cannabis; Commerce; Craving; Cues; Economics, Behavioral; Female; Heart Rate; Humans; Male; Marijuana Abuse; Marijuana Smoking; Motivation; Young Adult

With the non-medical use of prescription opioids increasingly becoming a method of abuse in Canada, the number of patients requiring methadone maintenance treatment (MMT) for opioid use disorder has increased dramatically. The rate of cannabis use in this population is disproportionately high (~50 %). Because its use is generally perceived as harmless, cannabis use is often not monitored during MMT. Current literature regarding the effects of cannabis use on MMT is conflicting, and the presence and nature of an association has not been clearly established. The primary objective of this review will be to conduct a systematic review of the literature and, if appropriate, a meta-analysis to determine whether there is an association between cannabis use and MMT outcomes. A secondary objective will be to perform subgroup analyses (by age, sex, method of cannabis measurement, and country) to determine whether cannabis use differentially influences MMT outcomes within these subgroups.. The search will be conducted on the following electronic databases using a predefined search strategy: MEDLINE, EMBASE, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Two authors (LZ and MB) will independently screen articles using predetermined inclusion/exclusion criteria and will extract data from included articles using a pilot-tested data extraction form. Disagreements at all stages of the screening process will be settled through discussion, and when consensus cannot be reached, a third author (ZS) will be consulted. An assessment of quality and risk of bias will be conducted on all included articles, and a sensitivity analysis will be used to compare results of studies with high and low risk of bias. We will perform random- and fixed-effects meta-analyses, if appropriate, with heterogeneity calculated using the I (2) statistic and formal evaluation of publication bias.. Results of this systematic review will elucidate the association between cannabis use and methadone maintenance treatment outcomes. We will provide evidence that will be useful to clinicians regarding whether monitoring cannabis use during MMT is advantageous for optimizing MMT outcomes.. PROSPERO CRD42015029372.

Topics: Analgesics, Opioid; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders; Research Design; Systematic Reviews as Topic; Treatment Outcome

The aim of this study was to investigate the relationship between psychotic-like experiences (PLEs) assessed using the Community Assessment of Psychic Experience (CAPE) questionnaire and the pattern of cannabis use in a non-clinical sample collected by snowball sampling.. Our sample was composed of 204 subjects, distributed into three groups by their cannabis use pattern: 68 were non-cannabis users, 40 were moderate cannabis users and 96 were daily cannabis users. We assessed the psychotic experiences in each group with the CAPE questionnaire; and then controlled for the effect of possible confounding factors like sex, age, social exclusion, age of onset of cannabis use, alcohol use and other drug use.. We found a significant quadratic association between the frequency of cannabis use and positive (β = -1.8; p = 0.004) and negative dimension scores (β = -1.2; p = 0.04). The first-rank and mania factors showed a significant quadratic association (p < 0.05), while the voices factor showed a trend (p = 0.07). Scores for the different groups tended to maintain a U-shape in their values for the different factors. When we adjusted for gender, age, social exclusion, age of onset of cannabis use, and use of alcohol and other drugs, only the first-rank experiences remained significant.. We found there was a U-shaped curve in the association between cannabis use and the positive and negative dimensions of the CAPE score. We also found this association in mania and first-rank experiences.

Topics: Adult; Alcohol Drinking; Bipolar Disorder; Cannabis; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Psychoses, Substance-Induced; Risk Factors; Substance-Related Disorders; Surveys and Questionnaires

Topics: Cannabis; Humans; Marijuana Abuse; Psychotic Disorders; Recurrence; Smoke

Topics: Adult; Cannabis; Cross-Sectional Studies; Humans; Marijuana Abuse; Marijuana Smoking; Marijuana Use; Surveys and Questionnaires

After decades of internal discussion, the Government of Jamaica recently amended its laws to create a regulated and licensed cannabis industry for medical and scientific purposes. The new law also decriminalizes personal possession and use of cannabis; allows cannabis to be used by individuals for religious, medical, scientific and therapeutic purposes; and permits home cultivation of up to five plants.. We first describe the statutory changes under the Dangerous Drugs (Amendment) Act of 2015 and compare it with other jurisdictions. We provide an analytical framework for understanding how the DDA Amendment affects key populations and achieves its stated goals, drawing on publicly available information and unstructured interviews with non-governmental stakeholders in Jamaica.. The Amendment's primary goals are to deliver economic impact and reduce criminal justice costs. A relaxed policy of enforcement toward possession and use seems to have occurred even before the law's passage; after the law's passage, enforcement remains limited. To access medical cannabis under the DDA residents must receive authorization from a certified health professional in Jamaica; tourists may self-declare their medical need; and Rastafarians may grow and exchange non-commercially for religious purposes.. Internally, many see "ganja" as an industry sorely needed to drive economic growth in Jamaica. Indeed, the potential impacts could be large, especially if Jamaica draws additional tourism or creates a viable export industry. A growing cannabis-related tourism industry seems more realistic. We maintain that policymakers and observers should proceed in an orderly fashion, continuing to identify and resolve remaining uncertainties, initiate new types of data collection, and make decisions based on realistic assessments of potentials for economic impact.

Topics: Cannabis; Commerce; Drug and Narcotic Control; Drug Trafficking; Goals; Government Regulation; Humans; Jamaica; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Policy Making; Program Evaluation; Religion; Travel

Currently, only four states have legalized recreational marijuana use for adults over 21 years of age. Therefore, little is known about the influence that legalization will have on adolescent marijuana use.. This study examines how marijuana legalization has impacted the frequency and consequences of adolescent use in a sample of participants in a school-based, substance use intervention. We hypothesized that adolescents enrolled in the intervention in years after marijuana legalization would present with more problematic use compared to those enrolled prior, and that changes in the perceived risk of marijuana would be a mechanism of problematic use.. Participants were 262 students enrolled in a school-based substance use intervention in 2010 to 2015. The Customary Drinking and Drug Use Record, Alcohol and Drug Use Consequences Questionnaire, and a decisional balance matrix were used to assess marijuana frequency, negative consequences, and perceived risk of use. A mediation model was used to test the degree to which marijuana legalization may lead to increased frequency and consequences of use through perceived risk.. Findings indicated a significantly positive correlation between marijuana-related consequences and perceived risk post legalization. Despite relatively equal use between both groups, adolescents in the legalization group experienced higher levels of perceived risk and increased negative consequences.. Due to the rising legalization status of marijuana in the United States, it is imperative that psychoeducation is provided to adults and adolescents about the consequences of underage marijuana use.

Topics: Adolescent; Cannabis; Humans; Legislation, Drug; Marijuana Abuse; Marijuana Smoking; Students

The European market for cannabis derivatives is being transformed. The cultivation of cannabis within the EU and the shift of demand from hashish to domestic marihuana are key aspects of this transformation. Spain, formerly central to the trade of Moroccan hashish, is becoming a marihuana-producing country. The emergence of "import-substitution" has been researched in other EU countries, but thus far the Spanish case remains undocumented.. This paper is based on analysis of data of 748 cannabis plantations seized by Spanish police in 2013. The sample comprises reports of seizures identified through a survey of online news and police reports. "Event-analysis" methods were applied to these sources.. The analysis offers a typology of plantations, a profile of participants and the different production systems, and a model of regional distribution. Half of the plantations were small (less than 42 plants) and half contained between 100 and 1000 plants, with an average size of 261 plants. About three-quarters of plants were cultivated indoors using stolen electricity. 86% of all plants seized were from large-scale plantations (more than 220 plants). Most plantations were located along the Mediterranean coast, where population and tourism are concentrated. Over three-quarters of those indicted by police were Spanish (85%). Among the foreign owners of big plantations, Dutch nationals predominated. The number of seized plants by province was directly associated with the number of grow shops (β=0.962, p<0.001).. The rise of large-scale cannabis plantations in the Spanish Mediterranean coast is increasingly replacing import of Moroccan hashish. Indoor cultivation supported by grow shops, that provide the technology and know-how, seem to be the dominant form of organization in this emerging industry. Large-scale plantations may have met most of the demand for marihuana in 2013.

Topics: Cannabis; Commerce; Crops, Agricultural; Drug Trafficking; Farmers; Humans; Law Enforcement; Marijuana Abuse; Marijuana Smoking; Models, Organizational; Spain

Cannabis is a widely used drug associated with increased risk for psychosis. The dopamine hypothesis of psychosis postulates that altered salience processing leads to psychosis. We therefore tested the hypothesis that cannabis users exhibit aberrant salience and explored the relationship between aberrant salience and dopamine synthesis capacity.. We tested 17 cannabis users and 17 age- and sex-matched non-user controls using the Salience Attribution Test, a probabilistic reward-learning task. Within users, cannabis-induced psychotic symptoms were measured with the Psychotomimetic States Inventory. Dopamine synthesis capacity, indexed as the influx rate constant K i cer , was measured in 10 users and six controls with 3,4-dihydroxy-6-[18F]fluoro-l-phenylalanine positron emission tomography.. There was no significant difference in aberrant salience between the groups [F 1,32 = 1.12, p = 0.30 (implicit); F 1,32 = 1.09, p = 0.30 (explicit)]. Within users there was a significant positive relationship between cannabis-induced psychotic symptom severity and explicit aberrant salience scores (r = 0.61, p = 0.04) and there was a significant association between cannabis dependency/abuse status and high implicit aberrant salience scores (F 1,15 = 5.8, p = 0.03). Within controls, implicit aberrant salience was inversely correlated with whole striatal dopamine synthesis capacity (r = -0.91, p = 0.01), whereas this relationship was non-significant within users (difference between correlations: Z = -2.05, p = 0.04).. Aberrant salience is positively associated with cannabis-induced psychotic symptom severity, but is not seen in cannabis users overall. This is consistent with the hypothesis that the link between cannabis use and psychosis involves alterations in salience processing. Longitudinal studies are needed to determine whether these cognitive abnormalities are pre-existing or caused by long-term cannabis use.

Topics: Adult; Brain; Cannabis; Case-Control Studies; Dihydroxyphenylalanine; Dopamine; Female; Humans; Male; Marijuana Abuse; Neostriatum; Positron-Emission Tomography; Psychoses, Substance-Induced; Radiopharmaceuticals; Reward; Young Adult

Although an association between adolescent sleep and substance use is supported by the literature, few studies have characterized the longitudinal relationship between early adolescent sleep and subsequent substance use. The current study examined the prospective association between the duration and quality of sleep at age 11 and alcohol and cannabis use throughout adolescence.. The present study, drawn from a cohort of 310 boys taking part in a longitudinal study in Western Pennsylvania, includes 186 boys whose mothers completed the Child Sleep Questionnaire; sleep duration and quality at age 11 were calculated based on these reports. At ages 20 and 22, participants were interviewed regarding lifetime alcohol and cannabis use. Cox proportional hazard analysis was used to determine the association between sleep and substance use.. After accounting for race, socioeconomic status, neighborhood danger, active distraction, internalizing problems, and externalizing problems, both the duration and quality of sleep at age 11 were associated with multiple earlier substance use outcomes. Specifically, less sleep was associated with earlier use, intoxication, and repeated use of both alcohol and cannabis. Lower sleep quality was associated with earlier alcohol use, intoxication, and repeated use. Additionally, lower sleep quality was associated with earlier cannabis intoxication and repeated use, but not first use.. Both sleep duration and sleep quality in early adolescence may have implications for the development of alcohol and cannabis use throughout adolescence. Further studies to understand the mechanisms linking sleep and substance use are warranted.

Topics: Adolescent; Cannabis; Child; Humans; Longitudinal Studies; Male; Marijuana Abuse; Prospective Studies; Sleep; Sleep Wake Disorders; Social Class; Surveys and Questionnaires; Time Factors; Underage Drinking; Young Adult

Notwithstanding a century of prohibition, marijuana is the most widely used illicit substance in Canada. Due to the growing public acceptance of recreational marijuana use and ineffectiveness of the existing control system in Canada, the issue surrounding legalizing this illicit drug has received considerable public and political attentions in recent years. Consequently, the newly elected Liberal Government has formally announced that Canada will introduce legislation in the spring of 2017 to start legalizing and regulating marijuana. This editorial aims to provide a brief overview on potential economic, social, and public health impacts of legal marijuana in Canada. The legalization could increase tax revenue through the taxation levied on marijuana products and could also allow the Government to save citizens' tax dollars currently being spent on prohibition enforcement. Moreover, legalization could also remove the criminal element from marijuana market and reduce the size of Canada's black market and its consequences for the society. Nevertheless, it may also lead to some public health problems, including increasing in the uptake of the drug, accidents and injuries. The legalization should be accompanied with comprehensive strategies to keep the drug out of the hands of minors while increasing awareness and knowledge on harmful effects of the drug. In order to get better insights on how to develop an appropriate framework to legalize marijuana, Canada should closely watch the development in the neighboring country, the United States, where some of its states viz, Colorado, Oregon, Washington, and Alaska have already legalized recreational use of marijuana.

Topics: Canada; Cannabis; Humans; Legislation, Drug; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Public Health; Social Problems; Taxes

Topics: Adult; Cannabis; Child; Cognitive Behavioral Therapy; Conduct Disorder; Depression; Humans; Marijuana Abuse; Randomized Controlled Trials as Topic; Schizophrenia; Suicide Prevention; Telemedicine

No abstract available.

Topics: Adolescent; Cannabis; Cross-Sectional Studies; Electronic Nicotine Delivery Systems; Female; Health Surveys; Humans; Male; Marijuana Abuse; Ontario; Prevalence; Risk Factors; Schools; Socioeconomic Factors; Students; Volatilization

The relationship between cannabis use and cognitive function in mid-life has rarely been examined despite verbal learning deficits in young adults.. A longitudinal cohort study of 1,897 Australians recruited at 40-46 years of age and followed up 4 years (94%) and 8 years (87%) later. Random effects regression was used to assess within- and between-person associations between cannabis use and cognitive function across waves of data, and examine whether age-related changes in cognitive performance were modified by cannabis use. The first list of the California Verbal Learning Test (immediate and delayed recall), Symbol Digit Modality Test, Digit Backwards, simple and choice reaction time tasks, were administered at each wave. The Spot-the-Word test was used to assess premorbid verbal ability. Self-reported cannabis use in the past year (no use, < weekly use,≥weekly use) was assessed at each wave.. Participants who used cannabis≥weekly had worse immediate recall (b=-0.68, p=0.014) and showed a trend toward worse delayed recall (b=-0.55, p=0.062) compared to non-users after adjusting for correlates of cannabis use and premorbid verbal ability. These effects were due to between-person differences. There were no significant within-person associations between cannabis use and recall, nor was there evidence of greater cognitive decline in cannabis users with age.. Mid-life cannabis users had poorer verbal recall than non-users, but this was not related to their current level of cannabis use, and cannabis use was not associated with accelerated cognitive decline.

Topics: Adult; Australia; Cannabis; Cognition; Cohort Studies; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Marijuana Abuse; Marijuana Smoking; Memory, Short-Term; Mental Recall; Middle Aged; Neuropsychological Tests; Random Allocation; Reaction Time; Verbal Learning

Distinct behavioral economic domains, including high perceived drug value (demand) and delay discounting (DD), have been implicated in the initiation of drug use and the progression to dependence. However, it is unclear whether frequent marijuana users conform to a "reinforcer pathology" addiction model wherein marijuana demand and DD jointly increase risk for problematic marijuana use and cannabis dependence (CD).. Participants (n=88, 34% female, 14% cannabis dependent) completed a marijuana purchase task at baseline. A delay discounting task was completed following placebo marijuana cigarette (0% THC) administration during a separate experimental session.. Marijuana demand and DD were quantified using area under the curve (AUC). In multiple regression models, demand uniquely predicted frequency of marijuana use while DD did not. In contrast, DD uniquely predicted CD symptom count while demand did not. There were no significant interactions between demand and DD in either model.. These findings suggest that frequent marijuana users exhibit key constituents of the reinforcer pathology model: high marijuana demand and steep discounting of delayed rewards. However, demand and DD appear to be independent rather than synergistic risk factors for elevated marijuana use and risk for progression to CD. Findings also provide support for using AUC as a singular marijuana demand metric, particularly when also examining other behavioral economic constructs that apply similar statistical approaches, such as DD, to support analytic methodological convergence.

Topics: Adolescent; Adult; Behavior, Addictive; Cannabis; Cross-Sectional Studies; Delay Discounting; Economics, Behavioral; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Reward; Surveys and Questionnaires; Young Adult

Topics: Cannabidiol; Cannabis; Dronabinol; Humans; Marijuana Abuse; Marijuana Smoking; Mental Disorders

We set out to determine the predisposing, enabling, and reinforcing factors that influence cannabis use in young people aged 13 to 19 years in Shamva District, Zimbabwe.. A descriptive cross-sectional study focusing on the correlates of cannabis use was conducted among 311 school-going adolescents who were selected using multistage sampling.. Eight percent of the students in our sample reported current use of cannabis. Associations were found between cannabis use and alcohol consumption (P < 0.001), cigarette smoking (P < 0.001), and having had engaged in sexual intercourse (P < 0.001). Significant relationships were found between recreational use of cannabis and having family members, friends, and parents who have used cannabis (P < 0.001).. Students who reported using alcohol, smoking cigarettes, and having had engaged in sexual activity were more likely to use cannabis. There is need for identification of these risky behaviours among students, and ecological frameworks and holistic approaches in health promotion programming should be fostered in an effort to increase awareness of the potential harmful effects of cannabis use on adolescents' health and life outcomes.

Topics: Adolescent; Adolescent Behavior; Alcohol Drinking; Cannabis; Cross-Sectional Studies; Female; Humans; Male; Marijuana Abuse; Risk-Taking; Schools; Sexual Behavior; Smoking; Students; Surveys and Questionnaires; Zimbabwe

Topics: Cannabinoids; Cannabis; Chronic Pain; Humans; Legislation, Drug; Marijuana Abuse; Medical Marijuana; United States

There is ongoing debate regarding the relationship between early tobacco, alcohol and cannabis use and later cocaine abuse. We utilised data from two Irish national general population surveys. Of the 1,897 young adult participants, the prevalence of lifetime use was as follows: tobacco 62%, alcohol 96%, cannabis 31% and cocaine 7.0%. Logistic regression analysis indicated that being single, earlier age of first alcohol use, and history of cannabis use were significant independent predictors of lifetime use of cocaine. The substance use route to cocaine use in this Irish sample is quite typical of that seen internationally. Those who commence alcohol use in the early teenage years are more likely to use cocaine subsequently, even after controlling for early onset cannabis use and other socio-demographic characteristics. This suggests that policies which delay age of first drinking may possibly also curtail cocaine use.

Topics: Adolescent; Adult; Age Factors; Alcohol Drinking; Cannabis; Cocaine; Cocaine-Related Disorders; Humans; Ireland; Marijuana Abuse; Prevalence; Regression Analysis; Substance-Related Disorders; Tobacco Use; Young Adult

Drug policy strategies and discussions often use prevalence of drug use as a primary performance indicator. However, three other indicators are at least as relevant: the number of heavy users, total expenditures and total amount consumed. This paper stems from our efforts to develop annual estimates of these three measures for cocaine (including crack), heroin, marijuana and methamphetamine in the United States.. The estimates exploit complementary strengths of a general population survey (National Survey on Drug Use and Health) and both survey and urinalysis test result data for arrestees (Arrestee Drug Abuse Monitoring Program), supplemented by many other data sources.. Throughout the 2000s US drug users spent in the order of $100 billion annually on these drugs, although the spending distribution and use patterns changed dramatically. From 2006 to 2010, the amount of marijuana consumed in the United States probably increased by more than 30%, while the amount of cocaine consumed in the United States fell by approximately 50%. These figures are consistent with supply-side indicators, such as seizures and production estimates. For all the drugs, total consumption and expenditures are driven by the minority of users who consume on 21 or more days each month.. Even for established drugs, consumption can change rapidly. The halving of the cocaine market in five years and the parallel (but independent) large rise in daily/near-daily marijuana use are major events that were not anticipated by the expert community and raise important theoretical, research, and policy issues.

Topics: Cannabis; Cocaine; Cocaine-Related Disorders; Heroin Dependence; Humans; Marijuana Abuse; Marijuana Smoking; Surveys and Questionnaires; United States

Adolescent exposure to violence and substance use are both public health problems, but how neighborhood context contributes to these outcomes is unclear. This study uses prospective data from 1416 adolescents to examine the direct and interacting influences of victimization and neighborhood factors on adolescent substance use. Based on hierarchical Bernoulli regression models that controlled for prior substance use and multiple individual-level factors, exposure to violence significantly increased the likelihood of marijuana use but not alcohol use or binge drinking. There was little evidence that community norms regarding adolescent substance use influenced rates of substance use or moderated the impact of victimization. Community disadvantage did not directly impact substance use, but the relationship between victimization and marijuana use was stronger for those in neighborhoods with greater disadvantage. The results suggest that victimization is particularly likely to affect adolescents' marijuana use, and that this relationship may be contingent upon neighborhood economic conditions.

Topics: Adolescent; Adolescent Behavior; Alcohol Drinking; Binomial Distribution; Cannabis; Child; Crime Victims; Exposure to Violence; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Poverty; Prospective Studies; Residence Characteristics; Risk Factors; Substance-Related Disorders; Violence

The association between cannabis use and mood disorders is well documented, yet evidence regarding causality is conflicting. This study explored the association between cannabis use, major depressive disorder (MDD) and bipolar disorder (BPD) in a 3-year prospective study.. Data was drawn from waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). MDD and BPD were controlled at baseline and defined as meeting full criteria in the 12 months prior to the follow-up. Initiation of cannabis use was defined as any cannabis used by former lifetime abstainers in the time period between baseline and follow-up.. Cannabis use was not significantly associated with increased incidence of MDD (Adjusted Odds Ratio (AOR) for daily use=0.58(0.22-1.51)). Weekly to almost daily cannabis use was associated with increased incidence of BPD ((AOR for weekly to daily use=2.47(1.03-5.92)); daily use was not (AOR=0.52(0.17-1.55)). Baseline MDD was associated with initiation of cannabis use (AOR=1.72(1.1-2.69)). A crude association between baseline BPD and incidence of cannabis use was not maintained in adjusted models (AOR=0.61(0.36-1.04)).. Lack of information regarding frequency of cannabis use at follow-up and limitations regarding generalization of the results.. Our findings do not support a longitudinal association between cannabis use and incidence of MDD. Results regarding the association between cannabis use and incidence of BPD are conflicting and require further investigation. Baseline MDD, but not BPD, may be associated with future initiation of cannabis use. This may have implications for clinical, social and legislative aspects of cannabis use.

Topics: Adult; Alcohol-Related Disorders; Bipolar Disorder; Cannabis; Causality; Female; Humans; Incidence; Longitudinal Studies; Male; Marijuana Abuse; Middle Aged; Mood Disorders; Odds Ratio; Prospective Studies; Substance-Related Disorders; Young Adult

Topics: Adult; Brain Ischemia; Cannabis; Cerebral Hemorrhage; Dose-Response Relationship, Drug; Hemiplegia; Humans; Male; Marijuana Abuse; Stroke

Cannabis is clearly the most popular illicit drug in North America, Europe and in other parts of the world. Evidence is accumulating for the involvement of the endocannabinoid system in emotional processing. However, only few studies examined emotional processing in chronic, heavy cannabis users and these studies were performed in cannabis dependent patients who were abstinent for 12-48 hours. The aim of this study was to investigate facial emotion identification and discrimination abilities in patients with cannabis dependence who were abstinent for at least 1 month.. The study included 30 males with cannabis dependency according to DSM-IV criteria and who had been abstinent for at least 1 month and 30 healthy controls. All the subjects were evaluated with Facial Emotion Identification Test (FEIT) and Facial Emotion Discrimination Test (FEDT).. The main finding of this study was the presence of deficits in both identification and discrimination of facial emotions in cannabis dependent patients during abstinence. In addition, when we examined negative and positive emotions separately, we found out that abstinent cannabis dependent patients performed significantly worse than controls in the identification of negative emotions but not positive emotions.. Our findings indicate that facial emotion recognition deficits which have previously been observed in current cannabis users are still detectable in abstinent cannabis dependent patients and do not improve quickly with abstinence (an average of 3.2 months).

Topics: Adult; Cannabis; Diagnostic and Statistical Manual of Mental Disorders; Discrimination, Psychological; Emotions; Facial Expression; Female; Humans; Male; Marijuana Abuse; Neuropsychological Tests; Recognition, Psychology; Substance Withdrawal Syndrome

Internet-mediated research methods are increasingly used to access hidden populations. The International Cannabis Cultivation Questionnaire (ICCQ) is an online survey designed to facilitate international comparisons into the relatively under-researched but increasingly significant phenomenon of domestic cannabis cultivation. The Global Cannabis Cultivation Research Consortium has used the ICCQ to survey over 6000 cannabis cultivators across 11 countries. In this paper, we describe and reflect upon our methodological approach, focusing on the digital and traditional recruitment methods used to access this hidden population and the challenges of working across multiple countries, cultures and languages.. Descriptive statistics showing eligibility and completion rates and recruitment source by country of residence.. Over three quarters of eligible respondents who were presented with the survey were included in the final sample of n=6528. English-speaking countries expended more effort to recruit participants than non-English-speaking countries. The most effective recruitment modes were cannabis websites/groups (33%), Facebook (14%) and news articles (11%). While respondents recruited through news articles were older, growing practice variables were strikingly similar between these main recruitment modes.. Through this process, we learnt that there are trade-offs between hosting multiple surveys in each country vs. using one integrated database. We also found that although perceived anonymity is routinely assumed to be a benefit of using digital research methodologies, there are significant limits to research participant anonymity in the current era of mass digital surveillance, especially when the target group is particularly concerned about evading law enforcement. Finally, we list a number of specific recommendations for future researchers utilising Internet-mediated approaches to researching hidden populations.

Topics: Adult; Australia; Cannabinoids; Cannabis; Commerce; Cooperative Behavior; Criminals; Drug and Narcotic Control; Drug Trafficking; Europe; Female; Humans; International Cooperation; Internationality; Internet; Male; Marijuana Abuse; Motivation; North America; Patient Selection; Policy Making; Public Health; Research Design; Risk Assessment; Risk Factors; Sample Size; Socioeconomic Factors; Surveys and Questionnaires; Young Adult

This article aims to provide an overview of: demographic characteristics; experiences with growing cannabis; methods and scale of growing operations; reasons for growing; personal use of cannabis and other drugs; participation in cannabis and other drug markets; contacts with the criminal justice system for respondents to an online survey about cannabis cultivation drawn from eleven countries (N=6530). Important similarities and differences between the national samples recruited will be discussed.. This paper utilizes data from the online web survey of predominantly 'small-scale' cannabis cultivators in eleven countries conducted by the Global Cannabis Cultivation Research Consortium (GCCRC). Here we focus primarily on descriptive statistics to highlight key similarities and differences across the different national samples.. Overall there was a great deal of similarity across countries in terms of: demographic characteristics; experiences with growing cannabis; methods and scale of growing operations; reasons for growing; use of cannabis and other drugs; participation in cannabis and other drug markets, and; contacts with the criminal justice system. In particular, we can recognise that a clear majority of those small-scale cannabis cultivators who responded to our survey are primarily motivated for reasons other than making money from cannabis supply and have minimal involvement in drug dealing or other criminal activities.. These growers generally come from 'normal' rather than 'deviant' backgrounds. Some differences do exist between the samples drawn from different countries suggesting that local factors (political, geographical, cultural, etc.) may have some influence on how small-scale cultivators operate, although differences in recruitment strategies in different countries may also account for some differences observed.

Topics: Adult; Australia; Cannabinoids; Cannabis; Commerce; Cooperative Behavior; Criminals; Drug and Narcotic Control; Drug Trafficking; Europe; Female; Humans; International Cooperation; Internationality; Internet; Male; Marijuana Abuse; Middle Aged; Motivation; North America; Policy Making; Public Health; Risk Assessment; Risk Factors; Socioeconomic Factors; Surveys and Questionnaires; Young Adult

Since the 1990s, a shift from the importation of foreign cannabis to domestic cultivation has taken place in Belgium, as it has in many other countries. This shift has prompted Belgian policy-making bodies to prioritize the repression of cannabis cultivation. Against this background, the article aims to systematically map and assess for the first time ever the harms associated with cannabis cultivation, covering the whole spectrum of growers.. This study is based on a web survey primarily targeting small-scale growers (N=1293) and on three interconnected sets of qualitative data on large-scale growers and traffickers (34 closed criminal proceedings, interviews with 32 criminal justice experts, and with 17 large-scale cannabis growers and three traffickers). The study relied on Greenfield and Paoli's (2013) harm assessment framework to identify the harms associated with cannabis cultivation and to assess the incidence, severity and causes of such harms.. Cannabis cultivation has become endemic in Belgium. Despite that, it generates, for Belgium, limited harms of medium-low or medium priority. Large-scale growers tend to produce more harms than the small-scale ones. Virtually all the harms associated with cannabis cultivation are the result of the current criminalizing policies.. Given the spread of cannabis cultivation and Belgium's position in Europe, reducing the supply of cannabis does not appear to be a realistic policy objective. Given the limited harms generated, there is scarce scientific justification to prioritize cannabis cultivation in Belgian law enforcement strategies. As most harms are generated by large-scale growers, it is this category of cultivator, if any, which should be the focus of law enforcement repression. Given the policy origin of most harms, policy-makers should seek to develop policies likely to reduce such harms. At the same time, further research is needed to comparatively assess the harms associated with cannabis cultivation (and trafficking) with those arising from use.

Topics: Belgium; Cannabis; Commerce; Criminals; Drug and Narcotic Control; Drug Trafficking; Government Regulation; Harm Reduction; Humans; Internet; Marijuana Abuse; Marijuana Smoking; Policy Making; Risk Assessment; Risk Factors; Surveys and Questionnaires

Cannabis is a psychotomimetic agent that induces impairment of sensory perception. We present detailed clinical and electrophysiological data of patients with hallucinogen persisting perception disorder (HPPD) after marijuana consumption.. A HPPD patient and four heavy cannabis smokers with no visual disturbances (controls) underwent complete ophthalmological examination including psychophysical tests (visual acuity, color vision, visual field, and dark adaptation) and detailed electrophysiological examinations, including extended Ganzfeld ERG, multifocal ERG, and electrooculography (EOG). Furthermore, electrically evoked phosphene thresholds (EPTs) were measured to further evaluate retinal function.. Ophthalmological and most electrophysiological examinations were within normal limits for the HPPD patient and for all control subjects. Interestingly, EOG results of the HPPD patient showed a slightly reduced fast oscillation ratio, diminished standing potentials of the slow oscillations, and a light peak within normal range resulting in higher Arden ratios. The EPTs of the patient were reduced, in particular for pulses with long durations (50 ms) causing visual sensations even at lowest possible currents of the neurostimulator. The control subjects did not reveal such alterations.. Our findings suggest a direct effect of cannabinoids on the retina and retinal pigment epithelium function, which may be involved in disturbances of the visual function experienced after drug consumption. The observations presented here may contribute to the elucidation of the detailed mechanism. Furthermore, EOG and EPT measurements may be useful tools to demonstrate long-term retinal alterations in cannabis-induced HPPD in patients.

Topics: Adult; Cannabis; Dark Adaptation; Electroretinography; Female; Humans; Male; Marijuana Abuse; Middle Aged; Perceptual Disorders; Retina; Retinal Pigment Epithelium; Vision Disorders; Visual Acuity; Visual Fields; Young Adult

Cannabis cultivation has become increasingly localized, whether soil-based or hydroponic growing methods are used. Characteristics of a given location, such as its climate and the equipment it requires may influence general accessibility or attract different types of offenders based on potential profits. The location of crops, especially hydroponic crops, suggests a certain proximity to the consumer market via semi-urban and urban environments, while making it possible to avoid detection. This article examines the cannabis market through its cultivation.. The stability of temporal and spatial clusters of cannabis cultivation, hotspots, and coldspots between 2001 and 2009 in the province of Quebec, Canada, are addressed. Studying the geography of crime is not a new endeavor, but coldspots are rarely documented in drug market research. Using arrests and general population data, as well as Kulldorff's scan statistics, results show that the temporal distribution of cannabis cultivation is highly seasonal for soil-based methods.. Hydroponic production shows adaptation to its soil-based counterpart. Stable patterns are found for both spatial distributions. Hotspots for soil-based cultivation are found near several urban centers and the Ontario border. For hydroponic cannabis cultivation, a new hotspot suggests the emergence of an American demand for Quebec-grown cannabis between 2007 and 2009. Curiously, the region surrounding Montreal, the largest urban center in Quebec, is a recurrent and stable coldspot for both methods of cultivation.. For all periods, spatial clusters are stronger for soil-based methods than in the hydroponic context. Temporal differences and spatial similarities between soil-based cultivation and hydroponic cultivation are discussed. The role of the metropolis is also addressed.

Topics: Cannabis; Cluster Analysis; Commerce; Criminals; Drug Trafficking; Humans; Hydroponics; Marijuana Abuse; Marijuana Smoking; Monte Carlo Method; Quebec; Seasons; Soil; Spatio-Temporal Analysis; Time Factors; Urban Population

Topics: Cannabinoids; Cannabis; Commerce; Cooperative Behavior; Criminals; Drug and Narcotic Control; Drug Trafficking; Humans; International Cooperation; Internationality; Marijuana Abuse; Policy Making; Public Health; Risk Assessment; Risk Factors

This article analyses how young people enrolled in drug addiction treatment in Copenhagen, Denmark, explain their cannabis careers and how they view their possibilities for quitting drug use again. Inspired by Mead and narrative studies of health and illness, the article identifies four different drug use 'aetiologies' drawn upon by the interviewees. These cover childhood experiences, self-medication, the influence of friends and cannabis use as a specific lifestyle. A central argument of the article is that these explanations not only concern the past but also point towards the future by assigning the interviewee a more or less agential position in relation to drugs. Further, the drug narratives are viewed as interactional achievements, related to the social context in which they were produced, namely, the institutional setting of the treatment centres. The article is based on 30 qualitative interviews with young people in drug addiction treatment.

Topics: Adolescent; Adult; Behavioral Symptoms; Cannabis; Denmark; Female; Humans; Interviews as Topic; Life Style; Male; Marijuana Abuse; Narration; Parents; Peer Group; Socioeconomic Factors; Young Adult

Topics: Antipsychotic Agents; Brain; Cannabidiol; Cannabis; Cerebral Cortex; Gene-Environment Interaction; Humans; Marijuana Abuse; Risk Factors; Schizophrenia; Schizophrenic Psychology; Treatment Outcome

Topics: Cannabidiol; Cannabis; Causality; Dronabinol; Humans; Marijuana Abuse; Psychoses, Substance-Induced; Risk Factors; Schizophrenia; Schizophrenic Psychology

The association between cannabinoids and psychosis has been known for almost a thousand years, but it is still speculated whether cannabis use may be a contributory cause of psychosis, that is, whether it may precipitate schizophrenia in those at risk. In this paper, we will briefly present the data from individual longitudinal studies in the field, together with the factors that are considered important for the association of cannabis abuse and occurrence of schizophrenia and prevention opportunities in the target population. The reviewed studies clearly suggest that cannabis abuse predicts an increased risk for schizophrenia, particularly in young adults. They underline both the need to create adequate prevention measures and consequently avoid the occurrence of the disease in the young at risk. Particular attention should be additionally devoted toward encouraging the young presenting with psychotic symptoms to stop or, at the very least, reduce the frequency of cannabis abuse. The issues are undoubtedly to be addressed by the health care system in general.

Topics: Adult; Age of Onset; Biomedical Research; Cannabis; Health Services Needs and Demand; Humans; Longitudinal Studies; Marijuana Abuse; Psychotic Disorders; Risk Assessment; Risk Factors; Schizophrenia; Young Adult

Synthetic cannabinoids (SCs) have become increasingly popular in recent years. Diverse in chemical structure, many have been subjected to legislative regulation, but their availability and use persists. Often marketed to reflect their similar effects to cannabis, their use has been associated with a range of negative health effects. We sought to determine the relative risk of seeking emergency medical treatment (EMT) following use of SCs and natural cannabis.. We utilized an anonymous online survey of drug use, obtaining data from 22,289 respondents. We calculated the relative risk of seeking EMT between the two substances using an estimate for days used in the past year.. Thirty-seven cannabis users (0.2%) and 21 SC users (1.0%) had sought EMT during the past year following use. The relative risk associated with the use of SCs was 30 (95% CI 17.5-51.2) times higher than that associated with cannabis. Significantly more symptoms (p=0.03) were reported by respondents seeking treatment for SCs than for cannabis.. Whilst these findings must be treated with caution, SCs potentially pose a greater risk to users' health than natural forms of cannabis. Regulation is unlikely to remove SCs from the market, so well-informed user-focused health promotion messages need to be crafted to discourage their use.

Topics: Cannabinoids; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Risk; Substance-Related Disorders

This research examined whether national population-level cannabis frequency rates moderate the strength of the relationship between individual-level psychosocial and behavioral risk factors (poor parental communication, bullying, fighting, etc.) and different levels of adolescent cannabis use (abstinence, experimental use, and regular use).. Data from the 2009/2010 Health Behaviour in School-Aged Children survey (N = 62,009, age = 15 years) from 31 countries were analyzed using multinomial hierarchical linear modeling.. Analyses showed that adolescents who reported experimental cannabis use and who lived in relatively high cannabis frequency countries were less likely than their counterparts in low cannabis frequency countries to present some of the cannabis-related psychosocial and behavioral risk factors. Conversely, regular cannabis use tended to occur among high-risk adolescents to an equal degree in high and low cannabis frequency countries.. The findings suggest that the normality of cannabis use in the youth population is important to consider when investigating the relationship between risk factors and cannabis use.

Topics: Adolescent; Adolescent Behavior; Aggression; Cannabis; Child; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Risk Factors; Schools; Surveys and Questionnaires

Risk-related liabilities associated with the development of cannabis use disorders (CUDs) during adolescence and early adulthood are thought to be established well before the emergence of the index episode. In this study, internalizing and externalizing psychopathology from earlier developmental periods were evaluated as risk factors for CUDs during adolescence and early adulthood. Participants (N = 816) completed 4 diagnostic assessments between the ages 16 and 30, during which current and past CUDs were assessed as well as a full range of psychiatric disorders associated with internalizing and externalizing psychopathology domains. In unadjusted and adjusted time-to-event analyses, externalizing but not internalizing psychopathology from proximal developmental periods predicted subsequent CUD onset. A large proportion of adolescent and early adult cases, however, did not manifest any externalizing or internalizing psychopathology during developmental periods before CUD onset. Findings are consistent with the emerging view that externalizing disorders from proximal developmental periods are robust risk factors for CUDs. Although the identification of externalizing liabilities may aid in the identification of individuals at risk for embarking on developmental pathways that culminate in CUDs, such liabilities are an incomplete indication of overall risk.

Topics: Adolescent; Adult; Anxiety Disorders; Attention Deficit and Disruptive Behavior Disorders; Attention Deficit Disorder with Hyperactivity; Cannabis; Conduct Disorder; Depressive Disorder; Female; Humans; Longitudinal Studies; Male; Marijuana Abuse; Marijuana Smoking; Mental Disorders; Oregon; Prospective Studies; Risk Factors; Young Adult

Topics: Cannabidiol; Cannabis; Dronabinol; Humans; Marijuana Abuse; Psychoses, Substance-Induced; Schizophrenia; Schizophrenic Psychology

The aim of the study was to investigate trajectories of social functioning in young people with first-episode psychosis (FEP) with and without cannabis misuse using a secondary analysis of data from the Episode-II trial. Forty-two young people with FEP and comorbid cannabis use disorder were compared with 39 young people with FEP but without a cannabis use disorder. Social functioning was assessed every 6 months during a 30-month follow-up. Multilevel linear growth curve modeling was used to compare the social functioning trajectories over time for those with and without cannabis misuse. Cannabis misuse was not associated with social functioning at baseline assessment. Over a 30-month follow-up, FEP patients without cannabis disorder showed significant improvements in their social functioning, whereas patients with cannabis misuse at baseline displayed no such improvement. Patients with and without cannabis misuse differed significantly in their levels of social functioning after 24 months. Similar results were obtained after adjusting for potential confounders (i.e., age, gender, negative symptoms, premorbid functioning, DSM-IV diagnoses, baseline social functioning and other substance use). In the context of a specialized early intervention service, patients with cannabis misuse at baseline did not attain the improvements in social outcomes observed in their counterparts without cannabis misuse. There is a need to develop effective interventions to reduce cannabis misuse to ultimately improve social outcomes in young people with psychosis.

Topics: Adolescent; Adult; Cannabis; Female; Follow-Up Studies; Humans; Male; Marijuana Abuse; Middle Aged; Psychotic Disorders; Social Skills; Young Adult

Topics: Cannabis; Federal Government; Government Regulation; Humans; Illicit Drugs; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Occupational Diseases; Occupational Health; Occupational Medicine; State Government; Substance Abuse Detection; United States

Topics: Cannabis; Cocaine; Cocaine-Related Disorders; Humans; Marijuana Abuse; Marijuana Smoking; Public Health; Surveys and Questionnaires; United States

Topics: Cannabis; Cocaine; Cocaine-Related Disorders; Humans; Marijuana Abuse; Marijuana Smoking; Surveys and Questionnaires; United States

Topics: Cannabis; Cocaine; Cocaine-Related Disorders; Drug Trafficking; Humans; Illicit Drugs; Marijuana Abuse; Marijuana Smoking; Substance-Related Disorders; Surveys and Questionnaires; United States

Cannabis use is becoming more accepted in mainstream society. In this paper, we use Zinberg's classic theoretical framework of drug, set, and setting to elucidate how older adult cannabis users managed health, social and legal risks in a context of normalized cannabis use.. We present selected findings from our qualitative study of Baby Boomer (born 1946-1964) cannabis users in the San Francisco Bay Area. Data collection consisted of a recorded, in-depth life history interview followed by a questionnaire and health survey. Qualitative interviews were analyzed to discover the factors of cannabis harm reduction from the users' perspectives.. Interviewees made harm reduction choices based on preferred cannabis derivatives and routes of administration, as well as why, when, where, and with whom to use. Most interviewees minimized cannabis-related harms so they could maintain social functioning in their everyday lives. Responsible and controlled use was described as moderation of quantity and frequency of cannabis used, using in appropriate settings, and respect for non-users. Users contributed to the normalization of cannabis use through normification.. Participants followed rituals or cultural practices, characterized by sanctions that helped define "normal" or "acceptable" cannabis use. Users contributed to cannabis normalization through their harm reduction methods. These cultural practices may prove to be more effective than formal legal prohibitions in reducing cannabis-related harms. Findings also suggest that users with access to a regulated market (medical cannabis dispensaries) were better equipped to practice harm reduction. More research is needed on both cannabis culture and alternative routes of administration as harm reduction methods.

Topics: Aged; Cannabis; Harm Reduction; Humans; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Mental Health; Middle Aged

Cannabis users are more likely to have psychotic experiences (PEs). The degree to which these associations are driven by genetic or environmental influences in adolescence is unknown. This study estimated the genetic and environmental contributions to the relationship between cannabis use and PEs. Specific PEs were measured in a community-based twin sample (4830 16-year-old pairs) using self-reports and parent-reports. Adolescents reported on ever using cannabis. Multivariate liability threshold structural equation model-fitting was conducted. Cannabis use was significantly correlated with PEs. Modest heritability (37%), common environmental influences (55%) and unique environment (8%) were found for cannabis use. For PEs, modest heritability (27-54%), unique environmental influences (E=12-50%) and little common environmental influences (11-20%), with the exception of parent-rated Negative Symptoms (42%), were reported. Environmental influences explained all of the covariation between cannabis use and paranoia, cognitive disorganization and parent-rated negative symptoms (bivariate common environment=69-100%, bivariate unique environment=28-31%), whilst the relationship between cannabis use and hallucinations indicated familial influences. Cannabis use explains 2-5% of variance in positive, cognitive, and negative PEs. Cannabis use and psychotic experience co-occur due to environmental factors. Focus on specific environments may reveal why adolescent cannabis use and psychotic experiences tend to 'travel together'.

Topics: Adolescent; Cannabis; Female; Hallucinations; Humans; Male; Marijuana Abuse; Marijuana Smoking; Parents; Risk Factors; Self Report; Social Environment; Twins

Substitution is operationalised as a conscious choice made by users to use one drug instead of, or in conjunction with another based on: perceived safety, level of addiction potential, effectiveness in relieving symptoms, access and level of acceptance. Harm reduction is a set of strategies that aim to minimise problems associated with drug use while recognising that for some users, abstinence may be neither a realistic nor a desirable goal. In this paper, we aim for deeper understandings of older adult cannabis users' beliefs and substitution practices as part of the harm reduction framework.. We present selected findings from our qualitative study of Baby Boomer (born 1946-1964) marijuana users in the San Francisco Bay Area. Although the sample consisted of primary cannabis users, many had personal experience with other drugs throughout their lifetimes. Data collection consisted of an audio-recorded, semi-structured in-depth life history interview followed by a questionnaire and health survey. Qualitative interviews were analysed to discover users' harm reduction beliefs and cannabis substitution practices.. Study participants described using cannabis as a safer alternative for alcohol, illicit drugs and pharmaceuticals based on their perceptions of less adverse side effects, low-risk for addiction and greater effectiveness at relieving symptoms, such as chronic pain.. Cannabis substitution can be an effective harm reduction method for those who are unable or unwilling to stop using drugs completely. More research is needed on cannabis as a safer alternative.

Topics: Aged; Attitude to Health; Cannabis; Chronic Pain; Female; Humans; Interviews as Topic; Male; Marijuana Abuse; Middle Aged; Qualitative Research; San Francisco

Chronic marijuana (MJ) use among adolescents has been associated with structural and functional abnormalities, particularly in developing regions responsible for higher order cognition.. This study investigated prefrontal (PFC) and parietal volumes and executive function in emerging adult MJ users and explored potential gender differences.. Participants (ages 18-25) were 27 MJ users and 32 controls without neurologic or psychiatric disorders or heavy other drug use. A series of multiple regressions examined whether group status, past year MJ use, and their interactions with gender predicted ROI volumes. Post hoc analyses consisted of brain-behavior correlations between volumes and cognitive variables and Fisher's z tests to assess group differences.. MJ users demonstrated significantly smaller medial orbitofrontal (mOFC; p = 0.004, FDR p = 0.024) and inferior parietal volumes (p = 0.04, FDR p = 0.12); follow-up regressions found that increased past year MJ use did not significantly dose-dependently predict smaller mOFC volume in a sub-sample of individuals with at least one past year MJ use. There were no significant gender interactions. There was a significant brain-behavior difference by group, such that smaller mOFC volumes were associated with poorer complex attention for MJ users (p < 0.05).. Smaller mOFC volumes among MJ users suggest disruption of typical neurodevelopmental processes associated with regular MJ use for both genders. These results highlight the need for longitudinal, multi-modal imaging studies providing clearer information on timing of neurodevelopmental processes and neurocognitive impacts of youth MJ initiation.

Topics: Adolescent; Adult; Cannabis; Cognition; Executive Function; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Organ Size; Parietal Lobe; Prefrontal Cortex; Sex Characteristics; Young Adult

Topics: Adolescent; Adolescent Behavior; Cannabis; Cognition Disorders; Female; Humans; Legislation, Drug; Marijuana Abuse; Medical Marijuana; Mental Disorders; Risk; United States

Sleep problems are commonly reported following alcohol and cannabis abuse, but our understanding of sleep in non-clinical drug using populations is limited. The present study examined the sleep characteristics of alcohol and cannabis users recruited from the wider community.. Two hundred forty-eight self-identified alcohol and/or cannabis users (131 women and 117 men) with a mean age of 26.41 years completed an online study that was advertised via online forums, print media and flyers. As part of the study, participants completed validated sleep scales assessing sleep quality (Pittsburgh Sleep Quality Index) and excessive daytime sleepiness (Epworth Sleepiness Scale) in addition to validated drug scales assessing alcohol (Alcohol Use Disorders Identification Test) and cannabis (Marijuana Screening Inventory) use.. Problems with sleep quality were more commonly reported than were complaints of excessive daytime sleepiness. Clinically significant poor sleep quality was associated with comorbid problem alcohol and cannabis use. Women reporting problem alcohol and cannabis use had poorer sleep outcomes than men.. Social drug users who report risky alcohol and cannabis use also report poor sleep. Poor sleep quality likely exacerbates any drug-associated problems in non-clinical populations.

Topics: Adult; Alcohol Drinking; Alcoholism; Cannabis; Comorbidity; Disorders of Excessive Somnolence; Female; Humans; Male; Marijuana Abuse; Risk-Taking; Sleep Initiation and Maintenance Disorders

Structural magnetic resonance imaging techniques are powerful tools for examining the effects of drug use on the brain. The nicotine and cannabis literature has demonstrated differences between nicotine cigarette smokers and cannabis users compared to controls in brain structure; however, less is known about the effects of co-occurring cannabis and tobacco use.. We used voxel-based morphometry to examine gray matter volume differences between four groups: (1) cannabis-dependent individuals who do not smoke tobacco (Cs); (2) cannabis-dependent individuals who smoke tobacco (CTs); (3) cannabis-naïve, nicotine-dependent individuals who smoke tobacco (Ts); and (4) healthy controls (HCs). We also explored associations between gray matter volume and measures of cannabis and tobacco use.. A significant group effect was observed in the left putamen, thalamus, right precentral gyrus, and left cerebellum. Compared to HCs, the Cs, CTs, and Ts exhibited larger gray matter volumes in the left putamen. Cs also had larger gray matter volume than HCs in the right precentral gyrus. Cs and CTs exhibited smaller gray matter volume than HCs in the thalamus, and CTs and Ts had smaller left cerebellar gray matter volume than HCs.. This study extends previous research that independently examined the effects of cannabis or tobacco use on brain structure by including an examination of co-occurring cannabis and tobacco use, and provides evidence that cannabis and tobacco exposure are associated with alterations in brain regions associated with addiction.

Topics: Adult; Brain; Cannabis; Female; Gray Matter; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Marijuana Abuse; Organ Size; Smoking; Tobacco Use Disorder

Individuals report using cannabis for the promotion of sleep, and the effects of cannabis on sleep may vary by cannabis species. Little research has documented preferences for particular cannabis types or cannabinoid concentrations as a function of use for sleep disturbances.. 163 adults purchasing medical cannabis for a physical or mental health condition at a cannabis dispensary were recruited. They provided self-report of (a) whether cannabis use was intended to help with sleep problems (e.g. insomnia, nightmares), (b) sleep quality (PSQI), (c) cannabis use (including preferred type), and (d) symptoms of DSM-5 cannabis dependence.. 81 participants reported using cannabis for the management of insomnia and 14 participants reported using cannabis to reduce nightmares. Individuals using cannabis to manage nightmares preferred sativa to indica strains (Fisher's exact test (2) = 6.83, p < 0.05), and sativa users were less likely to endorse DSM-5 cannabis dependence compared with those who preferred indica strains (χ(2)(2) = 4.09, p < 0.05). Individuals with current insomnia (t(9) = 3.30, p < 0.01) and greater sleep latency (F(3,6) = 46.7, p < 0.001) were more likely to report using strains of cannabis with significantly higher concentrations of CBD. Individuals who reported at least weekly use of hypnotic medications used cannabis with lower THC concentrations compared to those who used sleep medications less frequently than weekly (t(17) = 2.40, p < 0.05).. Associations between sleep characteristics and the type of cannabis used were observed in this convenience sample of individuals using cannabis for the management of sleep disturbances. Controlled prospective studies are needed to better characterize the impact that specific components of cannabis have on sleep.

Topics: Adolescent; Adult; Aged; California; Cannabinoids; Cannabis; Comorbidity; Dreams; Female; Humans; Hypnotics and Sedatives; Male; Marijuana Abuse; Medical Marijuana; Middle Aged; Sleep; Sleep Initiation and Maintenance Disorders; Young Adult

As an increasing number of states liberalize cannabis use and develop laws and local policies, it is essential to better understand the impacts of neighborhood ecology and marijuana dispensary density on marijuana use, abuse, and dependence. We investigated associations between marijuana abuse/dependence hospitalizations and community demographic and environmental conditions from 2001 to 2012 in California, as well as cross-sectional associations between local and adjacent marijuana dispensary densities and marijuana hospitalizations.. We analyzed panel population data relating hospitalizations coded for marijuana abuse or dependence and assigned to residential ZIP codes in California from 2001 through 2012 (20,219 space-time units) to ZIP code demographic and ecological characteristics. Bayesian space-time misalignment models were used to account for spatial variations in geographic unit definitions over time, while also accounting for spatial autocorrelation using conditional autoregressive priors. We also analyzed cross-sectional associations between marijuana abuse/dependence and the density of dispensaries in local and spatially adjacent ZIP codes in 2012.. An additional one dispensary per square mile in a ZIP code was cross-sectionally associated with a 6.8% increase in the number of marijuana hospitalizations (95% credible interval 1.033, 1.105) with a marijuana abuse/dependence code. Other local characteristics, such as the median household income and age and racial/ethnic distributions, were associated with marijuana hospitalizations in cross-sectional and panel analyses.. Prevention and intervention programs for marijuana abuse and dependence may be particularly essential in areas of concentrated disadvantage. Policy makers may want to consider regulations that limit the density of dispensaries.

Topics: Bayes Theorem; California; Cannabis; Commerce; Cross-Sectional Studies; Female; Geography, Medical; Hospitalization; Humans; Marijuana Abuse; Residence Characteristics

The purpose of this study was to describe historical trends in rates of recent substance use and associations between marijuana and other substances, among U.S. high school seniors by race and gender.. Data from Monitoring the Future (1976-2013; N = 599,109) were used to estimate historical trends in alcohol use, heavy episodic drinking (HED), cigarette use, and marijuana use. We used time-varying effect models to flexibly estimate changes in associations of substance use behaviors.. Past-month marijuana use rates peaked in the 1970s, declined through 1990, then rose again to reach levels of use of more than 20% for both black and white participants. Recent years show increasing disparities across groups such that males, and in particular black youth, are on a trajectory toward higher use. This rise in marijuana use is particularly concerning among black youth, with rates far exceeding those for cigarette use and HED. The association of marijuana use with both cigarette use and HED is particularly high in recent years among black adolescents.. Substance use recently declined among high school seniors, except for marijuana use, particularly among black youth. The increasing association between marijuana and other substances among black adolescents suggests future amplification in critical health disparities.

Topics: Adolescent; Adolescent Behavior; Alcohol Drinking; Black or African American; Cannabis; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Schools; Smoking; Students; Substance-Related Disorders; United States

The purpose of this study was to assess whether infrequent and frequent marijuana use at age 19/20 years predicts receipt of educational degrees by the mid-20s, independent of confounding age 18 adolescent risk factors.. Data were from the Monitoring the Future study, an annual nationally representative survey of high school seniors followed into adulthood. Thirteen cohorts (1990-2002) of high school seniors were followed longitudinally to their mid-20s (n = 4,925; 54% female). We used logistic regression and propensity score matching with successive inclusion of age 18 risk factors and substance use to compare age 19/20 frequent marijuana users (six or more occasions in past 30 days) to nonusers, frequent users to infrequent users (1-6 occasions), and infrequent users to nonusers on their likelihood of degree attainment by the mid-20s.. Frequent marijuana users were less likely than infrequent users and nonusers to earn bachelor's degrees, even after controlling for a host of age 18 risk factors (e.g., family socioeconomic background, academic performance, educational expectations, truancy). However, these differences were reduced in magnitude to statistical nonsignificance when we controlled for age 18 substance use. Across analyses, the proportion reaching this educational milestone did not differ significantly between infrequent users and nonusers.. Results support a growing body of work suggesting that frequent marijuana use predicts a lower likelihood of postsecondary educational attainment, and this difference may originate during secondary school.

Topics: Achievement; Adolescent; Adolescent Behavior; Adult; Age Factors; Cannabis; Educational Status; Female; Follow-Up Studies; Humans; Logistic Models; Male; Marijuana Abuse; Marijuana Smoking; Risk Factors; Socioeconomic Factors; Universities; Young Adult

Cannabis use is decreasing in England and Wales, while demand for cannabis treatment in addiction services continues to rise. This could be partly due to an increased availability of high-potency cannabis.. Adults residing in the UK were questioned about their drug use, including three types of cannabis (high potency: skunk; low potency: other grass, resin). Cannabis types were profiled and examined for possible associations between frequency of use and (i) cannabis dependence, (ii) cannabis-related concerns.. Frequent use of high-potency cannabis predicted a greater severity of dependence [days of skunk use per month: b = 0.254, 95% confidence interval (CI) 0.161-0.357, p < 0.001] and this effect became stronger as age decreased (b = -0.006, 95% CI -0.010 to -0.002, p = 0.004). By contrast, use of low-potency cannabis was not associated with dependence (days of other grass use per month: b = 0.020, 95% CI -0.029 to 0.070, p = 0.436; days of resin use per month: b = 0.025, 95% CI -0.019 to 0.067, p = 0.245). Frequency of cannabis use (all types) did not predict severity of cannabis-related concerns. High-potency cannabis was clearly distinct from low-potency varieties by its marked effects on memory and paranoia. It also produced the best high, was preferred, and most available.. High-potency cannabis use is associated with an increased severity of dependence, especially in young people. Its profile is strongly defined by negative effects (memory, paranoia), but also positive characteristics (best high, preferred type), which may be important when considering clinical or public health interventions focusing on cannabis potency.

Topics: Adult; Cannabis; Cross-Sectional Studies; Female; Humans; Male; Marijuana Abuse; Plant Preparations; Severity of Illness Index; United Kingdom; Young Adult

The mechanism underneath the relationship between cannabis and psychosis remains controversial, for which several hypotheses have been proposed, including cannabis as self-medication and cannabis as a risk for the development of psychosis. The aim of this work was to study the relationship between cannabis and psychosis in first-episode psychosis cannabis users and non-users, and non-psychotic cannabis users. The age at the first psychotic episode, duration of untreated psychosis, psychopathology and reasons for cannabis use were assessed. First-episode psychosis cannabis users showed an earlier age at psychosis onset than non-user patients. No significant differences in symptomatology were found. The distinguishing reasons to use cannabis for patients with first-episode psychosis with respect to non-psychotic users were to arrange their thoughts and deal with hallucinations and suspiciousness. These findings are in agreement with both hypotheses: self-medication and secondary psychosis hypothesis. However, longitudinal prospective cohort studies assessing reasons for cannabis use are needed to investigate both hypotheses and their complementarity.

Topics: Adolescent; Adult; Age Factors; Cannabis; Cross-Sectional Studies; Female; Hallucinations; Humans; Male; Marijuana Abuse; Prospective Studies; Psychopathology; Psychotic Disorders; Risk Factors; Schizophrenia; Schizophrenic Psychology; Self Medication; Surveys and Questionnaires; Young Adult

We aimed to examine the association between lifetime cannabis use and estimates of both premorbid and current cognitive function in psychotic disorders in an Australian cohort.. In an Australian multicenter cohort, 1237 participants with an established ICD-10 diagnosis of psychotic disorder were categorised according to history of lifetime cannabis use (non-users, n=354; cannabis users, n=221; cannabis dependency, n=662). Groups were analyzed according to available indices of cognitive ability: the National Adult Reading Test - Revised (NART-R) for ability prior to illness onset; and the Digit Symbol Coding Test (DSCT) for current ability. Two-way analysis of variance was conducted without any covariate, followed by a two-way analysis of covariance (using age, age at onset of psychiatric illness, premorbid IQ and the Socio-Economic Index for Areas (SEIFA) rankings).. Whilst there appeared to be a significant association between cannabis use and mean DSCT (higher DSCT scores in cannabis using groups) F(2,1080)=9.478, p<0.001, η2=0.017), once covariates were used in the analysis there were no significant differences between groups in mean DSCT scores (F(2,1011)=0.929, p=0.395, η2=0.002). Similarly there were no differences between groups in mean NART scores once, age, age at illness onset and SEIFA rankings were used as covariates (F(2,1032)=1.617, p=0.199, η2=0.003).. Confounding variables underpin the association between cannabis use and cognitive function in psychotic disorders. Taken together, it would appear that cannabis use or dependence has no additive effect on cognitive dysfunction in these disorders.

Topics: Adult; Australia; Cannabis; Cognition; Cognition Disorders; Cohort Studies; Female; Humans; Intelligence; Intelligence Tests; Male; Marijuana Abuse; Marijuana Smoking; Psychological Tests; Psychotic Disorders; Schizophrenia; Schizophrenic Psychology

Preclinical and clinical research indicates that there are sex differences in how men and women initiate, progress, respond to, and withdraw from cannabis use; however, neurophysiological differences, such as neural responses to cannabis cues, are not well understood. Using functional MRI and an event-related blood oxygen level-dependent backward-masking task, we compared neural responses to backward-masked cannabis cues to neutral cues in treatment-seeking, cannabis-dependent adults (N = 44; 27 males) and examined whether sex differences exist. In addition, functional MRI findings were correlated with cannabis craving. Backward-masked cannabis cues elicited greater neural responses than neutral cues in reward-related brain regions, including the striatum, hippocampus/amygdala, insula, anterior cingulate cortex, and lateral orbitofrontal cortex, p < .01, k > 121 voxels. Although no significant sex differences in neural responses to cannabis cues emerged, women showed a positive correlation between neural responses to cannabis cues in the bilateral insula and cannabis craving and an inverse correlation between neural responses to cannabis cues in the left lateral orbitofrontal cortex and cannabis craving. Men, however, showed a positive correlation between neural responses to cannabis cues in the striatum and cannabis craving. Given that cues and craving are important triggers and the focus on many behavioral treatment approaches, these findings suggest that treatment-seeking, cannabis-dependent men and women may benefit from sex-specific and tailored cannabis use disorder treatments.

Topics: Adolescent; Adult; Brain; Brain Mapping; Cannabis; Craving; Cues; Female; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Male; Marijuana Abuse; Middle Aged; Oxygen; Psychiatric Status Rating Scales; Sex Characteristics; Statistics as Topic; Surveys and Questionnaires; Young Adult

The prevalence of marijuana (MJ) use among youth and its legalization for medical or recreational use has intensified public health endeavors of understanding MJ effects on brain structure and function. Studies indicate that MJ use is related to impaired cognitive performance, and altered functional brain activation and chemistry in adolescents and adults, but MJ effects on brain morphology in emerging adults are less understood.. Fifteen MJ users (age 21.8±3.6, 2 females) and 15 non-user (NU) participants (age 22.3±3.5, 2 females) were included, demographically matched on age, education and alcohol use. High-resolution structural MR images were acquired at 3Tesla. Cortical thickness (CT) and volumetric analyses were performed using Freesurfer. A priori regions of interest (ROI) included orbitofrontal and cingulate cortices, amygdala, hippocampus and thalamus.. Whole brain CT analysis did not result in significant group differences in a priori ROIs but revealed MJ users had significantly less CT (i.e., thinness) in right fusiform gyrus (rFG) compared to NU (p<0.05). Thalamic volume was significantly smaller in MJ users compared to NU (right, p=0.05; left, p=0.01) and associated with greater non-planning (p<0.01) and overall impulsivity (p=0.04). There were no other group differences.. RFG cortical thinness and smaller thalamic volume in emerging adults is associated with MJ abuse. Furthermore, smaller thalamic volume associated with greater impulsivity contributes to growing evidence that the thalamus is neurobiologically perturbed by MJ use. Collectively, altered thalamic and rFG structural integrity may interfere with their known roles in regulating visuoperceptual and object information processing.

Topics: Adolescent; Adult; Amygdala; Atrophy; Cannabis; Case-Control Studies; Cerebral Cortex; Cognition Disorders; Female; Hippocampus; Humans; Impulsive Behavior; Magnetic Resonance Imaging; Male; Marijuana Abuse; Neuroimaging; Thalamus; Young Adult

Topics: Adolescent; Appetite; Biomedical Research; Cannabis; Child; Colorado; Confounding Factors, Epidemiologic; Dronabinol; Humans; Marijuana Abuse; Marijuana Smoking; Medical Marijuana; Multiple Sclerosis; Netherlands; New Zealand; Prevalence; Schizophrenia; Seizures; Sweden; Young Adult

To investigate the impact of inpatient detoxification treatment on psychiatric symptoms of chronic cannabis addicts and to analyze the influence of serum cannabinoid levels on the severity of these symptoms.. Thirty five treatment-seeking, not active co-morbid chronic cannabis dependents (ICD-10) were studied on admission and on abstinence days 8 and 16, using several observational and self-report scales, such as Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Young Mania Rating Scale (YMRS) and Brief Psychiatric Rating Scale (BPRS), and the Symptom Checklist-90-Revised (SCL-90-R). Simultaneously obtained serum was analyzed with regard to levels of delta-9-tetrahydrocannabinol (THC) and its main metabolites 11-hydroxy-delta-9-tetrahydrocannabinol (THC-OH) and 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH).. At admission, nearly 90% of the patients were not, or only mildly, affected by depression, anxiety or manic symptoms. In contrast, patients' self-description indicated a strong psychiatric burden in approximately 60% of the cases. All patients improved significantly within 16 days of the treatment. Effect sizes ranged from 0.7 to 1.4. (Cohen's d) for the respective scales. Serum THC-levels were positively associated with impairment of cognition in HAMA and motor retardation in BPRS. All other test results were not significantly related to the serum levels of the measured cannabinoids.. Effects of the cannabis withdrawal syndrome and executive dysfunctions might explain the discrepancy between the observer ratings and self-reported psychiatric burden.. Inpatient cannabis detoxification treatment significantly improved psychiatric symptoms. Serum THC-levels were not associated with affective symptoms and anxiety but predicted cognitive impairment and motor retardation.

Topics: Cannabis; Comorbidity; Dronabinol; Female; Humans; Inpatients; Male; Marijuana Abuse; Mental Disorders; Prospective Studies; Psychiatric Status Rating Scales; Substance Withdrawal Syndrome

Topics: Cannabis; Carbazoles; Carvedilol; Diagnosis, Differential; Glucose; Hemodialysis Solutions; Humans; Hypoglycemia; Kidney Failure, Chronic; Male; Marijuana Abuse; Marijuana Smoking; Mental Disorders; Patient Compliance; Polypharmacy; Propanolamines; Renal Dialysis; Weight Gain; Young Adult

Topics: Adolescent; Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Medical Marijuana

Topics: Cannabis; Cohort Studies; Humans; Marijuana Abuse; Marijuana Smoking; Psychoses, Substance-Induced; Psychotic Disorders; Risk Factors; Schizophrenia; Smoking; Smoking Cessation; Substance-Related Disorders; Surveys and Questionnaires

According to the gateway hypothesis, tobacco use is a gateway of cannabis use. However, there is increasing evidence that cannabis use also predicts the progression of tobacco use (reverse gateway hypothesis). Unfortunately, the importance of cannabis use compared to other predictors of tobacco use is less clear. The aim of this study was to examine which variables, in addition to cannabis use, best predict the onset of daily cigarette smoking in young men.. A total of 5,590 young Swiss men (mean age = 19.4 years, SD = 1.2) provided data on their substance use, socio-demographic background, religion, health, social context, and personality at baseline and after 18 months. We modelled the predictors of progression to daily cigarette smoking using logistic regression analyses (n = 4,230).. In the multivariate overall model, use of cannabis remained among the strongest predictors for the onset of daily cigarette use. Daily cigarette use was also predicted by a lifetime use of at least 50 cigarettes, occasional cigarette use, educational level, religious affiliation, parental situation, peers with psychiatric problems, and sociability.. Our results highlight the relevance of cannabis use compared to other potential predictors of the progression of tobacco use and thereby support the reverse gateway hypothesis.

Topics: Adult; Age of Onset; Behavior, Addictive; Cannabis; Cohort Studies; Humans; Longitudinal Studies; Male; Marijuana Abuse; Marijuana Smoking; Peer Group; Risk Factors; Smoking; Socioeconomic Factors; Sweden; Tobacco Use Disorder; Young Adult

Topics: Cannabis; Humans; Marijuana Abuse; Marijuana Smoking; Mental Health

Topics: Cannabinoids; Cannabis; Humans; Marijuana Abuse; Psychoses, Substance-Induced; Psychotic Disorders; Risk Factors; Schizophrenia

Topics: Cannabinoids; Cannabis; Humans; Marijuana Abuse; Psychoses, Substance-Induced; Psychotic Disorders; Risk Factors; Schizophrenia

Topics: Cannabinoids; Cannabis; Humans; Marijuana Abuse; Psychoses, Substance-Induced; Psychotic Disorders; Risk Factors; Schizophrenia

Most adolescent cannabis use occurs in social settings among peers. Solitary cannabis use during adolescence may represent an informative divergence from normative behavior with important implications for understanding risk for cannabis problems. This longitudinal study examined associations of adolescent solitary cannabis use with levels of cannabis use and problems in adolescence and in young adulthood.. Cannabis using-adolescents aged 12-18 were recruited from clinical programs (n=354; 43.8% female; 83.3% Caucasian) and community sources (n=93; 52.7% female; 80.6% Caucasian). Participants reported on cannabis use patterns and diagnostic symptoms at baseline and multiple follow-ups into young adulthood.. Compared to social-only users, adolescent solitary cannabis users were more likely to be male and reported more frequent cannabis use and more DSM-IV cannabis use disorder (CUD) symptoms. Regression analyses showed that solitary cannabis use in adolescence predicted CUD symptom counts in young adulthood (age 25) after controlling for demographic variables and the frequency of adolescent cannabis use. However, solitary adolescent cannabis use was no longer predictive of age 25 CUD symptoms after additionally controlling for adolescent CUD symptoms.. Solitary cannabis use is associated with greater cannabis use and problems during adolescence, but evidence is mixed that it predicts young adult cannabis problems.

Topics: Adolescent; Adolescent Behavior; Adult; Cannabis; Diagnostic and Statistical Manual of Mental Disorders; Disease Progression; Female; Humans; Longitudinal Studies; Male; Marijuana Abuse; Marijuana Smoking; Regression Analysis; Risk; Sex Factors; Social Behavior; Young Adult

Cannabis is the most widely used illicit substance among individuals with depressive disorders. This study aimed to evaluate whether among individuals with depressive disorders, higher frequency of cannabis use would be associated with poorer Quality of Life (QoL), based on a large nationally representative US sample. Individuals with depressive disorders (N=3416) were divided into categories according to no use (N=3096), occasional use (less than weekly, N=176) and regular (at least weekly, N=144) use of cannabis in the past 12 months. QoL was assessed using the Short-Form 12 (SF-12) questionnaire. Women who used cannabis regularly had a significantly lower SF-12 Mental Component Summary score (MCS) compared to non-users, with a mean difference of 0.4 Standard Deviations (SDs). Comparison of subscale scores showed no significant differences. No significant difference was noted when comparing women who used cannabis occasionally to non-users. No differences were found among men when comparing MCS and mental subscale scores of both regular and occasional users to non-users. Our findings highlight the importance of taking gender and the frequency of cannabis use into account, when assessing functional and emotional aspects of cannabis use among individuals with depressive disorders.

Topics: Adolescent; Adult; Aged; Cannabis; Depressive Disorder; Female; Humans; Male; Marijuana Abuse; Mental Health; Middle Aged; Psychiatric Status Rating Scales; Quality of Life; Surveys and Questionnaires; Young Adult

The relative contributions of cannabis and alcohol use to educational outcomes are unclear. We examined the extent to which adolescent cannabis or alcohol use predicts educational attainment in emerging adulthood.. Participant-level data were integrated from three longitudinal studies from Australia and New Zealand (Australian Temperament Project, Christchurch Health and Development Study, and Victorian Adolescent Health Cohort Study). The number of participants varied by analysis (N=2179-3678) and were assessed on multiple occasions between ages 13 and 25. We described the association between frequency of cannabis or alcohol use prior to age 17 and high school non-completion, university non-enrolment, and degree non-attainment by age 25. Two other measures of alcohol use in adolescence were also examined.. After covariate adjustment using a propensity score approach, adolescent cannabis use (weekly+) was associated with 1½ to two-fold increases in the odds of high school non-completion (OR=1.60, 95% CI=1.09-2.35), university non-enrolment (OR=1.51, 95% CI=1.06-2.13), and degree non-attainment (OR=1.96, 95% CI=1.36-2.81). In contrast, adjusted associations for all measures of adolescent alcohol use were inconsistent and weaker. Attributable risk estimates indicated adolescent cannabis use accounted for a greater proportion of the overall rate of non-progression with formal education than adolescent alcohol use.. Findings are important to the debate about the relative harms of cannabis and alcohol use. Adolescent cannabis use is a better marker of lower educational attainment than adolescent alcohol use and identifies an important target population for preventive intervention.

Topics: Achievement; Adolescent; Alcohol Drinking; Alcoholism; Australia; Cannabis; Cohort Studies; Educational Status; Female; Humans; Longitudinal Studies; Male; Marijuana Abuse; Marijuana Smoking; New Zealand; Risk Factors; Substance-Related Disorders; Underage Drinking

Topics: Cannabis; Female; Humans; Male; Marijuana Abuse; Substance Abuse Detection

Topics: Adolescent; Adult; Alcoholic Beverages; Alcoholism; Cannabis; Humans; Marijuana Abuse; Risk Factors; Young Adult

Over 300,000 individuals enter treatment for cannabis-use disorders (CUDs) in the United States annually. Cannabis withdrawal is associated with poor CUD-treatment outcomes, but no prior studies have examined sex differences in withdrawal among treatment-seeking cannabis users. Treatment-seeking cannabis users (45 women and 91 men) completed a Marijuana Withdrawal Checklist (Budney, Novy, & Hughes, 1999, Budney, Moore, Vandrey, & Hughes, 2003) at treatment intake to retrospectively characterize withdrawal symptoms experienced during their most recent quit attempt. Scores from the 14-item Composite Withdrawal Discomfort Scale (WDS), a subset of the Marijuana Withdrawal Checklist that corresponds to valid cannabis withdrawal symptoms described in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; APA, 2013) were calculated. Demographic and substance-use characteristics, overall WDS scores, and scores on individual WDS symptoms were compared between women and men. Women had higher overall WDS scores than men, and women had higher scores than men on 6 individual symptoms in 2 domains, mood symptoms (i.e., irritability, restlessness, increased anger, violent outbursts), and gastrointestinal symptoms (i.e., nausea, stomach pain). Follow-up analyses isolating the incidence and severity of WDS symptoms demonstrated that women generally reported a higher number of individual withdrawal symptoms than men, and that they reported experiencing some symptoms as more severe. This is the first report to demonstrate that women seeking treatment for CUDs may experience more withdrawal then men during quit attempts. Prospective studies of sex differences in cannabis withdrawal are warranted.

Topics: Adult; Cannabis; Female; Humans; Incidence; Irritable Mood; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Retrospective Studies; Severity of Illness Index; Sex Characteristics; Substance Withdrawal Syndrome; Young Adult

Cannabis-vaping entails relevant but probably varied effects for public health: it may reduce certain cannabis use-related health risks, but entice cannabis-naive individuals into use due to "cleaner" imagery. Improved evidence is needed to guide informed and differentiated policies for cannabis-vaping, which emphasizes the urgent need for public health-based cannabis regulation.

Topics: Cannabis; Health Policy; Humans; Marijuana Abuse; Marijuana Smoking; Public Health; Vaping

Topics: Cannabis; Humans; Illicit Drugs; Marijuana Abuse; Marijuana Smoking; Occupational Diseases; Occupational Health; Occupational Medicine

Topics: Cannabis; Humans; Illicit Drugs; Marijuana Abuse; Marijuana Smoking; Occupational Diseases; Occupational Health; Occupational Medicine

Cannabis is one of the most commonly drugs used by teenagers. Expectancies about its effects play a crucial role in cannabis consumption. Various tools have been used to assess expectancies, mainly self-report questionnaires measuring explicit expectancies, but implicit measures based on experimental tasks have also been developed, measuring implicit expectancies. The aim of this study was to simultaneously assess implicit/explicit expectancies related to cannabis among adolescent users and non-users. 130 teenagers attending school (55 girls) were enrolled (Age: M=16.40 years); 43.84% had never used cannabis ("non-users") and 56.16% had used cannabis ("users"). They completed self-report questionnaires evaluating cannabis use, cannabis-related problems, effect expectancies (explicit expectancies), alcohol use, social and trait anxiety, depression, as well as three Implicit Association Tests (IAT) assessing implicit expectancies. Adolescents manifested more implicit affective associations (relaxation, excitation, negative) than neutral ones regarding cannabis. These were not related to explicit expectancies. Cannabis users reported more implicit relaxation expectancies and less negative explicit expectancies than non-users. The frequency of use and related problems were positively associated with the explicit expectancies regarding relaxation and enhancement, and were negatively associated with negative explicit expectancies and negative implicit expectancies. Findings indicate that implicit and explicit expectancies play different roles in cannabis use by adolescents. The implications for experimentation and prevention are discussed.

Topics: Adolescent; Adolescent Behavior; Alcohol Drinking; Anxiety; Belgium; Cannabis; Depression; Female; Humans; Male; Marijuana Abuse; Relaxation; Self Report; Young Adult

To assess the associations between types of cannabis control policies at country level and prevalence of adolescent cannabis use.. Multilevel logistic regressions were performed on 172,894 adolescents 15 year of age who participated in the 2001/2002, 2005/2006, or 2009/2010 cross-sectional Health Behaviour in School-Aged Children (HBSC) survey in 38 European and North American countries.. Self-reported cannabis use status was classified into ever use in life time, use in past year, and regular use. Country-level cannabis control policies were categorized into a dichotomous measure (whether or not liberalized) as well as 4 detailed types (full prohibition, depenalization, decriminalization, and partial prohibition). Control variables included individual-level sociodemographic characteristics and country-level economic characteristics.. Considerable intra-class correlations (.15-.19) were found at country level. With respect to the dichotomized cannabis control policy, adolescents were more likely to ever use cannabis (odds ratio (OR) = 1.10, p = .001), use in past year (OR = 1.09, p = .007), and use regularly (OR = 1.26, p = .004). Although boys were substantially more likely to use cannabis, the correlation between cannabis liberalization and cannabis use was smaller in boys than in girls. With respect to detailed types of policies, depenalization was associated with higher odds of past-year use (OR = 1.14, p = .013) and regular use (OR = 1.23, p = .038), and partial prohibition was associated with higher odds of regular use (OR = 2.39, p = .016). The correlation between cannabis liberalization and regular use was only significant after the policy had been introduced for more than 5 years.. Cannabis liberalization with depenalization and partial prohibition policies was associated with higher levels of regular cannabis use among adolescents. The correlations were heterogeneous between genders and between short- and long-terms.

Topics: Adolescent; Adolescent Behavior; Cannabis; Child; Cross-Sectional Studies; Drug and Narcotic Control; Europe; Female; Global Health; Humans; Male; Marijuana Abuse; North America; Odds Ratio; Prevalence; Students

Topics: Animals; Brain; Cannabis; Humans; Marijuana Abuse; Mephitidae; White Matter

Cannabis is the most widely used illicit drug globally, and users are at increased risk of mental illnesses including psychotic disorders such as schizophrenia. Substance dependence and schizophrenia are both associated with dopaminergic dysfunction. It has been proposed, although never directly tested, that the link between cannabis use and schizophrenia is mediated by altered dopaminergic function.. We compared dopamine synthesis capacity in 19 regular cannabis users who experienced psychotic-like symptoms when they consumed cannabis with 19 nonuser sex- and age-matched control subjects. Dopamine synthesis capacity (indexed as the influx rate constant [Formula: see text] ) was measured with positron emission tomography and 3,4-dihydroxy-6-[(18)F]-fluoro-l-phenylalanine ([(18)F]-DOPA).. Cannabis users had reduced dopamine synthesis capacity in the striatum (effect size: .85; t36 = 2.54, p = .016) and its associative (effect size: .85; t36 = 2.54, p = .015) and limbic subdivisions (effect size: .74; t36 = 2.23, p = .032) compared with control subjects. The group difference in dopamine synthesis capacity in cannabis users compared with control subjects was driven by those users meeting cannabis abuse or dependence criteria. Dopamine synthesis capacity was negatively associated with higher levels of cannabis use (r = -.77, p < .001) and positively associated with age of onset of cannabis use (r = .51, p = .027) but was not associated with cannabis-induced psychotic-like symptoms (r = .32, p = .19).. These findings indicate that chronic cannabis use is associated with reduced dopamine synthesis capacity and question the hypothesis that cannabis increases the risk of psychotic disorders by inducing the same dopaminergic alterations seen in schizophrenia.

Topics: Cannabis; Case-Control Studies; Corpus Striatum; Dihydroxyphenylalanine; Dopamine; Dopaminergic Neurons; Female; Functional Neuroimaging; Humans; Male; Marijuana Abuse; Positron-Emission Tomography; Psychoses, Substance-Induced; Young Adult

Cannabis use is associated with the development of psychotic symptoms and increased risk for schizophrenia. The mismatch negativity (MMN) is a brain event-related potential marker of change detection thought to index glutamatergic N-methyl-D-aspartate receptor-mediated neurotransmission, which is known to be deficient in schizophrenia. This study examined auditory MMN in otherwise healthy chronic cannabis users compared with nonuser control subjects.. Forty-two chronic cannabis users and 44 nonuser healthy control subjects completed a multi-feature MMN paradigm, which included duration, frequency, and intensity deviants (deviants 6%; standards 82%). The MMN was compared between users and control subjects as well as between long- and short-term users and age- and gender-matched control subjects. Associations between MMN, cannabis use measures, and symptoms were examined.. The MMN amplitude was significantly reduced to frequency but not duration or intensity deviants in overall cannabis users relative to control subjects. Frequency MMN was similarly attenuated in short- and long-term users relative to control subjects. Long-term users also exhibited reduced duration MMN relative to control subjects and short-term users and this was correlated with increased duration of exposure to cannabis and increased psychotic-like experiences during intoxication. In short-term users, a younger age of onset of regular cannabis use and greater frequency of use were associated with greater psychotic-like experiences and symptomatic distress.. These results suggest impaired sensory memory that might reflect N-methyl-D-aspartate receptor dysfunction in chronic cannabis users. The pattern of MMN alterations in cannabis users differed from that typically observed in patients with schizophrenia, indicating overlapping but distinct underlying pathology.

Topics: Adolescent; Adult; Cannabis; Case-Control Studies; Chronic Disease; Evoked Potentials, Auditory; Female; Humans; Male; Marijuana Abuse; Middle Aged; Receptors, N-Methyl-D-Aspartate; Schizophrenia; Symptom Assessment; Synaptic Transmission; Time Factors; Young Adult

Little is known regarding cannabis administration routes for nonmedical use-that is, its delivery methods (e.g., joints, water pipe, food). Therefore, we examined the prevalence rates of different cannabis delivery methods and assessed the relationship of the distinct administration routes with problematic drug use. Subgroups of cannabis users were also investigated (i.e., "pure" cannabis users, previously described as employing a harmless route of administration, and water pipe users, previously described as using a harmful route of administration).. As part of the Cohort Study on Substance Use Risk Factors, 1,763 cannabis users answered questions concerning their drug use (i.e., routes of administration, problematic cannabis use, other illicit drug use). Descriptive statistics, latent class analysis, correlations and t-tests were assessed.. The main administration route was "joints with tobacco"; other routes of administration had prevalence rates from 23.99% to 38.23%. In addition, increasing the number of administration routes was associated with more problematic cannabis use, as well as heavier illicit drug use. Water pipes without tobacco were especially linked to heavy drug use patterns, whereas "pure" cannabis use seemed less harmful.. Our findings highlighted that diversification in routes of administration can be associated with heavier illicit drug use. This was especially true for water pipe users, whereas "pure" cannabis users, who did not mix cannabis with tobacco, were an exception. Indeed, these results may be useful for future preventive programs, which may need to focus on those who have diversified routes of administration for cannabis.

Topics: Cannabis; Cohort Studies; Drug Administration Routes; Eating; Humans; Male; Marijuana Abuse; Marijuana Smoking; Young Adult

Substance cue reactivity is theorized as having a significant role in addiction processes, promoting compulsive patterns of drug-seeking and drug-taking behavior. However, research extending this phenomenon to cannabis has been limited. To that end, the goal of the current work was to examine the relationship between cannabis cue reactivity and craving in a sample of 353 participants varying in self-reported cannabis use. Participants completed a visual oddball task whereby neutral, exercise, and cannabis cue images were presented, and a neutral auditory oddball task while event-related brain potentials (ERPs) were recorded. Consistent with past research, greater cannabis use was associated with greater reactivity to cannabis images, as reflected in the P300 component of the ERP, but not to neutral auditory oddball cues. The latter indicates the specificity of cue reactivity differences as a function of substance-related cues and not generalized cue reactivity. Additionally, cannabis cue reactivity was significantly related to self-reported cannabis craving as well as problems associated with cannabis use. Implications for cannabis use and addiction more generally are discussed.

Topics: Acoustic Stimulation; Adolescent; Auditory Perception; Brain; Cannabis; Cues; Drug-Seeking Behavior; Event-Related Potentials, P300; Evoked Potentials; Exercise; Female; Humans; Male; Marijuana Abuse; Neuropsychological Tests; Photic Stimulation; Visual Perception

Although previously thought to have no withdrawal symptoms, there is now convergent evidence for a cannabis withdrawal syndrome (CWS), criteria for its diagnosis, and evidence of its impact in the adolescent population. Cannabis withdrawal syndrome represents an important and under-recognized consideration in adolescents with disordered eating. We describe three clinical cases of adolescents presenting to an eating disorders program with primary complaints of gastrointestinal symptoms, food avoidance, and associated weight loss. They did not meet the criteria for an eating disorder, but did fulfill the DSM-5 criteria for CWS. This report emphasizes the importance of considering the impact of heavy cannabis use in adolescents presenting with gastrointestinal complaints, and eating disorder symptoms, including weight loss.

Topics: Adolescent; Cannabinoids; Cannabis; Feeding and Eating Disorders; Female; Humans; Marijuana Abuse; Substance Withdrawal Syndrome

Pregnenolone is considered the inactive precursor of all steroid hormones, and its potential functional effects have been largely uninvestigated. The administration of the main active principle of Cannabis sativa (marijuana), Δ(9)-tetrahydrocannabinol (THC), substantially increases the synthesis of pregnenolone in the brain via activation of the type-1 cannabinoid (CB1) receptor. Pregnenolone then, acting as a signaling-specific inhibitor of the CB1 receptor, reduces several effects of THC. This negative feedback mediated by pregnenolone reveals a previously unknown paracrine/autocrine loop protecting the brain from CB1 receptor overactivation that could open an unforeseen approach for the treatment of cannabis intoxication and addiction.

Topics: Animals; Brain; Cannabinoid Receptor Antagonists; Cannabis; Dronabinol; Male; Marijuana Abuse; Mice; Mice, Inbred C57BL; Pregnenolone; Rats; Rats, Sprague-Dawley; Rats, Wistar; Receptor, Cannabinoid, CB1

Deficits in incentive motivation are often present in both Schizophrenia Spectrum Disorders (SSD) and substance-use disorders. The current study aims to test whether the presence of such deficits confers vulnerability to cannabis use in individuals with SSD. SSD patients (n=35) and healthy controls (n=35) were each divided into a group with (n=20) and a group without (n=15) current cannabis use disorder. Subjects performed a behavioural task designed for schizophrenia patients in which they could seek exposure to pleasant and cannabis visual stimuli on the basis of internal representations of these stimuli. Intensity of cannabis use was assessed by self-report. SSD patients were significantly less likely than controls to exert effort to try to re-view pleasant stimuli but were not significantly less likely to work to avoid unpleasant stimuli. Lack of response to re-view pleasant stimuli significantly predicted higher subsequent cannabis self-administration in patients but not controls, after controlling for degree of prior exposure to cannabis. Deficits in incentive motivation may be an aspect of SSD which promotes cannabis use in this population.

Topics: Adult; Cannabinoids; Cannabis; Case-Control Studies; Cues; Emotions; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Motivation; Reward; Schizophrenia; Schizophrenic Psychology

Topics: Cannabis; Evoked Potentials, Auditory; Female; Humans; Male; Marijuana Abuse

Topics: Adolescent; Animals; Brain; Cannabis; Humans; Marijuana Abuse; Risk Factors; Schizophrenia

Increased delta-9-tetrahydrocannabinol (THC) concentrations in cannabis may lead to higher THC exposure, cannabis dependence and treatment need, but users may also adapt the actual intake of THC through reduced inhalation of THC containing smoke (titration). We investigated whether consumers of stronger cannabis use less cannabis per joint or inhale less smoke than those using less potent cannabis and whether these factors predict cannabis dependence severity.. Heavy cannabis users (n = 98) brought their own cannabis, rolled a joint and smoked it ad libitum in a naturalistic setting. We analysed the content of the joint, its association with smoking behaviour and the cross-sectional and prospective (1.5-year follow-up) relations between smoking behaviour and cannabis dependence severity (total number of DSM-IV dependence symptoms).. THC concentration in cannabis (range 1.10-24.70%) was correlated positively with cannabis dose per joint (b = 0.008, P = 0.01), but the resulting THC concentration per joint (range 0.24-15.72%) was associated negatively with inhalation volume (b = -0.05, P = 0.03). Smoking behaviour measures (number of puffs, inhaled volume, reduction of puff volume and puff duration while smoking) predicted follow-up dependence severity, independently of baseline dependence severity and monthly THC dose (number of joints × cannabis dose × cannabis THC concentration). Monthly THC dose only predicted follow-up dependence severity when unadjusted for baseline severity.. Cannabis users titrate their delta-9-tetrahydrocannabinol intake by inhaling lower volumes of smoke when smoking strong joints, but this does not fully compensate for the higher cannabis doses per joint when using strong cannabis. Thus, users of more potent cannabis are generally exposed to more delta-9-tetrahydrocannabinol. Smoking behaviour appears to be a stronger predictor for cannabis dependence severity than monthly delta-9-tetrahydrocannabinol dose.

Topics: Adult; Cannabis; Chromatography, Gas; Cross-Sectional Studies; Dose-Response Relationship, Drug; Dronabinol; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking; Netherlands; Prospective Studies; Severity of Illness Index; Young Adult

The dose-dependent toxicity of the main psychoactive component of cannabis in brain regions rich in cannabinoid CB1 receptors is well known in animal studies. However, research in humans does not show common findings across studies regarding the brain regions that are affected after long-term exposure to cannabis. In the present study, we investigate (using Voxel-based Morphometry) gray matter changes in a group of regular cannabis smokers in comparison with a group of occasional smokers matched by the years of cannabis use. We provide evidence that regular cannabis use is associated with gray matter volume reduction in the medial temporal cortex, temporal pole, parahippocampal gyrus, insula, and orbitofrontal cortex; these regions are rich in cannabinoid CB1 receptors and functionally associated with motivational, emotional, and affective processing. Furthermore, these changes correlate with the frequency of cannabis use in the 3 months before inclusion in the study. The age of onset of drug use also influences the magnitude of these changes. Significant gray matter volume reduction could result either from heavy consumption unrelated to the age of onset or instead from recreational cannabis use initiated at an adolescent age. In contrast, the larger gray matter volume detected in the cerebellum of regular smokers without any correlation with the monthly consumption of cannabis may be related to developmental (ontogenic) processes that occur in adolescence.

Topics: Adolescent; Adult; Age of Onset; Brain; Cannabis; Gray Matter; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Marijuana Abuse; Marijuana Smoking; Surveys and Questionnaires; Time Factors; Young Adult

Cannabis is the most widely used illicit drug in the United States, with lifetime prevalence of use estimated at 42% to 46%. The antiemetic properties of cannabis are well-known by the medical community and the general public; however, less well-recognized is the paradoxical potential for certain chronic users to develop hyperemesis. We describe in this case a patient with prior extensive work-up for nausea and vomiting and previous diagnosis of cyclic vomiting syndrome who presented with characteristic features of cannabinoid hyperemesis syndrome. We review the current literature for this condition and highlight potential mechanisms for its pathogenesis.

Topics: Adult; Cannabinoids; Cannabis; Humans; Male; Marijuana Abuse; Nausea; Syndrome; Vomiting

Cannabis is the most widely used illicit drug in the world, and regular use has been associated with reduced motivation, i.e. apathy. Regular long-term cannabis use has been associated with reduced dopamine synthesis capacity. The mesolimbic dopaminergic system mediates the processing of incentive stimuli by modifying their motivational value, which in turn is modulated by endocannabinoid signalling. Thus, it has been proposed that dopaminergic dysfunction underlies the apathy associated with chronic cannabis use.. The aim of this study was to examine the relationship between dopaminergic function and subjective apathy in cannabis users.. We measured dopamine synthesis capacity (indexed as the influx rate constant K i(cer)) via 3,4-dihydroxy-6-[(18)F]-fluoro-l-phenylalanine positron emission tomography and subjective apathy using the self-rated Apathy Evaluation Scale (AES-S) in 14 regular cannabis users.. All subjects scored in excess of 34 points on the AES-S (median [interquartile range] 59.5 [7.5]), indicative of significant apathy based on normative data. K i (cer) was inversely correlated to AES-S score in the whole striatum and its associative functional subdivision (Spearman's rho = -0.64, p = 0.015 [whole striatum]; rho = -0.69, p = 0.006 [associative]) but not in the limbic or sensorimotor striatal subdivisions. There were no significant relationships between AES-S and current cannabis consumption (rho = 0.28, p = 0.34) or age of first cannabis use (rho = 0.25, p = 0.40).. These findings indicate that the reduction in striatal dopamine synthesis capacity associated with chronic cannabis use may underlie reduced reward sensitivity and a motivation associated with chronic cannabis use.

Topics: Apathy; Brain; Brain Mapping; Cannabis; Cohort Studies; Corpus Striatum; Dihydroxyphenylalanine; Dopamine; Female; Fluorine Radioisotopes; Humans; Male; Marijuana Abuse; Positron-Emission Tomography; Psychiatric Status Rating Scales; Radiopharmaceuticals; Self Report; Young Adult

Topics: Adolescent; Adult; Attention; Cannabis; Executive Function; Humans; Marijuana Abuse; Marijuana Smoking; Memory; Public Health; Young Adult

Topics: Adolescent; Adult; Alcoholism; Brain; Cannabis; Humans; Illicit Drugs; Marijuana Abuse; Marijuana Smoking; National Institutes of Health (U.S.); United States; Young Adult

Topics: Cannabis; Humans; Illicit Drugs; Marijuana Abuse; Marijuana Smoking; Neurosciences

Topics: Cannabis; Dronabinol; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking

Dysfunctional reward processing is present in individuals with schizophrenia-spectrum disorders (SSD) and may confer vulnerability to addiction. Our objective was to identify a deficit in patients with SSD on response to rewarding stimuli and determine whether this deficit predicts cannabis use.. We divided a group of patients with SSD and nonpsychotic controls into cannabis users and nonusers. Response to emotional and cannabis-associated visual stimuli was assessed using self-report, event-related potentials (using the late positive potential [LPP]), facial electromyography and skin-conductance response.. Our sample comprised 35 patients with SSD and 35 nonpsychotic controls. Compared with controls, the patients with SSD showed blunted LPP response to pleasant stimuli (p = 0.003). Across measures, cannabis-using controls showed greater response to pleasant stimuli than to cannabis stimuli whereas cannabis-using patients showed little bias toward pleasant stimuli. Reduced LPP response to pleasant stimuli was predictive of more frequent subsequent cannabis use (β = -0.24, p = 0.034).. It is not clear if the deficit associated with cannabis use is specific to rewarding stimuli or nonspecific to any kind of emotionally salient stimuli.. The LPP captures a reward-processing deficit in patients with SSD and shows potential as a biomarker for identifying patients at risk of heavy cannabis use.

Topics: Adult; Brain; Cannabis; Cues; Electroencephalography; Electromyography; Evoked Potentials, Visual; Facial Muscles; Galvanic Skin Response; Heterosexuality; Humans; Male; Marijuana Abuse; Neuropsychological Tests; Photic Stimulation; Prognosis; Psychotic Disorders; Reward; Schizophrenic Psychology; Tobacco Use Disorder; Visual Perception

A new method for administering cannabinoids, called butane hash oil ("dabs"), is gaining popularity among marijuana users. Despite press reports that suggest that "dabbing" is riskier than smoking flower cannabis, no data address whether dabs users experience more problems from use than those who prefer flower cannabis.. The present study aimed to gather preliminary information on dabs users and test whether dabs use is associated with more problems than using flower cannabis.. Participants (n=357) reported on their history of cannabis use, their experience with hash oil and the process of "dabbing," reasons for choosing "dabs" over other methods, and any problems related to both flower cannabis and butane hash oil.. Analyses revealed that using "dabs" created no more problems or accidents than using flower cannabis. Participants did report that "dabs" led to higher tolerance and withdrawal (as defined by the participants), suggesting that the practice might be more likely to lead to symptoms of addiction or dependence.. The use of butane hash oil has spread outside of the medical marijuana community, and users view it as significantly more dangerous than other forms of cannabis use.

Topics: Adolescent; Adult; Aged; Attitude to Health; Butanes; Cannabis; Dronabinol; Female; Humans; Male; Marijuana Abuse; Middle Aged; Oils; Psychotropic Drugs; Young Adult

This paper investigates the link between cannabis depenalisation and crime using individual-level panel data for England and Wales from 2003 to 2006. We exploit the declassification of cannabis in the UK in 2004 as a natural experiment. Specifically, we use the fact that the declassification changed expected punishments differently in various age groups due to thresholds in British criminal law and employ a difference-in-differences type design using data from the longitudinal version of the Offending, Crime and Justice Survey. Our findings suggest essentially no increases in either cannabis consumption, consumption of other drugs, crime and other forms of risky behaviour.

Topics: Adolescent; Adult; Cannabis; Crime; Criminal Law; Empirical Research; England; Humans; Marijuana Abuse; Risk-Taking; Social Control Policies; Wales; Young Adult

Topics: Cannabis; Drug and Narcotic Control; Humans; Marijuana Abuse; Marijuana Smoking

To evaluate several psychometric properties of a questionnaire designed to assess college students' self-efficacy to employ 21 cognitive-behavioral strategies intended to reduce the amount and/or frequency with which they consume marijuana, we recruited 273 marijuana-using students to rate their confidence that they could employ each of the strategies. Examination of frequency counts for each item, principal components analysis, internal consistency reliability, and mean interitem correlation supported retaining all 21 items in a single scale. In support of criterion validity, marijuana use-reduction self-efficacy scores were significantly positively correlated with cross-situational confidence to abstain from marijuana, and significantly negatively correlated with quantity and frequency of marijuana use and marijuana-related problems. In addition, compared with respondents whose use of marijuana either increased or remained stable, self-efficacy was significantly higher among those who had decreased their use of marijuana over the past year. This relatively short and easily administered questionnaire could be used to identify college students who have low self-efficacy to employ specific marijuana reduction strategies and as an outcome measure to evaluate educational and skill-training interventions.

Topics: Adolescent; Adult; Cannabis; Female; Humans; Male; Marijuana Abuse; Psychometrics; Reproducibility of Results; Self Efficacy; Students; Surveys and Questionnaires; Young Adult

The purpose of the current study is to assess statistical associations between individual demographic and personality characteristics, the city-level physical availability of medical marijuana (as measured through densities per roadway mile of storefront dispensaries and delivery services), and the incidence and prevalence of marijuana use.. Individual level data on marijuana use were collected during a telephone survey of 8853 respondents living in 50 mid-size cities in California. Data on medical marijuana dispensaries and delivery services were obtained via six different websites and official city lists. Three outcome variables pertaining to lifetime, past year use, and frequency of past year use were analyzed using random effects logistic models (for lifetime and past year use) and random effects tobit models (for frequency of past 365-day use).. The current study finds that the total physical availability of medical marijuana through dispensaries and delivery services per roadway mile at the city-level is positively related to current marijuana use and greater frequency of use, controlling for a variety of demographic and personality characteristics. As expected, current physical availability of medical marijuana was unrelated to lifetime use.. Regulations on the number and densities of marijuana outlets may be a sufficient means to restrain overall levels of marijuana use within cities. However, alternative use of delivery services may also provide easy access to marijuana and mitigate these effects.

Topics: Adolescent; Adult; Aged; California; Cannabis; Female; Health Services Accessibility; Health Surveys; Humans; Logistic Models; Male; Marijuana Abuse; Medical Marijuana; Middle Aged; Prevalence; Urban Population; Young Adult

Topics: Cannabis; Dronabinol; Female; Humans; Male; Marijuana Abuse; Marijuana Smoking

Cannabis-induced psychotic disorder (CIPD) refers to psychotic symptoms that arise in the context of cannabis intoxication. Prepulse inhibition (PPI) deficits have been extensively identified in schizophrenia and in cannabis abusers. We aimed to characterize PPI in CIPD patients. We used a sample of 48 CIPD patients, 54 schizophrenia patients and cannabis abuse (SCHZ), 44 cannabis dependents (CD), and 44 controls. CIPD, SCHZ and CD were abstinent of cannabis consumption for 9 months. Participants were assessed with PPI at 30, 60, and 120 ms. At 30 ms, CIPD showed lower PPI levels than controls, and SCHZ obtained worse functioning than controls and CD. At 60 ms, only SCHZ exhibited worse PPI percentages (of object) than controls. Finally, at 120 ms, CIPD showed higher PPI levels than SCHZ, and SCHZ obtained lower percentages than controls. We found that CIPD and SCHZ patients showed deficits at the most pre-attentional levels, whereas CIPD patients performed better than SCHZ at higher attentional levels. These results suggest that CIPD constitutes a different group of patients than that of SCHZ. Deficits in PPI functioning at 30 ms could be a useful psychophysiological measure to detect CIPD patients, who are frequently confused with cannabis abusers whose symptoms may mimic that of schizophrenia.

Topics: Adult; Attention; Cannabis; Female; Humans; Male; Marijuana Abuse; Prepulse Inhibition; Psychoses, Substance-Induced; Reflex, Startle; Schizophrenic Psychology; Young Adult

Cannabis intoxication in toddlers is rare and mostly accidental. Our objectives were to focus on the characteristics and management of children under the age of 6 years who were admitted to our emergency department with cannabis poisoning reported as accidental by parents, and to point out the need to consider accidental cannabis ingestions as an indicator of neglect.. The medical records of children hospitalized for cannabis poisoning in a pediatric emergency department from January 2007 to November 2012 were retrospectively evaluated. Data collected included age, sex, drug ingested, source of drug, intentional versus accidental ingestion, pediatric intensive care unit or hospital admission, treatment and length of hospital stay, toxicology results, and rate of child protectives services referral.. Twelve toddlers (4 boys and 8 girls; mean age, 16.6 months) were included. All had ingested cannabis. Their parents reported the ingestion. Seven children experienced drowsiness or hypotonia. Three children were given activated charcoal. Blood screening for cannabinoids, performed in 2 cases, was negative in both, and urine samples were positive in 7 children (70%). All children had favorable outcomes after being hospitalized from 2 to 48 hours. Nine children were referred to social services for further assessment before discharge.. Cannabis intoxication in children should be reported to child protection services with the aim of prevention, to detect situations of neglect and at-risk families. Legal action against the parents may be considered. Accidental intoxication and caring parents should be no exception to this rule.

Topics: Cannabis; Charcoal; Child, Preschool; Female; Humans; Infant; Male; Marijuana Abuse; Parent-Child Relations; Retrospective Studies; Substance Abuse Detection

Topics: Acute Disease; Adult; Cannabis; Humans; Ischemic Attack, Transient; Magnetic Resonance Angiography; Male; Marijuana Abuse

In recent years, epidemiological data confirm that cannabis-related emergencies, cannabis-use disorders and dependence are significantly increased. Cannabis is generally considered a little dangerous substances of abuse, however, chronic consumption has been associated to the development of mental disorders, cognitive deficits, chronic bronchitis, emphysema, increased risk of myocardial infarction in the hour after use, increased mortality after myocardial infarction, liver inflammation and steatosis in patients affected by hepatitis C. In this article we described the pharmacological characteristics of Magnolia officinalis bark active principles suggesting a potential application in the treatment of both cannabis dependence and cannabis-related disorders.

Topics: Animals; Biphenyl Compounds; Cannabis; Humans; Inflammation; Lignans; Magnolia; Marijuana Abuse; Plant Bark; Plant Extracts; Polyphenols; Rats; Receptor, Cannabinoid, CB1; Receptor, Cannabinoid, CB2; Receptors, Cannabinoid; Receptors, G-Protein-Coupled