Cannabis use among a nationally representative cross-sectional sample of smokers and non-smokers in the Netherlands: results from the 2015 ITC Netherlands Gold Magic Survey

Fix, Brian V.; Smith, Danielle M.; O’Connor, Richard J.; Heckman, Bryan W.; Willemsen, Marc C.; Cummings, Michael; Fong, Geoffrey T.

doi:10.1136/bmjopen-2018-024497

Cited by 19 publications

(16 citation statements)

References 15 publications

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“…For example, this would be the case if male smokers were 15 times more likely to also use cannabis than non-smokers AND cannabis users were 10 times more likely to develop schizophrenia. Using evidence from the literature, the point represented by an OR of 3.90 for schizophrenia in cannabis users compared to non-users (Marconi, Di Forti, Lewis, Murray, & Vassos, 2016) and an OR of 4.13 for cannabis use in smokers compared to non-smokers (Fix et al, 2019) falls below and to the left both of the curve for the IRR and the lower bound of its 95% CI. This suggests that cannabis use cannot fully explain the association we found between smoking and schizophrenia.…”

Section: Resultsmentioning

confidence: 99%

Cigarette smoking as a risk factor for schizophrenia or all non-affective psychoses

et al. 2020

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Background Smoking tobacco is regarded as an epiphenomenon in patients with schizophrenia when it may be causal. We aimed to examine whether smoking status is related to the onset of schizophrenia or the broader diagnosis of non-affective psychosis, including schizophrenia. Methods We used data from The Health Improvement Network primary care database to identify people aged 15–24 between 1 January 2004 and 31 December 2009. We followed them until the earliest of: first diagnosis of schizophrenia (or psychosis), patient left the practice, practice left THIN, patient died or 31 December 2014. Results In men, incidence rates for schizophrenia per 100 000 person years at risk were higher in smoking initiators (non-smoker who became a smoker during the study) than in non-smokers (adjusted IRR 1.94; 95% CI 1.29–2.91) and higher still in smokers (adjusted IRR 3.32; 95% CI 2.67–4.14). Among women, the incidence rate of schizophrenia was higher in smokers than in non-smokers (adjusted IRR 1.50; 95% CI 1.06–2.12), but no higher in smoking initiators than non-smokers. For non-affective psychosis, the pattern was similar for men but more evident in women where psychosis incidence rates were higher in smoking initiators (adjusted IRR 1.90; 95% CI 1.40–2.56) and in smokers (adjusted IRR 2.13; 95% CI 1.76–2.57) than in non-smokers. Conclusions We found an important and strong association between smoking and incidence of schizophrenia. Smoking may increase risk through as yet unknown pathways or smoking may share genetic risk with schizophrenia and non-affective psychoses.

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Section: Resultsmentioning

confidence: 99%

Cigarette smoking as a risk factor for schizophrenia or all non-affective psychoses

et al. 2020

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“…The practice of co-administering cannabis with tobacco, but not identifying as a tobacco user, has been found elsewhere [10,30]. In qualitative studies, young cannabis users [31,32] describe co-administration as facilitating burning, and this is how they learned to smoke cannabis.…”

Section: Hidden Tobacco Exposurementioning

confidence: 99%

“…Cannabis and tobacco are commonly used together world-wide, by the same individuals, and in the same time period [10][11][12][13][14][15][16]. In the United Kingdom and Europe, it is also common to co-administer cannabis with tobacco in the same product (a joint/spliff).…”

Section: Introductionmentioning

confidence: 99%

Cannabis use and co‐use in tobacco smokers and non‐smokers: prevalence and associations with mental health in a cross‐sectional, nationally representative sample of adults in Great Britain, 2020

et al. 2021

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Background and aims In Great Britain, cannabis and tobacco are commonly used substances, both independently and together. Use of either substance is associated with mental health problems, but prevalence of co‐use within these populations is unknown. We aimed to (1) estimate prevalence of cannabis use, frequency of use and routes of administration (ROA) among tobacco smokers and non‐smokers and (2) investigate mental health problems among non‐users, tobacco‐only, cannabis‐only and co‐users of both substances. Design Cross‐sectional national on‐line survey (Action on Smoking and Health) fielded in February–March 2020. Setting Great Britain. Participants Adults in Great Britain aged ≥ 18 years (n = 12 809) Measurements Tobacco use status [smoker (daily or non‐daily) or non‐smoker (never or ex‐smoker)], cannabis use frequency (never to daily), detailed ROAs of cannabis, self‐reported treatment for mental health disorders (depression, anxiety and any). Statistically weighted prevalence estimates were computed to ensure representativeness. Correlates were assessed using χ2 tests and logistic regression. Findings In Great Britain in 2020, 7.1% of the sample had used cannabis in the past year. Tobacco smokers had greater odds of using cannabis in the past year (21.9%) and using cannabis daily (8.7%) than non‐smokers [past‐year: 4.7%; adjusted odds ratio (aOR) = 10.07, 95% confidence interval (CI) = 8.4–12.0; daily: 0.7%; aOR = 24.6, 95% CI = 18.0–33.6)]. Co‐administration with tobacco was common (46.2% of non‐smokers, 80.8% of tobacco smokers). Co‐users reported the highest prevalence of any treatment for mental health problems (54.2%) in comparison to cannabis‐only (45.8%), tobacco‐only (33.2%) and non‐users (22.7%; all P ≤ 0.05). Conclusion Approximately one in 13 adults in Great Britain reports having used cannabis in the past year, approximately four times as many among cigarette smokers as non‐smokers. Co‐administration of cannabis and tobacco, via smoking, appears to be common, including among self‐identified non‐smokers. Mental health problems appear to be particularly common among dual users.

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“…These data have been essential in demonstrating use of cannabis and tobacco is entangled, common and frequent across the life-span. Cannabis use [and cannabis use disorder (CUD)] is more common among tobacco users [7][8][9][10][11] and tobacco use [tobacco/nicotine use disorder (TUD/ NUD) is common in cannabis users [12][13][14]. Figure 1 illustrates how the relationship between CUD and NUD becomes stronger with increasing severity of CUD, in comparison to other mood/substance use disorders.…”

Section: Prevalence Of Cannabis and Tobacco Use Globallymentioning

confidence: 99%

“…Additionally, there is hidden tobacco exposure among non-smokers who use cannabis [8,9]. Nationally representative data from Europe show that smoking spliffs is common among non-cigarette smokers (76.5%).…”

Section: A Hidden Population Of Co-usersmentioning

confidence: 99%

Unknown population‐level harms of cannabis and tobacco co‐use: if you don't measure it, you can't manage it

Hindocha

McClure

2020

Addiction

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Background Nationally representative data of cannabis-tobacco co-use have shown that these substances are closely entwined and have significant adverse health consequences, although population-level harms of co-use are largely unknown. Current epidemiological research does not assess co-use in a manner that has yielded the necessary data to draw conclusions regarding health effects. This has given rise to a hidden population of co-users who go under-served. Therefore, this paper has two aims: (1) to review new challenges in the collection of co-use data due to rapidly changing regulations of cannabis and nicotine products and (2) to provide recommendations for the terminology and assessment of couse. Argument We argue that: (1) the prevalence of co-use is not being assessed accurately at a population level and (2) changes in legalization have created novel challenges, but without proper monitoring the impact on co-use will go undetected. We propose a three-level tiered set of recommendations for co-use assessments, which includes assessments of cannabis, tobacco and co-use metrics ranging from least burdensome (self-report of co-administered products) to most burdensome (assays, event-level data). Conclusions We propose that clinical studies begin to incorporate cannabistobacco co-use assessments to justify better their inclusion in clinical trials and national surveillance surveys. Integration of co-use assessments will aid in understanding the true impact on co-use of the changing cannabis and tobacco/nicotine regulatory environments. Co-use is prevalent and problematic, and the ability to make conclusions about its health outcomes is hindered by lack of nuance in data collection. If you do not measure it, you cannot manage it.

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Cannabis use among a nationally representative cross-sectional sample of smokers and non-smokers in the Netherlands: results from the 2015 ITC Netherlands Gold Magic Survey

Cited by 19 publications

References 15 publications

Cigarette smoking as a risk factor for schizophrenia or all non-affective psychoses

Cigarette smoking as a risk factor for schizophrenia or all non-affective psychoses

Cannabis use and co‐use in tobacco smokers and non‐smokers: prevalence and associations with mental health in a cross‐sectional, nationally representative sample of adults in Great Britain, 2020

Unknown population‐level harms of cannabis and tobacco co‐use: if you don't measure it, you can't manage it

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