Cannabis Use and Risk of Psychiatric Disorders

Abstract

IMPORTANCE 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. OBJECTIVE To examine prospective associations between cannabis use and risk of mental health and substance use disorders in the general adult population. DESIGN, SETTING, AND PARTICIPANTS 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. MAIN OUTCOMES AND MEASURES 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. RESULTS 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

Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States

“…In accord with prior studies, several demographic and clinical covariates were associated with cannabis use (17). These findings converge to highlight the wide range of factors that may influence initiation of cannabis.…”

“…An independent prospective association between cannabis use and onset of prescription opioid use disorder extends results from prior epidemiological research concerning a link between cannabis use and other forms problematic drug use (15–17). Previous work in this area has either been retrospective in design (15) or focused on general associations between cannabis use and substance use disorders (17) or problems (16) rather than specifically nonmedical opioid use or opioid use disorder.…”

“…Previous work in this area has either been retrospective in design (15) or focused on general associations between cannabis use and substance use disorders (17) or problems (16) rather than specifically nonmedical opioid use or opioid use disorder. Because in the present study the association was observed among adults with less than disorder-level of cannabis use and followed a dose response pattern, it suggests that some increased risk extends to a relatively large population of adult cannabis users.…”

“…A retrospective Australian twin study reported that early initiation of cannabis use was associated with increased risks of other drug use and abuse/dependence including opioid use and opioid abuse/dependence (16). Prospective epidemiological research further suggests that cannabis use is a risk factor for other drug use disorders (17). However, prospective epidemiological research has not previously examined the specific association between cannabis use and nonmedical opioid use or opioid use disorder to inform clinical practice and policy.…”

Frequency of Cannabis Use Among Primary Care Patients in Washington State

“…Cannabis use poses other significant health risks, which increase with the frequency and intensity of use: 1) central nervous system impairment, acute (e.g., judgment, coordination) and chronic (e.g., memory, cognition), 29 2) exacerbation and persistence of psychiatric symptoms (e.g., depression, psychosis), 30 3) development of other drug use disorders, including nicotine and alcohol 31 4) prescription medication interactions (e.g., antidepressants, opioids), 32 5) prenatal exposure during pregnancy, 33 6) pulmonary symptoms 29 and 7) accidents, particularly motor vehicle accidents. 34 Finally, frequent use of cannabis can cause significant withdrawal, which appears clinically similar to tobacco and opioid withdrawal, with symptoms of anxiety, irritability, depressed mood, disturbed sleep, decreased appetite and restlessness.…”