Co-occurrence across time and space of drug- and cannabinoid- exposure and adverse mental health outcomes in the National Survey of Drug Use and Health: combined geotemporospatial and causal inference analysis

Abstract

Background: Whilst many studies have linked increased drug and cannabis exposure to adverse mental health (MH) outcomes their effects on whole populations and geotemporospatial relationships are not well understood. Methods Ecological cohort study of National Survey of Drug Use and Health (NSDUH) geographically-linked substate-shapefiles 2010–2012 and 2014–2016 supplemented by five-year US American Community Survey. Drugs: cigarettes, alcohol abuse, last-month cannabis use and last-year cocaine use. MH: any mental illness, major depressive illness, serious mental illness and suicidal thinking. Data analysis: two-stage, geotemporospatial, robust generalized linear regression and causal inference methods in R. Results 410,138 NSDUH respondents. Average response rate 76.7%. When drug and sociodemographic variables were combined in geospatial models significant terms including tobacco, alcohol, cannabis exposure and various ethnicities remained in final models for all four major mental health outcomes. Interactive terms including cannabis were related to any mental illness (β-estimate = 1.97 (95%C.I. 1.56–2.37), P < 2.2 × 10− 16), major depressive episode (β-estimate = 2.03 (1.54–2.52), P = 3.6 × 10− 16), serious mental illness (SMI, β-estimate = 2.04 (1.48–2.60), P = 1.0 × 10− 12), suicidal ideation (β-estimate = 1.99 (1.52–2.47), P < 2.2 × 10− 16) and in each case cannabis alone was significantly associated (from β-estimate = − 3.43 (− 4.46 − −2.42), P = 3.4 × 10− 11) with adverse MH outcomes on complex interactive regression surfaces. Geospatial modelling showed a monotonic upward trajectory of SMI which doubled (3.62 to 7.06%) as cannabis use increased. Extrapolated to whole populations cannabis decriminalization (4.26%, (4.18, 4.34%)), Prevalence Ratio (PR) = 1.035(1.034–1.036), attributable fraction in the exposed (AFE) = 3.28%(3.18–3.37%), P < 10− 300) and legalization (4.75% (4.65, 4.84%), PR = 1.155 (1.153–1.158), AFE = 12.91% (12.72–13.10%), P < 10− 300) were associated with increased SMI vs. illegal status (4.26, (4.18–4.33%)). Conclusions Data show all four indices of mental ill-health track cannabis exposure across space and time and are robust to multivariable adjustment for ethnicity, socioeconomics and other drug use. MH deteriorated with cannabis legalization. Cannabis use-MH data are consistent with causal relationships in the forward direction and include dose-response and temporal-sequential relationships. Together with similar international reports and numerous mechanistic studies preventative action to reduce cannabis use is indicated.

Medical conditions of primary care patients with documented cannabis use and cannabis use disorder in electronic health records: a case control study from an academic health system in a medical marijuana state

“…Moreover, CUD-documented patients were over three times as likely as CU patients to have schizophrenia/psychotic disorders, and over twice as likely to have depression or anxiety diagnoses. These findings support the extensive body of research demonstrating a correlation between cannabis use and mental health problems [ 8 , 11 , 16 , 41 – 44 ] and the association between cannabis use documentation and the presence of psychiatric diagnoses in EHRs [ 15 , 17 ]. They also underscore the importance of screening and assessment for co-occurring mental health disorders among people who use cannabis or have cannabis use disorders, and ensuring that they receive evidence-based psychosocial and pharmacological interventions as needed [ 45 – 48 ].…”

Geospatiotemporal and causal inference study of cannabis and other drugs as risk factors for female breast cancer USA 2003–2017

“…Cannabinoid genotoxicity can be expected to manifest in public health in the clinical domains of congenital anomalies and cancer epidemiology. Combining recent multi-jurisdictional congenital anomaly data from Colorado, Hawaii, Canada, Australia and the USA [ 64 , 103–105 , 157 , 167 , 168 ] with the present report and previous testicular and paediatric cancer reports [ 12–15 , 18 , 21 , 33 , 34 , 36 , 38 , 39 ], together with well-documented negative impacts on mental health [ 66 ] and paediatric autism rates [ 62 , 63 , 100 ], the conclusion that widespread cannabis genotoxicity and neurotoxicity as implicit in cannabis-liberal paradigms constitute an impending public health disaster of catastrophic proportions seems inescapable. Further historical and time-projected health econometric quantitative studies across these wide domains of clinical pathology are indicated.…”

Socioeconomic, Ethnocultural, Substance- and Cannabinoid-Related Epidemiology of Down Syndrome USA 1986–2016: Combined Geotemporospatial and Causal Inference Investigation

“…In short the well described implication of cannabis with heritable clinical genotoxic syndromes is a major motivation for carefully controlling the community penetration of cannabinoid products of all types in line with the way known genotoxins are handled, addressed and carefully controlled in every other entry in the pharmacopeia of western medicine. This statement in relation to cannabinoid genotoxicity is strongly supported by the now known causal links relating to cannabinoid neurotoxicity both in the exposed, expressed as high rates of mental illness in young American adults [ 97 ], and in their offspring, expressed as high and rapidly increasing rates of child autism across USA [ 98 , 99 , 100 ].…”