Early, Chronic, and Acute Cannabis Exposure and Their Relationship With Cognitive and Behavioral Harms

Abstract

Background: Cannabis is the third most consumed drug worldwide. Thus, healthcare providers should be able to identify users who are in need for an intervention. This study aims to explore the relationship of acute, chronic, and early exposure (AE, CE, and EE) to cannabis with cognitive and behavioral harms (CBH), as a first step toward defining risky cannabis use criteria.Methods: Adults living in Spain who used cannabis at least once during the last year answered an online survey about cannabis use and health-related harms. Cannabis use was assessed in five dimensions: quantity on use days during the last 30 days (AE), frequency of use in the last month (AE), years of regular use (YRCU) (CE), age of first use (AOf) (EE), and age of onset of regular use (AOr) (EE). CBH indicators included validated instruments and custom-made items. Pearson correlations were calculated for continuous variables, and Student's t-tests for independent samples were calculated for categorical variables. Effect sizes were calculated for each of the five dimensions of use (Cohen's d or r Pearson correlation) and harm outcome. Classification and Regression Trees (CART) analyses were performed for those dependent variables (harms) significantly associated with at least two dimensions of cannabis use patterns. Lastly, logistic binary analyses were conducted for each harm outcome.Results: The mean age of participants was 26.2 years old [standard deviation (SD) 8.5]. Out of 2,124 respondents, 1,606 (75.6%) reported at least one harm outcome (mean 1.8 and SD 1.5). In our sample, using cannabis on 3 out of 4 days was associated with an 8-fold probability of scoring 4+ on the Severity Dependence Scale (OR 8.33, 95% CI 4.91–14.16, p <0.001), which is indicative of a cannabis use disorder. Also, a start of regular cannabis use before the age of 25 combined with using cannabis at least once per month was associated with a higher probability of risky alcohol use (OR 1.33, 95% CI 1.12–1.57, p = 0.001). Besides, a start of regular cannabis use before the age of 18 combined with a period of regular use of at least 7.5 years was associated with a higher probability of reporting a motor vehicle accident (OR 1.81, 95% CI 1.41–2.32, p < 0.0001). Results were ambiguous regarding the role that age of first use and milligrams of THC per day of use might play regarding cannabis-related harms.Conclusions: The relationship among AE, CE, and EE with CBH indicators is a complex phenomenon that deserves further studies. The pattern of cannabis use should be carefully and widely evaluated—(not just including frequency but also other dimensions of pattern of use)—in research (preferably in longitudinal studies) to assess cannabis-related harms.

Cannabis-Induced Anxiety Disorder in the Emergency Department

“…These have included panic attacks, paranoia, depression, suicidal ideation, behavioral crises, and even homicidal ideation (Table 2). The psychoactive constituents in marijuana, of which D9-tetrahydrocannabinol (THC) is the main ingredient, disrupt the innate functioning of the endocannabinoid system, which plays a vital role in anxiety, depression, cognition, and many other functions [15][16][17]. The word cannabinoid refers to any chemical substance, regardless of origin or structure, that binds to the cannabinoid receptors of the body and brain [17].…”

“…The psychoactive constituents in marijuana, of which D9-tetrahydrocannabinol (THC) is the main ingredient, disrupt the innate functioning of the endocannabinoid system, which plays a vital role in anxiety, depression, cognition, and many other functions [15][16][17]. The word cannabinoid refers to any chemical substance, regardless of origin or structure, that binds to the cannabinoid receptors of the body and brain [17]. The pathophysiology by which this plant causes an anxiogenic effect in some individuals is poorly understood.…”

Evaluation of the Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Questionnaire and its Relations to Cannabis-Related Problems

“…As quantity of use increases, the odds of having CUD increase, even after controlling for frequency of use and age of onset ( Callaghan et al, 2020 ). Further, past month quantity is significantly positively correlated with dependence symptoms ( López-Pelayo et al, 2021 ). Given difficulty in defining quantity, Zeisser et al (2012) attempted to create a “standard joint” (i.e., 10 puffs on a joint, 5 hits on a bong or pipe, or 0.5 grams of cannabis).…”

“…Another factor that may influence the experience of cannabis-related problems and CUD is age of onset (i.e., age of first cannabis use). Though recent work assessing age of onset is limited, several studies found that earlier age of onset (i.e., adolescence) is associated with increased odds of cannabis dependence ( López-Pelayo et al, 2021 ; Richmond-Rakerd, et al, 2016 ) and higher current frequency of use ( Azagba & Asbridge, 2019 ). However, the relation between age of onset and cannabis-related problems may become non-significant when frequency is controlled for ( Rioux et al, 2018 ).…”