Assessing Cannabis Use Disorder in Medical Cannabis Patients: Interim Analyses from an Observational, Longitudinal Study

Background: To date, no studies have directly assessed potential cannabis use disorder (CUD) in medical cannabis (MC) patients pre- vs post-MC treatment. Given that MC patients use cannabis for symptom alleviation rather than intoxication, we hypothesized that MC patients would exhibit few symptoms of CUD after initiating MC treatment. Methods: As part of an ongoing observational, longitudinal study, 54 MC patients completed baseline assessments prior to initiating MC use and returned for at least one follow-up assessment after three, six, and/or twelve months of a self-selected MC treatment regimen; detailed MC treatment information was collected and quantified. All patients completed the Cannabis Use Disorder Identification Test - Revised (CUDIT-R) at each visit. Changes in individual items scores and total scores were assessed over time, and we examined whether total CUDIT-R scores correlated with frequency of MC use, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) exposure. Further, Cronbach’s alpha analyses were conducted to provide preliminary data regarding the psychometric properties of the CUDIT-R when used among MC patients. Results: Although total CUDIT-R scores increased relative to baseline, on average, ratings fell below the ‘hazardous use’ threshold at each visit. Analyses of individual items revealed that increases in total scores were primarily attributable to increases in frequency of use and not necessarily other aspects of problematic use. Total CUDIT-R scores were not associated with number of MC uses or CBD exposure, but a significant relationship was detected between increased THC exposure and higher CUDIT-R scores. Importantly however, analyses revealed that the CUDIT-R does not appear to be an appropriate tool for identifying CUD in MC patients. Conclusions: Screening tools specifically designed to assess CUD in MC patients are needed and should distinguish between frequent use and problematic use; exposure to individual cannabinoids must also be considered.

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Cannabis based medicines and cannabis dependence: A critical review of issues and evidence

Journal of Psychopharmacology ◽

10.1177/0269881120986393 ◽

2021 ◽

pp. 026988112098639

Author(s):

Anne K Schlag ◽

Chandni Hindocha ◽

Rayyan Zafar ◽

David J Nutt ◽

H Valerie Curran

Keyword(s):

Critical Review ◽

Scientific Evidence ◽

Cannabis Use ◽

Present Review ◽

Cannabis Use Disorder ◽

Medical Cannabis ◽

Cannabis Dependence ◽

Frequency Of Use ◽

Growing Body ◽

Key Questions

Cannabis has been legalised for medical use in an ever-increasing number of countries. A growing body of scientific evidence supports the use of medical cannabis for a range of therapeutic indications. In parallel with these developments, concerns have been expressed by many prescribers that increased use will lead to patients developing cannabis use disorder. Cannabis use disorder has been widely studied in recreational users, and these findings have often been projected onto patients using medical cannabis. However, studies exploring medical cannabis dependence are scarce and the appropriate methodology to measure this construct is uncertain. This article provides a narrative review of the current research to discern if, how and to what extent, concerns about problems of dependence in recreational cannabis users apply to prescribed medical users. We focus on the main issues related to medical cannabis and dependence, including the importance of dose, potency, cannabinoid content, pharmacokinetics and route of administration, frequency of use, as well as set and setting. Medical and recreational cannabis use differs in significant ways, highlighting the challenges of extrapolating findings from the recreational cannabis literature. There are many questions about the potential for medical cannabis use to lead to dependence. It is therefore imperative to address these questions in order to be able to minimise harms of medical cannabis use. We draw out seven recommendations for increasing the safety of medical cannabis prescribing. We hope that the present review contributes to answering some of the key questions surrounding medical cannabis dependence.

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An adolescent with new-onset inattention

Child and Adolescent Psychiatry ◽

10.1093/med/9780197577479.003.0028 ◽

2021 ◽

pp. 221-228

Author(s):

Samantha M. Taylor ◽

David L. Beckmann

Keyword(s):

Behavioral Therapy ◽

Contingency Management ◽

Cannabis Use ◽

Motivational Enhancement Therapy ◽

Cannabis Use Disorder ◽

Psychoactive Substance ◽

Cognitive Domains ◽

Problematic Use ◽

High Concentrations ◽

Family Based

Cannabis use disorder is defined as a pattern of use that includes at least two signs or symptoms of problematic use. Cannabis is the second most commonly used psychoactive substance by adolescents. Cannabis use is associated with significant impairments in multiple cognitive domains, although even one week of abstinence can result in improved cognitive functioning. Cannabis use, particularly of products containing high concentrations of tetrahydrocannabinol (THC), increases the likelihood of developing schizophrenia. N-acetylcysteine (NAC) may be helpful for decreasing cravings and the risk of relapse. The most effective therapy modalities for cannabis use disorder are motivational enhancement therapy, contingency management, cognitive behavioral therapy (CBT), and family-based therapy.

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Cannabis use disorder and male sex predict medical cannabis card status in a sample of high risk adolescents

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2017.11.007 ◽

2018 ◽

Vol 183 ◽

pp. 25-33 ◽

Cited By ~ 2

Author(s):

Janet Kim ◽

Marilyn E. Coors ◽

Susan E. Young ◽

Kristen M. Raymond ◽

Christian J. Hopfer ◽

...

Keyword(s):

High Risk ◽

Cannabis Use ◽

Cannabis Use Disorder ◽

Medical Cannabis ◽

Male Sex

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Alcohol and Cannabis Use Disorder Symptom Severity, Conduct Disorder, and Callous-Unemotional Traits and Impairment in Expression Recognition

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.714189 ◽

2021 ◽

Vol 12 ◽

Author(s):

Robert James R. Blair ◽

Johannah Bashford-Largo ◽

Ru Zhang ◽

Avantika Mathur ◽

Amanda Schwartz ◽

...

Keyword(s):

Conduct Problems ◽

Alcohol Use Disorder ◽

Cannabis Use ◽

Cannabis Use Disorder ◽

Expression Recognition ◽

Diagnostic Status ◽

Cognitive Risk ◽

Recognition Ability ◽

Identification Test ◽

Disorder Identification

Background: 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 reduced emotion expression recognition ability. However, this work has primarily occurred in adults and has not considered neuro-cognitive risk factors associated with conduct problems that commonly co-occur with, and precede, substance use. Yet, conduct problems are also associated with reduced emotion expression recognition ability. The current study investigated the extent of negative association between AUD and CUD symptom severity and expression recognition ability over and above any association of expression recognition ability with conduct problems [conduct disorder (CD) diagnostic status].Methods: In this study, 152 youths aged 12.5–18 years (56 female; 60 diagnosed with CD) completed a rapid presentation morphed intensity facial expression task to investigate the association between relative severity of AUD/CUD and expression recognition ability.Results: Cannabis use disorder identification test (CUDIT) scores were negatively associated with recognition accuracy for higher intensity (particularly sad and fearful) expressions while CD diagnostic status was independently negatively associated with recognition of sad expressions. Alcohol use disorder identification test (AUDIT) scores were not significantly associated with expression recognition ability.Conclusions: These data indicate that relative severity of CUD and CD diagnostic status are statistically independently associated with reduced expression recognition ability. On the basis of these data, we speculate that increased cannabis use during adolescence may exacerbate a neuro-cognitive risk factor for the emergence of aggression and antisocial behavior.

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An overview of select cannabis use and supply indicators pre- and post-legalization in Canada

Substance Abuse Treatment Prevention and Policy ◽

10.1186/s13011-021-00405-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Benedikt Fischer ◽

Angelica Lee ◽

Tessa Robinson ◽

Wayne Hall

Keyword(s):

Public Health ◽

Health And Safety ◽

Population Level ◽

Cannabis Use ◽

Medical Cannabis ◽

Level Data ◽

Frequency Of Use ◽

Key Indicators ◽

Public Health And Safety ◽

Related Harm

Abstract Background Canada implemented the legalization and regulation of non-medical cannabis use, production and sale in 2018 aiming to improve public health and safety. While outcomes from legalization reforms in other jurisdictions mostly rely on US-based data have been assessed to be mixed, Canadian data are only emerging. We compiled select population-level data on key indicators to gauge initial developments from pre- to post-legalization of cannabis in Canada. Methods We examined indicators data focusing on the following topics: prevalence of cannabis use, frequency of use, methods/products of consumption, driving after cannabis use, and cannabis sourcing. Indicator data were obtained mostly from national and some provincial population surveys. Prevalence or percentages for the indicators pre- and post-legalization (e.g., 2017- 2020), including confidence intervals were reported, with changes noted, as available in and indicated by the data sources. Results Data suggested selected increases in cannabis use prevalence, mostly among mid- and older- but possibly also younger (e.g., under legal use age) users. Frequency of use and driving after cannabis use among active users do not appear to have changed. Methods of cannabis use show diversifying trends, with decreases in smoking and increases in alternatives use modes (e.g., edibles, vaping). There is a clearly increasing trend towards accessing cannabis from legal sources among adults, while under-legal-use-age youth do not appear to experience heightened barriers to obtaining cannabis in legalization contexts. Conclusions Preliminary indicators on cannabis legalization in Canada show a mixed picture, some similar to US-based developments. While some use increases are observed, these do not necessarily represent indications of increases in cannabis-related harm, also since key (e.g., hospitalization or injury) data are lacking to date. There is a gradual embracing of legal supply sources of cannabis among users, which can be expected to serve public health and safety objectives. At the same time, cannabis use and access among under-age users as a principally vulnerable group do not appear to be hindered or reduced by legalization.

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Where Are We and Where Are We Going?

10.1093/oso/9780190846848.003.0008 ◽

2018 ◽

Cited By ~ 4

Author(s):

Leslie Iversen

Keyword(s):

Neural Activity ◽

Genetic Screening ◽

Current Knowledge ◽

Scientific Research ◽

Cannabis Use ◽

Cannabis Use Disorder ◽

Recreational Drug ◽

Medical Cannabis ◽

High Quality ◽

Broad View

Cannabis research is flourishing despite the difficulties that scientists have in accessing high-quality cannabis. However, many questions remain: Can new medicines be discovered and developed based on the current knowledge of the biosynthesis, actions, and inactivation of endocannabinoids? Can genetic screening identify people who are particularly susceptible to cannabis use disorder and possibly to psychosis? Can researchers pinpoint in more detail how endocannabinoids modulate neural activity and how they change on exposure to stress? Scientific research will tackle all these questions and more in the coming decades. This chapter presents a broad view of the case for medical cannabis, along with some cautions. The case for the legalization of cannabis as a recreational drug is also presented.

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Frequency of Cannabis Use and Medical Cannabis Use Among Persons Living With HIV in the United States: Findings From a Nationally Representative Sample

AIDS Education and Prevention ◽

10.1521/aeap.2018.30.2.169 ◽

2018 ◽

Vol 30 (2) ◽

pp. 169-181 ◽

Cited By ~ 10

Author(s):

Lauren R. Pacek ◽

Sheri L. Towe ◽

Andrea L. Hobkirk ◽

Denis Nash ◽

Renee D. Goodwin

Keyword(s):

United States ◽

Perceived Risk ◽

The United States ◽

Cannabis Use ◽

Medical Cannabis ◽

Frequency Of Use ◽

Younger Age ◽

Persons Living With Hiv ◽

Nationally Representative ◽

Living With Hiv

Little is known about cannabis use frequency, medical cannabis use, or correlates of use among persons living with HIV (PLWH) in United States nationally representative samples. Data came from 626 PLWH from the 2005–2015 National Survey on Drug Use and Health. Logistic regression identified characteristics associated with frequency of cannabis use. Chi-squares identified characteristics associated with medial cannabis use. Non-daily and daily cannabis use was reported by 26.9% and 8.0%. Greater perceived risk of cannabis use was negatively associated with daily and non-daily use. Younger age, substance use, and binge drinking were positively associated with non-daily cannabis use. Smoking and depression were associated with non-daily and daily use. One-quarter reported medical cannabis use. Medical users were more likely to be White, married, and nondrinkers. Cannabis use was common among PLWH. Findings help to differentiate between cannabis users based on frequency of use and medical versus recreational use.

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Abstract 1122‐000209: Cannabis and Cerebrovascular Outcomes: A National Registry Analysis

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000209 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Amol Mehta ◽

Neha Siddiqui ◽

Johanna T Fifi ◽

Reade DeLeacy

Keyword(s):

Legal Status ◽

The United States ◽

National Registry ◽

Cannabis Use ◽

Cannabis Use Disorder ◽

Medical Cannabis ◽

Perioperative Morbidity ◽

Discharge Disposition ◽

Significant Difference ◽

Hospitalization Costs

Introduction : Recreational and medical cannabis use in the United States has been increasing in recent years in light of state and federal efforts to decriminalize and legalize its use. Its legal status has long precluded extensive research into its adverse effects, especially as it pertains to the realm of vascular and cerebrovascular outcomes. To date, minimal research has been completed on the sequelae of cannabis in inpatient admissions for stroke. Methods : A query of the 2012–2015 Nationwide Inpatient Sample searched for patients admitted with stroke ICD‐9 diagnoses. These patients were then grouped by the presence of concurrent diagnosis of cannabis use disorder, and compared with respect to various peri‐ and postoperative complications, all‐cause mortality, discharge disposition, length of stay, and hospitalization costs. Propensity score matching was utilized to control for potential baseline confounders. Results : A total of 414,340 patients met inclusion/exclusion criteria, 6794 (1.64%) of whom had cannabis use disorder. After controlling for baseline characteristics, these patients had higher rates of inpatient mortality (odds ratio [OR] 1.43; p = 0.01263), and non‐routine discharge, as well as increased lengths of stay (6.5 vs 5.7 days, p<0.001) and no significant difference in hospitalization charges ($67507 vs. $ 63328 10, p = 0.3918). Conclusions : Based on a national trends analysis, chronic cannabis use appears to be associated with increased perioperative morbidity and mortality among patients admitted for stroke diagnoses. Physicians should ensure affected patients be adequately informed of associated risks. Further research should include matching of risk factors not captured in databases.

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