The Health Effects of Cannabis and Cannabinoids The Current State of Evidence and Recommendations for Research (2017) / Chapter Skim
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13 Problem Cannabis Use
13 Problem Cannabis Use
Pages 333-356
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From page 333... ...
. In this chapter, the committee reviews the current research evidence that most directly addresses prioritized research questions related to the association between cannabis use and the development of problem cannabis use and to the risk and protective factors involved in the development or exacerbation of problem use.
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The primary literature was further limited to studies that included a sample size of >500 participants and to studies that investigated problem cannabis use as a function of the most relevant risk factors, including mental health, the age of initiation of cannabis use, risk factors during adolescence, biological sex, and other drug use. Large population-based studies that explored multiple demographic variables were also included.
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The progression of cannabis use to developing cannabis use disorder as a function of the frequency of cannabis use was also explored using Waves 1 and 2 of the NESARC data (Cougle et al., 2016) Among the pastyear weekly nondependent cannabis users in Wave 1 (n = 435)
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From page 336... ...
. Furthermore, while the primary literature indicates a weak association between the frequency of use and a greater risk of developing cannabis use disorder, it should be noted that the frequency of use in these studies was assessed in the absence of determining the amount of cannabis used per occasion, which is a primary variable hypothesized to affect the rates of developing problem cannabis use.
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They offered three possible explanations of this heterogeneity: differences in adjustment for confounding when calculating the OR, year of publication, and different methods for diagnosing anxiety. Based on this systematic review, it appears that while there is a small association between anxiety and CUD, anxiety does not seem to be a predisposing risk factor for developing CUD.
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Primary Literature The committee did not identify any good-quality primary literature that reported stimulant medication in children diagnosed with ADHD as a risk or a protective factor for developing problem cannabis use and that were published subsequent to the data collection period of the most recently published good- or fair-quality systematic review addressing the research question.
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Also, the pool of respondents in the earlier study was not limited to those who reported weekly cannabis use during Wave 1, as was the case with the later study. Another study assessing the impact of baseline depressive symptoms on developing cannabis abuse used data from a longitudinal study involving 1,980 participants (the 1980 Baltimore Epidemiologic Catchment Area study)
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. Biological Sex Systematic Reviews The committee did not identify a good- or fairquality systematic review that reported on biological sex as a risk or a protective factor for developing problem cannabis use.
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. However, a prospective analysis using data from Wave 1 and Wave 2 of the NESARC failed to find that biological sex predicted a progression from cannabis use to cannabis dependence in weekly nondependent cannabis users (OR, 1.17; 95% CI = 0.75–1.81)
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Primary Literature The age of initiation of cannabis use as a risk factor for developing cannabis dependence has been explored in many studies.
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to the development of the specific substance use disorder and found that the transition from first cannabis use to the development of CUD occurred at a faster rate than for those with alcohol or nicotine use disorders. Other Variables Specific to Adolescents Systematic Reviews The committee did not identify a good- or fairquality systematic review that reported on variables that protect against or increase the risk of developing cannabis use disorders among adolescents.
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, and anxiety and depressive behaviors served as risk factors for developing CUD. Overall, cannabis abuse or dependence (high, moderate, or severe)
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The primary risk factors that predicted the development of CUD included being male and having poor academic performance. Respondents with four or more of the following risk factors had a 50 percent risk of developing cannabis dependence: (1)
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Additional risk factors for the development of CUD during adolescence that are supported by moderate evidence include frequency of use, oppositional behaviors, younger age of first alcohol use, nicotine use, parental substance use, poor school performance, and childhood sexual abuse. The strength of association between the risk factors for developing problem cannabis use, including other drug use and psychopathology, differs between adult and adolescent onset of cannabis use.
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13-2(b) here is moderate evidence that anxiety, personality T disorders, and bipolar disorders are not risk factors for the development of problem cannabis use.
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13-2(k) here is moderate evidence that during adolescence T the frequency of cannabis use, oppositional behaviors, a younger age of first alcohol use, nicotine use, paren tal substance use, poor school performance, antisocial behaviors, and childhood sexual abuse are risk factors for the development of problem cannabis use.
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. Biological Sex Systematic Reviews The committee did not identify a good- or fairquality systematic review that reported on biological sex as a risk or a protective factor for the severity or persistence of problem cannabis use.
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. Discussion of Findings In addition to the limitations cited for the first two sections such as issues with self-reported cannabis use, the respondents' reporting of symptoms of problem cannabis use, and data restricted to trends of cannabis use and cannabis strength that do not accurately reflect current trends, the current findings are additionally restricted to limited followup with participants and to only a few of the risk factors highlighted in the second section, including biological sex.
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RESEARCH GAP To address the research gaps relevant to problem cannabis use, the committee suggests the following: • The impact of the primary risk factors for developing prob lem cannabis use needs to be explored as risk factors for both the severity and the recurrence of problem cannabis use over extended periods of time. SUMMARY This chapter outlines the committee's efforts to review the current evidence base (1)
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• B eing male and the severity of problem cannabis use, but the recurrence of problem cannabis use does not differ between males and females (13-3b) There is moderate evidence that: • nxiety, personality disorders, and bipolar disorders are not risk factors for A the development of problem cannabis use (13-2b)
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• D uring adolescence the frequency of cannabis use, oppositional behav iors, a younger age of first alcohol use, nicotine use, parental substance use, poor school performance, antisocial behaviors, and childhood sexual abuse are risk factors for the development of problem cannabis use (13-2k) There is moderate evidence of a statistical association between: • A persistence of problem cannabis use and a history of psychiatric treat ment (13-3a)
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2009. Multiple risk factor model predicting cannabis use and use disorders: A longitudinal study.
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2008. Adolescent cannabis users at 24 years: Trajectories to regular weekly use and dependence in young adult hood.
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