Why Are Adolescent Cannabis Use Disorder Treatment Admissions Declining in the US? The Mediated Pathway of State Treatment Admissions Rates before and after Recreational Cannabis Legalization.

Purpose: State-level prevalence data are used to investigate whether recreational cannabis legalization moderates the mediated pathway from the perception of low risk of harm, to cannabis use, to cannabis use disorder (CUD) treatment admissions, among adolescents (age 12-17) in the US. Methods: Annual state prevalence measures of perception of low risk, cannabis use, and CUD treatment admissions between 2008 and 2019 (N = 542 state-year observations) were collected from the National Survey on Drug Use and Health (NSDUH) and the Treatment Episode Dataset - Admissions (TEDS-A). A two-way fixed effects (state and year) moderated mediation model was used to test whether recreational legalization moderated the indirect effect of perception of low risk on treatment admissions via cannabis use. Results: A positive indirect effect of perceiving cannabis as low risk on CUD treatment admissions via cannabis use was observed prior to legalization but not afterwards. After legalization, the positive association of perceiving cannabis as low risk with cannabis use was strengthened, and the positive association of cannabis use with treatment admissions was suppressed, as compared to before legalization. Discussion: Recreational legalization may alter the social acceptability and medical self-administration of cannabis, potentially leading to CUD treatment utilization decline among adolescents even as risk factors for CUD increase. Linking recreational cannabis legalization to advancing awareness of the health risks associated with adolescent cannabis use and promoting adolescent CUD treatment engagement through mHealth approaches and primary care providers are key to addressing potential adolescent health challenges brought about by expanding cannabis legalization.

Urine Drug Screening for Isolated Marijuana Use in Labor and Delivery Units.

Isolated marijuana use is frequently used as an indication for urine drug screening in labor and delivery units. We aimed to identify the results of urine drug screening in a labor and delivery unit for isolated marijuana use. This retrospective cohort study reviewed data from patients admitted for delivery at an urban academic center from January 1, 2020, to December 31, 2020. Patients undergoing urine drug screening for isolated marijuana use were more likely to be younger (median age 25 vs 29 years, P <.001), more often Black (adjusted odds ratio [aOR] 2.58, 95% CI 1.94-3.41), and more likely to have public insurance (aOR 1.54, 95% CI 1.21-1.95). A few (5/338, 1.5%) urine drug screening tests performed for isolated marijuana use were positive for substances besides marijuana. Most patients (177/197, 89.8%) with a urine drug screening test result that was positive for marijuana were reported to the state child abuse hotline. The utility of isolated marijuana use as a criterion for urine drug screening thus appears limited in benefit but rife with inequitable potential to harm.

The impact of state legalization on rates of marijuana use in pregnancy in a universal drug screening population.

OBJECTIVE: To evaluate the effect of state legalization of rate on marijuana use in pregnancy in a population with universal drug screening. METHODS: This is a retrospective cohort study from July 2016 to December 2018 of pregnant women who had universal drug screening of marijuana use before and after legalization of recreational marijuana in California on 1 January 2018. Maternal medical conditions and neonatal outcomes associated with usage were also evaluated. Student's t-test, Wilcoxon rank-sum test, and multiple linear regression were used for statistical analyses. RESULTS: Of 466 women, initial marijuana usage in pregnancy confirmed by urine drug test increased after legalization from 6 to 11% (p = .05). Factors associated with marijuana usage included younger age, white or black race, single marital status, psychiatric disorders, intimate partner violence and concomitant tobacco and alcohol use. 73% of users in this study had cessation of marijuana use with subsequent negative UDT. There was no statistical difference in rates of preterm birth, small for gestational age, NICU admission, or Apgar scores, when adjusted for other risk factors. CONCLUSION: Rates of marijuana usage in pregnant women who underwent universal drug screening increased after legalization. There were no differences in neonatal outcomes between users and non-users.

Understanding and Addressing the Unique Challenges and Conditions of the Veteran: Improving Sleep and Well-Being.

Veterans are those who have served our country in one of the branches of armed forces or military reserves. The Veterans Health Administration is the largest integrated health system in the nation, providing health care services and latest research for veterans. Non-Veteran Health Administration primary care clinicians, who also take care of veterans, deserve to have an understanding of the unique challenges and conditions these individuals face and the resources that are available to improve sleep health and well-being of all veterans. This article guides these clinicians to manage sleep disorders, mental health disorders, and substance use among veterans.

Obesity, Diabetes, Coffee, Tea, and Cannabis Use Alter Risk for Alcohol-Related Cirrhosis in 2 Large Cohorts of High-Risk Drinkers.

INTRODUCTION: Sustained high alcohol intake is necessary but not sufficient to produce alcohol-related cirrhosis. Identification of risk factors, apart from lifetime alcohol exposure, would assist in discovery of mechanisms and prediction of risk. METHODS: We conducted a multicenter case-control study (GenomALC) comparing 1,293 cases (with alcohol-related cirrhosis, 75.6% male) and 754 controls (with equivalent alcohol exposure but no evidence of liver disease, 73.6% male). Information confirming or excluding cirrhosis, and on alcohol intake and other potential risk factors, was obtained from clinical records and by interview. Case-control differences in risk factors discovered in the GenomALC participants were validated using similar data from 407 cases and 6,573 controls from UK Biobank. RESULTS: The GenomALC case and control groups reported similar lifetime alcohol intake (1,374 vs 1,412 kg). Cases had a higher prevalence of diabetes (20.5% (262/1,288) vs 6.5% (48/734), P = 2.27 × 10-18) and higher premorbid body mass index (26.37 ± 0.16 kg/m2) than controls (24.44 ± 0.18 kg/m2, P = 5.77 × 10-15). Controls were significantly more likely to have been wine drinkers, coffee drinkers, smokers, and cannabis users than cases. Cases reported a higher proportion of parents who died of liver disease than controls (odds ratio 2.25 95% confidence interval 1.55-3.26). Data from UK Biobank confirmed these findings for diabetes, body mass index, proportion of alcohol as wine, and coffee consumption. DISCUSSION: If these relationships are causal, measures such as weight loss, intensive treatment of diabetes or prediabetic states, and coffee consumption should reduce the risk of alcohol-related cirrhosis.

Marijuana Use and Sexual Risk Behavior Among Young Black Men Who Have Sex with Men in California.

Young black men who have sex with men (YBMSM) are disproportionately affected by HIV and continue to experience higher rates of new HIV infections when compared to other population groups. As part of the Peer Promotion of Wellness and Enhanced Linkage to Resources Project, we examined problem marijuana use and the overall sexual risk profile of 250 YBMSM. Eighty percent reported prior use of marijuana in their lifetime (n = 200). Among those, problem marijuana use was correlated with problem use of alcohol (r = 0.51, p < 0.001) and other drugs (r = 0.29, p < 0.001); lower household income (r = - .22, p < .01); homelessness (r = 0.15, p < 0.05); incarceration (r = 0.16, p < 0.05); exchanging sex for money, drugs, or shelter (r = 0.18, p < 0.05); having sex with someone known or suspected of having HIV and/or an STI (r = 0.20, p < 0.01); having sex with someone known or suspected of being an injector (r = 0.24, p < 0.01); and having unprotected sex while under the influence of alcohol or drugs (r = 0.32, p < 0.001). The complex relationship between marijuana and sexual risk behavior was examined while accounting for the possible moderating effects of alcohol or other drugs. Problem marijuana, alcohol, and other drug use each made unique contributions to predicting risky sex behavior. A significant marijuana and other drug interaction was found to predict sexual risk behaviors. Future efforts should include holistic intervention approaches for YBMSM that consider factors facilitating high-risk sexual behaviors.

Experience of migraine, its severity, and perceived efficacy of treatments among cannabis users.

OBJECTIVES: As the legal and cultural landscape surrounding cannabis use in the United States continues to evolve, more Americans are turning to cannabis to self-medicate a number of ailments, including migraines. The purpose of the present study was to examine patterns of cannabis use and its associated relief among migraineurs. DESIGN: Participants were N = 589 adult cannabis users living in states with full legal access. Using a cross-sectional design, participants completed an online survey assessing their cannabis use profiles, migraine experience, and self-reported relief from cannabis and non-cannabis treatments. RESULTS: 161 participants (27.3 %) reported experiencing migraines. 76.4 % of migraineurs (N = 123) endorsed using cannabis to treat their migraines. 69.9 % (N = 86) of migraineurs using cannabis for migraine relief also endorsed using non-cannabis products (e.g., over-the-counter pain medication, triptans) to treat their migraines. Although their subjective health was similar (p = .17), migraineurs who endorsed using cannabis to treat their migraines reported more severe migraines compared to those who did not (p = .02). Migraineurs reported significantly more migraine relief from cannabis compared to non-cannabis products, even after controlling for migraine severity (p = .03). The majority of migraineurs using cannabis to treat their migraines were not medical cardholders (65.0 %), suggesting that these individuals were self-medicating in lieu of physician guidance. CONCLUSIONS: The present study provides insight into the prevalence of cannabis use for migraine relief in a sample of cannabis users, and suggests that these migraineurs experience a high level of migraine relief from cannabis. Future studies are needed to determine the cannabis forms, potencies, and dosages that are most effective at treating migraine pain.

Considerations and Implications of Cannabidiol Use During Pregnancy.

PURPOSE OF REVIEW: Cannabis is a naturally occurring plant that is composed of over sixty phytocannabinoids, of which cannabidiol (CBD) has been recently identified as having therapeutic potential. RECENT FINDINGS: Although not clearly understood in its mechanism of action, CBD contains potent anti-inflammatory, anti-hyperalgesia, and analgesic qualities now being further analyzed for its use in the treatment of a plethora of diseases. Related to its large safety profile and lack of psychoactive effects typically associated with cannabis and tetrahydrocannabinol (THC), CBD is being used more frequently for self-treatment of chronic pain, anxiety, and depression. With the help of broad marketing, CBD is being used by numerous people, including pregnant women who use CBD as an anti-emetic. Since marijuana is legalized in many states in the USA, the use of CBD has increased not only in the general population but also in specific groups such as pregnant women with chronic pain. Despite CBD's accessibility, there are limited studies showing its safety during pregnancy. While the use of cannabis has been well explored in terms of the effects on pregnancy, the use of CBD during pregnancy thus far has limited literature. The goal of this investigation is to impart the current understanding of CBD and its effects of pregnancy.

Effect of Lifestyle Factors on Outcomes in Patients With Inflammatory Bowel Diseases.

Various lifestyle factors including physical activity and obesity, stress, sleep, and smoking may modify the risk of developing inflammatory bowel diseases (IBDs). In patients with established IBD, these lifestyle factors may significantly impact the natural history and clinical outcomes. Recreational exercise decreases the risk of flare and fatigue in patients with IBD. In contrast, obesity increases the risk of relapse and is associated with higher anxiety, depression, fatigue, and pain and higher health care utilization. Obesity also modifies pharmacokinetics of biologic agents unfavorably and is associated with a higher risk of treatment failure. Sleep disturbance is highly prevalent in patients with IBD, independent of disease activity, and increases the risk of relapse and chronic fatigue. Similarly, stress, particularly perceived stress rather than major life events, may trigger symptomatic flare in patients with IBD, although its impact on inflammation is unclear. Cigarette smoking is associated with unfavorable outcomes including the risk of corticosteroid dependence, surgery, and disease progression in patients with Crohn's disease; in contrast, smoking does not significantly impact outcomes in patients with ulcerative colitis, although some studies suggest that it may be associated with a lower risk of flare. The effect of alcohol and cannabis use in patients with IBD is inconsistent, with some studies suggesting that cannabis may decrease chronic pain in patients with IBD, without a significant effect of biological remission. Although these lifestyle factors are potentially modifiable, only a few interventional studies have been conducted. Trials of structured exercise and psychological therapy including mindfulness-based therapies such as meditation and yoga and gut-directed hypnotherapy have not consistently demonstrated benefit in clinical and/or endoscopic disease activity in IBD, although may improve overall quality of life.

Adolescent treatment admissions for marijuana following recreational legalization in Colorado and Washington.

INTRODUCTION: There is concern that recreational marijuana legalization (RML) may lead to increased cannabis use disorder (CUD) among youth due to increased marijuana use. This study investigates whether adolescent substance use disorder treatment admissions for marijuana use increased in Colorado and Washington following RML. METHODS: Annual data on 2008-2017 treatment admissions for marijuana use from the SAMHSA TEDS-A dataset for adolescents age 12-17 were used to model state treatment admissions trends. Difference-in-differences models were used to investigate whether treatment admissions increased following RML in Colorado/Washington compared to non-RML states, after adjusting for socioeconomic characteristics and treatment availability. RESULTS: Over all states in the analysis, the rate of adolescent treatment admissions for marijuana use declined significantly over the study period (ß=-3.375, 95 % CI=-4.842, -1.907), with the mean rate falling nearly in half. The decline in admissions rate was greater in Colorado and Washington compared to non-RML states following RML, though this difference was not significant (ß=-7.671, 95 % CI=-38.798, 23.456). CONCLUSION: Adolescent treatment admissions for marijuana use did not increase in Colorado and Washington following RML. This may be because youth marijuana use did not increase, CUD did not increase (even if use did increase), or treatment seeking behaviors changed due to shifts in attitudes and perceptions of risk towards marijuana use.

A randomized clinical trial of motivational interviewing plus skills training vs. Relaxation plus education and 12-Steps for substance using incarcerated youth: Effects on alcohol, marijuana and crimes of aggression.

BACKGROUND: Motivational Interviewing plus Cognitive Behavior Therapy (MI/CBT) has been used to reduce adolescent substance use, but has rarely been applied in youth correctional settings. This trial compared MI/CBT against Relaxation Training plus Substance-Education/12-Steps (RT/SET) to reduce substance use and crime among incarcerated youth. METHODS: Participants (N = 199) were incarcerated juveniles (64.8 % non-White, 10.1 % girls, mean age of 17.1 years). Two individual sessions of MI (or RT) were followed by 10 group sessions of CBT (or SET). Youth were randomized to condition with follow-ups at 3- and 6-months after release. Major outcomes included alcohol, marijuana and crimes involving aggression. RESULTS: A marginal treatment by time interaction was found for percent heavy drinking days, with follow-up tests indicating less alcohol use in RT/SET than MI/CBT at 6 months, and increased use within MI/CBT from 3 to 6 months. A significant treatment by time interaction was found for alcohol-related predatory aggression, with follow-up tests indicating fewer youth engaged in this behavior from 3 to 6 months within RT/SET, and weak evidence favoring MI/CBT over RT/SET at 3 months. General predatory aggression decreased from 3 to 6-months for both treatments. CONCLUSIONS: Although weak evidence was found favoring MI/CBT with respect to alcohol-related predatory aggression, results generally support RT/SET in reducing percent heavy drinking days.

Cannabis use in early adulthood is prospectively associated with prescriptions of antipsychotics, mood stabilizers, and antidepressants.

OBJECTIVE: Cannabis is an acknowledged risk factor for some mental disorders, but for others the evidence is inconclusive. Prescribed medicinal drugs can be used as proxies for mental disorders. In this study, we investigate how use of cannabis is prospectively related to prescription of antipsychotics, mood stabilizers, antidepressants, and anxiolytics. METHODS: Data on cannabis exposure and relevant confounders were obtained from 2,602 individuals in the longitudinal Young in Norway Study, providing survey data from four data collection waves between 1992 and 2006. Data were coupled with information about prescriptions for psychotropic drugs from the Norwegian Prescription Database between 2007 and 2015. RESULTS: Past year cannabis use increased the risk of prescription of antipsychotics (OR = 5.56, 95 % CI 1.64 - 18.87), mood stabilizers (OR = 5.36, 95 % CI 1.99 - 14.44) and antidepressants (OR = 2.10, 95 % CI 1.36 - 3.25), after accounting for sociodemographic variables, conduct problems, additional drug use, mental distress, and prescriptions the year before cannabis use was measured. CONCLUSIONS: In this study of young adults from the general population, past year cannabis use was associated with later prescriptions of antipsychotics, mood stabilizers, and antidepressants.

A National Survey of Marijuana Use Among US Adults With Medical Conditions, 2016-2017.

Importance: The number of states legalizing marijuana for medical and recreational use is increasing. Little is known regarding how or why adults with medical conditions use it. Objectives: To report the prevalence and patterns of marijuana use among adults with and without medical conditions, overall and by sociodemographic group, and to further examine the associations between current marijuana use and the types and number of medical conditions. Design, Setting, and Participants: This survey study used a probability sample of US adults aged 18 years and older from the 2016 and 2017 Behavioral Risk Factor Surveillance System, a telephone-administered survey that collects data from a representative sample of US adult residents across the states regarding health-related risk behaviors, chronic health conditions, and use of preventive services. Main Outcomes and Measures: Current (past month) and daily (≥20 days in the last 30 days) marijuana use. Results: The study sample included 169 036 participants (95 780 female [weighted percentage, 52.0%]). Adults with medical conditions had higher odds of reporting current marijuana use than those without medical conditions (age 18-34 years: adjusted odds ratio, 1.8 [95% CI, 1.5-2.1]; age 35-54 years: adjusted odds ratio, 1.4 [95% CI, 1.2-1.7]; age ≥55 years: adjusted odds ratio, 1.6 [95% CI, 1.3-2.0]), especially among those with asthma, chronic obstructive pulmonary disease, arthritis, cancer, and depression. Among those with medical conditions, the prevalence of marijuana use decreased with increasing age, ranging from 25.2% (95% CI, 22.0%-28.3%) for those aged 18 to 24 years to 2.4% (95% CI, 2.0%-2.8%) for those aged 65 years or older for current marijuana use and from 11.2% (95% CI, 8.7%-13.6%) to 0.9% (95% CI, 0.7%-1.2%), respectively, for daily marijuana use. Most adults who used marijuana (77.5%; 95% CI, 74.7%-80.3%), either with or without medical conditions, reported smoking as their primary method of administration. Adults with medical conditions were more likely than those without medical conditions to report using marijuana for medical reasons (45.5% [95% CI, 41.1%-49.8%] vs 21.8% [95% CI, 17.8%-25.7%]; difference, 23.7% [95% CI, 17.8%-29.6%]) and less likely to report using marijuana for recreational purposes (36.2% [95% CI, 32.1%-40.3%] vs 57.7% [95% CI, 52.6%-62.9%]; difference, -21.5% [95% CI, -28.1% to 14.9%]). Conclusions and Relevance: This study found that marijuana use was more common among adults with medical conditions than those without such conditions. Notably, 11.2% of young adults with medical conditions reported using marijuana on a daily basis. Clinicians should screen for marijuana use among patients, understand why and how patients are using marijuana, and work with patients to optimize outcomes and reduce marijuana-associated risks.

Past-year opioid misuse and suicide attempt are positively associated in high suicide risk veterans who endorse past- year substance use.

The main purpose of this study was to test the relationship between past-year suicide attempt (SA) and past-year opioid misuse among Veterans at high risk of suicide who reported using at least one illicit substance or alcohol in the past year. Baseline data from 130 high suicide-risk Veterans (n = 39 past-year opioid misusers; n = 91 past-year users of other substances) who enrolled in a randomized controlled trial testing adjunctive Mindfulness-Based Cognitive Therapy to Prevent Suicidal Behavior were used. Information was collected on a semi-structured interview that included the Columbia-Suicide Severity Rating Scale to collect suicide attempt history. Past-year opioid misusers, compared to those who used at least one other illicit substance or alcohol in the past year, were more likely to have made a past-year SA. Past-year opioid misuse remained associated with past-year SA in multivariate analysis that included other known risk factors for SA. Our findings show a robust link between near-term SA and opioid misuse in Veterans.

Perceived Risk of Heroin in Relation to Other Drug Use in a Representative US Sample.

Low perception of risk is a risk factor for heroin use. Research is needed to determine whether this risk factor for heroin use is affected by the use of other drugs. Data were analyzed from participants in the 2015/2016 National Surveys on Drug Use and Health who denied lifetime heroin use (N= 110,102). We examined how recency of use of various drugs and number of drugs used relate to perceptions that using heroin is not a great risk. Results from multivariable models suggest that no lifetime drug use, and recent prescription opioid misuse and methamphetamine use, in particular, were associated with higher odds of perceiving that heroin use is not of great risk. Recent marijuana use was associated with lower odds of reporting that heroin use is not of great risk. Use of more drugs in one's lifetime, past year, and/or past month tended to be associated with lower odds of reporting heroin use as not a great risk. Prevention experts should consider that recent prescription opioid misuse in particular is a risk factor for the lower perception of risk, while individuals reporting no lifetime drug use may also require better education regarding harms associated with heroin use.

Correlates of lifetime cannabis use and cannabis use severity in a Canadian university sample.

This study aimed to broaden previous investigations of correlates of lifetime cannabis use and problematic cannabis use among post-secondary students by examining the novel and contemporary issues of medicinal use and deep inhalation practices. The sample included 2212 undergraduate and graduate post-secondary students from Alberta, Canada, who completed the University of Calgary's Campus Experience with Cannabis Survey (average age 23.2, SD = 5.2). Nine variables were entered into the binary logistic regression to examine their differentiation of lifetime users from non-users. A multiple regression model was completed with past six-month users (n = 697), where the continuous dependent variable was cannabis use severity as measured by total scores on the Cannabis Use Disorder Identification Test-Revised. Twenty independent variables were entered simultaneously. Varsity athlete status, family mental illness, severity of alcohol use, greater support for legalization and lower perceived risk associated with regular cannabis use, differentiated lifetime users from non-users. Higher rates of religiosity and living with parents or relatives were associated with lower-lifetime rates. Male gender, earlier age of first cannabis use, cannabis use motives (including coping, enhancement and expansion), past six-month medicinal use and increased frequency of deep inhalation during consumption, were found to be significant correlates of severity. Different factors seem to predict lifetime cannabis use versus severity, and these differences may help inform the development and delivery of prevention efforts. Given that medicinal use and male gender were the largest correlates of severity, populations representing these groups may benefit most from targeted education and prevention.

Positive parenting improves multiple aspects of health and well-being in young adulthood.

Aspects of positive parenting have previously been linked to better offspring health and well-being1,2, though often, individual outcomes have been examined separately. Examining multiple outcomes simultaneously, over multiple aspects of parenting, may provide a more holistic picture of the parenting-health dynamics3,4. Methodological limitations such as reverse causation-good childhood outcomes that make parenting easier-also remain a concern in many previous observational studies5. Here we examined the associations between multiple aspects of parenting (including parent-child relationship satisfaction concerning love, parental authoritativeness and family dinner frequency) and various subsequent offspring psychosocial, mental, behavioural and physical health and well-being outcomes. We analysed longitudinal data from the Growing Up Today Study 1 (N = 8,476, mean baseline age = 12.78 years) and Growing Up Today Study 2 (N = 5,453, mean baseline age = 17.75 years). Both parenting and health outcomes were based on offspring self-reports. The results suggest that greater relationship satisfaction was associated with greater emotional well-being, lower risk of mental illness, eating disorders, overweight or obesity and marijuana use. To a lesser extent, greater parental authoritativeness and regular family dinner were also associated with greater offspring emotional well-being, fewer depressive symptoms, lower risk of overeating and certain sexual behaviours. This study strengthens the evidence for a public health focus on improving parenting to promote population health and well-being.

Prevalence and correlates of medical cannabis patients' use of cannabis for recreational purposes.

BACKGROUND: Rates of legal medical cannabis (MC) use are increasing, but little is known about the prevalence and correlates of recreational cannabis (RC) use among medical users (MC/R). METHODS: 348 MC users who resided in a state in which MC is legal and had medical authorization to use MC legally completed an anonymous survey in Spring 2017 (64.1% female, 82.8% White, mean age 33.03[±10.37] years). Rates of endorsing MC/R and the following potential correlates of MC/R were examined: the legal status of RC in participants' states of residence, sex, age, race, primary medical condition, MC product(s) used, MC expectancies, features of MC sought out (e.g., high tetrahydrocannabinol [THC] content), and negative cannabis use consequences. RESULTS: 55.5% of MC users engaged in MC/R. MC/R was associated with residing in a state in which RC is legal, being female, using MC for pain or mental health conditions, vaping MC concentrates, holding positive expectancies for combustible MC, and seeking out MC products with high THC concentrations. Preferring MC products with high cannabidiol (CBD) concentrations protected against MC/R. CONCLUSIONS: More than half of MC users endorsed MC/R, which is considerably higher than rates of misuse observed for other prescription medications. Findings raise concerns about circumvention of RC laws in states where RC remains illegal and could be used to inform MC regulatory efforts (e.g., reducing THC content, increasing CBD content). Findings also suggest that prevention/intervention efforts to reduce MC/R are needed, especially among high-risk populations of MC users (e.g., women, pain patients, psychiatric patients).