Associations between cannabis policies and state-level specialty cannabis use disorder treatment in the United States, 2004-2019.

BACKGROUND: Cannabis use disorder (CUD) treatment prevalence decreased in the US between 2002 and 2019, yet structural mechanisms for this decrease are poorly understood. We tested associations between cannabis laws becoming effective and self-reported CUD treatment. METHODS: Restricted-use 2004-2019 National Surveys on Drug Use and Health included people ages 12+ classified as needing CUD treatment (i.e., past-year DSM-5-proxy CUD or last/current specialty treatment for cannabis). Time-varying indicators of medical cannabis laws (MCL) with/without cannabis dispensary provisions differentiated state-years before/after laws using effective dates. Multi-level logistic regressions with random state intercepts estimated individual- and state-adjusted CUD treatment odds by MCLs and model-based changes in specialty CUD treatment state-level prevalence. Secondary analyses tested associations between CUD treatment and MCL or recreational cannabis laws (RCL). RESULTS: Using a broad treatment need sample definition in 2004-2014, specialty CUD treatment prevalence decreased by 1.35 (95 % CI = -2.51, -0.18) points after MCL without dispensaries and by 2.15 points (95 % CI = -3.29, -1.00) after MCL with dispensaries provisions became effective, compared to before MCL. Among people with CUD in 2004-2014, specialty treatment decreased only in MCL states with dispensary provisions (aPD = -0.91, 95 % CI = -1.68, -0.13). MCL were not associated with CUD treatment use in 2015-2019. RCL were associated with lower CUD treatment among people classified as needing CUD treatment, but not among people with past-year CUD. CONCLUSIONS: Policy-related reductions in specialty CUD treatment were concentrated in states with cannabis dispensary provisions in 2004-2014, but not 2015-2019, and partly driven by reductions among people without past-year CUD. Other mechanisms (e.g., CUD symptom identification, criminal-legal referrals) could contribute to decreasing treatment trends.

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.

Contingency management is associated with positive changes in attitudes and reductions in cannabis use even after discontinuation of incentives among non-treatment seeking youth.

BACKGROUND: It is important to identify interventions that reduce harm in youth not motivated to change their cannabis use. This study evaluated how short-duration contingency management (CM) impacts cannabis use attitudes and behavior after abstinence incentives are discontinued among non-treatment seeking youth. METHODS: Participants (N=220) were randomized to 4 weeks of abstinence-based CM (CB-Abst; n=126) or monitoring (CB-Mon; n=94). Participants completed self-report and provided biochemical measures of cannabis exposure at baseline, end-of-intervention, and 4-week follow-up. Changes in self-reported cannabis use frequency (days/week; times/week) and biochemically verified creatinine-adjusted 11-nor-9-carboxy-tetrahydrocannabinol concentrations (CN-THCCOOH) were analyzed between groups from baseline to follow-up. In CB-Abst, cannabis use goals at end-of-intervention were described and changes in cannabis use at follow-up were explored by goals and cannabis use disorder (CUD) diagnosis. RESULTS: There was a group by visit interaction on cannabis use (days: beta=0.93, p=0.005; times: beta=0.71, p<0.001; CN-THCCOOH: beta=0.26, p=0.004), with reductions at follow-up detected only in CB-Abst. Following 4 weeks of abstinence, 68.4% of CB-Abst participants wanted to reduce or abstain from cannabis use following completion of CM. Those in CB-Abst who set end-of-intervention reduction goals and were without CUD had greater decreases in cannabis use frequency at follow-up (Goals*time on days/week: beta=-2.27, p<0.001; CUD*time on times/week: beta=0.48, SE=0.24, t=2.01, p=0.048). CONCLUSIONS: Findings support the utility of brief incentivized abstinence for generating motivation to reduce cannabis use and behavior change even after incentives end. This study supports CM as a potentially viable harm reduction strategy for those not yet ready to quit.

Development of Mobile Contingency Management for Cannabis Use Reduction.

Many interventions for cannabis use disorder (CUD) are associated with decreases in frequency and quantity of use but fail to increase overall rates of sustained abstinence. It is currently unknown whether reductions in use (in the absence of sustained abstinence) result in clinically significant improvements in functioning. The objective of this study was to refine a mobile contingency management approach to reduce cannabis use to ultimately evaluate whether reductions in frequency and quantity of cannabis are related to improvements in functional and mental health status. Three cohorts of participants (n = 18 total, n = 10 women) were enrolled and completed 2 weeks of ecological momentary assessment (EMA) during a baseline ad lib cannabis use period, followed by a 6-week reduction period. Participants completed EMA assessments multiple times per day and were prompted to provide videotaped saliva cannabis testing 2-3 times daily. Data from participants who were at least 80% adherent to all EMA prompts were analyzed (13 out of 18). During the ad lib phase, participants were using cannabis on 94% of the days and reported using a mean of 1.42 grams daily. The intervention was a mobile application that participants used to record cannabis use by saliva tests to bioverify abstinence and participants completed electronic diaries to report their grams used. During the 6-week intervention phase, participants reported reducing their use days to 47% of the days with a reported mean of .61 grams daily. In the last cohort, at least 50% of the heavy users were able to reduce their cannabis use by at least 50%. The effect of cannabis reduction (versus abstinence) is largely unknown. Observations suggest that it is possible to develop a mobile intervention to reduce cannabis use among heavy users, and this paradigm can be utilized in future work to evaluate whether reductions in cannabis use among heavy users will result in improvements in functional and mental health status.

A call for mindfulness-based interventions for cannabis-use disorders.

Cannabis use is being increasingly liberalized worldwide, and an increasing prevalence of cannabis-use disorder (CUD) is observed. The few current therapeutic options for CUD are only modestly effective. Mindfulness-based interventions offer promising prospects for the management of substance-use disorders. However, despite proliferating literature on mindfulness and substance use, few studies have explored mindfulness in terms of cannabis use and CUD. There are many possibilities for the implementation of mindfulness-based interventions for cannabis use reduction, especially for younger users, who are more vulnerable to cannabis-related harms. Accordingly, large controlled trials are needed to reliably assess the potential of such interventions.

A preliminary randomized controlled trial of repetitive transcranial magnetic stimulation applied to the left dorsolateral prefrontal cortex in treatment seeking participants with cannabis use disorder.

BACKGROUND: Cannabis use disorder (CUD) is a common and consequential disorder. When applied to the dorsolateral prefrontal cortex (DLPFC), repetitive transcranial magnetic stimulation (rTMS) reduces craving across substance use disorders and may have therapeutic clinical effects when applied in serial-sessions. The present study sought to preliminarily determine whether serial-sessions of rTMS applied to the DLPFC had a therapeutic effect in CUD. METHODS: This study was a two-site, phase-2, double-blind, randomized-controlled-trial. Seventy-two treatment-seeking participants (37.5% Women, mean age 30.2±9.9SD) with ≥moderate-CUD were randomized to active or sham rTMS (Beam-F3, 10Hz, 20-total-sessions, two-sessions-per-visit, two-visits-per-week, with cannabis cues) while undergoing a three-session motivational enhancement therapy intervention. The primary outcome was the change in craving between pre- and post- treatment (Marijuana Craving Questionnaire Short-Form-MCQ-SF). Secondary outcomes included the number of weeks of abstinence and the number of days-per-week of cannabis use during 4-weeks of follow-up. RESULTS: There were no significant differences in craving between conditions. Participants who received active-rTMS reported numerically, but not significantly, more weeks of abstinence in the follow-up period than those who received sham-rTMS (15.5%-Active; 9.3%-Sham; rate ratio = 1.66 [95% CI: 0.84, 3.28]; p=0.14). Participants who received active-rTMS reported fewer days-per-week of cannabis use over the final two-weeks of the follow-up period than those receiving sham-rTMS (Active vs. Sham: -0.72; Z=-2.33, p=0.02). CONCLUSIONS: This trial suggests rTMS is safe and feasible in individuals with CUD and may have a therapeutic effect on frequency of cannabis use, though further study is needed with additional rTMS-sessions and a longer follow-up period.

Association between cannabis use disorder symptom severity and probability of clinically-documented diagnosis and treatment in a primary care sample.

BACKGROUND: Brief cannabis screening followed by standardized assessment of symptoms may support diagnosis and treatment of cannabis use disorder (CUD). This study tested whether the probability of a medical provider diagnosing and treating CUD increased with the number of substance use disorder (SUD) symptoms documented in patients' EHRs. METHODS: This observational study used EHR and claims data from an integrated healthcare system. Adult patients were included who reported daily cannabis use and completed the Substance Use Symptom Checklist, a scaled measure of DSM-5 SUD symptoms (0-11), during routine care 3/1/2015-3/1/2021. Logistic regression estimated associations between SUD symptom counts and: 1) CUD diagnosis; 2) CUD treatment initiation; and 3) CUD treatment engagement, defined based on Healthcare Effectiveness Data and Information Set (HEDIS) ICD-codes and timelines. We tested moderation across age, gender, race, and ethnicity. RESULTS: Patients (N=13,947) were predominantly middle-age, male, White, and non-Hispanic. Among patients reporting daily cannabis use without other drug use (N=12,568), the probability of CUD diagnosis, treatment initiation, and engagement increased with each 1-unit increase in Symptom Checklist score (p's<0.001). However, probabilities of diagnosis, treatment, and engagement were low, even among those reporting ≥2 symptoms consistent with SUD: 14.0% diagnosed (95% CI: 11.7-21.6), 16.6% initiated treatment among diagnosed (11.7-21.6), and 24.3% engaged in treatment among initiated (15.8-32.7). Only gender moderated associations between Symptom Checklist and diagnosis (p=0.047) and treatment initiation (p=0.012). Findings were similar for patients reporting daily cannabis use with other drug use (N=1379). CONCLUSION: Despite documented symptoms, CUD was underdiagnosed and undertreated in medical settings.

Psychological Interventions for Cannabis Use among Adolescents and Young Adults: A Systematic Review.

Regular cannabis use during adolescence can lead to cognitive, psychological, and social consequences, causing significant distress. Although psychological interventions are the mainstay type of treatment for cannabis use disorder, the results remain mixed among youths. The objective of this review is twofold: to identify the existing psychological interventions for cannabis use among youths, and to assess the evidence regarding the effectiveness of those interventions. Randomized controlled trials focused exclusively on cannabis use among adolescents and young adults were included. Three databases-Embase, PsycInfo, and PubMed-were searched to identify relevant peer-reviewed manuscripts published before February 2022 in English and French. The risk of bias was assessed using the Cochrane Collaboration's tool. Twenty-five randomized controlled trials were included. Fourteen studies reported a significant outcome related to cannabis use. These were mainly non-intensive, online interventions that aimed to improve the patients' relationships and emotion regulation. This review highlights the need to conduct additional randomized control trials that target cannabis use disorder specifically among adolescents. These randomized control trials should also aim to reduce the risk of bias related to psychiatric comorbidities as well as detection and attrition problems.

Scoping Review of Cannabis-Reduction Psychosocial Interventions and Reasons for Use among Young Adults with Psychosis.

Objective: No evidence-based intervention effectively reduces cannabis use in young adults with psychosis (YAP). To generate hypotheses about why, a scoping review was conducted to synthesize evidence about motivations for cannabis use and reduction/cessation for YAP and the psychosocial interventions trialed to identify possible gaps between motivations and interventive strategies. Methods: A systematic literature search was conducted in December, 2022. Reviews of titles and abstracts (N = 3,216) and full-texts (n = 136) resulted in 46 articles. Results: YAP use cannabis for pleasure, to reduce dysphoria, and for social and recreational reasons; motivations for cessation include insight about cannabis-psychosis interactions, incompatibility with goals and social roles, and support from social networks. Interventions with at least minimal evidence of efficacy include motivational interviewing, cognitive-behavioral strategies, and family skills training. Conclusions: Authors recommend additional research on mechanisms of change and motivational enhancement therapy, behavioral activation, and family-based skills interventions matched to YAP motivations for use/cessation.

Restructuring reward: A pilot study to enhance natural reward response in adults with cannabis use disorder.

BACKGROUND: Hedonic dysregulation is a core mechanism of addiction. There is a dearth of research on hedonic dysregulation in cannabis use disorder (CUD). The current study tested whether personalized scripted imagery may be an efficacious approach to remediate reward functioning in adults with CUD. METHODS: Adults with CUD (n=10) and non-CUD controls (n=12) completed a single session personalized scripted imagery procedure. Non-drug (i.e. natural) reward and neutral scripts were transcribed and participants listened to the scripts in counterbalanced order. Primary outcomes included positive affect (PA), galvanic skin response (GSR), and cortisol and were assessed at four timepoints. Mixed effects models were used to compare between and within subject effects. RESULTS: Mixed effects models revealed a Condition (reward vs. neutral) X Group (CUD vs. control) interaction (p=0.01) on PA response, indicating blunted PA response to the neutral script relative to the reward script in CUD participants. Likewise, GSR response in CUD participants was decreased in response to the neutral script relative to the reward script (p=0.034; interaction n.s.). An interaction effect of Group X PA on cortisol response was found (p=.036) indicating that cortisol was positively correlated with PA in healthy control participants, but not CUD participants. CONCLUSIONS: Adults with CUD may demonstrate acute deficits in hedonic tone under neutral conditions relative to healthy controls. Personalized scripted imagery may be an efficacious tool to remediate hedonic dysregulation in CUD. Cortisol may play a role in healthy positive affect regulation warranting further investigation.

Cannabis Use Among U.S. Military Veterans Following Residential Substance Use Disorder Treatment.

INTRODUCTION: Use rates of cannabis, a substance associated with a host of comorbid physical and mental health concerns, continue to rise for military veterans. Despite this prevalence, descriptive patterns of use among veterans and research on treatment factors that predict cannabis outcomes are lacking. This study aimed to conduct a descriptive profile of veterans who endorse cannabis use, compare veterans endorsing cannabis use to those who do not endorse use, and investigate what factors (other substance use, psychiatric symptoms, and treatment outcomes) predicted return to cannabis use following residential treatment. MATERIALS AND METHODS: The study was a secondary data analysis of a longitudinal sample of U.S. military veterans (N = 200, 193 males, Mage = 50.14, SD = 9) participating in residential substance use disorder treatment through a Veterans Affairs medical center. Interview, survey, and electronic health data were collected over 12 months. Analyses included descriptive and frequency statistics to identify patterns in cannabis use behaviors and motives, independent t-tests to examine differences between the cannabis-using group and non-using group, and a series of univariate logistic regressions to examine potential predictors for cannabis use after treatment discharge. RESULTS: Lifetime cannabis use was common among veterans (77.5%), and 29.5% reported use during the study. On average, veterans had made one quit attempt before treatment entry. Veterans who endorsed cannabis use consumed more alcohol in the past 30 days at baseline and reported less impulse control and less confidence in maintaining abstinence at discharge. Length of stay in the residential program and no diagnosis of Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV cannabis use disorder criteria predicted post-treatment cannabis use such that veterans who remained in the program longer were more likely to abstain from cannabis use following treatment, and those who did not meet DSM-IV cannabis use disorder criteria were more likely to use following treatment. CONCLUSIONS: Identification of relevant risk factors and treatment processes, such as impulse control, confidence in treatment, and length of stay in treatment, provides practical recommendations for future intervention efforts. This study calls for further examination of cannabis use outcomes among veterans, particularly those participating in substance use treatment.

Increasing risk of cannabis use disorder among U.S. veterans with chronic pain: 2005-2019.

ABSTRACT: In the United States, cannabis is increasingly used to manage chronic pain. Veterans Health Administration (VHA) patients are disproportionately affected by pain and may use cannabis for symptom management. Because cannabis use increases the risk of cannabis use disorders (CUDs), we examined time trends in CUD among VHA patients with and without chronic pain, and whether these trends differed by age. From VHA electronic health records from 2005 to 2019 (∼4.3-5.6 million patients yearly), we extracted diagnoses of CUD and chronic pain conditions ( International Classification of Diseases [ ICD ]- 9-CM , 2005-2014; ICD-10-CM , 2016-2019). Differential trends in CUD prevalence overall and age-stratified (<35, 35-64, or ≥65) were assessed by any chronic pain and number of pain conditions (0, 1, or ≥2). From 2005 to 2014, the prevalence of CUD among patients with any chronic pain increased significantly more (1.11%-2.56%) than those without pain (0.70%-1.26%). Cannabis use disorder prevalence increased significantly more among patients with chronic pain across all age groups and was highest among those with ≥2 pain conditions. From 2016 to 2019, CUD prevalence among patients age ≥65 with chronic pain increased significantly more (0.63%-1.01%) than those without chronic pain (0.28%-0.47%) and was highest among those with ≥2 pain conditions. Over time, CUD prevalence has increased more among VHA patients with chronic pain than other VHA patients, with the highest increase among those age ≥65. Clinicians should monitor symptoms of CUD among VHA patients and others with chronic pain who use cannabis, and consider noncannabis therapies, particularly because the effectiveness of cannabis for chronic pain management remains inconclusive.

Pilot trial of a telehealth-delivered behavioral economic intervention promoting cannabis-free activities among adults with cannabis use disorder.

BACKGROUND: Cannabis is increasingly consumed and increasingly perceived as harmless. Among those whose use develops into a cannabis use disorder (CUD), <5% initiate and engage in treatment. Thus, novel options for low-barrier, appealing treatments are needed to foster engagement in care. METHODS: We conducted an open trial of a telehealth-delivered multicomponent behavioral economic intervention for non-treatment-engaged adults with CUD. Participants with CUD were recruited from a health system and screened for eligibility. Participants completed behavioral economic indices (cannabis demand, proportionate cannabis-free reinforcement), measures of cannabis use and mental health symptoms, and provided open-ended feedback on the intervention experience. RESULTS: Of the 20 participants who enrolled and engaged in the initial intervention session, 70% (14 out of 20) completed all intervention components. All participants were satisfied/very satisfied with the intervention and 85.7% reported the telehealth delivery made it at least slightly easier/more likely for them to receive substance use care. Baseline to immediate post-treatment, behavioral economic cannabis demand decreased (intensity: Hedges' g = 0.14, maximum total expenditure: Hedges' g = 0.53, maximum expenditure for a single hit: Hedges' g = 0.10) and proportionate cannabis-free reinforcement (Hedges' g = 0.12) increased. Past-month total cannabis use decreased by 8.9% from baseline to post-treatment (Hedges' g = 0.39), along with decreases in recent depression (Hedges' g = 0.50) and anxiety symptoms (Hedges' g = 0.29). DISCUSSION: These preliminary findings suggest that this behavioral economic intervention was highly acceptable and feasible for adults with untreated CUD. Changes in potential mechanisms of behavior change (cannabis demand, proportionate cannabis-free reinforcement) were consistent with reduced frequency of cannabis use and improved mental health outcomes.

Psychopathology and Pattern of Remission of Cannabis-Induced Psychotic Disorder.

Objective: To analyze the psychopathology and pattern of remission in cannabis-induced psychotic disorder with treatment.Methods: This was a prospective cohort study of a group of patients admitted with new-onset psychosis, cannabis use, and no evidence of other drug abuse from January 1 to June 31, 2019, to the psychiatry inpatient department of a multispecialty tertiary care hospital in Kerala, India. Patients were evaluated at admission and after 1 week in the hospital and 1 month after discharge using the Structured Clinical Interview for the Positive and Negative Syndrome Scale and the Clinical Global Impressions-Severity of illness scale.Results: Fifty-six male subjects were recruited for the study. The mean age of the subjects was 22.2 years, and the majority were active smokers of nicotine and cannabis. Total duration of abuse and family history of substance use in first-degree relatives correlated with severity of psychosis. Hostility, excitement, and grandiosity were the predominant positive symptoms, and these symptoms showed a steady reduction toward the end of the study. The most frequent negative symptoms were emotional withdrawal, passive or apathetic social withdrawal, and difficulty in abstract thinking, and these symptoms also showed significant improvement (P < .001 for all). For symptoms such as somatic concern and guilt feelings, significant treatment response was noted only in the initial week (P < .001).Conclusions: Cannabis-induced psychosis in the Indian setting presents with predominant positive symptoms and minimal affective symptoms. The steady improvement noted with complete cessation of cannabis indicates a possible contributory role for cannabis in precipitating psychosis.

Treatment outcomes among pregnant women with cannabis use disorder.

Cannabis use disorder (CUD) among pregnant women is on the rise in the United States. The American College of Obstetricians and Gynecologists have recommended against the use of cannabis during pregnancy and breastfeeding. However, limited research exists on CUD treatment in this vulnerable population. The purpose of this study was to examine factors that influence CUD treatment completion in pregnant women. Data from the 2010-2019 Treatment Episode Data Set-Discharges (TEDS-D) were used (n = 7,319 pregnant women who reported CUD and had no prior treatment history). Descriptive statistics, logistic regression, and classification tree analyses were conducted to assess treatment outcomes. Only 30.3% of the sample completed CUD treatment. Length of stay between 4 and 12 months was associated with a higher likelihood of CUD treatment completion. The odds of treatment completion were higher if the referral source was alcohol/drug use care provider (AOR = 1.60, 95% CI [1.01, 2.54]), other community referral (AOR = 1.65, 95% CI [1.38, 1.97]), and the court/criminal justice (AOR = 2.29, 95% CI [1.92, 2.72]) relative to being referred by individual/self. A relatively high proportion of CUD treatment completion (52%) was observed among pregnant women who had > 1 month of CUD treatment and were referred to the treatment program by the criminal justice system. For pregnant women, referrals from the justice system, community, and healthcare providers can increase the likelihood of successful CUD treatment outcomes. Developing targeted CUD treatments for pregnant populations is crucial due to increasing CUD rates, cannabis accessibility, and potency.

Monitoring adherence and abstinence of cannabis use disorder patients: Profile identification and relationship with long-term treatment outcomes.

BACKGROUND: Patients with cannabis use disorder (CUD) show heterogeneous sociodemographic and consumption patterns. Although previous studies, focused on identifying subgroups of CUD patients using input variables, have yielded useful results for planning individualized treatments, no published research has analyzed the profiles of CUD patients according to their therapeutic progress. This study therefore aims to identify subgroups of patients using adherence and abstinence indicators and to explore whether these profiles are associated with sociodemographic characteristics, consumption variables, and long-term therapeutic outcomes. METHODS: This was a retrospective observational study with a multisite sample of 2055 CUD outpatients who were beginning treatment. The study monitored patient data at two-year follow-up. We conducted latent profiles analysis on the appointment attendance ratio and percentage of negative cannabis tests. RESULTS: A three profile solution emerged: i) moderate abstinence/moderate adherence (n = 997); ii) high abstinence/moderate adherence (n = 613); and iii) high abstinence/high adherence (n = 445). The study found the most marked differences at the beginning of treatment for education level (chi2 (8) = 121.70, p < .001), source of referral (chi2 (12) = 203.55, p < .001), and frequency of cannabis use (chi2 (10) = 232.39, p < .001). Eighty percent of patients from the "high abstinence/high adherence" group were relapse-free at two year follow-up. This percentage decreased to 24.3 % in the "moderate abstinence/moderate adherence" group. CONCLUSIONS: Research has shown adherence and abstinence indicators to be useful for identifying subgroups of patients with different prognoses regarding long-term success. Recognizing the sociodemographic and consumption variables associated with these profiles at the beginning of treatment could help to inform the design of more individualized interventions.

Prevalence of cannabis use disorder among individuals using medical cannabis at admission to inpatient treatment for substance use disorders.

INTRODUCTION: Cannabis is used for medical and recreational purposes and may result in cannabis use disorder (CUD). This study explored the prevalence of cannabis use disorder and other psychiatric comorbidities among inpatients undergoing treatment for substance use disorder who reported medical cannabis use at admission. METHODS: We assessed CUD and other substance use disorders based on DSM-5 symptoms, anxiety with the Generalized Anxiety Disorder scale (GAD-7), depression with the Patient Health Questionnaire (PHQ-9), and post-traumatic stress disorder with the PTSD Checklist for DSM-5 (PCL-5). We compared the prevalence of CUD and other psychiatric comorbidities between inpatients who endorsed the use of cannabis for medical purposes only vs those endorsing use for medical and recreational purposes. RESULTS: Among 125 inpatients, 42% reported medical use only, and 58% reported medical and recreational use (dual motives). For CUD, 28% of Medical-Only and 51% of Dual-Use motives patients met the diagnostic criteria for CUD (p = 0.016). High psychiatric comorbidities were present: 79% and 81% screened positive for an anxiety disorder, 60% and 61% screened positive for depression, and 66% and 57% screened positive for PTSD for the Medical-Only and Dual-Use inpatients, respectively. CONCLUSIONS: Many treatment-seeking individuals with substance use disorder who report medical cannabis use meet criteria for CUD, particularly those reporting concurrent recreational use.

Cannabis Use Disorder Treatment Preferences: A Pilot Survey in Current Users of Cannabis.

OBJECTIVES: Highly effective treatments for cannabis use disorder (CUD) are lacking, and patient preferences have not been considered during treatment development. We therefore conducted an exploratory crowdsourced survey of individuals reporting current cannabis use and a willingness to cut down or quit their cannabis use, to determine their interest in various treatment aspects. METHODS: Subjects (n = 63) were queried about their willingness to take medications as a function of type, route, and regimen and to participate in adherence monitoring. Subjects were also asked about their willingness to engage in behavioral/psychosocial interventions as a function of type, setting, and duration. Measures theorized to be associated with treatment preferences were also collected, including cannabis use variables, readiness to change, reduction or cessation goal, perceived cessation barriers, and medication use beliefs and behaviors. RESULTS: Survey responses indicated that efforts to develop CUD medications should focus on nonsynthetic compounds administered orally or by mouth spray no more than once per day to maximize patient acceptance. Remote adherence monitoring and one-on-one outpatient behavioral treatment approaches, especially contingency management, are also anticipated to enhance participation. Most subjects indicated a preference to reduce their cannabis use rather than quit. CONCLUSIONS: These data provide guidance for the development of CUD interventions based on the preferences of individuals interested in treatment for their cannabis use. Additional research is needed to confirm these results in a larger sample and determine if matching CUD patients with their preferred treatments improves success rates.