How does resolving cannabis problems differ from problems with alcohol or other drugs?

Those resolving cannabis problems do so at younger ages, with less assistance than those resolving other substance-use problems

March 5, 2018

Science Daily/Massachusetts General Hospital

Individuals who report having resolved a problem with cannabis use appear to have done so at younger ages than those who resolved problems with alcohol or other drugs, report investigators from the Recovery Research Institute at Massachusetts General Hospital (MGH). While study participants also were much less likely to use any formal sources of assistance or support in resolving problems with cannabis than those whose problems were with other substances, that finding was less common in those who resolved a cannabis problem more recently, which may reflect the increased availability and potency of cannabis in recent years.

"Very little has been known about recovery from cannabis use problems, and this is the first study to examine that on a national basis," says John Kelly, PhD, director of the Recovery Research Institute, who led the study published in the March issue of the International Journal of Drug Policy. "Compared with alcohol and other drugs, cannabis holds a unique place in federal and state policies -- continuing to be illegal federally but with medical and recreational use legalized at the state level. Due to this increased availability and the proliferation of a for-profit cannabis industry, understanding the needs of individuals with cannabis problems will be increasingly important."

The current study analyzes data from the National Recovery Survey, conducted by Kelly's team. A nationally representative sample of nearly 40,000 U.S. adults who participate in the Knowledge Panel of the market research company GfK were asked "Did you used to have a problem with drugs or alcohol, but no longer do?" Of more than 25,000 respondents, a little over 2,000 indicated they had resolved such a problem and were sent a link to the full study survey, which asked a variety of questions such as the specific problem substances and details regarding how and when they had resolved their problem. As reported in a paper published last year in Drug and Alcohol Dependence, more than half of all respondents reported resolving their problem with no assistance.

The current study focused on participants who indicated having resolved a cannabis problem, who made up around 11 percent of respondents, reflecting around 2.4 million U.S. adults. Compared with those resolving problems with alcohol or other drugs, those resolving cannabis problems reported starting regular use -- once a week or more -- at younger ages but also resolving the problem at younger ages, an average of 29 compared with 38 for alcohol and 33 for other drugs.

Cannabis-primary respondents were even less likely to have used formal treatment or support services than were those resolving problems with illicit drugs -- 18 percent versus 42 percent -- but were more likely to have participated in drug courts than those who had resolved alcohol problems -- 24 percent versus 8 percent. Cannabis users also reported "addiction careers" -- the years between their first use and problem resolution -- that were significantly shorter than those of the alcohol group -- 12 years versus 18 years, which may reflect the greater physical and mental health impairment associated with alcohol and the continuing illegality of cannabis.

"We did expect that the cannabis-primary individuals would be less likely than the illicit drug group to use formal treatment; but very little is known about the magnitude or nature of such differences, " says Kelly. "That may be due to fewer physiological and other life consequences compared with the impairments caused by drugs like alcohol or opioids. For example, while there is a documented withdrawal syndrome related to cannabis dependence, withdrawal from opioids or alcohol is notoriously more severe and often requires medically-managed detoxification."

Given the increased levels of THC -- the psychoactive component of cannabis -- in products available today, the team investigated whether the use of formal support services had changed over time. Indeed, they found that utilization of outpatient services was more common in those resolving their problems within the past 5.5 years, while use of inpatient services was actually more common in those who resolved their problem around 20 years previously.

The Spallin Associate Professor of Psychiatry in Addiction Medicine at Harvard Medical School, Kelly explains that brain changes caused by the higher THC content in marijuana today -- 15 to 20 percent, versus 1 to 5 percent 10 or 20 years ago -- could make it harder for individuals using this more potent cannabis to stop on their own. While inpatient treatment was considered first-line treatment for addiction two decades ago, it is much less common today, and insurance companies often require attendance at outpatient treatment first.

"In the current landscape of higher potency cannabis and the greater availability and variety of cannabis products, it is more likely that individuals will need to seek help in resolving problems with cannabis," he says. "Now it will be important to determine whether the recovery timeline from high-potency cannabis will be different and more challenging. And since so many of the cannabis-primary group resolved their problem without either formal treatment or mutual help organizations like Marijuana Anonymous or Narcotics Anonymous, it will be critical to understand the changes in their lives that helped make recovery possible."

https://www.sciencedaily.com/releases/2018/03/180305160204.htm

Marijuana use associated with cognitive dysfunction in people with HIV who have substance abuse disorder

November 1, 2017

Science Daily/Boston University School of Medicine

Marijuana use is associated with cognitive dysfunction in people with HIV infection who have an alcohol or other drug use disorder, according to a new study from researchers at Boston University School of Public Health (BUSPH), Boston University School of Medicine (BUSM), and Boston Medical Center (BMC).

While researchers did not detect effects of lifetime cumulative exposure, the study, published in Substance Abuse, showed that more frequent current marijuana use was associated with a measure of cognitive dysfunction on the Medical Outcomes Study HIV Health Survey cognitive function scale.

"People with HIV infection have many reasons to have cognitive dysfunction, from the virus itself to medications for HIV infection and related conditions, particularly as they age," said co-author Richard Saitz, professor and chair of community health sciences at BUSPH, who served as principal investigator on the study. "They also have symptoms like chronic pain and mental health symptoms, and use of marijuana, medically or recreationally, may seem like an option to consider. But at least among people with substance use disorders, it appears to have detrimental effects on cognitive function."

Substance use and substance use disorder are disproportionally common among people living with HIV (PLWH) -- estimated at 40 percent to 74 percent. As PLWH are successfully treated for their infections and are now getting older, information about how alcohol and marijuana might affect their symptoms and physical function is critical to their continued health. Aging with HIV infection is associated with many of the same comorbid health conditions that occur in people without HIV infection. These include cardiovascular diseases and dementia, both of which can be affected by substance use.

"Few, if any, studies have examined the combined effects that alcohol use and marijuana use may have on cognition in PLWH," the authors wrote. "Such an understanding could contribute to efforts to reduce harmful substance use and prevent clinical consequences, particularly in an era in which 'moderate' drinking is at times discussed in terms of possible beneficial effects, and in which marijuana is discussed as a relatively safe and even therapeutic substance."

The researchers conducted cross-sectional regression analyses on 215 HIV-infected adults diagnosed with substance disorder, based on the current Diagnostic and Statistical Manual of Mental Disorders (fourth edition). Participants were part of the Boston Alcohol Research Collaboration on HIV/AIDS cohort, 18 years or older, and had current alcohol or other drug dependence. The study included measures of both current and lifetime alcohol and marijuana use.

There were no effects detected of alcohol or past marijuana exposure on cognitive function, nor did there appear to be any evidence for synergistic effects on cognition. Furthermore, neither alcohol nor marijuana appeared to affect simple tests of memory or attention. The authors postulated that such effects were not detected, even though they are expected at the least with heavy alcohol use, because of multiple other exposures and comorbid health conditions that participants had.

The study was led by Sara Lorkiewicz, who earned her Master of Medical Science at BUSM and is currently a doctoral student at Palo Alto University. The other authors were: Alicia Ventura, director of operations and special projects at BMC; Timothy Heeren, professor of biostatistics at BUSPH; Michael R. Winter, associate director of the Data Coordinating Center at BUSPH; Alexander Y. Walley, associate professor of medicine at Boston University; Meg Sullivan, clinical director of HIV services at Boston Medical Center; and Jeffrey Samet, professor of community health sciences at BUSPH.

https://www.sciencedaily.com/releases/2017/11/171101151215.htm