Study finds Cannabis Use Not Associated With Increased Suicide Risk in Patients with Psychiatric Disorders

MedicalResearch.com Interview with:

“Cannabis sativa” by Manuel is licensed under CC BY 2.0

Leen Naji, BHSc, MD
Family Medicine Resident
McMaster University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Cannabis use has consistently been linked to suicide attempt in the general population, but little data exists linking the association between cannabis use and suicide attempt amongst patients with psychiatric disorders. This is important data as we know that patients with psychiatric disorders are both more likely to use cannabis and to attempt suicide. Therefore, our goal was to study the association between cannabis use and suicide attempt amongst patients with psychiatric disorders. Additionally, since we know that women are more likely to suffer from mental health disorders, are more likely to attempt suicide and are more likely to incur the deleterious consequences of drug use at lower doses, we sought to compare the association between cannabis use and suicide attempt in men and women amongst our study population.

We conducted our analysis on a large sample of over 900 adults with psychiatric disorders (465 men, 444 women), of whom 112 men and 158 women had attempted suicide. The average age of our study sample was 40 years.

We found that cannabis use is not associated with an increased risk of suicide in patients with psychiatric disorders, though this association may vary when looking at specific subpopulations and/or amount of cannabis use. For instance, we found that heavier cannabis use is associated with an increased risk of suicide attempt amongst men with psychiatric disorders. Specifically, there was a 3% increased risk of suicide attempt for every day of cannabis use per month in men with psychiatric disorders. We also found that amongst those with psychiatric conditions, women, unemployed individuals and those with a mood disorder were at increased risk of suicide attempt.   Continue reading

Age of First Pot Smoking Does Matter

MedicalResearch.com Interview with:
Natalie Castellanos Ryan, PhD

École de Psychoéducation
Université de Montréal
Outremont Canada 

MedicalResearch.com: What is the background for this study?

Response: Our study followed a group of boys living in low socioeconomic neighbourhoods in Montreal (N=1030) from early childhood to 28 years of age to investigate:

1) whether the age at which one starts to use cannabis across adolescence is associated with the risk of developing drug abuse by early adulthood, when one controls for  arrange of known risk factors for cannabis use and problems assessed across development (risk factors in childhood, adolescence and early adulthood); and

2) the developmental pathways from early risk factors to drug abuse problems.

To examine these associations, the study collected  self-reported cannabis use information from these boys annually from ages 13 to 17 years and drug abuse symptoms at 28 years, as well as teacher, parent and child reported information on a number of environmental (family and friend) and child characteristics (e.g., impulsivity, delinquency, school performance) across childhood and adolescence. Alcohol and other drug use was also assessed across adolescence and early adulthood.

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Less Restrictive Marijuana Laws Linked To Reduced Opioid Prescriptions

MedicalResearch.com Interview with:

Dr. Italia V. Rolle, PhD and Dr. Tim McAfee, MD Office on Smoking and Health National Center for Chronic Disease Prevention and Health Promotion CDC

Marijuana plant

Hefei Wen, PhD
Assistant Professor, Department of Health Management & Policy
University of Kentucky College of Public Health 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Marijuana is one of the potential, non-opioid alternatives that can relieve pain at a relatively lower risk of addiction and virtually no risk of overdose. Medical and adult-use marijuana laws, has made marijuana available to more Americans. Yet no study to date has focused on the effect of medical and adult-use marijuana laws on opioid prescribing in particular.

Our study provides some of the first empirical evidence that the implementation of medical and adult-use marijuana laws between 2011 and 2016 was associated with lower opioid prescribing rates and spending among Medicaid enrollees.   Continue reading

States with Medical Cannabis Dispensaries Had Bigger Drop in Opioid Prescriptions

MedicalResearch.com Interview with

“Cannabis sativa” by Manuel is licensed under CC BY 2.0

David Bradford, Ph.D.
Busbee Chair in Public Policy
Department of Public Administration and Policy
University of Georgia
Athens, GA 30602

MedicalResearch.com: What is the background for this study?

Response: To give you some background, in 2016, part of our research team (Bradford and Bradford) published the first study to directly examine the impact that medical cannabis laws (MCLs) may be having on prescription use. We used yearly physician-level Medicare Part D data, looked at nearly all prescription drugs used to treat 9 broad categories of illness/diagnoses, and found substantial reductions in prescriptions. We published a follow-up study in 2017, this time using data from Medicaid Fee-for-Service.

Again, we found significant substitution away from prescription medications. In both of these studies, pain was included in the list of conditions for which cannabis may be used in patients, and in both studies, pain prescriptions fell. One of the unanswered questions from both of those studies, though, was what *type* of pain medications were being reduced.  From a public health standpoint, when we’re worried about opioid overdose, it matters whether the substitution away from pain medications is coming from substitutions away from things like NSAIDs or whether there is substitution away from opioids.

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Teen Marijuana Use Did Not Increase After Passage of Medical Marijuana Laws

MedicalResearch.com Interview with:
“medical marijuana : strains and varieties” by torbakhopper is licensed under CC BY 2.0Professor Deborah Hasin PhD
Department of Epidemiology in Psychiatry
Mailman School of Public Health
Columbia University

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: We began to think about this study after we published an earlier report (Hasin et al., The Lancet Psychiatry 2015) showing that after state medical marijuana laws (MML) were passed, U.S. teen marijuana use did not increase compared to the period before the laws were passed and to overall national trends. However, people continued to question whether MML led to teen increases in marijuana use. Therefore, in the present study, we combined findings from 11 large-scale national studies of teens to provide a more definite answer.

The findings were clear that teen marijuana use did not increase after passage of medical marijuana laws.  Continue reading

More Car Crashes on 4/20 Marijuana Celebration Day

MedicalResearch.com Interview with:
Dr. John A Staples, MD, FRCPC, MPH Scientist, Centre for Health Evaluation and Outcome Sciences Clinical Assistant Professor University of British ColumbiaDr. John A Staples
MD, FRCPC, MPH
Scientist, Centre for Health Evaluation and Outcome Sciences
Clinical Assistant Professor
University of British Columbia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Around 64 million Americans live in states that have legalized recreational marijuana. Many policymakers are trying to figure out what that means for traffic safety.

On April 20th, some Americans participate in an annual “4/20” counterculture holiday that celebrates and promotes the use of cannabis. Some 4/20 events such as those in Denver and San Francisco involve thousands of participants. Much like celebrations at midnight on New Year’s eve, public 4/20 events sometimes mark 4:20 p.m. by a countdown followed by synchronized mass consumption of cannabis. We thought this was a perfect natural experiment to evaluate the influence that cannabis intoxication has on the risk of motor vehicle crash.

To examine this question, we analyzed 25 years of data on all fatal traffic crashes in the United States. We compared the number of drivers in crashes between 4:20 p.m. and midnight on April 20th to the number of drivers in crashes during the same time interval on control days one week earlier and one week later.

We found that the risk of crash involvement was 12% higher on April 20th than on control days. In the subgroups of drivers younger than 21 years of age, the risk of crash involvement was 38% higher on April 20th than on control days.

Assuming fewer than 12% of Americans celebrate 4/20, our results suggest that substance use at April 20th celebrations more than doubles the risk of fatal crash.

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Marijuana Dispensaries Have Ability To Reduce Opioid Overdoses and Substance Abuse

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: David Powell  PhD Economist; Core Faculty, Pardee RAND Graduate School RAND, Santa Monica     MedicalResearch.com:  What is the background for this study?  What are the main findings?   Response: There has been some research suggesting that the adoption of state medical marijuana laws leads to reductions in prescriptions for opioid analgesics among certain populations and opioid-related overdoses overall.  However, medical marijuana laws are very different across states and they have changed over time as well.  We wanted to understand what components of a medical marijuana law could potentially lead to reductions in overdoses and substance abuse.  We focused specifically on the role of dispensaries, given their importance in providing access to medical marijuana, and tested for different effects in states with and without legally-protected and operational dispensaries.  We found that dispensaries are critical to reduce opioid-related overdoses and substance abuse.  We also found evidence that more recently-adopting states have experienced smaller reductions in overdoses and opioid substance abuse, potentially because the more recent adopters tend to enforce more stringent guidelines for dispensaries than the early adopters.   MedicalResearch.com: What should readers take away from your report?  Response: We find that the introduction of medical marijuana dispensaries has the potential to reduce opioid-related harms quite significantly.  More broadly, it also suggests that, when we think about the opioid crisis, improving access to pain management alternatives may be a useful mechanism for reducing dependence on opioids.        MedicalResearch.com: What recommendations do you have for future research as a result of this work?  Response: During most of the time period that we studied, prescription opioids were driving the opioid crisis, but it has recently transitioned to the point where heroin and illicit synthetic opioids are playing more prominent roles.  We are hesitant to suggest that medical marijuana access will have the same scope in a climate in which synthetic opioids and heroin are the primary substances of abuse.  Future work could do more to explore the potential of different types of medical marijuana laws to reduce overdoses related to these substances.        Citations: Do medical marijuana laws reduce addictions and deaths related to pain killers? ☆ •David Powella, , ,  •	Rosalie Liccardo Paculaa, b,  Mireille Jacobsonb  RAND, Santa Monica, United States  NBER Cambridge, MA, United StatesUniversity of California, Irvine, United States Received 14 November 2015, Revised 15 August 2017, Accepted 30 December 2017, Available online 3 February 2018  Journal of Health Economics Volume 58, March 2018, Pages 29–42  https://doi.org/10.1016/j.jhealeco.2017.12.007     The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Dr. Powell

David Powell  PhD
Economist; Core Faculty, Pardee RAND Graduate School
RAND, Santa Monica 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There has been some research suggesting that the adoption of state medical marijuana laws leads to reductions in prescriptions for opioid analgesics among certain populations and opioid-related overdoses overall.  However, medical marijuana laws are very different across states and they have changed over time as well.  We wanted to understand what components of a medical marijuana law could potentially lead to reductions in overdoses and substance abuse.  We focused specifically on the role of dispensaries, given their importance in providing access to medical marijuana, and tested for different effects in states with and without legally-protected and operational dispensaries.

We found that dispensaries are critical to reduce opioid-related overdoses and substance abuse.  We also found evidence that more recently-adopting states have experienced smaller reductions in overdoses and opioid substance abuse, potentially because the more recent adopters tend to enforce more stringent guidelines for dispensaries than the early adopters.   Continue reading

Insufficient Evidence To Determine Cardiovascular Risks of Marijuana

Dr. Italia V. Rolle, PhD and Dr. Tim McAfee, MD Office on Smoking and Health National Center for Chronic Disease Prevention and Health Promotion CDC

Marijuana plant (Cannabis sativa)

MedicalResearch.com Interview with:
Divya Ravi, MD, MPH

The Wright Center for Graduate Medical Education
Scranton, PA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There is evidence to suggest that Marijuana can bring about changes at the tissue level and has the ability to potentiate vascular disease, in ways similar to tobacco.  With change in legalization and increase usage trends, we conducted this review to examine the known effects of marijuana on cardiovascular outcomes and risk factors, given that cardiovascular disease remains the greatest cause of morbidity and mortality worldwide.

Our review found insufficient evidence to draw meaningful conclusions that marijuana use is associated with cardiovascular risk factors and outcomes. The few studies that suggested a possible benefit from marijuana use, were cross-sectional, and were contradicted by more robust longitudinal studies that reported potential harmful effects.

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Fewer Cigarettes But More Vaping Among Today’s Adolescents

MedicalResearch.com Interview with:
“Checking your phone and vaping as you do” by Alper Çuğun is licensed under CC BY 2.0
Richard Allen Miech, PhD
Research Professor, Survey Research Center
Institute for Social Research
University of Michigan 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Monitoring the Future conducts annual, nationally-representative surveys of ~45,000 adolescents every year to assess trends in substance use.  We track which drugs are gaining traction among adolescents and which are falling out of favor.  The survey draws separate, nationally-representative samples of 8th, 10th, and 12th grade students from about 400 total schools every year.  Once a recruited school agrees to participate, a field interviewer travels to the school to administer the paper-and-pencil survey, typically in classrooms.  The project is funded by the National Institute of Drug Abuse and is carried out by the University of Michigan.  More details on the project’s survey design and survey procedures can be found in chapter 3 here: http://monitoringthefutu re.org/pubs/monographs/mtf- vol1_2016.pdf

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Local Politics Determine How Cannabis Is Distributed and Marketed By Dispensaries

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Greta Hsu PhD Graduate School of Business Stanford University, Graduate School of Business   MedicalResearch.com: What is the background for this study? What are the main findings?  Response:  My co-authors, Ozgecan Kocak at Emory University and Balazs Kovacs at Yale University, and I became interested in the cannabis industry in early 2014, when Colorado and Washington states were in the early stages of licensing recreational cannabis operations.  As organizational researchers, we were interested in how the emergence of the new legalized recreational-use dispensary stores would impact existing medical cannabis dispensaries that had already been in existence for years in both states.  For decades, activists and many dispensaries had framed cannabis as medicine that relieves pain for patients suffering from a wide variety of illnesses.  As recreational-use legalization took hold, would medical dispensaries emphasize their identities as medical providers or downplay their medical orientation to compete directly for potential customers?  We found that some clusters of dispensaries were more conservative in their marketing, continuing and even accentuating an organizational identity focused on therapy and patients.  This was reflected in statements like: “We aim to educate our patients about cannabis treatments and other alternative health approaches to supplement their medicine.”  Counties where the majority of voters voted against legalizing recreational marijuana tended to encourage this increasing focus on therapy.  Dispensaries that embraced the new recreational market took more risk by advertising to a broader, emerging consumer class, which has been bolstered by a growing tourism industry.  These dispensaries de-emphasized their medical orientation and focused more on themes such as product variety and prices.  Dispensaries with this more recreational-oriented marketing tended to be in counties that voted in favor of legalizing recreational use.  Overall, our research suggests local communities hold a great deal of power in affecting how dispensaries present themselves both to consumers and the broader population.  MedicalResearch.com: What should clinicians and patients take away from your report? Response:  In states that have legalized cannabis for adult recreational-use and sales, the law often gives local municipalities flexibility in deciding how easily dispensaries can operate within their boundaries. Many counties have chosen to ban cannabis-related businesses. Others are carefully regulating sales and businesses through zoning and taxes.  Our research suggests that dispensaries are responsive to the level of concern raised by local community members about recreational-use cannabis.  How dispensaries choose to market and present themselves will be shaped by their need to project a positive organizational identity and be accepted as legitimate members of the local community.   MedicalResearch.com: What recommendations do you have for future research as a result of this study?  Response: Many national polls indicate strong support for legalizing the use of cannabis for medical and, to a somewhat lesser degree, recreational uses.  The progression of state-level legalization has been fast and is likely to continue in the coming years.  The overall landscape in the United States is incredibly complex.  Different states has enacted different types of state-level regulations, and different localities within each of these states also differ widely in the types of regulations enacted.  Future research studying dynamics in different states is needed to better understand how this fast-growing industry will continue to evolve.   MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.  Citation: Co-opt or co-exist? A study of medical cannabis dispensaries’ identity-based responses to recreational-use legalization in Colorado and Washington Greta Hsu* University of California, Davis Özgecan Koçak Emory University Balázs Kovács Yale University https://gsm.ucdavis.edu/sites/main/files/file-attachments/cannabis_os_final.pdf  Note:  Content is Not intended as medical advice.  Please consult your health care provider regarding your specific medical condition and questions.

Dr. Hsu

Greta Hsu PhD
Graduate School of Business
Stanford University, Graduate School of Business

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: My co-authors, Ozgecan Kocak at Emory University and Balazs Kovacs at Yale University, and I became interested in the cannabis industry in early 2014, when Colorado and Washington states were in the early stages of licensing recreational cannabis operations.  As organizational researchers, we were interested in how the emergence of the new legalized recreational-use dispensary stores would impact existing medical cannabis dispensaries that had already been in existence for years in both states.

For decades, activists and many dispensaries had framed cannabis as medicine that relieves pain for patients suffering from a wide variety of illnesses.  As recreational-use legalization took hold, would medical dispensaries emphasize their identities as medical providers or downplay their medical orientation to compete directly for potential customers?

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