Adults in Pain More Likely to Use Cannabis Without Prescription, Study Finds

Adults who experience pain are more likely to use cannabis without a prescription and have cannabis use disorder than those without pain, according to a study published yesterday in AJP in Advance.

“These results suggest that, among adults with pain, frequent nonmedical cannabis use and cannabis use disorder are growing problems,” wrote Deborah S. Hasin, Ph.D., of the New York State Psychiatric Institute and colleagues. “[T]he need remains for other interventions to manage pain that do not incur risk of another substance use disorder (i.e., cannabis use disorder) as an adverse treatment outcome.”

Hasin and colleagues analyzed data from two national surveys of adults: the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions and the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. Both surveys used the Alcohol Use Disorder and Associated Disabilities Interview Schedule to assess substance use and substance use disorders. As part of these surveys, the respondents were asked about their use of cannabis without a prescription or other than prescribed (nonmedical use). Respondents were also asked to rate how much pain interfered with their “normal work” during the previous four weeks.

Between the 2001-2002 and 2012-2013 surveys, the prevalence of pain among U.S. adults increased from 19.3% to 20%. Pain was associated with significantly greater risk for any nonmedical cannabis use in both surveys.

The prevalence of frequent cannabis use (defined as use at least three times a week) did not differ by pain status in the 2001-2002 survey. But frequent cannabis use was significantly more prevalent in those with pain compared with those without pain in the 2012-2013 survey (5.03% compared to 3.45%).

Cannabis use disorder (defined as meeting DSM-IV criteria for cannabis dependence or abuse) was also more prevalent in respondents with pain compared with those without. In the 2012-2013 survey, the prevalence of cannabis use disorder was 4.18% in those with pain compared with 2.74% in those without.

“Extrapolating to the number of U.S. adults potentially affected, approximately 1.5 million more adults with pain were frequent nonmedical cannabis users in the 2012-2013 period than in the 2001-2002 period, and approximately 0.9 million more adults with pain had past year cannabis use disorder in the 2012-2013 period than in the 2001-2002 period,” the authors wrote.

“Psychiatrists and other mental health professionals treating patients with moderate to severe pain should be informed about the potential risks of cannabis, including cannabis use disorder, provide information about these risks to their patients, and monitor patients for signs and symptoms of cannabis use disorder,” they concluded.

For related information, see the Psychiatric News article “National Academies Issues Report on Health Effects of Cannabis.”

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High-Risk Drinking, Alcohol Use Disorder Rises Significantly Over Past Decade

Between 2001-2002 and 2012-2013, the percentage of U.S. adults who engaged in regular high-risk drinking increased by almost 30%, and the percentage of people meeting criteria for alcohol use disorder (AUD) grew by 49.4%, according to a report published today in JAMA Psychiatry.

“Increases in all of these outcomes were greatest among women, older adults, racial/ethnic minorities, and individuals with lower educational level and family income,” Bridget F. Grant, Ph.D., of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and colleagues wrote.

Grant and colleagues compared information collected during face-to-face interviews from two nationally representative surveys of U.S. adults: NIAAA’s 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the 2012-2013 NESARC-III. Survey participants were asked identical questions regarding 12-month alcohol consumption and how often they engaged in high-risk drinking (four or more standard drinks containing alcohol [for example 12 oz. beer or 5 oz. wine] on any given day for women; five or more standard drinks for men); for this study, high-risk drinking was defined as exceeding the daily drinking limits at least weekly. Participants were considered to have a DSM-IV AUD diagnosis if they met criteria for alcohol dependence or abuse in the past 12 months.

The study sample included 43,093 participants in the NESARC and 36,309 participants in the NESARC III. Between 2001-2002 and 2012-2013, alcohol use in the United States increased from 65.4% to 72.7% (11.2% increase), high-risk drinking increased from 9.7% to 12.6% (29.2% increase), and the prevalence of DSM-IV AUD increased from 8.5% to 12.7% (49.4% increase). 

“While the prevalence of AUD among both 12-month alcohol users and 12-month high-risk drinkers increased, the prevalence of AUD among high-risk drinkers (46.5% in 2001-2002 and 54.5% in 2012-2013) was much greater than the prevalence of AUD among 12-month users (12.9% in 2001-2002 and 17.5% in 2012- 2013), highlighting the critical role of high-risk drinking in the increase in AUD between 2001-2002 and 2012-2013,” the authors wrote. 

In a related editorial, Marc A. Schuckit, M.D., a professor of psychiatry at the University of California, San Diego, described the costs associated with alcohol-related problems and noted that the populations that appear to be at greatest risk may also be least likely to have access to care.

The article “makes a compelling case that the United States is facing a crisis with alcohol use, one that is currently costly and about to get worse,” he wrote. It is also a reminder that “the chilling increases in opioid-related deaths reflect a broader issue regarding additional substance-related problems.”

The findings “highlight the urgency of educating the public, policymakers, and health care professionals about high-risk drinking and AUD, destigmatizing these conditions, and encouraging those who cannot reduce their alcohol consumption on their own, despite substantial harm to themselves and others, to seek treatment,” Grant and colleagues wrote.

For related information, see the Psychiatric News article “Why Treat Alcohol Use Disorders in Primary Care?” and the AJP article “Vulnerability for Alcohol Use Disorder and Rate of Alcohol Consumption.”

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People Who Use Marijuana May Be More Likely to Develop Other SUDs

A prospective analysis of the results of a survey of U.S. adults suggests marijuana use may be associated with an increased risk for developing alcohol and drug disorders, but not mood or anxiety disorders, according to a study published today in JAMA Psychiatry.

“Our findings suggest caution in the implementation of policies related to legalization of cannabis for recreational use, as it may lead to greater availability and acceptance of cannabis, reduced perception of risk of use, and increased risk of adverse mental health outcomes, such as substance abuse disorders,” Mark Olfson, M.D., M.P.H., of Columbia University Medical Center and colleagues wrote.

Olfson and colleagues prospectively examined the associations of cannabis use with the prevalence and incidence of mood, anxiety, and substance abuse disorders in a nationally representative sample of 34,653 U.S. adults interviewed three years apart (wave 1: 2001 to 2002; wave 2: 2004 to 2005) as part of the National Epidemiologic Survey on Alcohol and Related Conditions.

Cannabis use was assessed by asking respondents whether they had used cannabis in the 12 months preceding the interview, and psychiatric disorders were measured according to DSM-IV using the Alcohol Use Disorder and Associated Disabilities Interview Schedule. Incidence refers to disorders that were reported at wave 2 among respondents without a lifetime history of the disorder at wave 1.

Analysis of the data revealed that cannabis use in wave 1, which was reported by 1,279 respondents, was significantly associated with substance use disorders in wave 2 (odds ratio of any alcohol use disorder, cannabis use disorder, and nicotine dependence were 2.7, 9.5, and 1.7, respectively), but not any mood disorder. However, the authors noted that the study was unable to determine a causal association between cannabis use and new onset of substance use disorders.

“While the health benefits of cannabis use require further testing among patients who are unresponsive to more traditional treatments, the association of cannabis use with negative mental health outcomes, such as substance use disorders, appears strong,“ the authors concluded.

For related information, see the Psychiatric News article “NIDA Research Series to Shed Light on Opioid, Marijuana, and Tobacco Use. Also, orders for the new book Marijuana and Mental Health are now being accepted by APA Publishing.

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