Association of High-Potency Cannabis Use With Mental Health and Substance Use in Adolescence
Association of High-Potency Cannabis Use With Mental Health and Substance Use in Adolescence
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DOI：
10.1001/jamapsychiatry.2020.1035
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发表时间：
2020-10-01
期刊：
影响因子：
25.8
通讯作者：
Heron, Jon
中科院分区：
文献类型：
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作者：
Hines, Lindsey A.;Freeman, Tom P.;Heron, Jon
大麻的使用一直与较差的心理健康结果有关，有证据表明使用更高效力的大麻会增加这些风险。到目前为止，还没有研究描述了一般人群样本中大麻效力与并发心理健康之间的关联，或者使用纵向数据解决了混淆问题。目的探讨大麻效力与物质使用和心理健康结果之间的关系，解释先前的心理健康和大麻使用频率。设计、设置和参与者这项队列研究使用的数据来自雅芳父母和儿童纵向研究，这是一项英国出生队列研究，参与者出生于1991年4月1日至1992年12月31日。目前关于结果和暴露的数据是在2015年6月至2017年10月期间从1087名24岁的参与者中收集的，他们报告了最近的大麻使用情况。自我报告的过去一年中最常用的大麻类型，编码为使用高效力大麻或低效力大麻的二元暴露。主要结果和测量结果包括报告的大麻使用频率、报告的大麻使用问题、最近使用其他非法药物、烟草依赖、酒精使用障碍、抑郁症、广泛性焦虑症和精神病样经历。该研究使用了二手数据;因此，在收集数据后制定了假设。1087名参与者报告了去年的大麻使用情况（580名女性;大麻使用开始时的平均[SD]年龄为16.7 [3.0]岁）。其中，141名参与者（13.0%）报告使用高效力大麻。使用高效大麻与大麻使用频率增加（调整后的比值比[AOR]，4.38; 95%CI，2.89-6.63），大麻问题（AOR，4.08; 95%CI，1.41-11.81）和焦虑症可能性增加（AOR，1.92; 95%CI，1.11-3.32）相关。调整大麻使用频率减弱了与精神病经历（AOR 1.29; 95%CI，0.67-2.50）、烟草依赖（AOR，1.42; 95%CI，0.89-2.27）和其他非法药物使用（AOR，1.29; 95%CI，0.77-2.17）的相关性。没有证据表明使用高效大麻与酒精使用障碍或抑郁症之间存在关联。结论和相关性据我们所知，这项研究提供了第一个一般人群的证据表明，使用高效能大麻与心理健康和成瘾有关。限制高效力大麻的供应可能与发展大麻使用障碍的人数减少，防止大麻使用升级为常规行为，以及减少精神健康障碍的风险有关。问题（与使用低效力大麻相比）增加了因使用大麻、常见精神障碍、在控制了早期精神健康症状和使用频率后，在这项队列研究中，1087名参与者在前一年报告了大麻使用情况，在调整大麻使用频率和青少年早期心理健康后，使用高效大麻与大麻使用频率显着增加有关，大麻问题的可能性和焦虑症的可能性。使用高效能大麻的人精神病经历的可能性略有增加;然而，在调整大麻使用频率后，这种风险有所减弱。大麻使用问题和焦虑症的风险在报告使用高效力大麻的人中较高;提供公共卫生信息，说明减少大麻使用频率和药物效力的重要性，以及限制高效力大麻的供应，可能对降低这些风险有效。这项队列研究探讨了大麻效力与物质使用和心理健康结果之间的关系，考虑到之前的精神健康和大麻使用频率。
Importance Cannabis use is consistently linked to poorer mental health outcomes, and there is evidence that use of higher-potency cannabis increases these risks. To date, no studies have described the association between cannabis potency and concurrent mental health in a general population sample or addressed confounding using longitudinal data. Objective To explore the association between cannabis potency and substance use and mental health outcomes, accounting for preceding mental health and frequency of cannabis use. Design, Setting, and Participants This cohort study used data from the Avon Longitudinal Study of Parents and Children, a UK birth cohort of participants born between April 1, 1991, and December 31, 1992. Present data on outcomes and exposures were collected between June 2015 and October 2017 from 1087 participants at 24 years of age who reported recent cannabis use. Exposures Self-reported type of cannabis most commonly used in the past year, coded to a binary exposure of use of high-potency cannabis or lower-potency cannabis. Main Outcomes and Measures Outcomes were reported frequency of cannabis use, reported cannabis use problems, recent use of other illicit drugs, tobacco dependence, alcohol use disorder, depression, generalized anxiety disorder, and psychotic-like experiences. The study used secondary data; consequently, the hypotheses were formulated after data collection. Results Past-year cannabis use was reported by 1087 participants (580 women; mean [SD] age at onset of cannabis use, 16.7 [3.0] years). Of these, 141 participants (13.0%) reported the use of high-potency cannabis. Use of high-potency cannabis was associated with increased frequency of cannabis use (adjusted odds ratio [AOR], 4.38; 95% CI, 2.89-6.63), cannabis problems (AOR, 4.08; 95% CI, 1.41-11.81), and increased likelihood of anxiety disorder (AOR, 1.92; 95% CI, 1.11-3.32). Adjustment for frequency of cannabis use attenuated the association with psychotic experiences (AOR 1.29; 95% CI, 0.67-2.50), tobacco dependence (AOR, 1.42; 95% CI, 0.89-2.27), and other illicit drug use (AOR, 1.29; 95% CI, 0.77-2.17). There was no evidence of association between the use of high-potency cannabis and alcohol use disorder or depression. Conclusions and Relevance To our knowledge, this study provides the first general population evidence suggesting that the use of high-potency cannabis is associated with mental health and addiction. Limiting the availability of high-potency cannabis may be associated with a reduction in the number of individuals who develop cannabis use disorders, the prevention of cannabis use from escalating to a regular behavior, and a reduction in the risk of mental health disorders.Question Does use of high-potency cannabis (compared with use of low-potency cannabis) increase risks for problems resulting from cannabis use, common mental disorders, and psychotic experiences after controlling for early-life mental health symptoms and frequency of use? Findings In this cohort study of 1087 participants who reported cannabis use in the previous year, after adjusting for frequency of cannabis use and early adolescent mental health, use of high-potency cannabis was associated with a significant increase in the frequency of cannabis use, likelihood of cannabis problems, and likelihood of anxiety disorder. Those using high-potency cannabis had a small increase in the likelihood of psychotic experiences; however, this risk was attenuated after adjustment for frequency of cannabis use. Meaning Risks for cannabis use problems and anxiety disorders are higher among those reporting use of high-potency cannabis; provision of public health messaging regarding the importance of reducing both frequency of cannabis use and the potency of the drug, as well as limiting the availability of high-potency cannabis, may be effective for reducing these risks.This cohort study examines the association between cannabis potency and substance use and mental health outcomes, accounting for preceding mental health and frequency of cannabis use.