Association of cannabis use with hospital admission and antipsychotic treatment failure in first episode psychosis: an observational study

Patel, Rashmi; Wilson, R.F.; Jackson, Roy; Ball, Michael; Shetty, Hitesh; Broadbent, Matthew; Stewart, Robert; McGuire, Philip; Bhattacharyya, Sagnik

doi:10.1136/bmjopen-2015-009888

Cited by 118 publications

(89 citation statements)

References 30 publications

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“…Here, we extend this previous work to show that the adverse effect of continued cannabis use on outcome in early psychosis is partly mediated by an effect on adherence with medication treatment. These findings are consistent with studies that identified an association between cannabis use and medication adherence,8, 9, 15, 28 as well as between medication adherence and increased risk of relapse of psychosis 10, 11. We have reported 8 that failure of treatment with antipsychotic medication as indexed by the number of unique antipsychotic prescriptions could partly mediate the adverse effect of cannabis use on subsequent risk of relapse in first-episode psychosis.…”

Section: Discussionsupporting

confidence: 92%

“…These findings are consistent with studies that identified an association between cannabis use and medication adherence,8, 9, 15, 28 as well as between medication adherence and increased risk of relapse of psychosis 10, 11. We have reported 8 that failure of treatment with antipsychotic medication as indexed by the number of unique antipsychotic prescriptions could partly mediate the adverse effect of cannabis use on subsequent risk of relapse in first-episode psychosis. Although a change of antipsychotic medication could reflect a clinical judgment of failed treatment, several separate considerations either alone or in combination could lead to such a judgment, including one of treatment resistance, poor tolerability, or non-adherence to a specific antipsychotic.…”

Section: Discussionsupporting

confidence: 92%

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Poor medication adherence and risk of relapse associated with continued cannabis use in patients with first-episode psychosis: a prospective analysis

Schoeler

Petros

Forti

et al. 2017

The Lancet Psychiatry

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SummaryBackgroundCannabis use following the onset of first-episode psychosis has been linked to both increased risk of relapse and non-adherence with antipsychotic medication. Whether poor outcome associated with cannabis use is mediated through an adverse effect of cannabis on medication adherence is unclear.MethodsIn a prospective analysis of data acquired from four different adult inpatient and outpatient units of the South London and Maudsley Mental Health National Health Service Foundation Trust in London, UK, 245 patients were followed up for 2 years from the onset of first-episode psychosis. Cannabis use after onset of psychosis was assessed by self-reports in face-to-face follow-up interviews. Relapse data were collected from clinical notes using the WHO Life Chart Schedule. This measure was also used to assess medication adherence on the basis of both face-to-face interviews and clinical notes. Patients were included if they had a diagnosis of first-episode non-organic or affective psychosis according to ICD-10 criteria, and were aged between 18 and 65 years when referred to local psychiatric services. We used structural equation modelling analysis to estimate whether medication adherence partly mediated the effects of continued cannabis use on risk of relapse. The primary outcome variable was relapse, defined as admission to a psychiatric inpatient unit after exacerbation of symptoms within 2 years of first presentation to psychiatric services. Information on cannabis use over the first 2 years after onset of psychosis was investigated as a predictor variable for relapse. Medication adherence was assessed as a mediator variable on the basis of clinical records and self-report data. Study researchers (TS, NP, EK, and EF) rated the adherence.Findings397 patients who presented with their first episode of psychosis between April 12, 2002, and July 26, 2013 had a follow-up assessment until September, 2015. Of the 397 patients approached for followed up, 133 refused to take part in this study and 19 could not be included because of missing data. 91 (37%) of 245 patients with first-episode psychosis had a relapse over the 2 years of follow-up. Continued cannabis use predicted poor outcome, including risk of relapse, number of relapses, length of relapse, and care intensity at follow-up. In controlled structural equation modelling analyses, medication adherence partly mediated the effect of continued cannabis use on outcome, including risk of relapse (proportion mediated=26%, βindirect effects=0·08, 95% CI 0·004 to 0·16), number of relapses (36%, βindirect effects=0·07, 0·003 to 0·14), time until relapse (28%, βindirect effects=–0·26, −0·53 to 0·001) and care intensity (20%, βindirect effects=0·06, 0·004 to 0·11) but not length of relapse (6%, βindirect effects=0·03, −0·03 to 0·09). The adjusted models explained moderate amounts of variance for outcomes defined as risk of relapse (R2=0·25), number of relapses (R2=0·21), length of relapse (R2=0·07), time until relapse (R2=0·08), and care intensity index (R2=0·15...

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Poor medication adherence and risk of relapse associated with continued cannabis use in patients with first-episode psychosis: a prospective analysis

Schoeler

Petros

Forti

et al. 2017

The Lancet Psychiatry

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“…Other natural language-processing applications developed in the Clinical Record Interactive Search system in current research use include those ascertaining text on tobacco 22 and cannabis use, 23 medications for diabetes and other physical disorders, 7 and more than 70 different mental health symptoms 24 . These efforts have been supplemented by a range of new algorithms for ascertaining recorded body-mass index and mentions of comorbid physical disorders and use of several common illicit drugs.…”

Section: Discussionmentioning

confidence: 99%

Ethnicity and excess mortality in severe mental illness: a cohort study

Das‐Munshi

Chang

Dutta

et al. 2017

The Lancet Psychiatry

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SummaryBackgroundExcess mortality in severe mental illness (defined here as schizophrenia, schizoaffective disorders, and bipolar affective disorders) is well described, but little is known about this inequality in ethnic minorities. We aimed to estimate excess mortality for people with severe mental illness for five ethnic groups (white British, black Caribbean, black African, south Asian, and Irish) and to assess the association of ethnicity with mortality risk.MethodsWe conducted a longitudinal cohort study of individuals with a valid diagnosis of severe mental illness between Jan 1, 2007, and Dec 31, 2014, from the case registry of the South London and Maudsley Trust (London, UK). We linked mortality data from the UK Office for National Statistics for the general population in England and Wales to our cohort, and determined all-cause and cause-specific mortality by ethnicity, standardised by age and sex to this population in 2011. We used Cox proportional hazards regression to estimate hazard ratios and a modified Cox regression, taking into account competing risks to derive sub-hazard ratios, for the association of ethnicity with all-cause and cause-specific mortality.FindingsWe identified 18 201 individuals with a valid diagnosis of severe mental illness (median follow-up 6·36 years, IQR 3·26–9·92), of whom 1767 died. Compared with the general population, age-and-sex-standardised mortality ratios (SMRs) in people with severe mental illness were increased for a range of causes, including suicides (7·65, 95% CI 6·43–9·04), non-suicide unnatural causes (4·01, 3·34–4·78), respiratory disease (3·38, 3·04–3·74), cardiovascular disease (2·65, 2·45–2·86), and cancers (1·45, 1·32–1·60). SMRs were broadly similar in different ethnic groups with severe mental illness, although the south Asian group had a reduced SMR for cancer mortality (0·49, 0·21–0·96). Within the cohort with severe mental illness, hazard ratios for all-cause mortality and sub-hazard ratios for natural-cause and unnatural-cause mortality were lower in most ethnic minority groups relative to the white British group.InterpretationPeople with severe mental illness have excess mortality relative to the general population irrespective of ethnicity. Among those with severe mental illness, some ethnic minorities have lower mortality than the white British group, for which the reasons deserve further investigation.FundingUK Health Foundation and UK Academy of Medical Sciences.

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“…Several studies have reported potential adverse effects of illicit cannabis use, such as other illicit drug use (Volkow, Baler, Compton, & Weiss, 2014), motor vehicle accidents (Li et al, 2012), and hospitalizations (Patel et al, 2016). However, it is uncertain whether these findings on illicit cannabis use can be extended to medical cannabis use.…”

Section: Discussionmentioning

confidence: 99%

Cannabis Use is Associated with Lower Odds of Prescription Opioid Analgesic Use Among HIV-Infected Individuals with Chronic Pain

Sohler

Starrels

Khalid

et al. 2018

Substance Use & Misuse

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BACKGROUND Chronic pain is common in the United States and prescribed opioid analgesics use for non-cancer pain has increased dramatically in the past two decades, possibly accounting for the current opioid addiction epidemic. Co-morbid drug use in those prescribed opioid analgesics is common, but there are few data on polysubstance use patterns. OBJECTIVE We explored patterns of use of cigarette, alcohol, and illicit drugs in HIV-infected people with chronic pain who were prescribed opioid analgesics. METHODS We conducted a secondary data analysis of screening interviews conducted as part of a parent randomized trial of financial incentives to improve HIV outcomes among drug users. In a convenience sample of people with HIV and chronic pain, we collected self-report data on demographic characteristics; pain; patterns of opioid analgesic use (both prescribed and illicit); cigarette, alcohol, and illicit drug use (including cannabis, heroin, and cocaine) within the past 30 days; and current treatment for drug use and HIV. RESULTS Almost half of the sample of people with HIV and chronic pain reported current prescribed opioid analgesic use (N=372, 47.1%). Illicit drug use was common (N=505, 63.9%), and cannabis was the most commonly used illicit substance (N=311, 39.4%). In multivariate analyses, only cannabis use was significantly associated with lower odds of prescribed opioid analgesic use (adjusted odds ratio=0.57; 95% confidence interval: 0.38-0.87). CONCLUSIONS/IMPORTANCE Our data suggest that new medical cannabis legislation might reduce the need for opioid analgesics for pain management, which could help to address adverse events associated with opioid analgesic use.

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Association of cannabis use with hospital admission and antipsychotic treatment failure in first episode psychosis: an observational study

Cited by 118 publications

References 30 publications

Poor medication adherence and risk of relapse associated with continued cannabis use in patients with first-episode psychosis: a prospective analysis

Poor medication adherence and risk of relapse associated with continued cannabis use in patients with first-episode psychosis: a prospective analysis

Ethnicity and excess mortality in severe mental illness: a cohort study

Cannabis Use is Associated with Lower Odds of Prescription Opioid Analgesic Use Among HIV-Infected Individuals with Chronic Pain

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