Cross‐sectional and prospective relation of cannabis potency, dosing and smoking behaviour with cannabis dependence: an ecological study

Abstract

Cannabis users titrate their delta-9-tetrahydrocannabinol intake by inhaling lower volumes of smoke when smoking strong joints, but this does not fully compensate for the higher cannabis doses per joint when using strong cannabis. Thus, users of more potent cannabis are generally exposed to more delta-9-tetrahydrocannabinol. Smoking behaviour appears to be a stronger predictor for cannabis dependence severity than monthly delta-9-tetrahydrocannabinol dose.

Commentary on van der Pol et al. (2014): Reconsidering the association between cannabis exposure and dependence

“…Van der Pol et al 's [1] findings, however, throw this into some doubt. To understand why there is a discrepancy here, and its import, it is essential to consider how cannabis exposure/dose is typically measured and, thereby, how past studies may have clouded our understanding of the association between cannabis use and dependence.…”

“…[3]); in comparison, van der Pol et al's participants were using cannabis ranging from 3.6 to 15.7% THC and they smoked it as per usual, such that their smoking topographies varied. Taken together with the finding that total number of puffs and puff volume were significant predictors of dependence in van der Pol et al's study, these differences throw at least some doubt on the 'real world' validity of findings from previous studies (whether using real or proxy measures of exposure/dose) and illustrate how important naturalistic studies are to increasing our understanding of the acute and long-term effects of cannabis use, including dependence.Of particular interest here is the 'typical' smoking topography that van der Pol et al [1] found was predictive of cannabis dependence. Taking more frequent puffs of greater volume when commencing a session is evocative of someone seeking a quick hit, such as to 'take the edge off', then smoking with less urgency as the desired effects kick in.…”

“…Of particular interest here is the 'typical' smoking topography that van der Pol et al [1] found was predictive of cannabis dependence. Taking more frequent puffs of greater volume when commencing a session is evocative of someone seeking a quick hit, such as to 'take the edge off', then smoking with less urgency as the desired effects kick in.…”

“…Foremost among these are the efficiencies associated with the use of self-report questionnaires, which are often completed anonymously by participants and remotely from researchers. The classification of cannabis as an illicit substance within most jurisdictions globally, however, also acts to prevent the vast majority of cannabis researchers from undertaking as thorough an assessment of cannabis exposure/dose as has been demonstrated by van der Pol et al [1].…”

“…While most cannabis researchers will not be able to complete as extensive an assessment of cannabis exposure/THC dose as van der Pol et al [1], it should be possible to include additional items within self-report questionnaires or interview schedules; for example, to determine what proportion of a joint participants typically consume to achieve their desired state and whether their smoking topography is 'typical' or 'atypical' in nature. Furthermore, we need to question our assumptions about the association between cannabis exposure/THC dose and dependence, including being open to the possibility that our understanding of cannabis dependence may be more accurate if dependence is viewed as being indicative of a user who is experiencing comorbid psychosocial distress/stress.…”