Nondisordered Cannabis Use Among US Adolescents

Abstract

ImportanceCannabis use is increasingly viewed by adolescents as not harmful. Youths with cannabis use disorder (CUD) are recognized by clinicians as being at risk for adverse outcomes, yet little is known about the associations between subclinical cannabis use (ie, nondisordered cannabis use [NDCU]) and adverse psychosocial events.ObjectiveTo describe the prevalence and demographics of NDCU and to compare associations of cannabis use with adverse psychosocial events among adolescents with no cannabis use, NDCU, and CUD.Design, Setting, and ParticipantsThis cross-sectional study used a nationally representative sample derived from the 2015 to 2019 National Survey on Drug Use and Health. Participants were adolescents aged 12 to 17 years, separated into 3 distinct groups: nonuse (no recent cannabis use), NDCU (recent cannabis use below diagnostic threshold), and CUD. Analysis was conducted from January to May 2022.ExposuresCUD, NDCU, or cannabis nonuse. NDCU was defined as endorsing recent cannabis use but not meeting the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) CUD criteria. CUD was defined using DSM-5 criteria.Main Outcomes and MeasuresThe main outcomes were prevalence of adolescents meeting criteria for NDCU and associations between adverse psychosocial events and NDCU, adjusted for sociodemographic characteristics.ResultsThe 68 263 respondents (mean [SD] age, 14.5 [1.7] years; 34 773 [50.9%] males) included in the analysis represented an estimated yearly mean of 25 million US adolescents during 2015 to 2019. Among respondents, 1675 adolescents (2.5%) had CUD, 6971 adolescents (10.2%) had NDCU, and 59 617 adolescents (87.3%) reported nonuse. Compared with nonusers, individuals with NDCU had approximately 2 to 4 times greater odds of all adverse psychosocial events examined, including major depression (adjusted odds ratio [aOR], 1.86; 95% CI, 1.67-2.08), suicidal ideation (aOR, 2.08; 95% CI, 1.88-2.29), slower thoughts (aOR, 1.76; 95% CI, 1.58-1.96), difficulty concentrating (aOR, 1.81; 95% CI, 1.65-2.00), truancy (aOR, 1.90; 95% CI, 1.67-2.16), low grade point average (aOR, 1.80; 95% CI, 1.62-2.00), arrest (aOR, 4.15; 95% CI, 3.17-5.43), fighting (aOR, 2.04; 95% CI, 1.80-2.31), and aggression (aOR, 2.16; 95% CI, 1.79-2.62). Prevalence of adverse psychosocial events was greatest for adolescents with CUD (range, 12.6% to 41.9%), followed by NDCU (range, 5.2% to 30.4%), then nonuse (range, 0.8% to 17.3%).Conclusions and RelevanceIn this cross-sectional study of US adolescents, past-year NDCU was approximately 4 times as prevalent as past-year CUD. A stepwise gradient association was observed for odds of adverse psychosocial events between adolescent NDCU and CUD. In the context of US normalization of cannabis use, prospective research into NDCU is necessary.

Cannabis as a shareable commodity in a social discounting task.

“…As described in the introduction, cannabis use is meaningfully increasing in college-aged students in the United States (Patrick et al, 2022) and the current evidence suggests cannabis use disorder diagnoses are also increasing. Even individuals who have cannabis use patterns below those used in clinical diagnoses have shown increases in adverse psychological events (Sultan et al, 2023). Thus, finding a measure that can consistently and reliably predict problems associated with cannabis use would be a valuable tool for clinicians to facilitate treatment.…”

“…Of these, over a quarter of cannabis use disorder diagnoses can be attributed to those aged 18–25 who also represent the age group with the highest cannabis usage (Substance Abuse and Mental Health Services Administration, 2023). However, even nonclinical outcomes from cannabis use among youth has been shown to increase adverse psychosocial events, such as major depression diagnoses (Sultan et al, 2023). Thus, increasing recreational cannabis use and increasing college student use points to cannabis use continuing to be an important social activity on college campuses with potentially serious health outcomes.…”

Analysing the effects of using cannabis on youth mental health

“…Young cannabis users fall behind their non-using peers by as much as three years of schooling. These effects of using cannabis are shown even in young people who are not yet dependent on the drug (Sultan et al, 2023). Cannabis use in youth is also associated with delinquent behaviours such as truancy, aggression, arrests and fighting (Sultan et al, 2023).…”

“…(Gobbi et al, 2019). These increased mental health risks are found even in youth who use cannabis recreationally (Sultan et al, 2023).…”

Rewiring the future: drugs abused in adolescence may predispose to mental illness in adult life by altering dopamine axon growth

“…Drug abuse rates are subject to fluctuations based on the region, the age of the users, and the drug in question; however, abuse of stimulants, opioids, and cannabis has generally increased in recent years (Drug Use Among Youth: Facts and Statistics 2023 ; Marijuana and hallucinogen use among young adults reached all time-high in 2021 2022 ; Drug Overdose Death Rates 2023 ; NIDA IC Fact Sheet 2024 2023 ). This situation has been accentuated in some areas due to changes in accessibility or regulation, such as the case of prescription opioids and the legalization of cannabis, respectively (Hughes et al 2023 ; Sultan et al 2023 ; Zuckermann et al 2021 ).…”