Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: The impact of contextual factors

Lucas, Philippe; Walsh, Zach; Crosby, Kim; Callaway, Robert; Belle-Isle, Lynne; Kay, Robert; Capler, Rielle; Holtzman, Susan

doi:10.1111/dar.12323

Cited by 131 publications

(79 citation statements)

References 31 publications

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“…One recent study also reported reduced opioid use frequency among people who inject drugs in California who also used marijuana compared to who did not (Kral et al, 2015). However, the potential role of medical marijuana use as a harm reduction approach among opioid-using populations is still under debate and requires more research (Lucas et al, 2016). Anglin et al (Anglin, Almog, Fisher, & Peters, 1989) and Almog et al (Almog, Anglin, & Fisher, 1993) found an inverse relationship between alcohol use and heroin use among heroin dependent individuals in opioid treatment programs in California and the pattern was evident in addiction, treatment and post-discharge stages of individuals’ drug use career (Anglin, et al, 1989).…”

Section: Discussionmentioning

confidence: 99%

Polydrug use and its association with drug treatment outcomes among primary heroin, methamphetamine, and cocaine users

Wang

Min

Krebs

et al. 2017

International Journal of Drug Policy

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Background Polydrug use may challenge effective treatment for substance use disorders. We evaluate whether secondary substance use modifies the association between treatment and primary drug use among primary heroin, cocaine and methamphetamine (MA) users. Methods Data were obtained from prospective cohort studies on people who use illicit drugs (PWUD) in California, USA. Using repeated monthly data on self-reported secondary substance use (heroin, cocaine, MA, alcohol or marijuana; ≥1 day in a month), primary drug use (≥1 day in a month), and treatment participation, collected via timeline follow-back, we fitted generalized linear mixed multiple regression models controlling for potential confounders to examine the interactions between treatment and secondary substance use on the odds of primary heroin, cocaine and MA use, respectively. Results Included in our study were 587 primary heroin, 444 primary MA, and 501 primary cocaine users, with a median of 32.4, 13.3 and 18.9 years of follow-up, respectively. In the absence of secondary substance use, treatment was strongly associated with decreased odds of primary drug use (adjusted odds ratios (aORs): 0.25, 95% CI: 0.24, 0.27, 0.07 (0.06, 0.08), and 0.07 (0.07, 0.09)) for primary heroin, MA, and cocaine users, respectively. Secondary substance use of any kind moderated these associations (0.82 (0.78, 0.87), 0.25 (0.21, 0.30) and 0.53 (0.45, 0.61), respectively), and these findings were consistent for each type of secondary substance considered. Moreover, we observed different associations in terms of direction and magnitude between secondary substance use and primary drug use during off-treatment periods across substance types. Conclusions This study demonstrates secondary substance use moderates the temporal associations between treatment and primary drug use among primary heroin, MA and cocaine users. Disparate patterns of polydrug use require careful measurement and analysis to inform targeted treatment for polydrug users.

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Section: Discussionmentioning

confidence: 99%

Polydrug use and its association with drug treatment outcomes among primary heroin, methamphetamine, and cocaine users

Wang

Min

Krebs

et al. 2017

International Journal of Drug Policy

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“…In terms of differences in group co-variates based on the multivariate analysis results, the MCU group reported higher disability scores after controlling for potential confounders. This likely reflects the fact that MCUs commonly feature severe overall health problems, as documented by several North American studies [13,30,31,32], including (often multiple) chronic physical and/or mental conditions. These chronic conditions are often indicated as the reason for medical cannabis use.…”

Section: Discussionmentioning

confidence: 99%

Comparing Medical and Recreational Cannabis Users on Socio-Demographic, Substance and Medication Use, and Health and Disability Characteristics

et al. 2017

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Background: While recreational cannabis use is common, medical cannabis programs have proliferated across North America, including a federal program in Canada. Few comparisons of medical and recreational cannabis users (RCUs) exist; this study compared these groups on key characteristics. Methods: Data came from a community-recruited sample of formally approved medical cannabis users (MCUs; n = 53), and a sub-sample of recreational cannabis users (RCUs; n = 169) from a representative adult survey in Ontario (Canada). Samples were telephone-surveyed on identical measures, including select socio-demographic, substance and medication use, and health and disability measures. Based on initial bivariate comparisons, multivariate logistical regression with a progressive adjustment approach was performed to assess independent predictors of group status. Results: In bivariate analyses, older age, lower household income, lower alcohol use, higher cocaine, prescription opioid, depression and anxiety medication use, and lower health and disability status were significantly associated with medical cannabis use. In the multivariate analysis, final model, household income, alcohol use, and disability levels were associated with medical cannabis use. Conclusions/Scientific Significance: Compared to RCUs, medical users appear to be mainly characterized by factors negatively influencing their overall health status. Future studies should investigate the actual impact and net benefits of medical cannabis use on these health problems.

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“…In contrast to previous studies conducted in the general US adult samples (Compton et al, 2007; Eaton et al, 2012), sex differences in the prevalence of behavior health disorders were not seen in medical marijuana user groups, with the exception of MDE among medical only users. The magnitude of sex differences may be attenuated by use of medical marijuana as a psychopharmacological treatment for mental problems or a substitute for alcohol or drugs (Lucas et al, 2016; Reiman, 2007, Reiman, 2009, Walsh et al, 2013; Webb and Webb, 2014). …”

Section: Discussionmentioning

confidence: 99%

“…Consistent with previous findings (Compton et al, 2017), medical use only was negatively associated with drug or alcohol use disorders and unmet need for drug use disorder treatment among both males and females. This is probably due to use of medical marijuana as a substitute for alcohol or other drugs (Lucas et al, 2016; Reiman, 2007; Reiman, 2009), which might be related to reduction in alcohol use and alcohol-related problems (Mikuriya, 2004). Medical use only was also negatively associated with opioid use disorder among females.…”

Section: Discussionmentioning

confidence: 99%

Differences in behavioral health disorders and unmet treatment needs between medical marijuana users and recreational marijuana users: Results from a national adult sample

Park

2017

Drug and Alcohol Dependence

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Background Available data suggest that medical marijuana users may have more mental health problems than recreational marijuana users. There is limited information about differences in behavioral health disorders and unmet treatment needs between medical and recreational marijuana users. Methods We compared past-year prevalence of behavioral health disorders and unmet treatment needs across three marijuana subgroups (recreational use only, medical use only, and both). Sex-stratified logistic regression was performed to determine their associations with marijuana use status. We analyzed data from adults (≥18 years) who used marijuana in the past year (N=15,440) from 2013-2014 National Surveys on Drug Use and Health. Results Among 15,440 past-year marijuana users, 90.2% used recreational marijuana only, 6.2% used medical marijuana only, and 3.6% used both. Both users had the highest prevalence of behavioral health disorders and unmet treatment needs overall, with no significant sex differences. In the sex-specific logistic regression analysis, medical only users and both users showed somewhat different patterns of associations (reference group=recreational only users). Medical only users had decreased odds of alcohol or drug use disorders, and unmet need for alcohol or drug treatment among males and females. Additionally, female medical only users had decreased odds of opioid use disorder. Both users had increased odds of major depressive episode, hallucinogen use disorder, and unmet need for mental health services among males, and cocaine use disorder among females. Conclusions Different approaches tailored to individuals' sex and motives for marijuana use is needed for the prevention and treatment of behavioral health problems.

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Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: The impact of contextual factors

Cited by 131 publications

References 31 publications

Polydrug use and its association with drug treatment outcomes among primary heroin, methamphetamine, and cocaine users

Polydrug use and its association with drug treatment outcomes among primary heroin, methamphetamine, and cocaine users

Comparing Medical and Recreational Cannabis Users on Socio-Demographic, Substance and Medication Use, and Health and Disability Characteristics

Differences in behavioral health disorders and unmet treatment needs between medical marijuana users and recreational marijuana users: Results from a national adult sample

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