Trajectories of cannabis use and risk for opioid misuse in a young adult urban cohort

Abstract

Background-Although much of the attention surrounding the opioid epidemic has focused on rural and suburban Whites and prescription opioids, heroin overdoses among urban Blacks are on the rise. While some argue that legalization of cannabis will combat the epidemic, there are concerns it ignores the shift in the epidemic and could increase vulnerability to opioid misuse. The goal of this study is to examine the association between cannabis use from adolescence to young adulthood with opioid misuse in a primarily urban Black cohort.Methods-Data are from a study of 580 youth (85% Black, 67% low SES) residing in Baltimore City followed from ages 626. Cannabis trajectories were identified between ages 14-26 using group-based trajectory modeling. Logistic regressions were conducted to examine the impact of trajectories on opioid misuse in young adulthood adjusting for individual, neighborhood and peer factors. Opioid misuse was defined as using heroin or narcotics or painkillers without a prescription between ages 1926.Results-Four cannabis trajectories were identified: Low/Non-Users (59.7%) Adolescent Onset Limited (19.5%), Young Adult Onset (10.8%), and Adolescent Onset Chronic (10.0%). Adolescent Onset Chronic cannabis users had the highest rate of opioid misuse (44.8%) followed by Adolescent Onset Limited (18.8%), Young Adult Onset (14.8%) and Low/Non-Users (8.3%). Prevalences were significantly higher for Adolescent Onset group relative to Low/Non-Users even after adjustment for neighborhood factors.

Variations of cannabis-related adverse mental health and addiction outcomes across adolescence and adulthood: A scoping review

“…Early cannabis users had between two and 14 times the odds of using other drugs compared with non-users ( 34 , 41 , 42 , 68 , 88 , 135 ). After covariates adjustment, these odds were increased to between two and 17 times ( 34 , 62 , 88 , 135 ), or became non-significant ( 149 ). These results are in line with increased prevalence of a range of illicit drug uses among early cannabis users compared with non-users ( 47 , 85 ), especially in frequent cannabis users ( 143 ).…”

“…Stanley et al ( 137 ) reported that while late cannabis users had 16 times the odds of misusing prescription drugs compared with non-users, early cannabis users had 47 times these odds. Early cannabis initiators had twice the odds of misusing prescription opioids compared with non-users ( 135 ), and nearly twice the risk of prescription opioid misuse compared with late users ( 129 ). This contrasts with Moss et al ( 85 ) findings of similar prevalence of pain reliever misuse between early cannabis users and non-users.…”

“…Hall et al (95) reported that majority of the 17 studies reviewed associated early cannabis use with other illicit substance use. Early cannabis users had between two and 14 times the odds of using other drugs compared with non-users (34,41,42,68,88,135). After covariates adjustment, these odds were increased to between two and 17 times (34,62,88,135), or became non-significant (149).…”

“I got a bunch of weed to help me through the withdrawals”: Naturalistic cannabis use reported in online opioid and opioid recovery community discussion forums

“…Additionally, several studies have found that medical cannabis patients report pain management as one of the most common reasons for cannabis use [10][11][12] and that cannabis use was associated with lower opioid use among people who use illicit drugs [13,14]. However, there are also ongoing concerns about cannabis use increasing the risk for non-medical opioid use and opioid and cannabis use disorders, especially among adolescents and young adults [15][16][17][18], and that cannabis use may lead to return to opioid use by people with a history of OUD [19][20][21][22].…”

THC modifies the impact of heroin delivered by vapor inhalation in rats

“…Cannabis co-use triples the risk of dependence on heroin in those diagnosed with a substance use disorder (Crummy et al, 2020) and cannabis users over 50 years of age exhibit a 6.3 increased odds ratio of heroin use (Ramadan et al, 2020). Adolescents in one urban setting who use cannabis regularly are at twice the risk for opioid misuse compared with occasional users of cannabis (Reboussin et al, 2020) and age 14 onset of frequent cannabis use increases the risk of opioid use at age 19 (Thrul et al, 2020). Almost two thirds of individuals in one sample first used heroin while co-using cannabis (Olthuis et al, 2013) and 50-60% of individuals in heroin-maintenance and methadone-maintenance treatment for opioid use disorder were co-using cannabis (Musshoff et al, 2010).…”