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Original Investigation |

Cannabis Use and Risk of Psychiatric Disorders Prospective Evidence From a US National Longitudinal Study

Carlos Blanco, MD, PhD1; Deborah S. Hasin, PhD2; Melanie M. Wall, PhD2; Ludwing Flórez-Salamanca, MD3,4; Nicolas Hoertel, MD, MPH2,3,4,5; Shuai Wang, PhD2; Bradley T. Kerridge, PhD, PhD2; Mark Olfson, MD, MPH2
[+] Author Affiliations
1Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
2Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York
3Assistance Publique-Hôpitaux de Paris, Corentin Celton Hospital, Paris, France
4Department of Psychiatry, Paris Descartes University, Pôle de Recherche et d’Enseignement Supérieur Sorbonne Paris Cité, Paris, France
5Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 894, Psychiatry and Neurosciences Center, Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
JAMA Psychiatry. 2016;73(4):388-395. doi:10.1001/jamapsychiatry.2015.3229.
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Importance  With rising rates of marijuana use in the general population and an increasing number of states legalizing recreational marijuana use and authorizing medical marijuana programs, there are renewed clinical and policy concerns regarding the mental health effects of cannabis use.

Objective  To examine prospective associations between cannabis use and risk of mental health and substance use disorders in the general adult population.

Design, Setting, and Participants  A nationally representative sample of US adults aged 18 years or older was interviewed 3 years apart in the National Epidemiologic Survey on Alcohol and Related Conditions (wave 1, 2001-2002; wave 2, 2004-2005). The primary analyses were limited to 34 653 respondents who were interviewed in both waves. Data analysis was conducted from March 15 to November 30, 2015.

Main Outcomes and Measures  We used multiple regression and propensity score matching to estimate the strength of independent associations between cannabis use at wave 1 and incident and prevalent psychiatric disorders at wave 2. Psychiatric disorders were measured with a structured interview (Alcohol Use Disorder and Associated Disabilities Interview Schedule–DSM-IV). In both analyses, the same set of wave 1 confounders was used, including sociodemographic characteristics, family history of substance use disorder, disturbed family environment, childhood parental loss, low self-esteem, social deviance, education, recent trauma, past and present psychiatric disorders, and respondent’s history of divorce.

Results  In the multiple regression analysis of 34 653 respondents (14 564 male [47.9% weighted]; mean [SD] age, 45.1 [17.3] years), cannabis use in wave 1 (2001-2002), which was reported by 1279 respondents, was significantly associated with substance use disorders in wave 2 (2004-2005) (any substance use disorder: odds ratio [OR], 6.2; 95% CI, 4.1-9.4; any alcohol use disorder: OR, 2.7; 95% CI, 1.9-3.8; any cannabis use disorder: OR, 9.5; 95% CI, 6.4-14.1; any other drug use disorder: OR, 2.6; 95% CI, 1.6-4.4; and nicotine dependence: OR, 1.7; 95% CI, 1.2-2.4), but not any mood disorder (OR, 1.1; 95% CI, 0.8-1.4) or anxiety disorder (OR, 0.9; 95% CI, 0.7-1.1). The same general pattern of results was observed in the multiple regression analyses of wave 2 prevalent psychiatric disorders and in the propensity score–matched analysis of incident and prevalent psychiatric disorders.

Conclusions and Relevance  Within the general population, cannabis use is associated with an increased risk for several substance use disorders. Physicians and policy makers should take these associations of cannabis use under careful consideration.

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Figure.
Prevalence of Psychiatric Disorders in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions by Level of Cannabis Use in Wave 1

For respondents in the 3 past 12-month cannabis use groups in wave 1, the prevalence for any disorder in wave 2 was 31.0% (no use), 65.0% (some use but <1 use per month), and 75.3% (≥1 use per month), with P < .001 for all 3 pairwise comparisons. The corresponding prevalence of any mood disorder in wave 2 was 9.3%, 18.9%, and 17.1%, with P < .001 for the no use and some use comparison and P < .001 for the no use and more use comparison. The corresponding prevalence of any anxiety disorder in wave 2 was 12.2%, 19.4%, and 21.8%, with P = .003 for the no use and some use comparison and P < .001 for the no use and more use comparison. The corresponding prevalence of any substance use disorder in wave 2 was 19.3%, 57.4%, and 70.5%, with P < .001 for all 3 pairwise comparisons. The other pairwise comparisons had P > .05.

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