Q&A: Self-medication with cannabis can lead to problematic use in young people
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Key takeaways:
- Among young adults, 36.3% were considered at moderate to severe risk for problematic cannabis use.
- PCPs should be aware of patients self-medicating with alternative pain management therapies.
Cannabis use for several purposes, especially for physical health, was linked to a risk for problematic cannabis use, a study published in BMC Public Health found.
Problematic cannabis use (PCU), defined as cannabis use that can lead to current or future health or social harms, has become a particular concern in the youth population — particularly given its growing acceptance and legalization across states — according to Wura Jacobs, PhD, a health behavior researcher at Indiana University School of Public Health, and colleagues.
“While some health-focused reasons (eg, nausea) require infrequent use, some other reasons (eg, chronic pain) require continued use, which could exacerbate or lead to other adverse outcomes, including PCU,” they wrote. “Hence, research is needed to evaluate the PCU risk associated with cannabis use for these different categories of health-focused reasons most commonly highlighted as motivations for cannabis use.”
Jacobs and colleagues evaluated the risk for PCU from cannabis use for sleep, physical health and mental health purposes with survey responses from 954 young adults.
Participants were 63.9% women, 54.9% Hispanic and had a mean age of 21 years.
Mental health was the most common reason (73.3%) participants used cannabis.
The researchers identified 36.3% of participants as being at risk for severe use. The adjusted RR for severe PCU was:
- 4.38 (95% CI, 3.06-6.69) for those who used cannabis for physical health;
- 2.81 (95% CI, 1.86-4.72) for those who used cannabis for mental health; and
- 1.83 (95% CI, 1.17-2.63) for those who used cannabis for sleep purposes.
“Given the current legalization efforts and cultural acceptance surrounding cannabis use, [PCU] is a concern that would likely increase as the prevalence of users increase,” Jacobs and colleagues concluded.
Jacobs spoke to Healio to explain what may constitute PCU, what implications there are for primary care physicians and more.
Healio: What is considered PCU?
Jacobs: In the study we used the Cannabis Abuse Screening Test (CAST) to define PCU. CAST is a six-item question that asks individuals about their cannabis use behaviors such as whether they use cannabis before noon; when they were alone; if they had memory problems when using cannabis; if they've been advised to reduce cannabis use; and whether they had any problems (eg, fight, accident, argument) because of their cannabis use. Individuals could score a minimum of 0 to 24. A score of 7 or higher meant the individual is at moderate to severe PCU risk.
Healio: How often would a person have to use cannabis for each intended purpose to see a risk for PCU?
Jacobs: We did not examine frequency of use, but these individuals in the study had reported using one or more forms of cannabis products in the past 6 months.
Healio: What are your thoughts on the findings? Did anything stand out to you?
Jacobs: What stood out was the finding that irrespective of the underlying self-identified health reason, cannabis use in this current product landscape poses a health risk. Also, more than half of young adults in the study were classified as having moderate to severe risk for PCU risk. That is concerning. And those who endorsed using cannabis due to physical health (eg, chronic pain, physical problems such as muscle spasm, and nausea) had the highest RR for severe PCU. Again, concerning. Most of the reasons individuals endorsed for using cannabis require that individuals continue to use for a long period of time. Given the lack of product standardization and production regulation, how can an individual who self-medicates with cannabis products verify the product formulation and ascertain that their product is indeed suitable for medicinal use? The significant overlap in marketing, promotion and use of recreational cannabis products for medicinal purposes warrants attention, and people should not allow marketing ploys to give them the erroneous impression that cannabis use is safe or healthy.
Healio: What are the clinical implications for PCPs?
Jacobs: Given the current cannabis landscape, especially with expanding legalization, cultural acceptance and product diversity, PCU or even cannabis use disorder is a concern that might likely increase as times progress, and clinicians need to be aware of that. It is important that PCPs are also aware of alternative pain management therapies that their patients are employing to self-medicate. Patients must be made aware about the health risks associated with cannabis use, especially given the lack of regulation surrounding the products and their formulation. Patients need to be educated about the alarmingly high THC levels in some of these products marketed as having medicinal uses. Many of these claims have not been verified as true; therefore, care must be exercised.
Healio: Anything else to add?
Jacobs: This work provides scientific evidence to show there is a risk for cannabis use disorder associated with using cannabis, even if for health-focused reasons. More research is needed on many aspects of cannabis use for medicinal purposes, including the route of administration (smoking, vaping) and cannabis product type (edibles, leaves). This work was a cross-sectional analysis, but more work is needed to examine the long-term impact. There is much work to be done still.