Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Determining Risks for Cannabis Use Disorder in the Face of Changing Legal Policies

Abstract

Purpose of Review

This review aims to summarize and critically evaluate the current literature on the associations between individual and socio-cultural factors that increase risk for cannabis use disorder (CUD), and policy change.

Recent findings

Epidemiological studies show that areas with permissive legal cannabis climates are associated with greater individual risk factors for CUD. This includes (1) higher rates of edible consumption and vaping, (2) higher delta-9-tetrahydrocannabinol (THC) potency and lower cannabidiol (CBD) levels, and (3) younger age of initiation of use.

Summary

A change in the socio-cultural level, such as shifts in the legalization of cannabis, could interact with individual-level factors in their associations with CUD. There is currently a lack of empirical studies that evaluate this interaction. We propose that future research consider a bioecological framework for CUD to allow for a comprehensive understanding of the effects of legal climate that could inform policy and clinical practice.

This is a preview of subscription content, log in to check access.

Fig. 1

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Reed J. Marijuana legalization in Colorado: early findings: a report pursuant to Senate Bill 13-283 (March 2016). 2016;147.

  2. 2.

    •• Hasin DS, Kerridge BT, Saha TD, Huang B, Pickering R, Smith SM, et al. Prevalence and correlates of DSM-5 cannabis use disorder, 2012–2013: findings from the National Epidemiologic Survey on Alcohol and Related Conditions – III. Am J Psychiatry. 2016;173:588–99 This epidemiology study examines prevalence of cannabis use disorder and related risk factors in the United States.

  3. 3.

    United Nations, Office on Drugs and Crime. World drug report 2016. 2016.

  4. 4.

    Degenhardt L, Chiu W-T, Sampson N, Kessler RC, Anthony JC, Angermeyer M, et al. Toward a global view of alcohol, tobacco, cannabis, and cocaine use: findings from the WHO World Mental Health Surveys. PLoS Med. 2008;5:e141.

  5. 5.

    Hall W, Degenhardt L. Prevalence and correlates of cannabis use in developed and developing countries. Curr Opin Psychiatry. 2007;20:393.

  6. 6.

    Poulton RG, Brooke M, Moffitt TE, Stanton WR, Silva PA. Prevalence and correlates of cannabis use and dependence in young New Zealanders. N Z Med J. 1997;110:68–70.

  7. 7.

    Bogt TT, Schmid H, Gabhainn SN, Fotiou A, Vollebergh W. Economic and cultural correlates of cannabis use among mid-adolescents in 31 countries. Addiction. 2006;101:241–51.

  8. 8.

    Acuda SW, Eide AH. Epidemiological study of drug use in urban and rural secondary schools in Zimbabwe. 1984 [cited 2018 Jul 11]; Available from: https://opendocs.ids.ac.uk/opendocs/handle/123456789/7039.

  9. 9.

    Bronfenbrenner U. Ecological systems theory (1992). Mak Hum Hum Bioecological Perspect Hum Dev. Thousand Oaks: Sage Publications Ltd; 2005. p. 106–73.

  10. 10.

    Ungar M, Ghazinour M, Richter J. Annual research review: What is resilience within the social ecology of human development? J Child Psychol Psychiatry. 2013;54:348–66.

  11. 11.

    Teesson M, Slade T, Swift W, Mills K, Memedovic S, Mewton L, et al. Prevalence, correlates and comorbidity of DSM-IV cannabis use and cannabis use disorders in Australia. Aust N Z J Psychiatry. 2012;46:1182–92.

  12. 12.

    Stinson FS, Ruan WJ, Pickering R, Grant BF. Cannabis use disorders in the USA: prevalence, correlates and co-morbidity. Psychol Med. 2006;36:1447–60.

  13. 13.

    von Sydow K, Lieb R, Pfister H, Höfler M, Wittchen H-U. What predicts incident use of cannabis and progression to abuse and dependence?: a 4-year prospective examination of risk factors in a community sample of adolescents and young adults. Drug Alcohol Depend. 2002;68:49–64.

  14. 14.

    Clough A, D’Abbs P, Cairney S, Gray D, Maruff P, Parker R, et al. Emerging patterns of cannabis and other substance use in Aboriginal communities in Arnhem Land, Northern Territory: a study of two communities. Drug Alcohol Rev. 2004;23:381–90.

  15. 15.

    Coffey C, Lynskey M, Wolfe R, Patton GC. Initiation and progression of cannabis use in a population-based Australian adolescent longitudinal study. Addiction. 2000;95:1679–90.

  16. 16.

    • Castellanos-Ryan N, Pingault J-B, Parent S, Vitaro F, Tremblay RE, Séguin JR. Adolescent cannabis use, change in neurocognitive function, and high-school graduation: A longitudinal study from early adolescence to young adulthood. Dev Psychopathol. 2017;29:1253–66 This paper is novel in that it employs a longitudinal approach to explore correlates of early cannabis initiation and predicts educational attainment based on cannabis use.

  17. 17.

    Hofler M, Lieb R, Perkonigg A, Schuster P, Sonntag H, Wittchen H-U. Covariates of cannabis use progression in a representative population sample of adolescents: a prospective examination of vulnerability and risk factors. Addiction. 1999;94:1679–94.

  18. 18.

    Buckner JD, Keough ME, Schmidt NB. Problematic alcohol and cannabis use among young adults: the roles of depression and discomfort and distress tolerance. Addict Behav. 2007;32:1957–63.

  19. 19.

    Verdejo-Garcia A, Benbrook A, Funderburk F, David P, Cadet J-L, Bolla KI. The differential relationship between cocaine use and marijuana use on decision-making performance over repeat testing with the Iowa Gambling Task. Drug Alcohol Depend. 2007;90:2–11.

  20. 20.

    • Vingerhoets W, Koenders L, van den Brink W, Wiers R, Goudriaan A, van Amelsvoort T, et al. Cue-induced striatal activity in frequent cannabis users independently predicts cannabis problem severity three years later. J Psychopharmacol (Oxf). 2016;30:152–8 This paper utilizes a longitudinal approach to predict CUD symptom severity based on neural activity.

  21. 21.

    Cousijn J, Wiers RW, Ridderinkhof KR, van den Brink W, Veltman DJ, Goudriaan AE. Effect of baseline cannabis use and working-memory network function on changes in cannabis use in heavy cannabis users: a prospective fMRI study. Hum Brain Mapp. 2014;35:2470–82.

  22. 22.

    Agrawal A, Lynskey MT. The genetic epidemiology of cannabis use, abuse and dependence. Addiction. 2006;101:801–12.

  23. 23.

    • Cosker E, Schwitzer T, Ramoz N, Ligier F, Lalanne L, Gorwood P, et al. The effect of interactions between genetics and cannabis use on neurocognition. A review. Prog Neuro-Psychopharmacol Biol Psychiatry. 2018;82:95–106 This review summaries how factors at the individual level (genetics and cognitive ability) can influence cannabis use.

  24. 24.

    Caspi A, Moffitt TE, Cannon M, McClay J, Murray R, Harrington H, et al. Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-O-methyltransferase gene: longitudinal evidence of a gene X environment interaction. Biol Psychiatry. 2005;57:1117–27.

  25. 25.

    Tunbridge EM, Dunn G, Murray RM, Evans N, Lister R, Stumpenhorst K, et al. Genetic moderation of the effects of cannabis: catechol-O-methyltransferase (COMT) affects the impact of Δ9-tetrahydrocannabinol (THC) on working memory performance but not on the occurrence of psychotic experiences. J Psychopharmacol (Oxf). 2015;29:1146–51.

  26. 26.

    Henquet C, Rosa A, Krabbendam L, Papiol S, Faňanás L, Drukker M, et al. An experimental study of Catechol-O-Methyltransferase Val158Met moderation of Δ-9-tetrahydrocannabinol-induced effects on psychosis and cognition. Neuropsychopharmacology. 2006;31:2748–57.

  27. 27.

    Manseau MW, Goff DC. Cannabinoids and schizophrenia: risks and therapeutic potential. Neurotherapeutics. 2015;12:816–24.

  28. 28.

    Estrada G, Fatjó-Vilas M, Muñoz MJ, Pulido G, Miñano MJ, Toledo E, et al. Cannabis use and age at onset of psychosis: further evidence of interaction with COMT Val158Met polymorphism. Acta Psychiatr Scand. 2011;123:485–92.

  29. 29.

    Hambrecht M, Häfner H. Cannabis, vulnerability, and the onset of schizophrenia: an epidemiological perspective. Aust N Z J Psychiatry. 2000;34:468–75.

  30. 30.

    Fu Q, Heath AC, Bucholz KK, Nelson E, Goldberg J, Lyons MJ, et al. Shared genetic risk of major depression, alcohol dependence, and marijuana dependence: contribution of antisocial personality disorder in Men. Arch Gen Psychiatry. 2002;59:1125–32.

  31. 31.

    Biederman J, Wilens T, Mick E, Faraone SV, Weber W, Curtis S, et al. Is ADHD a risk factor for psychoactive substance use disorders? Findings from a four-year prospective follow-up study. J Am Acad Child Adolesc Psychiatry. 1997;36:21–9.

  32. 32.

    Lee SS, Humphreys KL, Flory K, Liu R, Glass K. Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clin Psychol Rev. 2011;31:328–41.

  33. 33.

    Angarita GA, Emadi N, Hodges S, Morgan PT. Sleep abnormalities associated with alcohol, cannabis, cocaine, and opiate use: a comprehensive review. Addict Sci Clin Pract. 2016;11:9.

  34. 34.

    Babson KA, Boden MT, Harris AH, Stickle TR, Bonn-Miller MO. Poor sleep quality as a risk factor for lapse following a cannabis quit attempt. J Subst Abus Treat. 2013;44:438–43.

  35. 35.

    Bonn-Miller MO, Harris AHS, Trafton JA. Prevalence of cannabis use disorder diagnoses among veterans in 2002, 2008, and 2009. Psychol Serv. 2012;9:404–16.

  36. 36.

    Bonn-Miller MO, Babson KA, Vandrey R. Using cannabis to help you sleep: heightened frequency of medical cannabis use among those with PTSD. Drug Alcohol Depend. 2014;136:162–5.

  37. 37.

    Cornelius JR, Kirisci L, Reynolds M, Clark DB, Hayes J, Tarter R. PTSD contributes to teen and young adult cannabis use disorders. Addict Behav. 2010;35:91–4.

  38. 38.

    Feingold D, Weiser M, Rehm J, Lev-Ran S. The association between cannabis use and anxiety disorders: results from a population-based representative sample. Eur Neuropsychopharmacol J Eur Coll Neuropsychopharmacol. 2016;26:493–505.

  39. 39.

    Kevorkian S, Bonn-Miller MO, Belendiuk K, Carney DM, Roberson-Nay R, Berenz EC. Associations among trauma, posttraumatic stress disorder, cannabis use, and cannabis use disorder in a nationally representative epidemiologic sample. Psychol Addict Behav J Soc Psychol Addict Behav. 2015;29:633–8.

  40. 40.

    Ruglass LM, Shevorykin A, Brezing C, Hu M-C, Hien DA. Demographic and clinical characteristics of treatment seeking women with full and subthreshold PTSD and concurrent cannabis and cocaine use disorders. J Subst Abus Treat. 2017;80:45–51.

  41. 41.

    Wittchen H-U, Fröhlich C, Behrendt S, Günther A, Rehm J, Zimmermann P, et al. Cannabis use and cannabis use disorders and their relationship to mental disorders: a 10-year prospective-longitudinal community study in adolescents. Drug Alcohol Depend. 2007;88:S60–70.

  42. 42.

    Wagner FA, Anthony JC. From first drug use to drug dependence: developmental periods of risk for dependence upon marijuana, cocaine, and alcohol. Neuropsychopharmacology. 2002;26:479–88.

  43. 43.

    Winters KC, Lee C-YS. Likelihood of developing an alcohol and cannabis use disorder during youth: association with recent use and age. Drug Alcohol Depend. 2008;92:239–47.

  44. 44.

    The Health and Social Effects of Nonmedical Cannabis Use. [Internet]. 2016 [cited 2018 Jun 12]. Available from: http://www.deslibris.ca/ID/10090267.

  45. 45.

    Best D, Best D, Gross S, Best D, Gross S, Manning V, et al. Cannabis use in adolescents: the impact of risk and protective factors and social functioning. Drug Alcohol Rev. 2005;24:483–8.

  46. 46.

    Hayatbakhsh MR, Najman JM, Bor W, O’Callaghan MJ, Williams GM. Multiple risk factor model predicting cannabis use and use disorders: a longitudinal study. Am J Drug Alcohol Abuse. 2009;35:399–407.

  47. 47.

    Hyman SM, Sinha R. Stress-related factors in cannabis use and misuse: implications for prevention and treatment. J Subst Abus Treat. 2009;36:400–13.

  48. 48.

    Pedersen W. Adolescents initiating cannabis use: cultural opposition or poor mental health? J Adolesc. 1990;13:327–39.

  49. 49.

    Wu L-T, Swartz MS, Brady KT, Hoyle RH. Perceived cannabis use norms and cannabis use among adolescents in the United States. J Psychiatr Res. 2015;64:79–87.

  50. 50.

    Sandberg S. The importance of culture for cannabis marketstowards an economic sociology of illegal drug markets. Br J Criminol. 2012;52:1133–51.

  51. 51.

    Prashad S, Milligan AL, Cousijn J, Filbey FM. Cross-cultural effects of cannabis use disorder: evidence to support a cultural neuroscience approach. Curr Addict Rep. 2017;4:100–9.

  52. 52.

    Copeland J. Developments in the treatment of cannabis use disorder. Curr Opin Psychiatry. 2004;17:161.

  53. 53.

    Hopfer C. Implications of marijuana legalization for adolescent substance use. Subst Abuse Off Publ Assoc Med Educ Res Subst Abuse. 2014;35:331–5.

  54. 54.

    Hall W, Lynskey M. Evaluating the public health impacts of legalizing recreational cannabis use in the United States. Addiction. 2016;111:1764–73.

  55. 55.

    Joffe A, Yancy WS. Legalization of marijuana: potential impact on youth. Pediatrics. 2004;113:e632–8.

  56. 56.

    Veen ND, Selten J-P, van der Tweel I, Feller WG, Hoek HW, Kahn RS. Cannabis use and age at onset of schizophrenia. Am J Psychiatry. 2004;161:501–6.

  57. 57.

    Degenhardt L, Hall W, Lynskey M. Alcohol, cannabis and tobacco use among Australians: a comparison of their associations with other drug use and use disorders, affective and anxiety disorders, and psychosis. Addiction. 2001;96:1603–14.

  58. 58.

    Lynskey MT, Heath AC, Bucholz KK, Slutske WS, Madden PAF, Nelson EC, et al. Escalation of drug use in early-onset cannabis users vs co-twin controls. JAMA. 2003;289:427–33.

  59. 59.

    Cerdá M, Wall M, Keyes KM, Galea S, Hasin D. Medical marijuana laws in 50 states: Investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence. Drug Alcohol Depend. 2012;120:22–7.

  60. 60.

    Sznitman SR, Bretteville-Jensen AL. Public opinion and medical cannabis policies: examining the role of underlying beliefs and national medical cannabis policies. Harm Reduct J [Internet]. 2015 [cited 2018 Sep 13];12. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606899/.

  61. 61.

    •• Borodovsky JT, Crosier BS, Lee DC, Sargent JD, Budney AJ. Smoking, vaping, eating: is legalization impacting the way people use cannabis? Int J Drug Policy. 2016;36:141–7 This paper provides an important example of how legalization may affect other components of cannabis use, without increasing CUD rates.

  62. 62.

    ElSohly MA, Mehmedic Z, Foster S, Gon C, Chandra S, Church JC. Changes in cannabis potency over the last two decades (1995-2014) - analysis of current data in the United States. Biol Psychiatry. 2016;79:613–9.

  63. 63.

    Sevigny EL, Pacula RL, Heaton P. The effects of medical marijuana laws on potency. Int J Drug Policy. 2014;25:308–19.

  64. 64.

    •• Chandra S, Radwan MM, Majumdar CG, Church JC, Freeman TP, ElSohly MA. New trends in cannabis potency in USA and Europe during the last decade (2008-2017). Eur Arch Psychiatry Clin Neurosci. 2019;269:5–15 This recently published paper provides evidence for a gradual increase in THC potency over more than a decade in the United States and Europe.

  65. 65.

    Niesink RJM, Rigter S, Koeter MW, Brunt TM. Potency trends of Δ9-tetrahydrocannabinol, cannabidiol and cannabinol in cannabis in the Netherlands: 2005–15. Addiction. 2015;110:1941–50.

  66. 66.

    Maier SL, Mannes S, Koppenhofer EL. The implications of marijuana decriminalization and legalization on crime in the United States. Contemp Drug Probl. 2017;44:125–46.

  67. 67.

    • Rotermann M. Analysis of trends in the prevalence of cannabis use and related metrics in Canada. Health Rep. 2019;30:3–13 This paper provides preliminary evidence for an increase in cannabis use in Canada.

  68. 68.

    Mader J, Smith JM, Afzal AR, Szeto ACH, Winters KC. Correlates of lifetime cannabis use and cannabis use severity in a Canadian university sample. Addict Behav. 2019;98:106015.

  69. 69.

    Sandhu HS, Anderson LN, Busse JW. Characteristics of Canadians likely to try or increase cannabis use following legalization for nonmedical purposes: a cross-sectional study. CMAJ Open. 2019;7:E399–404.

  70. 70.

    Otten R, Barker ED, Huizink AC, Engels RCME. The interplay between parental monitoring and the dopamine D4 receptor gene in adolescent cannabis use. PLoS One. 2012;7:e49432.

  71. 71.

    Enoch M-A. The role of early life stress as a predictor for alcohol and drug dependence. Psychopharmacology. 2011;214:17–31.

  72. 72.

    Jutras-Aswad D, Jacobs MM, Yiannoulos G, Roussos P, Bitsios P, Nomura Y, et al. Cannabis-dependence risk relates to synergism between neuroticism and proenkephalin SNPs associated with amygdala gene expression: case-control study. PLoS One. 2012;7:e39243.

  73. 73.

    Verweij KJH, Zietsch BP, Lynskey MT, Medland SE, Neale MC, Martin NG, et al. Genetic and environmental influences on cannabis use initiation and problematic use: a meta-analysis of twin studies. Addict Abingdon Engl. 2010;105:417–30.

  74. 74.

    Fatjó-Vilas M, Prats C, Fañanás L. Chapter e4 - COMT genotypes, cannabis use, and psychosis: gene-environment interaction evidence from human populations, and its methodological concerns. In: Preedy VR, editor. Handb Cannabis Relat Pathol [Internet]. San Diego: Academic Press; 2017 [cited 2019 Mar 6]. p. e29–41. Available from: http://www.sciencedirect.com/science/article/pii/B9780128007563000314.

  75. 75.

    Gerra MC, Manfredini M, Cortese E, Antonioni MC, Leonardi C, Magnelli F, et al. Genetic and environmental risk factors for cannabis use: preliminary results for the role of parental care perception. Subst Use Misuse. 2019;0:1–11.

  76. 76.

    Segal-Gavish H, Gazit N, Barhum Y, Ben-Zur T, Taler M, Hornfeld SH, et al. BDNF overexpression prevents cognitive deficit elicited by adolescent cannabis exposure and host susceptibility interaction. Hum Mol Genet. 2017;26:2462–71.

  77. 77.

    Morgan CJA, Freeman TP, Powell J, Curran HV. AKT1 genotype moderates the acute psychotomimetic effects of naturalistically smoked cannabis in young cannabis smokers. Transl Psychiatry. 2016;6:e738.

  78. 78.

    Vink JM. Genetics of addiction: future focus on gene × environment interaction? J Stud Alcohol Drugs. 2016;77:684–7.

  79. 79.

    Colizzi M, Iyegbe C, Powell J, Ursini G, Porcelli A, Bonvino A, et al. Interaction between functional genetic variation of DRD2 and cannabis use on risk of psychosis. Schizophr Bull. 2015;41:1171–82.

  80. 80.

    Shi Y, Lenzi M, An R. Cannabis liberalization and adolescent cannabis use: a cross-national study in 38 countries. PLoS One. 2015;10:e0143562.

  81. 81.

    Reinarman C, Cohen PDA, Kaal HL. The limited relevance of drug policy: cannabis in Amsterdam and in San Francisco. Am J Public Health. 2004;94:836–42.

  82. 82.

    Wouters M, Korf DJ. Access to licensed cannabis supply and the separation of markets policy in the Netherlands. J Drug Issues. 2009;39:627–51.

  83. 83.

    Cabral TS. The 15th anniversary of the Portuguese drug policy: Its history, its success and its future. Drug Sci Policy Law. 2017;3:2050324516683640.

  84. 84.

    Sandberg S. Cannabis culture: a stable subculture in a changing world cannabis culture: a stable subculture in a changing world. Criminol Crim Just. 2013;13:63–79.

  85. 85.

    General (US) O of the S, Services (US) C for MH, Health (US) NI of M. Chapter 2 Culture counts: the influence of culture and society on mental health [Internet]. Substance Abuse and Mental Health Services Administration (US); 2001 [cited 2018 Aug 31]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK44249/.

  86. 86.

    Rubin V. Cannabis and Culture. Walter de Gruyter; 1975.

  87. 87.

    •• Eriksson M, Ghazinour M, Hammarström A. Different uses of Bronfenbrenner’s ecological theory in public mental health research: what is their value for guiding public mental health policy and practice? Soc Theory Health. 2018;16:414–33 This systematic review explores how aspects of Bronfenbrenner’s ecological theory has been and will continue to be applied in a mental health context.

  88. 88.

    Atzaba-Poria N, Pike A, Deater-Deckard K. Do risk factors for problem behaviour act in a cumulative manner? An examination of ethnic minority and majority children through an ecological perspective. J Child Psychol Psychiatry. 2004;45:707–18.

Download references

Funding

This work was supported by the National Institutes of Health under Grant 1R01DA042490-01A1

Author information

Correspondence to Francesca Filbey.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Cannabis

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Taylor, M., Cousijn, J. & Filbey, F. Determining Risks for Cannabis Use Disorder in the Face of Changing Legal Policies. Curr Addict Rep 6, 466–477 (2019). https://doi.org/10.1007/s40429-019-00288-6

Download citation

Keywords

  • Cannabis use disorder
  • Risk
  • Public health
  • Legalization
  • Bioecological model
  • Cultural