Abstract
Patterns of cannabis consumption among regular users within a legalized environment have not been explored in detail. We aimed to conduct a survey among regular cannabis users to collect detailed information on frequency of use, methods of use, amounts consumed, and adverse health effects experienced. Data was collected via the Cannabis Users Survey on Health, a self-administered, anonymous online survey. Participants were adults (age 21+), residing in Colorado, who used cannabis at least once in the past month. Survey administration occurred June through October 2016. Of 1297 participant responses, 65.1% used cannabis at least once daily and smoking was the most common method of use (83.1%). Cannabis flower was the product most frequently purchased (n = 1006) and in the largest average amount per month (10 g). Adverse health effects were experienced by ~ 40%; most prevalent was paranoia (20.8%). The Cannabis Users Survey on Health provided data needed to inform public health on patterns of cannabis use in Colorado. Surveillance of adverse effects is needed to assess severity. High prevalence of daily use and smoking are concerning for long-term health effects. Continued data collection will allow public health to better assess the effects of increased cannabis availability on use patterns and health.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
American Heart Association. (2018). About Arrhythmia. Retrieved December 2, 2018, from http://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia
Azofeifa, A., Sherman, L. J., Mattson, M. E., & Pacula, R. L. (2017). Marijuana buyers in the United States, 2010-2014. Drug and Alcohol Dependence, 183, 34–42. https://doi.org/10.1016/j.drugalcdep.2017.10.019.
Barber, P. A., Pridmore, H. M., Krishnamurthy, V., Roberts, S., Spriggs, D. A., Carter, K. N., & Anderson, N. E. (2013). Cannabis, ischemic stroke, and transient ischemic attack: a case-control study. Stroke, 44(8), 2327–2329. https://doi.org/10.1161/strokeaha.113.001562.
Blanco, C., Hasin, D. S., Wall, M. M., Florez-Salamanca, L., Hoertel, N., Wang, S., et al. (2016). Cannabis use and risk of psychiatric disorders: prospective evidence from a US National Longitudinal Study. JAMA Psychiatry, 73(4), 388–395. https://doi.org/10.1001/jamapsychiatry.2015.3229.
Colorado Department of Revenue. (2015). Marijuana equivalency in portion and dosage. Retrieved April 6, 2017, from https://www.colorado.gov/pacific/enforcement/marijuana-related-reports-studies
Colorado Department of Public Health and Environment. (2016). Cannabis Users Survey on Health (CUSH). Unpublished data.
Colorado Department of Public Health and Environment. (2017). 2016 Behavioral Risk Factor Surveillance System Data. Available from: https://www.cohealthdata.dphe.state.co.us/Home/DataByTopic#
D'Souza, D. C., Perry, E., MacDougall, L., Ammerman, Y., Cooper, T., Wu, Y. T., . . . Krystal, J. H. (2004). The psychotomimetic effects of intravenous delta-9-tetrahydrocannabinol in healthy individuals: implications for psychosis. Neuropsychopharmacology, 29(8), 1558–1572. doi:https://doi.org/10.1038/sj.npp.1300496.
Englund, A., Atakan, Z., Kralj, A., Tunstall, N., Murray, R., & Morrison, P. (2016). The effect of five day dosing with THCV on THC-induced cognitive, psychological and physiological effects in healthy male human volunteers: a placebo-controlled, double-blind, crossover pilot trial. Journal of Psychopharmacology, 30(2), 140–151. https://doi.org/10.1177/0269881115615104.
Falkstedt, D., Wolff, V., Allebeck, P., Hemmingsson, T., & Danielsson, A. K. (2017). Cannabis, tobacco, alcohol use, and the risk of early stroke: a population-based cohort study of 45 000 Swedish men. Stroke, 48(2), 265–270. https://doi.org/10.1161/strokeaha.116.015565.
Feingold, D., Weiser, M., Rehm, J., & Lev-Ran, S. (2015). The association between cannabis use and anxiety disorders: results from a population-based representative sample. European Neuropsychopharmacology, 26, 493–505. https://doi.org/10.1016/j.euroneuro.2015.12.037.
Frost, L., Mostofsky, E., Rosenbloom, J. I., Mukamal, K. J., & Mittleman, M. a. (2013). Marijuana use and long-term mortality among survivors of acute myocardial infarction. American Heart Journal, 165(2), 170–175. https://doi.org/10.1016/j.ahj.2012.11.007.
Geller, T., Loftis, L., & Brink, D. S. (2004). Cerebellar infarction in adolescent males associated with acute marijuana use. Pediatrics, 113(4), e365–e370.
Grotenhermen, F. (2003). Pharmacokinetics and pharmacodynamics of cannabinoids. Clinical Pharmacokinetics, 42(4), 327–360. https://doi.org/10.2165/00003088-200342040-00003.
Hackam, D. G. (2015). Cannabis and stroke: systematic appraisal of case reports. Stroke, 46(3), 852–856. https://doi.org/10.1161/STROKEAHA.115.008680.
Hemachandra, D., McKetin, R., Cherbuin, N., & Anstey, K. J. (2016). Heavy cannabis users at elevated risk of stroke: evidence from a general population survey. Australian and New Zealand Journal of Public Health, 40(3), 226–230. https://doi.org/10.1111/1753-6405.12477.
Jouanjus, E., Lapeyre-Mestre, M., Micallef, J., French Association of the Regional, A, & Dependence Monitoring Centres Working Group on Cannabis, C. (2014). Cannabis use: signal of increasing risk of serious cardiovascular disorders. Journal of the American Heart Association, 3(2), e000638. https://doi.org/10.1161/JAHA.113.000638.
Kalla, A., Krishnamoorthy, P. M., Gopalakrishnan, A., & Figueredo, V. M. (2018). Cannabis use predicts risks of heart failure and cerebrovascular accidents: results from the National Inpatient Sample. Journal of Cardiovascular Medicine (Hagerstown, Md.), 19(9), 480–484. https://doi.org/10.2459/JCM.0000000000000681.
Kedzior, K. K., & Laeber, L. T. (2014). A positive association between anxiety disorders and cannabis use or cannabis use disorders in the general population—a meta-analysis of 31 studies. BMC Psychiatry, 14(1), 136. https://doi.org/10.1186/1471-244x-14-136.
Mason, O., Morgan, C. J., Dhiman, S. K., Patel, A., Parti, N., Patel, A., & Curran, H. V. (2009). Acute cannabis use causes increased psychotomimetic experiences in individuals prone to psychosis. Psychological Medicine, 39(6), 951–956. https://doi.org/10.1017/S0033291708004741.
Mittleman, M. A., Lewis, R. A., Maclure, M., Sherwood, J. B., & Muller, J. E. (2001). Triggering myocardial infarction by marijuana. Circulation, 103(23), 2805–2809.
Morgan, C. J., Rothwell, E., Atkinson, H., Mason, O., & Curran, H. V. (2010). Hyper-priming in cannabis users: a naturalistic study of the effects of cannabis on semantic memory function. Psychiatry Research, 176(2–3), 213–218. https://doi.org/10.1016/j.psychres.2008.09.002.
Morrison, P. D., Zois, V., McKeown, D. A., Lee, T. D., Holt, D. W., Powell, J. F., et al. (2009). The acute effects of synthetic intravenous Delta9-tetrahydrocannabinol on psychosis, mood and cognitive functioning. Psychological Medicine, 39(10), 1607–1616. https://doi.org/10.1017/s0033291709005522.
Mukamal, K. J., Maclure, M., Muller, J. E., & Mittleman, M. a. (2008). An exploratory prospective study of marijuana use and mortality following acute myocardial infarction. American Heart Journal, 155(3), 465–470. https://doi.org/10.1016/j.ahj.2007.10.049.
Reis, J. P., Auer, R., Bancks, M. P., Goff, D. C., Jr., Lewis, C. E., Pletcher, M. J., et al. (2017). Cumulative lifetime marijuana use and incident cardiovascular disease in middle age: the Coronary Artery Risk Development in Young Adults (CARDIA) study. American Journal of Public Health, 107(4), 601–606. https://doi.org/10.2105/ajph.2017.303654.
Rumalla, K., Reddy, A. Y., & Mittal, M. K. (2016). Recreational marijuana use and acute ischemic stroke: a population-based analysis of hospitalized patients in the United States. Journal of the Neurological Sciences, 364, 191–196. https://doi.org/10.1016/j.jns.2016.01.066.
Sidney, S., Beck, J. E., Tekawa, I. S., Quesenberry, C. P., & Friedman, G. D. (1997). Marijuana use and mortality. American Journal of Public Health, 87(4), 585–590.
Substance Abuse and Mental Health Services Administration. (2015). 2015 National survey on drug use and health (NSDUH): final CAI specifications for programming (english version). Retrieved March 26, 2017 from http://samhda.s3-us-gov-west-1.amazonaws.com/s3fs-public/field-uploads-protected/studies/NSDUH-2015/NSDUH-2015-datasets/NSDUH-2015-DS0001/NSDUH-2015-DS0001-info/NSDUH-2015-DS0001-info-questionnaire-specs.pdf.
Substance Abuse and Mental Health Services Administration. (2017). Population data/NSDUH. Available from: https://www.samhsa.gov/data/population-data-nsduh/
Thanvi, B. R., & Treadwell, S. D. (2009). Cannabis and stroke: is there a link? Postgraduate Medical Journal, 85(1000), 80–83. https://doi.org/10.1136/pgmj.2008.070425.
Twomey, C. D. (2017). Association of cannabis use with the development of elevated anxiety symptoms in the general population: a meta-analysis. Journal of Epidemiology and Community Health, 71(8), 811–816. https://doi.org/10.1136/jech-2016-208145.
Vigil, D., Hall, K., Contreras, E., Anderson Mellies, A., Bui, A. G., Tolliver, R., & Van Dyke, M. (2017). Monitoring changes in marijuana use patterns: behavioral risk factor surveillance system (BRFSS) 2014–2015 Survey Results. Retrieved January 25, 2017, from https://www.colorado.gov/cdphe/marijuana-health-report
Vin-Raviv, N., Akinyemiju, T., Meng, Q., Sakhuja, S., & Hayward, R. (2017). Marijuana use and inpatient outcomes among hospitalized patients: analysis of the nationwide inpatient sample database. Cancer Medicine, 6(1), 320–329. https://doi.org/10.1002/cam4.968.
Westover, A. N., McBride, S., & Haley, R. W. (2007). Stroke in young adults who abuse amphetamines or cocaine: a population-based study of hospitalized patients. Archives of General Psychiatry, 64(4), 495–502. https://doi.org/10.1001/archpsyc.64.4.495.
Acknowledgements
The authors would like to thank Lisa Barker, Maria Butler, Michele Coleman, Troy Curtis, Erika Kelley, David Ross, Aaron Shipman, Amber Vaughn, and the Council of State and Territorial Epidemiologists (CSTE).
Funding
This publication was supported by the Council of State and Territorial Epidemiologists (CSTE), with funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) through the Centers for Disease Control (CDC) cooperative agreement number 5U38OT00143. The contents are solely the responsibility of the authors and do not necessarily represent the official views of CSTE, SAMHSA, CDC, or the Department of Health and Human Services.
This study/report was supported in part by an appointment to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded through the Centers for Disease Control and Prevention (CDC) Cooperative Agreement Number 1U38OT000143-04 by the Substance Abuse and Mental Health Services Administration.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Authors Alexandra Elyse Contreras, Katelyn E. Hall, Daniel I. Vigil, Allison Rosenthal, Alejandro Azofeifa, and Michael Van Dyke ensure accepted principles of ethical and professional conduct have been followed regarding human participants and informed consent.
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Contreras, A.E., Hall, K.E., Vigil, D.I. et al. Results from the Colorado Cannabis Users Survey on Health (CUSH), 2016. Int J Ment Health Addiction 18, 1–13 (2020). https://doi.org/10.1007/s11469-018-0047-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11469-018-0047-x