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BYLINE: Enrique Rivero

EMBARGOED FOR USE UNTIL:

11 A.M. (EDT) ON JUNE 5, 2024

Cannabis use common among patients, with most using it to manage a symptom or health condition

Newswise — One in six patients in primary care reported cannabis use, with 35% of those using at levels indicating moderate- to high-risk for cannabis use disorder, new UCLA research finds.

The findings, to be published June 5 in JAMA Network Open, suggest that most patients reported using cannabis for symptom management, despite identifying as recreational users, indicating the need for routine cannabis screening.   Currently few healthcare systems offer this screening in primary care settings.

“Patients may not tell their primary care providers about their cannabis use, and their doctors may not ask about it,” said lead author Dr. Lillian Gelberg, professor of family medicine at the David Geffen School of Medicine at UCLA and of health policy and management at the UCLA Fielding School of Public Health  “Not asking patients about their cannabis use results in a missed opportunity for opening up doctor-patient communication regarding use of cannabis generally and for management of their symptoms. “

Thirty-eight states, three US territories and the District of Columbia allow cannabis for medical use, and 24 of these states also permit recreational use. Stigma over cannabis use has fallen likely due to these legal moves. While there has been an increased perception that its use is risk free, cannabis potency has increased.

The U.S. Preventive Services Task Force recommended in 2020 that primary care physicians screen their adult patients for use of cannabis and other substances. The following year the investigators implemented the UCLA universal electronic health record-based, self-administered survey on cannabis use and medical cannabis use. Patients complete this survey as pre-visit screening prior to their primary care visits as sent to them via the Epic patient portal.

The researchers used patients’ de-identified electronic health records at UCLA collected from January 2021 to May 2023 to determine the prevalence, correlates and reasons for current cannabis use. The UCLA Health system is one of the few to ask patients to voluntarily complete cannabis use surveys during pre-appointment check-ins. The survey used the WHO Alcohol Substance Involvement Screening Test (ASSIST) to assess cannabis use.

Nearly 176,000 patients completed surveys. Of those, nearly 30,000 (17%) reported cannabis use among whom 35% had results suggesting moderate- to high-risk for a cannabis use disorder, defined as a score of 8 or higher on the screening survey. Among users, 40% used cannabis once or twice in the previous three months, 17% used monthly, 25% used weekly and 19% used it daily or almost daily.

Other findings included:

• Cannabis use was lowest among people living in the most disadvantaged neighborhoods (14%), yet the risk for disordered use was highest among this group
• Inhaled modes of cannabis use were as common as ingestion (65.0% and 64.7%), including 29% who vaped
• 47% used cannabis for medical reasons
• 76% used it to manage symptoms such as mental health symptoms or stress (56%), sleep (56%), and pain (37%). Further, most patients who reported using cannabis only for recreational reasons had also used it at some point to manage a symptom.

The study has some limitations. The findings are based on patients’ self-reported use and though cannabis is legal in California, some patients may still have been reluctant to disclose using it. Much of the data were from screenings taken during the COVID-19 lockdown, during which cannabis use may have been higher than it might have been otherwise. In addition, the findings may not be applicable to other health systems, particularly in states where cannabis use is still illegal.

However, “given the high rates of cannabis use and medical cannabis use that we found in this large urban healthcare system, it is essential that healthcare systems implement routine screening of all primary care patients,” the researchers write.  “Integrating screening efforts to include information regarding cannabis use for symptom management could help enhance the identification and documentation of medical cannabis usage, particularly in the healthcare context.” 

Study co-authors are Dana Beck, PhD, MSN; Julia Koerber, MPH; Whitney N. Akabike, PMP, MSPH; Lawrence Dardick, MD; Clara Lin, MD; Steve Shoptaw, PhD; and Marjan Javanbakht, MPH, PhD.

The study was funded by the University of California Tobacco-Related Disease Research Program (grant #T29IR0277) and the National Institutes of Health National Center for Advancing Translational Science (NCATS) UCLA CTSI (grant #UL1TR001881). 

Article: [citation] doi:10.1001/jamanetworkopen.2024.14809

Newswise — Physical and sexual abuse, having parents who misuse substances, and witnessing violent crime are tragic events that don’t remain locked in a single point in time. Rather, they are termed adverse childhood experiences (ACEs) and 64 percent of American adults who participated in a recent survey reported experiencing at least one ACE prior to turning 18 years old. 

The wake of these events can extend into adulthood and include harmful behaviors such as self-medicating—which one new study found is akin to adding fuel to an already burning fire.  

This new research, published in Nature Human Behavior, showed that individuals exposed to ACEs are at increased risk of developing mood, anxiety, and substance use disorders. In part, the substance use disorder risk is related to the use of alcohol or drugs to self-medicate mood and anxiety disorders. 

Henry Kranzler, MD, a professor of Psychiatry and the director of the Center for Studies of Addiction in the Perelman School of Medicine at the University of Pennsylvania, co-authored the work. He and his colleagues found that people with these mental health conditions reported experiencing more ACEs and lacking protective factors, such as close family connections, that can mitigate their harms. 

However, according to Kranzler, there are multiple entry points. “These findings suggest that multiple pathways lead to mental health conditions after exposure to childhood adversity,” Kranzler said.  

Prevalence of adverse childhood events   

The axiom “kids are resilient” continues to be tested, and sometimes broken, as the world continues to adapt to the impact of remote learning, stunted social-emotional development, and a spectrum of issues weighing on children during the past few years.   

That spectrum includes the impact of ACEs on children across the country. According to the Centers for Disease Control and Prevention, three in four high school students reported experiencing at least one ACE during the pandemic and were more likely to report poor mental health or suicidal behavior.  

Other research has shown that adverse childhood experiences can influence negative behavior into adulthood, as well as detailed the significant economic impact of ACEs. One recent study put the national economic burden of ACEs-related adult health conditions at $14.1 trillion annually ($183 billion in direct medical spending and $13.9 trillion in lost healthy life-years), or $88,000 per affected adult annually and $2.4 million over their lifetime. 

Finding the fire before it spreads 

The group led by Kranzler examined associations among ACEs, mood or anxiety disorders, and substance dependence in 12,668 individuals—42.5 percent Black and 42.1 percent white) and compared two primary hypotheses: self-medication (using substances to cope with trauma) and substance-induced psychiatric disorders (mental health issues caused by substance use). Stronger support was found for the self-medication hypothesis, suggesting that interventions focusing on coping skills and emotional resilience may help reduce the risk of future mental health issues in children exposed to ACEs. 

“Earlier intervention is key,” added Rachel Kember, MSc, PhD, an assistant professor of Psychiatry and study co-author. “The findings provide a better understanding of how it may be best to intervene based on an individual’s specific needs.” 

Genetic factors also play a role, with some individuals having a higher genetic predisposition for developing substance use, mood, or anxiety disorders. The interaction between genetic risk and childhood adversity influences the development of mental health disorders, highlighting the importance of understanding different pathways and designing early interventions to promote emotional regulation and coping skills. 

“Given these results, it’s crucial to prioritize efforts to reduce children’s exposure to early traumatic experiences,” said study co-author Christal Davis, PhD, a postdoctoral fellow at the Corporal Michael J. Crescenz VA Medical Center (VAMC). “This would enhance access to protective factors, which could prevent the need for future mental health interventions.” 

Because there are multiple pathways to the development of mental health conditions following exposure to childhood adversity, regular screening for ACEs and targeted interventions to improve emotional regulation and other coping skills, may help to reduce the harmful impacts of childhood adversity. 

According to Kranzler, greater priority should be placed on both reducing children’s exposure to early traumatic experiences and increasing their access to protective factors. For example, safe, stable, and nurturing relationships, positive friendships and peer networks, and supportive school environments that promote learning and socialization, may help prevent the need for future mental health interventions.  

Though the team expressed caution—more data are necessary to chart firmer next steps due to the novelty of the dataset the team analyzed—it does represent a first step. 

“The findings underscore the need for efforts to prevent or intervene early with individuals who experience adverse childhood events, as they have the potential to prevent or limit the development of a variety of psychiatric disorders, including substance dependence,” Kranzler said.  

“Gene x Environment and Mediation Effects among Adverse Childhood Events, Mood and Anxiety Disorders, and Substance Dependence” was published with colleagues from the Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Quinnipiac University, and Yale University School of Medicine. 

Newswise — New research from the University of South Australia (UniSA) and Curtin University finds that up to 36% of young people leaving foster homes in Australia wind up homeless – compared to less than 10% of the general youth population.

In a paper published in the journal Child Abuse & Neglect, mental health, alcohol, and substance abuse disorders were identified as increasing the risk of homelessness, emphasising the importance of employing systems and resources to improve the outcomes for out-of-home care (OHC)  leavers.

Professor Melissa O’Donnell, Deputy Director of Research at UniSA’s Australian Centre for Child Protection, says more needs to be done to support young people who haven’t had the typical growing-up experience that could otherwise help them with the transition to adulthood and independent living.

“Young people leaving care need help securing stable housing, financial assistance, mentorship support, education and employment services, and life skills training,” Prof O’Donnell says.

“We need to diversify our approach to supporting these groups, with tailored strategies unique to each person and their needs.

“These young people often have minimal social and/or financial support to transition smoothly from OHC to adulthood, which leads to homelessness, substance misuse, and poor mental health.

“Providing transition programs which offer a range of support and resources is vital so that they are tailored to individual needs and goals.”

Curtin University PhD student Fadzai Chikwava says a lack of extended support post-care contributes significantly to homelessness.

“There’s a lack of follow-up on OHC leavers, which is contributing to these poor outcomes,” Chikwava says.

“Evaluation and monitoring systems need to be strengthened as a form of early intervention, and leavers need to be involved in developing support and transition plans to ensure security and success post-care.

“All Australian states have committed to extending leaving care until age 21, however the frequency and extent of this varies depending on the child welfare system in each state.

“Even though leavers have these extra years of support, the quality of this care needs to be improved to ensure young people are provided trauma-informed care and that the support and resources they receive are meeting their needs.”

Notes to editors:

“Trajectories of homelessness and association with mental health and substance use disorders among young people transitioning from out-of-home care in Australia” is authored by Fadzai Chikwava (Curtin University); Reinie Cordier (Northumbria University); Anna Ferrante (Curtin University); Melissa O’Donnell (UniSA) and Eduwin Pakpahan (Northumbria University).

Newswise — A new study by researchers at the Case Western Reserve University School of Medicine reveals that the popular diabetes and weight-loss drugs Wegovy and Ozempic are linked to reduced incidence and recurrence of alcohol abuse or dependence.

The team’s findings, recently published in the journal Nature Communications, may suggest a possible new treatment for excessive alcohol use—including alcohol-use disorder (AUD), a health condition that causes about 178,000 deaths in the United States each year, according to the Centers for Disease Control.

To date, the U.S. Food and Drug Administration (FDA) has approved only three medications to treat AUD.

The active ingredient in Wegovy and Ozempic is semaglutide, which belongs to a class of medications known as glucagon-like peptide-1 receptor agonists (GLP-1). GLP-1 helps regulate blood sugar in type 2 diabetes and reduces appetite.

The researchers examined electronic health records of nearly 84,000 patients with obesity. They found those treated with semaglutide, compared to those treated with other anti-obesity medications, showed a 50% to 56% decrease for both the initiation and re-occurrence of alcohol-use disorder in the year following.

“This is very promising news in that we may have a new therapeutic method to treat AUD,” said Rong Xu, a professor of biomedical informatics at the School of Medicine and the study’s lead researcher.

Xu, also director of the medical school’s Center for AI in Drug Discovery, was joined by medical school co-authors Nathan Berger, the Hanna-Payne Professor of Experimental Medicine, and Pamela Davis, the Arline H. and Curtis F. Garvin Research Professor. Nora D. Volkow, director of the National Institute for Drug Abuse, also co-authored the study.

“We collected real-world evidence in a manner similar to our previous two studies reported earlier this year,” Berger said. “In January we showed that semaglutide is associated with a decrease in suicidal thoughts, and in March, we demonstrated that semaglutide is also associated with a reduction in both new diagnoses and recurrence of cannabis-use disorder.”

Similar findings were replicated when the team examined electronic health records for about 600,000 patients with type 2 diabetes. Again, they found consistent reductions in alcohol-use disorder diagnoses among those treated with semaglutide.

“While the findings are promising and provide preliminary evidence of the potential benefit of semaglutide in AUD in real-world populations,” Davis said, “further randomized clinical trials are needed to support its use clinically for AUD.”

Author: Jessica Scully

Newswise — Mindfulness training has made its way into school districts, self-help and health books, and workplaces. One day soon, it could also be widely offered as a “medicine” for some physical and mental health conditions.

A particular form of mindfulness emphasizing pleasure is proven to work as well as a starting dose of a narcotic for pain and better than a traditional psychotherapy treatment for substance abuse, according to Eric Garland, PhD, a professor in the College of Social Work at the University of Utah and director of the Center on Mindfulness and Integrative Health Intervention Development.

Mindfulness may be helpful for many conditions beyond chronic pain and addiction. “The techniques that we teach are also very likely effective treatments for depression, anxiety, post-traumatic stress disorder, and simply increasing resilience in people without any diagnosable mental health conditions,” Garland says.

What is mindfulness?

Mindfulness might seem like a way to relax. But as a form of therapy, mindfulness is a kind of mental training for cultivating awareness, Garland says. Mindfulness means focusing attention on your thoughts, emotions, and body sensations in the moment you’re experiencing them. The goal isn’t to try to push these away, or to make them stay, but “watching your experience as if you were a witness,” he says. “It’s a practice of wakefulness, of becoming awake to the way your mind works and becoming aware of how you’re operating in life.” 

Garland studies Mindfulness-Oriented Recovery Enhancement (MORE), a specific form of mindfulness therapy. MORE therapy sessions include an important additional component: teaching people how to mindfully savor pleasure, meaningful experiences, and joy. 

That might mean, for example, focusing as you hear or see something beautiful or taste something delicious. Then, when you notice those feelings, you turn your attention inward, Garland says, “to savor the positive inner feeling and to absorb it deeply inside yourself, like water seeping into the soil.”

Mindfulness as medicine

In a scientific study Garland and his team conducted, they found 15 minutes of mindfulness meditation can reduce pain by about 30%. This is an equivalent amount of pain relief as that provided by five milligrams of oxycodone, a common starting dose for the medication.

Chronic physical pain often also hurts people emotionally. People feel hopeless and worry the pain will never end, preventing them from living their lives fully. Mindfulness helps people with chronic pain separate emotional and physical reactions and think about pain as physical sensations, Garland says. That decreases pain intensity by changing how the brain processes pain, he adds. 

It hasn’t yet been proven in research, but savoring healthy pleasure could also decrease pain intensity by making the brain produce endorphins, which reduce pain, Garland says. Brain research has shown that savoring increases activity in the brain’s rewards system, Garland adds, which is associated with decreased pain.

Mindfulness to treat addiction takes a similar approach—with a slightly different focus. It tackles the compulsion of addiction by cultivating both self-awareness and self-control. People become aware of their automatic reactions and habits around using substances and then can better control their choices, Garland says.

Learning to savor positive experiences helps with both conditions, he adds. For those suffering from addiction, Garland has found that as the brain and body become more sensitive to healthy pleasures, craving is reduced. Among people treated with MORE, Garland has also found they’re nearly twice as likely as those treated with supportive psychotherapy to have stopped misusing opioids nine months later.

Limitations to mindfulness treatments

Like a drug for pain, though, a “dose” of mindfulness doesn’t last forever. Currently, science doesn’t have a thorough explanation for why, though Garland thinks this is because the brain returns to its habitual patterns. However, with months or years of practice, the brain becomes set to a more mindful baseline. 

Mindfulness studies back this up, Garland says. His work has found that an eight-week mindfulness treatment reduces addictive behavior and pain, and these reductions last at least nine months later. 

Mindfulness clearly offers many benefits. But is there anyone who shouldn’t use it, or for whom the practice might not be safe? Garland says that although mindfulness is safe and beneficial for many people, it’s not yet known for whom mindfulness works for and for whom it doesn’t. He does caution that all mindfulness training isn’t equal, and the quality of the techniques taught depends on the skill of the teacher. 

He also cautions that people who have experienced trauma or post-traumatic stress disorder could experience flashbacks or intrusive memories during mindfulness meditation. These groups should be particularly careful to learn correct mindfulness techniques from a well-trained and licensed psychotherapist, he says.

Newswise — Since cannabidiol (CBD), the non-intoxicating component of cannabis, was legalized in the United States by the 2018 Farm Bill, products containing the compound have flooded the consumer health sector. While there is a single FDA-approved medication containing CBD which can be used to treat rare forms of epilepsy, evidence for the efficacy of commercial CBD products, which generally contain low doses of CBD, is limited. However, this has not stopped their widespread and growing use.

Now, a new study published in Cannabis and Cannabinoid Research reveals that nearly 3% of healthy adolescents aged 11-15 have used commercial CBD products for medicinal or health-related reasons. The study, led by Natasha Wade, Ph.D., assistant professor in the Department of Psychiatry at UC San Diego School of Medicine, is the first to investigate the prevalence and predictors of commercial CBD use in young, healthy adolescents.

“While this study documents that about 3% of young teens have been given CBD for medicinal reasons, we believe this is likely an underreport,” said Wade. “Parents might not be comfortable saying they’re giving CBD to their kids, even though they’re trying to help them.”

The new study analyzed data from more than 11,000 participants in the Adolescent Brain Cognitive Development (ABCD) Study, a large, longitudinal study of healthy adolescents in the United States. The researchers found that 2.8% of participants had used commercial CBD products, with the most common methods of administration being oil/tincture, topical/transdermal, and edible/capsule/pill. None reported prescription CBD use.

The study also identified several predictors of commercial CBD use, including older age, having parents with some college education, and certain health conditions, such as sleep problems, mental health symptoms, and physical pain. Additionally, the researchers found that youth with more lenient parental attitudes towards cannabis use were more likely to use commercial CBD products.

The researchers also found that, for a subsample of teens that had undergone hair toxicology testing, 23% of participants who used CBD products had THC in their hair, suggesting that some parents may be unknowingly giving their kids CBD products that contain THC. Wade noted that the study’s findings raise concerns about the chemical content of commercial CBD use in adolescents.

“This highlights the need for regulation of CBD products to ensure that the products contain what the labels claim,” said Wade.

In response to the study’s findings, Wade and her team are now working on a broader online survey to investigate why parents are giving CBD to their kids and whether it is effective in treating their conditions. “We need to know why parents are giving CBD to their kids, and if they think it’s actually working,” she said.

The study’s authors also emphasize the importance of clinicians asking about CBD use in their patients and parents being open about their use of CBD products.

“We know very little about what CBD effectively treats in youth, and at what doses,” said Wade. “There are also some adverse effects associated with CBD use. The goal of any medical treatment is to ensure the health and well-being of the child, so talking with doctors is essential to make sure the best decisions can be made for each child.”

Full link to study: https://doi.org/10.1089/can.2024.0015

Co-authors of the study include: Tam T. Nguyen-Louie, Alexander L. Wallace, and Susan F. Tapert at UC San Diego School of Medicine, and Ryan M. Sullivan at University of Wisconsin-Milwaukee.

This study was supported by the National Institute on Drug Abuse (DA050779), the National Institutes of Health (U01DA041048, U01DA050989, U01DA051016, U01DA041022, U01DA051018, U01DA051037, U01DA050987, U01DA041174, U01DA041106, U01DA041117, U01DA041028, U01DA041134, U01DA050988, U01DA051039, U01DA041156, U01DA041025, U01DA041120, U01DA051038, U01DA041148, U01DA041093, U01DA041089, U24DA041123, U24DA041147), and the National Institute of Mental Health (T32 AA013525).

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Disclosures: the authors declare no competing interests

Newswise — Researchers say the first U.S. trial of varenicline for e-cigarette cessation shows promising results.

A team from Yale School of Medicine and the Medical University of South Carolina published their results May 16 in the American Journal of Preventive Medicine.

Participants received 8 weeks of treatment with varenicline or placebo, along with a self-guided vaping cessation booklet and a single counseling session. Researchers say they found a significant disparity between the placebo group and the group receiving the medication.

“We had a 15 percent difference in quit rates, with those in the medication group having a quit rate of 45 percent,” said Lisa Fucito, PhD, lead author and associate professor of psychiatry at Yale School of Medicine. Fucito is director of the Tobacco Treatment Service at the Yale Cancer Center and Smilow Cancer Hospital.

Varenicline, better known by the brand name Chantix, is FDA-approved to help adults to stop smoking traditional cigarettes, but there are currently no approved medication options for e-cigarette cessation. The research team says vaping devices are more convenient to use, and harder to track usage of, than traditional cigarettes.

“People can get to very high levels of nicotine exposure with these e-cigarette products, and they can use them near constantly throughout the day. So, the question we all have is, ‘Can any pharmacotherapy stand up to this challenge?’” Fucito said.

Previous studies have shown that a majority of people using e-cigarettes want to quit, but researchers say it has been unclear whether products used to stop smoking traditional combustible cigarettes would also work for e-cigarettes.

“We need more pharmacotherapy treatments to help address the really strong physical dependence that can develop from e-cigarette use,” Fucito said. “People undergo significant withdrawal when they try to stop, and that withdrawal is so unpleasant and hard to manage with just behavioral support alone.”

Benjamin A. Toll was senior author of the study. Study authors included Stephen Baldassarri, Stephanie O’Malley, Suchitra Krishnan-Sarin, Nathaniel L. Baker, Amanda M. Palmer, and Kevin M. Gray.