The relevance of patterns of use: A survey to assess cannabis use related harm
DOI:
https://doi.org/10.20882/adicciones.1570Keywords:
cannabis, risk, harm, THC, survey, onlineAbstract
Lifetime prevalence of cannabis use is estimated 192 million adults worldwide (2017) and has increased by 16% in the last decade. However, data on quantity and frequency of use that can lead to harm is lacking. We have developed a survey to assess patterns of cannabis use and related harms in a sample of cannabis users. This paper focuses on evaluating the feasibility of the survey and the users’ satisfaction in a pilot sample. Forty cannabis users were recruited (>18 years old, living in Spain, cannabis use at least once during the last 12 months) between December 2018 and January 2019. Participants answered an online survey (mental health, organic harm and injury) and an ad hoc questionnaire to assess accessibility, feasibility, satisfaction, design and content appropriateness. Of the participants, 93.23% (n = 37.3) were satisfied with the design, 94.92% (n = 38.2) were satisfied with the content, and 94.73% (n = 37.0) were satisfied with the accessibility of the survey; only minor changes were required to improve feasibility and accessibility. Participants used a median of 1.0 Standard Joint Unit per day (Interquartile Range [IQR] 1.0-2.0). Of the sample, 92.5% reported at least one related harm and suffers a median of 4.0 disorders (IQR, 1.25-5.0). The present study allows for designing a feasible online survey to conduct a cross-sectional study with a larger sample.References
Abdel-Baki, A., Ouellet-Plamondon, C., Salvat, É., Grar, K. & Potvin, S. (2017). Symptomatic and functional outcomes of substance use disorder persistence 2 years after admission to a first-episode psychosis program. Psychiatry Research, 247, 113-119. doi:10.1016/j.psychres.2016.11.007.
Alderson, H. L., Semple, D. M., Blayney, C., Queirazza, F., Chekuri, V. & Lawrie, S. M. (2017). Risk of transition to schizophrenia following first admission with substance-induced psychotic disorder: a population-based longitudinal cohort study. Psychological Medicine, 47, 2548-2555. doi:10.1017/S0033291717001118.
Arendt, M., Rosenberg, R., Foldager, L., Perto, G. & Munk-Jorgensen, P. (2005). Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: follow-up study of 535 incident cases. The British Journal of Psychiatry, 187, 510-515. doi:10.1192/bjp.187.6.510.
Arias, F., Szerman, N., Vega, P., Mesías, B., Basurte, I., Morant, C., … Babín, F. (2013). Estudio Madrid sobre prevalencia y características de los pacientes con patología dual en tratamiento en las redes de salud mental & de atención al drogodependiente. Adicciones, 25, 118-127.
Baldacchino, A., Hughes, Z., Kehoe, M., Blair, H., Teh, Y., Windeatt, S. & Crome, I. B. (2012). Cannabis psychosis: examining the evidence for a distinctive psychopathology in a systematic and narrative review. The American Journal on Addictions, 21, S88-98. doi:10.1111/j.1521-0391.2012.00295.x.
Callaghan, R. C., Cunningham, J. K., Allebeck, P., Arenovich, T., Sajeev, G., Remington, G., …
Kish, S. J. (2012). Methamphetamine use and schizophrenia: a population-based cohort study in California. American Journal of Psychiatry, 169, 389-396. doi:10.1176/appi.ajp.2011.10070937.
Cantor-Graae, E., Nordström, L. G. & McNeil, T. F. (2001). Substance abuse in schizophrenia: a review of the literature and a study of correlates in Sweden. Schizophrenia Research, 48, 69-82. doi:10.1016/s0920-9964(00)00114-6.
Caton, C. L., Drake, R. E., Hasin, D. S., Dominguez, B., Shrout, P. E., Samet, S. & Schanzer, B. (2005). Differences between early-phase primary psychotic disorders with concurrent substance use and substance-induced psychoses. Archives of General Psychiatry, 62, 137-145. doi:10.1001/archpsyc.62.2.137.
Caton, C. L., Hasin, D. S., Shrout, P. E., Drake, R. E., Dominguez, B., First, M. B., … Schanzer, B. (2007). Stability of early-phase primary psychotic disorders with concurrent substance use and substance-induced psychosis. The British Journal of Psychiatry, 190, 105-111. doi:10.1192/bjp.bp.105.015784.
Chambers, R. A., Krystal, J. H. & Self, D. W. (2001). A neurobiological basis for substance abuse comorbidity in schizophrenia. Biological Psychiatry, 50, 71-83. doi:10.1016/s0006-3223(01)01134-9.
Chaudhury, S., Krishna, S. T. & Kumar, A. B. (2016). Impact of substance use disorder on presentation of schizophrenia. Dual Diagnosis Open Access, 1, 7. doi:10.21767/2472-5048.100007.
Chen, C. K., Lin, S. K., Sham, P. C., Ball, D., Loh, E. W., Hsiao, C. C., … Murray, R. M. (2003). Pre-morbid characteristics and co-morbidity of methamphetamine users with and without psychosis. Psychological Medicine, 33, 1407-1414. doi:10.1017/S0033291703008353.
Chen, W. L., Hsieh, C. H., Chang, H. T., Hung, C. C. & Chan C. H. (2015). The epidemiology and progression time from transient to permanent psychiatric disorders of substance-induced psychosis in Taiwan. Addictive Behaviors, 47, 1-4. doi:10.1016/j.addbeh.2015.02.013.
Crebbin, K., Mitford, E., Paxton, R. & Turkington, D. (2009). First-episode drug-induced psychosis: a medium term follow up study reveals a high-risk group. Social Psychiatry and Psychiatric Epidemiology, 44, 710-715. doi:10.1007/s00127-008-0490-2.
Fiorentini, A., Volonteri, L. S., Dragogna, F., Rovera, C., Maffini, M., Mauri, M. C. & Altamura, C. A. (2011). Substance-induced psychoses: a critical review of the literature. Current Drug Abuse Reviews, 4, 228-240. doi:10.2174/1874473711104040228.
Fonseca-Pedrero, E., Lucas-Molina, B., Pérez-Albéniz, A., Inchausti, F. &Ortuño-Sierra, J. (2020). Psychotic-like experiences and cannabis use inadolescents from the general population. Adicciones, 32, 41-51. doi:10.20882/adicciones.1149.
Fraser, S., Hides, L., Philips, L., Proctor, D. & Lubman, D. I. (2012). Differentiating first episode substance induced and primary psychotic disorders with concurrent substance use in young people. Schizophrenia Research, 136 110-115. doi:10.1016/j.schres.2012.01.022.
Fusar-Poli, P., Cappucciati, M., Rutigliano, G., Heslin, M., Stahl, D., Brittenden, Z., … Carpenter, W. T. (2016). Diagnostic stability of ICD/DSM first episode psychosis diagnoses: meta-analysis. Schizophrenia Bulletin, 42, 1395-1406. doi:10.1093/schbul/sbw020.
Gage, S. H., Hickman, M. & Zammit, S. (2016). Association between cannabis and psychosis: epidemiologic evidence. Biological Psychiatry,
79, 549–56. doi:10.1016/j.biopsych.2015.08.001.
García Álvarez, L., Gomar, J. J., García-Portilla, M. P. & Bobes, J. (2019). Cannabis use and cognitive impairment in schizophrenia and first-episodepsychosis. Adicciones, 31, 89-94. doi:10.20882/adicciones.1328.
Gregg, L., Barrowclough, C. & Haddock, G. (2007). Reasons for increased substance use in psychosis. Clinical Psychology Review,
27, 494-510. doi:10.1016/j.cpr.2006.09.004.
IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.
Kadouri, A., Coeeuble, E. & Falissard B. (2007). The improved Clinical Global Impression Scale (iCGI): development and validation in depression. BMC Psychiatry, 7, 1. doi: 10.1186/1471-244X-7-7.
Kay, S. R., Fiszbein, A. & Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261-276. doi:10.1093/schbul/13.2.261.
Kay, S. R., Opler, L. A. & Lindenmayer, J. P. (1989). The Positive and Negative Syndrome Scale (PANSS): rationale and standardisation. British Journal of Psychiatry. Supplement, 7, 59-67.
Kay, S. R. & Sevy, S. (1990). Pyramidical model of schizophrenia. Schizophrenia Bulletin,
16, 537-545. doi:10.1093/schbul/16.3.537
Keshavan, M. S. & Kaneko Y. (2013). Secondary psychoses: an update. World Psychiatry, 12, 4-15. doi:10.1002/wps.20001.
Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harvard Review of Psychiatry, 4, 231-244. doi:10.3109/10673229709030550.
Latt, N., Jurd, S., Tennant, C., Lewis, J., Macken, L., Joseph, A., … Long, L. (2011). Alcohol and substance use by patients with psychosis presenting to an emergency department: changing patterns. Australasian Psychiatry, 19, 354-359. doi:10.3109/10398562.2011.579971.
Mathias, S., Lubman, D. I. & Hides, L. (2008). Substance-induced psychosis: a diagnostic conundrum. The Journal of Clinical Psychiatry, 69, 358-367. doi:10.4088/jcp.v69n0304.
Mauri, M. C., Di Pace, C., Reggiori, A., Paletta, S. & Colasanti, A. (2017). Primary psychosis with comorbid drug abuse and drug-induced psychosis: diagnostic and clinical evolution at follow up, Asian Journal of Psychiatry, 29, 117-122. doi:10.1016/j.ajp.2017.04.014.
Møller, T. & Linaker, O. M. (2004). Symptoms and lifetime treatment experiences in psychotic patients with and without substance abuse. Nordic Journal of Psychiatry,
58, 237-242. doi:10.1080/08039480410006296.
Moshe, L. B., Weizman, A., Ben, D. H., Konas, S., Fischel, Z., Aizenberg, D., … Valevski, A. (2018). Differences in demographic and clinical characteristics between cannabis users and non-drug users: a retrospective study of patients with first hospitalization due to psychotic symptoms, Psychiatry Research,
268, 454-459. doi:10.1016/j.psychres.2018.07.037.
Myles, N., Newall, H., Nielssen, O. & Large, M. (2012). The association between cannabis use and earlier age at onset of schizophrenia and other psychoses: meta-analysis of possible confounding factors. Current Pharmaceutical Design, 18, 5055-5069. doi:10.2174/138161212802884816.
Myles, H., Myles, N. & Large, M. (2015). Cannabis use in first episode psychosis: Meta-analysis of prevalence, and the time course of initiation and continued use. Australian and New Zealand Journal of Psychiatry,
50, 208-219. doi:10.1177/0004867415599846.
Niemi-Pynttäri, J. A., Sund, R., Putkonen, H., Vorma, H., Wahlbeck, K. & Pirkola, S.P. (2013). Substance-induced psychoses converting into schizophrenia: a register-based study of 18,478 Finnish inpatient cases. The Journal of Clinical Psychiatry, 74, e94-9. doi:10.4088/JCP.12m07822.
Núñez, L. A. & Gurpegui, M. (2002). Cannabis-induced psychosis: a cross-sectional comparison with acute schizophrenia. Acta Psychiatrica Scandinavica, 105, 173-178. doi:10.1034/j.1600-0447.2002.1o079.x.
Organización Mundial de la Salud. (1992). CIE-10. Trastornos Mentales y del Comportamiento. Décima Revisión de la Clasificación Internacional de las Enfermedades. Descripciones Clínicas y pautas para el diagnóstico. Ginebra: Organización Mundial de la Salud.
Paparelli, A., Di Forti, M., Morrison, P. D. & Murray, R. M. (2011). Drug-induced psychosis: how to avoid star gazing in schizophrenia research by looking at more obvious sources of light. Frontiers in Behavioral Neuroscience, 5, 1. doi:10.3389/fnbeh.2011.00001.
Pedrós, A., Martí
,
J., Gutiérrez, G., Tenías, J. M. & Ruescas, S. (2009). Two-year diagnostic stability and prognosis in acute psychotic episodes. Actas Españolas de Psiquiatría, 37, 245-251.
Peralta, V. & Cuesta, M. J. (1994). Psychometric properties of the positive and negative syndrome scale (PANSS) in schizophrenia. Psychiatry Research, 53, 31-40. doi:10.1016/0165-1781(94)90093-0.
Rodríguez-Jiménez, R., Bagney, A., Mezquita, L., Martínez-Gras, I., Sánchez-Morla, E. M., Mesa, N., … Palomo, T. (2013). Cognition and the five-factor model of the positive and negative syndrome scale in schizophrenia. Schizophrenia Research, 143, 77-83. doi:10.1016/j.schres.2012.10.020.
Rognli, E. B., Berge, J., Håkansson, A. & Bramness, J. G. (2015). Long-term risk factors for substance-induced and primary psychosis after release from prison. A longitudinal study of substance users. Schizophrenia Research, 168, 185-190. doi:10.1016/j.schres.2015.08.032.
Sara, G. E., Burgess, P. M., Malhi, G. S., Whiteford, H. A. & Hall, W. C. (2014). The impact of cannabis and stimulant disorders on diagnostic stability in psychosis. The Journal of Clinical Psychiatry, 75, 349-356. doi:10.1016/j.schres.2015.08.032.
Schuckit, M. A. (2006). Comorbidity between substance use disorders and psychiatric conditions. Addiction,
101 (Suppl 1), 76-88. doi:10.1111/j.1360-0443.2006.01592.x.
Seddon, J. L., Birchwood, M., Copello, A., Everard, L., Jones, P. B., Fowler, D., … Sing, S. P. (2016). Cannabis use is associated with increased psychotic symptoms and poorer psychosocial functioning in first-episode psychosis: a report from the UK national EDEN study. Schizophrenia Bulletin,
42, 619-625. doi:10.1093/schbul/sbv154.
Semple, D. M., McIntosh, A. M. & Lawrie, S. M. (2005). Cannabis as a risk factor for psychosis: systematic review. Journal of Psychopharmacology, 19, 187-194. doi:10.1177/0269881105049040.
Shah, D., Chand, P., Bandawar, M., Benegal, V. & Murthy, P. (2017). Cannabis induced psychosis and subsequent psychiatric disorders. Asian Journal Psychiatry, 30, 180-184. doi:10.1016/j.ajp.2017.10.003.
Singal, A., Bhat, P. S., Srivastava, K. & Prakash, J. (2015). The study of primary psychotic disorders with concurrent substance abuse in terms of their diagnostic stability. Indian Journal of Psychiatry, 57, 224-228. doi:10.4103/0019-5545.166638.
Soyka, M. (2008). Prevalence of alcohol-induced psychotic disorders. European Archives of Psychiatry and Clinical Neuroscience, 258, 317-318. doi:10.1007/s00406-008-0767-1.
Starzer, M. S. K., Nordentoft, M. & Hjorthøj, C. (2018). Rates and predictors of conversion to schizophrenia or bipolar disorder following substance-induced psychosis. American Journal of Psychiatry, 175, 343-350. doi:10.1176/appi.ajp.2017.17020223.
Thirthalli, J. & Benegal, V. (2006). Psychosis among substance users. Current Opinion in Psychiatry, 19, 239-245. doi:10.1097/01.yco.0000218593.08313.fd.
Tosato, S., Lasalvia, A., Bonetto, C., Mazzoncini, R., Cristofalo, D., De Santi, K., … Ruggeri, M. (2013). The impact of cannabis use on age of onset and clinical characteristics in first-episode psychotic patients. Data from the Psychosis Incident Cohort Outcome Study (PICOS). Journal of Psychiatric Research,
47, 438-444. doi:10.1016/j.jpsychires.2012.11.009.
Wallwork, R. S., Fortgang, R., Hashimoto, R., Weinberger, D. R. & Dickinson, D. (2012). Searching for a consensus five-factor model of the Positive and Negative Syndrome Scale for schizophrenia. Schizophrenia Research, 137, 246-250. doi:10.1016/j.schres.2012.01.031.
Weibell, M. A., Joa, I., Bramness, J., Johannessen, J. O., McGorry, P. D., Ten Velden Hegelstad, W. & Larsen, T. K. (2013). Treated incidence and baseline characteristics of substance induced psychosis in a Norwegian catchment area. BMC Psychiatry, 13, 319. doi:10.1186/1471-244X-13-319.
Volkow, N. D. (2001). Drug abuse and mental illness: progress in understanding comorbidity. American Journal of Psychiatry, 158, 1181-1183. doi:10.1176/appi.ajp.158.8.1181.
Zawilska, J. B. & Wojcieszak, J. (2013). Designer cathinones-an emerging class of novel recreational drugs. Forensic Science International, 231, 42-53. doi:10.1016/j.forsciint.2013.04.015.
