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The findings are reported as use of cannabis during pregnancy has 'skyrocketed'

Date: September 23, 2020 Source: Washington University in St. Louis

While cannabis use during pregnancy is on the rise, researchers at Washington University in St. Louis have found evidence that the resulting children are more likely to have psychopathology in middle childhood.

"There have been increasingly permissive and lenient attitudes toward cannabis use among pregnant people," said Sarah Paul, a clinical psychology graduate student. "It has skyrocketed in the past few years," she added, with data indicating a quick rise from 3% to 7% past-month use.

"Unfortunately, despite the increase in use, we know remarkably little about the potential consequences of prenatal cannabis exposure," Paul said. "Prior studies have linked prenatal cannabis exposure to birth-related outcomes such as lower birth weight and infant characteristics like disrupted sleep and movement. Relatively fewer studies have examined behavior and problems as children age," and, she said, "findings have been tenuous due to inconsistent replication and an inability to account for potential confounding variables."

Their findings were published today in JAMA Psychiatry.

They looked at data from the Adolescent Brain and Cognitive Development Study (ABCD Study), an ongoing longitudinal study of nearly 12,000 children ages 9-11 and their parent or caregiver from 22 sites across the United States that began in 2016.

The researchers grouped participants into three mutually exclusive groups: Children who were not exposed to cannabis prenatally; children who were prenatally exposed to cannabis before the pregnancy was known, but not after; and children who had been exposed to cannabis after the pregnancy was known, regardless of exposure before.

The data showed children who were exposed to cannabis in the womb (regardless of when that exposure occurred) were slightly more likely to have adverse outcomes. They had elevated psychopathology -- more psychotic-like experiences; more problems with depression and anxiety as well as impulsivity and attention; and social problems as well as sleep disturbance. They also had lower cognitive performance, lower indices of global brain structure during middle childhood as well as lower birth weight.

"Cutting to the chase ... clinicians and dispensaries should discourage cannabis use among those who are pregnant or are considering becoming pregnant.

"However, when we look at exposure after maternal knowledge of pregnancy, which corresponds to when endocannabinoid type 1 receptors are expressed in the fetal brain, the associations with child psychopathology largely remain -- these children tend to have more psychotic-like experiences, more impulsivity and attention problems, and social problems," he said. "This raises the intriguing possibility that prenatal cannabis exposure may plausibly impact child behavior. It in no way shows causation, but documenting that effects are independent of common confounding factors provides incremental support for potential causation."

"Being attentive to substance use problems among family members and providing them with support and access to help is critical for anyone regardless of pregnancy status," Bogdan said. "Learning of one's pregnancy may produce additional reason to stop use. Someone who has just learned of a pregnancy and has previously used cannabis, might think, well I have already exposed the fetus to cannabis, so I may as well not stop. The current data might provide the clinician and parent-to-be with evidence that stopping after learning of the pregnancy may reduce the likelihood of negative outcomes among their children."

From a public health perspective, Bogdan suggested looking to the highly effective public health campaigns and clinician attention directed at reducing the use of tobacco and alcohol during pregnancy. In fact, he said, "This study found that prenatal cannabis exposures were more strongly and consistently associated with adverse child outcomes than prenatal tobacco or alcohol exposure."

For complete article

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by CU Anschutz Medical Campus

A new study led by researchers from the University of Colorado School of Medicine compares adolescent siblings to determine the impact of early and frequent use of marijuana on cognitive function.

This study, published in the journal Addiction, contrasts with previous studies by finding that moderate adolescent cannabis use may have adverse effects that cannot be explained by the genetic or environmental factors that siblings may have in common.

"We wanted to expand our understanding of whether cannabis use is related to lower cognitive functioning," said lead author Jarrod M. Ellingson, Ph.D., assistant professor of psychiatry at the CU School of Medicine. "There's a large body of evidence that cannabis use is linked to cognitive functioning, but we know that cannabis use is not isolated from other important risk factors. That was the primary motivation behind this study, in which we compared siblings to account for many of these risk factors."

Such possibilities include environmental risk factors, such as peer group influence, parental behavior, and socioeconomic status. In addition, by designing the study to look at siblings, researchers could consider whether genetic factors explain a shared risk for worse cognitive functioning and earlier or heavier cannabis use.

With this study, Ellingson and his colleagues were able to establish comparisons between siblings and then determine that differential levels of cannabis use were related to poorer cognitive functioning, particularly verbal memory.

In the article, Ellingson and his co-authors state, "Due to changes in the legality of recreational and medical cannabis and widespread access in many states, valid empirical data must be available to inform policy and public health decisions, including how cannabis use may affect the developing brain."

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Interactive effects of PTSD and substance use on suicidal ideation and behavior in military personnel: Increased risk from marijuana use

 Background: The current study examines the unique and interactive effects of posttraumatic stress disorder (PTSD) symptoms and days using alcohol, opioids, and marijuana on PTSD symptoms, suicidal ideation, and suicidal behavior up to 1 year, later in a high‐risk sample of military personnel not active in mental health treatment.

Conclusions: Results suggest marijuana, especially for military personnel experiencing elevated PTSD symptoms may negatively impact suicidal thoughts and behavior. These results are relevant to suggestions that medical marijuana could be used in treating or augmenting treatment for PTSD.

(Source: Published Depression & Anxiety https://onlinelibrary.wiley.com/doi/abs/10.1002/da.22954)

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Marijuana Use is Associated with Worse Outcomes in Symptom Severity and Violent Behavior in Patients with PTSD

Conclusions: The above limitations notwithstanding, our study has suggestive implications for clinical practice and public policy. The results of our study provide no support for the hypothesis that marijuana is associated with general improvement in PTSD symptoms and the observed associations suggest that it may actually worsen PTSD symptoms or nullify the benefits of specialized, intensive treatment. Especially in light of the adverse health effects of marijuana use,1 these data indicate that providers should be cautious or even avoidant in using this agent to treat PTSD. Given that our study only shows associations and not causation, it remains possible that more severe PTSD symptoms drive people to seek marijuana to transiently self-medicate symptoms. Prospective randomized clinical trials would be needed to establish a more definitive understanding of the impact of marijuana use on individuals with PTSD

Clinical Points:

  • Medical marijuana has been approved for treatment of post-traumatic stress disorder (PTSD) in several states, despite an absence of clinical trials evaluating efficacy and safety
  • Psychiatrists are frequently asked whether they would recommend marijuana for PTSD
  • This study shows that starting marijuana use may be associated with worse outcomes in PTSD

(Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258013/)

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The Impact of Cannabis Use Disorder on Suicidal and Nonsuicidal Self-Injury in Iraq/Afghanistan-Era Veterans with and without Mental Health Disorders

Abstract: The objective of the present study was to assess the association between cannabis use disorder (CUD) and self-injury among veterans. As expected, after adjusting for sex, age, sexual orientation, combat exposure, traumatic life events, traumatic brain injury, posttraumatic stress disorder, depression, alcohol use disorder, and non-cannabis drug use disorder, CUD was significantly associated with both suicidal (OR=3.10, p=0.045) and nonsuicidal (OR=5.12, p=0.009) self-injury. CUD was the only variable significantly associated with self-injury in all three models examined. These findings are consistent with prior research among civilians and suggest that CUD may also increase veterans’ risk for self-injurious behavior. Keywords: Nonsuicidal self-injury, suicide, suicide attempts, posttraumatic stress disorder, depression, veterans         

Despite the strong political push for legalization of cannabis, many questions and concerns have been raised regarding the safety of the drug, as heavy cannabis use has been associated with an array of physical and mental health problems, including pulmonary problems, cognitive impairment, lower levels of educational attainment, unemployment, and increased risk for mental health disorders, such as cannabis use disorder (CUD) and psychotic disorders (e.g., Borges et al., 2016Curran et al., 2016Gentes et al., 2016Goldman et al., 2010Hoch et al., 2015Joshi et al., 2014Sherman & McRae-Clark, 2016).

One area of research particularly important to the debate concerning cannabis legalization is the relationship between heavy cannabis use and self-injury. There has been only limited research on this association to date (e.g., Borges et al., 2016Giletta et al., 2012Moller et al., 2012), none of which has focused on veterans with mental health disorders—a population known to be at markedly increased risk for both suicidal and nonsuicidal self-injury (e.g., Bullman & Kang, 1994Kimbrel et al., 2014a2014b2016a, 2016b). The present study aimed to address this gap in the literature by conducting the first comprehensive assessment of the association between CUD and self-injury among veterans with and without mental health disorders.

Cannabis Use and Self-injury in Veterans: Taken together, the findings from the literature reviewed above suggest that cannabis use is likely to be associated with increased risk for both suicidal and nonsuicidal self-injury in civilians. Unfortunately, the association between cannabis use and self-injury has been largely overlooked among veterans to date. The lack of research on this topic is surprising, given that a recent study found that rates of CUD had increased by over 50% among veterans who received their care from the Veterans Affairs (VA) Health Care System between 2002 and 2009 (Bonn-Miller et al., 2012). Other recent studies have shown that veterans with PTSD, depression, and other mental health disorders are at elevated risk for both suicidal (e.g., Kimbrel et al., 2014b e.g., Kimbrel et al., 2016b) and nonsuicidal self-injury (Kimbrel et al., 2014a2015a2016a). However, to our knowledge, no study has examined the relationship between CUD and self-injury in veterans to date, although one recent study did find that self-reported cannabis use was positively associated with self-reported suicidal ideation in a large sample of male veterans seeking treatment for PTSD (Gentes et al., 2016). This study did not, however, evaluate the relationship between cannabis use and actual self-injury (i.e., actual suicide attempts or nonsuicidal self-injury).

(Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597481/)

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JAMA Netw Open. 2020;3(8):e2013802. doi:10.1001/jamanetworkopen.2020.13802

Findings  In this repeated cross-sectaional study of 16 216 adults, those with depression increased their rates of cannabis use significantly faster than those without depression. In 2005 to 2006, individuals with depression had 46% higher odds of any cannabis use and 37% higher odds of near-daily cannabis use, while in 2015 to 2016, individuals with depression had 130% higher odds of any cannabis use and 216% higher odds of daily cannabis use.

Meaning  In this study, an increasing number of adults with depression used cannabis during the study period.

Abstract

Importance  Despite studies showing that repeated cannabis use may worsen depressive symptoms, the popular media increasingly presents cannabis as beneficial to mental health, and many members of the public view cannabis as beneficial for depression. Therefore, cannabis use among individuals with depression may be becoming more prevalent.

Conclusions and Relevance  The findings of this study indicate that individuals with depression are at increasing risk of cannabis use, with a particularly strong increase in daily or near-daily cannabis use. Clinicians should be aware of these trends and the evidence that cannabis does not treat depression effectively when discussing cannabis use with patients.

For complete Research go to Cannabis & Depression JAMA

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