Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland (NB); Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA (DMC, JHS, RS); Department of Biostatistics, Boston University School of Public Health, Boston, MA (DMC); Department of Psychological and Brain Sciences, Boston University, Boston, MA (TPP); Data Coordinating Center, Boston University School of Public Health, Boston, MA (CL-T); and Department of Community Health Sciences, Boston University School of Public Health, Boston, MA (JHS, RS).
J Addict Med. 2018 Jan/Feb;12(1):45-52. doi: 10.1097/ADM.0000000000000362.
This exploratory study aims to investigate whether anxiety, depression, and pain are associated with changes in marijuana use and drug use consequences among primary care patients.
In all, 331 adult primary care patients with marijuana as the only drug used were followed prospectively to investigate associations between anxiety/depression symptoms (no/minimal symptoms; anxiety or depression symptoms; symptoms of both) and pain (1-10 scale: none [0]; low [1-3]; medium [4-6]; high [7-10]) (independent variables) and substance use outcomes in regression models. These outcomes were changes (over 6 months) in primary outcomes: marijuana use days (past 30); and drug use consequences (Short Inventory of Problems-Drugs [SIP-D]); secondary outcomes-drug use risk (Alcohol, Smoking, and Substance Involvement Screening Test [ASSIST] score for drugs).
At baseline, 67% reported no/minimal anxiety/depression symptoms, 16% anxiety or depression symptoms, 17% both; 14% reported no pain, 16% low, 23% medium, 47% high pain level. Mean (SD) number of marijuana use days was 16.4 (11.6), mean SIP-D 5.9 (9.0), mean ASSIST 12.5 (7.8); no significant association was found between anxiety/depression and marijuana use changes. Given the same baseline status for SIP-D and ASSIST, respectively, those with anxiety or depression had greater increases in SIP-D (adjusted mean difference [95% confidence interval] +3.26 [1.20; 5.32], P = 0.004) and borderline significant increases in ASSIST (+3.27 [-0.12; 6.65], P = 0.06) compared with those without anxiety or depression; those with both anxiety and depression had greater increases in ASSIST (+5.42 [2.05; 8.79], P = 0.003), but not SIP-D (+1.80 [-0.46; 4.06], P = 0.12). There was no significant association between pain and marijuana use and SIP-D changes. Given the same baseline ASSIST level, those with high pain level had greater increases in ASSIST (+4.89 [1.05; 8.72], P = 0.04) compared with those with no pain.
In these exploratory analyses, anxiety, depression, and high pain level appear to be associated with increases in drug-related harm among primary care patients using marijuana.
本探索性研究旨在调查初级保健患者中焦虑、抑郁和疼痛是否与大麻使用变化和药物使用后果有关。
共有 331 名以大麻为唯一药物的成年初级保健患者进行前瞻性随访，以调查焦虑/抑郁症状（无/轻度症状；焦虑或抑郁症状；两者都有）和疼痛（1-10 分制：无[0]；低[1-3]；中[4-6]；高[7-10]）（自变量）与回归模型中物质使用结果之间的关系。这些结果是主要结果的变化（6 个月内）：大麻使用天数（过去 30 天）；和药物使用后果（简短药物问题清单[Short Inventory of Problems-Drugs，SIP-D]）；次要结果-药物使用风险（药物酒精、吸烟和物质使用参与筛查测试[Alcohol, Smoking, and Substance Involvement Screening Test，ASSIST]评分）。
基线时，67%报告无/轻度焦虑/抑郁症状，16%焦虑或抑郁症状，17%两者都有；14%报告无疼痛，16%低疼痛，23%中疼痛，47%高疼痛水平。大麻使用天数的平均（SD）为 16.4（11.6），SIP-D 的平均（SD）为 5.9（9.0），ASSIST 的平均（SD）为 12.5（7.8）；焦虑/抑郁与大麻使用变化之间无显著关联。在 SIP-D 和 ASSIST 的相同基线状态下，分别有焦虑或抑郁的患者 SIP-D 增加（调整后的平均差异[95%置信区间]为+3.26[1.20；5.32]，P=0.004）和 ASSIST 略有增加（+3.27[-0.12；6.65]，P=0.06）与无焦虑或抑郁的患者相比；同时患有焦虑和抑郁的患者 ASSIST 增加（+5.42[2.05；8.79]，P=0.003），但 SIP-D 增加（+1.80[-0.46；4.06]，P=0.12）无显著差异。疼痛与大麻使用和 SIP-D 变化之间无显著关联。在 ASSIST 相同的基线水平下，疼痛程度高的患者 ASSIST 增加（+4.89[1.05；8.72]，P=0.04）与无疼痛的患者相比。
在这些探索性分析中，焦虑、抑郁和高疼痛水平似乎与使用大麻的初级保健患者药物相关伤害的增加有关。
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