Butelman Eduardo R, Maremmani Angelo G I, Bacciardi Silvia, Chen Carina Y, Correa da Rosa Joel, Kreek Mary Jeanne
Laboratory on the Biology of Addictive Diseases, Rockefeller University, New York, NY, United States.
"VP Dole" Dual Diagnosis Unit, Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy.
Front Psychiatry. 2018 Jun 27;9:283. doi: 10.3389/fpsyt.2018.00283. eCollection 2018.
The impact of increasing non-medical cannabis use on vulnerability to develop opioid use disorders has received considerable attention, with contrasting findings. A dimensional analysis of self-exposure to cannabis and other drugs, in individuals with and without opioid dependence (OD) diagnoses, may clarify this issue. To examine the age of onset of maximal self-exposure to cannabis, alcohol, cocaine, and heroin, in volunteers diagnosed with OD, using a rapidly administered instrument (the KMSK scales). To then determine whether maximal self-exposure to cannabis, alcohol, and cocaine is a dimensional predictor of odds of OD diagnoses. This outpatient observational study examined maximal self-exposure to these drugs, in volunteers diagnosed with DSM-IV OD or other drug diagnoses, and normal volunteers. In order to focus more directly on opioid dependence diagnosis as the outcome, volunteers who had cocaine dependence diagnoses were excluded. Male and female adults of diverse ethnicity were consecutively ascertained from the community, and from local drug treatment programs, in 2002-2013 ( = 574, of whom = 94 had OD diagnoses). The age of onset of maximal self-exposure of these drugs was examined. After propensity score matching for age at ascertainment, gender, and ethnicity, a multiple logistic regression examined how increasing self-exposure to non-medical cannabis, alcohol and cocaine affected odds of OD diagnoses. Volunteers with OD diagnoses had the onset of heaviest use of cannabis in the approximate transition between adolescence and adulthood (mean age = 18.9 years), and onset of heaviest use of alcohol soon thereafter (mean age = 20.1 years). Onset of heaviest use of heroin and cocaine was detected later in the lifespan (mean ages = 24.7 and 25.3 years, respectively). After propensity score matching for demographic variables, we found that the maximal self-exposure to cannabis and cocaine, but not to alcohol, was greater in volunteers with OD diagnoses, than in those without this diagnosis. Also, a multiple logistic regression detected that increasing self-exposure to cannabis and cocaine, but not alcohol, was a positive predictor of OD diagnosis. Increasing self-exposure to non-medical cannabis, as measured with a rapid dimensional instrument, was a predictor of greater odds of opioid dependence diagnosis, in propensity score-matched samples.
非医用大麻使用增加对患阿片类物质使用障碍易感性的影响已受到相当多的关注，但研究结果相互矛盾。对有和没有阿片类物质依赖（OD）诊断的个体进行的大麻和其他药物自我暴露的维度分析，可能会澄清这个问题。使用一种快速实施的工具（KMSK量表），研究被诊断为OD的志愿者中，大麻、酒精、可卡因和海洛因自我暴露量最大时的起始年龄。然后确定大麻、酒精和可卡因的最大自我暴露量是否是OD诊断几率的维度预测指标。这项门诊观察性研究调查了被诊断为DSM-IV OD或其他药物诊断的志愿者以及正常志愿者对这些药物的最大自我暴露量。为了更直接地将阿片类物质依赖诊断作为研究结果，排除了有可卡因依赖诊断的志愿者。2002年至2013年期间，从社区和当地药物治疗项目中连续招募了不同种族的成年男女（n = 574，其中94人有OD诊断）。研究了这些药物自我暴露量最大时的起始年龄。在对确定时的年龄、性别和种族进行倾向得分匹配后，进行多元逻辑回归分析，以研究增加对非医用大麻、酒精和可卡因的自我暴露如何影响OD诊断的几率。有OD诊断的志愿者在青春期和成年期的大致过渡阶段开始大量使用大麻（平均年龄 = 18.9岁），此后不久开始大量使用酒精（平均年龄 = 20.1岁）。海洛因和可卡因的大量使用起始年龄在生命后期被检测到（平均年龄分别为24.7岁和25.3岁）。在对人口统计学变量进行倾向得分匹配后，我们发现有OD诊断的志愿者对大麻和可卡因的最大自我暴露量，高于没有该诊断的志愿者，但酒精的最大自我暴露量并非如此。此外，多元逻辑回归分析发现，增加对大麻和可卡因的自我暴露量（而非酒精）是OD诊断的正向预测指标。在倾向得分匹配样本中，用快速维度工具测量的增加对非医用大麻的自我暴露量，是阿片类物质依赖诊断几率更高的预测指标。
