Translational Addiction Research Laboratory, 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Department of Pharmacology and Toxicology, University of Toronto, Ontario, Canada.
Can J Psychiatry. 2022 Jan;67(1):48-56. doi: 10.1177/0706743721996118. Epub 2021 Mar 4.
Following recommendations from the Lower Risk Cannabis Use Guidelines, we evaluated how lower risk cannabis use (late initiation and low use frequency) was associated with the risk of developing cannabis abuse/dependence over a 3-year follow-up period compared to 12-month abstinence (controls) or higher risk cannabis use (early initiation and higher use frequency). We also explored the effect of cannabis quantity.
Data were obtained from the U.S. nationally representative survey, National Epidemiologic Survey on Alcohol and Related Conditions wave I (2001 to 2002) and wave II (2004 to 2005), which included 31,464 respondents with no lifetime history of cannabis abuse/dependence at the first interview. We applied multiple logistic regression and propensity score matching analyses to examine the association between different use patterns at wave I and cannabis abuse/dependence at wave II, adjusting for covariates. Lower risk cannabis use and the transition to higher use frequency were also assessed.
For propensity score analysis, lower risk cannabis use at wave I was associated with higher risk of cannabis use/dependence at wave II compared to controls (odds ratio []: 4.27; 95% confidence interval [95% CI], 1.57 to 11.61); however, there was no association with use frequency increase (: 2.52; 95% CI, 0.88 to 7.17). Higher risk use had a greater risk of cannabis use/dependence than controls (: 6.27; 95% CI, 2.56 to 15.38) and lower risk use (: 2.69; 95% CI, 1.12 to 6.47). Logistic regression analyses showed similar results, except that lower risk use was significantly associated with use frequency increase (: 2.49; 95% CI, 1.22 to 5.08). For the lower risk use group, 1 to 3 joints/day of use was significantly associated with cannabis abuse/dependence.
We found that following recommended use patterns can significantly lower one's risk of cannabis abuse/dependence. However, risk of cannabis abuse/dependence is still 4 times higher than staying abstinent. Updated recommendations on safe cannabis exposure levels are needed to guide cannabis use in the general population after cannabis legalization.
根据《低风险大麻使用指南》的建议，我们评估了与 12 个月戒断（对照组）或更高风险大麻使用（早启动和更高使用频率）相比，低风险大麻使用（晚启动和低使用频率）在 3 年随访期间发展为大麻滥用/依赖的风险。我们还探讨了大麻数量的影响。
数据来自美国全国代表性调查，国家酒精和相关条件流行病学调查第 I 波（2001 年至 2002 年）和第 II 波（2004 年至 2005 年），其中包括 31464 名在第一次访谈时没有终生大麻滥用/依赖史的受访者。我们应用多因素逻辑回归和倾向评分匹配分析来检验第 I 波时不同使用模式与第 II 波时大麻滥用/依赖之间的关联，同时调整协变量。还评估了低风险大麻使用和向更高使用频率的转变。
对于倾向评分分析，与对照组相比，第 I 波时的低风险大麻使用与第 II 波时更高的大麻使用/依赖风险相关（比值比[]：4.27；95%置信区间[95%CI]，1.57 至 11.61）；然而，与使用频率增加无关（：2.52；95%CI，0.88 至 7.17）。更高风险的使用比对照组（：6.27；95%CI，2.56 至 15.38）和低风险使用（：2.69；95%CI，1.12 至 6.47）的大麻使用/依赖风险更大。逻辑回归分析显示了类似的结果，除了低风险使用与使用频率增加显著相关（：2.49；95%CI，1.22 至 5.08）。对于低风险使用组，每天使用 1 至 3 个烟卷与大麻滥用/依赖显著相关。
我们发现，遵循推荐的使用模式可以显著降低大麻滥用/依赖的风险。然而，大麻滥用/依赖的风险仍然比保持戒断高 4 倍。在大麻合法化后，需要更新关于安全大麻暴露水平的建议，以指导普通人群中的大麻使用。
