Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Wilson, Mills, Sunderland, Teesson, Marel); Addiction and Mental Health Group, University of Bath, Bath, U.K. (Freeman); Sydney Medical School, University of Sydney, Sydney, Australia (Haber); Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia (Haber).
Am J Psychiatry. 2024 Feb 1;181(2):135-143. doi: 10.1176/appi.ajp.20230088. Epub 2023 Nov 29.
Cannabis use is common among individuals with opioid use disorder, but it remains unclear whether cannabis use is associated with an increase or a reduction in illicit opioid use. To overcome limitations identified in previous longitudinal studies with limited follow-ups, the authors examined a within-person reciprocal relationship between cannabis and heroin use at several follow-ups over 18 to 20 years.
The Australian Treatment Outcome Study (ATOS) recruited 615 people with heroin dependence in 2001 and 2002 and reinterviewed them at 3, 12, 24, and 36 months as well as 11 and 18-20 years after baseline. Heroin and cannabis use were assessed at each time point using the Opiate Treatment Index. A random-intercept cross-lagged panel model analysis was conducted to identify within-person relationships between cannabis use and heroin use at subsequent follow-ups.
After accounting for a range of demographic variables, other substance use, and mental and physical health measures, an increase in cannabis use 24 months after baseline was significantly associated with an increase in heroin use at 36 months (estimate=0.21, SE=0.10). Additionally, an increase in heroin use at 3 months and 24 months was significantly associated with a decrease in cannabis use at 12 months (estimate=-0.27, SE=0.09) and 36 months (estimate=-0.22, SE=0.08). All other cross-lagged associations were not significant.
Although there was some evidence of a significant relationship between cannabis and heroin use at earlier follow-ups, this was sparse and inconsistent across time points. Overall, there was insufficient evidence to suggest a unidirectional or bidirectional relationship between the use of these substances.
在患有阿片类药物使用障碍的个体中，大麻的使用很常见，但仍不清楚大麻的使用是否会导致非法阿片类药物使用的增加或减少。为了克服以前纵向研究中随访时间有限的局限性，作者在 18 至 20 年内的多次随访中检查了大麻和海洛因使用之间的个体内相互关系。
澳大利亚治疗结果研究（ATOS）于 2001 年和 2002 年招募了 615 名海洛因依赖者，并在基线后 3、12、24 和 36 个月以及 11 个月和 18-20 年内对他们进行了重新访谈。在每个时间点使用阿片类药物治疗指数评估海洛因和大麻的使用情况。进行随机截距交叉滞后面板模型分析，以确定随后随访中大麻使用与海洛因使用之间的个体内关系。
在考虑了一系列人口统计学变量、其他物质使用以及心理和身体健康指标后，基线后 24 个月大麻使用的增加与 36 个月海洛因使用的增加显著相关（估计值=0.21，SE=0.10）。此外，3 个月和 24 个月海洛因使用的增加与 12 个月（估计值=-0.27，SE=0.09）和 36 个月（估计值=-0.22，SE=0.08）大麻使用的减少显著相关。所有其他交叉滞后关联均不显著。
尽管在早期随访中存在大麻和海洛因使用之间存在显著关系的一些证据，但这种关系稀疏且在时间点上不一致。总体而言，没有足够的证据表明这些物质的使用存在单向或双向关系。
