Cynthia Fontanella, PhD, associate professor in the department of psychiatry and behavioral health at The Ohio State University, talks about a the effects pf chronic marijuana use on teen mood disorders and risks.
I wanted to ask you first, starting about your most recent research that was just published in JAMA Pediatrics. Can you tell me a little bit about what you and your colleagues were looking at?
FONTANELLA: We were looking at the effect of cannabis use on adolescents and young adults with mood disorders, specifically the effect on mortality outcomes such as suicide, self-harm, suicide, and all-cause mortality.
Can you tell me a little bit about how you went about getting your numbers? Was it a survey?
FONTANELLA: We used existing Medicaid data and our target population was 204,000 of youth and adolescents enrolled in Medicaid from 2010 to 2017.
And is that nationwide?
FONTANELLA: It was just in Ohio.
And what did you and your colleagues find?
FONTANELLA: We found that cannabis use was significantly associated with the increased risk for self harm, all-cause mortality, unintentional overdoses, and homicide risk.
Were you able to quantify how much of a risk?
FONTANELLA: Yes, the hazard and the risk for self harm, was increased by three times. Three times more likely to have a risk of self harm, 59% more likely for all-cause mortality, 2.4 times more likely for unintentional overdose, and 3.2 times more likely for homicide.
So, why were you and your colleagues interested specifically in this topic?
FONTANELLA: Well, because we treat adolescents and young adults with mood disorders and we notice, you know, a high prevalence of cannabis use and cannabis use disorders in this population, and we were curious about what the negative effects of that was on their trajectory for mood disorders. And so that’s what kind of led to the research.
You mentioned cannabis use and cannabis use disorder. How do you characterize when it’s a disorder?
FONTANELLA: Well, cannabis use can be used at any frequency. Cannabis use disorder is actually a DSM-V disorder, and it’s a frequent disorder that causes significant impairment in functioning, frequent use of cannabis, use that causes significant impairment in functioning.
Was there anything about these findings that surprised you and your colleagues?
FONTANELLA: Well, most of the research is done on adults, and there is research that suggests that cannabis use and cannabis use disorder is associated with increased risk of self harm and suicide, so that wasn’t surprising. But the all-cause mortality, unintentional overdoses, and homicide … we were kind of surprised by that.
What are those findings suggest then, again, for you and your research?
FONTANELLA: Well, it suggests that we need to be aware of some of these negative harmful effects of cannabis use.
We had talked a little bit and I had asked you before, a lot of states are starting to OK and approve recreational use, so some people might say, ‘oh, it’s just pot.’ From where you and your colleagues sit, what’s your thought on that?
FONTANELLA: Well, I think that providers and policymakers need to be aware of the negative harmful effects of cannabis use. Cannabis use in both people with mood disorders and without mood disorders has been found to be associated with increased risk of of early onset of mood disorder, psychosis, anxiety disorders, as well as a lot of these increased risks for mortality. So, the policymakers need to be aware of the negative outcomes associated with cannabis use. So far the research has suggested, though, that the effects of these policies has not increased risk in adolescents. It has not increased use of cannabis use in adolescents and young adults, but it has increased risks for cannabis use in older persons, 20 to 64.
People with mood disorders, are they being, for some reason, being drawn to the use or addiction? Or is the use and addiction creating such a situation where they’re likely to have more depression or anxiety?
FONTANELLA: Yeah, that’s actually an excellent question. We really don’t know which comes first. We know that kids that have mood disorders have a high rate of comorbidity with substance abuse disorders, including cannabis use disorder. In our study, we found that 10% of our population had a cannabis use disorder which is, you know, a fairly high rate of cannabis use disorder. And we know that kids with mood disorders can tend to self-medicate with cannabis use to deal with some of the symptoms of mood disorders.
And the definition of cannabis use disorder?
FONTANELLA: Cannabis use disorder is frequent use of cannabis use and causing significant impairment in functioning.
So, is the important part the impairment or is it the frequency?
FONTANELLA: The impairment in functioning.
Was there a number? When you say frequent, more than a couple of times a week? Or is there a way that it’s defined?
FONTANELLA: It’s not defined specifically like that.
What are some of the common misconceptions about marijuana use?
FONTANELLA: Well, the common misconceptions and attitudes is that marijuana is harmless, which it’s not. So that is a common misconception.
And just to play off of that question a little bit, some of the risks or harms of using?
FONTANELLA: The risk of deliberate self-harm, suicide attempts, you know, all-cause mortality. And we think that the risk of self harm is associated with increased impulsivity because kids that use cannabis use tend to be more impulsive and it clouds their thinking and judgment. It also can increase anxiety and depersonalization, and that can lead to increased risk to self-harm and suicide.
Is there anything I didn’t ask you, Cynthia, that you want to make our viewers know?
FONTANELLA: I think, in terms of one of the clinical implications of the research, we need to effectively treat both cannabis use disorders and mood disorders. We also need to screen youth and young adults for cannabis use disorders. And there are a lot of effective treatments for cannabis use disorders. There are family-based treatments for cannabis use disorders and individualized treatments such as cognitive behavioral therapy and motivational enhancement therapies that have been effective in treating cannabis use disorders.
So important to get the word out, again, from a clinical perspective to others who may be working with young people?
FONTANELLA: Absolutely. Getting the word out about the importance of screening for cannabis use and effective treatment of cannabis use.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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