Canada's Cannabis Legalization with Strict Public Health Control Lessons for Germany?

Aims: To describe the impact of the legalization of cannabis for recreational use under strict public health control in 2018 on the following outcomes: cannabis use and use patterns, attributable harm, economic considerations. Methodology: Narrative review based on government documents, surveys, and published literature. Result(s): The 12-month prevalence increased after legalization and has decreased during the COVID-19 pandemic. Little change in prevalence for adolescents. Persons with daily use remained stable. No rigorous studies on changes in attributable health harm, but some indication that harm, as measured in prevalence of cannabis use disorders, treatment rate, and attributable traffic injury remained stable. No data yet available for cancer. Cannabis attributable emergency visits increased, including among children (poisoning). Cannabis-related offences decreased as biggest public health gain. Economic predictions were not realized, and there is some pressure from cannabis industry to loosen public health regulations in order to increase use. Conclusion(s): Overall, while not achieving its main objectives of more youth protection and decreases in cannabis-attributable health harm, legalization with strict public health control resulted in less cannabis-related offences and up to now did not seem to increase cannabis-attributable disease burden.Copyright © 2023 Hogrefe Verlag GmbH & Co. KG. All rights reserved.

Cannabis use, abuse and dependence during the COVID-19 pandemic: a scoping review.

The interaction between cannabis use or addiction and SARS-COV-2 infection rates and COVID-19 outcomes is obscure. As of 08/01/2022 among 57 evaluated epidemiological/clinical studies found in Pubmed-database, most evidence for how cannabis use patterns were influenced by the pandemic was given by two systematic reviews and 17 prospective studies, mostly involving adolescents. In this age group, cannabis use patterns have not changed markedly. For adults, several cross-sectional studies reported mixed results with cannabis use having increased, decreased or remained unchanged. Two cross-sectional studies demonstrated that the severity of adults´ cannabis dependence was either increased as a consequence of increasing cannabis use during the pandemic or not changed. Regarding the effect of cannabis use on COVID-19 outcomes, we found only five retrospective/cross-sectional studies. Accordingly, (i) cannabis use did not impact mild COVID-19 symptoms; (ii) cannabis using individuals experienced more COVID-19-related hospitalizations; (iii) cannabis using veterans were associated with reduced SARS-COV-2 infection rates; (iv) frequent cannabis use was significantly associated with COVID-19 mortality, and (v) cannabis dependents were at higher risk of COVID-19 breakthrough after vaccination. It should be outlined that the validity of these retrospective/cross-sectional studies (all self-reports or register/e-health-records) is rather low. Future prospective studies on the effects of cannabis use on SARS-COV-2 infection rates and COVID-19 outcomes are clearly required for conclusive risk-benefit assessments of the role of cannabis on users' health during the pandemic. Moreover, substance dependence (including cannabis) is associated with (often untreated) somatic comorbidity, which severity is a proven key risk factor for worse COVID-19 outcomes.

RISK FACTORS TO SUICIDE IDEATION EMERGENCY ROOM ADMISSIONS IN RURAL MARYLAND

Purpose of the study: Rural areas in the United States have been disproportionately burdened with high rates of substance use, mental health challenges and suicide behaviors. Factors such as a lack of mental health services, decreased accessibility to public health resources, and social isolation contribute to these disparities. The current study explore risk factors to suicide related admissions, using emergency room discharge data from Maryland. Methods: The current study used data from the Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) from the State of Maryland. Logistic regression was used to assess the association between opioid use disorder, alcohol use disorder, cannabis use disorder, major depressive disorder, and the outcome variable, of suicide ideation emergency department discharge based on International Classification of Disease, 10th edition (ICD-10). We controlled for income based on zip code of residence, race, age, and gender. Results: Previous major depressive disorder diagnosis (OR = 79.30;95%CI 51.91-121.15), alcohol use disorder (OR = 6.87;95% CI 4.97-9.51), opioid use disorder (OR = 5.39;95% CI 3.63- 7.99), and cannabis use disorder (OR = 2.67;95% CI 1.37-5.18) were all positively associated with suicidal ideation discharge status. Conclusion: The study highlights the strong link between substance use disorder, depression and suicidal ideation admission, indicating the need for prevention and intervention, particularly among those in rural areas burden. As health disparities between rural and urban areas further widened during the COVID-19 pandemic, there is an urgent need to address these issues.

P.0286 Apathy and anhedonia in adult and adolescent cannabis users and controls before and during the coronavirus lockdown

Background: COVID-19 lockdown measures have caused significant disruptions to work and education, and have prevented people from participating in activities they normally find rewarding. Cannabis users might be especially vulnerable to adverse effects of lockdown and social isolation on motivation and hedonic capacity, due to putatively elevated levels of apathy and anhedonia. Additionally, due to the brain still being in development and to peer interaction being critical, adolescence may constitute a particularly vulnerable period for harmful effects of cannabis, as well as social isolation, placing adolescents at further risk. In the current study, we investigated apathy and anhedonia before and after lockdown measures were implemented, in a large sample of adult and adolescent cannabis users and controls. We hypothesised that cannabis users would have higher levels of apathy and anhedonia compared to controls, and a larger increase in levels since lockdown onset. We also hypothesised that the difference between users and controls would be larger for adolescents compared to adults. Methods: A total of n=256 adult and n=200 adolescent cannabis users, and n=170 adult and n=172 adolescent controls participated in this online survey study, between June and August 2020. Apathy was measured with the Apathy Evaluation Scale (AES), and anhedonia was measured with the Snaith-Hamilton Pleasure Scale (SHAPS). Higher scores indicated greater levels of apathy and anhedonia, respectively. The Severity of Dependence Scale was used to assess cannabis dependence. Scores on the AES and SHAPS were investigated with separate mixed measures Analyses of Covariance, with factors User-Group, Age-Group, and Time. The Time*User-Group, Time*Age-Group, User-Group*Age-Group, and Time*User-Group*Age-Group interactions were also included. All models controlled for depression and anxiety, as well as alcohol, cigarette, and other illicit drug use. Results: Adolescent cannabis users had significantly higher SHAPS scores before lockdown, compared to adolescent controls (p=0.03, ηp2=0.013). After lockdown, conversely, adult users had significantly lower scores on both the SHAPS (p<0.001, ηp2=0.030) and AES (p<0.001, ηp2=0.048) compared to adult controls. Scores on both scales increased during lockdown across groups, and this increase was significantly smaller for cannabis users (AES p=0.001, ηp2=0.014;SHAPS p=0.01, ηp2=0.008). A total of n=130 adult and n=69 adolescent cannabis users were classified as dependent. Due to strong bivariate correlations between cannabis dependence and scores on the AES and SHAPS, we performed additional exploratory analyses within cannabis users, with factor Dependence in place of User-Group. Dependent cannabis users had significantly higher scores on both the AES (p<0.001, ηp2=0.037) and SHAPS (p<0.001, ηp2=0.029) compared to non-dependent users, and a larger increase in scores on both scales during lockdown (AES p=0.04, ηp2=0.010;SHAPS p=0.04, ηp2=0.010). Conclusions: Our results suggest that adolescents and adults have differential associations between cannabis use, and apathy and anhedonia. Adolescent cannabis users appear to be at especially increased risk of anhedonia. We found no evidence of higher levels of apathy or anhedonia in adult users, compared to age-matched controls. Cannabis dependence may be associated with higher levels of apathy and anhedonia within users, regardless of age, and a greater increase in levels during the COVID-19 lockdown. Conflict of interest Disclosure statement: This work was supported by Eton College and the Wallitt Foundation. The research is conducted within the NIHR Cambridge Biomedical Research Centre (Mental Health Theme and Neurodegeneration Theme) and Invitro Diagnostic Co-operative (MIC). CL is funded by the Wellcome Trust Collaborative Award 200181/Z/15/Z. MS is funded by an Aker Scholarship from the Aker Foundation. BJS consults for Cambridge Cognition and Greenfield BioVentures. VV consults for Boehringer Ingelheim. Remaining authors have no conflicts of inte est to disclose.

P.0338 Chronotype and area-specific deficits in mental health

Background: The COVID-19 pandemic has caused a palpable rise in mental health conditions, including greater anxiety, depression and stress. There have been many suggested driving factors for this rise, from unemployment to exposure to negative news. However, during the pandemic there have been both a rise in drug consumption and a shift to a later chronotype. Chronotype is a measure of the timing of an individual's behavioural patterns, with early and late chronotypes being more colloquially known as ‘early larks’ and ‘night owls’ respectively. Later chronotype has often been associated with increased drug consumption and there have not yet been investigations into the influence of these factors on the rise of mental ill-health during the COVID-19 pandemic. Objectives: We aimed to investigate the effect of chronotype on mental health in the general public. The Munich Chronotype Questionnaire (MCTQ) was used to assess the chronotype of each participant. The 21-item Depression Anxiety Stress Scale (DASS21) was used to assess mental health. As it is known that drug consumption increases with later chronotype, we then assessed whether increased drug consumption was responsible for these relationships. We used the Alcohol Use Disorders Identification Test (AUDIT), Revised Cannabis Use Disorders Identification Test (CUDIT-R) and the Fagerström Test for Nicotine Dependence (FTND) to quantify alcohol, cannabis and tobacco use respectively. We hypothesised that a later chronotype would be associated with poorer mental health and that total drug consumption would mediate this relationship. Methods: This was a cross-sectional study in the Cambridge county area (N=209), with data collection being completed using an online survey. The MCTQ gathers data regarding sleep timing throughout the week, allowing us to generate a mid-sleep time which has been validated as an indicator of chronotype. The DASS21 with its individual subscales allowed us to generate scores for depression, anxiety, stress and overall mental health. We then completed multiple regression analysis to investigate the associations between chronotype and these mental health measures. Mediation pathway analysis was used to examine whether total drug consumption was responsible for the significant associations. Total drug consumption was calculated by summing the scores from the AUDIT, CUDIT-R and the FTND. Results: Multivariate regression analyses revealed that chronotype was significantly associated with overall mental health score (β=0.16, p=0.022) and anxiety (β=0.18, p=0.009). Chronotype was not significantly associated with depression or stress. Causal mediation analysis showed that overall drug consumption mediated both relationships. Conclusion: The association between later chronotype and poorer mental health is driven by increased anxiety rather than depression or stress. However, these relationships can be explained by the increased drug consumption that occurs in these late chronotypes. These results can inform counselling and future treatments for late chronotypes that focus on reducing their drug consumption. The evidence that anxiety drives the relationship with mental health will also allow healthcare professionals to screen for anxious symptoms to identify those that require interventions more effectively. No conflict of interest