Cannabis and Mental Health: Adverse Outcomes and Self-Reported Impact of Cannabis Use by Mental Health Status.

Background: Cannabis can induce negative outcomes among consumers with mental health conditions. This study examined medical help-seeking behavior, patterns of adverse effects, and perceived impacts of cannabis among consumers with and without mental health conditions. Methods: Data came from the International Cannabis Policy Study, via online surveys conducted in 2018. Respondents included 6,413 past 12-month cannabis consumers aged 16-65, recruited from commercial panels in Canada and the US. Regression models examined differences in adverse health effects and perceived impact of cannabis among those with and without self-reported past 12-month experience of anxiety, depression, PTSD, bipolar disorder, psychosis. Results: Overall, 7% of past 12-month consumers reported seeking medical help for adverse effects of cannabis, including panic, dizziness, nausea. Help-seeking was greater for those with psychosis (13.8%: AOR = 1.78; 1.11-2.87), depression (8.9%: AOR = 1.57; 1.28-1.93), and bipolar disorder (10.1%: AOR = 1.53; 1.44-2.74). Additionally, 54.1% reported using cannabis to manage symptoms of mental health, with higher rates among those with bipolar (90.8%) and PTSD (90.7%). Consumers reporting >1 condition were more likely to perceive positive impacts on friendships, physical/mental health, family life, work, studies, quality of life (all p < .001). Consumers with psychosis were most likely to perceive negative effects across categories. Conclusion: For conditions with substantial evidence suggesting cannabis is harmful, greater help-seeking behaviors and self-perceived negative effects were observed. Consumers with mental health conditions generally perceive cannabis to have a positive impact on their lives. The relationship between cannabis and mental health is disorder specific and may include a combination of perceived benefits and harms.

Cannabis and mental health: Prevalence of use and modes of cannabis administration by mental health status.

BACKGROUND: Cannabis can have an adverse impact on some mental health conditions, while many consumers report using cannabis to manage or improve mental health. Little data exists on how patterns of cannabis use differ by mental health status. The current study examined the prevalence of cannabis use and modes of cannabis administration among consumers who experienced a mental health condition in the past 12-months. METHODS: Data came from the International Cannabis Policy Study (Wave 1). Online surveys were conducted from Aug - Oct 2018 with 25,747 respondents aged 16-65, recruited from commercial panels in Canada and the US. Multinomial and binary regression models examined differences in cannabis prevalence and use of nine cannabis product types among those with and without self-reported past 12-month experience of anxiety, depression, PTSD, bipolar disorder, and psychosis. RESULTS: Respondents with each of the five mental health conditions reported more frequent cannabis use than those without a mental health condition (p < .01). Past 12-month cannabis consumers who experienced mental health conditions were significantly more likely to use the most potent products (solid concentrates, THC vape oils, hash) (p < .05), with fewer differences for dried flower, edibles, and other forms. Patterns of use were similar across specific mental health conditions, with some differences among respondents reporting psychosis and bipolar disorder. CONCLUSION: Individuals experiencing mental health conditions report more frequent cannabis use and use of more potent product types. These findings highlight the need to target use of specific high potency products in prevention, treatment, and harm reduction among these populations.

Steering clear: Traffic violations among emerging adults who engage in habitual or casual cannabis use.

While some research has shown that cannabis use can impair driving ability, evidence to the degree and impact of impairment are lacking. This study examined the association between habitual or casual cannabis use and past-year traffic violations among emerging adults (EAs). Data come from the 2012 Canadian Community Health Survey-Mental Health. Respondents (n = 5630) were categorized as: early (15-19 y), middle (20-24 y), and late (25-29 y) EAs. Traffic violations were measured using self-report and cannabis use was measured using the WHO Composite International Diagnostic Interview. The prevalence of traffic violations was higher for males (19.2 %) vs females (9.9 %) and middle (16.2 %) and late (19.4 %) EAs vs early (8.8 %) EAs. The odds of reporting traffic violations were higher for EAs who engaged in habitual [OR = 1.77 (1.17-2.67)] or casual [OR = 1.79 (1.27-2.51)] cannabis use when compared to non-users. Age moderated the association such that higher odds of traffic violations were reported in early EAs who were casual cannabis users and middle EAs who were habitual or casual cannabis users when compared to non-users. Use of other drugs was also a moderator-in the absence vs. presence of other drug use, odds of traffic violations were higher in those who engaged in either habitual or casual use of cannabis. When accounting for the moderating effects of age and drug use, habitual and casual cannabis use resulted in increased odds of a traffic violation. Future research is warranted to explore the robustness of our findings.

Clinical predictors of protracted length of stay in Ontario Complex Continuing Care hospitals.

BACKGROUND: Post-acute care hospitals are often subject to patient flow pressures because of their intermediary position along the continuum of care between acute care hospitals and community care or residential long-term care settings. The purpose of this study was to identify patient attributes associated with a prolonged length of stay in Complex Continuing Care hospitals. METHODS: Using information collected using the interRAI Resident Assessment Instrument Minimum Data Set 2.0 (MDS 2.0), a sample of 91,113 episodes of care for patients admitted to Complex Continuing Care hospitals between March 31, 2001 and March 31, 2013 was established. All patients in the sample were either discharged to a residential long-term care facility (e.g., nursing home) or to the community. Long-stay patients for each discharge destination were identified based on a length of stay in the 95th percentile. A series of multivariate logistic regression models predicting long-stay patient status for each discharge destination pathway were fit to characterize the association between demographic factors, residential history, health severity measures, and service utilization on prolonged length of stay in post-acute care. RESULTS: Risk factors for prolonged length of stay in the adjusted models included functional and cognitive impairment, greater pressure ulcer risk, paralysis, antibiotic resistant and HIV infection need for a feeding tube, dialysis, tracheostomy, ventilator or a respirator, and psychological therapy. Protective factors included advanced age, medical instability, a greater number of recent hospital and emergency department visits, cancer diagnosis, pneumonia, unsteady gait, a desire to return to the community, and a support person who is positive towards discharge. Aggressive behaviour was only a risk factor for patients discharged to residential long-term care facilities. Cancer diagnosis, antibiotic resistant and HIV infection, and pneumonia were only significant factors for patients discharged to the community. CONCLUSIONS: This study identified several patient attributes and process of care variables that are predictors of prolonged length of stay in post-acute care hospitals. This is valuable information for care planners and health system administrators working to improve patient flow in Complex Continuing Care and other post-acute care settings such as skilled nursing and inpatient rehabilitation facilities.

Challenges to evidence-based health promotion: a case study of a Food Security Coalition in Ontario, Canada.

Developing the evidence base for health promotion can be challenging because interventions often have to target competing determinants of health, including social, structural, environmental and political determinants; all of which are difficult to measure and thus evaluate. Drawing on a case study of food insecurity, which refers to inadequate access to food due to financial constraints, we illustrate the challenges faced by community-based organizations in collecting data to form an evidence base for the development and evaluation of collective programmes aimed at addressing food insecurity. Interviews were conducted with members of a multi-stakeholder coalition (n = 22 interviewees; n = 10 organizations) who collectively work to address food insecurity in their community through a range of community-based programmes and services. Member organizations also provided a list of measures currently used to inform programme and service development and evaluation. Data were collected in a city in Southern Ontario, Canada between May and September 2015. Participants identified four barriers to collecting data: Organizational needs and philosophies; concerns surrounding clientele wellbeing and dignity; issues of feasibility; and restrictive requirements imposed by funding bodies. Participants also discussed their previous successes in collecting meaningful data for identifying impact. Our results point to the challenge of generating data suitable for developing and evaluating programmes aimed at broader determinants of health, while maintaining the primary goal of meeting clients' needs. Documenting change at intermediate- and macro-levels would provide evidence for the collective effectiveness of current programmes and services offered. However, appropriate resources need to be invested to allow for scientific evaluation.