Thursday, November 30, 2023
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.25 ABIM MOC points
Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)
Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)
Physician Assistant - 0.25 AAPA hour(s) of Category I credit
IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit
This activity is intended for primary care clinicians, pediatricians, psychiatrists, addiction medicine specialists, nurses, physician assistants, nurse practitioners, pharmacists, and other clinicians who treat and manage patients who might use cannabis.
The goal of this activity is for members of the healthcare team to be better able to evaluate trends in the risk for schizophrenia associated with cannabis use disorder.
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Awarded 0.25 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.00 contact hours are in the area of pharmacology.
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CME / ABIM MOC / CE Released: 6/9/2023
Valid for credit through: 6/9/2024, 11:59 PM EST
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There are many controversies regarding the health effects of cannabis, and one of them centers on the relationship between cannabis use and the risk for schizophrenia. Some, but not all, research has demonstrated a significant link between cannabis use and a higher prevalence of psychosis. Marconi and colleagues performed a review and meta-analysis of this relationship, and their results were published in the September 2016 issue of Schizophrenia Bulletin.[1]
Eighteen studies were included in the systematic review, and 10 provided outcomes that could be measured in the meta-analysis. A total of 66,816 individuals were included in these studies. Compared with a cohort with no cannabis use, those with the heaviest cannabis use experienced an odds ratio (OR) of 3.90 (95% CI, 2.84-5.34) for schizophrenia and other psychotic disorders. The median OR for schizophrenia or psychosis with any cannabis use was 1.97 (95% CI, 1.68-2.31).
The authors of the current study note that the potential effect of cannabis in promoting incident schizophrenia appears to be stronger in males. In addition, the increasing concentration of delta-9-tetrahydrocannibinol in cannabis may also be having an effect in promoting more psychotic disorders. The authors of the current study examine specifically how sex and time have affected any relationship between cannabis use disorder (CUD) and schizophrenia.
A new study confirms the robust link between cannabis use and schizophrenia among men and women, but suggests that young men may be especially susceptible to schizophrenia from cannabis abuse.
Of note, the investigators estimate that roughly 15% of schizophrenia cases among young males may be preventable by avoiding CUD
“The entanglement of substance use disorders and mental illnesses is a major public health issue, requiring urgent action and support for people who need it,” study coauthor Nora Volkow, MD, director of the National Institute on Drug Abuse, says in a news release.
“As access to potent cannabis products continues to expand, it is crucial that we also expand prevention, screening, and treatment for people who may experience mental illnesses associated with cannabis use,” Dr Volkow adds.
The study was published online May 4 in Psychological Medicine.[2]
The researchers analyzed Danish registry data spanning 5 decades and representing more than 6.9 million people in Denmark to estimate the population-level percentage of schizophrenia cases attributable to CUD.
A total of 60,563 participants were diagnosed with CUD. Three quarters of cases were in men; there were 45,327 incident cases of schizophrenia during the study period.
The overall adjusted hazard ratio (aHR) for CUD on schizophrenia was slightly higher among males than females (aHR, 2.42 vs 2.02); however, among those aged 16 to 20 years, the adjusted incidence risk ratio (aIRR) for males was more than twice that for females (aIRR, 3.84 vs 1.81).
The researchers estimate that in 2021, about 15% of schizophrenia cases among males aged 16 to 49 years could have been avoided by preventing CUD compared with 4% among females in this age range.
For young men aged 21 to 30 years, the proportion of preventable schizophrenia cases related to CUD may be as high as 30%, the authors report.
“Alongside the increasing evidence that CUD is a modifiable risk factor for schizophrenia, our findings underscore the importance of evidence-based strategies to regulate cannabis use and to effectively prevent, screen for, and treat CUD as well as schizophrenia,” the researchers write.
In a press statement, lead investigator Carsten Hjorthøj, PhD, from the University of Copenhagen, Denmark, notes that “increases in the legalization of cannabis over the past few decades have made it one of the most frequently used psychoactive substances in the world, while also decreasing the public’s perception of its harm. This study adds to our growing understanding that cannabis use is not harmless, and that risks are not fixed at one point in time.”
In a prior study, Dr Hjorthøj and colleagues found that the proportion of new schizophrenia cases attributable to CUD has consistently increased over the past 20 years, as reported by Medscape Medical News.[3]
“In my view, the association is most likely causative, at least to a large extent,” Dr Hjorthøj told Medscape Medical News at the time this research was published.
“It is of course nearly impossible to use epidemiological studies to actually prove causation, but all the numbers behave exactly in the way that would be expected under the theory of causation,” Dr Hjorthøj added.
The study received no specific funding. The authors have disclosed no relevant financial relationships.
Psychol Med. Published online May 4, 2023.
