High‐potency cannabis more than quadruples risk for use disorder

Higher‐potency cannabis increases the risk for the onset of the first cannabis use disorder (CUD) symptom, researchers have found. Therefore, guidelines for potency are critical for reducing negative health outcomes, they concluded, in their study published in the December issue of Drug and Alcohol Dependence.     

Psychosis caused by cannabis: Intoxication or induced?

Telling the difference between primary psychosis, cannabis intoxication and cannabis‐induced psychosis is challenging but important, especially now that it's known that almost 50% of cannabis‐induced psychosis precedes primary psychosis. A fictional case study reported in Paediatrics & Child Health makes these challenges come to life. But the purpose of the case study is only as an introduction to the meat of the article, which is how to differentiate between the three. The authors are psychiatrists from Canada.     

Predicting ecstasy use among young people at risk: a prospective study of initially ecstasy-naive subjects

Our aim is to identify predictors of first-time ecstasy use in a prospective study among young people at risk. As part of the multidisciplinary Netherlands XTC Toxicity Study (NeXT), we monitored 188 subjects aged > or = 18 who were ecstasy-naive at baseline but seemed likely to start taking ecstasy in the near future. After an 11- to 26-month follow-up period, 160 respondents remained (85.1%; mean age 21.0 years, 58.1% females): 65 who took ecstasy at least once (ecstasy users) and 95 non-users. At baseline and four times during follow-up, respondents completed self-report questionnaires. Cox regression analysis was used to examine the effects of baseline respondent characteristics on incident ecstasy use. Development of peer group ecstasy use was analyzed by logistic regression. Intention to use ecstasy, low education, and current weekly cannabis use independently increased the hazard rate for first ecstasy use. Although ecstasy use among peers at baseline was not a predictor, the proportion of ecstasy users with ecstasy-using peers increased markedly during the study. Our results suggest that targeted prevention activities should focus in particular on young people who have strong intentions to take ecstasy, especially if they are also regular smokers of cannabis.     

Briefly Noted

Internalizing and externalizing problems predicted onset of any tobacco use in youth; however, findings differed for internalizing and externalizing problems across tobacco products, researchers found in analyzing the Population Assessment of Tobacco and Health Study of 12‐ to 24‐year‐old never‐users. Self‐reported internalizing and externalizing symptoms were assessed at wave 1 (45,971 subjects), and past‐12‐month use of tobacco products was assessed at wave 2 (38,443 subjects). The researchers found that high‐severity internalizing symptoms at wave 1 increased the risk by 1.5 times of using tobacco by wave 2, and that high‐severity externalizing problems increased the risk of tobacco use by 1.3 times at wave 2. Low‐ and moderate‐severity problems did not predict tobacco onset. The study was funded by the National Institute on Drug Abuse and the Food and Drug Administration. Several authors declared conflicts of interest — one as an expert witness in a lawsuit against the tobacco industry. The article, “Mental Health Problems and Onset of Tobacco Use Among 12‐ to 24‐Year‐Olds in the PATH Study,” was published in the December 2018 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.     

CDC on the complexities of using ICD coding to track NAS

It should be noted that in 2001 a patent application was filed with the U.S. Patent Office by G. R. Barrie Webster of Manitoba and published on July 22, 2004, regarding the conversion of cannabidiol (CBD) to tetrahydrocannabinol (THC). That application cited earlier work by Gaoni and Mechoulam that converted CBD to THC. Thus, while it can be done to produce yields up to 70 percent THC, one would need access to key chemicals, certain acids, organic solvents, nitrogen, methylene chloride and other substances. Again, if the object is to get “high,” converting CBD to THC would generally not be done, because it is costly, labor‐intensive and unnecessary given the availability of cannabis‐THC.     

Reflections Regarding Future Cannabis Use Among High‐Frequency Users in a Canadian University Student Population

Cannabis is the most widely used illicit drug worldwide, and the most commonly used illicit drug in Canada, among postsecondary student populations. This cross‐sectional study qualitatively assessed 112 high‐frequency, cannabis‐using university students in Canada: It examined their subjective expectations regarding what they anticipated their cannabis use would look like in the short‐ and mid‐term future and explored factors they saw potentially contributing to changes in their prospective drug use. Results indicated that participants believe that decisions about future cannabis use will be influenced by several contextual factors, including education and employment responsibilities, intimate relationships, and peer associations. These findings help illuminate the natural evolution of cannabis use and can guide the development of interventions for high‐frequency cannabis users in the future.     

Risk of teen cannabis use includes suicidality and depression

The risk at the individual level from cannabis use is moderate to low, in general. However, because so many adolescents are now consuming it, the number of young people who could develop depression and suicidality as a result is large, researchers have found. This is a problem that needs a public health policy response, they concluded in their study, “Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood: A Systematic Review and Meta‐analysis,” published in the February issue of JAMA Psychiatry.     

Parental Divorce and Offspring Depressive Symptoms: Dutch Developmental Trends During Early Adolescence

In this study, we investigated if the association between parental divorce and depressive symptoms changes during early adolescence and if developmental patterns are similar for boys and girls. Data were collected in a prospective population cohort of Dutch adolescents (N = 2,149), aged 10 – 15 years. Outcome variables were self‐reported and parent‐reported depressive symptoms. The effects of divorce were adjusted for parental depression. In both self‐reported and parent‐reported data, we found a three‐way interaction of gender, age, and parental divorce, indicating that with increasing age, parental divorce became more strongly associated with depressive symptoms among girls, but not boys. These results suggest that girls with divorced parents are at particularly high risk to develop depressive symptoms during adolescence.     

Study finds ‘low‐risk’ alcohol relapsers have same brain volume as abstainers

While abstinence is an option for many, requiring it also can deter patients from seeking treatment, or doom them to failure if they relapse, according to some researchers. A study published June 17 in Alcoholism: Clinical and Experimental Research has found that gray matter brain volume is the same for people who relapse to low risk levels as it is for people who stay abstinent. Furthermore, the study, “Not All Is Lost for Relapsers: Relapsers With Low WHO Risk Drinking Levels and Complete Abstainers Have Comparable Regional Gray Matter Volumes,” found that low‐risk relapsers have better cognitive performance than high‐risk relapsers.     

Hispanic Assimilation and Fertility in New U.S. Destinations

This paper evaluates comparative patterns of fertility in new Hispanic destinations and established gateways using pooled cross‐sectional data from the 2005–2009 microdata files of the American Community Survey. Changing Hispanic fertility provides a useful indicator of cultural incorporation. Analyses show that high fertility among Hispanics has been driven in part by the Mexican origin and other new immigrant populations (e.g., non‐citizens, those with poor English language skills, etc.). However, high fertility rates among Hispanics cannot be explained entirely by sociodemographical characteristics that place them at higher risk of fertility. For 2005–2009, Hispanic fertility rates were 48 percent higher than fertility among whites; they were roughly 25 percent higher after accounting for differences in key social characteristics, such as age, nativity, country of origin, and education. Contrary to most previous findings of spatial assimilation among in‐migrants, fertility rates among Hispanics in new destinations exceeded fertility in established gateways by 18 percent. In the multivariate analyses, Hispanics in new destinations were roughly 10 percent more likely to have had a child in the past year than those living in established gateways. Results are consistent with subcultural explanations of Hispanic fertility and raise new questions about the spatial patterning of assimilation and the formation of ethnic enclaves outside traditional settlement areas.     

Self‐Perceived Competence in Mainland China: A Multiwave Longitudinal Examination of Internalizing Symptoms in Chinese Adolescents

The present 9‐wave, 2‐year study examined whether Cole's (1991) theory of self‐perceived competence could help explain vulnerability to depressive and anxiety symptoms in a sample of adolescents from mainland China. Participants included 624 adolescents (319 females and 305 males) from an urban school in Changsha (n = 308) and from a rural school in Liuyang (n = 316). Findings showed that self‐perceived academic competence was negatively associated with prospective depressive and anxiety symptoms. Meanwhile, adolescents with low levels of self‐perceived social competence were at heightened risk for depressive symptoms during times of increased stressors (supporting a vulnerability‐stress model). These findings advance past research by highlighting new developmental pathways for depressive and anxiety symptoms in Chinese adolescents.     

Painful Passages: Traumatic Experiences and Post‐Traumatic Stress among U.S. Immigrant Latino Adolescents and their Primary Caregivers

Using data from a stratified random sample of 281 foreign‐born adolescents and their parents in the United States, this study provides data on migration‐related trauma exposures and examines how the migration process influences the risk of experiencing trauma and developing posttraumatic stress disorder (PTSD). We find that 29 percent of foreign‐born adolescents and 34 percent of foreign‐born parents experienced trauma during the migration process. Among those that experienced trauma, 9 percent of adolescents and 21 percent of their parents were at risk for PTSD. Pre‐migration poverty combined with clandestine entry into the U.S. increased the risk of trauma and the subsequent development of PTSD symptoms. Post‐migration experiences of discrimination and neighborhood disorder further exacerbated this risk, while social support and familism mitigated it. Our results emphasize the importance of understanding how factors prior to, during, and after migration combine to influence the health of immigrants.     

THE DURATION OF FIRM‐DESTINATION EXPORT RELATIONSHIPS: EVIDENCE FROM SPAIN, 1997–2006

This article uses survival analysis to investigate the duration of Spanish firms' trade relationships by destination over 1997–2006. Whereas firm export status is highly persistent, firms' destination portfolio is very dynamic: a typical firm‐country exporting relationship has a median duration of 2 years. Yet, if a firm manages to export to a country beyond 2 years the risk of exiting that market sharply falls afterwards. The results indicate that not only firm heterogeneity but also destination heterogeneity are crucial to explain survival in export markets. In particular, country (political) risk heavily shapes the effect of firm, product, and other destination characteristics on the length of trade relationships. Whereas firm productivity, comparative advantage, partners' GDP, and proximity enhance duration of trade with low‐risk countries, they have no effect on trade survival with high‐risk countries. On the contrary, information spillovers are particularly relevant to enhance survival of trade relationships with high‐risk countries. (JEL C41, F10, F14)     

Investigating the mediational role of negative urgency in the anxiety sensitivity pathway to cannabis problems and dependence symptoms among postsecondary students

Objectives: Anxiety sensitivity (AS) is associated with cannabis use. People high in AS may use cannabis to cope with elevated anxiety. This association is consistently supported in the literature. However, we have much to learn about the mechanisms of the AS pathway to cannabis use. We aimed to examine negative urgency—the tendency to act impulsively when distressed—as a mediator of the association of AS with cannabis problems and cannabis dependence symptoms. We hypothesized that negative urgency would uniquely mediate the association of AS with cannabis outcomes after controlling for other facets of impulsivity. Participants and Methods: Postsecondary students (N = 91; Fall 2012) completed online self-reports. To participate, students needed to be ≥18 years old, enrolled in postsecondary studies, and needed to report current cannabis use. Results: Negative urgency uniquely mediated associations between AS and cannabis problems and dependence symptoms. Conclusions: Our findings suggest a mechanistic role of negative urgency in the AS pathway to cannabis misuse.     

Maternal Postpartum Depression Increases Vulnerability for Toddler Behavior Problems through Infant Cortisol Reactivity

The current study examined the role of hypothalamic‐pituitary‐adrenal reactivity (a physiological indicator of stress) in early infancy as a mediator of the relationship between maternal postpartum depression and toddler behavior problems. Participants were 137 at‐risk mothers and their children participating in a longitudinal study of intergenerational transmission of risk. Mothers’ depression was measured five times during the infants’ first 18 months. Infant cortisol was collected during a social stressor (the still‐face paradigm) when infants were 6 months old, and mothers reported on toddlers’ internalizing and externalizing symptoms at 18 months. Among this sample of high‐risk mother–infant dyads, early postpartum depression predicted atypical infant cortisol reactivity at 6 months, which mediated the effect of maternal depression on increased toddler behavior problems. Clinical implications are discussed.     

Prenatal use of cannabis associated with preterm birth

Self‐reported cannabis use by pregnant women was associated with a significant increase in the rate of preterm birth, even after adjustment for confounding, researchers reported in the Journal of the American Medical Association.     

Young Adults' Fertility Expectations and Events: Associations With College Enrollment and Persistence

The analyses described in this article investigated the association between adolescent fertility expectations and college enrollment (N = 7,838). They also explored the potential impact of fertility expectations and events on college persistence among 4‐year (n = 2,605) and 2‐year (n = 1,962) college students. The analysis, which used data from the National Longitudinal Survey of Youth 1997 cohort, showed a significant association between expectations for early parenthood and the likelihood of going to a 4‐year college or 2‐year college for both men and women. In addition, the authors found that pregnancies were associated with an increased risk of college dropout for women; however, if all of the estimated effect of pregnancies on the risk of dropout were causal, they would still not be a major factor contributing to educational attainment because fertile pregnancies among college women are so rare.     

THE IMPACT OF SCHOOL RACIAL COMPOSITIONS ON NEIGHBORHOOD RACIAL COMPOSITIONS: EVIDENCE FROM SCHOOL REDISTRICTING

I use data surrounding public school redistricting to study how school racial compositions affect neighborhood racial compositions. This redistricting followed from the end of court‐ordered busing for racial desegregation, significantly changing the racial composition of the assigned school for many neighborhoods. Over a 5‐year period, the impact of an increase in the percent black of the assigned elementary school on the percent black of the neighborhood was positive. The effects increased over time, consistent with a simple model of short‐run neighborhood racial dynamics. These results have implications for potential effects of school racial desegregation policy changes on neighborhood racial compositions. (JEL H75, I28, R23)     

Briefly Noted

Researchers have found that attention‐deficit hyperactivity disorder (ADHD) may be a risk factor for developing smartphone addiction, based on the neurobiological substrates underlying each separately and those that are shared. The study found a greater than six times likelihood that children with ADHD also had smartphone addiction. The study looked at the prevalence of smartphone addiction and its association with depression, anxiety, and ADHD symptoms in a total of 4,512 South Korean middle and high school students, who completed surveys. There were 338 subjects (7.5%) in the smartphone addiction group. The odds ratio of the ADHD group compared to the non‐ADHD group for smartphone addiction was 6.43, the highest among all variables. The study, “The relationship between smartphone addiction and symptoms of depression, anxiety, and attention‐deficit/hyperactivity in South Korean adolescents” is published in the March issue of the Annals of General Psychiatry.     

A Note on CBD: It's All in a Name

I recently saw an article with the following title: “Medical cannabis relieves symptoms in children with autism.” On reading it, I realized that the Drug Target Review was talking about cannabidiol, otherwise known as CBD, not THC (tetrahydrocannabinol, the psychoactive ingredient in cannabis). I also realized the words cannabis and marijuana are no longer useful in talking about marijuana now that CBD has been moved to Schedule V of the Controlled Substances Act when manufactured by GW Pharmaceuticals. Still, it is common to see CBD lumped with the hundreds of other cannabinoids, especially if not produced by a Food and Drug Administration (FDA)–approved pharmaceutical company where it is still classified as Schedule I by the Drug Enforcement Administration (DEA). I think this has implications for popular understanding and clinical utility.