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Pharmacopsychiatry 2024; 57(03): 141-151
DOI: 10.1055/a-2264-1047
Original Paper

Perceptions, Experiences, and Patterns of Cannabis Use in Individuals with Mood and Anxiety Disorders in the Context of Cannabis Legalization and Medical Cannabis Program in Canada – A Qualitative Study

Ankita Das
1   Institute of Medical Sciences, University of Toronto, Toronto, Canada
4   Centre for Addiction and Mental Health, Toronto, Canada
,
Christian S. Hendershot
2   Department of Psychiatry and Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, NC, USA
,
M.Ishrat Husain
1   Institute of Medical Sciences, University of Toronto, Toronto, Canada
3   Department of Psychiatry, University of Toronto, Toronto, Canada
4   Centre for Addiction and Mental Health, Toronto, Canada
5   Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
6   Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
,
Yuliya Knyahnytska
3   Department of Psychiatry, University of Toronto, Toronto, Canada
4   Centre for Addiction and Mental Health, Toronto, Canada
,
Sonja Elsaid
1   Institute of Medical Sciences, University of Toronto, Toronto, Canada
4   Centre for Addiction and Mental Health, Toronto, Canada
,
Bernard Le Foll
1   Institute of Medical Sciences, University of Toronto, Toronto, Canada
3   Department of Psychiatry, University of Toronto, Toronto, Canada
4   Centre for Addiction and Mental Health, Toronto, Canada
5   Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
6   Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
7   Department of Family and Community Medicine, University of Toronto, Toronto, Canada
8   Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Canada
,
Stefan Kloiber
1   Institute of Medical Sciences, University of Toronto, Toronto, Canada
3   Department of Psychiatry, University of Toronto, Toronto, Canada
4   Centre for Addiction and Mental Health, Toronto, Canada
5   Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
6   Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
› Author Affiliations Funding Information Canadian Centre on Substance Use and Addiction and Toronto Cannabis and Cannabinoid Research Consortium (TC3) Fellowship Award.
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Abstract

Introduction Perceptions of cannabis as a potential medical treatment for mood and anxiety disorders have been increasing in the context of legalizations, availability, and medical cannabis programs, though current evidence predominately indicates risks and negative effects of cannabis use (CU) on mental health outcomes. This study aims to understand motivations, perceptions, effects, and patterns of CU in individuals with mood and anxiety disorders.

Methods Thirty-six adult patients diagnosed with mood or anxiety disorders, obsessive-compulsive disorder, or posttraumatic stress disorder who were currently using cannabis completed an in-depth qualitative interview on individual motivations, perceptions, experiences, effects, and patterns of their CU. The thematic analysis focused on phases of CU and sources of cannabis products and information.

Results Reported motivations for initiation of CU included curiosity, peer pressure, and dissatisfaction with conventional treatments. Factors such as psychotropic effects and coping with mental health symptoms and insomnia contributed to the continuation of CU. More negative effects, including cognitive dysfunction, worsening of mood, and anxiety symptoms, were acknowledged with ongoing CU. Concerning findings included common initiation of CU before age 18, combined medical and recreational CU, rare consultation of medical professionals on CU, and potential effects and harms.

Discussion Findings indicate individual complexity of motivations, perceptions, and patterns of CU in the study population. The reported potential beneficial effects of specific cannabis products should be further investigated. Findings emphasize patient-provider dialogue on both CU and conventional treatments. Information from this study can contribute to and inform the development of education, prevention, and intervention strategies.

Keywords

perceptions - motivations - cannabis - mood disorders - anxiety disorders


Publication History

Received: 16 September 2023
Received: 16 January 2024

Accepted: 30 January 2024

Article published online:
11 March 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Guardian T. Canada becomes second country to legalise Cannabis. 2018
    PubMed
  • 2 Kourgiantakis T, Lee E, Kosar AKT. et al. Youth cannabis use in Canada post-legalization: service providers’ perceptions, practices, and recommendations. Subst Abuse Treat Prev Policy 2023; 18: 36
    CrossrefPubMedGoogle Scholar
  • 3 Statistics C. Looking back from 2020, how cannabis use and related behaviours changed in Canada. 2021
    PubMedGoogle Scholar
  • 4 Canadian Cannabis Survey 2017. Summary, 2017
    PubMed
  • 5 Shim M, Nguyen H, Grootendorst P. Lessons from 20 years of medical cannabis use in Canada. PLoS One 2023; 18: e0271079
    CrossrefPubMedGoogle Scholar
  • 6 Curran HV, Freeman TP, Mokrysz C. et al. Keep off the grass? Cannabis, cognition and addiction. Nat Rev Neurosci 2016; 17: 293-306
    CrossrefPubMedGoogle Scholar
  • 7 Bloomfield MA, Morgan CJ, Egerton A. et al. Dopaminergic function in cannabis users and its relationship to cannabis-induced psychotic symptoms. Biol Psychiatry 2014; 75: 470-478
    CrossrefPubMedGoogle Scholar
  • 8 Connor JP, Stjepanović D, Le Foll B. et al. Cannabis use and cannabis use disorder. Nat Rev Dis Primers 2021; 7: 16
    CrossrefPubMedGoogle Scholar
  • 9 Lowe DJE, Sasiadek JD, Coles AS. et al. Cannabis and mental illness: A review. Eur Arch Psychiatry Clin Neurosci 2019; 269: 107-120
    CrossrefPubMedGoogle Scholar
  • 10 Marconi A, Di Forti M, Lewis CM. et al. Meta-analysis of the association between the level of cannabis use and risk of psychosis. Schizophr Bull 2016; 42: 1262-1269
    CrossrefPubMedGoogle Scholar
  • 11 Tervo-Clemmens B, Simmonds D, Calabro FJ. et al. Adolescent cannabis use and brain systems supporting adult working memory encoding, maintenance, and retrieval. Neuroimage 2018; 169: 496-509
    CrossrefPubMedGoogle Scholar
  • 12 Becker B, Wagner D, Gouzoulis-Mayfrank E. et al. Altered parahippocampal functioning in cannabis users is related to the frequency of use. Psychopharmacology (Berl) 2010; 209: 361-374
    CrossrefPubMedGoogle Scholar
  • 13 Bossong MG, Jager G, van Hell HH. et al. Effects of Δ9-tetrahydrocannabinol administration on human encoding and recall memory function: A pharmacological FMRI study. J Cogn Neurosci 2012; 24: 588-599
    CrossrefPubMedGoogle Scholar
  • 14 Bossong MG, Jager G, Bhattacharyya S. et al. Acute and non-acute effects of cannabis on human memory function: A critical review of neuroimaging studies. Curr Pharm Des 2014; 20: 2114-2125
    CrossrefPubMedGoogle Scholar
  • 15 Xue S, Husain MI, Zhao H. et al. Cannabis use and prospective long-term association with anxiety: A systematic review and meta-analysis of longitudinal studies. Can J Psychiatry 2012; 66: 126-138
    CrossrefPubMedGoogle Scholar
  • 16 Abrams DI, Guzman M. Cannabis in cancer care. Clin Pharmacol Ther 2015; 97: 575-586
    CrossrefPubMedGoogle Scholar
  • 17 Boehnke KF, Litinas E, Clauw DJ. Medical cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain. J Pain 2016; 17: 739-744
    CrossrefPubMedGoogle Scholar
  • 18 Rog DJ, Nurmikko TJ, Friede T. et al. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 2005; 65: 812-819
    CrossrefPubMedGoogle Scholar
  • 19 Smith LA, Azariah F, Lavender VT. et al. Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane Database Syst Rev 2015; 2015: Cd009464
    PubMedGoogle Scholar
  • 20 Wade DT, Makela P, Robson P. et al. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Mult Scler 2004; 10: 434-441
    CrossrefPubMedGoogle Scholar
  • 21 Lucatch AM, Coles AS, Hill KP. et al. Cannabis and mood disorders. Curr Addict Rep 2018; 5: 336-345
    CrossrefPubMedGoogle Scholar
  • 22 Schoeler T, Theobald D, Pingault JB. et al. Developmental sensitivity to cannabis use patterns and risk for major depressive disorder in mid-life: Findings from 40 years of follow-up. Psychol Med 2018; 48: 2169-2176
    CrossrefPubMedGoogle Scholar
  • 23 Lev-Ran S, Le Foll B, McKenzie K. et al. Bipolar disorder and co-occurring cannabis use disorders: characteristics, co-morbidities and clinical correlates. Psychiatry Res 2013; 209: 459-465
    CrossrefPubMedGoogle Scholar
  • 24 Feingold D, Rehm J, Lev-Ran S. Cannabis use and the course and outcome of major depressive disorder: A population based longitudinal study. Psychiatry Res 2017; 251: 225-234
    CrossrefPubMedGoogle Scholar
  • 25 Grant BF, Chou SP, Goldstein RB. et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2008; 69: 533-545
    CrossrefPubMedGoogle Scholar
  • 26 Weinstock LM, Gaudiano BA, Wenze SJ. et al. Demographic and clinical characteristics associated with comorbid cannabis use disorders (CUDs) in hospitalized patients with bipolar I disorder. Compr Psychiatry 2016; 65: 57-62
    CrossrefPubMedGoogle Scholar
  • 27 Spradlin A, Mauzay D, Cuttler C. Symptoms of obsessive-compulsive disorder predict cannabis misuse. Addict Behav 2017; 72: 159-164
    CrossrefPubMedGoogle Scholar
  • 28 Cooper ML, Frone MR, Russell M. et al. Drinking to regulate positive and negative emotions: a motivational model of alcohol use. J Pers Soc Psychol 1995; 69: 990-1005
    CrossrefPubMedGoogle Scholar
  • 29 Cox WM, Klinger E. A motivational model of alcohol use. J Abnorm Psychol 1988; 97: 168-180
    CrossrefPubMedGoogle Scholar
  • 30 Ikard FF, Green DE, Horn D. A scale to differentiate between types of smoking as related to the management of affect. Int J Addict 1969; 4: 649-659
    CrossrefPubMedGoogle Scholar
  • 31 Russell MAH, Peto J, Patel UA. The classification of smoking by factorial structure of motives. J R Stat Soc Ser A 1974; 137: 313-346
    CrossrefPubMedGoogle Scholar
  • 32 Stewart SH, Zeitlin SB, Samoluk SB. Examination of a three-dimensional drinking motives questionnaire in a young adult university student sample. Behav Res Ther 1996; 34: 61-71
    CrossrefPubMedGoogle Scholar
  • 33 Stewart SH, Zvolensky MJ, Eifert GH. Negative-reinforcement drinking motives mediate the relation between anxiety sensitivity and increased drinking behavior. Pers Individ Dif 2001; 31: 157-171
    CrossrefPubMedGoogle Scholar
  • 34 Zvolensky MJ, Feldner MT, Leen-Feldner E. et al. Evaluating the role of anxiety sensitivity in smoking outcome expectancies among regular smokers. Cognit Ther Res 2004; 28: 473-486
    CrossrefPubMedGoogle Scholar
  • 35 Walsh Z, Callaway R, Belle-Isle L. et al. Cannabis for therapeutic purposes: Patient characteristics, access, and reasons for use. Int J Drug Policy 2013; 24: 511-516
    CrossrefPubMedGoogle Scholar
  • 36 Earleywine M, Bolles JR. Marijuana, expectancies, and post-traumatic stress symptoms: A preliminary investigation. J Psychoactive Drugs 2014; 46: 171-177
    CrossrefPubMedGoogle Scholar
  • 37 Elliott L, Golub A, Bennett A. et al. PTSD and cannabis-related coping among recent veterans in New York city. Contemp Drug Probl 2015; 42: 60-76
    CrossrefPubMedGoogle Scholar
  • 38 Guillem E, Notides C, Vorspan F. et al. Cannabis expectancies in substance misusers: French validation of the Marijuana Effect Expectancy Questionnaire. Am J Addict 2011; 20: 543-554
    CrossrefPubMedGoogle Scholar
  • 39 Metrik J, Jackson K, Bassett SS. et al. The mediating roles of coping, sleep, and anxiety motives in cannabis use and problems among returning veterans with PTSD and MDD. Psychol Addict Behav 2016; 30: 743-754
    CrossrefPubMedGoogle Scholar
  • 40 Bonn-Miller MO, Boden MT, Bucossi MM. et al. Self-reported cannabis use characteristics, patterns and helpfulness among medical cannabis users. Am J Drug Alcohol Abuse 2014; 40: 23-30
    CrossrefPubMedGoogle Scholar
  • 41 Lankenau SE, Ataiants J, Mohanty S. et al. Health conditions and motivations for marijuana use among young adult medical marijuana patients and non-patient marijuana users. Drug Alcohol Rev 2018; 37: 237-246
    CrossrefPubMedGoogle Scholar
  • 42 Turna J, Balodis I, Munn C. et al. Overlapping patterns of recreational and medical cannabis use in a large community sample of cannabis users. Compr Psychiatry 2020; 102: 152188
    CrossrefPubMedGoogle Scholar
  • 43 Reynolds IR, Fixen DR, Parnes BL. et al. Characteristics and patterns of marijuana use in community-dwelling older adults. J Am Geriatr Soc 2018; 66: 2167-2171
    CrossrefPubMedGoogle Scholar
  • 44 Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19: 349-357
    CrossrefPubMedGoogle Scholar
  • 45 Cuttler C, Spradlin A, McLaughlin RJ. A naturalistic examination of the perceived effects of cannabis on negative affect. J Affect Disord 2018; 235: 198-205
    CrossrefPubMedGoogle Scholar
  • 46 Sexton M, Cuttler C, Finnell JS. et al. A cross-sectional survey of medical cannabis users: Patterns of use and perceived efficacy. Cannabis Cannabinoid Res 2016; 1: 131-138
    CrossrefPubMedGoogle Scholar
  • 47 Leung J, Chan G, Stjepanović D. et al. Prevalence and self-reported reasons of cannabis use for medical purposes in USA and Canada. Psychopharmacology 2022; 239: 1509-1519
    CrossrefPubMedGoogle Scholar
  • 48 Lee CM, Neighbors C, Hendershot CS. et al. Development and preliminary validation of a comprehensive marijuana motives questionnaire. J Stud Alcohol Drugs 2009; 70: 279-287
    CrossrefPubMedGoogle Scholar
  • 49 Lee CM, Neighbors C, Woods BA. Marijuana motives: Young adults’ reasons for using marijuana. Addict Behav 2007; 32: 1384-1394
    CrossrefPubMedGoogle Scholar
  • 50 Ahmadi J, Fakoor A, Pezeshkian P. et al. Substance use among Iranian psychiatric inpatients. Psychol Rep 2001; 89: 363-365
    CrossrefPubMedGoogle Scholar
  • 51 Winters KC, Lee CY. Likelihood of developing an alcohol and cannabis use disorder during youth: Association with recent use and age. Drug Alcohol Depend 2008; 92: 239-247
    CrossrefPubMedGoogle Scholar
  • 52 Arseneault L, Cannon M, Poulton R. et al. Cannabis use in adolescence and risk for adult psychosis: Longitudinal prospective study. BMJ 2002; 325: 1212-1213
    CrossrefPubMedGoogle Scholar
  • 53 Cyrus E, Coudray MS, Kiplagat S. et al. A review investigating the relationship between cannabis use and adolescent cognitive functioning. Curr Opin Psychol 2021; 38: 38-48
    CrossrefPubMedGoogle Scholar
  • 54 Fontes MA, Bolla KI, Cunha PJ. et al. Cannabis use before age 15 and subsequent executive functioning. Br J Psychiatry 2011; 198: 442-447
    CrossrefPubMedGoogle Scholar
  • 55 Gobbi G, Atkin T, Zytynski T. et al. Association of cannabis use in adolescence and risk of depression, anxiety, and suicidality in young adulthood: A systematic review and meta-analysis. JAMA Psychiatry 2019; 76: 426-434
    CrossrefPubMedGoogle Scholar
  • 56 Moore TH, Zammit S, Lingford-Hughes A. et al. Cannabis use and risk of psychotic or affective mental health outcomes: A systematic review. Lancet 2007; 370: 319-328
    CrossrefPubMedGoogle Scholar
  • 57 Silins E, Horwood LJ, Patton GC. et al. Young adult sequelae of adolescent cannabis use: An integrative analysis. Lancet Psychiatry 2014; 1: 286-293
    CrossrefPubMedGoogle Scholar
  • 58 Lubman DI, Cheetham A, Yücel M. Cannabis and adolescent brain development. Pharmacol Ther 2015; 148: 1-16
    CrossrefPubMedGoogle Scholar
  • 59 Scott JC, Slomiak ST, Jones JD. et al. Association of cannabis with cognitive functioning in adolescents and young adults: A systematic review and meta-analysis. JAMA Psychiatry 2018; 75: 585-595
    CrossrefPubMedGoogle Scholar
  • 60 Clark HK, Ringwalt CL, Shamblen SR. Predicting adolescent substance use: The effects of depressed mood and positive expectancies. Addict Behav 2011; 36: 488-493
    CrossrefPubMedGoogle Scholar
  • 61 Farris SG, Zvolensky MJ, Boden MT. et al. Cannabis use expectancies mediate the relation between depressive symptoms and cannabis use among cannabis-dependent veterans. J Addict Med 2014; 8: 130-136
    CrossrefPubMedGoogle Scholar
  • 62 Hasin DS, Saha TD, Kerridge BT. et al. Prevalence of marijuana use disorders in the United States between 2001-2002 and 2012-2013. JAMA Psychiatry 2015; 72: 1235-1242
    CrossrefPubMedGoogle Scholar
  • 63 Volkow ND, Baler RD, Compton WM. et al. Adverse health effects of marijuana use. N Engl J Med 2014; 370: 2219-2227
    CrossrefPubMedGoogle Scholar
  • 64 Lopez-Quintero C. Pérez de los Cobos J, Hasin DS et al. Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend 2011; 115: 120-130
    CrossrefPubMedGoogle Scholar
  • 65 Gates PJ, Albertella L, Copeland J. The effects of cannabinoid administration on sleep: A systematic review of human studies. Sleep Med Rev 2014; 18: 477-487
    CrossrefPubMedGoogle Scholar
  • 66 Pinto JV, Saraf G, Frysch C. et al. Cannabidiol as a treatment for mood disorders: A systematic review. Can J Psychiatry 6 2020; 5: 213-227
    CrossrefPubMedGoogle Scholar
  • 67 Linares IM, Zuardi AW, Pereira LC. et al. Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test. Braz J Psychiatry 2019; 41: 9-14
    CrossrefPubMedGoogle Scholar
  • 68 Zuardi AW. Cannabidiol: From an inactive cannabinoid to a drug with wide spectrum of action. Braz J Psychiatry 2008; 30: 271-280
    CrossrefPubMedGoogle Scholar
  • 69 Morgan CJ, Gardener C, Schafer G. et al. Sub-chronic impact of cannabinoids in street cannabis on cognition, psychotic-like symptoms and psychological well-being. Psychol Med 2012; 42: 391-400
    CrossrefPubMedGoogle Scholar
  • 70 Schubart CD, Sommer IE, van Gastel WA. et al. Cannabis with high cannabidiol content is associated with fewer psychotic experiences. Schizophr Res 2011; 130: 216-221
    CrossrefPubMedGoogle Scholar
  • 71 Hazekamp A, Ruhaak R, Zuurman L. et al. Evaluation of a vaporizing device (Volcano) for the pulmonary administration of tetrahydrocannabinol. J Pharm Sci 2006; 95: 1308-1317
    CrossrefPubMedGoogle Scholar
  • 72 Merlin JS, Althouse A, Feldman R. et al. Analysis of state cannabis laws and dispensary staff recommendations to adults purchasing medical cannabis. JAMA Netw Open 2021; 4: e2124511
    CrossrefPubMedGoogle Scholar