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Marijuana use and breastfeeding.

QUESTION: One of my breastfeeding patients is using marijuana to combat chronic pain. Is it safe for her to breastfeed? ANSWER: Lactating mothers should refrain from consuming cannabinoids. Advising mothers to discontinue breastfeeding if they cannot stop using cannabinoids must incorporate the known risks of formula feeding. Cannabinoid exposure through milk has not been shown to increase neonatal risk, but there are no appropriate studies of this. In every case, nursing babies should be closely monitored.

Analgesics, Non-Narcotic↗

Self-reported anal sex practice and sexual risk-taking after marijuana use among a sample of Georgia inmates.

The primary aim of this study was to examine factors related to anal sex practices and sexual risk-taking among a sample of soon-to-be-released adult male inmates with respect to self-reported HIV/AIDS risk behaviours. This study focused on collecting data from adult male inmates during the period from 2000 to 2003. Baseline level data were collected by project staff after a pool of eligible participants was selected by Department of Corrections personnel. Inmates had to be 18 years of age or older, male, and sexually active. Findings suggest that inmates did not vary much with respect to feeling that they would be less likely to take precautions before having sex after using marijuana. Inmates who reported having anal sex were more likely to indicate that they felt they were better lovers while under the influences of marijuana. Those with a history of anal sex also reported being more likely to do things sexually under the influence of marijuana than they would if they were sober (P < 0.03).

Adult↗

Factors associated with marijuana use among American Indian adolescents.

AIM: To examine the characteristics of marijuana users among a large sample of American Indian high school students. DESIGN: High school survey. SETTING: Seven predominantly American Indian high schools in four communities west of the Mississippi. PARTICIPANTS: 1464 Indian adolescents who: (1) completed a survey in November, 1993, (2) were in grades 9 to 12, (3) were members of one of four Indian tribal groups; and (4) had a complete set of data for these analyses. MEASUREMENTS: Logistic regression models were developed to predict the probability of low-frequency (1-3 times over the last month) and high-frequency (11 or more times) marijuana use. Independent variables included measures of socio-demographics, stressful life events, personal characteristics and beliefs, psychiatric symptomatology and other substance use. FINDINGS: Forty per cent of these American Indian adolescents had used marijuana at least once in the last month. The prevalence of marijuana use varied across the four tribes. Males were no more likely than females to use marijuana at a low frequency, but were more likely to use at a high frequency. The factors associated with marijuana use varied with the frequency of use and by gender. In the final multivariate models, low-frequency marijuana use among females was associated with reporting that peers encouraged alcohol use as well as use of alcohol and stimulants. Among males, low-frequency use was associated with greater positive alcohol expectancies, lower grades in school and alcohol use. While high-frequency marijuana use was associated with use of alcohol, stimulants and cocaine among females, such use was associated with higher scores on the antisocial behavior scale as well as the use of alcohol, stimulants and cocaine among males. Overall, the strongest associations were with the use of alcohol and other illicit substances. CONCLUSION: Low-frequency and high-frequency marijuana use are distinct patterns of use and have different correlates across genders. Marijuana use among American Indian adolescents is a complex phenomenon that is best understood within the context of other substance use.

Adolescent↗

Social factors associated with ethnic differences in alcohol and marijuana use by Vietnamese-, Arabic- and English-speaking youths in Sydney, Australia.

OBJECTIVE: To describe the use of marijuana and alcohol among Arabic- and Vietnamese-speaking senior school students compared with English-speaking background senior school students in Sydney Australia. METHOD: A quantitative survey of 2573 school students attending Years 10 and 11 from 12 high schools with a high Vietnamese and Arabic population was conducted in Sydney in 1998. Self-reported marijuana use, school and cultural background information was collected. RESULTS: Students from an English-speaking background, both males and females, had almost double the prevalence of marijuana use (once or more) during their lifetime (48.3 and 43.6%), the 12 months (40.9 and 36.3%) and 1 month prior to survey administration (23.1 and 13.4%) than the group with the second highest frequency of use (students of European and other backgrounds). Female Vietnamese (7.3% lifetime use) and Arabic students (8.6% lifetime use) had the lowest marijuana use rates, which were less than half that of male Vietnamese (23.5% lifetime use) and Arabic students (28% lifetime use). A similar pattern was found for three types of alcohol use. Spending three or more evenings a week out with friends was associated with higher alcohol use for Vietnamese students (relative risk ratio of 2.76). CONCLUSIONS: These results confirm lower marijuana and alcohol use among students from Vietnamese- and Arabic-speaking backgrounds compared with students from an English-speaking background. Harm minimization strategies may be learned from some migrant communities.

Acculturation↗

Exposure opportunity as a mechanism linking youth marijuana use to hallucinogen use.

The aim of this study is to shed light upon an observed association between the use of marijuana and hallucinogens (e.g. LSD), with a specific focus on the idea that two separate mechanisms might link marijuana use to hallucinogen use: (1) greater hallucinogen exposure opportunity for marijuana users versus nonusers; (2) increased probability of hallucinogen use for marijuana users versus nonusers, once the opportunity to use hallucinogens has occurred. This work is based on a novel analysis of retrospective, self-report data from more than 40000 young participants in the 1991-1994 National Household Surveys on Drug Abuse (NHSDA), with discrete time survival analysis models. Youths who had used marijuana were substantially more likely than nonusers to have the opportunity to use hallucinogens (estimated unadjusted relative risk, uRR=16.3; 95%. Confidence interval (CI)=14.3-18.6). Once an opportunity to use hallucinogens occurred, marijuana users were more likely than nonusers to initiate hallucinogen use (uRR=12.6; 95% CI=9.0-17.6). This evidence provides a more complete view of interconnections between marijuana use and hallucinogen use, and helps to clarify the pivotal role for drug exposure opportunities. Important next steps will be to understand what accounts for variation in the exposure opportunities experienced by marijuana users, and to understand why some marijuana users do not progress even when they have a chance to do so.

Adolescent↗

Social and personal factors in marijuana use and intentions to use drugs among inner city minority youth.

Limited information is available about the etiology of illicit drug use among minority youth. This study examined predictors of marijuana use and intentions to use marijuana, cocaine/crack, and other drugs for African-American and Hispanic seventh graders (N = 757). Self-reports of marijuana use and intentions to use drugs were collected along with data concerning background, social environmental, and individual characteristics hypothesized to be related to drug use. Results indicated that social influences, including adults, friends, and the most admired person's marijuana use, predicted marijuana use. Individual characteristics, such as a lack of knowledge about the prevalence and negative social consequences of marijuana use, positive attitudes toward marijuana use, and inadequate social, communication, and refusal skills increased suspectability to marijuana use. Lack of self-efficacy was related to intentions to use cocaine and other drugs. Implications of these findings are discussed with respect to the development of effective prevention programs.

Achievement↗

Artificial neural networks for adolescent marijuana use and clinical features of marijuana dependence.

This article compares the performance of multiple logistic regression (MLR) with feed-forward, artificial neural network (ANN) models for the assessment of adolescent marijuana use and clinical features of dependence based on self-evaluation from recent National Household Surveys on Drug Abuse (NHSDA). The effect of training and testing the neural networks with randomly selected data was compared to data selected as a function of survey year. The technical aim of the study was to account for adolescent marijuana use and features of marijuana dependence based on experiences with alcohol and tobacco. Similarities observed in MLR and ANN model performance may indicate no major complex or nonlinear relationships in cross-sectional epidemiological data selected to model adolescent drug use and dependence in this specific application. We concluded that ANNs should be further studied in future longitudinal research, perhaps with modeling of recursive networks, allowing feedback from drug dependence to levels of marijuana use. The ANN models also have the potential to model drug use and dependence based on input parameters with no obvious direct link to drug involvement--e.g., polymorphisms associated with "openness to experience" or other personality traits hypothesized to function as distal antecedents, and could thus be implemented to identify higher risk youths using assessments indirectly related or nonlinearly associated to adolescent drug use and dependence but less sensitive to survey-related response tendencies.

Adolescent↗

Comparison of extended versus brief treatments for marijuana use.

Adult marijuana users (N = 291) seeking treatment were randomly assigned to an extended 14-session cognitive-behavioral group treatment (relapse prevention support group; RPSG), a brief 2-session individual treatment using motivational interviewing (individualized assessment and intervention; IAI), or a 4-month delayed treatment control (DTC) condition. Results indicated that marijuana use, dependence symptoms, and negative consequences were reduced significantly in relation to pretreatment levels at 1-, 4-, 7-, 13-, and 16-month follow-ups. Participants in the RPSG and IAI treatments showed significantly and substantially greater improvement than DTC participants at the 4-month follow-up. There were no significant differences between RPSG and IAI outcomes at any follow-up. The relative efficacy of brief versus extended interventions for chronic marijuana-using adults is discussed.

Adult↗

The Relationship of Stress and Coping Methods to Adolescent Marijuana Use.

As the use of marijuana among adolescents remains high, more effective interventions are needed. We conducted this cross-sectional survey at an outpatient, university-based, adolescent clinic to determine the prevalence of marijuana use in an inner-city adolescent population and to examine the relationship of stress and coping methods to marijuana user status (never user, experimenter, and frequent user). The subjects were 918 adolescents aged 12-21 years. Lifetime use in this population was 59% (n = 611) with 18.4% (n = 191) reporting frequent weekly use. Almost all (97%) marijuana users acknowledged marijuana use by friends. Stepwise logistic regression analysis showed that negative life events, greater use of the negative coping method of anger and less frequent use of the positive coping method of parental support were significantly and independently related to marijuana user status. In the presence of high peer use, exploring parent-child relationships and use of anger coping and intervening accordingly may decrease marijuana use.

Journal Article↗

Good cop, bad cop: federal prosecution of state-legalized medical marijuana use after United States v. Lopez.

The Supreme Court's recent decisions in United States v. Lopez and United States v. Morrison articulate a vision of federalism under which Congress's regulatory authority under the Commerce Clause is severely limited in favor of returning traditional areas of state concern, particularly criminal law enforcement, to local or state control. The Court's decisions in these cases coincide with ballot initiatives legalizing the medical use of marijuana garnering a majority of the vote in California, Arizona, Alaska, Colorado, Nevada, Oregon, Washington, Maine, and Washington D.C. Those who use marijuana for medical purposes under sanction of state law, however, still face the threat of federal prosecution under the Controlled Substances Act. Medical marijuana proponents have traditionally, and unsuccessfully, contested federal prosecution using individual rights arguments under theories of equal protection or substantive due process. This Comment argues that after Lopez and Morrison, the federal government's authority to regulate intrastate use of marijuana for medicinal purposes is not the foregone conclusion it once was. The author suggests that proponents of medical marijuana use should invoke the federalism arguments of Lopez and Morrison and argue for state legislative independence from the federal government on this issue.

Cannabis↗

Abstinence symptoms during withdrawal from chronic marijuana use.

Although marijuana is the most commonly used illicit drug in the United States, it is not established whether withdrawal from chronic use results in a clinically significant abstinence syndrome. The present study was conducted to characterize symptoms associated with marijuana withdrawal following chronic use during a supervised 28-day abstinence period. Three groups of participants were studied: (a) current chronic marijuana users, (b) former chronic marijuana users who had not used marijuana for at least 6 months prior to the study, and (c) marijuana nonusers. Current users experienced significant increases in anxiety, irritability, physical tension, and physical symptoms and decreases in mood and appetite during marijuana withdrawal. These symptoms were most pronounced during the initial 10 days of abstinence, but some were present for the entire 28-day withdrawal period. These findings support the notion of a marijuana withdrawal syndrome in humans.

Adult↗

Marijuana use in schizophrenia: a clear hazard.

The use of marijuana as the independent variable produced a serious exacerbation of a psychotic process in four schizophrenic patients whose illness was otherwise well controlled with antipsychotic medication. Each patient served as his own control--the sole substance abused was marijuana and antipsychotic medication intake remained constant. Each time marijuana use at moderate levels began, there was exacerbation and deterioration. The author suggests that marijuana use is a special hazard to schizophrenic patients and that physicians should alert such high-risk patients to the possible untoward interaction between their illness and marijuana.

Acute Disease↗

The differential disinhibition effect of marijuana use on violent behavior: a comparison of this effect on a conventional, non-delinquent group versus a delinquent or deviant group.

The following Kaplan/Damphouse hypothesis was tested and cross validated: The use of marijuana either predicts to or has a greater effect on increasing the degree of violent behavior for a group that is low on delinquent behavior, than it does for a group that scores high on these behaviors. For the conventional, non-delinquent sub-group, a higher degree of significant relationship between degree of marijuana use and degree of violent behavior was found, compared to the degree of this type of relationship than was found for either cocaine/crack use, amphetamine use, or tranquilizer/sedative use. For example, for the commission of the offense of Attempted Homicide/Reckless Endangerment: for the conventional, non-delinquent group there was a highly significant relationship to the degree of marijuana use; but there was a non-significant relationship between this type of offense and the degree of use of each of the other types of drugs. Thus, this special disinhibition effect was found only for marijuana, and not for other drugs, regardless of whether they were stimulant types of drugs, or were sedative drugs.

Adolescent↗

Perceived paternal relationships, adolescent personality, and female marijuana use.

This study was designed to examine the interconnection of paternal factors and adolescent personality attributes and their impact on the adolescent girls' use of marijuana. Analysis of the data suggested that fathers who are affectionate and child-centered and whose daughters identify with them are less likely to have daughters who use marijuana. Adolescent nonusers differed from users on a number of personality attributes reflecting conventionality and a cognitive style of receptivity to change. In general, the results suggest that paternal factors and adolescent personality attributes each have an independent impact on the adolescents' marijuana use.

Adolescent↗

Psychoses associated with marijuana use in Thailand.

Marijuana use among the 45,000 Air Force troops stationed in Thailand during the period September 1971 to September 1972 was extensive. Nevertheless, only five cases of prolonged psychosis associated with marijuana use in this population were referred for psychiatric evaluation. These cases resembled several types of adverse reactions previously described in the literature: one case of a "marijuana psychosis"; one case of an "organic marijuana syndrome"; and three cases of "marijuana-mobilized functional psychosis." With the exception of the patient with the "marijuana psychosis," this small group of men had either borderline or schizoidal premorbid personalities. Other more transient psychotic episodes appear to go unreported by the troops because of the rapid clearing of symptoms and the punitive policy of the Air Force toward drug abuse.

Adult↗

Prenatal marijuana use: epidemiology, methodologic issues, and infant outcome.

What do we know about marijuana use among women of reproductive age and about the use of marijuana during pregnancy? Marijuana is the most commonly used illicit substance, and after alcohol and tobacco, the most commonly used drug during pregnancy. Women who use marijuana are more likely to be white, younger, and to use other substances. The characteristics of women who use marijuana during early pregnancy are similar, although women who continue to use marijuana throughout pregnancy are somewhat different. These women are less-well educated, of lower social class, much more likely to use other substances, and more likely to be black. We do not know why some women use marijuana while others do not, and why some women discontinue their use during pregnancy while others do not. What do we know about the effects of marijuana use during pregnancy? A number of studies have investigated the relationship between prenatal marijuana exposure and outcome at birth. The results, unfortunately, are equivocal. Prospective studies that have examined women at regular and frequent intervals during pregnancy, in general, have not found a relationship between marijuana use and birthweight (Day NL, Sambamoorthi U, Taylor P, et al: unpublished data, 1990) although some have reported a small effect of marijuana use on birth length (Day NL, Sambamoorthi U, Taylor P, et al: unpublished data, 1990). Other studies, some prospective and some retrospective, have reported correlations between marijuana use during pregnancy and smaller size at birth. Several of these studies, however, failed to control adequately for other illicit drug use while one used marijuana only as a dichotomous variable in the analysis. Therefore, we do not yet know whether there is or is not an effect of marijuana use during pregnancy on intrauterine growth retardation. Only a few studies have reported on growth outside the neonatal period, and these studies have not found a consistent effect of prenatal marijuana exposure. There are, however, too few reports to assume that this is definitive. Several studies reported a relationship between prenatal marijuana use and the gestational age of the infant. As with growth, however, other studies have not corroborated these findings. Similarly, two studies have noted an increase in morphologic abnormalities, although one of these did not have a control group for comparison. Most studies have reported finding no relationship with either minor or major morphologic abnormalities. At birth, investigators have assessed the relationship between prenatal marijuana exposure and neurobehavioral outcome. Again, the results are contradictory.(ABSTRACT TRUNCATED AT 400 WORDS)

Female↗

Brain morphological changes and early marijuana use: a magnetic resonance and positron emission tomography study.

BACKGROUND: The focus of this report is on the possible role that the age of first use of marijuana may play on brain morphology and function. METHODS: Magnetic resonance imaging (MRI) and positron emission tomography (PET) were utilized to study 57 subjects. Brain volume measures (whole brain, gray matter, white matter and lateral ventricle volumes), global cerebral blood flow (CBF) and body size were evaluated. RESULTS: There are three primary findings related to age of first use of marijuana. Subjects who started using marijuana before age 17, compared to those who started later, had smaller whole brain and percent cortical gray matter and larger percent white matter volumes. Functionally, males who started using marijuana before 17 had significantly higher CBF than other males. Both males and females who started younger were physically smaller in height and weight, with the effects being greater in males. CONCLUSIONS: These findings suggest that the age at which exposure to marijuana begins is important. Early adolescence may be a critical period for effects that are not present when exposure begins later. These results are discussed in light of reported effects of marijuana on gonadal and pituitary hormones.

Adolescent↗

Adolescent marijuana use: a review.

The adolescent marijuana literature is reviewed. Studies show that the prevalence of marijuana use is generally quite low in elementary schools. In junior and senior high samples, findings vary greatly from place to place. The prevalence of use increased dramatically during the 1970s although the use patterns may have peaked already in some areas. The use of marijuana increases with age, but some evidence suggests that a slight drop-off in use occurs near the end of high school. Female use seems to be increasing more than male use. Use seems to be somewhat more prevalent in middle- and upper-middle-class homes and in broken homes. Mixed support has been found for the hypothesis that marijuana users have parents that are more permissive. Parents of marijuana users are generally characterized as being less warm and supportive, and more inclined toward the use of drugs themselves. Peer and sibling use of marijuana seem to be particularly important predictors of adolescent marijuana use. Findings on personality characteristics of marijuana users are not extensive and are somewhat contradictory. There is some evidence that users tend to be somewhat alienated, external in their locus of control, and possibly higher on anxiety. Users are also characterized by a higher value on independence vs achievement and more positive attitudes toward marijuana use. Behavioral correlates of marijuana use include greater use of alcohol and other drugs, and poorer school performance.

Adolescent↗