Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-15T15:17:34.334Z Has data issue: false hasContentIssue false
  • English
  • Français

Characterising heterogeneity in the use of different cannabis products: latent class analysis with 55 000 people who use cannabis and associations with severity of cannabis dependence

Published online by Cambridge University Press:  13 October 2019

Sam Craft Open the ORCID record for Sam Craft [Opens in a new window] ,
Adam Winstock ,
Jason Ferris ,
Clare Mackie ,
Michael T. Lynskey  and
Tom P. Freeman
Sam Craft
Affiliation:
National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Adam Winstock
Affiliation:
University College London, London, UK Global Drug Survey Ltd, London, UK
Jason Ferris
Affiliation:
Centre for Health Services Research, University of Queensland, QLD, Australia
Clare Mackie
Affiliation:
National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Michael T. Lynskey
Affiliation:
National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Tom P. Freeman*
Affiliation:
National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK University College London, London, UK Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
*
Author for correspondence: Tom P. Freeman, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

As new cannabis products and administration methods proliferate, patterns of use are becoming increasingly heterogeneous. However, few studies have explored different profiles of cannabis use and their association with problematic use.

Methods

Latent class analysis (LCA) was used to identify subgroups of past-year cannabis users endorsing distinct patterns of use from a large international sample (n = 55 240). Past-12-months use of six different cannabis types (sinsemilla, herbal, hashish, concentrates, kief, edibles) were used as latent class indicators. Participants also reported the frequency and amount of cannabis used, whether they had ever received a mental health disorder diagnosis and their cannabis dependence severity via the Severity of Dependence Scale (SDS).

Results

LCA identified seven distinct classes of cannabis use, characterised by high probabilities of using: sinsemilla & herbal (30.3% of the sample); sinsemilla, herbal & hashish (20.4%); herbal (18.4%); hashish & herbal (18.8%); all types (5.7%); edibles & herbal (4.6%) and concentrates & sinsemilla (1.7%). Relative to the herbal class, classes characterised by sinsemilla and/or hashish use had increased dependence severity. By contrast, the classes characterised by concentrates use did not show strong associations with cannabis dependence but reported greater rates of ever receiving a mental health disorder diagnosis.

Conclusions

The identification of these distinct classes underscores heterogeneity among cannabis use behaviours and provides novel insight into their different associations with addiction and mental health.

Keywords

Cannabis dependencehashishlatent class analysis: cannabis concentratespatterns of cannabis usesinsemilla
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 14 , October 2020 , pp. 2364 - 2373
Check for updates
Copyright
Copyright © Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arterberry, BJ, Treloar Padovano, H, Foster, KT, Zucker, RA and Hicks, BM (2019) Higher average potency across the United States is associated with progression to first cannabis use disorder symptom. Drug and Alcohol Dependence 195, 186–192.CrossRefGoogle ScholarPubMed
Barratt, MJ, Ferris, JA, Zahnow, R, Palamar, JJ, Maier, LJ and Winstock, AR (2017) Moving on from representativeness: testing the utility of the global drug survey. Substance Abuse: Research and Treatment 11, 1178221817716391–1178221817716391.Google ScholarPubMed
Bidwell, L, York Williams, SL, Mueller, RL, Bryan, AD and Hutchison, KE (2018) Exploring cannabis concentrates on the legal market: user profiles, product strength, and health-related outcomes. Addictive Behaviors Reports 8, 102–106.CrossRefGoogle Scholar
Borodovsky, JT, Crosier, BS, Lee, DC, Sargent, JD and Budney, AJ (2016) Smoking, vaping, eating: is legalization impacting the way people use cannabis? The International Journal on Drug Policy 36, 141–147.CrossRefGoogle ScholarPubMed
Canadian Cannabis Survey (2018). https://www.canada.ca/en/services/health/publications/drugs-health-products/canadian-cannabis-survey-2018-summary.htmlGoogle Scholar
Caulkins, JP, Bao, Y, Davenport, S, Fahli, I, Guo, Y, Kinnard, K, Najewicz, M, Renaud, L and Kilmer, B (2018) Big data on a big new market: insights from Washington State's legal cannabis market. International Journal of Drug Policy 57, 86–94.CrossRefGoogle ScholarPubMed
Chan, GCK, Hall, W, Freeman, TP, Ferris, J, Kelly, AB and Winstock, A (2017) User characteristics and effect profile of butane hash oil: an extremely high-potency cannabis concentrate. Drug and Alcohol Dependence 178, 32–38.CrossRefGoogle ScholarPubMed
Chandra, S, Radwan, MM, Majumdar, CG, Church, JC, Freeman, TP and ElSohly, MA (2019) New trends in cannabis potency in USA and Europe during the last decade (2008–2017). European Archives of Psychiatry and Clinical Neuroscience 269, 5–15.CrossRefGoogle Scholar
Clark, S and Muthén, B (2009) Relating latent class analysis results to variables not included in the analysis. Available from: https://www.statmodel.com/download/relatinglca.pdf.Google Scholar
Curran, HV, Freeman, TP, Mokrysz, C, Lewis, DA, Morgan, CJ and Parsons, LH (2016) Keep off the grass? Cannabis, cognition and addiction. Nature Reviews Neuroscience 17, 293–306.CrossRefGoogle ScholarPubMed
Curran, HV, Hindocha, C, Morgan, CJA, Shaban, N, Das, RK and Freeman, TP (2018) Which biological and self-report measures of cannabis use predict cannabis dependency and acute psychotic-like effects? Psychological Medicine 49, 1574–1580.CrossRefGoogle ScholarPubMed
Di Forti, M, Marconi, A, Carra, E, Fraietta, S, Trotta, A, Bonomo, M, Bianconi, F, Gardner-Sood, P, O'Connor, J, Russo, M, Stilo, S, Reis Marques, T, Mondelli, V, Dazzan, P, Pariante, C, David, A, Gaughran, F, Atakan, Z, Iyegbe, C and Murray, R (2015) Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study. Lancet 2, 233–238.Google ScholarPubMed
Di Forti, M, Quattrone, D, Freeman, TP, Tripoli, G, Gayer-Anderson, C, Quigley, H, Rodriguez, V, Jongsma, HE, Ferraro, L, La Cascia, C, La Barbera, D, Tarricone, I, Berardi, D, Szoke, A, Arango, C, Tortelli, A, Velthorst, E, Bernardo, M, Del-Ben, CM, Menezes, PR, Selten, JP, Jones, PB, Kirkbride, JB, Rutten, BP, de Haan, L, Sham, PC, van Os, J, Lewis, CM, Lynskey, M, Morgan, C and Murray, RM (2019) The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. The Lancet Psychiatry 6, 427–436.CrossRefGoogle ScholarPubMed
EMCDDA (2019) Developments in the European cannabis market. EMCDDA Papers.Google Scholar
Englund, A, Morrison, PD, Nottage, J, Hague, D, Kane, F, Bonaccorso, S, Stone, JM, Reichenberg, A, Brenneisen, R, Holt, D, Feilding, A, Walker, L, Murray, RM and Kapur, S (2013) Cannabidiol inhibits THC-elicited paranoid symptoms and hippocampal-dependent memory impairment. Journal of Psychopharmacology 27, 19–27.CrossRefGoogle ScholarPubMed
Freeman, TP and Winstock, AR (2015) Examining the profile of high-potency cannabis and its association with severity of cannabis dependence. Psychological Medicine 45, 3181–3189.CrossRefGoogle ScholarPubMed
Freeman, TP, Morgan, CJA, Hindocha, C, Schafer, G, Das, RK and Curran, HV (2014) Just say ‘know’: how do cannabinoid concentrations influence users' estimates of cannabis potency and the amount they roll in joints? Addiction 109, 1686–1694.CrossRefGoogle ScholarPubMed
Freeman, TP, Groshkova, T, Cunningham, A, Sedefov, R, Griffiths, P and Lynskey, MT (2018 a) Increasing potency and price of cannabis in Europe, 2006–16. Addiction 114, 1015–1023.CrossRefGoogle Scholar
Freeman, TP, van der Pol, P, Kuijpers, W, Wisselink, J, Das, RK, Rigter, S, van Laar, M, Griffiths, P, Swift, W, Niesink, R and Lynskey, MT (2018 b) Changes in cannabis potency and first-time admissions to drug treatment: a 16-year study in the Netherlands. Psychological Medicine 48, 2346–2352.CrossRefGoogle ScholarPubMed
Freeman, TP, Hindocha, C, Green, SF and Bloomfield, MAP (2019) Medicinal use of cannabis based products and cannabinoids. BMJ 365, l1141.CrossRefGoogle ScholarPubMed
Gossop, M, Darke, S, Griffiths, P, Hando, J, Powis, B, Hall, W and Strang, J (1995) The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users. Addiction 90, 607–614.CrossRefGoogle ScholarPubMed
Gourdet, C, Giombi, KC, Kosa, K, Wiley, J and Cates, S (2017) How four U.S. States are regulating recreational marijuana edibles. International Journal of Drug Policy 43, 83–90.CrossRefGoogle ScholarPubMed
Hall, W and Lynskey, M (2016) Why it is probably too soon to assess the public health effects of legalisation of recreational cannabis use in the USA. The Lancet. Psychiatry 3, 900–906.CrossRefGoogle Scholar
Haney, M, Malcolm, RJ, Babalonis, S, Nuzzo, PA, Cooper, ZD, Bedi, G, Gray, KM, McRae-Clark, A, Lofwall, MR, Sparenborg, S and Walsh, SL (2016) Oral cannabidiol does not alter the subjective, reinforcing or cardiovascular effects of smoked Cannabis. Neuropsychopharmacology 41, 1974–1982.CrossRefGoogle ScholarPubMed
Hardwick, S. and King, L. (2008). Home Office Cannabis Potency Study. Home Office Scientific Development Branch (ed.), London, UK: Home Office Scientific Development Branch.Google Scholar
Hindocha, C, Shaban, ND, Freeman, TP, Das, RK, Gale, G, Schafer, G, Falconer, CJ, Morgan, CJ and Curran, HV (2015) Associations between cigarette smoking and cannabis dependence: a longitudinal study of young cannabis users in the United Kingdom. Drug and Alcohol Dependence 148, 165–171.CrossRefGoogle ScholarPubMed
Hindocha, C, Freeman, TP, Ferris, JA, Lynskey, MT and Winstock, AR (2016) No smoke without tobacco: a global overview of cannabis and tobacco routes of administration and their association with intention to quit. Frontiers in Psychiatry 7, 104–104.CrossRefGoogle ScholarPubMed
Huestis, MA (2007) Human cannabinoid pharmacokinetics. Chemistry & Biodiversity 4, 1770–1804.CrossRefGoogle ScholarPubMed
Korf, DJ, Benschop, A and Wouters, M (2007) Differential responses to cannabis potency: a typology of users based on self-reported consumption behaviour. International Journal of Drug Policy 18, 168–176.CrossRefGoogle ScholarPubMed
Krauss, MJ, Rajbhandari, B, Sowles, SJ, Spitznagel, EL and Cavazos-Rehg, P (2017) A latent class analysis of poly-marijuana use among young adults. Addictive Behaviors 75, 159–165.CrossRefGoogle ScholarPubMed
Loflin, M and Earleywine, M (2014) A new method of cannabis ingestion: the dangers of dabs? Addictive Behaviors 39, 1430–1433.CrossRefGoogle ScholarPubMed
MacCoun, RJ and Mello, MM (2015) Half-baked—the retail promotion of marijuana edibles. The New England Journal of Medicine 372, 989–991.CrossRefGoogle ScholarPubMed
Manning, K, Garey, L, Paulus, DJ, Buckner, JD, Hogan, JBD, Schmidt, NB and Zvolensky, MJ (2018) Typology of cannabis use among adults: a latent class approach to risk and protective factors. Addictive Behaviours 92, 6–13.CrossRefGoogle ScholarPubMed
Meacham, MC, Paul, MJ and Ramo, DE (2018) Understanding emerging forms of cannabis use through an online cannabis community: an analysis of relative post volume and subjective highness ratings. Drug and Alcohol Dependence 188, 364–369.CrossRefGoogle ScholarPubMed
Meier, MH (2017) Associations between butane hash oil use and cannabis-related problems. Drug and Alcohol Dependence 179, 25–31.CrossRefGoogle ScholarPubMed
Muthén, LK and Muthén, BO (2017) Mplus User's Guide. 1998–2017, 8th Edn. Los Angeles, CA: Muthén & Muthén.Google Scholar
Nylund-Gibson, K and Choi, AY (2018) Ten frequently asked questions about latent class analysis. Translational Issues in Psychological Science 4, 440–461.CrossRefGoogle Scholar
Pacula, RL, Jacobson, M and Maksabedian, EJ (2016) In the weeds: a baseline view of cannabis use among legalizing states and their neighbours. Addiction 111, 973–980.CrossRefGoogle ScholarPubMed
Pearson, MR, Bravo, AJ, Conner, BT and Marijuana Outcomes Study T (2017). Distinguishing subpopulations of marijuana users with latent profile analysis. Drug and Alcohol Dependence 172, 1–8.CrossRefGoogle ScholarPubMed
Potter, DJ (2014) A review of the cultivation and processing of cannabis (Cannabis sativa L.) for production of prescription medicines in the UK. Drug Testing and Analysis 6, 31–38.CrossRefGoogle ScholarPubMed
Potter, DJ, Hammond, K, Tuffnell, S, Walker, C and Di Forti, M (2018) Potency of Delta(9)-tetrahydrocannabinol and other cannabinoids in cannabis in England in 2016: implications for public health and pharmacology. Drug Testing and Analysis 10, 628–635.CrossRefGoogle ScholarPubMed
Raber, JC, Elzinga, S and Kaplan, C (2015) Understanding dabs: contamination concerns of cannabis concentrates and cannabinoid transfer during the act of dabbing. Journal of Toxicological Sciences 40, 797–803.CrossRefGoogle ScholarPubMed
Ream, GL, Benoit, E, Johnson, BD and Dunlap, E (2008) Smoking tobacco along with marijuana increases symptoms of cannabis dependence. Drug and Alcohol Dependence 95, 199–208.CrossRefGoogle ScholarPubMed
Russell, C, Rueda, S, Room, R, Tyndall, M and Fischer, B (2018) Routes of administration for cannabis use – basic prevalence and related health outcomes: a scoping review and synthesis. International Journal of Drug Policy 52, 87–96.CrossRefGoogle ScholarPubMed
Sagar, KA, Lambros, AM, Dahlgren, MK, Smith, RT and Gruber, SA (2018) Made from concentrate? A national web survey assessing dab use in the United States. Drug and Alcohol Dependence 190, 133–142.CrossRefGoogle ScholarPubMed
Schoeler, T, Petros, N, Di Forti, M, Pingault, JB, Klamerus, E, Foglia, E, Small, A, Murray, R and Bhattacharyya, S (2016) Association between continued cannabis use and risk of relapse in first-episode psychosis: a quasi-experimental investigation within an observational study. JAMA Psychiatry 73, 1173–1179.CrossRefGoogle ScholarPubMed
Smart, R, Caulkins, JP, Kilmer, B, Davenport, S and Midgette, G (2017) Variation in cannabis potency and prices in a newly legal market: evidence from 30 million cannabis sales in Washington state. Addiction 112, 2167–2177.CrossRefGoogle Scholar
Spindle, TR, Cone, EJ, Schlienz, NJ, Mitchell, JM, Bigelow, GE, Flegel, R, Hayes, E and Vandrey, R (2018) Acute effects of smoked and vaporized cannabis in healthy adults who infrequently use cannabis: a crossover trial acute effects of smoked vs vaporized cannabis use in infrequent cannabis users acute effects of smoked vs vaporized cannabis use in infrequent cannabis users. JAMA Network Open 1, e184841–e184841.CrossRefGoogle Scholar
Spindle, TR, Bonn-Miller, MO and Vandrey, R (2019) Changing landscape of cannabis: novel products, formulations, and methods of administration. Current Opinion in Psychology 30, 98–102.CrossRefGoogle ScholarPubMed
Stambouli, H, El Bouri, A and Bouayoun, T (2016) Évolution de la teneur en Δ9-THC dans les saisies de résines de cannabis au Maroc de 2005 à 2014. Toxicologie Analytique et Clinique 28, 146–152.CrossRefGoogle Scholar
StataCorp (2017) Stata Statistical Software: Release 15. StataCorp LLC: College Station, TX.Google Scholar
Swift, W, Copeland, J and Hall, W (1998) Choosing a diagnostic cut-off for cannabis dependence. Addiction 93, 1681–1692.CrossRefGoogle ScholarPubMed
Temple, EC, Brown, RF and Hine, DW (2011) The ‘grass ceiling’: limitations in the literature hinder our understanding of cannabis use and its consequences. Addiction 106, 238–244.CrossRefGoogle ScholarPubMed
UNODC (2018) World Drug Report. United Nations Office on Drugs and Crime.Google Scholar
Valjent, E, Mitchell, JM, Besson, MJ, Caboche, J and Maldonado, R (2002) Behavioural and biochemical evidence for interactions between Delta 9-tetrahydrocannabinol and nicotine. British Journal of Pharmacology 135, 564–578.CrossRefGoogle ScholarPubMed
Wilson, J, Freeman, TP and Mackie, CJ (2019) Effects of increasing cannabis potency on adolescent health. The Lancet Child & Adolescent Health 3, 121–128.CrossRefGoogle ScholarPubMed
Winstock, AR, Mitcheson, L, Gillatt, DA and Cottrell, AM (2012) The prevalence and natural history of urinary symptoms among recreational ketamine users. BJU International 110, 1762–1766.CrossRefGoogle ScholarPubMed
Zamengo, L, Frison, G, Bettin, C and Sciarrone, R (2015) Cannabis potency in the Venice area (Italy): update 2013. Drug Testing and Analysis 7, 255–258.CrossRefGoogle ScholarPubMed
Supplementary material: PDF

Craft et al. supplementary material

Craft et al. supplementary material

Download Craft et al. supplementary material(PDF)
PDF 457.8 KB