Comment

Cannabis use and cannabis use disorders

Over the past 20 years many US states have relaxed policies used cannabis in the previous year despite an increase
towards cannabis (marijuana) use within their borders, in the prevalence of daily and near daily cannabis
moving from strict prohibition to legalisation of medical use. First, there could be an age cohort eect. Grucza
use in the 1990s and even legalisation of recreational and colleagues11 found a reduction in cannabis use in
use by adults in four US states in the 2010s.1,2 Critics 1217-year-olds who are at higher risk than their peers of

John Greim/Science Photo Library

have argued that these policy changes will increase the developing cannabis use disorder because of comorbid
prevalence of cannabis use and cannabis use disorders.35 conduct problems, whereas Compton and colleagues
In The Lancet Psychiatry, Wilson Compton and found increased use in people aged 18 years or older.
colleagues6 have assessed the validity of these concerns Younger users (aged 1214 years) are more likely to
by analysing trends in cannabis use in the USA in adults develop dependence than older users (aged 1517 years).
(aged 18 years or older) who were interviewed in annual A second possibility is that relaxation of cannabis policy Lancet Psychiatry 2016
surveys between 2002 and 2014. The prevalence has increased the number of new cannabis users in older Published Online
August 31, 2016
of cannabis use in the previous year increased from adults or the number of older adults resuming cannabis http://dx.doi.org/10.1016/
104% in 2002 to 133% in 2014, with rates increasing use. Older adults generally use cannabis less often, and S2215-0366(16)30270-X

after 2007. Initiation of use in the previous 12 months could therefore reduce the proportion of current users See Online/Articles
http://dx.doi.org/10.1016/
increased from 07% to 11% and the prevalence of who meet criteria for cannabis use disorders. S2215-0366(16)30208-5
daily or near daily cannabis use increased from 19% These changes in the prevalence of cannabis use
to 35%, with the upward trend beginning in 2007. occurred during a period when many US states legalised
All these trends remained signicant after controlling cannabis for medicinal use, but before four states went
for sociodemographic variables. on to legalise recreational cannabis use (after 2014). It is
Surprisingly, the prevalence of cannabis use disorders probably too soon to draw conclusions about the eects
in the previous year remained at 15% of the adult of these legal changes on rates of cannabis use and
population, while the prevalence of disorders in people cannabis related harms,1 but it is likely that these policy
who used cannabis in the previous year decreased from changes will increase the prevalence and frequency of
148% in 2002 to 110% in 2014. The latter nding is cannabis use and, potentially, cannabis use disorders in
surprising given increases in the prevalence and frequency the longer term. To investigate this possibility, the USA
of cannabis use and an increase in the potency of cannabis needs to continue to monitor cannabis use and disorders
products over the same period,7 which would be expected in large scale surveys, such as the National Survey on
to increase the risk of cannabis use disorders in users.8 Drug Use and Health and the Monitoring the Future
There is a discrepancy between these ndings and national survey of high school students. Monitoring
those from the National Epidemiologic Survey of of cannabis use will need to address one of the major
Alcohol and Related Conditions (NESARC). Hasin and limitations of these surveys for this task, namely, that
colleagues9 reported that the prevalence of DSM-IV they were designed to provide nationally representative
cannabis use disorders increased from 15% to 29%. samples and do not necessarily provide representative
Compton and colleagues suggest that that the samples of individual states. US Federal funding agencies
discrepancy can be explained by the superior methods should consider funding oversampling of representative
of their survey. Grucza and colleagues10 have also population samples within states that have and have not
argued that the earlier NESARC survey might have legalised cannabis for recreational and medical use.
underestimated the prevalence of cannabis use. Notably,
the two surveys produced comparable estimates of Michael Lynskey, *Wayne Hall
previous year use in 201214, but the household survey National Addiction Centre, Institute of Psychiatry, Psychology and
Neuroscience, Kings College London, London, UK (ML, WH); and
estimates for 2002 were much higher than the 2002
Centre for Youth Substance Abuse Research, University of
gures reported by NESARC (104% vs 41%). Queensland, Royal Brisbane and Womens Hospital Site, Herston,
Several explanations might explain the decreased QLD 4029, Australia (WH)
prevalence of cannabis use disorders in people who [email protected]

www.thelancet.com/psychiatry Published online August 31, 2016 http://dx.doi.org/10.1016/S2215-0366(16)30270-X 1

 Comment

We declare no competing interests. 7 Mehmedic Z, Chandra S, Slade D, et al. Potency trends of Delta9-THC and
other cannabinoids in conscated cannabis preparations from 1993 to
1 Hall W, Lynskey M. Why it is probably too soon to assess the public health
2008. J Forensic Sci 2010; 55: 120917.
eects of legalisation of recreational cannabis use in the USA.
Lancet Psychiatry 2016; 3: 90006. 8 Freeman TP, Winstock AR. Examining the prole of high-potency cannabis
and its association with severity of cannabis dependence. Psychol Med
2 Pardo B. Cannabis policy reforms in the Americas: a comparative analysis of
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Colorado, Washington, and Uruguay. Int J Drug Policy 2014; 25: 72735.
9 Hasin DS, Saha TD, Kerridge BT, et al. Prevalence of marijuana use disorders
3 Cerda M, Wall M, Keyes KM, Galea S, Hasin D. Medical marijuana laws in
in the United States Between 20012002 and 20122013. JAMA Psychiatry
50 states: investigating the relationship between state legalization of
2015; 72: 123542.
medical marijuana and marijuana use, abuse and dependence.
Drug Alcohol Depend 2012; 120: 2227. 10 Grucza RA, Agrawal A, Krauss MJ, Cavazos-Rehg PA, Bierut LJ. Recent trends
in the prevalence of marijuana use and associated disorders in the United
4 Lynne-Landsman SD, Livingston MD, Wagenaar AC. Eects of state medical
States. JAMA Psychiatry 2016; 73: 30001.
marijuana laws on adolescent marijuana use. Am J Public Health 2013;
103: 150006. 11 Grucza RA, Agrawal A, Krauss MJ, et al. Declining prevalence of marijuana
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5 Sabet K. The (often unheard) case against marijuana leniency. In:
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Earleywine M, ed. Pot politics: marijuana and the costs of prohibition.
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6 Compton W, Han B, Jones C, Blanco C, Hughes A. Marijuana use and use
disorders in adults in the USA, 200214: analysis of annual cross-sectional
surveys. Lancet Psychiatry 2016; published online Aug 31. http://dx.doi.
org/10.1016/S2215-0366(16)30208-5.

2 www.thelancet.com/psychiatry Published online August 31, 2016 http://dx.doi.org/10.1016/S2215-0366(16)30270-X