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Journal Club

Journal Club. Alcohol, Other Drugs, and Health: Current Evidence July–August 2016. Featured Article. Cannabis use and risk of psychiatric disorders: prospective evidence from a US national longitudinal study Blanco C, et al. JAMA Psychiatry. 2016;73(4):388–395. Study Objective.

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Journal Club

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  1. Journal Club Alcohol, Other Drugs, and Health: Current Evidence July–August 2016 www.aodhealth.org

  2. Featured Article Cannabis use and risk of psychiatric disorders: prospective evidence from a US national longitudinal study Blanco C, et al. JAMA Psychiatry. 2016;73(4):388–395. www.aodhealth.org

  3. Study Objective • To examine the prospective associations between cannabis use and substance use disorder (SUD) among adults, and mood and anxiety disorders at 3 year follow-up. www.aodhealth.org

  4. Study Design • Prospective survey of 34,653 US adults from two waves of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). • Wave 2 was interviewed approximately 3 years after wave 1. • Researchers used multivariable logistic analysis and propensity score matching. www.aodhealth.org

  5. Assessing Validity of an Article about Prognosis • Are the results valid? • What are the results? • How can I apply the results to patient care? www.aodhealth.org

  6. Are the Results Valid? • Was the sample representative? • Were the subjects sufficiently homogeneous with respect to prognostic risk? • Was follow-up sufficiently complete? • Were objective and unbiased outcome criteria used? www.aodhealth.org

  7. Was the sample representative? All subjects in this study… • were a nationally representative cohort of US adults (N=34,563) • 14,564 were male; mean age 45 years • “Black and Hispanic individuals and young adults (aged 18-24 years) were oversampled, with data adjusted for oversampling and household- and person-level nonresponse” • 1279 of participants in wave 1 had cannabis use www.aodhealth.org

  8. Were the subjects sufficiently homogeneous with respect to prognostic risk? • Yes. www.aodhealth.org

  9. Was follow-up sufficiently complete? • Yes. 81.5% (n = 34 653) of participants interviewed in wave 1 were interviewed for wave 2. • Researchers developed sample weights to adjust for non-response in wave 2. www.aodhealth.org

  10. Were objective and unbiased outcome criteria used? • Yes. • Primary outcome development of a mood, anxiety, and substance use disorder using the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-IV) • It is not stated whether this assessment was blinded to knowledge of cannabis exposure www.aodhealth.org

  11. What Are the Results? • How likely are the outcomes over time? • How precise are the estimates of likelihood? www.aodhealth.org

  12. How likely are the outcomes over time? • In adjusted analyses, cannabis use was associated with an increased prevalence and incidence of SUD (odds ratio [OR], 6.2), but not mood (OR, 1.1) and anxiety disorders (OR, 0.9). www.aodhealth.org

  13. How precise are the estimates of likelihood? • Cannabis use was associated with: • alcohol use disorder (prevalence: OR, 2.5; incidence: OR, 2.7; 95% CI, 1.9-3.8) • cannabis use disorder (prevalence: OR, 12.4; incidence: OR, 9.5; 95% CI, 6.4-14.1) • other drug use disorder (prevalence: OR, 3.1; incidence: OR, 2.6; 95% CI, 1.6-4.4) • nicotine dependence (prevalence: OR, 1.5; incidence: OR, 1.7; 95% CI, 1.2-2.4). www.aodhealth.org

  14. How Can I Apply the Resultsto Patient Care? • Were the study patients and their management similar to those in my practice? • Was follow-up sufficiently long? • Can I use the results in the management of patients in my practice? www.aodhealth.org

  15. Were the study patients similar to those in my practice? • The study population was large and nationally representative, although the sample is household and not clinically-based www.aodhealth.org

  16. Was follow-up sufficiently long? • Likely not. The patients were followed 3 years after initial interviews. Given the adult sample and the time course for the emergence of mood and anxiety disorders, there may not have been sufficient time for the development of such conditions. www.aodhealth.org

  17. Can I use the results in the management of patients in my practice? • Yes. Cannabis use appears to be associated with increased risk for alcohol, cannabis, nicotine, and other drug use disorders. This can inform screening and prevention interventions. www.aodhealth.org

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