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The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study

Published on May 1, 2019in The Lancet Psychiatry18.33
· DOI :10.1016/S2215-0366(19)30048-3
M. Di Forti34
Estimated H-index: 34
(Mental Health Foundation),
Diego Quattrone8
Estimated H-index: 8
(Mental Health Foundation)
+ 84 AuthorsElsje van der Ven7
Estimated H-index: 7
Cite
Abstract
Summary Background Cannabis use is associated with increased risk of later psychotic disorder but whether it affects incidence of the disorder remains unclear. We aimed to identify patterns of cannabis use with the strongest effect on odds of psychotic disorder across Europe and explore whether differences in such patterns contribute to variations in the incidence rates of psychotic disorder. Methods We included patients aged 18–64 years who presented to psychiatric services in 11 sites across Europe and Brazil with first-episode psychosis and recruited controls representative of the local populations. We applied adjusted logistic regression models to the data to estimate which patterns of cannabis use carried the highest odds for psychotic disorder. Using Europe-wide and national data on the expected concentration of Δ 9 -tetrahydrocannabinol (THC) in the different types of cannabis available across the sites, we divided the types of cannabis used by participants into two categories: low potency (THC Findings Between May 1, 2010, and April 1, 2015, we obtained data from 901 patients with first-episode psychosis across 11 sites and 1237 population controls from those same sites. Daily cannabis use was associated with increased odds of psychotic disorder compared with never users (adjusted odds ratio [OR] 3·2, 95% CI 2·2–4·1), increasing to nearly five-times increased odds for daily use of high-potency types of cannabis (4·8, 2·5–6·3). The PAFs calculated indicated that if high-potency cannabis were no longer available, 12·2% (95% CI 3·0–16·1) of cases of first-episode psychosis could be prevented across the 11 sites, rising to 30·3% (15·2–40·0) in London and 50·3% (27·4–66·0) in Amsterdam. The adjusted incident rates for psychotic disorder were positively correlated with the prevalence in controls across the 11 sites of use of high-potency cannabis (r = 0·7; p=0·0286) and daily use (r = 0·8; p=0·0109). Interpretation Differences in frequency of daily cannabis use and in use of high-potency cannabis contributed to the striking variation in the incidence of psychotic disorder across the 11 studied sites. Given the increasing availability of high-potency cannabis, this has important implications for public health. Funding source Medical Research Council, the European Community's Seventh Framework Program grant, Sao Paulo Research Foundation, National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London and the NIHR BRC at University College London, Wellcome Trust.
  • References (32)
  • Citations (14)
Cite
References32
Newest
Published on Sep 4, 2018in Psychological Medicine5.64
H. Valerie Curran3
Estimated H-index: 3
(UCL: University College London),
Chandni Hindocha10
Estimated H-index: 10
(UCL: University College London)
+ 3 AuthorsTom P. Freeman20
Estimated H-index: 20
(UCL: University College London)
BACKGROUND: Changes in cannabis regulation globally make it increasingly important to determine what predicts an individual's risk of experiencing adverse drug effects. Relevant studies have used diverse self-report measures of cannabis use, and few include multiple biological measures. Here we aimed to determine which biological and self-report measures of cannabis use predict cannabis dependency and acute psychotic-like symptoms. METHOD: In a naturalistic study, 410 young cannabis users were a...
Published on Oct 1, 2018in Psychological Medicine5.64
Tom P. Freeman20
Estimated H-index: 20
,
Pol van der P12
Estimated H-index: 12
+ 8 AuthorsRaymond J.M. Niesink27
Estimated H-index: 27
Background The number of people entering specialist drug treatment for cannabis problems has increased considerably in recent years. The reasons for this are unclear, but rising cannabis potency could be a contributing factor. Methods Cannabis potency data were obtained from an ongoing monitoring programme in the Netherlands. We analysed concentrations of δ -9-tetrahydrocannabinol (THC) from the most popular variety of domestic herbal cannabis sold in each retail outlet (2000–2015). Mixed effect...
Published on Apr 1, 2018in British Journal of Psychiatry7.23
Antti Mustonen1
Estimated H-index: 1
(OUH: Oulu University Hospital),
Solja Niemelä22
Estimated H-index: 22
(University of Oulu)
+ 4 AuthorsJouko Miettunen44
Estimated H-index: 44
(OUH: Oulu University Hospital)
Background The association between cannabis use and the risk of psychosis has been studied extensively but the temporal order still remains controversial. Aims To examine the association between cannabis use in adolescence and the risk of psychosis after adjustment for prodromal symptoms and other potential confounders. Method The sample ( n = 6534) was composed of the prospective general population-based Northern Finland Birth Cohort of 1986. Information on prodromal symptoms of psychosis and c...
Published on Apr 1, 2018in Drug Testing and Analysis2.80
David Potter4
Estimated H-index: 4
(GW Pharmaceuticals),
Kathy Hammond1
Estimated H-index: 1
(GW Pharmaceuticals)
+ 2 AuthorsM. Di Forti34
Estimated H-index: 34
('KCL': King's College London)
In 2005 and 2008, studies reported that cannabis in England had become dominated by the sinsemilla (unseeded female) form. The average potency (Δ9-tetrahydrocannabinol [THC] content) of this material had doubled over the previous decade. Cannabis resin then circulating contained approximately equal ratios of THC and cannabidiol (CBD), whereas sinsemilla was almost devoid of CBD. Despite raised health concerns regarding sinsemilla use and the development of psychotic disorders, no update on stree...
Published on Jan 1, 2018in JAMA Psychiatry15.92
Hannah Jongsma2
Estimated H-index: 2
(University of Cambridge),
Charlotte Gayer-Anderson11
Estimated H-index: 11
('KCL': King's College London)
+ 24 AuthorsIlaria Tarricone16
Estimated H-index: 16
(UNIBO: University of Bologna)
The European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) Project is funded by grant agreement HEALTH-F2-2010-241909 (Project EU-GEI) from the European Community’s Seventh Framework Programme. The Brazilian study was funded by grant 2012/0417-0 from the Sao Paulo Research Foundation. Dr Kirkbride is funded by the Wellcome Trust and grant 101272/Z/13/Z from the Royal Society. Ms Jongsma and Dr Jones are funded by the National Institute of Health Resea...
Published on Sep 1, 2017in Neuropharmacology4.37
Robin M. Murrayand143
Estimated H-index: 143
('KCL': King's College London),
Amir Englund6
Estimated H-index: 6
('KCL': King's College London)
+ 6 AuthorsDeepak Cyril D'Souza2
Estimated H-index: 2
(Yale University)
Abstract Prospective epidemiological studies have consistently demonstrated that cannabis use is associated with an increased subsequent risk of both psychotic symptoms and schizophrenia-like psychoses. Early onset of use, daily use of high-potency cannabis, and synthetic cannabinoids carry the greatest risk. The risk-increasing effects are not explained by shared genetic predisposition between schizophrenia and cannabis use. Experimental studies in healthy humans show that cannabis and its acti...
Published on Aug 1, 2017in The Lancet Psychiatry18.33
Amir Englund6
Estimated H-index: 6
('KCL': King's College London),
Tom P. Freeman20
Estimated H-index: 20
(UCL: University College London)
+ 1 AuthorsPhilip McGuire105
Estimated H-index: 105
('KCL': King's College London)
Summary Cannabis use and related problems are on the rise globally alongside an increase in the potency of cannabis sold on both black and legal markets. Additionally, there has been a shift towards abandoning prohibition for a less punitive and more permissive legal stance on cannabis, such as decriminalisation and legalisation. It is therefore crucial that we explore new and innovative ways to reduce harm. Research has found cannabis with high concentrations of its main active ingredient, δ-9-...
Published on Mar 1, 2017in Addiction6.85
Michelle Taylor12
Estimated H-index: 12
(UoB: University of Bristol),
John T. Sullivan27
Estimated H-index: 27
+ 2 AuthorsMatthew Hickman59
Estimated H-index: 59
(UoB: University of Bristol)
Aims We investigate the extent of and factors associated with denial of previously reported cannabis and other illicit drug use, and assess the potential of hair testing for measuring substance use in general population samples. Design Birth cohort study. Setting United Kingdom, 1991–present. Participants A total of 3643 participants who provided hair and self-report measures of cannabis and other illicit drug use in the Avon Longitudinal Study of Parents and Children (ALSPAC) at age 18 years. M...
Published on Nov 1, 2016in Translational Psychiatry5.18
Claire Mokrysz9
Estimated H-index: 9
(UCL: University College London),
Tom P. Freeman20
Estimated H-index: 20
(UCL: University College London)
+ 2 AuthorsHv Curran22
Estimated H-index: 22
(UCL: University College London)
Are adolescents more vulnerable to the harmful effects of cannabis than adults? A placebo-controlled study in human males
Published on Oct 1, 2016in Addiction6.85
Wayne Hall87
Estimated H-index: 87
(UQ: University of Queensland),
Michael T. Lynskey85
Estimated H-index: 85
('KCL': King's College London)
Background and aims Since 2012 four US states have legalized the retail sale of cannabis for recreational use by adults, and more are likely to follow. This report aimed to (1) briefly describe the regulatory regimes so far implemented; (2) outline their plausible effects on cannabis use and cannabis-related harm; and (3) suggest what research is needed to evaluate the public health impact of these policy changes. Method We reviewed the drug policy literature to identify: (1) plausible effects o...
Cited By14
Newest
Published on 2019in BMC Medicine8.29
Luke Sheridan Rains2
Estimated H-index: 2
(UCL: University College London),
Louise Marston26
Estimated H-index: 26
(UCL: University College London)
+ 7 AuthorsJonathan Spencer1
Estimated H-index: 1
('KCL': King's College London)
Background Cannabis is the most commonly used illicit substance amongst people with psychosis. Continued cannabis use following the onset of psychosis is associated with poorer functional and clinical outcomes. However, finding effective ways of intervening has been very challenging. We examined the clinical and cost-effectiveness of adjunctive contingency management (CM), which involves incentives for abstinence from cannabis use, in people with a recent diagnosis of psychosis.
Published on Oct 1, 2019in Current Psychiatry Reports3.82
Simona A. Stilo13
Estimated H-index: 13
,
Robin M. Murrayand143
Estimated H-index: 143
Published on 2019in Acta Psychiatrica Scandinavica4.69
Esther Setién-Suero3
Estimated H-index: 3
,
Karl David Neergaard2
Estimated H-index: 2
(AMU: Aix-Marseille University)
+ 4 AuthorsRosa Ayesa-Arriola14
Estimated H-index: 14
Published on Oct 1, 2019in World Psychiatry34.02
Craig Morgan (Economic and Social Research Council), Gemma Knowles (Economic and Social Research Council), Gerard Hutchinson34
Estimated H-index: 34
(UWI: University of the West Indies)
Alkomiet Hasan29
Estimated H-index: 29
,
Rupert von Keller1
Estimated H-index: 1
+ 6 AuthorsEva Hoch2
Estimated H-index: 2
Published on Sep 19, 2019in Psychological Medicine5.64
Diego Quattrone8
Estimated H-index: 8
,
Alexander Richards21
Estimated H-index: 21
+ 4 AuthorsM. Di Forti34
Estimated H-index: 34
Published on 2019in Addiction6.85
Emese Kroon1
Estimated H-index: 1
(UvA: University of Amsterdam),
Lauren Kuhns1
Estimated H-index: 1
(UvA: University of Amsterdam)
+ 1 AuthorsJanna Cousijn17
Estimated H-index: 17
(UvA: University of Amsterdam)
Published on Sep 1, 2019in Trends in Neurosciences12.31
Urs A. Meyer88
Estimated H-index: 88
(UZH: University of Zurich)
Maternal immune activation (MIA), be it triggered by infectious or noninfectious stimuli, is implicated in various psychiatric and neurological disorders with developmental etiologies. Its consequences on the offspring’s mental health are heterogeneous and influenced by a number of factors shaping the specificity and/or severity of pathological outcomes. There is also a substantial degree of resilience to MIA, which determines the extent to which offspring are protected from developing neurodeve...
Published on Jun 5, 2019in JAMA Psychiatry15.92
David W. Volk24
Estimated H-index: 24
(University of Pittsburgh),
David A. Lewis103
Estimated H-index: 103
(University of Pittsburgh)
View next paperPatterns of cannabis use and prospective associations with health issues among young males.