Cannabis Use Need Not Meet Criteria for Use Disorder to Be Harmful to Adolescents

Cannabis use can affect memory, motivation, attention, and mental health. Adolescents are particularly susceptible to its effects due to critical brain development during this developmental stage. As more US states legalize cannabis, adolescents are increasingly perceiving it to be safe, compared with a decade ago. This study used data from the National Survey on Drug Use and Health to investigate the association of both cannabis use disorder (CUD) and non-disordered cannabis use (NDCU)* with adverse psychological events among US adolescents.

  • NDCU was found to be 4 times more prevalent than CUD. Youth with NDCU averaged meeting 0.5 DSM-5 CUD criteria, while those with CUD met an average of 3.5 criteria.
  • Both NDSU and CUD were associated with poor mental health, but the difference between the two was not significant.
  • NDCU was associated with difficulty concentrating (adjusted odds ratio [aOR], 1.8) and truancy (aOR, 2.4), compared with non-use; the odds were greater for those with CUD (aOR, 2.4 and 3.0, respectively).
  • NDCU was also associated with past-year arrests (aOR, 4.2) and the association was stronger among those with CUD (aOR, 10.5); both NDCU and CUD were associated with aggression when compared with non-use.

* CUD defined as meeting DSM-5 CUD criteria; NDCU defined as recent cannabis use that does not meet criteria for CUD.

Comments: This study suggests that cannabis use is potentially harmful for all adolescents, even when it does not meet criteria for a use disorder. This reinforces the importance of screening all adolescents for cannabis use. All cannabis use in adolescence should be taken seriously, particularly in this time of increasing legalization in the US, where attitudes towards cannabis use are becoming more positive and availability has increased.

Corey McBrayer, DO, MPH** & Darius A. Rastegar, MD

** 2022–23 Rich Saitz Editorial Intern & Grant Medical Center Addiction Medicine Fellow, OhioHealth.

Reference: Sultan RS, Zhang AW, Olfson M, et al. Nondisordered cannabis use among US adolescentsJAMA Netw Open. 2023;6(5):e2311294.

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