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Marijuana Use among High-Risk Mothers in Washington State

Principal Investigator:
Therese M. Grant, PhD
Professor
Psychiatry and Behavioral Sciences

Date: March 1, 2016 to June 30, 2016
Sponsor: Dedicated Marijuana Fund
Categories: Marijuana | Pregnancy and Alcohol / Drugs

Other Investigators: Chris Graham, Bia Carlini, Cara Ernst, Natalie Novick Brown


Description: This study examined how legalization affected alcohol and drug use in a sample of pregnant and parenting women with substance use disorders. Data source: Exit interviews from a three-year case management intervention program (Parents and Child Assistance Program - PCAP) from nine counties in Washington State. The sample (N = 1,359) was divided into two cohorts based on whether participants had completed the program before or after legalization. Results: Most study participants reported complete abstinence from alcohol and non-prescription drugs at program exit. Among those who were still using substances, women who completed the intervention after marijuana legalization were significantly more likely to report marijuana use at program exit compared to women who completed before legalization. Across both cohorts (pre- and post-legalization), we found a positive association of exit marijuana use with alcohol, illegal methadone, other opioids, amphetamines, and cocaine use; after controlling for historical period, marijuana use at PCAP exit increased significantly after marijuana legalization in the state. Women who were not abstinent from marijuana at program exit were likely to report use of other substances as well. Our study design demonstrates an association but does not allow us to conclude that marijuana use leads to other substance use among this sample of women with a history of poly-substance use. Results add to the preliminary body of literature on how legalization of marijuana affects substance use in specific populations.

Results: Grant TM, Graham JC; Carlini BH; Ernst CC; Brown NN. Use of marijuana and other substances among pregnant and parenting women with substance use Disorders: Changes in Washington State after marijuana legalization. Journal of Studies on Alcohol and Drugs 2018;79(1):88-95. doi: 10.15288/jsad.2018.79.88.

Medical Cannabis in HIV-positive Substance Users

Principal Investigator:
Howard Newville, PhD
Research Consultant
Alcohol and Drug Abuse Institute
Center for AIDS Research)

Date: March 1, 2016 to June 30, 2016
Sponsor: Dedicated Marijuana Fund
Categories: Marijuana | HIV/AIDS


Description: Recreational cannabis use has been associated with other substance use and decreased antiretroviral therapy (ART) adherence among people living with HIV (PLWH), but the effect of medical cannabis is unknown. We examined substance use and ART adherence in PLWH, comparing medical, recreational, and non-cannabis users. Out of 294 participants, 84 (63%) reported medical cannabis use, while 50 (37%) acknowledged recreational use. Recreational cannabis users were more likely to use a variety of substances than medical and non-cannabis users. They had greater alcohol and drug use severity than non-cannabis users, while medical cannabis users did not differ from non-cannabis users. Recreational cannabis users also had lower rates of ART adherence than non-cannabis users and medical cannabis users, who did not differ from each other. Controlling for substance use severity and age, ART nonadherence was associated with recreational cannabis use, while medical cannabis users did not differ from non-cannabis users. PLWH who use medical cannabis may have different substance use and ART adherence patterns than recreational cannabis users, indicating they are distinct groups. It is important to learn more about the specific reasons for cannabis use and their benefits and consequences to more precisely focus HIV treatments.

Results: Newville H & Sorensen JL Substance use and antiretroviral adherence in medical, recreational, and non-users of cannabis. Manuscript in preparation.

Multi-State Examination of Cannabis Use Disorder Rates in HIV Care

Principal Investigator:
Bryan Hartzler, PhD
Senior Research Scientist
Alcohol and Drug Abuse Institute

Date: March 1, 2016 to June 30, 2016
Sponsor: Marijuana Dedicated Fund
Categories: Marijuana | HIV/AIDS


Description: A Center for AIDS Research Network of Integrated Clinical Systems cohort (N=10,652) of HIV-positive adults linked to care at seven United State sites, including Seattle, was examined. Based on a patient-report instrument, the prevalence of recent cannabis use and corresponding conditional probabilities for Cannabis Use Disorder (CUD) were calculated for the aggregate sample and demographic subgroups. Conditional probability of CUD among cannabis-using patients was 49%, with the highest conditional probabilities among demographic subgroups of young adults and those with non-specified sexual orientation (67-69%) and the lowest conditional probability among females and those 50+ years of age (42% apiece). Similarly, youthful age and male gender emerged as robust multivariate model predictors of CUD. In the context of increasingly lenient policies for use of cannabis as a therapeutic agent for chronic conditions like HIV/AIDS, current study findings offer needed direction in terms of specifying targeted patient groups in HIV care on whom resources for enhanced surveillance and intervention efforts will be most impactful.

Results: Hartzler B, Carlini BH, Newville H, Crane HM, Eron JJ, Elvin H. Geng EH, Mathews WC, Mayer KH, Moore RD, Mugavero MJ, Napravnik S, Rodriguez B, Donovan DM. Identifying HIV care enrollees at-risk for cannabis use disorder. AIDS Care 2017;29(7):846-850.

Comparative Examination of Cannabis Use Disorder as a Risk Factor in HIV Care

Principal Investigator:
Bryan Hartzler, PhD
Senior Research Scientist
Alcohol and Drug Abuse Institute

Date: March 1, 2017 to June 30, 2017
Sponsor: Dedicated Marijuana Fund
Categories: Marijuana | HIV/AIDS


Description: A Center for AIDS Research Network of Integrated Clinical Systems cohort (N=9,153) of HIV+ patients linked to care at seven U.S. settings, including Seattle, was examined. Patient-report surveys were used to delineate the cohort as follows: cannabis abstainers, cannabis users without Cannabis Use Disorder (CUD), and cannabis users with CUD. Generalized estimating equations examined two-year care continuity, comparing these cannabis groups and testing effect modification by established CUD predictors (i.e., age-group, sex, care setting, assessment timing). Supplemental analyses explored group rates of concurrent risky use of other substances. Findings include: 1) a group effect, with 68% care continuity among cannabis users with CUD vs. 73% among cannabis abstainers; 2) effect modification by age-group and assessment timing, with lower care continuity rate among 18-29 year-old cannabis users with CUD than same-age counterparts (56% vs. 67-69%) and greater historical reliability in assessment of their poor care continuity; and 3) cannabis use as a correlate of risky tobacco use, and CUD as a correlate of risky tobacco and alcohol use. Taken together, findings distinguish CUD—and not cannabis use per se—as a risk to care continuity, and underscore a need for diagnostic assessment and polysubstance screening in surveillance efforts.

Results: Hartzler B, Carlini BH, Williams JR, Crane HM, Eron JJ, Elvin H. Geng EH, Mathews WC, Mayer KH, Moore RD, Mugavero MJ, Napravnik S, Rodriguez B, & Donovan DM. Cannabis as a Risk Factor to HIV Care Continuity in the United States. Manuscript submitted to AIDS Care.


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