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. 2023 May 1;6(5):e2311294.
doi: 10.1001/jamanetworkopen.2023.11294.

Nondisordered Cannabis Use Among US Adolescents

Ryan S Sultan  1   2   3 , Alexander W Zhang  1   2 , Mark Olfson  1   2   4 , Muhire H Kwizera  1   2 , Frances R Levin  1   2
Affiliations

Nondisordered Cannabis Use Among US Adolescents

Ryan S Sultan et al. JAMA Netw Open. .

Abstract

Importance: Cannabis use is increasingly viewed by adolescents as not harmful. Youths with cannabis use disorder (CUD) are recognized by clinicians as being at risk for adverse outcomes, yet little is known about the associations between subclinical cannabis use (ie, nondisordered cannabis use [NDCU]) and adverse psychosocial events.

Objective: To describe the prevalence and demographics of NDCU and to compare associations of cannabis use with adverse psychosocial events among adolescents with no cannabis use, NDCU, and CUD.

Design, setting, and participants: This cross-sectional study used a nationally representative sample derived from the 2015 to 2019 National Survey on Drug Use and Health. Participants were adolescents aged 12 to 17 years, separated into 3 distinct groups: nonuse (no recent cannabis use), NDCU (recent cannabis use below diagnostic threshold), and CUD. Analysis was conducted from January to May 2022.

Exposures: CUD, NDCU, or cannabis nonuse. NDCU was defined as endorsing recent cannabis use but not meeting the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) CUD criteria. CUD was defined using DSM-5 criteria.

Main outcomes and measures: The main outcomes were prevalence of adolescents meeting criteria for NDCU and associations between adverse psychosocial events and NDCU, adjusted for sociodemographic characteristics.

Results: The 68 263 respondents (mean [SD] age, 14.5 [1.7] years; 34 773 [50.9%] males) included in the analysis represented an estimated yearly mean of 25 million US adolescents during 2015 to 2019. Among respondents, 1675 adolescents (2.5%) had CUD, 6971 adolescents (10.2%) had NDCU, and 59 617 adolescents (87.3%) reported nonuse. Compared with nonusers, individuals with NDCU had approximately 2 to 4 times greater odds of all adverse psychosocial events examined, including major depression (adjusted odds ratio [aOR], 1.86; 95% CI, 1.67-2.08), suicidal ideation (aOR, 2.08; 95% CI, 1.88-2.29), slower thoughts (aOR, 1.76; 95% CI, 1.58-1.96), difficulty concentrating (aOR, 1.81; 95% CI, 1.65-2.00), truancy (aOR, 1.90; 95% CI, 1.67-2.16), low grade point average (aOR, 1.80; 95% CI, 1.62-2.00), arrest (aOR, 4.15; 95% CI, 3.17-5.43), fighting (aOR, 2.04; 95% CI, 1.80-2.31), and aggression (aOR, 2.16; 95% CI, 1.79-2.62). Prevalence of adverse psychosocial events was greatest for adolescents with CUD (range, 12.6% to 41.9%), followed by NDCU (range, 5.2% to 30.4%), then nonuse (range, 0.8% to 17.3%).

Conclusions and relevance: In this cross-sectional study of US adolescents, past-year NDCU was approximately 4 times as prevalent as past-year CUD. A stepwise gradient association was observed for odds of adverse psychosocial events between adolescent NDCU and CUD. In the context of US normalization of cannabis use, prospective research into NDCU is necessary.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Levin reported receiving grants from the National Institute on Drug Abuse (NIDA), Substance Abuse and Mental Health Services Administration (SAMSHA), National Center for Advancing Translational Sciences (NCATS), US World Meds, and Aelis Pharmaceuticals and personal fees from Major League Baseball and the American Psychological Association outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Prevalence of Adverse Adolescent Psychosocial Events Among Nonuse, Nondisordered Cannabis Use, and Cannabis Use Disorder Groups
Data are from the 2015 to 2019 National Surveys on Drug Use and Health. GPA indicates grade point average.
Figure 2.
Figure 2.. Mean Number of Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) Cannabis Use Disorder Criteria Met by Degree of Adolescent Cannabis Use
See this image and copyright information in PMC

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