Identifying risk-thresholds for the association between frequency of cannabis use and development of cannabis use disorder: A systematic review and meta-analysis

Tessa Robinson; Muhammad Usman Ali; Bethany Easterbrook; Stephanie Coronado-Montoya; Dimitri Daldegan-Bueno; Wayne Hall; Didier Jutras-Aswad; Benedikt Fischer

doi:10.1016/j.drugalcdep.2022.109582

Identifying risk-thresholds for the association between frequency of cannabis use and development of cannabis use disorder: A systematic review and meta-analysis

Drug Alcohol Depend. 2022 Sep 1:238:109582. doi: 10.1016/j.drugalcdep.2022.109582. Epub 2022 Jul 21.

Authors

Tessa Robinson¹, Muhammad Usman Ali², Bethany Easterbrook³, Stephanie Coronado-Montoya⁴, Dimitri Daldegan-Bueno⁵, Wayne Hall⁶, Didier Jutras-Aswad⁴, Benedikt Fischer⁷

Affiliations

¹ Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
² Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, Ontario, Canada.
³ Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada; MacDonald-Franklin Operational Stress Injury Research Centre, London, Ontario, Canada.
⁴ Department of Psychiatry and Addictology, Université de Montréal, Montréal, Quebec, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec, Canada.
⁵ Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada.
⁶ National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Queensland, Australia; National Addiction Centre, Institute of Psychiatry, Kings College London, United Kingdom.
⁷ Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada; School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand; Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil. Electronic address: bfischer@sfu.ca.

PMID: 35932748
DOI: 10.1016/j.drugalcdep.2022.109582

Abstract

Background: Cannabis use disorder (CUD) affects one-in-five cannabis users, presenting a major contributor to cannabis-associated disease burden. Epidemiological data identify the frequency of cannabis use as a risk factor for CUD. This review aimed to determine quantifiable risk-thresholds of the frequency of cannabis use for developing CUD.

Methods: Systematic search of Medline, EMBASE, PsycInfo, CINAHL, and Web of Science for cohort/case-control studies that assessed the association between frequency of cannabis use and CUD from 2000 to 2022. Effect estimates were converted to risk ratios (RR). A random-effects multi-level multivariate meta-analytic approach was utilized, and sensitivity analyses conducted. Quality of included studies was assessed with the Newcastle Ottawa Scale.

Results: Six prospective cohort studies were included in this review, drawn from two main source studies. Random-effect modeling showed a significant log-linear dose-response association between the frequency of cannabis use and CUD risk (p < 0.0001). The risk of CUD increased from RR:2.03 (95% CI:1.85-2.22) for 'yearly' use, to RR:4.12 (95% CI:3.44-4.95) for 'monthly" use, RR:8.37 (95% CI:6.37-11.00) for 'weekly' use, and RR:16.99 (95% CI:11.80-24.46) for 'daily' use. Multi-level modeling showed an absolute risk increase (ARI) from 3.5% (95% CI:2.6-4.7) for 'yearly' use, to 8.0% (95% CI:5.3-12.1) for 'monthly' use, to 16.8% (95% CI:8.8-32.0) for 'weekly' use, and 36% (95% CI:27.047.9) for 'daily' use.

Conclusion: A limited risk of CUD as a potential outcome of cannabis use exists even at infrequent levels of use, but significantly increases as frequency of use increases. Corresponding information should be conveyed to cannabis users as part of targeted prevention messaging to promote safer cannabis use.

Keywords: Cannabis; Cannabis use disorder; Dose-response; Meta-analysis; Risk-thresholds; Systematic review.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Cannabis* / adverse effects
Cohort Studies
Humans
Marijuana Abuse* / epidemiology
Prospective Studies
Risk Factors