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A Six-Year Follow-up of People Who Use Cannabis in Iran – A Case Series

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Official websites use. Share sensitive information only on official, secure websites. Frequent cannabis use is associated with adverse health-related outcomes. This study followed up individuals who used cannabis to assess their use and adverse event status. The eligible individuals, recruited in the Iranian Mental Health Survey IranMHS , were contacted via telephone calls six years after the index interview. The frequency of cannabis use and the occurrence of selected adverse events were recorded. The baseline status was extracted from the index survey. Of the 50 eligible individuals all male , two had died. Moreover, from among 25 reached participants, 19 reported abstinence from cannabis in the past year, and 18 reported at least one adverse event in the past six years. Violence and imprisonment were the most common events reported. Six years after the index interview, most of the participants abstained from cannabis. Besides, adverse events were common, emphasizing the need for further investigations on larger samples of cannabis users. Globally, an estimated million people used cannabis in , making cannabis the most common substance used worldwide. There are serious health consequences associated with non-medical cannabis use and use disorder. Cannabis use disorder is associated with other psychiatric disorders, low birth weight, motor vehicle injuries, and bronchitis. This study is a part of the six-year follow-up project of those who used drugs in the IranMHS study. The eligible participants were contacted primarily via telephone. In case of non-response, alternative methods, including sending an invitation letter, were used. Two psychologists were trained to obtain verbal consent and conduct the interview once they ensured the interviewee was the same person as the baseline survey. The vital status of those who did not respond, including those whose family members reported their death, was verified using the registry of deaths of the National Organization for Civil Registration and the Ministry of Health and Medical Education. Baseline sociodemographic characteristics, the diagnoses of substance use disorders and other primary psychiatric comorbidities, and the frequency of cannabis use in the past year were derived from the IranMHS. A short questionnaire was developed for the telephone interview, which included questions regarding current sociodemographic characteristics, the frequency of cannabis use in the past year , and non-fatal health-related adverse events in the past six years. The frequency of cannabis use was recorded as almost daily, three to four days per week, one to two days per week, one to three days per month, and less than once per month, similarly both in the baseline and the follow-up. The investigated adverse health-related events were any history of suicide attempt, imprisonment, homelessness, non-fatal overdose due to any illicit drug use , traffic accident, and violence. Serious non-fatal overdose, traffic accident, and violence were included if they had led to an emergency department admission or involvement of the judiciary system. At the index interview, the participants were all male with a mean age of The majority of the participants had high-school education Among them, From all 50 participants, two had not permitted re-contact. Moreover, two cases were dead at the follow-up; one aged 60 years and reported almost daily cannabis use without any use disorder and died 44 months after the IranMHS due to hepatic disease and the other aged 38 years and was diagnosed with cannabis and other drug use disorder who died due to an accident contact with hot gases 26 months after the baseline survey. Figure 1 presents the reasons for the non-inclusion. Follow-up time for the respondents ranged from 6. The individual characteristics of the respondents and deceased cases are presented in Table 1. Two married participants were divorced in the follow-up and two employed individuals became unemployed. The flow chart for identification of eligible cases and summary of health-related adverse events. An event was defined as serious if it had led to an emergency department admission or involvement of the judiciary system. The data on the self-reported frequency of cannabis use in the baseline was missing for one participant. In the follow-up survey, nineteen cases reported cannabis abstinence in the past year. Six other individuals, of whom five were diagnosed with cannabis use disorder at baseline, reported continued cannabis use. Of the 25 participants, 18 individuals reported at least one adverse health-related event, while six cases experienced three or more adverse events in the past six years. The most prevalent event was violence, reported among 12 individuals, of which half were in serious forms. Eleven participants reported a history of imprisonment, seven reported overdose, and seven reported traffic accidents. Five individuals attempted suicide, and two individuals experienced homelessness in the past six years. Two deaths were detected in the follow-up period; one due to a non-traffic accident and the other due to hepatic disease. Diminished motor coordination and injuries have been linked to immediate and long-term cannabis use. Regarding the frequency of cannabis use, most of the participants reported at least weekly use in the past year in the baseline survey. Six years later, the majority of the respondents reported cannabis abstinence in the past year. High rates of abstinence and remission have been reported in another follow-up survey of a representative sample of general population adults with cannabis use disorder. The participants with continued use of cannabis were also found, almost all having been diagnosed with cannabis use disorder in the baseline. However, the presence of cannabis use disorder was not assessed in the follow-up interview. In a study among male adolescents followed up to adulthood, four different trajectories have been defined. In another prospective study on those with cannabis use disorder recruited from treatment centers, although recovery has been reported among the majority of the participants, one-third of the cases continued their cannabis use for more than seven years. Further studies are required to elucidate the natural course of both those with cannabis use and use disorder in the country. Two-thirds of the participants experienced at least one health-related adverse event in the past six years, with one-third experiencing three or more adverse events. Half of the individuals reported violence in the follow-up period, which seems a high rate compared to the estimated prevalence of violence among the Iranian general population as 1. Violence has been associated with cannabis use in previous studies, 21 more notably among those with heavy use. Incarceration was the second most common adverse event in the follow-up interview. It has also been reported in other studies that legal involvement was significantly higher among those with cannabis use disorder than those with no drug use disorder. Additionally, a noteworthy number of cases reported other adverse health events. In other studies, the association of cannabis use has been highlighted with suicide, 25 unemployment, 12 , 26 and traffic accidents. More studies are also needed to understand better the high rates of polydrug use among those with cannabis use in this study. Moreover, it seems that those with a higher number of adverse events belonged to low socioeconomic status and were mostly unemployed in the follow-up study, signifying the role of other covariates. Several limitations should be considered in the interpretation of the results. First, a relatively small sample of people who used cannabis more than five times in the past year at baseline and an inevitably high rate of drop-out at the follow-up make us unable to draw a strong conclusion. Second, we entirely missed the female subgroup who might have different patterns of cannabis use and health-related problems. Fourth, as the follow-up was conducted via telephone calls, the presence of use disorder was not assessed. Fifth, there could be under or over-reporting of outcomes due to the self-reporting nature of the measurements. Finally, regarding the length of the follow-up period, recall bias could exist. This study indicated the follow-up outcomes of individuals with cannabis use recruited from the general population. A high rate of health-related adverse events was found among the participants, requiring further investigations. Furthermore, although most individuals reported cannabis abstinence in the past year, some cases reported continued cannabis use. Future health measures for education regarding harms associated with cannabis use, case identification, and care should be implemented. Finally, as the number of cases was limited, no causal associations would be inferred. Future studies are needed to assess the outcomes of a higher number of those who use only cannabis. The Tehran University of Medical Sciences supported this research under the code The funding source had no role in the study design, implementation, analysis, interpretation of the data, and the writing of the manuscript. We would like to extend our appreciation to Marziyeh Hamzehzadeh. A six-year follow-up of people who use cannabis in Iran — A case series. Addict Health. As a library, NLM provides access to scientific literature. Find articles by Yasna Rostam-Abadi. Find articles by Masoumeh Amin-Esmaeili. Find articles by Shahab Baheshmat. Find articles by Ardavan Mohammad Aghaei. Find articles by Jaleh Gholami. Find articles by Afarin Rahimi-Movaghar. Open in a new tab. Competing Interests The authors have no conflict of interest. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. IranMHS Follow-up High school. Cannabis use. Overdose; Traffic accident; Violence. Middle school. South Khorasan. Never married. Almost daily. Suicide attempt; Imprisonment; Homelessness; Overdose; Violence. Imprisonment; Violence. Retired; Employed. Cannabis use; Opioid UD. Mood disorder. Less than once per month. Traffic accident. Razavi Khorasan. Psychotic disorder. Suicide attempt; Overdose; Violence. Cannabis use; Alcohol UD. Traffic accident; Violence. East Azarbayjan. Cannabis use; Stimulant UD. Suicide attempt; Overdose. Overdose; Traffic accident. Overdose; Violence. Sistan and Balochestan. Mood and anxiety disorder. Suicide attempt; Imprisonment; Overdose; Traffic accident; Violence. Anxiety disorder. Imprisonment; Homelessmess; Traffic accident; Violence. Suicide attempt; Imprisonment; Traffic accident; Violence. West Azarbayjan. Death Hepatic disease; 44 months d. High scool. Death; Non-traffic accident; 26 months d.

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