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Official websites use. Share sensitive information only on official, secure websites. Address correspondence to Jan A. Lindsay, Ph. Lindsay uth. Marijuana is the most commonly used illicit substance, yet among the least studied in medication development research. Cocaine-dependent individuals frequently also use marijuana; however, little is known about the effect of this combined use on treatment presentation. Marijuana use was assessed in individuals seeking outpatient treatment for cocaine dependence. Differences on baseline measures of substance use, addiction severity ASI , psychopathology, and sociodemographic characteristics were examined as a function of level of marijuana use. Frequent marijuana users were more likely to be female, Caucasian, and younger than other groups. Cocaine-dependent patients with frequent marijuana use also used more cocaine and alcohol, and reported more medical, legal, and psychiatric problems, including antisocial personality disorder. Cocaine-dependent patients with frequent marijuana use present for treatment with more severe impairment. Accounting for this heterogeneity among participants may improve treatment outcome. Keywords: Clinical treatment trial, cocaine dependence, dual substance abuse, marijuana. Marijuana is the most commonly used illicit substance in the general population and among cocaine users 1 — 4. Marijuana use is highly salient in the context of substance dependence not only because of its prevalence but also because of its unpredictable effects when used in combination with other drugs 9. The pervasive and devastating effects of cocaine dependence are well documented. More recently, the serious consequences of chronic marijuana use have been established. On its own, frequent marijuana use can lead to interpersonal difficulties, decreased motivation, cognitive impairment, respiratory and cardiovascular disease, and an increased risk of use of other substances 1 , 10 — Exactly how the effects of marijuana interact with the negative health and psychosocial effects of chronic cocaine use is unclear; however, there is evidence suggesting an exacerbation of consequences when using both drugs together 14 , For example, Budney et al. Human studies of the interaction of cocaine and marijuana have shown that combining the two drugs increases absorption of cocaine, and raises heart rate and blood pressure 17 , Thus, cocaine-marijuana users may engage in heavier or more frequent drug use in order to seek these desired behavioral and subjective effects. In general, polydrug use is associated with poorer treatment outcome than single drug use 20 , but results of studies specifically examining the impact of concurrent marijuana use on cocaine treatment outcome are mixed. Two studies reported adverse effects of continued marijuana use on risk of cocaine use or relapse 6 , 21 , while two other studies found a positive association between concurrent marijuana use and treatment retention 5 , Others have failed to find an association between marijuana use and treatment outcome of cocaine dependence 16 , Marijuana use and dependence, while not exclusionary in most cocaine clinical trials, may introduce an important source of population heterogeneity. Thus, initial research is needed to understand the potentially important differences among groups of cocaine users with and without concurrent marijuana use. The present study focused on concurrent use of marijuana and its relation to the clinical profile of cocaine dependent individuals, including sociodemographics, substance use, and psychosocial variables. The extent to which cocaine dependent individuals used marijuana was expected to be related to the severity of their clinical presentation, with more frequent marijuana users showing the greatest impairment. Participants were consecutive admissions to behavioral and pharmacological treatment studies for cocaine dependence conducted at the Treatment Research Clinic TRC in Houston, Texas. Subjects were cocaine-dependent, English-speaking, between the ages of 18 and 60, able to participate in 12 weeks of outpatient treatment, and competent to give informed consent. Individuals were excluded if they met diagnostic criteria for current DSM-IV substance dependence except nicotine, cannabis and cocaine or Axis I disorders, used psychotropic medications, or experienced unstable or serious medical illnesses. Subjects took part in a two-week intake evaluation process to determine study eligibility, which included a physical examination, laboratory work-up, and a structured clinical interview for DSM-IV diagnoses. Most were African American Reported use of cocaine in the 30 days prior to treatment was The majority of subjects Author-constructed forms were used to collect sociodemographic and drug history information. Interviewers underwent standard ASI training procedures and received ongoing supervision. ASI composite severity scores were calculated. All Axis I modules and the three Axis II modules for antisocial, borderline, and dependent personality disorder were administered. As recommended, a series of practice interviews was performed to enhance interrater reliability before beginning interviews with study participants. Provisional SCID-based diagnoses were confirmed by the study psychologist or psychiatrist. Ninety-five percent of subjects in this cocaine-dependent sample reported ever having used marijuana. This classification system demonstrated convergent validity with intake urine screen results. Percentage of marijuana positive screens was Additionally, frequent users were more likely to meet current marijuana dependence criteria Tukey tests were used to control for Type I error in post hoc pairwise comparisons. Conversely, examining the prediction of marijuana group status by salient baseline variables employed logistic regression. Table 1 presents the sociodemographic characteristics across levels of concurrent marijuana use. Gender differences indicated a higher proportion of women than men in the frequent using group only. For race, group differences indicated a higher proportion of Caucasians than African-Americans or Hispanics in the frequent using group. Age differences were found as well, with the frequent using group younger than the occasional and non-using groups. The frequent using group had higher ASI severity scores on the alcohol, drug, psychiatric, and legal scales compared to occasional and non-users. In contrast, the frequent using group had lower severity scores on the employment subscale. They were more likely to be employed than the occasional and non-users. Odds of membership in frequent versus occasional using groups was computed by binary logistic regression. Calculation of this variable included ASI item used to define marijuana group. Table 2 presents the substance use characteristics across level of concurrent marijuana use. Compared to non-users and occasional users, those in the frequent using group reported more recent days using cocaine and alcohol. Frequent users reported an earlier age of first use of cocaine than occasional users and reported more intranasal use of cocaine than occasional users. Among users of marijuana, frequent users were more likely to perceive marijuana as a problem but rated their desire to quit using marijuana lower than occasional users. By study protocol, eligible subjects met DSM-IV criteria for cocaine dependence and did not meet criteria for current dependence on alcohol, sedatives, opioids, or hallucinogens. Frequent marijuana users were more likely to have current and lifetime cannabis use disorders. As shown in Table 3 no differences were found on lifetime diagnoses of alcohol abuse or dependence. The proportion of subjects meeting criteria for lifetime abuse of hallucinogens and opioids was highest among the frequent using group. Of the Axis II disorders assessed, differences were found for the diagnosis of Antisocial Personality Disorder ASPD with the frequent using group more likely to meet criteria for this disorder compared to occasional users. Occasional users met ASPD criteria more often than non-users. The large percentage Overall, findings support our hypothesis that frequent concurrent marijuana users present with a distinct clinical profile. In most comparisons, between-group effects were driven by greater differences between frequent users and the other groups. Key points from this study are summarized below. Concurrent marijuana is associated with problem severity in cocaine-dependent patients, a finding that is consistent with other studies documenting the negative consequences of using cocaine in combination with other drugs, including alcohol 27 , 28 and opioids 29 , We found that frequent users of marijuana showed a pattern of greater impairment, exemplified by more severe ASI scores and heavier patterns of drug use. These individuals present for treatment with heavier recent use of marijuana, cocaine, and alcohol. Level of marijuana use is positively related to length of time using cocaine earlier onset and likelihood of meeting lifetime abuse or dependence criteria for other substances. In this sample, frequent marijuana users were also more likely to meet criteria for ASPD compared to less frequent marijuana using patients. Together, these results, along with those reported previously suggest increased risk of psychopathology among cocaine dependent patients with a higher frequency of marijuana use 16 , Marijuana was more likely to be perceived as a problem in the frequent using group; however, this group rated their desire to quit using marijuana as lower than less frequent users. Compared to cocaine, marijuana tends to be associated with more ambivalence about quitting and lower readiness to quit 25 , 32 , Levin et al. Gender differences found here are consistent with SAMHSA data showing that a higher percentage of women cite marijuana as a secondary drug of abuse 2. In epidemiological and treatment studies of marijuana as a primary drug of abuse, men have been overrepresented 3 , 34 — Based on our results indicating that cocaine-dependent females versus males were more likely to be frequent users of marijuana, additional research targeting dual-drug-using women is needed. One of the strengths of this study is that findings are based on data collected from a large and well-defined sample of treatment-seeking cocaine dependent individuals. Grouping marijuana users according to frequency of use provided new information about how the level of concurrent use impacts clinical presentation. The lack of reliable differences between non-users and occasional users suggests that the clinically important feature is not whether or not cocaine patients use marijuana concurrently, but rather the extent to which they use marijuana. Further research on the temporal and functional relationship between cocaine and marijuana use, especially in the frequent using subgroup, is warranted. Additionally, we recommend that future studies employ a more fine-grained measurement of marijuana use to include amount in addition to frequency of use. While the present study advances our knowledge about marijuana use in the population of cocaine dependent individuals, outcome data are not yet available to assess whether differences found at baseline are meaningful predictors of outcome. Significant findings reported provide a starting point for generating hypotheses. Multiple substance use is common in cocaine patients and allowing for concurrent use of other drugs has been recommended to increase feasibility and generalizability of results However, the present findings strongly suggest that concurrent marijuana use should not go ignored or unmonitored in cocaine clinical trials. Future studies should assess differences in presenting clinical characteristics of marijuana-using cocaine dependent patients and consider the impact of these differences in evaluation of treatment outcomes. Declaration of Interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article. Jan A. Angela L. Charles E. Joy M. As a library, NLM provides access to scientific literature. Am J Drug Alcohol Abuse. Find articles by Jan A Lindsay. Angela L Stotts , Ph. Find articles by Angela L Stotts. Charles E Green , Ph. Find articles by Charles E Green. David V Herin , Ph. Find articles by David V Herin. Joy M Schmitz , Ph. Find articles by Joy M Schmitz. Open in a new tab. 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.

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According to the latest data from the Ministry of Health, alcohol and tobacco are still the most common drugs taken legally in Spain, followed by the illegal drugs, cannabis and cocaine. According to the report from the Spanish Observatory on Drugs and Addictions , Among illegal drugs, cannabis is by far the most widespread taken in Spain, and on the increase. One in 10 individuals has taken it at some time in their life, with cocaine ranking second. Meanwhile, amphetamine consumption has increased over the years The study also evaluated the prevalence according to sex, with men recording a higher rate of consumption for almost all psychoactive substances. In fact, a European study by the drug and addiction monitoring centre , which has collected data since and analyses wastewater from different cities in Europe , concluded that cocaine and cannabis were the drugs consumed most in Spanish cities. Substance abuse mostly begins at the ages of with tobacco, alcohol and cannabis before moving on to other drugs between the ages of 16 and When a person takes an addictive substance, it leads to self-administration when consumption becomes a primary need. The drug acts on brain circuits causing reward and pleasure, leading to compulsive consumption by the person, despite the negative physical, psychological and social consequences. There are also behavioural addictions such as those involving gambling, sex, video games and even mobile phones. The clinical effects are similar, but cerebral circuits are not stimulated directly by a substance and therefore severity and prevalence are less. There are three factors to consider when determining how harmful a substance is: brain toxicity, addictive capacity and epidemiological extent. Methamphetamine, for example, is one of the most toxic and addictive substances. Cocaine is similar, although it is not as toxic as methamphetamine; however, its use is more widespread. Cannabis is less toxic and addictive than both methamphetamine and cocaine, but is widely used by young people. It is estimated that a quarter of young people have taken this substance in the last year. Continued use of cannabis can lead to psychotic disorders, lung diseases, decreased intellectual performance, academic failure, increased road accidents and amotivational syndrome, which is a loss of interest in any subject or activity. Meanwhile, frequent use of cocaine can lead to a significant risk of cardiovascular pathologies, including myocardial infarction and cerebral vascular accidents. It can also cause psychotic disorders, hallucinations, especially kinaesthetic ones sensations within the body and a persecution complex. It can also lead to perforation of the nasal septum and malnutrition. In both cases, the greatest risk is chronic use leading to addiction. The only prudent alternative is regulation , which must be done according to scientific and health criteria; however, not all substances can be regulated in the same way. Regulating a substance means finding a balance between price and availability. For example, alcohol and tobacco are legal substances and are the most consumed drugs with the worst social costs compared to all others. We have received your information. Check your inbox, in a few moments you will receive a confirmation email. This link opens in a new tab. Navigation thread Home News Chronic consumption of cannabis and cocaine can cause psychotic disorders News. Related contents. Schizophrenia Addictions. Did you like this article? Related news. Name field required. Email field required. I have read and agree privacy policy. Thanks for your subscription! An error has occurred and we have not been able to send your data, please try again later.

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