Cynthia Fontanella, PhD, on the Risks of Cannabis Use in Youth With Mood Disorders

In this podcast, Cynthia Fontanella, PhD, talks about her team’s study examining how cannabis use disorder impacts the risks of self-harm, suicide, and mortality in adolescents and young adults with mood disorders.

Additional resource:

• Fontanella CA, Steelesmith DL, Brock G, Bridge JA, Campo JV, Fristad MA. Association of cannabis use with self-harm and mortality risk among youths with mood disorders. JAMA Pediatr. Published online January 19, 2020. doi: 10.1001/jamapediatrics.2020.5494 

Cynthia Fontanella, PhD, is an associate professor in the Department of Psychiatry and Behavioral Health at Ohio State University's Wexner Medical Center in Columbus, Ohio. 

TRANSCRIPT:

Leigh Precopio:  Hello everyone and welcome to another installment of Podcasts360, your go‑to resource for medical news and clinical updates. I'm your moderator, Leigh Precopio, with Consultant360 Specialty Network.

As cannabis use becomes legalized in many parts of the United States and becomes more ingrained in our society, it is increasingly important to understand the impact of cannabis use among our nation's youth. Cannabis use disorder is known to be common among adolescents and young adults with mood disorders, but the relationship between cannabis use disorder and the risk of self‑harm and mortality in this population is not well understood.

In a recent study, researchers examined this relationship and found that cannabis use disorder is associated with an increased risk of self‑harm, suicide, and all‑cause mortality in youth aged 10 to 24 years with mood disorders.

Here to discuss the study findings further is lead study author Dr. Cynthia Fontanella, who is an associate professor in the Department of Psychiatry and Behavioral Health at Ohio State University's Wexner Medical Center. Thank you for taking the time to speak with me today.

To begin, could you discuss what prompted this research question?

Cynthia Fontanella:  I worked with adolescents and young adults with depression and bipolar disorder, and we noticed the high prevalence of cannabis use disorder. So we were curious about what the negative effects might be.

Leigh Precopio:  Why did you decide to focus on cannabis use for this age group rather than older adults with mood disorders?

Cynthia Fontanella:  Well there's very little known about the effects of cannabis use in adolescents and young adults. Most of the research is done on adults which is why we decided to focus on adolescents and young adults.

Leigh Precopio:  Was the frequency of cannabis use or age of first consumption factors in your findings? Did any other patient characteristic such as type of mood disorder, gender, or race play a role in your results?

Cynthia Fontanella:  We looked at age, adolescents and young adults. We found that older age, 14 vs 18 compared to 10 to 13, was significantly associated with having a cannabis use disorder.

Male sex and Black race was associated with having a cannabis use disorder and other factors, such as bipolar disorder, prior history of self‑harm, and previous outpatient mental health visits. We only looked at cannabis use disorder. We didn't look at frequency of cannabis use.

Leigh Precopio:  The results indicated that cannabis use and cannabis use disorder are associated with higher risks of self‑harm, overall mortality, death by unintentional overdose, and homicide in this patient population. How do you believe this finding will impact clinical practice?

Cynthia Fontanella:  One of the things that I wanted to touch on was why cannabis use is a risk factor for self‑harm and mortality in youths. One of the reasons for this is that cannabis use is associated with greater impulsivity, poor judgment, and clouded thinking. It can also have a profound effect on emotions, leading to increased panic attacks and depersonalization.

I think that the perception is that cannabis use is harmless for adolescents and young adults, but that's not the case. We feel that clinicians need to be aware of the health outcomes, increased risk for suicidal ideation, and other negative effects associated with cannabis use, and screen for cannabis use disorders.

Clinicians need to effectively treat both cannabis use disorders, and mood disorders. Family‑based models and individual approaches such as cognitive‑behavioral therapy both alone or in conjunction with motivational enhancement therapy have been shown to be effective for treatment of children and adolescents with cannabis use disorders.

Leigh Precopio:  As recreational cannabis use becomes legal in more states across the United States, what are the signs of cannabis misuse that healthcare providers should be aware of? What other health risks does it pose to adolescents and young adults?

Cynthia Fontanella:  Some of the signs of cannabis use problems are impaired coordination, sensory and time perception difficulties, difficulty concentrating and solving problems, short attention span and distractibility, decreased alertness and impaired learning, and euphoria. It can also worsen psychiatric symptoms. It can cause panic attacks and depersonalization. In patients with schizophrenia, it can also increase psychotic symptoms.

In patients without mood disorders, early‑onset cannabis use has been associated with onset of mood disorders, depression, psychosis, and anxiety disorders. So when we think about implementing policies related to recreational marijuana laws, we need to consider negative effects.

Leigh Precopio:  How does your study contribute to the existing literature on drug use and mental illness in youths? What knowledge gaps remain on this topic?

Cynthia Fontanella:  This is the first study that looked at the effect of cannabis use disorders on mortality outcomes, and self‑harm. We filled a major gap in the literature for adolescents and young adults. Still, there's a lot of gaps in the literature. We need to look at the effect of cannabis use on psychiatric disorders, the problems of psychiatric disorders, and the effect of legalization of marijuana laws on outcomes, motor vehicle accidents, prevalence of psychiatric disorders, and mortality outcomes.

Leigh Precopio:  Thank you for taking the time to speak with me today, Dr. Fontanella.

Cynthia Fontanella:  Thank you very much. I hope this was helpful.