Cannabis & Causes of Psychosis Overview

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Questions and Answers

What intervention showed the most short-term benefits among available treatments?

Cognitive behavioral therapy

Psychosocial therapy

Contingency management (correct)

Motivational interviewing

Why does effectiveness of psychosocial treatments vary among individuals?

Resulting from the efficacy of therapist skills

Based on individual engagement and motivation (correct)

Due to differences in dosage

Because of availability of medications

Which statement accurately reflects the challenges in treating cannabis use in individuals with severe mental illness?

Substance use does not correlate with psychiatric symptoms

Symptoms of mental illness may obstruct therapy participation (correct)

Higher rates of social and economic stability

Cognitive impairments enhance treatment efficacy

What is a common outcome measured in evaluating the effectiveness of treatments?

Reduction in substance use Signup and view all the answers

What is the nature of the financial incentives provided in contingency management?

Rewards for reducing cannabis use Signup and view all the answers

Which group tends to benefit less from treatments regarding psychosocial therapies?

Individuals with severe mental illness Signup and view all the answers

What ethical consideration is highlighted when providing treatment options?

Providing access to potential help, even with modest effects Signup and view all the answers

What may indicate a nuanced understanding of treatment effectiveness?

The benefits of treatments may vary widely based on individual circumstances Signup and view all the answers

What is one of the pharmacological approaches being investigated for treating cannabis use in mental illness?

N-acetylcysteine (NAC) Signup and view all the answers

Which of the following is a challenge in the implementation of dual diagnosis treatment?

Limited resources and availability Signup and view all the answers

What is one of the stages in an intervention approach for treating cannabis use and mental illness?

Motivational enhancement Signup and view all the answers

What factor can influence treatment engagement among individuals with cannabis use and mental illness?

Stigma associated with substance use Signup and view all the answers

Which of the following is a harm reduction strategy for cannabis use in individuals with mental illness?

Education on safer cannabis use practices Signup and view all the answers

Which aspect is emphasized in the emerging research areas regarding cannabis and mental illness?

Genetic factors influencing cannabis use Signup and view all the answers

What is one of the key implications regarding treatments for those with cannabis use and mental illness?

Limited evidence base for effective treatments Signup and view all the answers

How can policy and legal considerations impact mental health services in relation to cannabis?

Evidence-based policies considering mental health implications Signup and view all the answers

What effect does a high PRS have on the likelihood of developing SCZ?

Increases the vulnerability to SCZ when combined with environmental factors. Signup and view all the answers

How does dopamine contribute to psychotic symptoms in individuals?

It leads to aberrant assignment of salience to stimuli. Signup and view all the answers

What is the relationship between cannabis use and the development of psychosis in vulnerable populations?

Cannabis use can increase the likelihood of developing psychosis among vulnerable individuals. Signup and view all the answers

What is a common consequence for children who later develop SCZ?

They may experience subtle motor difficulties. Signup and view all the answers

How does the prevalence of cannabis use compare between people with severe mental disorders and the general population?

It is higher in people with severe mental disorders. Signup and view all the answers

Which of the following statements regarding the effects of THC and CBD is accurate?

THC may contribute to anxiety and psychosis, while CBD may have therapeutic benefits. Signup and view all the answers

What type of receptor is primarily associated with dopamine signaling in psychosis?

D2 receptor Signup and view all the answers

What percentage of people with first-episode psychosis (FEP) are reported to be current cannabis users?

40-50% Signup and view all the answers

What is indicated by excessive dopamine release in individuals who are acutely psychotic?

An increase in psychotic symptoms Signup and view all the answers

Which event can compound genetic impairments in neurodevelopment?

Pre/perinatal complications such as oxygen deprivation. Signup and view all the answers

What trend is observed regarding the potency of cannabis products over time?

Cannabis products now show higher concentrations of THC. Signup and view all the answers

Among individuals with schizophrenia, what is the lifetime prevalence of cannabis use disorder?

Up to 42% Signup and view all the answers

What can long-term anxiety and depression in adolescents indicate concerning psychosis?

Early signs of potential psychotic experiences. Signup and view all the answers

What is a significant aspect of dopamine's role in assigning salience?

It assigns importance to ideas and objects indiscriminately. Signup and view all the answers

Which demographic is notably more likely to have used cannabis in the last year?

Individuals aged 16-24. Signup and view all the answers

What substance is noted for being used more frequently by individuals with severe mental illness?

High-THC cannabis products. Signup and view all the answers

What model is associated with the relationship between stress and psychosis?

Vulnerability Stress Model Signup and view all the answers

What percentage of psychosis cases in Europe could potentially be prevented if high-potency cannabis use were eliminated?

12% Signup and view all the answers

Which region shows the highest population attributable fraction for first episode psychosis linked to high-potency cannabis use?

Amsterdam Signup and view all the answers

What factor is specifically noted as heavily impacting psychosis rates in London and Amsterdam?

High Potency Cannabis Signup and view all the answers

What role does stress play in the context of psychosis according to the findings?

Stressful events can trigger the onset of psychosis. Signup and view all the answers

Which dietary factor could be linked to the lower rates of psychosis in Italy and Spain?

Mediterranean Diet Signup and view all the answers

What distinguishes schizophrenia from bipolar disorder according to the summary?

Developmental cognitive impairment Signup and view all the answers

What is considered a primary public health approach to prevent an epidemic of psychosis?

Reducing exposure to environmental risk factors Signup and view all the answers

What is the primary psychoactive component in Khat that causes its effects?

Cathinone Signup and view all the answers

How does Cannabidiol (CBD) interact with Tetrahydrocannabinol (THC)?

It potentially antagonizes the effects of THC. Signup and view all the answers

Which of the following statements about cannabis potency is correct?

Skunk cannabis can have approximately 16% THC. Signup and view all the answers

What are users of high-potency cannabis more likely to experience compared to regular cannabis users?

Higher likelihood of seeking emergency treatment Signup and view all the answers

What effect does Tetrahydrocannabinol (THC) have on cognition?

Impairments in attention and learning Signup and view all the answers

What is the relationship between dopamine synthesis and psychosis based on PET scans?

Elevated striatal dopamine synthesis is observed. Signup and view all the answers

What potential role does genetics play in understanding psychosis?

Genetic testing can identify predispositions to various illnesses. Signup and view all the answers

Which cannabis product is typically associated with no CBD content?

Skunk Signup and view all the answers

What does the NICE recommendation for brief motivational intervention primarily aim to achieve?

Explore ambivalence about drug use and treatment options Signup and view all the answers

Which cognitive aspect may be affected by long-term use of cannabis in individuals with bipolar disorder?

Attention and executive function Signup and view all the answers

Which treatment focuses on changing cognitive distortions related to cannabis use?

Cognitive Behavioral Therapy Signup and view all the answers

What is a key feature of Group Therapy in the treatment of cannabis use disorders?

Peer support and shared experiences Signup and view all the answers

Which type of therapy integrates mindfulness practices with cognitive-behavioral strategies?

Mindfulness-Based Relapse Prevention Signup and view all the answers

What concern is raised regarding the evidence base for psychosocial interventions in treating cannabis use?

No treatment showed superiority over standard care Signup and view all the answers

What does Motivational Enhancement Therapy primarily focus on?

Building intrinsic motivation to change behavior Signup and view all the answers

What are potential functional outcomes affected by long-term cannabis use in mental health conditions?

Impairments in social functioning and quality of life Signup and view all the answers

How does the polygenic risk score (PRS) relate to the likelihood of developing schizophrenia (SCZ)?

Those in the top 10% of PRS are 7 times more likely to develop SCZ. Signup and view all the answers

What environmental factors can interact with genetic vulnerabilities to influence the development of schizophrenia?

Pre/perinatal events, like long labor or oxygen deprivation. Signup and view all the answers

What is a common characteristic observed in children who later develop SCZ?

Subtle motor difficulties and social deficits. Signup and view all the answers

Which statement accurately describes the relationship between cannabis use and psychosis risk?

The risk of psychosis increases with the extent of cannabis use. Signup and view all the answers

What neurological mechanism is typically linked to the onset of psychosis in individuals predisposed to SCZ?

Dopamine dysregulation. Signup and view all the answers

What is a key factor influencing the effectiveness of psychosocial treatments for individuals with severe mental illness?

Presence of cognitive impairments affecting engagement Signup and view all the answers

Why might engagement be a significant indicator of effectiveness in contingency management?

Those with higher motivation are likely to show better outcomes Signup and view all the answers

What is a common misconception about the effectiveness of treatments for individuals with severe mental illness?

Effectiveness is the same across all populations Signup and view all the answers

What should be emphasized when considering treatment options for patients with severe mental illness and substance use issues?

The importance of individualized approaches Signup and view all the answers

What challenge complicates the treatment of cannabis use in individuals with severe mental illness?

Symptoms of mental illness interfering with therapy participation Signup and view all the answers

In the context of psychosocial treatments, what is true about their effectiveness?

Variability in effectiveness can be significant from person to person Signup and view all the answers

What implication arises from recent findings on cannabis use interventions in individuals with early psychosis?

Motivation can play a crucial role in treatment effectiveness Signup and view all the answers

What ethical consideration is recognized in providing treatment options for individuals despite lack of strong overall evidence?

Ensuring individuals have access to potential help Signup and view all the answers

What is the primary causal factor in the development of psychosis related to dopamine?

Excessive dopamine release Signup and view all the answers

How does the abnormal salience assigned to stimuli influence thoughts in a person experiencing psychosis?

It may generate delusions as explanations for perceived significance. Signup and view all the answers

What effect does chronic stress have on dopamine neurotransmission and psychosis development?

It leads to increased dopamine release during stress. Signup and view all the answers

What role does dopamine play in differentiating significant events from general experiences in individuals prone to psychosis?

It mediates aberrant assignment of salience to stimuli. Signup and view all the answers

How does medication typically address the issue of dopamine signaling in psychotic conditions?

By blocking D2 receptors to prevent dopamine binding. Signup and view all the answers

What is indicated by a high polygenic risk score (PRS) in relation to psychosis?

Higher susceptibility to developing psychotic disorders Signup and view all the answers

What role do adverse life events play in the development of psychosis?

They increase striatal dopamine synthesis Signup and view all the answers

How is schizophrenia traditionally perceived in the context of mental disorders?

As a discrete category with no overlaps with normality Signup and view all the answers

What is the relationship between psychotic symptoms and stress sensitivity in individuals with psychosis?

Those with psychosis are more sensitive to stress and have an active dopamine system Signup and view all the answers

What characterizes minor psychotic symptoms?

They may not present as severely but indicate risk for psychosis Signup and view all the answers

What does the continuum model suggest about psychosis and normality?

Symptoms of psychosis can overlap with other neurotic disorders Signup and view all the answers

What might prodromal signs indicate concerning psychosis?

An impending onset of psychotic symptoms Signup and view all the answers

Which of the following factors is NOT mentioned as impacting striatal dopamine synthesis?

Excessive exercise Signup and view all the answers

What is the estimated contribution of Copy Number Variants (CNVs) to Autism prevalence?

10-20% Signup and view all the answers

Which gene-related factor is significantly associated with schizophrenia?

Genes that increase susceptibility to schizophrenia Signup and view all the answers

What are the common psychiatric disorders that show overlap with schizophrenia?

Bipolar disorder, Depression, and Anxiety disorders Signup and view all the answers

What role do social factors play in the development of psychosis?

They increase the risk of developing psychosis in vulnerable populations. Signup and view all the answers

Which of the following is a possible effect of complications during pregnancy on brain development?

Subtle damage to brain connectivity Signup and view all the answers

Which statement accurately describes Copy Number Variants (CNVs) in relation to schizophrenia?

Loss of genes is generally worse than gene duplication. Signup and view all the answers

What is one major consequence of excessive dopamine in individuals with schizophrenia?

Increased social withdrawal Signup and view all the answers

Which social factor can contribute to psychosis?

Experiencing neglect during childhood Signup and view all the answers

What age group in the UK has shown significant cannabis use in the last year?

Ages 16-24 Signup and view all the answers

How much more likely are people with severe mental illness to use cannabis compared to those without?

3.5 times more likely Signup and view all the answers

What is the estimated lifetime prevalence of cannabis use disorder among individuals with schizophrenia?

42% Signup and view all the answers

What factor is associated with higher rates of psychosis among cannabis users?

Frequenter use of stronger forms like skunk Signup and view all the answers

What percentage of individuals with first-episode psychosis (FEP) are current cannabis users?

40-50% Signup and view all the answers

What is one of the geographical factors heavily impacting psychosis rates?

Urban vs. rural residence Signup and view all the answers

Which mental disorder shows the highest comorbidity with cannabis use at approximately 20-50%?

Bipolar Disorder Signup and view all the answers

Which trend in cannabis potency has potential mental health implications?

Increasing THC content Signup and view all the answers

What may be a factor affecting the effectiveness of psychosocial treatments in individuals with severe mental illness?

Lower economic status Signup and view all the answers

What is an implication of the findings related to contingency management for cannabis use in early psychosis?

Engagement and motivation are crucial for effectiveness. Signup and view all the answers

Which characteristic of treatments indicates that they may be less effective in populations with severe mental illness?

Tend to have smaller benefits when they work Signup and view all the answers

How does individual engagement impact the outcomes of psychosocial treatments for cannabis use?

It serves as a good indicator of treatment effectiveness. Signup and view all the answers

What challenge might cognitive impairments present in treating cannabis use in individuals with severe mental illness?

They can affect treatment engagement and efficacy. Signup and view all the answers

What is a common outcome measured in evaluating treatment effectiveness for cannabis use?

Reduction in substance use Signup and view all the answers

Why might some individuals benefit from psychosocial treatments despite the lack of strong overall evidence?

The treatments are tailored to individual needs and preferences. Signup and view all the answers

How does the approach towards providing treatment options reflect ethical considerations?

Providing access may help even if effects are only modest. Signup and view all the answers

What is one challenge associated with dual diagnosis treatment?

Resource allocation and implementation Signup and view all the answers

Which pharmacological treatment is noted for its potential as a glutamate modulator?

N-acetylcysteine (NAC) Signup and view all the answers

What strategy is suggested for improving treatment engagement among individuals using cannabis?

Leveraging technology like mobile apps Signup and view all the answers

Which of the following is a harm reduction strategy for cannabis use?

Education on safer cannabis practices Signup and view all the answers

What is identified as a potential factor influencing treatment outcomes in various populations?

Cultural adaptations of interventions Signup and view all the answers

What approach focuses on simultaneous treatment of cannabis use and mental illness?

Dual diagnosis treatment Signup and view all the answers

Which of these is a consideration when developing evidence-based policies regarding cannabis?

Incorporating mental health considerations Signup and view all the answers

What is one emerging research area within the context of cannabis and mental health?

Development of biomarkers for risk identification Signup and view all the answers

What triggers the onset of psychosis in individuals during their late teens or early 20s?

Excessive dopamine dysregulation Signup and view all the answers

Which statement best describes the role of dopamine in psychotic symptoms?

Dopamine mediates the attachment of salience to irrelevant stimuli Signup and view all the answers

What is a significant predictor of developing schizophrenia (SCZ) in individuals?

Having a high polygenic risk score (PRS) Signup and view all the answers

What impact does excessive dopamine release have during acute psychosis?

It increases the experience of abnormal salience Signup and view all the answers

Which environmental factors can interact with genetic vulnerability to exacerbate the risk of developing schizophrenia?

Poor nutrition during early childhood Signup and view all the answers

What is the average age for the presentation of psychosis in England?

28-29 years Signup and view all the answers

What type of receptor is primarily involved in the signaling of dopamine during psychotic episodes?

D2 receptor Signup and view all the answers

How might children who later develop schizophrenia demonstrate early developmental challenges?

Delay in speech and movement skills Signup and view all the answers

What is a potential consequence of chronic cannabis use on the brain?

Changes in brain structure and function Signup and view all the answers

How does Tetrahydrocannabinol (THC) primarily affect individuals when consumed?

Altered perception and impaired memory Signup and view all the answers

Which receptor is primarily involved in the effects of cannabis on mental health and psychosis?

CB1 receptors Signup and view all the answers

What is the potential interaction of Cannabidiol (CBD) with Tetrahydrocannabinol (THC)?

CBD can mitigate some negative effects of THC Signup and view all the answers

In the context of cannabis use, what is a dose-dependent relationship with psychosis risk?

Increased cannabis use leads to higher psychosis risk Signup and view all the answers

What is a recognized impact of cannabis use on individuals with pre-existing mental health disorders?

It complicates their treatment and recovery processes Signup and view all the answers

What distinguishes synthetic cannabinoids from natural cannabis products?

The potency of synthetic cannabinoids can vary significantly Signup and view all the answers

What potential therapeutic effects does CBD (Cannabidiol) have?

Provides neuroprotective properties and anti-anxiety effects Signup and view all the answers

Which statement best describes the genetic factors associated with schizophrenia?

There are numerous genes that make individuals more susceptible to schizophrenia. Signup and view all the answers

What is the primary implication of Copy Number Variants (CNVs) found in schizophrenia patients?

Losing genes is generally more problematic than duplicating them in relation to schizophrenia. Signup and view all the answers

Which factor is NOT associated with an increased risk of developing psychosis?

Migration from a safe environment Signup and view all the answers

How do genetic predispositions to schizophrenia correlate with other psychiatric disorders?

There is a significant overlap between genes for schizophrenia and bipolar disorder. Signup and view all the answers

Which of the following associations between human tissues and schizophrenia genes highlights a specific part of the brain?

Hippocampus and excitatory glutamatergic neurons Signup and view all the answers

Which developmental issues are associated with the risk of schizophrenia?

Complications during delivery such as asphyxia Signup and view all the answers

What role do childhood experiences play in the context of schizophrenia risk?

Negative childhood experiences can increase the likelihood of psychosis. Signup and view all the answers

Which statement accurately reflects the findings related to genetic overlap across disorders?

30% of the genes related to schizophrenia are also associated with anxiety and depression. Signup and view all the answers

Study Notes

Cannabis & Psychosis (Luke Sheridan Rains)

Three key areas covered:
- Link between cannabis and severe mental illness
- Different effects of THC vs CBD
- Treatment/managing cannabis use in severe mental illness
Cannabis is the most widely used drug in the UK.
Ages 16-24 more likely to have used cannabis in the past year than the general adult population
Use among young people has decreased sharply over the last 30 years, similar to the trend of young people smoking cigarettes.
High rates of cannabis use among young people still notable, placing them at high risk for developing severe mental illness for the first time.
Cannabis use is associated with high rates (especially among those with severe mental disorders).
Study of 10,000 people with severe mental illness found 3.5 times higher cannabis use compared to 10,000 without.
Some studies suggest that up to 40-50% of people with "FEP" (or similar condition - likely a medical abbreviation) are current cannabis users.

Cannabis Use and Mental Health

Cannabis is most used illicit substance in general population and psychiatric patients globally.
Prevalence varies by country and specific psychiatric disorder, generally 2-3 times higher than general population.
Schizophrenia: up to 42% lifetime prevalence of cannabis use disorder.
Bipolar Disorder: Approx. 20-50% comorbidity with cannabis use.
Major Depressive Disorder: Around 17% comorbidity.
Increasing THC content in available cannabis products poses potential mental health risks

Neurobiological Mechanisms

THC (Tetrahydrocannabinol):
- Primary psychoactive component of cannabis.
- Acute effects: altered perception, impaired memory, increased anxiety.
- Chronic effects: potential changes in brain structure and function, associated with an increased risk of psychotic symptoms.
- Skunk is especially high in THC.
- Can impair cognitive function and memory
CBD (Cannabidiol):
- Non-psychoactive component.
- Potential therapeutic effects, including anti-anxiety and anti-psychotic properties.
- May counteract negative effects of THC.
Interaction with neurotransmitter systems.
- Dopamine: relevance to psychosis.
- Serotonin: Implications for mood regulation.
- GABA and Glutamate: Impact on cognitive function and anxiety.
Importance of understanding THC to CBD ratio in cannabis products

Cannabis Use and Mental Illness: Detailed Associations

Psychotic disorders: dose-dependent relationship between cannabis use and psychosis; earlier cannabis use linked to earlier psychosis onset.
Impact on symptom severity and course of illness
Mood disorders: bidirectional relationship with depression and anxiety; potential exacerbation of manic episodes in Bipolar disorders.
Cognitive impairment: effects on attention, memory and executive function, with potential for cumulative cognitive deficits with long-term use.

Treatment Recommendations

NICE recommends brief motivational interventions (typically 2 sessions, 45 minutes each).
Purpose: Explore ambivalence about drug use and treatment options.
Goal: Increase motivation to change behavior.
Techniques: May include decisional balance exercises, goal-setting, self-help or CBT approaches, or formal interventions.

Psychosocial Treatments: Effectiveness and Challenges

Studies encompassing 41 studies on psychosocial interventions found no evidence supporting any particular treatment over standard care.
Studied outcomes such as remaining in treatment and reduction in substance use.
Interventions may be more effective for individuals without severe mental illness.
Some interventions demonstrate short-term benefits, such as contingency management, offering financial incentives for reducing cannabis use

Effectiveness of Treatments: Nuanced Understanding

Treatments are generally less effective for individuals with severe mental illness
When treatments do work, the benefits tend to be less profound for individuals with severe mental illness

Pharmacological Approaches

Limited evidence base for pharmacological treatments specifically for cannabis use in mental illness.
Potential medications under investigation (e.g., N-acetylcysteine, cannabinoid receptor antagonists/inverse agonists).

Integrated Treatment Models

Dual diagnosis treatment: simultaneous treatment of both cannabis use and mental illness.
Challenges: implementation and resource allocation.
Stages intervention approaches (e.g., engagement and rapport building; motivational enhancement; active treatment; relapse prevention and recovery maintenance).

Harm Reduction Approaches

Principles of harm reduction apply to individuals with severe mental illness.
Strategies include education on safer cannabis use (e.g., education on safer cannabis use practices).

Policy and Legal Considerations

Impact of cannabis legalization on mental health services.
Need for evidence-based policies considering mental health implications.
Regulation of cannabis products with mental health considerations.

Emerging Research Areas

Genetic factors influencing cannabis use and mental illness comorbidity.
Neuroimaging studies on the effects of cannabis use in psychiatric populations.
Development of biomarkers for identifying individuals at high risk of adverse effects.
Potential therapeutic applications of cannabinoids in mental health treatment.

Key Takeaways and Clinical Implications

Limited evidence base for effective treatments specific to this population.
Importance of managing expectations for treatment outcomes.
Need for comprehensive assessment of cannabis use and mental health symptoms.
Consideration of harm reduction approaches alongside abstinence-based treatments.
Integration of cannabis use treatment with mental health care
Need for continued research on effective interventions for this specific population

Future Directions and Research Needs

Development of tailored interventions for individuals with severe mental illness and cannabis use.
Investigation into neurobiological interactions between cannabis use and mental health symptoms.
Exploration of potential protective factors and resilience in this population.
Long-term follow-up studies to assess sustained treatment effects.
Examination of the role of newer cannabis products (e.g., high-potency strains, edibles) on treatment outcomes.
Collaborative care models involving mental health, addiction, and primary care services.
Importance of considering the interaction between cannabis use and mental health symptoms in treatment planning

Cannabis and Schizophrenia

Schizophrenia is not a discrete entity; it can merge into bipolar disorder.
Identified cognitive impairments, risk factors.
Exposure to risk factors like cannabis use should be a public health priority

Childhood physical, sexual abuse, and neglect are associated with an increased risk of psychosis.
Experiences of migration and ethnic minority status, bullying and intrusive events may increase risk of psychosis.
Stressful life events, and potentially adverse life events like migration increase risk of psychosis.
Social factors can impact dopamine release, potentially increasing risk of psychosis.

The Problem

Synthesis of too much dopamine in the striatum is implicated in psychosis
Dopamine normally has a role in assigning importance to events, but in psychosis this function is dysregulated.

Genetics and Drug Use

Genes, in addition to environmental factors, increase risk of psychosis.
Both environmental factors (e.g., drug use) and genes play a role contributing to psychosis.
Heavy use/exposure to cannabis is a specific environmental factor implicated with an increased risk of psychosis, but is not the sole determinant.

Minor & Prodromal Psychotic Symptoms

Mild psychotic symptoms don't always signal a disorder.
Prodormal symptoms can cause a significant impact on an individual's wellbeing.
Individuals experiencing minor symptoms may face issues with daily functioning.

Important Note

These notes summarize the provided information.

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Description

This quiz explores the complex relationship between cannabis use and severe mental illness, focusing on the effects of THC and CBD. It discusses the prevalence of cannabis use among young people in the UK, and the associated risks of developing severe mental health disorders. Gain insights into treatment and management strategies for those with mental illness linked to cannabis use.