Advertisement

Routes of Administration of Cannabis Used for Nonmedical Purposes and Associations With Patterns of Drug Use

      Abstract

      Purpose

      Little is known regarding cannabis administration routes for nonmedical use—that is, its delivery methods (e.g., joints, water pipe, food). Therefore, we examined the prevalence rates of different cannabis delivery methods and assessed the relationship of the distinct administration routes with problematic drug use. Subgroups of cannabis users were also investigated (i.e., “pure” cannabis users, previously described as employing a harmless route of administration, and water pipe users, previously described as using a harmful route of administration).

      Methods

      As part of the Cohort Study on Substance Use Risk Factors, 1,763 cannabis users answered questions concerning their drug use (i.e., routes of administration, problematic cannabis use, other illicit drug use). Descriptive statistics, latent class analysis, correlations and t-tests were assessed.

      Results

      The main administration route was “joints with tobacco”; other routes of administration had prevalence rates from 23.99% to 38.23%. In addition, increasing the number of administration routes was associated with more problematic cannabis use, as well as heavier illicit drug use. Water pipes without tobacco were especially linked to heavy drug use patterns, whereas “pure” cannabis use seemed less harmful.

      Conclusions

      Our findings highlighted that diversification in routes of administration can be associated with heavier illicit drug use. This was especially true for water pipe users, whereas “pure” cannabis users, who did not mix cannabis with tobacco, were an exception. Indeed, these results may be useful for future preventive programs, which may need to focus on those who have diversified routes of administration for cannabis.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Suris J.C.
        • Akre C.
        • Berchtold A.
        • et al.
        Some go without a cigarette: Characteristics of cannabis users who have never smoked tobacco.
        Arch Pediatr Adolesc Med. 2007; 161: 1042-1047
        • Agrawal A.
        • Lynskey M.T.
        Tobacco and cannabis co-occurrence: Does route of administration matter?.
        Drug Alcohol Depend. 2009; 99: 240-247
        • Choquet M.
        • Morin D.
        • Hassler C.
        • et al.
        Is alcohol, tobacco, and cannabis use as well as polydrug use increasing in France?.
        Addict Behav. 2004; 29: 607-614
        • Kokkevi A.
        • Nic Gabhainn S.
        • Spyropoulou M.
        Early initiation of cannabis use: A cross-national European perspective.
        J Adolesc Health. 2006; 39: 712-719
        • Kohn L.
        • Dramaix M.
        • Favresse D.
        • et al.
        Trends in cannabis use and its determinants among teenagers in the French-speaking community of Belgium.
        Rev Epidemiol Sante Publique. 2005; 53: 3-13
        • Coffey C.
        • Carlin J.B.
        • Degenhardt L.
        • et al.
        Cannabis dependence in young adults: An Australian population study.
        Addiction. 2002; 97: 187-194
        • von Sydow K.
        • Lieb R.
        • Pfister H.
        • et al.
        What predicts incident use of cannabis and progression to abuse and dependence? A 4-year prospective examination of risk factors in a community sample of adolescents and young adults.
        Drug Alcohol Depend. 2002; 68: 49-64
        • Kandel D.B.
        Does marijuana use cause the use of other drugs?.
        JAMA. 2003; 289: 482-483
        • Perkonigg A.
        • Goodwin R.D.
        • Fiedler A.
        • et al.
        The natural course of cannabis use, abuse and dependence during the first decades of life.
        Addiction. 2008; 103 (discussion 450–1): 439-449
        • van Leeuwen A.P.
        • Verhulst F.C.
        • Reijneveld S.A.
        • et al.
        Can the gateway hypothesis, the common liability model and/or, the route of administration model predict initiation of cannabis use during adolescence? A survival analysis—the TRAILS study.
        J Adolesc Health. 2011; 48: 73-78
        • Kandel D.B.
        Examining the gateway hypothesis stages and pathways of drug involvement. Stages and pathways of drug involvement: Examining the gateway hypothesis.
        Cambridge University Press, New York2002: 3-15
        • Patton G.C.
        • Coffey C.
        • Carlin J.B.
        • et al.
        Reverse gateways? Frequent cannabis use as a predictor of tobacco initiation and nicotine dependence.
        Addiction. 2005; 100: 1518-1525
        • Agrawal A.
        • Madden P.A.F.
        • Bucholz K.K.
        • et al.
        Transitions to regular smoking and to nicotine dependence in women using cannabis.
        Drug Alcohol Depend. 2008; 95: 107-114
        • Aung A.T.
        • Pickworth W.B.
        • Moolchan E.T.
        History of marijuana use and tobacco smoking topography in tobacco-dependent adolescents.
        Addict Behav. 2004; 29: 699-706
        • Amos A.
        • Wiltshire S.
        • Bostock Y.
        • et al.
        “You can't go without a fag … you need it for your hash”—a qualitative exploration of smoking, cannabis and young people.
        Addiction. 2004; 99: 77-81
        • Highet G.
        The role of cannabis in supporting young people's cigarette smoking: A qualitative exploration.
        Health Educ Res. 2004; 19: 635-643
        • Korhonen T.
        • van Leeuwen A.P.
        • Reijneveld S.A.
        • et al.
        Externalizing behavior problems and cigarette smoking as predictors of cannabis use: The TRAILS Study.
        J Am Acad Child Adolesc Psychiatry. 2010; 49: 61-69
        • Chabrol H.
        • Massot E.
        • Montovany A.
        • et al.
        Modes de consommation, représentations du cannabis et dépendance: Étude de 159 adolescents consommateurs.
        Arch de Pédiatrie. 2002; 9: 780-788
        • Chabrol H.
        • Roura C.
        • Armitage J.
        Bongs or water pipes, a method of using cannabis linked to dependence.
        Can J Psychiatry. 2003; 48: 709
        • Aggarwal S.K.
        • Carter G.T.
        • Sullivan M.D.
        • et al.
        Medicinal use of cannabis in the United States: Historical perspectives, current trends, and future directions.
        J Opioid Manag. 2009; 5: 153-168
        • Lee D.
        • Karschner E.L.
        • Milman G.
        • et al.
        Can oral fluid cannabinoid testing monitor medication compliance and/or cannabis smoking during oral THC and oromucosal Sativex administration?.
        Drug Alcohol Depend. 2013; 130: 1-3
        • Watson S.J.
        • Benson Jr., J.A.
        • Joy J.E.
        Marijuana and medicine: Assessing the science base: A summary of the 1999 Institute of Medicine report.
        Arch Gen Psychiatry. 2000; 57: 547-552
        • Grotenhermen F.
        Harm reduction associated with inhalation and oral administration of cannabis and THC.
        Cannabis Therapeutics in HIV/AIDS. 2001; 3/4: 133-152
        • Kalant H.
        Medicinal use of cannabis: History and current status.
        Pain Res Manag. 2001; 6: 80-91
        • Isbell H.
        • Gorodetzsky C.W.
        • Jasinski D.
        • et al.
        Effects of delta-9-trans-tetrahydrocannabinol in man.
        Psychopharmacologia. 1967; 11: 184-188
        • Hollister L.E.
        Hunger and appetite after single doses of marihuana, alcohol, and dextroamphetamine.
        Clin Pharmacol Ther. 1971; 12: 44-49
        • Perez-Reyes M.
        • Lipton M.A.
        • Timmons M.C.
        • et al.
        Pharmacology of orally administered 9 -tetrahydrocannabinol.
        Clin Pharmacol Ther. 1973; 14: 48-55
        • Corral V.L.
        Differential effects of medical marijuana based on strain and route of administration: A three-year observational study.
        Cannabis Therapeutics in HIV/AIDS. 2001; : 43-59
        • Lemberger L.
        • Silberstein S.D.
        • Axelrod J.
        • et al.
        Marihuana: Studies on the disposition and metabolism of delta-9-tetrahydrocannabinol in man.
        Science. 1970; 170: 1320-1322
        • Huestis M.A.
        Human cannabinoid pharmacokinetics.
        Chem Biodivers. 2007; 4: 1770-1804
        • Duhig A.M.
        • Cavallo D.A.
        • McKee S.A.
        • et al.
        Daily patterns of alcohol, cigarette, and marijuana use in adolescent smokers and nonsmokers.
        Addict Behav. 2005; 30: 271-283
        • Lewinsohn P.M.
        • Rohde P.
        • Brown R.A.
        Level of current and past adolescent cigarette smoking as predictors of future substance use disorders in young adulthood.
        Addiction. 1999; 94: 913-921
        • Studer J.
        • Baggio S.
        • Mohler-Kuo M.
        • et al.
        Examining non-response bias in substance use research—Are late respondents proxies for non-respondents?.
        Drug Alcohol Depend. 2013; 132: 316-323
        • Adamson S.J.
        • Sellman J.D.
        A prototype screening instrument for cannabis use disorder: the Cannabis Use Disorders Identification Test (CUDIT) in an alcohol-dependent clinical sample.
        Drug Alcohol Rev. 2003; 22: 309-315
        • Goodman L.A.
        Exploratory latent structure analysis using both identifiable and unidentifiable models.
        Biometrika. 1974; 61: 215-231
        • Lazarsfeld P.F.
        • Henry N.W.
        Latent structure analysis.
        Houghton, Mifflin, New York1968
        • Lo Y.
        • Mendell N.R.
        • Rubin D.B.
        Testing the number of components in a normal mixture.
        Biometrika. 2001; 88: 767-778
        • Muthén L.K.
        • Muthén B.O.
        Mplus user's guide.
        6th ed. Muthén & Muthén, Los Angeles (CA)2010
        • Meier M.H.
        • Caspi A.
        • Ambler A.
        • et al.
        Persistent cannabis users show neuropsychological decline from childhood to midlife.
        Proc Natl Acad Sci U S A. 2012; 40: E2657-E2664
        • Hall W.
        The adverse health effects of cannabis use: What are they, and what are their implications for policy?.
        Int J Drug Policy. 2009; 20: 458-466