Marijuana Use Disorders in the United States: 1991-1992 and 2001-2002
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Transcript of Marijuana Use Disorders in the United States: 1991-1992 and 2001-2002
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Marijuana Use Disorders in the United States:
1991-1992 and 2001-2002
Wilson M. Compton, M.D., M.P.E.Director, Division of Epidemiology, Services and Prevention Research
National Institute on Drug AbuseDepartment of Health and Human Services
May 5, 2004American Psychiatric Association Annual Meeting
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Background
A great deal of information about trends in use of drugs is available, but no data provides reliable and valid measures of drug disorders over the past decade.
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Background
With data from two large household surveys of the U.S. adult population, this study seeks to answer the following questions:
1. What are the rates of marijuana abuse and dependence in 1991-1992 compared to 2001-2002?
2. Have the relationships of age, race/ethnicity or gender to marijuana abuse and dependence changed during this period?
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Methods
Studies:
• Large studies of the U.S. non-institutionalized household adult (18+) population conducted by the Census Bureau.
• NLAES: National Longitudinal Alcohol Epidemiologic Study (N = 42,862)
• NESARC: National Epidemiologic Study of Alcohol and Related Conditions (N = 43,093)
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Methods
Interview:
• AUDADIS: Alcohol Use Disorder and Related Disabilities Interview Schedule - DSM-IV Version
– Specific measures of each criterion of abuse and dependence on marijuana
– Reliability and validity well-established
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Methods
Outcomes
• Marijuana use, abuse and dependence in overall population and by age, race/ethnicity and sex
• Marijuana abuse and dependence among marijuana users by age, race/ethnicity and sex
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Results: Total Population
4.01.2
30.2
4.11.5
35.6
05
10152025303540
Use Abuse/Dependence Abuse/Dependencein Users
NLAES 1991-1992 NESARC 2001-2002
= p < .05
%
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Results: Total PopulationComparing 1991-1992 to 2001-2002:
• Marijuana use rates were virtually the same: 4.0% versus 4.1%
• Marijuana abuse or dependence increased from 1.2% to 1.5% (p = .014)
• Marijuana abuse or dependence among users increased from 30.2% to 35.6% (p < .01)
How consistent are these results across age groups, race/ethnic groups and sexes?
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Results: Marijuana Use by Sex and Race/Ethnicity
0
1
2
3
4
5
6
Black White Hispanic Male Female
NLAES 1991-1992 NESARC 2001-2002= p < .05
%
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Results: Marijuana Use In Age Groups
0
2
4
6
8
10
12
Total 18-29 30-44 45-64
NLAES 1991-1992 NESARC 2001-2002= p < .05
%
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Results: Marijuana Use in Whites
0
2
4
6
8
10
12
Total 18-29 30-44 45-64
NLAES 1991-1992 NESARC 2001-2002
= p < .05
%
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Results: Marijuana Use in Blacks
0
2
4
6
8
10
12
Total 18-29 30-44 45-64
NLAES 1991-1992 NESARC 2001-2002
= p < .05
%
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Results: Marijuana Use in Hispanics
0
1
2
3
4
5
6
7
8
Total 18-29 30-44
NLAES 1991-1992 NESARC 2001-2002= p < .05
%
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Results: Marijuana Use in Men
0
2
4
6
8
10
12
14
Total 18-29 30-44 45-64
NLAES NESARC
= p < .05
%
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Results: Marijuana Use in Women
0
1
2
3
4
5
6
7
8
Total 18-29 30-44 45-64
NLAES NESARC
= p < .05
%
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• Use increased significantly for:
– White males 45-64 years old
– Black females overall and Black females 18-29 and 46-64 years old
– Hispanic females 18-29 years old
Results: Marijuana Use in Detailed Age-Sex-Race/Ethnicity Categories
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• Rates did not change significantly overall
• Rates increased significantly for:
– 18-29 and 45-64 year olds
– Black and Hispanic 18-29 year olds
– White and Black 45-64 years olds
– Women 18-29 years old and both men and women 45-64 years old
– Selected age-sex-race/ethnicity categories
Results: Summary of Marijuana Use
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Results: Marijuana Abuse or Dependence in Overall Population
0.00.51.01.52.02.53.03.54.04.5
Total 18-29 30-44 45-64
NLAES 1991-1992 NESARC 2001-2002= p < .05
%
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Results: Marijuana Abuse or Dependence by Sex and Race/Ethnicity
0.0
0.5
1.0
1.5
2.0
2.5
Black White Hispanic Male Female
NLAES 1991-1992 NESARC 2001-2002= p < .05
%
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Results: Marijuana Abuse or Dependence in Whites
0.0
1.0
2.0
3.0
4.0
5.0
Total 18-29 30-44
NLAES 1991-1992 NESARC 2001-2002
= p < .05
%
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Results: Marijuana Abuse or Dependence in Blacks
0.0
1.0
2.0
3.0
4.0
5.0
Total 18-29 30-44
NLAES 1991-1992 NESARC 2001-2002
= p < .05
%
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Results: Marijuana Abuse or Dependence in Hispanics
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Total 18-29 30-44
NLAES 1991-1992 NESARC 2001-2002
= p < .05
%
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Results: Marijuana Abuse or Dependence in Men
0
1
2
3
4
5
6
7
Total 18-29 30-44 45-64
NLAES 1991-1992 NESARC 2001-2002
= p < .05
%
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Results: Marijuana Abuse or Dependence in Women
0.0
0.5
1.0
1.5
2.0
2.5
Total 18-29 30-44
NLAES 1991-1992 NESARC 2001-2002
= p < .05
%
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• Rates increased significantly overall• Increases in rates were significant for:
– 18-29 and 45-64 year olds overall– Blacks and Hispanics overall and 18-29
years old– Women overall and 18-29 years old– Men 45-64 years old– Black and Hispanic men overall and 18-29
years old– Black women overall and 18-29 years old
Results: Summary of Marijuana Abuse or Dependence
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Results: Marijuana Abuse or Dependence Among Users in Overall Population
05
1015202530354045
Total 18-29 30-44 45-64
NLAES 1991-1992 NESARC 2001-2002= p < .05
%
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Results: Marijuana Abuse or Dependence among Users, by Sex and Race/Ethnicity
0
5
10
15
20
25
30
35
40
Black White Hispanic Male Female
NLAES 1991-1992 NESARC 2001-2002
= p < .05
%
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Results: Marijuana Abuse or Dependence Among Black Users
05
1015202530354045
Total 18-29 30-44
NLAES 1991-1992 NESARC 2001-2002= p < .05
%
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Results: Marijuana Abuse or Dependence Among White Users
05
1015202530354045
Total 18-29 30-44
NLAES 1991-1992 NESARC 2001-2002= p < .05
%
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Results: Marijuana Abuse or Dependence Among Hispanic Users
05
1015202530354045
Total 18-29 30-44
NLAES 1991-1992 NESARC 2001-2002= p < .05
%
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Results: Marijuana Abuse or Dependence Among Male Users
0
10
20
30
40
50
Total 18-29 30-44 45-64
NLAES 1991-1992 NESARC 2001-2002= p < .05
%
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Results: Marijuana Abuse or Dependence Among Female Users
0
5
10
15
20
25
30
35
Total 18-29 30-44
NLAES 1991-1992 NESARC 2001-2002= p < .05
%
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• Rates increased significantly overall
• Increases in rates were significant for:
– 18-29 and 30-44 year olds overall
– Blacks overall and 30-44 and 18-29 years old
– Hispanics overall and 18-29 years old
– Women and men overall and 18-29 years old
– Black and Hispanic men overall and 18-29 years old
– Black women overall and 18-29 years old
Results: Summary of Marijuana Abuse or Dependence Among Users
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Estimated Population Increases in Marijuana Abuse or Dependence
10%
26%
35%
29%38%
38%
10%
14%Male Female
20%
26%
24%
30%
White
Black
Hispanic
Other
Total
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Why have rates increased?
• Changes in quantity/frequency of marijuana use?
• Changes in potency of marijuana?
• Psychosocial factors?
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Why have rates increased?
Changes in quantity/frequency of marijuana use?
Not likely…
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Changes in Frequency of MJ Use?
0
5
10
15
20
25
30
35
40
<1 dy/mo 1-3 dys/mo 1-4 dys/wk 5-7dys/wk
1991-1992 2001-2002
%
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Changes in Quantity of MJ Smoked?
0
10
20
30
40
50
60
70
1 Joint 2-3 Joints 4-6 Joints 7+ Joints
1991-1992 2001-2002
%
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Why have rates increased?
Changes in potency of marijuana?
Possibly…
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Changes in Potency of Marijuana
0%
1%
2%
3%
4%
5%
6%
7%
1991
1993
1995
1997
1999
2001
Δ9-THC
Source: Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi; 2003
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Why have rates increased?
Psychosocial factors?
Possibly…
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Plausible Psychosocial Factors
• Acculturation?
• Lifestyle factors and attitudinal factors?
• Sociodemographic or socioeconomic factors?
• Economic factors such as price, tax and policy changes affecting other substances that may inadvertently affect marijuana?
• Historical and cultural factors?
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Summary
• Rates of Marijuana use were nearly the same in the total population in 1991-1992 as in 2001-2002, but increases were seen in certain subgroups:
– younger male and female blacks,
– younger Hispanic males
– white and black 45-64 year olds.
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• Marijuana-related disorders (abuse and dependence) increased from 1991-1992 to 2001-2002, especially for younger male and female blacks and younger hispanic males.
• Increased potency of marijuana may play a role
Summary
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Marijuana Use Disorders in the United States: 1991-1992 and 2001-2002
Wilson M. Compton, M.D., M.P.E. - NIDA
Bridget F. Grant, Ph.D., Ph.D. - NIAAA
James D. Colliver, Ph.D. - NIDA
Meyer D. Glantz, Ph.D. - NIDA
Frederick S. Stinson, Ph.D. - NIAAA