Concurrent Paper Session A

The Association between Cannabis Use and Lifetime Suicidal Ideation and Attempts

Summary
Suicide is a global public health concern worldwide and ranks as one of the leading causes of death in the United States. With legislation of marijuana in communities across the US, the use is on the rise while the public perception of its harmful effect continues to decrease. This concerning statistic underscores the importance of identifying factors which significantly influences the association between cannabis use and suicidality. These factors are generally under researched, and our study will be the first to investigate those factors that influence the association between cannabis use and suicidal intensity.

Methods
This study included 530 psychiatric inpatients voluntarily admitted to a psychiatric inpatient hospital between 2012 and 2018 with ages ranging from 18 to 71 years. Participants were evaluated using the Structured Clinical Interview for DSM-IV (SCID-I/II). Key domains assessed include depression, anxiety, sleep, personality, suicidal ideation and behavior, and well-being. Patients electing to participate completed study instruments including the C-SSRS, SCID, Difficulties in Emotion Regulation Scale (DERS; 25), and Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Statistical analyses using the SPSS version 26 and STATA version 16 2 2023 AAAP Annual Meeting and Scientific Symposium (College Station, TX) were performed. Statistical significance was retained as two-tailed, p < 0.05. No modifications were made for multiple comparisons (Type I error) using the Bonferroni correction as only a single generalized SEM analysis was performed.

Results
Variables associated with higher suicidal intensity were Personality Factor 1 (p = .003), having a Mood Disorder (p = .006), having a greater amount of emotional dysregulation (p = .007), and the combination of increased cannabis use in the context of lower levels of psychological flexibility (p = .047). Partial mediation of cannabis on suicide intensity via emotional dysregulation was found (p = .007). Testing the indirect path of personality factor 3 to cannabis use to DERS to suicidal intensity resulted in a small but significant effect (β = 4.25e-18 ± 1.53e-18, p = .006). Cannabis was also directly associated with suicidal intensity (p = .029), and the criteria of partial mediation was confirmed.

Conclusion
This finding highlights the importance of looking broadly at cannabis use and suicidality. It highlights the need to undertake interventions that will mitigate suicide behaviors.

Scientific Significance
Suicide is a global public health concern worldwide and ranks as one of the leading causes of death in the United States. With the legislation of marijuana in communities across the US, the use is on the rise while the public perception of its harmful effect continues to decrease. This concerning statistic underscores the importance of identifying factors which significantly influences the association between cannabis use and suicidality. These factors are generally under researched, and our study will be the first to investigate those factors that influence the association between cannabis use and suicidal intensity

Learning Objectives

To show that higher levels of cannabis use as measured by the ASSIST cannabis total score will be associated with higher suicidal intensity.
To show that elevated emotional dysregulation and lower levels of psychological flexibility will influence the associations between cannabis use and suicidal intensity.
To show that a common genetic pathway using an externalizing polygenic risk score assessment will indirectly influence the association between cannabis use and suicidal intensity.

Keywords

Cannabis
Suicide Risk
Substance Use
Emotion Regulation

Presenter
Adeolu Oladunjoye, MD, MPH

Dr. Oladunjoye is a psychiatry resident physician at Baylor College of Medicine, Houston, TX. He is member of the Clinician Educator Track within his program, a specialized track that focuses on training residents interested in academic medicine on how to be excellent clinician-educators. He was the Co-Chair of the Texas Society of Psychiatric Physicians (TSPP) Resident Fellow Member committee where he led other residents and fellows in the state of Texas to engage in workshops and scientific presentations at one of the annual conferences in the last year. He is an Associate Editor of the American Journal of Psychiatry Residents’ Journal. He has authored/co-authored many journal articles and presented at different national or international conferences. Currently he has over 80 published book chapters/articles/posters or oral presentations.

He is a recipient of several awards including the 2022 American Academy of Addiction Psychiatry Regional Award and the 2023 American Psychiatry Association Foundation, Public Psychiatry Fellow Award.

Co-Authors: Alan Swann, Thomas Kosten, Michelle Patriquin, Timothy Bigdeli, Peter Barr, Mark Harding, David Nielsen, David Graham

The Influence of Childhood Trauma on the Effects of Delta-9-Tetrahydrocannabinol in Persons with Opioid Use Disorder: Insights from a Randomized, Placebo-Controlled, Crossover Clinical Trial

Summary
Childhood trauma may modulate the acute effects of cannabis and its constituent cannabinoids among patients with opioid use disorder (OUD). In this post hoc analysis of a randomized, placebo-controlled clinical trial administering delta-9 tetrahydrocannabinol (THC) — the main psychoactive constituent of cannabis — among patients receiving methadone therapy for OUD, we demonstrate that higher levels of childhood trauma are associated with reduced perceptions of THC’s aversive effects. This information may contribute to decision-making processes regarding the therapeutic potential of cannabinoids for OUD.

Methods
We conducted a post-hoc analysis of a recently completed randomized, placebo-controlled, crossover clinical trial, which investigated the dose-dependent acute effects of orally administered THC among 25 persons receiving methadone therapy for OUD. Participants received single doses of oral THC (10 mg, 20 mg, administered as dronabinol) or placebo across three five-hour test sessions. Childhood trauma was assessed at baseline using the Childhood Trauma Questionnaire (CTQ). Using a mixed regression model, we examined the relationship between childhood trauma and the acute analgesic, subjective, and cognitive effects of THC — indexed by the Cold Pressor Test (CPT), the Drug Effects Questionnaire (DEQ) and the Continuous Performance Test (ContPT), respectively.

Results
Preliminary results suggest that a higher severity of childhood trauma is associated with a lower perception of aversive effects induced by higher doses (20 mg) of THC (p = 0.006).

Conclusion
Our findings suggest that in patients with OUD, a more severe history of childhood trauma may result in less perceived adverse effects from cannabinoids. These data could influence treatment development approaches, given that these patients appear less sensitive to THC's adverse events. Furthermore, this observation might account for the elevated rates of concurrent cannabis use disorder in this population.

Scientific Significance
These results underscore the necessity of including trauma history assessments in the development of therapeutic strategies for OUD. Further controlled research is needed to clarify this relationship and to develop targeted interventions that address the unique requirements of individuals with co-existing trauma and opioid addiction.

Learning Objectives

To discuss the relationship between childhood trauma and the perception of cannabinoids' adverse effects in patients with OUD.

Keywords

Cannabis/THC
Opioid Use Disorder
Childhood Trauma

Presenter
Julio Nunes, MD

Julio Nunes is a Mexican-Brazilian medical doctor from Rio de de Janeiro. He was a postdoctoral research fellow at the Stanford Center for Clinical Research, where he researched shared decision-making and behavioral interventions in cardiology as well as racial-ethnic disparities in clinical trials. Now he is a psychiatry resident at Yale and is interested in medical education, palliative care, and the intersection between pain and addiction.

Co-Authors: Michael Rogan, João P. de Aquino

A Randomized Controlled Trial of Varenicline for Cannabis Use Disorder: Main Efficacy Findings

Summary
The proposed paper presentation will summarize methods, main efficacy findings, and clinical practice implications of a recently completed clinical trial of varenicline for cannabis use disorder (CUD). The presentation will include a review of established evidence-based treatments for CUD and a brief summary of CUD pharmacotherapy development efforts to date. The rationale, methods and findings of a recently completed trial of varenicline for CUD will be presented. Findings will be discussed in clinical context, with the goal of conveying actionable information for incorporation in front-line clinical practice.

Methods
Adults with CUD (N=174; ages 18+; 35% female; 63% White) were randomized to receive a 12-week course of double-blind varenicline (n=90) or placebo (n=84), with varenicline dosing following established recommendations for tobacco use disorder (0.5 mg daily for 3 days, 0.5 mg twice daily for 4 days, then 1 mg twice daily thereafter); all participants received weekly medical clinician-delivered medication management as a platform treatment. The primary efficacy outcome of interest was cannabis use reduction, reflected in the number of weekly cannabis use sessions in weeks 6-12, compared between the varenicline and placebo groups. A one-month follow-up visit allowed for examination of sustained treatment effects after treatment conclusion.

Results
The varenicline and placebo treatment groups did not differ significantly in demographic or baseline cannabis use variables or in overall trial retention. At baseline, participants across both groups averaged 27 days of cannabis use and 3 use sessions per day in the 30 days prior to enrollment. A significant (p<0.05) treatment group by sex interaction was noted, indicating that cannabis reduction outcomes differed between females and males. Specifically, there was a significant effect of varenicline on cannabis use sessions per week in males but not females during weeks 6-12 of treatment (p=0.04) and at post-treatment follow-up (p=0.002). These outcomes were not significantly modified by baseline cigarette smoking status or weight/body mass index, or by medication adherence over the 12-week treatment course.

Conclusion
Findings indicate that varenicline treatment for CUD may benefit males but not females in yielding significant cannabis use reduction. Clinical providers should consider tailoring CUD treatment accordingly. Further work is needed to elucidate underlying factors contributing to this sex difference.

Scientific Significance
In a randomized controlled trial of varenicline for CUD, varenicline treatment yielded significant cannabis use reduction in males but not females.

Learning Objectives

At the conclusion of the educational session, the audience will be able to summarize the current evidence base for treating CUD.
At the conclusion of the educational session, the audience will be able to describe the methods and main efficacy findings of a clinical trial of varenicline for CUD.
At the conclusion of the educational session, the audience will be able to indicate the clinical practice implications of the study’s main efficacy findings.

Keywords

Cannabis Use Disorder
Clinical Treatment
Pharmacotherapy

Presenter
Kevin M. Gray, MD

Kevin M. Gray, M.D., is Professor and Director of Addiction Sciences in the Department of Psychiatry and Behavioral Sciences and Assistant Vice President for Advancing Research Partnerships at the Medical University of South Carolina (MUSC). As a physician-scientist co-leading the MUSC Youth Collaborative, he conducts National Institutes of Health supported clinical research, contributing novel advances to treatments for substance use disorders in adolescents and young adults. Dr. Gray is Principal Investigator of the National Institute on Drug Abuse/American Academy of Child and Adolescent Psychiatry Physician Scientist Program in Substance Use, serves on the 2 2023 AAAP Annual Meeting and Scientific Symposium Editorial Board of the Journal of the American Academy of Child and Adolescent Psychiatry, and serves on the Executive Committee of the American Academy of Addiction Psychiatry. In addition to clinical, administrative, and research efforts, Dr. Gray is dedicated to education, providing didactic instruction across training programs and mentoring multiple early career faculty and trainees in clinical research.

Co-Authors: Nathaniel Baker, Amanda Wagner, Elizabeth Chapman, Alonzo Steplight, Bryan Tolliver, Erin McClure, Aimee McRae-Clark

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