Even non-disordered cannabis use in teens was linked to depression, suicidal thoughts, and worse school outcomes | Research

The takeaway

Among 68,000+ US adolescents, those who used cannabis without meeting disorder criteria still had roughly doubled odds of major depression, suicidal ideation, truancy, and low grades compared to non-users.

Pediatricians, school counselors, adolescent mental health professionals, parents, and policymakers focused on youth substance use.

NDCU 4x more common than cannabis use disorder; still linked to 2-4x higher odds of adverse outcomes

What the researchers found

Nondisordered cannabis use (NDCU) was 4 times more prevalent than cannabis use disorder (10.2% vs. 2.5%) among US adolescents. NDCU was associated with 2-4 times greater odds of adverse psychosocial events compared to non-use, forming a stepwise gradient from non-use through NDCU to CUD.

Why it matters

Clinical attention typically focuses on cannabis use disorder, but subclinical use is four times more common in teens and still carries significant associations with depression, suicidality, and academic problems.

The numbers in context

68,263 respondents representing ~25 million US adolescents annually. NDCU: 10.2%, CUD: 2.5%, non-use: 87.3%. NDCU adjusted odds ratios vs. non-use: depression 1.86, suicidal ideation 2.08, arrest 4.15, fighting 2.04, low GPA 1.80, truancy 1.90.

How the study worked

Cross-sectional analysis of the 2015-2019 National Survey on Drug Use and Health. 68,263 adolescents aged 12-17 classified as non-users, nondisordered cannabis users, or having cannabis use disorder (DSM-5 criteria). Adjusted logistic regression examined associations with adverse psychosocial events.

What this study cannot tell us

Cross-sectional design cannot determine causation. Adolescents with pre-existing mental health issues may be more likely to use cannabis (reverse causation). Self-reported data may be affected by social desirability. NDCU is defined by absence of disorder criteria, not by frequency or quantity.

How to read the evidence

Large nationally representative sample with validated measures. Cross-sectional design precludes causal inference.

When this study was published

Published 2023. Data from 2015-2019.

The bigger picture

As cannabis is increasingly normalized, the assumption that use below the disorder threshold is harmless deserves scrutiny. This nationally representative data suggests a dose-response pattern where any regular use in adolescence correlates with worse outcomes.

Questions still open

Does NDCU in adolescence predict later development of cannabis use disorder? Would prospective studies confirm the associations or reveal that pre-existing vulnerabilities explain the pattern?

Common questions

What is nondisordered cannabis use?

It means using cannabis in the past year but not meeting DSM-5 criteria for cannabis use disorder. This includes teens who use occasionally or regularly but have not developed the pattern of compulsive use, tolerance, withdrawal, or functional impairment that defines a clinical disorder.

Does casual cannabis use harm teenagers?

This study found associations between any cannabis use (even below disorder threshold) and higher rates of depression, suicidal thoughts, academic problems, and arrests in teens. However, the cross-sectional design cannot prove cannabis caused these outcomes. Pre-existing mental health issues may lead some teens to both use cannabis and experience these problems.

Read the original research

Nondisordered Cannabis Use Among US Adolescents.

JAMA network open, 6(5), e2311294

View on PubMed ↗Publisher’s paper ↗

Citation

Sultan, Ryan S; Zhang, Alexander W; Olfson, Mark; Kwizera, Muhire H; Levin, Frances R. (2023). Nondisordered Cannabis Use Among US Adolescents.. JAMA network open, 6(5), e2311294. https://doi.org/10.1001/jamanetworkopen.2023.11294