College publishes on cannabis and suicidal behaviors

Dr. Manik Ahuja, Assistant Professor in the East Tennessee State University College of Public Health’s Department of Health Services Management and Policy, is lead author of an article in Substance Abuse: Research and Treatment.  The article, “Early Age of Cannabis Initiation and Its Association With Suicidal Behaviors,” examines the association between the age of cannabis initiation and lifetime suicidal ideations and attempts in a sample of adults aged 18 or older.

ETSU College of Public Health doctoral students Manul Awasthi, Johanna Cimilluca, Kawther Al-Ksir, and Master of Public Health student Johnathan Tremblay are co-authors.  Additional co-authors include Praveen Fernandopulle from ETSU’s Department of Psychiatry and Behavioral Sciences as well as faculty from Long Island University, the University of Northern Colorado, UConn Health, and the Aureus School of Medicine.

Suicide rates in the U.S. have continued to rise over the last 2 decades. Cannabis (marijuana) is the most widely used illicit drug worldwide.  Adolescent cannabis use in the U.S. is widespread with more than 11.8 million young adults reporting cannabis use in the 2018 and 2019 annual surveys of U.S. middle and high school students. Students reported a significant increase in daily cannabis use, with about 11.8% eighth graders and 28.8% of 10th graders disclosing cannabis use in the past year.   Adolescent cannabis use has been associated with negative outcomes including lower educational attainment, negative mental health outcomes, the use of other illicit drugs, and suicidal ideation and behaviors.

While prior research has found links between early initiation of cannabis initiation and suicidal ideation behaviors, most studies have focused on suicide ideation behaviors during adolescence, and are from outside the U.S., only a few studies have examined the link between adolescent age of cannabis initiation and suicidality, particularly in adulthood.  The current study hypothesizes that early initiation of cannabis may be predictive of future suicide ideation behaviors during adulthood.

The current study involved secondary analysis of data from the National Co-Morbidity Survey Replication, the National Survey of American Life, and the National Latino and Asian American Study as these were presented in the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001 to 2003.  The full sample included 20,013 respondents (aged >18 years), of which 15,328 participants responded to the variables of interest.  The findings of this study suggest that initiation of cannabis use before the age of 14 is associated with greater than a 3-fold increase in suicide ideation and greater than a 4-fold increase odds of suicide attempt. Later age of cannabis initiation was associated with a 2.5-fold increased odds of suicide attempt. The findings reveal that while cannabis use at any point of one’s lifetime increases their risk for suicidal behaviors, initiating use at age 14 or earlier has the greatest risk.

These findings are of concern because there have been unprecedented shifts in the cannabis policy environment over the last decade, including legalization of cannabis for recreational use in several U.S. states.  The increased availability and broader legalization of cannabis is a public health concern, particularly among adolescents.