Skip to main content Accessibility help
×
Home

Cannabis use and adherence to antipsychotic medication: a systematic review and meta-analysis

  • E. Foglia (a1), T. Schoeler (a1), E. Klamerus (a1), K. Morgan (a2) and S. Bhattacharyya (a1)...

Abstract

Background

Substance use may increase the risk of non-adherence to antipsychotics, resulting in negative outcomes in patients with psychosis.

Method

We aimed to quantitatively summarize evidence regarding the effect of cannabis use, the most commonly used illicit drug amongst those with psychosis, on adherence to antipsychotic medication. Studies were identified through a systematic database search. Adopting random-effects models, pooled odds ratios (OR) for risk of non-adherence to antipsychotic medications were calculated comparing: cannabis-users at baseline v. non-users at baseline; non users v. continued cannabis users at follow-up; non-users v. former users at follow-up; former users v. current users.

Results

Fifteen observational studies (n = 3678) were included. Increased risk of non-adherence was observed for cannabis users compared to non-users (OR 2.46, n = 3055). At follow-up, increased risk of non-adherence was observed for current users compared to non-users (OR 5.79, n = 175) and former users (OR 5.5, n = 192), while there was no difference between former users and non-users (OR 1.12, n = 187).

Conclusions

Cannabis use increases the risk of non-adherence and quitting cannabis use may help adherence to antipsychotics. Thus, cannabis use may represent a potential target for intervention to improve medication adherence in those with psychosis.

Copyright

Corresponding author

*Address for correspondence: S. Bhattacharyya, Ph.D., Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email: sagnik.2.bhattacharyya@kcl.ac.uk)

References

Hide All
Addington, J, Addington, D (2007). Patterns, predictors and impact of substance use in early psychosis: a longitudinal study. Acta Psychiatrica Scandinavia 115, 304309.
Barbeito, S, Vega, P, Ruiz de Azua, S, Saenz, M, Martinez-Cengotitabengoa, M, Gonzalez-Ortega, I, Bermudez, C, Hernanz, M, Corres, BF, Gonzalez-Pinto, A (2013). Cannabis use and involuntary admission may mediate long-term adherence in first-episode psychosis patients: a prospective longitudinal study. BMC Psychiatry 13, 326.
Beards, S, Gayer-Anderson, C, Borges, S, Dewey, ME, Fisher, HL, Morgan, C (2013). Life events and psychosis: a review and meta-analysis. Schizophrenia Bulletin 39, 740747.
Borenstein, M, Hedges, LV, Higgins, JP, Rothstein, HR (2011). Introduction to Meta-analysis. Wiley.
Buckley, PF (2007). Prevalence and consequences of the dual diagnosis of substance abuse and severe mental illness. Journal of Clinical Psychiatry 67, 59.
Buckley, PF, Wirshing, DA, Bhushan, P, Pierre, JM, Resnick, SA, Wirshing, WC (2007). Lack of insight in schizophrenia: impact on treatment adherence. CNS Drugs 21, 129141.
Castberg, I, Andreas, AW, Olav, S (2009). Does level of care, sex, age, or choice of drug influence adherence to treatment with antipsychotics? Journal of Clinical Psychopharmacology 29, 415420.
Coldham, E, Addington, J, Addington, D (2002). Medication adherence of individuals with a first episode of psychosis. Acta Psychiatrica Scandinavica 106, 286290.
Colom, F, Vieta, E, Tacchi, MJ, Sanchez-Moreno, J, Scott, J (2005). Identifying and improving non-adherence in bipolar disorders. Bipolar Disorders 7, 2431.
Conrod, P, Castellanos-Ryan, N, Strang, J (2010). Brief personality-targeted coping skills interventions and survival as a non-drug user over a 2-year period. Archive General Psychiatry 67, 8593.
Cramer, JA, Rosenheck, R (1998). Compliance with medication regimen for mental and physical disorders. Psychiatric Services 49, 196201.
de Haan, L, van Amelsvoort, T, Dingemans, P, Linszen, P (2007). Risk factors for medication non-adherence in patients with first episode schizophrenia and related disorders; a prospective five year follow-up. Pharmacopsychiatry 40, 264268.
DerSimonian, R, Laird, N (1986). Meta-analysis in clinical trials. Controlled Clinical Trials 7, 177188.
Egger, M, Davey Smith, G, Schneider, M, Minder, C (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal (Clinical Research Edition) 315, 629634.
Faridi, K, Joober, R, Malla, A (2012). Medication adherence mediates the impact of sustained cannabis use on symptom levels in first-episode psychosis. Schizophrenia Research 141, 7882.
Fenton, WS, Blyler, CR, Heinsse, RK (1997). Determinants of medication compliance in schizophrenia: empirical and clinical findings. Schizophrenia Bulletin 23, 637651.
Foti, DJ, Kotov, R, Guey, LT, Bromet, EJ (2010). Cannabis use and the course of schizophrenia: 10-year follow-up after first hospitalization. American Journal of Psychiatry 167, 987993.
Gonzalez-Pinto, A, Mosquera, F, Alonso, M, Lòpez, P, Ramìrez, F, Vieta, E, Baldessarini, RJ (2006). Suicidal risk in bipolar I disorder patients and adherence to long-term lithium treatment. Bipolar Disorders 8, 618624.
Gonzalez-Pinto, A, Reed, C, Novick, D, Bertsch, J, Haro, JM (2010). Assessment of medication adherence in a cohort of patients with bipolar disorder. Pharmacopsychiatry 43, 263270.
Grech, A, Van Os, J, Jones, PB, Lewis, SW, Murray, RM (2005). Cannabis use and outcome of recent onset psychosis. European Psychiatry 20, 349353.
Green, AI (2006). Pharmacotherapy for schizophrenia and co-occurring substance use disorders. Neurotoxicity Research 11, 3339.
Green, B, Young, R, Kavanagh, D (2005). Cannabis use and misuse prevalence among people with psychosis. British Journal of Psychiatry 187, 306313.
Higashi, K, Medic, G, Littlewood, KJ, Diez, T, Granström, O, De Hert, M (2013). Medication Adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review. Therapeutic Advances in Psychopharmacology 3, 200218.
Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG (2003). Measuring inconsistency in meta-analyses. British Medical Journal (Clinical Research Edition) 327, 557560.
Jónsdóttir, H, Opjordsmoen, S, Birkenaes, A, Simonsen, C, Engh, J, Ringen, P, Vaskinn, A, Friis, S, Sundet, K, Andreassen, O (2013). Predictors of medication adherence in patients with schizophrenia and bipolar disorder. Acta Psychiatrica Scandinavica 127, 2333.
Julius, RJ, Novitsky, MA Jr., Dubin, WR (2009). Medication adherence: a review of the literature and implications for clinical practice. Journal of Psychiatric Practice 15, 3444.
Kampman, O, Lehtinen, K (1999). Compliance in psychoses. Acta Psychiatrica Scandinavia 100, 167175.
Keith, SJ, Kane, JM (2003). Partial compliance and patient consequences in schizophrenia: our patients can do better. Journal of Clinical Psychiatry 64, 13081315.
Koskinen, J, Lohonen, J, Koponen, H, Isohanni, M, Miettunen, J (2010). Rate of cannabis use disorders in clinical samples of patients with schizophrenia: a meta-analysis. Schizophrenia Bulletin 36, 11151130.
Kovasznay, B, Fleischer, J, Tanenberg-Karant, M, Jandorf, L, Miller, AD, Bromet, E (1997). Substance use disorder and the early course of illness in schizophrenia and affective psychosis. Schizophrenia Bulletin 23, 195201.
Lacro, JP, Dunn, LB, Dolder, CR, Leckband, SG, Jeste, DV (2002). Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. Journal of Clinical Psychiatry 63, 892909.
Large, M, Sharma, S, Compton, MT, Slade, T, Nielssen, O (2011). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Archive General Psychiatry 68, 555561.
Linszen, DH, Dingemans, PM, Lenior, ME (1994). Cannabis abuse and the course of recent-onset schizophrenic disorders. Archives of General Psychiatry 51, 273279.
Liraud, F, Verdoux, H (2001). Association between temperamental characteristics and medication adherence in subjects presenting with psychotic or mood disorders. Psychiatry Research 102, 9195.
Martinez-Arevalo, MJ, Calcedo-Ordonez, A, Varo-Prieto, JR (1994). Cannabis consumption as a prognostic factor in schizophrenia. British Journal of Psychiatry 164, 679681.
Martinez-Ortega, JM, Gutierrez-Rojas, L, Jurado, D, Higueras, A, Diaz, FJ, Gurpegui, M (2012). Factors associated with frequent psychiatric admissions in a general hospital in Spain. International Journal of Social Psychiatry 58, 532535.
McGrath, J, Saha, S, Welham, J, El Saadi, O, MacCauley, C, Chant, D (2004). A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Medicine 2, 1.
Miller, R, Ream, G, McCormack, J, Gunduz-Bruce, H, Sevy, S, Robinson, D (2009). A prospective study of cannabis use as a risk factor for non-adherence and treatment dropout in first-episode schizophrenia. Schizophrenia Research 113, 138144.
Mojtabai, R, Lavelle, J, Gibson, PJ, Sohler, NL, Craig, TJ, Carlson, GA (2002). Gaps in Use of Antipsychotics after discharge by first-admission patients with schizophrenia, 1989 to 1996. Psychiatric Services 53, 337339.
Moore, THM, Zammit, S, Lingford-Hughes, A, Barnes, TR, Jones, PB, Burke, M, Lewis, G (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 370, 319328.
Mutsatsa, SH, Joyce, EM, Hutton, SB, Webb, E, Gibbins, H, Paul, S, Barnes, TR (2003). Clinical correlates of early medication adherence: west London first episode schizophrenia study. Acta Psychiatrica Scandinavia 108, 439446.
Nosè, M, Barbui, C, Tansella, M (2003). How often do patients with psychosis fail to adhere to treatment programs? A systematic review. Psychological Medicine 33, 11491160.
Penttila, M, Jaaskelainen, E, Hirvonen, N, Isohanni, M, Miettunen, J (2014). Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis. British Journal of Psychiatry 205, 8894.
Perkins, DO, Johnson, JL, Hamer, RM, Zipursky, RB, Keefe, RS, Centorrhino, F, Green, AI, Glick, IB, Kahn, RS, Sharma, T (2006). Predictors of antipsychotic medication adherence in patients recovering from a first psychotic episode. Schizophrenia Research 83, 5363.
Pogge, DL, Singer, MB, Harvey, PD (2005). Rates and predictors of adherence with atypical antipsychotic medication: a follow-up study of adolescent inpatients. Journal of Child & Adolescent Psychopharmacology 15, 901912.
Reed, RA, Harrow, M, Herbener, ES, Martin, EM (2002). Executive function in schizophrenia: is it linked to psychosis and poor life functioning? Journal of Nervous Mental Disorders 190, 725732.
Rehman, IU, Farooq, S (2007). Schizophrenia and comorbid self reported cannabis abuse: impact on course, functioning and services use. Journal of the Pakistan Medical Association 57, 60.
Schimmelmann, B, Conus, P, Cotton, S, Kupferschmid, S, McGorry, P, Lambert, M (2012). Prevalence and impact of cannabis use disorders in adolescents with early onset first episode psychosis. European Psychiatry 27, 463469.
Schoeler, T, Monk, A, Sami, MB, Klamerus, E, Foglia, E, Brown, R, Murray, R, Camuri, G, Altamura, AC, Murray, R, Bhattacharyya, S (2016 a). Continued versus discontinued cannabis use in patients with psychosis: a systematic review and meta-analysis. Lancet Psychiatry 3, 215225.
Schoeler, T, Petros, N, Di Forti, M, Pingault, JB, Klamerus, E, Foglia, E, Small, A, Murray, R, Bhattacharyya, S (2016 b). Association between continued cannabis use and risk of relapse in first-episode psychosis: a quasi-experimental investigation within an observational study. JAMA Psychiatry 73, 11731179.
Sendt, KV, Tracy, DK, Bhattacharyya, S (2014). A systematic review of factors influencing adherence to antipsychotic medication in schizophrenia-spectrum disorders. Psychiatry Research 225, 1430.
Sharma, T, Antonova, L (2003). Cognitive function in schizophrenia: deficits, functional consequences, and future treatment. Psychiatric Clinicas of North America 26, 2540.
Strakowski, SM, DelBello, MP, Fleck, DE, Adler, CM, Anthenelli, RM, Keck, PE, Arnold, LM, Amicone, J (2007). Effects of co-occurring cannabis use disorders on the course of bipolar disorder after a first hospitalization for mania. Archives of General Psychiatry 64, 5764.
Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D, Moher, D, Becker, BJ, Sipe, TA, Thacker, SB (2000). Meta-analysis of observational studies in epidemiology: a proposal for reporting. Journal of the American Medical Association 283, 20082012.
Swann, AC, Dougherty, DM, Pazzaglia, PJ, Pham, M, Moeller, FG (2004). Impulsivity: a link between bipolar disorder and substance abuse. Bipolar Disorders 6, 204212.
Van Dijk, D, Koeter, MWJ, Hijman, R, Kahn, RS, van den Brink, W (2012). Effect of cannabis use on the course of schizophrenia in male patients: a prospective cohort study. Schizophrenia Research 37, 5057.
Velligan, DI, Lam, YW, Glahn, DC, Barrett, JA, Maples, NJ, Ereshefsky, L, Miller, AL (2006). Defining and assessing adherence to oral antipsychotics: a review of the literature. Schizophrenia Bulletin 32, 724742.
Wilson, RP, Bhattacharyya, S (2016). Antipsychotic efficacy in psychosis with co-morbid cannabis misuse: a systematic review. Journal of Psychopharmacology 30, 99111.
Zammit, S, Moore, THM, Lingford-Hughes, A, Barnes, TR, Jones, PB, Burke, M (2008). Effects of cannabis use on outcomes of psychotic disorders: systematic review. British Journal of Psychiatry 193, 357363.

Keywords

Type Description Title
WORD
Supplementary materials

Foglia supplementary material
Foglia supplementary material 1

 Word (130 KB)
130 KB

Cannabis use and adherence to antipsychotic medication: a systematic review and meta-analysis

  • E. Foglia (a1), T. Schoeler (a1), E. Klamerus (a1), K. Morgan (a2) and S. Bhattacharyya (a1)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed