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Disentangling Medicinal and Recreational cannabis Use Among People Living with HIV: An Ecological Momentary Assessment Study

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Abstract

This study examined the feasibility of using ecological momentary assessment (EMA) to disentangle medicinal cannabis use (MCU) from recreational cannabis use (RCU) among people living HIV (PLWH). Over a 14-day period, PLWH (N = 29) who engaged in both MCU and RCU completed a smartphone-based survey before and after every cannabis use event assessing general motivation for cannabis use (MCU-only, RCU-only, or mixed MCU/RCU), cannabis use behavior, and several antecedents and outcomes of cannabis use. A total of 739 pre-cannabis surveys were completed; 590 (80%) of the prompted post-cannabis surveys were completed. Motives for cannabis use were reported as MCU-only on 24%, RCU-only on 30%, and mixed MCU/RCU on 46% of pre-cannabis surveys. Mixed effects models examined within-person differences across MCU-only, RCU-only, and mixed MCU/RCU events. Results showed that relative to RCU-only events, MCU-only events were more likely to involve symptom management and drug substitution motives, physical and sleep-related symptoms, solitary cannabis use, and use of cannabis oils and sprays; MCU-only events were less likely to involve relaxation, happiness, and wellness motives, cannabis flower use, and positive cannabis consequences. Differences between mixed MCU/RCU and RCU-only events were similar, except that mixed MCU/RCU events were additionally associated with stress reduction motives and symptoms of anxiety and depression. Findings support the feasibility of partially disentangling MCU and RCU behavior among PLWH who engage in concurrent MCU and RCU. This study highlights the need for more EMA studies isolating MCU from RCU to inform ongoing changes to cannabis policies.

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Data Availability

De-identified study data and study materials are available upon request, subject to any applicable ethics approval.

Code Availability

Data analysis syntax/code is available upon request.

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Acknowledgements

The authors wish to thank Dinat Khan, Korina Toguba, Dennis Padilla, and Katalin Halasz for their assistance with data collection for this study.

Funding

This research was supported by grants from the Canadian Institutes of Health Research Canadian HIV Trials Network (CTN PT037; PIs: Jeffrey D. Wardell and Sergio Rueda) and from the Canadian Institutes of Health Research (159754; PIs: Jeffrey D. Wardell and Christian S. Hendershot). The views expressed herein do not necessarily represent the official policy of the Canadian Institutes of Health Research. Sergio Rueda holds an Innovator Award from the Ontario HIV Treatment Network. Cecilia T. Costiniuk holds a FRQ-S Junior 2 Clinician-Researcher Career Award. Mohammad-Ali Jenabian holds the Tier 2 CIHR Canada Research Chair in Immuno-Virology.

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Authors and Affiliations

  1. Department of Psychology, York University, 101 Behavioural Sciences Building, 4700 Keele St, M3J 1P0, Toronto, ON, Canada

    Jeffrey D. Wardell & Nicolle Fox

  2. Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada

    Jeffrey D. Wardell, Sergio Rueda, Paul Shuper & John A. Cunningham

  3. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Jeffrey D. Wardell, Sergio Rueda & John A. Cunningham

  4. Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, BC, Canada

    Jeffrey D. Wardell, Sergio Rueda, Cecilia T. Costiniuk, Mohammad-Ali Jenabian, Shari Margolese, Enrico Mandarino & Joel Singer

  5. Chronic Viral Illness Service and Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada

    Cecilia T. Costiniuk

  6. Infection and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada

    Cecilia T. Costiniuk

  7. Department of Biological Sciences, Université du Québec à Montréal, Montreal, QC, Canada

    Mohammad-Ali Jenabian

  8. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Paul Shuper

  9. Bowles Centre for Alcohol Studies, University of North Carolina–Chapel Hill, Chapel Hill, NC, USA

    Christian S. Hendershot

  10. Department of Psychiatry, University of North Carolina–Chapel Hill, Chapel Hill, NC, USA

    Christian S. Hendershot

  11. Department of Addictions, Kings College London, London, UK

    John A. Cunningham

  12. Unity Health Toronto, St. Michael’s Hospital, Toronto, ON, Canada

    Gordon Arbess

  13. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada

    Gordon Arbess

  14. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

    Joel Singer

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  1. Jeffrey D. Wardell
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Contributions

All authors contributed to the study conceptualization and design, and to the development of the funding proposal. Jeffrey D. Wardell and Sergio Rueda led the study. Preparation of study materials, development of the study protocol, community outreach, and participant recruitment were performed by Nicolle Fox, Shari Margolese, and Enrico Mandarino. Data analyses were performed by Jeffrey D. Wardell with guidance from Joel Singer; Sergio Rueda, Shari Margolese, Enrico Mandarino, and Nicolle Fox all contributed to interpretation of the results. Jeffrey D. Wardell wrote the first draft of the manuscript with assistance from Nicolle Fox, and all authors provided feedback on earlier versions of the manuscript. All authors have read and approved the final version of the article.

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Correspondence to Jeffrey D. Wardell.

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The authors declare that they have no conflicts of interest to disclose.

Ethics Approval

All study procedures were approved by the Human Participants Review Committee of the York University Research Ethics Board (certificate # 2020 − 280).

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Informed consent was obtained from all study participants.

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Wardell, J.D., Rueda, S., Fox, N. et al. Disentangling Medicinal and Recreational cannabis Use Among People Living with HIV: An Ecological Momentary Assessment Study. AIDS Behav 27, 1350–1363 (2023). https://doi.org/10.1007/s10461-022-03871-7

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