All statistical analyses were completed using R statistical software . The purpose of this pilot study was to examine the association between non-daily and daily MJ use patterns on sleep patterns in young adults recruited from the community. Daily MJ users endorsed more sleep disturbance on the PSQI and ISI than non-daily users. These results are consistent with previous studies showing an association between sleep disturbance and heavy MJ use in adults. Of note, however, was our finding that nondaily MJ users and non-users had similar sleep indices. Daytime sleepiness and chronotype did not differ across our three groups. This study provides new information about the relationship between MJ use patterns, mood, sleep, and daytime functioning. We found that the proportion of persons reporting a clinically significant PSQI threshold of >5, which distinguishes good from poor sleepers, was lowest among non-daily users and highest among the daily users . We also found that these non-daily users tended to use MJ mostly at nighttime, whereas daily users smoked considerably more MJ on use days and used during the day and the evening. The effects of MJ on sleep in intermittent users may be similar, in part, to that of alcohol where improvements in sleep continuity measures have been reported with intermittent use, whereas daily use results in the worsening of sleep. However, methodological differences in previous marijuana studies limit definitive support. While a review of 39 research studies on the effects of cannabis on sleep revealed that cannabis may interrupt sleep patterns and result in non-restorative sleep,commercial greenhouse supplies objective polysomnography in heavy MJ users show normal sleep patterns during periods of cannabis use.

One possible explanation for the study findings is that individuals habituate to the sleep inducing effects of cannabis after continued use. In addition, our finding that non-users had similar ISI scores to non-daily users, and that a lower proportion reached clinical criteria for insomnia, suggests that sleep disturbance, which is common in this age group, may not be increased by non-daily MJ use. Because this is not a MJ administration trial, this remains speculative. The clinical significance of the lower ISI score in non-daily users is likely minimal, as all scores <10 typically reflect sub threshold insomnia. Our findings suggest that anxiety is significantly related to scores on the PSQI. Persons with anxiety may be using MJ to mitigate their sleep symptoms. This is consistent with the literature, where MJ is the most commonly used illicit substance in individuals with anxiety disorders 40 and where higher MJ use has been associated with higher rates of anxiety. Lev Ran et al. found that when adjusting for any concurrent mood disorder, there was a significant impact of regular, but not occasional, use of cannabis on mental health-related quality of life in participants with anxiety disorders. It remains possible that our ISI scores might have been higher in the daily MJ users because MJ was contributing to anxiety, which in turn may have exacerbated the severity of insomnia. We found gender effects on our PSQI and ISI scores, but not on ESS or MEQ scores. The relationship between insomnia and gender was expected as insomnia is more common in females than in males in non-substance using populations. Lev-Ran et al. found that compared to non-users, occasional MJ users had poorer mental health scores in females, but not among males. These findings suggest that MJ use patterns may affect females differently given their increased risk of both insomnia and depression. MJ has been shown to affect women more significantly than men on neuropsychological tasks.We expected that there would be more evening chronotypes in the daily MJ use category, because evening chronotypes have been shown to be more likely to use alcohol, to have poor impulse control, depression, and difficulty falling asleep.

However, our MEQ results did not differ between non-users, non-daily and, or daily users. This finding is consistent with results of one study which utilized the Horne Ostberg questionnaire to assess chronotype in MJ users and reported that there were no chronotype differences between heavy MJ users and non-users. Our study is among others to examine chronotype among persons who are primarily MJ users where the influence of concurrent heavy alcohol use has been mitigated. While the relationship between chronotype and substance use is likely multifactorial, future studies might consider exploring whether evening chronotypes may be more likely to use alcohol or MJ. Our study had several limitations. First, daily MJ users in this study were heavy users, therefore, we are unable to know if the sleep reports of daily users are a result of frequency of use or quantity of use. Future studies might try to recruit daily MJ users who smoke minimally, perhaps only at night to “treat” sleep disturbance. Second, participants selfreported MJ use and sleep indices. Third, given the cross-sectional nature of this study, we are unable to assess causality. Fourth, the size of our sample increases the risk of Type 1 error, missing associations that might have been seen in a larger study. Fifth, the absence of significant difference between the non-user and user groups may have been due to low power, as the non-user group had a lower number than user groups. Sixth, we did not quantify the use patterns beyond the past month. Therefore there may have been users in our non-user groups that could have quit more than one month ago. Seventh, the sample may not be representative of this population for two reasons. Even though we recruited MJ users and non-user controls from a larger study on alcohol and marijuana, our exclusion criteria may have been too limiting. In addition, given the high rate of unemployment and low rate of high school graduates in our study sample, this study sample may not be representative of this demographic. Eighth, the non-using control sample in this study was recruited from a larger study, which may have affected statistical assumptions for comparing the MJ user group with the HC group. Lastly, a formal diagnosis of insomnia was not conducted in this study and therefore associations with insomnia based on the ISI should be interpreted cautiously. With the increasing availability of MJ and an increasing number of individuals using it for insomnia with the belief that MJ use improves sleep, our study suggests that daily use may not in fact improve sleep, although this study cannot est. Large scale studies assessing the impact of MJ on sleep are warranted.

In 1996, California became the first state to legalize medical marijuana. Known officially as the Compassionate Use Act, Proposition 215 allowed patients and caregivers to cultivate and possess marijuana for medical use. The campaign in favor of Proposition 215 focused on the benefits for seriously ill patients. Claiming that the Proposition “sends our children the false message that marijuana is safe and healthy,” the campaign against the Proposition focused on anti-drug education . Neither side addressed potential public health consequences. If Proposition 215 led to an increase in marijuana use, for example, might it also lead to higher rates of all injury deaths , including deaths from assault , deaths from motor vehicle crashes ,cannabis dry rack and—the subject of the present study—deaths from suicide ? Such consequences assume that medical and recreational users are similar. With one exception, the evidence supports this assumption. Since most California medical users were introduced to marijuana as recreational users, for example, it is reasonable to assume that the user-types have similar socioeconomic backgrounds . Compared with recreational users, however, California’s medical users were more likely to report early health problems or disabilities that would warrant medical use . Although Proposition 215 was drafted so loosely that it effectively legalized all uses of marijuana , marijuana use by California juveniles, who were not eligible for medical marijuana certificates, did not increase following Proposition 215 . Nevertheless, at the national level, during a 15-year period when a majority of states loosened their control of medical marijuana, the U.S. suicide rate rose by 24 percent , prompting many to question how legalization and suicide might be linked. The systematic evidence connecting this trend to the availability of medical marijuana is ambiguous, however. Rylander, Valdez, and Nussbaum , for example, find no correlation between a state’s suicide rate and the number of medical marijuana cardholders in the state. Similarly, comparing suicide before and after a state enacts a medical marijuana law, Grucza et al. find no change in a state’s suicide rate. In contrast, Anderson, Rees, and Sabia report a 10.8 percent reduction in suicides averaged across all medical marijuana states. Attributing a suicide trend to the availability of medical marijuana raises questions about the potential mechanisms at play. What theoretical mechanisms could lead us to expect a relationship between the availability of medical marijuana and suicide? Could these mechanisms be more salient for certain types of suicides than others? If the expected relationship is observed, what methodological rules could be used to support a causal interpretation of the relationship? We address these questions in order. Sociological theories of suicide follow Durkheim’s dictum that “suicide varies inversely with the degree of integration of the social groups of which the individual forms a part” . Institutions that successfully integrate the individual, providing a sense of belonging to the community, inhibit suicide. When institutions break down, so do the community ties that might otherwise inhibit suicide atrophy; and suicide increases.

Durkheim used cross-sectional correlations between suicide and the strength of religious, familial, and socioeconomic institutions to demonstrate his theory. The theory has been used to investigate relationships between suicide and unemployment, , poverty and income inequality , divorce and family structure , immigration and cultural assimilation , and cohort size . Regardless of focus, research largely advances a motivational argument for understanding variation in suicide rates across place or time. Although legalization of medical marijuana is likely to affect a range of societal institutions, the indirect effects through these institutions are expected to accrue gradually. Individual-level direct effects, in contrast, are expected to be realized abruptly. A more appropriate individuallevel theory for explaining the relationship between medical marijuana and suicide posits suicide risk as the product of motivation and opportunity factors. Holding motivation constant, suicide risk responds to changes in opportunity. Holding opportunity constant, risk responds to changes in motivation. Chew and McCleary use motivation/ opportunity mechanisms to explain lifecourse changes in suicide. Kubrin and Wadsworth use motivation/opportunity mechanisms to explain the effects of socioeconomic factors and firearms availability on race-specific suicide. Wadsworth, Kubrin, and Herting use motivation/opportunity mechanisms to explain suicide trends for young Black males. Consistent with this literature, we argue that if medical marijuana affects suicide risk, it must do so through one or both pathways. Mental health theories operate through a motivation pathway. The psychiatric consensus is that suicide is related to depression, anxiety, and other treatable disorders . If marijuana alleviates the acute stress associated with these disorders, then we expect suicide risk to decrease following legalization of medical marijuana. The evidence for this is mixed, however . Whereas medical users report that alleviation of acute symptoms of these disorders was a primary motivation for permit applications , a systematic review by Walsh et al. reported that this was not consistently observed across credible studies. Of course, marijuana use itself may constitute a risk factor for suicide apart from alleviating symptoms related to depression and anxiety, at least among some populations and for some levels of suicidality .A meta-analysis by Darvishi, Farhadi, Haghtalab, and Poorolajal supports the strong consensus that alcohol use disorder “significantly increases the risk of suicidal ideation, suicide attempt, and completed suicide.” With respect to medical marijuana, of course, the theoretical prediction depends on whether marijuana is used in addition to or instead of alcohol. If marijuana and alcohol use are combined, one might expect no change in suicide risk or even an increase in suicide following legalization. If marijuana replaces alcohol, on the other hand, one might expect a decrease in suicide risk following legalization.