Proportions and correlates of high-risk cannabis use in Australia-A cross-sectional analysis of the 2022-2023 National Drug Strategy Household Survey.

Abstract

Cannabis use is prevalent in Australia, however, limited research has explored the levels of high-risk cannabis use within nationally representative samples. This study aimed to address this gap by examining the proportion of individuals meeting criteria for high-risk cannabis use and identifying its correlates in a representative Australian dataset. Observational study using data from the 2022-2023 Australian National Drug Strategy Household Survey on respondents self-reporting cannabis use every few months or more frequently (N = 1504). The outcome variable was the past 3 month cannabis use risk, assessed using the World Health Organization's ASSIST-Lite (WHO-ASSIST-Lite). A multinomial logistic regression on cannabis risk levels (moderate and high vs low) was conducted, with cannabis use patterns, psychological distress, and sociodemographic characteristics as independent variables. An estimated 6.2% (95% confidence interval [CI]: 4.6, 7.8) of people who consume cannabis met criteria for high-risk cannabis use. Prevalence was substantially higher among individuals who used cannabis daily (14.8% [10.2, 19.3]) compared with those who used it weekly (5.5% [2.7, 8.2]; relative risk ratio (RRR) = 5.70 [3.25, 9.98], p < 0.001). Early initiation, particularly before age 15, was also associated with greater risk of high-risk use (RRR = 2.52 [1.25, 5.08], p = 0.009), compared with initiation at age 18 or older. Respondents who reported psychological distress had an increased risk of high-risk cannabis use (RRR = 3.19 [1.66, 6.11], p < 0.001). A minority proportion of Australians who consume cannabis appear to meet criteria for high-risk use. Daily use, early age of initiation, and high psychological distress may be key risk factors.