Cannabis controversies: how genetics can inform the study of comorbidity.
OBJECTIVE
To review three key and controversial comorbidities of cannabis use-other illicit drug use, psychosis and depression, as well as suicide, from a genetically informed perspective.


METHODS
Selective review.


RESULTS
Genetic factors play a critical role in the association between cannabis use, particularly early-onset use and use of other illicit drugs, psychosis and depression, as well as suicide, albeit via differing mechanisms. For other illicit drugs, while there is strong evidence for shared genetic influences, residual association that is attributable to causal or person-specific environmental factors cannot be ruled out. For depression, common genetic influences are solely responsible for the association with cannabis use but for suicidal attempt, evidence for person-specific factors persists. Finally, even though rates of cannabis use are inordinately high in those with psychotic disorders, there is no evidence of shared genetic etiologies underlying this comorbidity. Instead, there is limited evidence that adolescent cannabis use might moderate the extent to which diathesis influences psychosis.


CONCLUSIONS
Overlapping genetic influences underlie the association between early-onset cannabis use and other illicit drug use as well as depression and suicide. For psychosis, mechanisms other than shared genetic influences might be at play.
Washington University School of Medicine, Department of Psychiatry, St Louis, MO, USA.
Arpana
A
Agrawal
Michael T
MT
Lynskey
D002188:Cannabis; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology* / Q000235:genetics; D020022:Genetic Predisposition to Disease; D006801:Humans; D013287:Illicit Drugs; D008385:Marijuana Smoking / Q000453:epidemiology* / Q000235:genetics; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000235:genetics; D012931:Social Environment; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000235:genetics; D013405:Suicide / Q000706:statistics & numerical data*; D014429:Twins, Dizygotic / Q000235:genetics; D014430:Twins, Monozygotic / Q000235:genetics
D013287:Illicit Drugs
Cannabis; comorbidity; gateway; genetics; psychosis; twin