Cannabis Consumption Rates were Underestimated

Letters to the Editor regarding the article Cannabis Use in Germany Frequency, Routes of Administration, and Co-use of Inhaled Nicotine or Tobacco Products by Prof. Dr. Daniel Kotz, PhD MSc MPH, PD Dr. rer. nat. Sabrina Kastaun, Dr. rer. nat. Jakob Manthey, PD Dr. rer. nat. Eva Hoch, and Dr. PH Stephanie Klosterhalfen in issue 2/2024

With potential legislative changes, it is important to closely monitor the development of cannabis use in the population. We therefore highly appreciate the recent analysis of the prevalence of past-year cannabis use (1).

Considering other national surveys, we agree with the authors’ conclusions that their prevalence of 4.6% for adults in 2023 is most likely an underestimation (1). For example, according to estimates from the Epidemiological Survey on Substance Abuse (ESA), the prevalence of past-year cannabis use has been above 5.0% since 2000 (2) and was 8.8% in 2021 (3). Likewise, the prevalence of past-year cannabis use reported for adolescents and young adults (11.4% for 14– to 24-year-olds [1]) is also most likely an underestimation. The Alcohol Survey estimated in 2021 the prevalence to be 7.6% for 12– to 17-year-olds and 25.0% for 18– to 25-year-olds (4) and the ESA reported 23.9% for 18– to 24-year-olds (2).

Illegal behavior, including cannabis use, is difficult to assess due to the sensitive nature of the behavior. Participants may show socially desirable responses, such as selecting answers to maximize positive valuations (i.e., denying an illegal behavior) or choosing to skip the question, which leads to a systematic underestimation of the behavior. Thus, we want to highlight the post-hoc sensitivity analysis conducted in consideration of this known bias towards not responding to questions about illegal behavior. Through this re-estimation, Kotz and colleagues (1) identified a past-year cannabis use prevalence of 8.4% among adults, which is more consistent with estimates from other national surveys.

DOI: 10.3238/arztebl.m2024.0092

Dr. Sally Olderbak, Ph.D. M.A.; Eva Krowartz, MSc; Justin Möckl, MSc

Forschungsgruppe „Epidemiologie und Diagnostik“

IFT Institut für Therapieforschung gGmbH, München

Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität Klinikum

References

1. Kotz D, Kastaun S, Manthey J, Hoch E, Klosterhalfen S: Cannabis use in Germany: Frequency, routes of administration, and co-use of inhaled nicotine or tobacco products. Dtsch Arztebl Int 2024; 121: 52–7

2. Rauschert C, Möckl J, Wilms N, Hoch E, Kraus L, Olderbak S: Kurzbericht Epidemiologischer Suchtsurvey 2021. Tabellenband: Trends der Prävalenz des (problematischen) Konsums illegaler Drogen nach Geschlecht und Alter 1990–2021. IFT Institut für Therapieforschung München 2023. www.esa-survey.de/ergebnisse/kurzberichte-1/ (last accessed on 24 April 2024).

3. Rauschert C, Möckl J, Seitz NN, Wilms N, Olderbak S, Kraus L: The use of psychoactive substances in Germany—findings from the Epidemiological Survey of Substance Abuse 2021. Dtsch Arztebl Int 2022; 119: 527–34

4. Orth B, Merkel C: Der Substanzkonsum Jugendlicher und junger Erwachsener in Deutschland. Ergebnisse des Alkoholsurveys 2021 zu Alkohol, Rauchen, Cannabis und Trends (BZgA-Forschungsbericht). Bundeszentrale für gesundheitliche Aufklärung 2022. www.doi.org/10.17623/BZGA:Q3-ALKSY21-DE-1.0 (last accessed on 24 April 2024).