In-transition culture of experimentation with cannabis in Latin American college students: A new role within a potential drug use sequencing pattern

Introduction and Aims: Given a scenario of intense discussion about the legal situation of cannabis users worldwide, this paper aims to investigate the role of cannabis within a drug use sequencing pattern. Design and Methods: Data came from a representative sample of college students from 27 Brazilian capitals (n = 12 711). We analysed the patterns of transition from/to the first use of cannabis to/from the first use of alcohol, tobacco and seven other illegal drugs. Survival analysis methods were used to analyse age of onset data on all potential drug pairs. Drugs that were not specified as the target drug pair tested in each survival model were included as time-varying covariates in all models. Results: We found significant transitions from alcohol [adjusted hazard ratio (aHR) = 1.41, 95% confidence interval (CI) 1.15–1.73, P < 0.001] and inhalants (aHR = 1.56, 95% CI 1.26–1.93, P < 0.001) to cannabis. Moreover, we found significant transitions from cannabis to alcohol (aHR = 2.40, 95% CI 1.47–3.91, P < 0.001), cocaine (aHR = 7.47, 95% CI = 4.26–13.09, P < 0.001), prescription opioids (aHR = 2.16, 95% CI 1.29–3.63, P < 0.01) and tranquilisers (aHR = 1.51, 95% CI 1.11–2.06, P < 0.01). Discussion and Conclusions: Overall, our findings point to a strategic role of cannabis within drug first use sequence pattern. We had an important and unexpected finding—the bi-directional relationship between alcohol and cannabis. In addition, the first use of cannabis still precedes the first use of cocaine and non-medical use of tranquilisers and prescription opioids. [Castaldelli-Maia JM, Nicastri S, Cerdá M, Kim JH, Oliveira LG, Andrade AG, Martins, SS. In-transition culture of experimentation with cannabis in Latin American college students: A new role within a potential drug use sequencing pattern. Drug Alcohol Rev 2017;00:000-000].