Combat Exposure and Cannabis Use: Are they associated?

Abstract

Cannabis also known as marijuana is an illicit psychoactive substance derived from the Cannabis sativa plant. Regular cannabis use is associated with cannabis dependence syndrome. Cannabis users are also more likely to use other illicit drugs. Studies in high-income countries show that the pattern of drug initiation starts with alcohol and tobacco, followed by cannabis use, and then other illicit drugs. The objective of this study was to assess the prevalence of cannabis use among Sri Lanka Navy (SLN) personnel and to identify any relationship with cannabis use and combat exposure. This cross-sectional study was carried out among representative samples of SLN Special Forces (Special Boat Squadron) and regular forces deployed in combat areas. Both Special Forces and regular forces were selected using simple random sampling. Personnel who had served continuously in combat areas during the one year period prior to end of combat operations were included in the study. Cannabis use was defined as smoking cannabis at least once during the past 12 months. Only personnel who had served continuously in combat areas during the one year period prior to end of combat operations were included in the study. Since there were no females in the Special Forces, females were excluded from the regular forces group. A total of 259 Special Forces and 412 regular navy personnel were recruited to the study. The sample consisted of 259 Special Forces and 412 regular navy personnel. Prevalence of cannabis use was 5.22% (95% CI 3.53-6.9). There was no significant difference in prevalence of cannabis use among Special Forces personnel compared to regular forces. Significantly higher risk of cannabis use was associated with age 18-24 years [OR 4.42(05%CI 2.18-8.97), personnel who were never married [OR 2.02 (95% CI 0.99-4.12), and an educational level less than GCE 'O' Level [OR 4.02(95% CI 1.17-13.78). There was significant association between cannabis use and hazardous alcohol use [OR 4.74 (95%CI 2.35-9.54)]. There was no significant association between cannabis use and combat exposure. Prevalence of cannabis use was less than that reported among military personnel in several other countries. In the absence of data on cannabis use among the general population in Sri Lanka, it is not possible to compare the prevalence rate in a military population with the general population. Among SLN personnel cannabis use was significantly associated with hazardous alcohol use but not smoking. Exposure to combat was not associated with an increased risk of cannabis use. These findings are consistent with the observation that overall substance use is lower in the Sri Lankan Military. Another reason could be that the study was done almost immediately after the war during which the personnel had limited access to these substances.