La consommation de cannabis est un problème de santé publique, particulièrement accru chez les jeunes. Nous manquons actuellement de données sur la prise en charge médicale et le suivi des jeunes consommateurs de cannabis en France.

Étudier les caractéristiques cliniques et psychiatriques des patients consultant pour sevrage de cannabis et déterminer les facteurs liés à leur suivi médical et psychiatrique.

Étude descriptive rétrospective des patients âgés de moins de 40ans, ayant consulté, entre 2005 et 2007, dans quatre centres franciliens intra- et extrahospitaliers, un centre de tabacologie, une consultation spécifique jeunes consommateurs de cannabis, un centre de soins, d’accompagnement et de prévention en addictologie et un centre d’accueil-jeunes. Des modèles logistiques uni- et multivariés ont été réalisés pour évaluer les facteurs associés au suivi de ces patients.

Cent quarante-huit dossiers ont été analysés. L’âge moyen des patients est de 26ans, 59 % des consultants présentent des troubles anxieux et 28 % une symptomatologie dépressive d’après le score HAD. Le taux de perdus de vue est de 40 % après la première visite. L’analyse multivariée retrouve une association entre le suivi et le fait d’avoir déjà tenté d’arrêter le cannabis (p=0,04), d’avoir un traitement pharmacologique de sevrage tabagique (p=0,04) ou un traitement antidépresseur (p=0,04). Seul un quart des patients est sevré du cannabis et/ou du tabac à un mois de suivi.

Compte tenu du faible taux de suivi des jeunes consommateurs de cannabis, de nouvelles études sont nécessaires pour développer des traitements adaptés à leur prise en charge médicale.

Cannabis use is very problematic among young French people, because of the young age of first consumption and its health consequences. Indeed, the average age of cannabis experimentation is about 15 in France and 49.5% of 17 year-olds report having used cannabis in their lives. To prevent this problem, tobacco and cannabis cessation services are dedicated to handle patients who want to stop tobacco and/or cannabis. Moreover, in 2004, specific medical outpatient services have been implemented to address the problem of young cannabis users. Since their establishment, some studies have reported demographic and clinical characteristics of the patients attending these services, but we still lack data on their follow-up and their medical and psychological care.

The aim of this study is to describe the clinical and psychiatric characteristics of young patients referred to tobacco/cannabis cessation consultations or specific young cannabis users’ consultations and to evaluate their medical care and monitoring.

We designed a retrospective study in seven cessation clinics in the Paris area between 2005 and 2007. Eligible patients were regular cannabis users aged under 40. An electronic medical database was completed using patients’ medical records. Medical files reported demographic and clinical data. Psychiatric disorders were assessed using the HAD and the Beck scores. Nicotine dependence was evaluated by Fagerström’s score. The history of addictions, and data about consumption of cannabis, tobacco, alcohol and other drugs were recorded in the medical file. The follow-up of patients was defined by having at least two visits at the medical outpatient services. Tobacco and cannabis cessations were assessed at one-month follow-up. Univariate and multivariate logistic models were used to assess factors associated with patients’ follow up and monitoring.

Four cessation clinics accepted to participate in our study. One hundred and eight eligible patients were listed during the study period. One hundred and eleven patients (75%) were males and seventy-nine (53%) were employed. The average age of patients was 26 years old (±6.8). Fifty patients (34%) came to the clinic on their own decision, thirty-three (22%) were referred by a hospital and twenty-eight (19%) came because of their family’s advice. The mean age of first cannabis consumption was 16 years old (±7.3) and cannabis consumption was most often associated with tobacco use. Fifty-nine percent of patients had anxiety disorders and 28% had depression according to D-HAD score. The dropout rate after first visit was about 40%. The most frequent therapy proposed to young cannabis users was nicotine replacement therapy. Follow-up data were collected for 135 patients and only 85 (37%) patients made at least two visits at the outpatient services. The average number of consultations was five (±3.8). Multivariate analysis found an association between follow-up and previous cannabis cessation (P=0.04), pharmacological treatment of tobacco withdrawal (P=0.04), and antidepressant treatment (P=0.04). Only one quarter of patients had quit cannabis and/or tobacco at one-month follow-up.

This study describes clinical characteristics of patients attending cannabis consultations in France. As reported in other studies, anxiety disorders and depression are important problems in this population and should be considered during their medical care. The efficacy of specific French medical outpatient services is difficult to evaluate because of the high rate of dropout. Some patients’ characteristics seem linked to their monitoring but other studies should be assessed to confirm these results. As pharmacological treatments seem associated with patients’ follow-up, new research should be implemented to develop therapeutic solutions for cannabis addiction.