Cannabis use for sleep aid among high school students: Concurrent and prospective associations with substance use and sleep problems

Introduction: Adolescents are at risk for both sleep problems and cannabis use. Despite emerging evidence for college students’ self-medication with cannabis to help sleep, generalizability to earlier developmental stages remains unknown. This study remedied this literature gap by characterizing high school students’ cannabis sleep aid use in terms of psychosocial correlates and prospective associations with substance use and sleep. Methods: Data were drawn from a longitudinal urban adolescent health behavior study, Project Teen, including 407 9th-11th graders (Year 1 M_age = 16.00 [SD = 1.08, range = 13–19]; 58% female; 41% Black, 22% White, 18% Asian, 17% multiracial, 2% Native Hawaiian or other Pacific Islander, 1% American Indian or Alaska Native; 12% Hispanic/Latinx). Students completed two web-based surveys (M_interval = 388.89 days [SD = 27.34]) assessing substance use and sleep at Year 1 (Y1) and Year 2 (Y2). Results: Students reporting lifetime cannabis sleep aid use (8%) endorsed greater depression and anxiety symptoms at Y1, as well as greater cannabis, alcohol, and cigarette use (but not insomnia symptoms or sleep durations) at Y1 and Y2, compared to non-using peers. Over one year, cannabis sleep aid use was associated with increased cannabis dependence symptoms among students using cannabis, past-2-week binge drinking among students using alcohol, and lifetime cigarette use. However, cannabis sleep aid use was not prospectively associated with changes in insomnia symptoms or sleep durations. Conclusions: Although replication is needed, cannabis sleep aid use among high school students may be associated with exacerbated cannabis dependence symptoms and increased binge drinking and cigarette use over time, without the intended sleep benefit.