Risk and protective factors for cannabis, cocaine, and opioid use disorders: An umbrella review of meta-analyses of observational studies

Marco Solmi, Elena Dragioti, Giovanni Croatto, Joaquim Radua, Stefan Borgwardt, Andrè F. Carvalho, Jacopo Demurtas, Anna Mosina, Peter Konstantin Kurotschka, Jae Il Shin, Paolo Fusar-Poli

Research output: Contribution to journalReview articlepeer-review

8 Citations (Scopus)


Several meta-analyses of observational studies have addressed the association between risk and protective factors and cannabis/cocaine/opioid use disorders, but results are conflicting. No umbrella review has ever graded the credibility of this evidence (not significant/weak/suggestive/highly suggestive/convincing). We searched Pubmed-MEDLINE/PsycInfo, last search September 21, 2020. We assessed the quality of meta-analyses with the AMSTAR-2 tool. Out of 3,072 initial references, five were included, providing 19 associations between 12 putative risk/protective factors and cannabis/cocaine/opioid use disorders (cases: 4539; N = 1,118,872,721). While 84 % of the associations were statistically significant, none was convincing. One risk factor (smoking) had highly suggestive evidence for association with nonmedical use of prescription opioid medicines (OR = 3.07, 95 %CI:2.27 to 4.14). Convincing evidence emerged in sensitivity analyses on antisocial behavior and cannabis use disoder (OR 3.34, 95 %CI 2.53–4.41). Remaining associations had weak evidence. The quality of meta-analyses was rated as moderate in two (40 %), low in one (20 %), and critically low in two (40 %). Future research is needed to better profile risk/protective factors for cannabis/cocaine/opioid use disorders disorders informing preventive approaches.

Original languageEnglish
Pages (from-to)243-251
Number of pages9
JournalNeuroscience and Biobehavioral Reviews
Publication statusPublished - 2021 Jul

Bibliographical note

Funding Information:
ED, GC, JR, SB, AFC, JD, AM, PK, JIS have no conflict of interest to declare. MS has been a consultant and/or advisor to or has received honoraria from Angelini and Lundbeck outside of this work. PFP received research support from Lundbeck and personal fees from Lundbeck, Menarini and Angelini outside this work.

Publisher Copyright:
© 2021

All Science Journal Classification (ASJC) codes

  • Neuropsychology and Physiological Psychology
  • Cognitive Neuroscience
  • Behavioral Neuroscience


Dive into the research topics of 'Risk and protective factors for cannabis, cocaine, and opioid use disorders: An umbrella review of meta-analyses of observational studies'. Together they form a unique fingerprint.

Cite this