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We aimed to measure the association between early cannabis exposure and subsequent bipolar disorder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting and Participants<\/jats:title><jats:p>Observational study linking a sample from the northern Finland birth cohort 1986 (<jats:italic>n<\/jats:italic>\u2009=\u20096325) to nation\u2010wide register data to examine the association of life\u2010time cannabis exposure at age 15\/16\u2009years and subsequent bipolar disorder until age 33 (until the end of 2018); 6325 individuals (48.8% males) were included in the analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Cannabis exposure was measured via self\u2010report. Bipolar disorder was measured via bipolar disorder\u2010related diagnostic codes (ICD\u201010: F30.xx, F31.xx) collected from the Care Register for Health Care 2001\u201318, the Register of Primary Health Care Visits 2011\u201318, the medication reimbursement register of the Social Insurance Institution of Finland 2001\u201305 and the disability pensions of the Finnish Center for Pensions 2001\u201316. Potential confounders included demographic characteristics, parental psychiatric disorders, emotional and behavioral problems and other substance use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Three hundred and fifty\u2010two adolescents (5.6%) reported any cannabis use until the age of 15\u201316\u2009years. Of the whole sample, 66 (1.0%) were diagnosed with bipolar disorder. Adolescent cannabis use was associated with bipolar disorder [hazard ratio (HR)\u2009=\u00a03.46; 95% confidence interval (CI)\u2009=\u00a01.81\u20136.61]. This association remained statistically significant after adjusting for sex, family structure and parental psychiatric disorders (HR\u2009=\u00a03.00; 95% CI\u2009=\u00a01.47\u20136.13) and after further adjusting for adolescent emotional and behavioral problems (HR\u2009=\u00a02.34; 95% CI\u2009=\u00a01.11\u20134.94). Further adjustments for frequent alcohol intoxications, daily smoking and lifetime illicit drug use attenuated the associations to statistically non\u2010significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In Finland, the positive association between early cannabis exposure and subsequent development of bipolar disorder appears to be confounded by other substance use.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.15881","type":"journal-article","created":{"date-parts":[[2022,3,22]],"date-time":"2022-03-22T03:21:12Z","timestamp":1647919272000},"page":"2264-2272","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Is early exposure to cannabis associated with bipolar disorder? Results from a Finnish birth cohort study"],"prefix":"10.1111","volume":"117","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5019-2600","authenticated-orcid":false,"given":"Alexander","family":"Denissoff","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Department of Psychiatry University of Turku  Turku Finland"},{"name":"Addiction Psychiatry Unit, Department of Psychiatry Turku University Hospital  Turku Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antti","family":"Mustonen","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Technology Tampere University  Tampere Finland"},{"name":"Department of Psychiatry Sein\u00e4joki Central Hospital  Sein\u00e4joki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anni\u2010Emilia","family":"Alakokkare","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Psychiatry University of Turku  Turku Finland"},{"name":"Medical Research Center Oulu Oulu University Hospital and University of Oulu  Oulu Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James G.","family":"Scott","sequence":"additional","affiliation":[{"name":"QIMR Berghofer Medical Research Institute  Herston Qld Australia"},{"name":"Metro North Mental Health Service  Herston Qld Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Musa B.","family":"Sami","sequence":"additional","affiliation":[{"name":"Institute of Mental Health University of Nottingham  Nottingham UK"},{"name":"Nottinghamshire Healthcare Trust  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jouko","family":"Miettunen","sequence":"additional","affiliation":[{"name":"Medical Research Center Oulu Oulu University Hospital and University of Oulu  Oulu Finland"},{"name":"Center for Life Course Health Research University of Oulu  Oulu Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solja","family":"Niemel\u00e4","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Psychiatry University of Turku  Turku Finland"},{"name":"Addiction Psychiatry Unit, Department of Psychiatry Turku University Hospital  Turku Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,4,8]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-021-01161-7"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61611-6"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12408"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1017\/neu.2019.21"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.npp.1300496"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(20)30074-2"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2014.10.006"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.11m06912"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2006.05.002"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2007.01875.x"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2015.05.004"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2012.04.010"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbx158"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2015.04.025"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2010.01539.x"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2014.09.016"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2016.12.014"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pharmthera.2018.10.006"},{"key":"e_1_2_9_20_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugalcdep.2020.108222","article-title":"Patterns of substance use among adolescents: a systematic review","volume":"216","author":"Halladay J","year":"2020","journal-title":"Drug Alcohol Depend"},{"key":"e_1_2_9_21_1","unstructured":"University of Oulu.Northern Finland Birth Cohort 1986 [internet]. 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