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Ananth P, Reed-Weston A, Wolfe J. Medical marijuana in pediatric oncology: A review of the evidence and implications for practice. Pediatr Blood Cancer 2018; 65. [PMID: 28926679 DOI: 10.1002/pbc.26826] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 12/12/2022]
Abstract
Medical marijuana (MM) has become increasingly legal at the state level and accessible to children with serious illness. Pediatric patients with cancer may be particularly receptive to MM, given purported benefits in managing cancer-related symptoms. In this review, we examine the evidence for MM as a supportive care agent in pediatric oncology. We describe the current legal status of MM, mechanism of action, common formulations, and potential benefits versus risks for pediatric oncology patients. We offer suggestions for how providers might approach MM requests. Throughout, we comment on avenues for future investigation on this growing trend in supportive care.
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Affiliation(s)
- Prasanna Ananth
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Anne Reed-Weston
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Joanne Wolfe
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
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102
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Peters J, Chien J. Contemporary Routes of Cannabis Consumption: A Primer for Clinicians. J Osteopath Med 2018; 118:67-70. [DOI: 10.7556/jaoa.2018.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Although cannabis use is federally prohibited, medical cannabis is legal in some form in 30 states and the District of Columbia, and recreational use is legal in 8 states and the District of Columbia. The increasing legal acceptance of cannabis has led to a burgeoning industry that is producing an expanding variety of cannabis products. Physicians and other health care professionals should be aware of modern forms of cannabis consumption, as well as variations in tetrahydrocannabinol concentrations, to improve assessment of cannabis use and approach to treatment. This review aims to familiarize clinicians with modern forms of cannabis consumption and enable comparisons between disparate cannabis products.
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103
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Russell C, Rueda S, Room R, Tyndall M, Fischer B. Routes of administration for cannabis use – basic prevalence and related health outcomes: A scoping review and synthesis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 52:87-96. [DOI: 10.1016/j.drugpo.2017.11.008] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 10/31/2017] [Accepted: 11/02/2017] [Indexed: 01/10/2023]
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Krauss MJ, Rajbhandari B, Sowles SJ, Spitznagel EL, Cavazos-Rehg P. A latent class analysis of poly-marijuana use among young adults. Addict Behav 2017; 75:159-165. [PMID: 28756354 DOI: 10.1016/j.addbeh.2017.07.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/27/2017] [Accepted: 07/13/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION With more states legalizing marijuana use, the marijuana industry has grown, introducing a variety of marijuana products. Our study explores the use of multiple marijuana products (poly-marijuana use) and the characteristics associated with this behavior. METHODS Past-month marijuana users aged 18-34years were surveyed online via an existing online panel (n=2444). Participants answered questions about past-month use of three types of marijuana (plant-based, concentrates, edibles), marijuana use patterns, and driving after use. Latent class analysis was used to identify subgroups of marijuana users. RESULTS Four classes of marijuana users were identified: Light plant users, who used only plant-based products infrequently and were unlikely to drive after use (32%); Heavy plant users, who used mainly plant-based products frequently, multiple times per day, and were likely to drive after use (37%); Plant and concentrates users, who used plant-based products heavily and concentrates at least infrequently, used multiple times per day, and were likely to drive after use (20%); Light plant and edibles users, who used both products infrequently and were unlikely to drive after use (10%). Those in legal marijuana states were more likely to belong to the poly-marijuana groups. DISCUSSION Our findings reflect the increase in popularity of new marijuana products in legal states and suggest that heavy user groups, including concentrates users, are associated with driving after use. As various forms of marijuana use increases, monitoring and surveillance of the use of multiple types of marijuana will be important for determining potential varying impacts on physiological and social consequences.
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Affiliation(s)
- Melissa J Krauss
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States.
| | - Biva Rajbhandari
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Shaina J Sowles
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Edward L Spitznagel
- Department of Mathematics, Washington University School of Medicine, St. Louis, MO, United States
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
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105
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Smart R, Caulkins JP, Kilmer B, Davenport S, Midgette G. Variation in cannabis potency and prices in a newly legal market: evidence from 30 million cannabis sales in Washington state. Addiction 2017; 112:2167-2177. [PMID: 28556310 PMCID: PMC5673542 DOI: 10.1111/add.13886] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/17/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022]
Abstract
AIMS To (1) assess trends and variation in the market share of product types and potency sold in a legal cannabis retail market and (2) estimate how potency and purchase quantity influence price variation for cannabis flower. DESIGN Secondary analysis of publicly available data from Washington State's cannabis traceability system spanning 7 July 2014 to 30 September 2016. Descriptive statistics and linear regressions assessed variation and trends in cannabis product variety and potency. Hedonic regressions estimated how purchase quantity and potency influence cannabis flower price variation. SETTING Washington State, USA. PARTICIPANTS (1) A total of 44 482 176 million cannabis purchases, including (2) 31 052 123 cannabis flower purchases after trimming price and quantity outliers. MEASUREMENTS Primary outcome measures were (1) monthly expenditures on cannabis, total delta-9-tetrahydrocannabinol (THC) concentration and cannabidiol (CBD) concentration by product type and (2) excise tax-inclusive price per gram of cannabis flower. Key covariates for the hedonic price regressions included quantity purchased, THC and CBD. FINDINGS Traditional cannabis flowers still account for the majority of spending (66.6%), but the market share of extracts for inhalation increased by 145.8% between October 2014 and September 2016, now comprising 21.2% of sales. The average THC-level for cannabis extracts is more than triple that for cannabis flowers (68.7% compared to 20.6%). For flower products, there is a statistically significant relationship between price per gram and both THC [coefficient = 0.012; 95% confidence interval (CI) = 0.011-0.013] and CBD (coefficient = 0.017; CI = 0.015-0.019). The estimated discount elasticity is -0.06 (CI = -0.07 to -0.05). CONCLUSIONS In the state of Washington, USA, the legal cannabis market is currently dominated by high-THC cannabis flower, and features growing expenditures on extracts. For cannabis flower, both THC and CBD are associated with higher per-gram prices, and there are small but significant quantity discounts.
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Affiliation(s)
| | - Jonathan P. Caulkins
- RAND Corporation, Santa Monica, CA, USA
- Heinz College, Carnegie Mellon University, Pittsburgh, PA, USA
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Cavazos-Rehg PA, Krauss MJ, Sowles SJ, Bierut LJ. Marijuana-Related Posts on Instagram. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2017; 17:710-20. [PMID: 27262456 DOI: 10.1007/s11121-016-0669-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Instagram is a highly visual social networking site whose audience continues to grow, especially among young adults. In the present study, we examine marijuana-related content on Instagram to better understand the varied types of marijuana-related social networking occurring on this popular social media platform. We collected 417,561 Instagram posts with marijuana-related hashtags from November 29 to December 12, 2014. We assessed content of a random sample (n = 5000) of these posts with marijuana-related hashtags. Approximately 2136 (43 %) were explicit about marijuana and further analyzed. Of the 2136 marijuana-related posts, images of marijuana were common (n = 1568). Among these 1568 marijuana images, traditional forms (i.e., buds/leaves) were the most common (63 %), followed by some novel forms of marijuana, including marijuana concentrates (20 %). Among the 568 posts that displayed marijuana being ingested, 20 % showed someone dabbing marijuana concentrates. Marijuana-related advertisements were also observed among the 2136 marijuana-related posts (9 %). Our findings signal the promotion of marijuana use in its traditional plant-based form; trendy and novel modes of marijuana ingestion were also endorsed. This content along with the explicit marketing of marijuana that we observed on Instagram have potential to influence social norms surrounding marijuana use.
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Affiliation(s)
- Patricia A Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA.
| | - Melissa J Krauss
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA
| | - Shaina J Sowles
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA
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Borodovsky JT, Budney AJ. Legal cannabis laws, home cultivation, and use of edible cannabis products: A growing relationship? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 50:102-110. [PMID: 29102847 DOI: 10.1016/j.drugpo.2017.09.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 09/16/2017] [Accepted: 09/26/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Over half of U.S. states have enacted legal cannabis laws (LCL). In parallel, edible cannabis products (i.e., edibles) have presented new regulatory challenges. LCL provisions that dictate access to cannabis (e.g., home cultivation (HC) or dispensaries (DSP)) may impact edible production and use. This study examined relationships among HC and DSP provisions, cannabis cultivation, and edible use. METHODS An online cannabis use survey was distributed using Facebook. Data were collected from 1813 cannabis-using adults. U.S. states were classified as states without LCL (Non-LCL) or LCL states that: (1) only permit DSP (LCL DSP-only), (2) only permit HC (LCL HC-only), or (3) permit HC and DSP (LCL HC+DSP). Analyses tested associations among these classifications, cannabis growing, and edible use and procurement. RESULTS Individuals in LCL HC-only and LCL HC+DSP states were more likely to report currently growing cannabis at home (OR: 3.3, 95% CI: 1.7, 6.2; OR: 3.9, 95% CI: 2.4, 6.3, respectively) and past-month edible use (OR: 2.1, 95% CI: 1.4, 3.4; OR: 2.9, 95% CI: 2.2, 3.9, respectively) than individuals in LCL DSP-only states. Regardless of state, those who had grown cannabis were more likely to have made edibles than those who had never grown cannabis (OR: 2.2, 95% CI: 1.8, 2.6). Individuals in LCL HC-only states were more likely to have made edibles in the past month than individuals from Non-LCL (OR: 2.75, 95% CI: 1.5, 5.3) and DSP-only states (OR: 2.1, 95% CI: 1.0, 4.4). Individuals in LCL HC+DSP states were more likely to have purchased edibles in the past month than individuals from Non-LCL (OR: 3.7, 95% CI: 2.4, 5.6) and DSP-only states (OR: 3.2, 95% CI: 1.8, 5.5). CONCLUSION Specific LCL provisions may differentially affect individuals' propensity to grow cannabis and make, buy, and use edible cannabis products. Permitting home cultivation contributes to a greater likelihood of growing cannabis. Those who grow cannabis economize the plant by creating homemade edible cannabis products. Conversely, permitting dispensaries increases the likelihood of purchasing edibles. The psychoactive effects of edibles with unknown and variable cannabinoid content will be unpredictable. Policymakers should carefully consider how specific LCL provisions can affect patterns of cannabis edible product access and quality.
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Affiliation(s)
- Jacob T Borodovsky
- Dartmouth Geisel School of Medicine, Center for Technology and Behavioral Health, 46 Centerra Parkway, Lebanon, NH 03766, United States; The Dartmouth Institute for Health Policy and Clinical Practice, 74 College St., Hanover, NH 03755, United States.
| | - Alan J Budney
- Dartmouth Geisel School of Medicine, Center for Technology and Behavioral Health, 46 Centerra Parkway, Lebanon, NH 03766, United States
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108
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Lapham GT, Lee AK, Caldeiro RM, McCarty D, Browne KC, Walker DD, Kivlahan DR, Bradley KA. Frequency of Cannabis Use Among Primary Care Patients in Washington State. J Am Board Fam Med 2017; 30:795-805. [PMID: 29180554 PMCID: PMC5769869 DOI: 10.3122/jabfm.2017.06.170062] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/09/2017] [Accepted: 06/17/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Over 12% of US adults report past-year cannabis use, and among those who use daily, 25% or more have a cannabis use disorder. Use is increasing as legal access expands. Yet, cannabis use is not routinely assessed in primary care, and little is known about use among primary care patients and relevant demographic and behavioral health subgroups. This study describes the prevalence and frequency of past-year cannabis use among primary care patients assessed for use during a primary care visit. METHODS This observational cohort study included adults who made a visit to primary care clinics with annual behavioral health screening, including a single-item question about frequency past-year cannabis use (March 2015 to February 2016; n = 29,857). Depression, alcohol and other drug use were also assessed by behavioral health screening. Screening results, tobacco use, and diagnoses for past-year behavioral health conditions (e.g., mental health and substance use disorders) were obtained from EHRs. RESULTS Among patients who completed the cannabis use question (n = 22,095; 74% of eligible patients), 15.3% (14.8% to 15.8%) reported any past-year use: 12.2% (11.8% to 12.6%) less than daily, and 3.1% (2.9%-3.3%) daily. Among 2228 patients age 18 to 29 years, 36.0% (34.0% to 38.0%) reported any cannabis use and 8.1% (7.0% to 9.3%) daily use. Daily cannabis use was common among men age 18 to 29 years who used tobacco or screened positive for depression or used tobacco: 25.5% (18.8% to 32.1%) and 31.7% (23.3% to 40.0%), respectively. CONCLUSIONS Cannabis use was common in adult primary care patients, especially among younger patients and those with behavioral health conditions. Results highlight the need for primary care approaches to address cannabis use.
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Affiliation(s)
- Gwen T Lapham
- From the Kaiser Permanent Washington Health Research Institute (formerly Group Health Research Institute) (GTL, AKL, KAB); Department of Health Services, University of Washington, Seattle, WA (GTL, KAB); Behavioral Health Support Services, Kaiser Permanente Washington (formerly Group Health Cooperative), Seattle (RMC); Oregon Health & Science University (OHSU) - Portland State University School of Public Health, OHSU, Portland, OR (DM); Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle (KCB, DRK); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (KCB, DRK); Innovative Programs Research Group, School of Social Work, University of Washington, Seattle (DDW); Health Services Research & Development VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle (DRK); Department of Medicine, University of Washington, Seattle (KAB).
| | - Amy K Lee
- From the Kaiser Permanent Washington Health Research Institute (formerly Group Health Research Institute) (GTL, AKL, KAB); Department of Health Services, University of Washington, Seattle, WA (GTL, KAB); Behavioral Health Support Services, Kaiser Permanente Washington (formerly Group Health Cooperative), Seattle (RMC); Oregon Health & Science University (OHSU) - Portland State University School of Public Health, OHSU, Portland, OR (DM); Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle (KCB, DRK); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (KCB, DRK); Innovative Programs Research Group, School of Social Work, University of Washington, Seattle (DDW); Health Services Research & Development VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle (DRK); Department of Medicine, University of Washington, Seattle (KAB)
| | - Ryan M Caldeiro
- From the Kaiser Permanent Washington Health Research Institute (formerly Group Health Research Institute) (GTL, AKL, KAB); Department of Health Services, University of Washington, Seattle, WA (GTL, KAB); Behavioral Health Support Services, Kaiser Permanente Washington (formerly Group Health Cooperative), Seattle (RMC); Oregon Health & Science University (OHSU) - Portland State University School of Public Health, OHSU, Portland, OR (DM); Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle (KCB, DRK); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (KCB, DRK); Innovative Programs Research Group, School of Social Work, University of Washington, Seattle (DDW); Health Services Research & Development VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle (DRK); Department of Medicine, University of Washington, Seattle (KAB)
| | - Dennis McCarty
- From the Kaiser Permanent Washington Health Research Institute (formerly Group Health Research Institute) (GTL, AKL, KAB); Department of Health Services, University of Washington, Seattle, WA (GTL, KAB); Behavioral Health Support Services, Kaiser Permanente Washington (formerly Group Health Cooperative), Seattle (RMC); Oregon Health & Science University (OHSU) - Portland State University School of Public Health, OHSU, Portland, OR (DM); Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle (KCB, DRK); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (KCB, DRK); Innovative Programs Research Group, School of Social Work, University of Washington, Seattle (DDW); Health Services Research & Development VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle (DRK); Department of Medicine, University of Washington, Seattle (KAB)
| | - Kendall C Browne
- From the Kaiser Permanent Washington Health Research Institute (formerly Group Health Research Institute) (GTL, AKL, KAB); Department of Health Services, University of Washington, Seattle, WA (GTL, KAB); Behavioral Health Support Services, Kaiser Permanente Washington (formerly Group Health Cooperative), Seattle (RMC); Oregon Health & Science University (OHSU) - Portland State University School of Public Health, OHSU, Portland, OR (DM); Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle (KCB, DRK); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (KCB, DRK); Innovative Programs Research Group, School of Social Work, University of Washington, Seattle (DDW); Health Services Research & Development VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle (DRK); Department of Medicine, University of Washington, Seattle (KAB)
| | - Denise D Walker
- From the Kaiser Permanent Washington Health Research Institute (formerly Group Health Research Institute) (GTL, AKL, KAB); Department of Health Services, University of Washington, Seattle, WA (GTL, KAB); Behavioral Health Support Services, Kaiser Permanente Washington (formerly Group Health Cooperative), Seattle (RMC); Oregon Health & Science University (OHSU) - Portland State University School of Public Health, OHSU, Portland, OR (DM); Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle (KCB, DRK); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (KCB, DRK); Innovative Programs Research Group, School of Social Work, University of Washington, Seattle (DDW); Health Services Research & Development VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle (DRK); Department of Medicine, University of Washington, Seattle (KAB)
| | - Daniel R Kivlahan
- From the Kaiser Permanent Washington Health Research Institute (formerly Group Health Research Institute) (GTL, AKL, KAB); Department of Health Services, University of Washington, Seattle, WA (GTL, KAB); Behavioral Health Support Services, Kaiser Permanente Washington (formerly Group Health Cooperative), Seattle (RMC); Oregon Health & Science University (OHSU) - Portland State University School of Public Health, OHSU, Portland, OR (DM); Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle (KCB, DRK); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (KCB, DRK); Innovative Programs Research Group, School of Social Work, University of Washington, Seattle (DDW); Health Services Research & Development VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle (DRK); Department of Medicine, University of Washington, Seattle (KAB)
| | - Katharine A Bradley
- From the Kaiser Permanent Washington Health Research Institute (formerly Group Health Research Institute) (GTL, AKL, KAB); Department of Health Services, University of Washington, Seattle, WA (GTL, KAB); Behavioral Health Support Services, Kaiser Permanente Washington (formerly Group Health Cooperative), Seattle (RMC); Oregon Health & Science University (OHSU) - Portland State University School of Public Health, OHSU, Portland, OR (DM); Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle (KCB, DRK); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (KCB, DRK); Innovative Programs Research Group, School of Social Work, University of Washington, Seattle (DDW); Health Services Research & Development VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle (DRK); Department of Medicine, University of Washington, Seattle (KAB)
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The potential impact of cannabis legalization on the development of cannabis use disorders. Prev Med 2017; 104:31-36. [PMID: 28668544 PMCID: PMC5735001 DOI: 10.1016/j.ypmed.2017.06.034] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 06/24/2017] [Accepted: 06/26/2017] [Indexed: 01/21/2023]
Abstract
Specific provisions of legal cannabis legislation and regulation could influence cannabis initiation, frequency and quantity of use, and progression to cannabis use disorder. This brief essay highlights scientifically based principles and risk factors that underlie substance use and addiction that can be leveraged to inform policies that might mitigate the development and consequences of cannabis use disorder. Specifically, pharmacologic, access/availability, and environmental factors are discussed in relation to their influence on substance use disorders to illustrate how regulatory provisions can differentially affect these factors and risk for addiction. Relevant knowledge from research and experience with alcohol and tobacco regulation are also considered. Research designed to inform regulatory policy and to evaluate the impact of cannabis legislation on cannabis use and problems is progressing. However, definitive findings will come slowly, and more concerted efforts and resources are needed to expedite this process. In the meantime, policymakers should take advantage of the large body of scientific literature on substance use to foster empirically-guided, common sense approaches to cannabis policy that focus on prevention of addiction.
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Abstract
PURPOSE OF REVIEW Physicians of all disciplines must rapidly adjust their clinical practices following the expansion of marijuana legalization across the country. Organ transplantation teams are uniquely struggling in this gray zone with eight states having passed laws explicitly banning the denial of transplant listing based on a patient's use of medical marijuana. In this review, we examine the clinical evidence of marijuana use in transplant patients to enable psychiatric providers to meaningfully contribute to the relevant medical and psychiatric aspects of this issue in a unique patient population. RECENT FINDINGS There is no consensus among experts regarding marijuana use in transplantation patients. There are extant case reports of post-transplant complications attributed to marijuana use including membranous glomerulonephritis, ventricular tachycardia, and tacrolimus toxicity. However, recent studies suggest that the overall survival rates in kidney, liver, lung, and heart transplant patients using marijuana are equivalent to non-users. Transplant teams should not de facto exclude marijuana users from transplant listing but instead holistically evaluate a patient's candidacy, integrating meaningful medical, psychiatric, and social variables into the complex decision-making process. Psychiatric providers can play a key role in this process. Appropriate stewardship over donor organs, a limited and precious resource, will require a balance of high-clinical standards with inclusive efforts to treat as many patients as possible.
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Affiliation(s)
- Harinder Singh Rai
- University of Michigan Department of Psychiatry, 9D 9816 University Hospital, 1500 E. Medical Center Dr. SPC 5118, Ann Arbor, MI, 48109-5118, USA
| | - Gerald Scott Winder
- University of Michigan Department of Psychiatry, 9D 9816 University Hospital, 1500 E. Medical Center Dr. SPC 5118, Ann Arbor, MI, 48109-5118, USA.
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111
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Meier MH. Associations between butane hash oil use and cannabis-related problems. Drug Alcohol Depend 2017; 179:25-31. [PMID: 28750253 DOI: 10.1016/j.drugalcdep.2017.06.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/11/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND High-potency cannabis concentrates are increasingly popular in the United States, and there is concern that use of high-potency cannabis might increase risk for cannabis-related problems. However, little is known about the potential negative consequences of concentrate use. This study reports on associations between past-year use of a high-potency cannabis concentrate, known as butane hash oil (BHO), and cannabis-related problems. METHODS A sample of 821 college students were recruited to complete a survey about their health and behavior. Participants who had used cannabis in the past year (33%, n=273) completed questions about their cannabis use, including their use of BHO and cannabis-related problems in eight domains: physical dependence, impaired control, academic-occupational problems, social-interpersonal problems, self-care problems, self-perception, risk behavior, and blackouts. RESULTS Approximately 44% (n=121) of past-year cannabis users had used BHO in the past year. More frequent BHO use was associated with higher levels of physical dependence (RR=1.8, p<0.001), impaired control (RR=1.3, p<0.001), cannabis-related academic/occupational problems (RR=1.5, p=0.004), poor self-care (RR=1.3, p=0.002), and cannabis-related risk behavior (RR=1.2, p=0.001). After accounting for sociodemographic factors, age of onset of cannabis use, sensation seeking, overall frequency of cannabis use, and frequency of other substance use, BHO use was still associated with higher levels of physical dependence (RR=1.2, p=0.014). CONCLUSIONS BHO use is associated with greater physiological dependence on cannabis, even after accounting for potential confounders. Longitudinal research is needed to determine if cannabis users with higher levels of physiological dependence seek out BHO and/or if BHO use increases risk for physiological dependence.
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Affiliation(s)
- Madeline H Meier
- Department of Psychology, Arizona State University, PO Box 871104, Tempe, AZ 85287-1104, United States.
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112
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Popova L, McDonald EA, Sidhu S, Barry R, Richers Maruyama TA, Sheon NM, Ling PM. Perceived harms and benefits of tobacco, marijuana, and electronic vaporizers among young adults in Colorado: implications for health education and research. Addiction 2017; 112:1821-1829. [PMID: 28449191 PMCID: PMC5593776 DOI: 10.1111/add.13854] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/15/2016] [Accepted: 04/26/2017] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate how young adults perceive and compare harms and benefits of marijuana and tobacco products in the context of a legal marijuana market in Colorado. DESIGN Semi-structured qualitative interviews. SETTING Denver, CO, USA. PARTICIPANTS Thirty-two young adults (aged 18-26 years) who used tobacco/marijuana/vaporizers. MEASUREMENTS Semi-structured interviews addressed perceived harms and benefits of various tobacco and marijuana products and personal experiences with these products. FINDINGS Young adults evaluated harms and benefits using five dimensions: (1) combustion-smoking was considered more harmful than non-combustible products (e.g. e-cigarettes, vaporizers and edibles); (2) potency-edibles and marijuana concentrates were perceived as more harmful than smoking marijuana flower because of potential to receive too large a dose of tetrahydrocannabinol (THC); (3) chemicals-products containing chemical additives were seen as more harmful than 'pure' or 'natural' plant products; (4) addiction-participants recognized physiological addiction to nicotine, but talked primarily about psychological or life-style dependence on marijuana; and (5) source of knowledge-personal experiences, warning labels, campaigns, the media and opinions of product retailers and medical practitioners affected perceptions of harms and benefits. CONCLUSIONS Among young adults in Colorado, USA, perceived harms and benefits of tobacco and marijuana include multiple dimensions. Health educational campaigns could benefit from addressing these dimensions, such as the potency of nicotine and cannabis concentrates and harmful chemicals present in the organic material of tobacco and marijuana. Descriptors such as 'natural' and 'pure' in the promotion or packaging of tobacco and marijuana products might be misleading.
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Affiliation(s)
- Lucy Popova
- School of Public Health, Georgia State University
| | - Emily Anne McDonald
- Department of Anthropology, City University of New York, John Jay College of Criminal Justice
| | - Sohrab Sidhu
- Internal Medicine and Preventive Medicine Residency, Kaiser Permanente San Francisco and University of California, San Francisco
| | - Rachel Barry
- School of Social and Political Science, University of Edinburgh
| | - Tracey A. Richers Maruyama
- Tobacco Prevention and Education Program, Health Promotion Division, Denver Public Health, Denver Health and Hospital Authority
| | - Nicolas M. Sheon
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco
| | - Pamela M. Ling
- Division of General Internal Medicine, Department of Medicine, Center for Tobacco Control Research and Education, University of California, San Francisco
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113
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Meehan-Atrash J, Luo W, Strongin RM. Toxicant Formation in Dabbing: The Terpene Story. ACS OMEGA 2017; 2:6112-6117. [PMID: 28983528 PMCID: PMC5623941 DOI: 10.1021/acsomega.7b01130] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/12/2017] [Indexed: 05/25/2023]
Abstract
Inhalable, noncombustible cannabis products are playing a central role in the expansion of the medical and recreational use of cannabis. In particular, the practice of "dabbing" with butane hash oil has emerged with great popularity in states that have legalized cannabis. Despite their growing popularity, the degradation product profiles of these new products have not been extensively investigated. The study herein focuses on the chemistry of myrcene and other common terpenes found in cannabis extracts. Methacrolein, benzene, and several other products of concern to human health were formed under the conditions that simulated real-world dabbing. The terpene degradation products observed are consistent with those reported in the atmospheric chemistry literature.
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114
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Cavazos-Rehg PA, Krauss MJ, Sowles SJ, Zewdie K, Bierut L. Operating a motor vehicle after marijuana use: Perspectives from people who use high-potency marijuana. Subst Abus 2017; 39:21-26. [DOI: 10.1080/08897077.2017.1365802] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
| | - Melissa J. Krauss
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Shaina J. Sowles
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kidist Zewdie
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Laura Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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115
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Chan GCK, Hall W, Freeman TP, Ferris J, Kelly AB, Winstock A. User characteristics and effect profile of Butane Hash Oil: An extremely high-potency cannabis concentrate. Drug Alcohol Depend 2017. [PMID: 28624604 DOI: 10.1016/j.drugalcdep.2017.04.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent reports suggest an increase in use of extremely potent cannabis concentrates such as Butane Hash Oil (BHO) in some developed countries. The aims of this study were to examine the characteristics of BHO users and the effect profiles of BHO. DESIGN Anonymous online survey in over 20 countries in 2014 and 2015. Participants aged 18 years or older were recruited through onward promotion and online social networks. The overall sample size was 181,870. In this sample, 46% (N=83,867) reported using some form of cannabis in the past year, and 3% reported BHO use (n=5922). MEASUREMENTS Participants reported their use of 7 types of cannabis in the past 12 months, the source of their cannabis, reasons for use, use of other illegal substances, and lifetime diagnosis for depression, anxiety and psychosis. Participants were asked to rate subjective effects of BHO and high potency herbal cannabis. FINDINGS Participants who reported a lifetime diagnosis of depression (OR=1.15, p=0.003), anxiety (OR=1.72, p<0.001), and a larger number of substance use (OR=1.29, p<0.001) were more likely to use BHO than only using high potency herbal cannabis. BHO users also reported stronger negative effects and less positive effects when using BHO than high potency herbal cannabis (p<0.001) CONCLUSION: Mental health problems and other illicit drug use were associated with use of BHO. BHO was reported to have stronger negative and weaker positive effects than high potency herbal cannabis.
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Affiliation(s)
- Gary C K Chan
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD 4029, Australia.
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Tom P Freeman
- National Addiction Centre, King's College London, 4 Windsor Walk, London SE5 8BB, UK; Clinical Psychopharmacology Unit, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Jason Ferris
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Brisbane 4068, Australia
| | - Adrian B Kelly
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Adam Winstock
- Global Drug Survey, Fergusson House,124/128 City Road, London EC1 V2NJ, UK; University College London,Gower Street, London WC1E 6BT, UK
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Daniulaityte R, Lamy FR, Barratt M, Nahhas RW, Martins SS, Boyer EW, Sheth A, Carlson RG. Characterizing marijuana concentrate users: A web-based survey. Drug Alcohol Depend 2017; 178:399-407. [PMID: 28704769 PMCID: PMC5567791 DOI: 10.1016/j.drugalcdep.2017.05.034] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/27/2017] [Accepted: 05/29/2017] [Indexed: 12/20/2022]
Abstract
AIMS The study seeks to characterize marijuana concentrate users, describe reasons and patterns of use, perceived risk, and identify predictors of daily/near daily use. METHODS An anonymous web-based survey was conducted (April-June 2016) with 673 US-based cannabis users recruited via the Bluelight.org web-forum and included questions about marijuana concentrate use, other drugs, and socio-demographics. Multivariable logistic regression analyses were conducted to identify characteristics associated with greater odds of lifetime and daily use of marijuana concentrates. RESULTS About 66% of respondents reported marijuana concentrate use. The sample was 76% male, and 87% white. Marijuana concentrate use was viewed as riskier than flower cannabis. Greater odds of marijuana concentrate use was associated with living in states with "recreational" (AOR=4.91; p=0.001) or "medical, less restrictive" marijuana policies (AOR=1.87; p=0.014), being male (AOR=2.21, p=0.002), younger (AOR=0.95, p<0.001), number of other drugs used (AOR=1.23, p<0.001), daily herbal cannabis use (AOR=4.28, p<0.001), and lower perceived risk of cannabis use (AOR=0.96, p=0.043). About 13% of marijuana concentrate users reported daily/near daily use. Greater odds of daily concentrate use was associated with being male (AOR=9.29, p=0.033), using concentrates for therapeutic purposes (AOR=7.61, p=0.001), using vape pens for marijuana concentrate administration (AOR=4.58, p=0.007), and lower perceived risk of marijuana concentrate use (AOR=0.92, p=0.017). CONCLUSIONS Marijuana concentrate use was more common among male, younger and more experienced users, and those living in states with more liberal marijuana policies. Characteristics of daily users, in particular patterns of therapeutic use and utilization of different vaporization devices, warrant further research with community-recruited samples.
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Affiliation(s)
- Raminta Daniulaityte
- Center for Interventions, Treatment, and Addictions Research (CITAR), Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, United States; Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis), Department of Computer Science and Engineering, Wright State University, United States.
| | - Francois R. Lamy
- Center for Interventions, Treatment, and Addictions Research (CITAR); Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine,Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis); Department of Computer Science and Engineering, Wright State University
| | - Monica Barratt
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW Australia,National Drug Research Institute, Faculty of Public Health, Curtin University, Australia,Centre for Population Health; Burnet Institute, Australia
| | - Ramzi W. Nahhas
- Division of Epidemiology and Biostatistics; Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine,Department of Psychiatry; Wright State University Boonshoft School of Medicine
| | - Silvia S. Martins
- Department of Epidemiology; Columbia University Mailman School of Public Health
| | - Edward W. Boyer
- Department of Emergency Medicine; University of Massachusetts Medical School
| | - Amit Sheth
- Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis); Department of Computer Science and Engineering, Wright State University
| | - Robert G. Carlson
- Center for Interventions, Treatment, and Addictions Research (CITAR); Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine,Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis); Department of Computer Science and Engineering, Wright State University
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Fischer B, Russell C, Sabioni P, van den Brink W, Le Foll B, Hall W, Rehm J, Room R. Lower-Risk Cannabis Use Guidelines: A Comprehensive Update of Evidence and Recommendations. Am J Public Health 2017. [PMID: 28644037 DOI: 10.2105/ajph.2017.303818] [Citation(s) in RCA: 243] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cannabis use is common in North America, especially among young people, and is associated with a risk of various acute and chronic adverse health outcomes. Cannabis control regimes are evolving, for example toward a national legalization policy in Canada, with the aim to improve public health, and thus require evidence-based interventions. As cannabis-related health outcomes may be influenced by behaviors that are modifiable by the user, evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG)-akin to similar guidelines in other health fields-offer a valuable, targeted prevention tool to improve public health outcomes. OBJECTIVES To systematically review, update, and quality-grade evidence on behavioral factors determining adverse health outcomes from cannabis that may be modifiable by the user, and translate this evidence into revised LRCUG as a public health intervention tool based on an expert consensus process. SEARCH METHODS We used pertinent medical search terms and structured search strategies, to search MEDLINE, EMBASE, PsycINFO, Cochrane Library databases, and reference lists primarily for systematic reviews and meta-analyses, and additional evidence on modifiable risk factors for adverse health outcomes from cannabis use. SELECTION CRITERIA We included studies if they focused on potentially modifiable behavior-based factors for risks or harms for health from cannabis use, and excluded studies if cannabis use was assessed for therapeutic purposes. DATA COLLECTION AND ANALYSIS We screened the titles and abstracts of all studies identified by the search strategy and assessed the full texts of all potentially eligible studies for inclusion; 2 of the authors independently extracted the data of all studies included in this review. We created Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow-charts for each of the topical searches. Subsequently, we summarized the evidence by behavioral factor topic, quality-graded it by following standard (Grading of Recommendations Assessment, Development, and Evaluation; GRADE) criteria, and translated it into the LRCUG recommendations by the author expert collective on the basis of an iterative consensus process. MAIN RESULTS For most recommendations, there was at least "substantial" (i.e., good-quality) evidence. We developed 10 major recommendations for lower-risk use: (1) the most effective way to avoid cannabis use-related health risks is abstinence, (2) avoid early age initiation of cannabis use (i.e., definitively before the age of 16 years), (3) choose low-potency tetrahydrocannabinol (THC) or balanced THC-to-cannabidiol (CBD)-ratio cannabis products, (4) abstain from using synthetic cannabinoids, (5) avoid combusted cannabis inhalation and give preference to nonsmoking use methods, (6) avoid deep or other risky inhalation practices, (7) avoid high-frequency (e.g., daily or near-daily) cannabis use, (8) abstain from cannabis-impaired driving, (9) populations at higher risk for cannabis use-related health problems should avoid use altogether, and (10) avoid combining previously mentioned risk behaviors (e.g., early initiation and high-frequency use). AUTHORS' CONCLUSIONS Evidence indicates that a substantial extent of the risk of adverse health outcomes from cannabis use may be reduced by informed behavioral choices among users. The evidence-based LRCUG serve as a population-level education and intervention tool to inform such user choices toward improved public health outcomes. However, the LRCUG ought to be systematically communicated and supported by key regulation measures (e.g., cannabis product labeling, content regulation) to be effective. All of these measures are concretely possible under emerging legalization regimes, and should be actively implemented by regulatory authorities. The population-level impact of the LRCUG toward reducing cannabis use-related health risks should be evaluated. Public health implications. Cannabis control regimes are evolving, including legalization in North America, with uncertain impacts on public health. Evidence-based LRCUG offer a potentially valuable population-level tool to reduce the risk of adverse health outcomes from cannabis use among (especially young) users in legalization contexts, and hence to contribute to improved public health outcomes.
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Affiliation(s)
- Benedikt Fischer
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Cayley Russell
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Pamela Sabioni
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Wim van den Brink
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Bernard Le Foll
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Wayne Hall
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Jürgen Rehm
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Robin Room
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Cuttler C, Spradlin A. Measuring cannabis consumption: Psychometric properties of the Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQ-CU). PLoS One 2017. [PMID: 28552942 DOI: 10.1371/journal.pone.0178194)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE We created the Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQ-CU) because the current lack of psychometrically sound inventories for measuring these dimensions of cannabis use has impeded research on the effects of cannabis in humans. METHOD A sample of 2,062 cannabis users completed the DFAQ-CU and was used to assess the DFAQ-CU's factor structure and reliability. To assess validity, a subsample of 645 participants completed additional measures of cannabis dependence and problems (Marijuana Smoking History Questionnaire [MSHQ], Timeline Followback [TLFB], Cannabis Abuse Screening Test [CAST], Cannabis Use Disorders Identification Test Revised [CUDIT-R], Cannabis Use Problems Identification Test [CUPIT], and Alcohol Use Disorder Identification Test [AUDIT]). RESULTS A six-factor structure was revealed, with factors measuring: daily sessions, frequency, age of onset, marijuana quantity, cannabis concentrate quantity, and edibles quantity. The factors were reliable, with Cronbach's alpha coefficients ranging from .69 (daily sessions) to .95 (frequency). Results further provided evidence for the factors' convergent (MSHQ, TLFB), predictive (CAST, CUDIT-R, CUPIT), and discriminant validity (AUDIT). CONCLUSIONS The DFAQ-CU is the first psychometrically sound inventory for measuring frequency, age of onset, and quantity of cannabis use. It contains pictures of marijuana to facilitate the measurement of quantity of marijuana used, as well as questions to assess the use of different forms of cannabis (e.g., concentrates, edibles), methods of administering cannabis (e.g., joints, hand pipes, vaporizers), and typical THC levels. As such, the DFAQ-CU should help facilitate research on frequency, quantity, and age of onset of cannabis use.
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Affiliation(s)
- Carrie Cuttler
- Department of Psychology, Washington State University, Pullman, WA, United States of America
| | - Alexander Spradlin
- Department of Psychology, Washington State University, Pullman, WA, United States of America
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Cuttler C, Spradlin A. Measuring cannabis consumption: Psychometric properties of the Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQ-CU). PLoS One 2017; 12:e0178194. [PMID: 28552942 PMCID: PMC5446174 DOI: 10.1371/journal.pone.0178194] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/08/2017] [Indexed: 11/19/2022] Open
Abstract
Objective We created the Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQ-CU) because the current lack of psychometrically sound inventories for measuring these dimensions of cannabis use has impeded research on the effects of cannabis in humans. Method A sample of 2,062 cannabis users completed the DFAQ-CU and was used to assess the DFAQ-CU’s factor structure and reliability. To assess validity, a subsample of 645 participants completed additional measures of cannabis dependence and problems (Marijuana Smoking History Questionnaire [MSHQ], Timeline Followback [TLFB], Cannabis Abuse Screening Test [CAST], Cannabis Use Disorders Identification Test Revised [CUDIT-R], Cannabis Use Problems Identification Test [CUPIT], and Alcohol Use Disorder Identification Test [AUDIT]). Results A six-factor structure was revealed, with factors measuring: daily sessions, frequency, age of onset, marijuana quantity, cannabis concentrate quantity, and edibles quantity. The factors were reliable, with Cronbach’s alpha coefficients ranging from .69 (daily sessions) to .95 (frequency). Results further provided evidence for the factors’ convergent (MSHQ, TLFB), predictive (CAST, CUDIT-R, CUPIT), and discriminant validity (AUDIT). Conclusions The DFAQ-CU is the first psychometrically sound inventory for measuring frequency, age of onset, and quantity of cannabis use. It contains pictures of marijuana to facilitate the measurement of quantity of marijuana used, as well as questions to assess the use of different forms of cannabis (e.g., concentrates, edibles), methods of administering cannabis (e.g., joints, hand pipes, vaporizers), and typical THC levels. As such, the DFAQ-CU should help facilitate research on frequency, quantity, and age of onset of cannabis use.
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Affiliation(s)
- Carrie Cuttler
- Department of Psychology, Washington State University, Pullman, WA, United States of America
- * E-mail:
| | - Alexander Spradlin
- Department of Psychology, Washington State University, Pullman, WA, United States of America
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Holman MJ, Greene DN, Gandhi JC, Soeprono TM. A Diagnostic Dilemma Involving Dabs in First-Episode Psychosis. J Appl Lab Med 2017; 2:113-117. [DOI: 10.1373/jalm.2016.022525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 12/14/2016] [Indexed: 11/06/2022]
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Abstract
The cannabis withdrawal syndrome (CWS) is a criterion of cannabis use disorders (CUDs) (Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition) and cannabis dependence (International Classification of Diseases [ICD]-10). Several lines of evidence from animal and human studies indicate that cessation from long-term and regular cannabis use precipitates a specific withdrawal syndrome with mainly mood and behavioral symptoms of light to moderate intensity, which can usually be treated in an outpatient setting. Regular cannabis intake is related to a desensitization and downregulation of human brain cannabinoid 1 (CB1) receptors. This starts to reverse within the first 2 days of abstinence and the receptors return to normal functioning within 4 weeks of abstinence, which could constitute a neurobiological time frame for the duration of CWS, not taking into account cellular and synaptic long-term neuroplasticity elicited by long-term cannabis use before cessation, for example, being possibly responsible for cannabis craving. The CWS severity is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors. Therefore, naturalistic severity of CWS highly varies. Women reported a stronger CWS than men including physical symptoms, such as nausea and stomach pain. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require an inpatient treatment (preferably qualified detox) and post-acute rehabilitation. There are promising results with gabapentin and delta-9-tetrahydrocannabinol analogs in the treatment of CWS. Mirtazapine can be beneficial to treat CWS insomnia. According to small studies, venlafaxine can worsen the CWS, whereas other antidepressants, atomoxetine, lithium, buspirone, and divalproex had no relevant effect. Certainly, further research is required with respect to the impact of the CWS treatment setting on long-term CUD prognosis and with respect to psychopharmacological or behavioral approaches, such as aerobic exercise therapy or psychoeducation, in the treatment of CWS. The up-to-date ICD-11 Beta Draft is recommended to be expanded by physical CWS symptoms, the specification of CWS intensity and duration as well as gender effects.
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Affiliation(s)
- Udo Bonnet
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Castrop-Rauxel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen
| | - Ulrich W Preuss
- Vitos-Klinik Psychiatrie und Psychotherapie Herborn, Herborn
- Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Parnes JE, Bravo AJ, Conner BT, Pearson MR. A Burning Problem: Cannabis Lessons Learned from Colorado. ADDICTION RESEARCH & THEORY 2017; 26:3-10. [PMID: 38464667 PMCID: PMC10923185 DOI: 10.1080/16066359.2017.1315410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/05/2017] [Accepted: 03/29/2017] [Indexed: 03/12/2024]
Abstract
With recent increases in cannabis' popularity, including being legalized in several states, new issues have emerged related to use. Increases in the number of users, new products, and home growing all present distinct concerns. In the present review, we explored various cannabis-related concerns (i.e. use, acquiring, growing, and public health/policy) that have arisen in Colorado in order to provide information on emerging issues and future directions to mitigate negative outcomes that could occur in states considering, or that already have implemented, a legalized cannabis market. Specific to Colorado, issues have arisen related to edibles, vaporizers/'e-cannabis', concentrates, growing, quantifying use, intoxicated driving, and arrests. Understanding cannabis dosing (including dose-dependent effects and related consequences), standardizing quantities, evaluating the safety of new products, and developing harm reduction interventions are important next steps for informing public policy and promoting health and well-being. Overall, increasing our knowledge of emerging issues related to cannabis is key to promoting the benefits and combating the potential harms of cannabis, especially for states legalizing medical or recreational cannabis.
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Affiliation(s)
- Jamie E. Parnes
- Department of Psychology, Colorado State University, 1876 Campus
Delivery, Fort Collins, CO 80523 USA
| | - Adrian J. Bravo
- Center on Alcoholism, Substance Abuse, & Addictions, University
of New Mexico, 2650 Yale Blvd SE, Albuquerque, NM 87106 USA
| | - Bradley T. Conner
- Department of Psychology, Colorado State University, 1876 Campus
Delivery, Fort Collins, CO 80523 USA
| | - Matthew R. Pearson
- Center on Alcoholism, Substance Abuse, & Addictions, University
of New Mexico, 2650 Yale Blvd SE, Albuquerque, NM 87106 USA
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Carlini BH, Garrett SB, Harwick RM. Beyond joints and brownies: Marijuana concentrates in the legal landscape of WA State. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 42:26-29. [DOI: 10.1016/j.drugpo.2017.01.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
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Varlet V. Drug Vaping: From the Dangers of Misuse to New Therapeutic Devices. TOXICS 2016; 4:toxics4040029. [PMID: 29051432 PMCID: PMC5606648 DOI: 10.3390/toxics4040029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/02/2016] [Accepted: 12/13/2016] [Indexed: 11/24/2022]
Abstract
Users of e-cigarettes are unwitting volunteers participating in a worldwide epidemiological study. Because of the obvious benefits of e-cigarettes compared with traditional cigarette smoking, these electronic devices have been introduced all around the world to support tobacco smoking cessation. Same potential harm reduction could be considered by cannabis vaping for marijuana smokers. However, the toxicities of liquids and aerosols remain under investigation because although the use of e-cigarettes is likely to be less harmful than traditional cigarette smoking, trace levels of contaminants have been identified. Simultaneously, other electronic devices, such as e-vaporisers, e-hookahs or e-pipes, have been developed and commercialised. Consequently, misuse of electronic devices has increased, and experimentation has been documented on Internet web fora. Although legal and illegal drugs are currently consumed with these e-devices, no scientific papers are available to support the observations reported by numerous media and web fora. Moreover, building on illegal drug vaping and vaporisation with e-devices (vaping misuse), legal drug vaping (an alternative use of vaping) could present therapeutic benefits, as occurs with medical cannabis vaporisation with table vaporisers. This review seeks to synthesise the problems of e-cigarette and liquid refill toxicity in order to introduce the dangers of illegal and legal drugs consumed using vaping and vaporisation for recreational purposes, and finally, to present the potential therapeutic benefits of vaping as a new administration route for legal drugs.
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Affiliation(s)
- V Varlet
- Forensic Toxicology and Chemistry Unit, University Centre of Legal Medicine Lausanne-Geneva, Lausanne CH-1011, Switzerland.
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125
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Troup LJ, Andrzejewski JA, Braunwalder JT, Torrence RD. The relationship between cannabis use and measures of anxiety and depression in a sample of college campus cannabis users and non-users post state legalization in Colorado. PeerJ 2016; 4:e2782. [PMID: 27957402 PMCID: PMC5149055 DOI: 10.7717/peerj.2782] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/10/2016] [Indexed: 12/28/2022] Open
Abstract
As part of an ongoing research program into the relationship between cannabis use and emotion processing, participants were assessed on their level of cannabis exposure using the Recreational Cannabis Use Examination, a measure developed specifically to assess cannabis use in Colorado post state legalization. Three groups were created based on self-reported use: a control group who have never used, a casual user group and a chronic user group. Each participant also completed two measures of mood assessment, the Center for Epidemiologic Studies Depression Scale and the State-Trait Anxiety Inventory. Relationships between cannabis use groups and scores on these measures were then analyzed using both correlations and multivariate analysis of variance. Results indicate a relationship between casual cannabis use and scoring highly for depressive symptomatology on the Center for Epidemiologic Studies Depression Scale. There were no significant relationships between cannabis use and scores on the State-Trait Anxiety Inventory.
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Affiliation(s)
- Lucy J Troup
- Department of Psychology, Colorado State University , Fort Collins , CO , United States
| | - Jeremy A Andrzejewski
- Department of Psychology, Colorado State University , Fort Collins , CO , United States
| | - Jacob T Braunwalder
- Department of Psychology, Colorado State University , Fort Collins , CO , United States
| | - Robert D Torrence
- Department of Psychology, Colorado State University , Fort Collins , CO , United States
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126
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Haug NA, Kieschnick D, Sottile JE, Babson KA, Vandrey R, Bonn-Miller MO. Training and Practices of Cannabis Dispensary Staff. Cannabis Cannabinoid Res 2016; 1:244-251. [PMID: 28861496 PMCID: PMC5531366 DOI: 10.1089/can.2016.0024] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: The proliferation of cannabis dispensaries within the United States has emerged from patient demand for the legalization of cannabis as an alternative treatment for a number of conditions and symptoms. Unfortunately, nothing is known about the practices of dispensary staff with respect to recommendation of cannabis strains/concentrations for specific patient ailments. To address this limitation, the present study assessed the training and practices of cannabis dispensary staff. Materials and Methods: Medical and nonmedical dispensary staff (n=55) were recruited via e-mail and social media to complete an online survey assessing their demographic characteristics, dispensary features, patient characteristics, formal training, and cannabis recommendation practices. Results: Fifty-five percent of dispensary staff reported some formal training for their position, with 20% reporting medical/scientific training. A majority (94%) indicated that they provide specific cannabis advice to patients. In terms of strains, dispensary staff trended toward recommendations of Indica for anxiety, chronic pain, insomnia, nightmares, and Tourette's syndrome. They were more likely to recommend Indica and hybrid plants for post-traumatic stress disorder (PTSD)/trauma and muscle spasms. In contrast, staff were less likely to recommend Indica for depression; hybrid strains were most often recommended for amyotrophic lateral sclerosis (ALS). In terms of cannabinoid concentrations, dispensary staff were most likely to recommend a 1:1 ratio of delta-9-tetrahydrocannabinol (THC):cannabidiol (CBD) for patients suffering from anxiety, Crohn's disease, hepatitis C, and PTSD/trauma, while patients seeking appetite stimulation were most likely to be recommended THC. Staff recommended high CBD for arthritis and Alzheimer's disease and a high CBD or 1:1 ratio for ALS, epilepsy, and muscle spasms. Conclusions: Although many dispensary staff are making recommendations consistent with current evidence, some are recommending cannabis that has either not been shown effective for, or could exacerbate, a patient's condition. Findings underscore the importance of consistent, evidence-based, training of dispensary staff who provide specific recommendations for patient medical conditions.
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Affiliation(s)
- Nancy A. Haug
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Dustin Kieschnick
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, California
| | - James E. Sottile
- Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, California
| | - Kimberly A. Babson
- National Center for PTSD, VA Palo Alto Healthcare System, Palo Alto, California
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marcel O. Bonn-Miller
- National Center for PTSD, VA Palo Alto Healthcare System, Palo Alto, California
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California
- Center of Excellence in Substance Abuse Treatment and Education, Philadelphia VAMC, Philadelphia, Pennsylvania
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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127
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Lynskey MT, Hindocha C, Freeman TP. Legal regulated markets have the potential to reduce population levels of harm associated with cannabis use. Addiction 2016; 111:2091-2092. [PMID: 27145424 DOI: 10.1111/add.13390] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Michael T Lynskey
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Tom P Freeman
- Clinical Psychopharmacology Unit, University College London, London, UK
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128
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Hall W. Alcohol and cannabis: Comparing their adverse health effects and regulatory regimes. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 42:57-62. [PMID: 27908654 DOI: 10.1016/j.drugpo.2016.10.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/04/2016] [Accepted: 10/28/2016] [Indexed: 01/13/2023]
Abstract
The claim that the adverse health effects of cannabis are much less serious than those of alcohol has been central to the case for cannabis legalisation. Regulators in US states that have legalised cannabis have adopted regulatory models based on alcohol. This paper critically examines the claim about adverse health effects and the wisdom of regulating cannabis like alcohol. First, it compares what we know about the adverse health effects of alcohol and cannabis. Second, it discusses the uncertainties about the long term health effects of sustained daily cannabis use. Third, it speculates about how the adverse health effects of cannabis may change after legalisation. Fourth, it questions the assumption that alcohol provides the best regulatory model for a legal cannabis market. Fifth, it outlines the major challenges in regulating cannabis under the liberal alcohol-like regulatory regimes now being introduced.
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Affiliation(s)
- Wayne Hall
- National Addiction Centre, Kings College London and Centre for Youth Substance Abuse Research, University of Queensland, Australia.
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129
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Bell C, Slim J, Flaten HK, Lindberg G, Arek W, Monte AA. Butane Hash Oil Burns Associated with Marijuana Liberalization in Colorado. J Med Toxicol 2016; 11:422-5. [PMID: 26289652 DOI: 10.1007/s13181-015-0501-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Butane hash oil (BHO), also known as "amber," "dab," "glass," "honey," "shatter," or "wax," is a potent marijuana concentrate, containing up to 90 % tetrahydrocannabinol (THC). BHO is easily manufactured using highly volatile butane as a solvent. Our objective was to characterize hydrocarbon burns associated with BHO manufacture in Colorado. This was a cross-sectional study utilizing the National Burn Repository to capture all hydrocarbon burns reported to the local burn center from January 1st, 2008, through August 31st, 2014. We abstracted demographic and clinical variables from medical records for patients admitted for hydrocarbon burns associated with butane hash oil extraction. Twenty-nine cases of BHO burns were admitted to the local burn center during the study period. Zero cases presented prior to medical liberalization, 19 (61.3 %) during medical liberalization (Oct 2009-Dec 2013), and 12 (38.7 %) in 2014 since legalization. The majority of cases were Caucasian (72.4 %) males (89.7 %). Median age was 26 (range 15-58). The median total-body-surface-area (TBSA) burn size was 10 % (TBSA range 1-90 %). Median length of hospital admission was 10 days. Six required intubation for airway protection (21 %). Nineteen required skin grafting, eight wound care only, one required surgical fracture repair, and one required surgical debridement. Hydrocarbon burns associated with hash oil production have increased since the liberalization of marijuana policy in Colorado. A combination of public health messaging, standardization of manufacturing processes, and worker safety regulations are needed to decrease the risks associated with BHO production.
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Affiliation(s)
- Cameron Bell
- University of Colorado Hospital Burn Center, Aurora, CO, USA
| | - Jessica Slim
- Denver Health Emergency Medicine Residency, Denver Health & Hospital Authority, Denver, CO, USA
| | - Hanna K Flaten
- University of Colorado Department of Emergency Medicine, Leprino Building, 7th Floor Campus Box B-215, 12401 E. 17th Avenue, Aurora, CO, 80045, USA
| | - Gordon Lindberg
- University of Colorado Hospital Burn Center, Aurora, CO, USA
| | - Wiktor Arek
- University of Colorado Hospital Burn Center, Aurora, CO, USA
| | - Andrew A Monte
- Denver Health Emergency Medicine Residency, Denver Health & Hospital Authority, Denver, CO, USA. .,University of Colorado Department of Emergency Medicine, Leprino Building, 7th Floor Campus Box B-215, 12401 E. 17th Avenue, Aurora, CO, 80045, USA. .,Rocky Mountain Poison & Drug Center, Denver, CO, USA.
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130
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Zhang Z, Zheng X, Zeng DD, Leischow SJ. Tracking Dabbing Using Search Query Surveillance: A Case Study in the United States. J Med Internet Res 2016; 18:e252. [PMID: 27637361 PMCID: PMC5045525 DOI: 10.2196/jmir.5802] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/15/2016] [Accepted: 08/21/2016] [Indexed: 11/30/2022] Open
Abstract
Background Dabbing is an emerging method of marijuana ingestion. However, little is known about dabbing owing to limited surveillance data on dabbing. Objective The aim of the study was to analyze Google search data to assess the scope and breadth of information seeking on dabbing. Methods Google Trends data about dabbing and related topics (eg, electronic nicotine delivery system [ENDS], also known as e-cigarettes) in the United States between January 2004 and December 2015 were collected by using relevant search terms such as “dab rig.” The correlation between dabbing (including topics: dab and hash oil) and ENDS (including topics: vaping and e-cigarette) searches, the regional distribution of dabbing searches, and the impact of cannabis legalization policies on geographical location in 2015 were analyzed. Results Searches regarding dabbing increased in the United States over time, with 1,526,280 estimated searches during 2015. Searches for dab and vaping have very similar temporal patterns, where the Pearson correlation coefficient (PCC) is .992 (P<.001). Similar phenomena were also obtained in searches for hash oil and e-cigarette, in which the corresponding PCC is .931 (P<.001). Dabbing information was searched more in some western states than other regions. The average dabbing searches were significantly higher in the states with medical and recreational marijuana legalization than in the states with only medical marijuana legalization (P=.02) or the states without medical and recreational marijuana legalization (P=.01). Conclusions Public interest in dabbing is increasing in the United States. There are close associations between dabbing and ENDS searches. The findings suggest greater popularity of dabs in the states that legalized medical and recreational marijuana use. This study proposes a novel and timely way of cannabis surveillance, and these findings can help enhance the understanding of the popularity of dabbing and provide insights for future research and informed policy making on dabbing.
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Affiliation(s)
- Zhu Zhang
- Department of Management Information Systems, The University of Arizona, Tucson, AZ, United States
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131
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Russo EB. Current Therapeutic Cannabis Controversies and Clinical Trial Design Issues. Front Pharmacol 2016; 7:309. [PMID: 27683558 PMCID: PMC5022003 DOI: 10.3389/fphar.2016.00309] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/30/2016] [Indexed: 12/12/2022] Open
Abstract
This overview covers a wide range of cannabis topics, initially examining issues in dispensaries and self-administration, plus regulatory requirements for production of cannabis-based medicines, particularly the Food and Drug Administration "Botanical Guidance." The remainder pertains to various cannabis controversies that certainly require closer examination if the scientific, consumer, and governmental stakeholders are ever to reach consensus on safety issues, specifically: whether botanical cannabis displays herbal synergy of its components, pharmacokinetics of cannabis and dose titration, whether cannabis medicines produce cyclo-oxygenase inhibition, cannabis-drug interactions, and cytochrome P450 issues, whether cannabis randomized clinical trials are properly blinded, combatting the placebo effect in those trials via new approaches, the drug abuse liability (DAL) of cannabis-based medicines and their regulatory scheduling, their effects on cognitive function and psychiatric sequelae, immunological effects, cannabis and driving safety, youth usage, issues related to cannabis smoking and vaporization, cannabis concentrates and vape-pens, and laboratory analysis for contamination with bacteria and heavy metals. Finally, the issue of pesticide usage on cannabis crops is addressed. New and disturbing data on pesticide residues in legal cannabis products in Washington State are presented with the observation of an 84.6% contamination rate including potentially neurotoxic and carcinogenic agents. With ongoing developments in legalization of cannabis in medical and recreational settings, numerous scientific, safety, and public health issues remain.
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Abstract
Purpose
The purpose of this paper is to study vaporizers – especially the vape pen – as a new technology in cannabis use. Until now, almost all information on the use of vaporizers or e-cigarettes for cannabis consumption has come from the internet, the popular press, and accounts by users, but not from the scientific literature. More research is needed.
Design/methodology/approach
Since scientific studies of the phenomenon are virtually non-existent, the author will also base his study on sociological reflections upon internet sites and articles published both in subcultural and mainstream media. The author will document a national estimate of the prevalence of vaping based on a recent population survey in Finland.
Findings
Vaping is an emerging trend in cannabis culture internationally. It has been seen as a healthier route of administration than traditional ways of smoking cannabis. Other images, created especially with the help of advanced high-tech machinery and stylish and fashionable designs for the vape pen, are aiming at being cool and easy to use. In Finland, 6 percent of cannabis users make regular use of a vaporizer, and around a quarter of users use one occasionally. A vape pen or e-cigarette was regularly used by 2.6 percent and occasionally by 9.1 percent of cannabis users.
Originality/value
The trend of increasing vaping and the use of new devices has not been properly recognized among researchers. The paper presents some original results from a national population survey.
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133
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Cavazos-Rehg PA, Sowles SJ, Krauss MJ, Agbonavbare V, Grucza R, Bierut L. A content analysis of tweets about high-potency marijuana. Drug Alcohol Depend 2016; 166:100-8. [PMID: 27402550 PMCID: PMC4983477 DOI: 10.1016/j.drugalcdep.2016.06.034] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION "Dabbing" involves heating extremely concentrated forms of marijuana to high temperatures and inhaling the resulting vapor. We studied themes describing the consequences of using highly concentrated marijuana by examining the dabbing-related content on Twitter. METHODS Tweets containing dabbing-related keywords were collected from 1/1-1/31/2015 (n=206,854). A random sample of 5000 tweets was coded for content according to pre-determined categories about dabbing-related behaviors and effects experienced using a crowdsourcing service. An examination of tweets from the full sample about respiratory effects and passing out was then conducted by selecting tweets with relevant keywords. RESULTS Among the 5000 randomly sampled tweets, 3540 (71%) were related to dabbing marijuana concentrates. The most common themes included mentioning current use of concentrates (n=849; 24%), the intense high and/or extreme effects from dabbing (n=763; 22%) and excessive/heavy dabbing (n=517; 15%). Extreme effects included both physiological (n=124/333; 37%) and psychological effects (n=55/333; 17%). The most common physiologic effects, passing out (n=46/333; 14%) and respiratory effects (n=30/333; 9%), were then further studied in the full sample of tweets. Coughing was the most common respiratory effect mentioned (n=807/1179; 68%), and tweeters commonly expressed dabbing with intentions to pass out (416/915; 45%). CONCLUSIONS This study adds to the limited understanding of marijuana concentrates and highlights self-reported physical and psychological effects from this type of marijuana use. Future research should further examine these effects and the potential severity of health consequences associated with concentrates.
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134
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Hall W, Lynskey M. Why it is probably too soon to assess the public health effects of legalisation of recreational cannabis use in the USA. Lancet Psychiatry 2016; 3:900-6. [PMID: 27374072 DOI: 10.1016/s2215-0366(16)30071-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/11/2016] [Accepted: 04/20/2016] [Indexed: 12/21/2022]
Abstract
The citizens of four US states-Alaska, Colorado, Oregon, and Washington-have voted to legalise the sale of cannabis to adults for recreational purposes, and more states look likely to follow. Experience with alcohol and tobacco suggests that a for-profit legal cannabis industry will increase use by making cannabis more socially acceptable to use, making it more readily available at a cheaper price, and increasing the number of users and frequency of their use. We argue that it is too early to see the full effects of legalised cannabis policies on use and harm because several factors could delay the full commercialisation of a legal cannabis industry. These factors include restrictions on various licensed producers and sellers, and legal conflicts between Federal and State laws that might provide a brake on the speed and scale of commercialisation in states that have legalised cannabis. Any increases in cannabis use and harm could be minimised if governments introduced public health policies that limited the promotional activities of a legal cannabis industry, restricted cannabis availability to adults, and maintained cannabis prices at a substantial fraction of the black market price. So far, no states have chosen to implement these policies.
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Affiliation(s)
- Wayne Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Herston, QLD, Australia; National Addiction Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
| | - Michael Lynskey
- National Addiction Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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135
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Raber JC, Elzinga S, Kaplan C. Understanding dabs: contamination concerns of cannabis concentrates and cannabinoid transfer during the act of dabbing. J Toxicol Sci 2016; 40:797-803. [PMID: 26558460 DOI: 10.2131/jts.40.797] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Cannabis concentrates are gaining rapid popularity in the California medical cannabis market. These extracts are increasingly being consumed via a new inhalation method called 'dabbing'. The act of consuming one dose is colloquially referred to as "doing a dab". This paper investigates cannabinoid transfer efficiency, chemical composition and contamination of concentrated cannabis extracts used for dabbing. The studied concentrates represent material available in the California medical cannabis market. Fifty seven (57) concentrate samples were screened for cannabinoid content and the presence of residual solvents or pesticides. Considerable residual solvent and pesticide contamination were found in these concentrates. Over 80% of the concentrate samples were contaminated in some form. THC max concentrations ranged from 23.7% to 75.9% with the exception of one outlier containing 2.7% THC and 47.7% CBD. Up to 40% of the theoretically available THC could be captured in the vapor stream of a dab during inhalation experiments. Dabbing offers immediate physiological relief to patients in need but may also be more prone to abuse by recreational users seeking a more rapid and intense physiological effect.
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136
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Johnson RM, Brooks-Russell A, Ma M, Fairman BJ, Tolliver RL, Levinson AH. Usual Modes of Marijuana Consumption Among High School Students in Colorado. J Stud Alcohol Drugs 2016; 77:580-8. [PMID: 27340962 PMCID: PMC4987070 DOI: 10.15288/jsad.2016.77.580] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the prevalence of modes of marijuana consumption among Colorado youth and explore variation by demographics, access, substance use, and risk perceptions. METHOD Data are from a 2013 survey of Colorado high school students (N = 25,197; 50.5% female). The outcome variable was usual mode of marijuana consumption (i.e., smoking, vaporizing, ingesting edibles, or other) among those reporting past 30-day marijuana use. Classification variables included sex, grade level, race/ethnicity, sexual orientation, current alcohol and cigarette use, frequent marijuana use, early marijuana use (<13 years), perceived harmfulness, and perceived wrongfulness. We calculated prevalence estimates overall and by the variables listed above, and also conducted multinomial logistic regression models. RESULTS Findings indicate that 15% of Colorado high school students who use marijuana report that they usually use a mode of consumption other than smoking. Among students reporting past 30-day marijuana use, 85% said smoking was their usual mode of consumption. The remainder reported that their usual mode of consumption was vaporizing (6%), ingesting edibles (5%), or another method (4%). Boys, Whites, Asians, and 12th graders were the most likely to report vaporizing. High perceived harmfulness was associated with vaporizing or ingesting edibles. CONCLUSIONS The majority of Colorado youth who use marijuana usually smoke it. Youth may be using vaporizers and ingesting edibles as a way to reduce the harm associated with inhaling combusted smoke.
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Affiliation(s)
- Renee M. Johnson
- Department of Mental Health, Johns Hopkins
Bloomberg School of Public Health, Baltimore, Maryland,Correspondence may be sent to Renee M. Johnson
at the Department of Mental Health, Johns Hopkins Bloomberg School of public Health,
624 North Broadway, 8th Floor, Room 898, Baltimore, MD 21205-1999, or via email at:
| | - Ashley Brooks-Russell
- Department of Community and Behavioral Health,
Colorado School of Public Health, University of Colorado Anschutz Medical Campus,
Aurora, Colorado
| | - Ming Ma
- Community Epidemiology and Program Evaluation
Group, University of Colorado Cancer Center, University of Colorado Anschutz Medical
Campus, Aurora, Colorado
| | - Brian J. Fairman
- Department of Mental Health, Johns Hopkins
Bloomberg School of Public Health, Baltimore, Maryland
| | - Rickey L. Tolliver
- Health Statistics Section, Colorado Department
of Public Health and Environment, Denver, Colorado
| | - Arnold H. Levinson
- Department of Community and Behavioral Health,
Colorado School of Public Health, University of Colorado Anschutz Medical Campus,
Aurora, Colorado,Community Epidemiology and Program Evaluation
Group, University of Colorado Cancer Center, University of Colorado Anschutz Medical
Campus, Aurora, Colorado
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137
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Varlet V, Concha-Lozano N, Berthet A, Plateel G, Favrat B, De Cesare M, Lauer E, Augsburger M, Thomas A, Giroud C. Drug vaping applied to cannabis: Is "Cannavaping" a therapeutic alternative to marijuana? Sci Rep 2016; 6:25599. [PMID: 27228348 PMCID: PMC4881394 DOI: 10.1038/srep25599] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/19/2016] [Indexed: 11/09/2022] Open
Abstract
Therapeutic cannabis administration is increasingly used in Western countries due to its positive role in several pathologies. Dronabinol or tetrahydrocannabinol (THC) pills, ethanolic cannabis tinctures, oromucosal sprays or table vaporizing devices are available but other cannabinoids forms can be used. Inspired by the illegal practice of dabbing of butane hashish oil (BHO), cannabinoids from cannabis were extracted with butane gas, and the resulting concentrate (BHO) was atomized with specific vaporizing devices. The efficiency of "cannavaping," defined as the "vaping" of liquid refills for e-cigarettes enriched with cannabinoids, including BHO, was studied as an alternative route of administration for therapeutic cannabinoids. The results showed that illegal cannavaping would be subjected to marginal development due to the poor solubility of BHO in commercial liquid refills (especially those with high glycerin content). This prevents the manufacture of liquid refills with high BHO concentrations adopted by most recreational users of cannabis to feel the psychoactive effects more rapidly and extensively. Conversely, "therapeutic cannavaping" could be an efficient route for cannabinoids administration because less concentrated cannabinoids-enriched liquid refills are required. However, the electronic device marketed for therapeutic cannavaping should be carefully designed to minimize potential overheating and contaminant generation.
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Affiliation(s)
- Vincent Varlet
- Forensic Toxicology and Chemistry Unit, University Centre of Legal Medicine, Geneva-Lausanne, Switzerland
| | - Nicolas Concha-Lozano
- Institute for Work and Health (IST), University of Lausanne, University of Geneva, Lausanne, Switzerland
| | - Aurélie Berthet
- Institute for Work and Health (IST), University of Lausanne, University of Geneva, Lausanne, Switzerland
| | - Grégory Plateel
- Institute for Work and Health (IST), University of Lausanne, University of Geneva, Lausanne, Switzerland
| | - Bernard Favrat
- Psychology and Traffic Medicine Unit, University Centre of Legal Medicine, Lausanne, Switzerland
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | - Mariangela De Cesare
- Psychology and Traffic Medicine Unit, University Centre of Legal Medicine, Lausanne, Switzerland
| | - Estelle Lauer
- Forensic Toxicology and Chemistry Unit, University Centre of Legal Medicine, Geneva-Lausanne, Switzerland
| | - Marc Augsburger
- Forensic Toxicology and Chemistry Unit, University Centre of Legal Medicine, Geneva-Lausanne, Switzerland
| | - Aurélien Thomas
- Forensic Toxicology and Chemistry Unit, University Centre of Legal Medicine, Geneva-Lausanne, Switzerland
- Faculty of Biology and Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Christian Giroud
- Forensic Toxicology and Chemistry Unit, University Centre of Legal Medicine, Geneva-Lausanne, Switzerland
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138
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Pierre JM, Gandal M, Son M. Cannabis-induced psychosis associated with high potency "wax dabs". Schizophr Res 2016; 172:211-2. [PMID: 26876313 DOI: 10.1016/j.schres.2016.01.056] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 01/27/2016] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
Abstract
With mounting evidence that the risk of cannabis-induced psychosis may be related to both dose and potency of tetrahydrocannbinol (THC), increasing reports of psychosis associated with cannabinoids containing greater amounts of THC are anticipated. We report two cases of emergent psychosis after using a concentrated THC extract known as cannabis "wax," "oil," or "dabs" raising serious concerns about its psychotic liability. Although "dabbing" with cannabis wax is becoming increasingly popular in the US for both recreational and "medicinal" intentions, our cases raise serious concerns about its psychotic liability and highlight the importance of understanding this risk by physicians recommending cannabinoids for purported medicinal purposes.
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Affiliation(s)
- Joseph M Pierre
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Veterans Affairs, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
| | - Michael Gandal
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Maya Son
- College of Medicine, University of Vermont, Burlington, VT
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139
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Sobesky M, Gorgens K. Cannabis and adolescents: Exploring the substance misuse treatment provider experience in a climate of legalization. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 33:66-74. [PMID: 26992485 DOI: 10.1016/j.drugpo.2016.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/23/2016] [Accepted: 02/08/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Understanding consumer attitudes toward drugs is vital for the design and implementation of effective substance misuse prevention and treatment programs. Research that enhances our understanding of these perceptions is of the utmost importance in the climate of cannabis legalization. While there is a body of literature focused on the perceptions of drug use among adolescents, less attention has been paid to the experiences of health care professionals who serve this vulnerable population. Research aimed at better understanding the experiences of professionals may improve cannabis misuse prevention efforts and inform policy decisions as cannabis moves closer to legalization nationwide. METHODS The present study applied a grounded theory qualitative methodology to interview 11 adolescent substance misuse treatment providers. Each participant had at least two years of clinical practice in Colorado before January 1, 2014, when cannabis became available for recreational sale. FINDINGS Extensive analysis of data obtained from participant interviews, yielded seven core concepts related to cannabis use and decriminalization: normalizing, increasing access, rising addiction potential, link to opioids and other drugs, complicating substance treatment, diversity issues, and responding to change. According to participants, legalization has contributed to the continuing normalization of cannabis, validation of its consumption, and greater access to a host of new and more potent THC products by adolescents. Providers attributed these attitudinal changes to heavier use of both cannabis and other drugs and increased resistance to treatment efforts and interventions. CONCLUSIONS These results support the need to expand access to a wider range of substance misuse treatment options for adolescents and to further our understanding of the impact on this population of the cannabis laws.
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Affiliation(s)
- Matthew Sobesky
- Graduate School of Professional Psychology, Office of Graduate Studies, University of Denver, 9993 East 29th Ave, Denver, CO 80238, United States.
| | - Kim Gorgens
- Graduate School of Professional Psychology, Office of Graduate Studies, University of Denver, 9993 East 29th Ave, Denver, CO 80238, United States
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140
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Keller CJ, Chen EC, Brodsky K, Yoon JH. A case of butane hash oil (marijuana wax)-induced psychosis. Subst Abus 2016; 37:384-386. [PMID: 26820171 DOI: 10.1080/08897077.2016.1141153] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Marijuana is one of the most widely used controlled substances in the United States. Despite extensive research on smoked marijuana, little is known regarding the potential psychotropic effects of marijuana "wax," a high-potency form of marijuana that is gaining in popularity. CASE The authors present a case of "Mr. B," a 34-year-old veteran who presented with profound psychosis in the setting of recent initiation of heavy, daily marijuana wax use. He exhibited incoherent speech and odd behaviors and appeared to be in a dream-like state with perseverating thoughts about his combat experience. His condition persisted despite treatment with risperidone 4 mg twice a day (BID), but improved dramatically on day 8 of hospitalization with the return of baseline mental function. Following discharge, Mr. B discontinued all marijuana use and did not exhibit the return of any psychotic symptoms. DISCUSSION This study highlights the need for future research regarding the potential medical and psychiatric effects of new, high-potency forms of marijuana. Could cannabis have a dose-dependent impact on psychosis? What other potential psychiatric effects could emerge heretofore unseen in lower potency formulations? Given the recent legalization of marijuana, these questions merit timely exploration.
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Affiliation(s)
- Corey J Keller
- a Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA.,b VA Palo Alto Health Care System , Palo Alto , California , USA
| | - Evan C Chen
- a Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA.,b VA Palo Alto Health Care System , Palo Alto , California , USA
| | - Kimberly Brodsky
- a Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA.,b VA Palo Alto Health Care System , Palo Alto , California , USA
| | - Jong H Yoon
- a Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA.,b VA Palo Alto Health Care System , Palo Alto , California , USA
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141
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Miller BL, Stogner JM, Miller JM. Exploring Butane Hash Oil Use: A Research Note. J Psychoactive Drugs 2016; 48:44-9. [DOI: 10.1080/02791072.2015.1118173] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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142
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Grafton SE, Huang PN, Vieira AR. Dental treatment planning considerations for patients using cannabis: A case report. J Am Dent Assoc 2016; 147:354-61. [PMID: 26768516 DOI: 10.1016/j.adaj.2015.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 11/02/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OVERVIEW There is a deficit in clinical research on the potential risks involved in treating dental patients who use cannabis for either medicinal or recreational purposes. The aim of this case report is to illustrate the need for additional education for oral health care professionals so they can understand the wide variety of available cannabis options and their potential effects on dental treatment. CASE DESCRIPTION A 27-year-old man sought care at the dental clinic with a nonrestorable molar requiring extraction. During the review of his medical history, the patient reported taking a "dab" of marijuana approximately 5 hours before his appointment. Because of the admission of recent illicit drug use, no treatment was rendered. The patient was offered an appointment the next day but he refused, citing bias in regard to his cannabis use. CONCLUSIONS AND PRACTICAL IMPLICATIONS The number of Americans using marijuana is increasing rapidly. Twenty-three states and the District of Columbia have laws legalizing cannabis to some degree, and Alaska, Colorado, Oregon, and Washington have legalized marijuana for recreational use. This drastic upswing in availability and usage will require dentists to address the possible effects of cannabis on dental practices. It is imperative that dental care providers make clinical decisions based on scientific evidence regarding the pharmacologic and psychological effects of marijuana, not on the societal stigma associated with illegal drug use. Dentists should be familiar with popular delivery systems and understand the differences between various marijuana options. Clinical guidelines may need to be developed to help providers assess the patient's degree of cognitive impairment. Dentists should be able to advise patients on the potential consequences of this habit on their oral health.
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143
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Schauer GL, King BA, Bunnell RE, Promoff G, McAfee TA. Toking, Vaping, and Eating for Health or Fun: Marijuana Use Patterns in Adults, U.S., 2014. Am J Prev Med 2016; 50:1-8. [PMID: 26277652 DOI: 10.1016/j.amepre.2015.05.027] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 05/12/2015] [Accepted: 05/28/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Policies legalizing marijuana for medical and recreational use have been increasing in the U.S. Considering the potential impact of these policies, important knowledge gaps exist, including information about the prevalence of various modes of marijuana use (e.g., smoked in joints, bowls, bongs; consumed in edibles or drinks) and about medical versus recreational use. Accordingly, this study assessed (1) prevalence and correlates of modes of current and ever marijuana use and (2) prevalence of medicinal and recreational marijuana use in U.S. adults. METHODS Data came from Summer Styles (n=4,269), a nationally representative consumer panel survey of adults aged ≥18 years, collected in 2014. The survey asked about past 30-day (current) and ever mode of marijuana use and current reason for use (medicinal, recreational, both). Weighted prevalence estimates were computed and correlates were assessed in 2014 using logistic regression. RESULTS Overall, 7.2% of respondents reported current marijuana use; 34.5% reported ever use. Among current users, 10.5% reported medicinal-only use, 53.4% reported recreational-only use, and 36.1% reported both. Use of bowl or pipe (49.5%) and joint (49.2%) predominated among current marijuana users, with lesser use of bong, water pipe, or hookah (21.7%); blunts (20.3%); edibles/drinks (16.1%); and vaporizers (7.6%); 92.1% of the sample reported combusted-only marijuana use. CONCLUSION Combusted modes of marijuana use are most prevalent among U.S. adults, with a majority using marijuana for recreation. In light of changing policies and patterns of use, improved marijuana surveillance is critical for public health planning.
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Affiliation(s)
- Gillian L Schauer
- Carter Consulting, Inc., Contractor to Office on Smoking and Health, CDC, Atlanta, Georgia; Department of Behavioral Sciences and Health Education, Emory University, Atlanta, Georgia;.
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Rebecca E Bunnell
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Gabbi Promoff
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Timothy A McAfee
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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144
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Subritzky T, Pettigrew S, Lenton S. Issues in the implementation and evolution of the commercial recreational cannabis market in Colorado. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 27:S0955-3959(15)00354-0. [PMID: 26777400 DOI: 10.1016/j.drugpo.2015.12.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/27/2015] [Accepted: 12/01/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND For almost a century, the cultivation, sale and use of recreational cannabis has been prohibited by law in most countries. Recently, however, under ballot initiatives four states in the US have legalised commercial, non-medical (recreational) cannabis markets. Several other states will initiate similar ballot measures attached to the 2016 election that will also appoint a new President. As the first state to implement the legislation in 2014, Colorado is an important example to begin investigating early consequences of specific policy choices while other jurisdictions consider their own legislation although the empirical evidence base is only beginning to accrue. METHOD This paper brings together material sourced from peer reviewed academic papers, grey literature publications, reports in mass media and niche media outlets, and government publications to outline the regulatory model and process in Colorado and to describe some of the issues that have emerged in the first 20 months of its operation. RESULTS These issues include tension between public health and profit, industry and investment, new methods of consumption, the black market and product testing. CONCLUSION The paper concludes that, while it is too early to determine the impact of the scheme, and noting that it includes some features designed to mitigate adverse impacts, it faces major challenges. Not least of these are the lack of an effective overarching federal regulatory structure, as a consequence of the federal prohibition on cannabis, combined with a rapidly growing cannabis industry which, like other industries, will seek to exploit loopholes to maximise profit.
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Affiliation(s)
- Todd Subritzky
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Simone Pettigrew
- School of Psychology and Speech Pathology, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - Simon Lenton
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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145
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Stogner JM, Miller BL. The Dabbing Dilemma: A Call for Research on Butane Hash Oil and Other Alternate Forms of Cannabis Use. Subst Abus 2015; 36:393-5. [DOI: 10.1080/08897077.2015.1071724] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- John M. Stogner
- University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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146
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Abstract
Cannabis is a genus of annual flowering plant. Cannabis is often divided into 3 species-Cannabis sativa, Cannabis indica, and Cannabis ruderalis-but there is significant disagreement about this, and some consider them subspecies of the same parent species. Cannabis sativa can grow to 5-18 feet or more, and often has a few branches. Cannabis indica typically grows 2-4 feet tall and is compactly branched. Cannabis ruderalis contains very low levels of Δ-9-tetrahyocannabinol so is rarely grown by itself. Cannabis ruderalis flowers as a result of age, not light conditions, which is called autoflowering. It is principally used in hybrids, to enable the hybrid to have the autoflowering property. There are > 700 strains of cannabis, often with colorful names. Some are strains of 1 of the 3 subspecies. Many are crossbred hybrids. The strains can be named in a variety of ways: smell or lineage are common ways of naming. There are only a few rules about how the strains are named, and most strains' names do not follow the rules. There are 4 basic preparations of marijuana: bhang, hasish, oil (or hash oil), and leaves and/or buds. In medical marijuana trials, subjective outcomes are frequently used but blind breaking can introduce significant bias. Blind breaking occurs when patients figure out if they are in the control or the treatment group. When this occurs, there is significant overestimation of treatment effect.
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Affiliation(s)
- David Gloss
- Department of Neurology, Geisinger Clinic, 100 N Academy Ave, Danville, PA, 17822, USA.
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147
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Krauss MJ, Sowles SJ, Mylvaganam S, Zewdie K, Bierut LJ, Cavazos-Rehg PA. Displays of dabbing marijuana extracts on YouTube. Drug Alcohol Depend 2015; 155:45-51. [PMID: 26347408 PMCID: PMC4591851 DOI: 10.1016/j.drugalcdep.2015.08.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dabbing involves heating marijuana extracts to a high temperature and inhaling the vapor. Little is known about this new method of using marijuana. YouTube, the most popular platform for sharing online videos, may be a go-to resource for individuals interested in learning about dabbing. Our objective was to explore the content of dabbing-related videos on YouTube. METHODS We searched for dabbing-related videos on YouTube using the search terms "dabbing" and "dabs" on January 22, 2015. For each term, videos were sorted by relevance and view count. A sample of 116 dabbing videos were viewed and coded for content. RESULTS The 116 videos (published by 75 unique channels) had a total of 9,545,482 views. Most (76%) of the channels had a specific focus on marijuana and 23% were located in California. Eighty-nine percent of the videos showed at least one person dabbing, and 61% of these showed someone dabbing repeatedly. Most dabbers were male (67%) and many appeared to be >25 years old (42%). Approximately 34% of the videos contained a product review, 28% provided instructions on dabbing or other educational information, and 21% contained at least a brief cautionary message. Over half (54%) of the videos referenced medical marijuana, and only 20% of the videos had an age-restriction. CONCLUSIONS Dabbing-related videos are easily found and can be readily viewed on YouTube. As marijuana use becomes more accepted by the general population, the popularity of dabbing-related videos could increase, potentially normalizing this potent form of marijuana use.
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Affiliation(s)
- Melissa J Krauss
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
| | - Shaina J Sowles
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
| | - Shalinee Mylvaganam
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
| | - Kidist Zewdie
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
| | - Patricia A Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
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148
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Daniulaityte R, Nahhas RW, Wijeratne S, Carlson RG, Lamy FR, Martins SS, Boyer EW, Smith GA, Sheth A. "Time for dabs": Analyzing Twitter data on marijuana concentrates across the U.S. Drug Alcohol Depend 2015; 155:307-11. [PMID: 26338481 PMCID: PMC4581982 DOI: 10.1016/j.drugalcdep.2015.07.1199] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Abstract
AIMS Media reports suggest increasing popularity of marijuana concentrates ("dabs"; "earwax"; "budder"; "shatter; "butane hash oil") that are typically vaporized and inhaled via a bong, vaporizer or electronic cigarette. However, data on the epidemiology of marijuana concentrate use remain limited. This study aims to explore Twitter data on marijuana concentrate use in the U.S. and identify differences across regions of the country with varying cannabis legalization policies. METHODS Tweets were collected between October 20 and December 20, 2014, using Twitter's streaming API. Twitter data filtering framework was available through the eDrugTrends platform. Raw and adjusted percentages of dabs-related tweets per state were calculated. A permutation test was used to examine differences in the adjusted percentages of dabs-related tweets among U.S. states with different cannabis legalization policies. RESULTS eDrugTrends collected a total of 125,255 tweets. Almost 22% (n=27,018) of these tweets contained identifiable state-level geolocation information. Dabs-related tweet volume for each state was adjusted using a general sample of tweets to account for different levels of overall tweeting activity for each state. Adjusted percentages of dabs-related tweets were highest in states that allowed recreational and/or medicinal cannabis use and lowest in states that have not passed medical cannabis use laws. The differences were statistically significant. CONCLUSIONS Twitter data suggest greater popularity of dabs in the states that legalized recreational and/or medical use of cannabis. The study provides new information on the epidemiology of marijuana concentrate use and contributes to the emerging field of social media analysis for drug abuse research.
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Affiliation(s)
- Raminta Daniulaityte
- Center for Interventions, Treatment, and Addictions Research (CITAR), Department of Community Health, Wright State University Boonshoft School of Medicine, 3171 Research Blvd., Suite 124, Dayton, OH 45420-4006, United States.
| | - Ramzi W Nahhas
- Lifespan Health Research Center, Department of Community Health, Wright State University Boonshoft School of Medicine, Dayton, OH, United States; Department of Psychiatry, Wright State University Boonshoft School of Medicine, Dayton, OH, United States
| | - Sanjaya Wijeratne
- Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis), Department of Computer Science and Engineering, Wright State University, Dayton, OH, United States
| | - Robert G Carlson
- Center for Interventions, Treatment, and Addictions Research (CITAR), Department of Community Health, Wright State University Boonshoft School of Medicine, 3171 Research Blvd., Suite 124, Dayton, OH 45420-4006, United States
| | - Francois R Lamy
- Center for Interventions, Treatment, and Addictions Research (CITAR), Department of Community Health, Wright State University Boonshoft School of Medicine, 3171 Research Blvd., Suite 124, Dayton, OH 45420-4006, United States
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Edward W Boyer
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - G Alan Smith
- Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis), Department of Computer Science and Engineering, Wright State University, Dayton, OH, United States
| | - Amit Sheth
- Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis), Department of Computer Science and Engineering, Wright State University, Dayton, OH, United States
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149
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Morean ME, Kong G, Camenga DR, Cavallo DA, Krishnan-Sarin S. High School Students' Use of Electronic Cigarettes to Vaporize Cannabis. Pediatrics 2015; 136:611-6. [PMID: 26347431 PMCID: PMC4586732 DOI: 10.1542/peds.2015-1727] [Citation(s) in RCA: 188] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Electronic cigarette (e-cigarette) use is increasing rapidly among high school (HS) students. Of concern, e-cigarettes can be used to vaporize cannabis, although use rates among adolescents are unknown. We evaluated lifetime rates of using e-cigarettes to vaporize cannabis among all lifetime e-cigarette users (27.9%), all lifetime cannabis users (29.2%), and lifetime users of both e-cigarettes and cannabis (18.8%); common means of vaporizing cannabis including hash oil, wax infused with Δ-9-tetrahydrocannabinol (THC), and dried cannabis; and demographic predictors of using e-cigarettes to vaporize cannabis. METHODS In the spring of 2014, 3847 Connecticut HS students completed an anonymous survey assessing e-cigarette and cannabis use. RESULTS Vaporizing cannabis using e-cigarettes was common among lifetime e-cigarette users, lifetime cannabis users, and lifetime dual users (e-cigarette 18.0%, cannabis 18.4%, dual users 26.5%). Students reported using e-cigarettes to vaporize hash oil (e-cigarette 15.4%, cannabis 15.5%, dual users 22.9%) and wax infused with THC (e-cigarette 10.0%, cannabis 10.2%, dual users 14.8%) and using portable electronic vaporizers to vaporize dried cannabis leaves (e-cigarette 19.6%, lifetime cannabis 23.1%, lifetime dual users 29.1%). Binary logistic regression indicated that male students (odds ratio [OR] = 2.05), younger students (OR = 0.64), lifetime e-cigarette users (OR = 5.27), and lifetime cannabis users (OR = 40.89) were most likely to vaporize cannabis using e-cigarettes. Rates also differed by HS attended. CONCLUSIONS Rates of vaporizing cannabis using e-cigarettes were high. These findings raise concerns about the lack of e-cigarette regulations and the potential use of e-cigarettes for purposes other than vaping nicotine.
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Affiliation(s)
- Meghan E. Morean
- Department of Psychology, Oberlin College, Oberlin, Ohio;,Department of Psychiatry, and
| | | | - Deepa R. Camenga
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
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150
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Giroud C, de Cesare M, Berthet A, Varlet V, Concha-Lozano N, Favrat B. E-Cigarettes: A Review of New Trends in Cannabis Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:9988-10008. [PMID: 26308021 PMCID: PMC4555324 DOI: 10.3390/ijerph120809988] [Citation(s) in RCA: 171] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/04/2015] [Accepted: 08/17/2015] [Indexed: 11/16/2022]
Abstract
The emergence of electronic cigarettes (e-cigs) has given cannabis smokers a new method of inhaling cannabinoids. E-cigs differ from traditional marijuana cigarettes in several respects. First, it is assumed that vaporizing cannabinoids at lower temperatures is safer because it produces smaller amounts of toxic substances than the hot combustion of a marijuana cigarette. Recreational cannabis users can discretely “vape” deodorized cannabis extracts with minimal annoyance to the people around them and less chance of detection. There are nevertheless several drawbacks worth mentioning: although manufacturing commercial (or homemade) cannabinoid-enriched electronic liquids (e-liquids) requires lengthy, complex processing, some are readily on the Internet despite their lack of quality control, expiry date, and conditions of preservation and, above all, any toxicological and clinical assessment. Besides these safety problems, the regulatory situation surrounding e-liquids is often unclear. More simply ground cannabis flowering heads or concentrated, oily THC extracts (such as butane honey oil or BHO) can be vaped in specially designed, pen-sized marijuana vaporizers. Analysis of a commercial e-liquid rich in cannabidiol showed that it contained a smaller dose of active ingredient than advertised; testing our laboratory-made, purified BHO, however, confirmed that it could be vaped in an e-cig to deliver a psychoactive dose of THC. The health consequences specific to vaping these cannabis preparations remain largely unknown and speculative due to the absence of comprehensive, robust scientific studies. The most significant health concerns involve the vaping of cannabinoids by children and teenagers. E-cigs could provide an alternative gateway to cannabis use for young people. Furthermore, vaping cannabinoids could lead to environmental and passive contamination.
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Affiliation(s)
- Christian Giroud
- Forensic Toxicology and Chemistry Unit, University Center of Legal Medicine (CURML), CH-1000 Lausanne 25, Switzerland; E-Mail:
- Department of Community Medicine and Health (DUMSC), Rue du Bugnon 44, CH-1011 Lausanne, Switzerland; E-Mails: (A.B.); (N.C.-L.); (B.F.)
- Lausanne University Hospital (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +41(0)-79-556-58-91; Fax: +41(0)-21-314-70-90
| | - Mariangela de Cesare
- Unità di Medicina e Psicologia del Traffico, via Trevano 4, Casella postale 4044, CH-6904 Lugano, Switzerland; E-Mail:
| | - Aurélie Berthet
- Department of Community Medicine and Health (DUMSC), Rue du Bugnon 44, CH-1011 Lausanne, Switzerland; E-Mails: (A.B.); (N.C.-L.); (B.F.)
- Lausanne University Hospital (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Institute for Work and Health (IST), Route de la Corniche 2, CH-1066 Epalinges - Lausanne, University of Lausanne and Geneva, Switzerland
| | - Vincent Varlet
- Forensic Toxicology and Chemistry Unit, University Center of Legal Medicine (CURML), CH-1000 Lausanne 25, Switzerland; E-Mail:
- Department of Community Medicine and Health (DUMSC), Rue du Bugnon 44, CH-1011 Lausanne, Switzerland; E-Mails: (A.B.); (N.C.-L.); (B.F.)
- Lausanne University Hospital (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Nicolas Concha-Lozano
- Department of Community Medicine and Health (DUMSC), Rue du Bugnon 44, CH-1011 Lausanne, Switzerland; E-Mails: (A.B.); (N.C.-L.); (B.F.)
- Lausanne University Hospital (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Institute for Work and Health (IST), Route de la Corniche 2, CH-1066 Epalinges - Lausanne, University of Lausanne and Geneva, Switzerland
| | - Bernard Favrat
- Department of Community Medicine and Health (DUMSC), Rue du Bugnon 44, CH-1011 Lausanne, Switzerland; E-Mails: (A.B.); (N.C.-L.); (B.F.)
- Lausanne University Hospital (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Unit of Traffic Medicine and Psychology, CURML, CH-1005 Lausanne, Switzerland
- Center of General Medicine, Department of Ambulatory Care and Community Medicine (PMU), University of Lausanne, Rue du Bugnon 44, CH-1011 Lausanne, Switzerland
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